Postural Tachycardia Syndrome debate (link to The ME Association’s leaflet below)

Postural Tachycardia Syndrome Hansard text debate available to download
Volume 773: debated on Tuesday 14 October 2025
 
ME Research UK give a detailed explanation on this recent debate
Westminster debate on PoTS
21 October 2025
Labour MP for Lancaster and  Wyre, Cat Smith, led the Westminster debate on postural orthostatic tachycardia syndrome (PoTS) emphasising that PoTS is not a rare disease, yet individuals with PoTS are “falling through the cracks” of a healthcare system unprepared to recognise or support them. Drawing on her own experience and those of constituents across the UK, she called for urgent reform in diagnosis, treatment, and care pathways for people with PoTS. Minister Ashley Dalton responded during the session that lasted around half an hour.
Overview of Minister Ashley Dalton’s response, including  -
1. Diagnostic delays and disbelief
2. Shortage of expertise and overwhelmed services
3. Systemic and structural failings
4. Gender health gap
5. Calls for government action
 
At the beginning of Cat Smith’s speech she took several interventions from MPs, representing constituents across the UK, who also highlighted how important raising the issue was.
 
Key themes from MP Interventions
1. Diagnosis delays and misdiagnosis
2. Need for national clinical guidelines and care pathways
3. Awareness and training for medical professionals
4. Impact on individuals and families
 
Overview of Minister Ashley Dalton’s response
Minister for Public Health and Prevention, Ashley Dalton, began by congratulating Cat Smith MP for “bringing this very important issue forward” and praised her passionate advocacy stemming from personal experience.
 
What could this mean for patients and campaigners?
The Minister’s response clearly recognised the daily struggles of people with PoTS and the systemic barriers they face. However, it did not announce any new funding, policy changes, or immediate interventions for overstretched clinics. Responsibility was largely deferred to local ICBs and future research outcomes.
In short, the response provided welcome recognition but limited action - a positive start in tone, but not yet the decisive, coordinated strategy that advocates seem to be asking for.
 
See the ME Research UK detailed explanation on this recent Westminster debate on PoTS
21 October 2025
 
 
The ME Association’s Postural Orthostatic Tachycardia Syndrome (PoTS) downloadable leaflet.
We explain PoTS, why it affects some people with ME/CFS (and Long Covid) and how it can be diagnosed and treated. You might also like to review the NICE Guideline on ME/CFS.
 
 
MEA report PoTS and long Covid including information for people with ME/CFS
December 2021
Dr Charles Shepherd, Honorary Medical for the ME Association comments on the following paper; Autonomic dysfunction post-acute COVID-19 infection (Desai et al, Nov 2021)
This new paper from an American research group provides further evidence of dysfunction of the autonomic nervous system (ANS) in Long Covid -  in particular, the presence of Postural Orthostatic Tachycardia Syndrome (PoTS) in a significant proportion of people with Long Covid
 
Much of the information on management is also applicable to PoTS where it occurs in ME/CFS. 
ANS dysfunction is very common in ME/CFS and we have been pointing out the important overlap involving this symptom between ME/CFS and Long Covid for well over a year.
The MEA information leaflet on PoTS covers all aspects of PoTS in relation to ME/CFS:
Postural Orthostatic Tachycardia Syndrome (PoTS)
PoTS UK is a medical charity that can provide more detailed information and has a list of NHS specialists:  PoTS UK Website
Plus Dr Shepherd’s thoughts.


•  Coronavirus (COVID 19)  •  Government U.K.  •  M.E. Association  •  MERUK  •  MP  •  N.I.C.E.  •  Parliament U.K. •  Post COVID Syndrome (Long COVID)  •  Research 

ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) and PCS (Post Covid) Services.
Herefordshire and Worcestershire Post Viral Fatigue Service..
 
To contact the Herefordshire and Worcestershire Post Viral Fatigue Service,
the Phone Number remains the same at Malvern Community Hospital - 01684 612671, the new email address is - [email protected].

Marina Townend, the Service Lead/Specialist Occupational Therapist of the Herefordshire & Worcestershire ME/Chronic Fatigue Syndrome and Post-Covid Syndrome Services, has again been in touch updating us with forthcoming changes to the NHS Worcestershire ME/CFS Specialist Services).  Marina joined us on Wednesday, 9 April, at our afternoon café meeting, and explained that the following information was emailed to their patients last week, as a follow up to the previous mailing.

