ESCAPE-pain trains 1000 facilitators to help people living with osteoarthritis in boost to out-of-hospital care

By Professor Mike Hurley, Clinical Director MSK Programme, Health Innovation Network and creator of ESCAPE-pain.

If we are serious about achieving the goals of the NHS’ Long Term Plan, physical activity should be prescribe-able on the NHS and we need to facilitate its delivery through leisure centre and community halls.

It is well documented that people in our communities are now living far longer but they are more likely to live with multiple long-term conditions. Osteoarthritis (chronic knee/hip pain) is a major cause of suffering, physical and mental ill-health in people in our country. It is estimated that in England 4.11 million people (18.2 percent of people aged over 45 years) have osteoarthritis of the knee and 2.46 million people (10.9 percent of people aged over 45 years) have osteoarthritis of the hip.

Typically, these patients are managed in primary care. Despite the risk of side effects and high costs, treatment for osteoarthritis is all too often the prescription of painkillers, typically non-steroidal anti-inflammatory drugs, with little to no practical support. Many people with these conditions mistakenly believe that physical activity will make their condition worse, when it can actually benefit them.

Physical activity and reduced pain

There is unequivocal evidence that physical activity can reduce pain, improve mobility and function, quality of life, makes people feel less depressed and gets people up, out and about, while simultaneously improving other health problems. Yet it can’t be prescribed like a drug and there is limited access to this effective treatment inside the NHS.

ESCAPE-pain is an innovation that integrates self-management and coping strategies with an exercise regimen individualised for people living with osteoarthritis. It is an evidence-based, group rehabilitation programme, delivered to small groups of people twice a week, for six weeks (total 12 classes). It was adopted as a case study in NICE’s Quality, Innovation, Productivity and Prevention programme [2013] and delivers the NICE core recommendations of exercise and education for the management of osteoarthritis.

The Academic Health Science Network (AHSN) identified ESCAPE-pain as a national programme for 2018-2020 and so currently all 15 AHSNs are supporting it across the country.

Scaling up
Originally facilitated by physiotherapists in hospital outpatient departments, in 2017 we moved to widen our pool of facilitators to include fitness and leisure centre instructors. We have now trained a total of over 1,000 people to facilitate this programme (629 clinicians and 380 fitness instructors). The widening of our approach to training; going beyond physiotherapists and into the leisure sector, has enabled the programme to be delivered at over 200 locations across the UK, including leisure centres and community halls, to over 4000 people.

Essential to reaching the millions more people who could benefit from this programme is having enough facilitators trained to deliver the it in local communities. Now that over 1000 people have been trained there is a trained facilitator of the programme in every region of England.

Delivering this programme in the community and outside of traditional hospital settings, is a great example of how we can deliver on the Long Term Plan’s ambition to boost out-of-hospital care. I hope the success of this model is, as it could be, replicated in many other areas of care.

Got 30 minutes to learn more about the NHS Innovation landscape? Listen to our AHSN Network Innovation Exchange podcast in which NHS Clinical Director for Older People, Martin Vernon talks Healthy Ageing, featuring Prof Mike Hurley.

Or find out more about ESCAPE-pain and it’s impact here or contact us at hin.southlondon@nhs.net to get involved.