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Professor Mike Hurley, Clinical Director, ESCAPE-pain Programme, Orthopaedic Research UK (ORUK) 

Before the COVID-19 pandemic about 20 million people suffered with knee, hip and/or back pain, that impaired their physical, mental and emotional health, wellbeing and quality of life. GPs struggled to manage people with largely ineffective painkillers, while waiting lists for surgery were already long – and growing longer. The pandemic made all these problems much worse, and now the waiting time for medical and surgical treatment will take many years to clear – if ever.

We need interventions that can be delivered to large numbers of people outside of the NHS, and such interventions already exist. Enabling Self-management and Coping of Arthritic Pain through Exercise, ESCAPE-pain, is a programme that combines supervised exercise with simple information and advice. It helps people understand their problem better, what to do and what not to do, and encourages them to adopt healthier lifestyles.

In particular, it stresses the importance of physical activity in reducing joint pain and its effects, based on the National Institute for health and Care Excellence (NICE) recommendations. Clinical trials show ESCAPE-pain reduces pain, improves physical function, as well as mental and emotional well-being – benefits that can last up to two and a half years.

Programme participants love it because they experience that exercise is safe, helpful, makes them feel better about themselves, gets them up and out, reduces their dependency on others and they don’t have to rely on tablets or surgery. We need programmes like this now more than ever.

With the support of NHS, Public Health and Sport England and ukactive, we have helped leisure centres and clinical departments across the country deliver our programme. A one-day CIMSPA-accredited training programme – which won Specialist Training Programme at the ukactive Awards 2019 – enables exercise professionals and clinicians to deliver the programme. In March 2020 it was delivered in nearly 300 venues, by more than 1,400 trained facilitators, and nearly 20,000 people had participated in the programme, saving the health system an estimated £30m.

Several leisure and community organisations have formed partnerships local authorities, public health and clinical departments to deliver ESCAPE-pain. A major aim of the NHS Long Term Plan is to increase the opportunities for people with long term conditions to have easier access to community-based healthcare interventions that encourage self-management. So local Clinical Commissioning Groups (CCGs) have contracted with community-based organisations to deliver our programme to ease long physiotherapy waiting lists, while knowing people are getting NICE-recommended treatment.

The benefits:

  • People get easier access to the care they need, when they need it, in their local community, where they can also receive better opportunities to support them to remain active;
  • The NHS uses its resources more efficiently by partnering with the leisure sector to deliver high quality NICE-recommended health interventions in the community, fulfilling the integrated care between the community and health systems in the NHS Long Term Plan;
  • Leisure and community organisations can raise their profile, expand the offer to their local population (in particular the growing demographic of older people who could use their facilities off-peak), and forge partnerships with health providers and commissioners to deliver national policy and develop new revenues.

During the COVID-19 pandemic the face-to-face ESCAPE-pain programme had to stop. Very recently

Orthopaedic Research UK (ORUK), has taken over ESCAPE-pain. Our ambitious plan is to restart the face-to-face programmes at the pre-pandemic venues, and spread the programme to as many organisations as possible so that millions of people can access the programme. Through its leisure and community organisations, the physical activity sector is uniquely placed to reshape the way healthcare is delivered to millions of people post-pandemic.

For information about the ESCAPE-pain programme visit