Good afternoon
Many thanks to everyone who completed the patient survey about the new model for the ME/CFS and PCS services. I am writing to share a summary of the feedback we received.
 
How you feel about the changes.
The perception of the changes seems mainly positive, with a small minority expressing concern that the change is financially motivated and that there will be less resources available for both patient groups. I want to reassure you that this is not the case. The commissioner in our Integrated Care Board recognises the impact that these conditions have on sufferers and has chosen to invest in this service at a time when many Trusts are closing LC services, and many have never commissioned an ME/CFS service.
 
Some people thought that the sharing of resources may be more efficient in an integrated service, with easier access and increased support. We believe and hope that this will be the case – although we do acknowledge that with the current pressure in the NHS, we may never have all the resources that we would ideally like!
 
Many people with ME/CFS felt encouraged that it will be easier for them to receive a diagnosis. Others noted the overlap between the conditions, and thought it would streamline the services and make it simpler for GP’s and referrers.
 
There were some concerns that the differences between the conditions might not be recognised or addressed. All diagnoses are coded, for monitoring and research purposes, and ME/CFS and LC each have different codes.  We try to address each person as an individual rather than by their diagnosis - something that is especially important with these conditions as they can vary hugely between each person.
 
 
What you’d like to continue:
- 1:1 support
- Information groups
- Group support
- Employment support
- Support for carers/ loved ones
- Peer support
-  We plan to continue with all these things in the new service, in the same or similar formats to now.
 
 What else you’d like:
    >Access to a wider MDT
We will have improved access to specialist medical care in the new service and will continue to build on this. We have recently employed a physiotherapist, who is due to start in April, and we are hoping to recruit a dietician. We will be able to refer all patients to the fast-track pathway for NHS Talking Therapies if counselling is required. You will also be able to see a specialist GP (hopefully in post by July).
 
    >Better referral pathways for tests and other specialists
This is currently being discussed, as we recognise that the current system (where we have to go back to your GP to request tests, investigations and onward referrals) can be slow and work-heavy for colleagues in primary care.
 
  >Raising awareness and education for GPs and other health professionals
Educational sessions will be planned when the new service is established. Some GP’s do not seem to be aware that there is specialist provision for ME/CFS/LC exist locally, so communication will be sent out to all practices about the new service, with details of what we offer and how to refer.
 
    >Faster access to the service
We apologise that some people have had to wait a long time to be seen, for various reasons. The new service will be more streamlined, and our aim is for all new referrals to be assessed within 10 weeks. Due to staff sickness and vacancies, there is a waiting list already so we will not be able to achieve this immediately.
 
   >On-going support for those who have the condition for a long time
We recognise that, although some people make a full recovery, many will experience long-term effects of ME/CFS and LC. Unfortunately, there is high demand for the service, and we are unable to support everyone within the service indefinitely. We will offer an on-line support group for people after discharge, with the hope of being able to expand to localised face-to-face meetings in future. We are also going to trial annual reviews for the more severely affected patients, recognising that many GP’s do not offer this, even though it is recommended in NICE guidelines for ME/CFS.
 
      >More access to face-to-face appointments
Although much of our work is currently on-line, to help manage symptoms of fatigue, face-to-face appointments can be requested and are offered where clinically indicated. There is likely to be more capacity for this in the new service, with some clinics planned.
 
      >Patient-led support
A new development in the combined service will be Participation Partners. These are people with lived experience, who will be trained and supported to help others. We hope that a Participation Partner will be present in all our groups, and may take a lead in developing options for peer support in future.
 
     > A way to re-access the service
We have agreed with commissioners that patients have the option of self-referring directly to the service for 6 months after discharge. This bypasses the need to go via your GP, unless symptoms have changed significantly.
 
    >Follow up after groups
In the new service, all patients will be offered a 1:1 review after completing attendance at the group sessions. This will allow us to review what has been helpful and is working well, as well as identifying areas where more support may be required and making a plan to address these.
 
The name of the new service
Responses to the suggestions made were very evenly spread. Having read all the comments, including other suggestions, it was decided that the new service will be called the Post Viral Fatigue Service. We appreciate this will not reflect everyone's experience of ME/CFS or LC (e.g. you may have ME/CFS without having had a virus) but the vast majority will fit into that description. The service is for everyone with ME/CFS and LC, whether or not symptoms followed a viral infection, and GP's will be aware of that.
 
 
Over the next few weeks, we will be gradually transitioning to the combined service but you shouldn't notice any significant changes to your care. We will continue to be based at Malvern Community Hospital, with the same phone number. We do have a new email address though: [email protected]  Please use this for future correspondence.
 
 We greatly appreciate your comments and suggestions, and will use them in our quest to improve the service going forwards. There will be on-going opportunities to provide feedback via Care Opinion (more information about this shortly!) so please keep in touch and let us know how you are finding things.
 
​Kind regards
Marina
Marina Townend
Service Lead/ Specialist Occupational Therapist
Post Viral Fatigue service
Malvern Community Hospital | 185 Worcester Road | Malvern | WR14 1EX
Tel. 01684 612671

Future Changes combining the local Services. 
Please respond with your suggestions this week.
 
Marina Townend is the Service Lead/Specialist Occupational Therapist, of the Herefordshire & Worcestershire ME/Chronic Fatigue Syndrome and Post-Covid Syndrome Services.  She has been in touch updating us with forthcoming changes to the NHS Worcestershire ME/CFS Specialist Services). 
 
Marina informed us that this week, an email went out to all patients on their current ME/CFS and PCS caseloads, and the Recovery and Management (RaM) Group - totalling approximately 400 people, giving them a survey to complete.

Good morning,
 
At the moment in Herefordshire and Worcestershire there are two separate NHS services for people living with post-viral syndromes.   One for people with Post Covid Syndrome (PCS) (sometimes called Long Covid) and another for people with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS).
 
There is now a plan to bring the two services together which will be helpful for a number of reasons:

• Less Covid testing has meant some people cannot access either service because they don’t have a clear diagnosis.

• There is an increasing number of people who meet the criteria for both conditions.
• GPs sometimes aren’t sure which service to refer patients to as they have very similar symptoms.  The new service will be easier to refer to, and may allow more people to access treatment and support.

• The Long Covid Service has been funded on an annual basis up until now.  The new service has long term funding which means patients with Long Covid will get the same offer of longer-term support like those with ME/CFS. 
• It will allow patients with ME/CFS and Long Covid to access specialist GP and Consultant input which is not always possible now.

 
We know this change might be worrying for you and the people who support you.  We want to let you know that many of the staff already work across both services and are knowledgeable about both ME/CFS and PCS.  We will continue to treat people based on their symptoms and needs, using the same group work and 1:1 support we offer now.
 
We want a service that is helpful to all, and those who care for you.  To do this we want to know how people feel about the proposed changes,  Please complete the attached ME/CFS specialist services survey by the END OF FEBRUARY if you can.   If you need help to fill it in or would like to talk to us about it instead, please let us know.

The Worcestershire ME/CFS Therapy Team can currently be contacted through Malvern Community Hospital. (01684 612671   [email protected] and their webpage NHS Worcestershire ME/CFS Specialist Services).
 
 
Marina continued with further news about the local combined services.  She explained that all residence of Herefordshire and Worcestershire, with Post Covid Syndrome (PCS) (sometimes called Long Covid), or Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS), are invited to share their thoughts. 
 
By the END OF FEBRUARY, please email [email protected]  with your comments or suggestions.  Please include the subject "combined services".
Please include how you feel about the plan bringing the two services together to create one service, and what would you like to see the new service do?
Have you any suggestion what to call the new service?  Maybe, Post Viral Fatigue service;  Living well with ME/CFS and Long Covid;  or Wellbeing for Long Covid and ME/CFS (the WELCOME service);  or your further thoughts.
 
Marina, confirmed that there will be wider communications going out in the next few weeks, including to the general public, GPs and other health professionals.  We also understand from Marina that it is hoped to follow this up with some GP training, including around the NICE guideline recommendations that patients receive an annual review.  Also, before the new combined service goes live on 1st April, the ME Association (MEA) and British Association of Clinicians in ME/CFS (BACME) will be updated with the Worcestershire and Herefordshire.NHS Services for people living with post-viral syndromes.

Part 4.  Worcestershire County Council SEND, TYMES TRUST, and All Party Parliamentary Group (APPG) on SEND
 
Welcome to SENDIASS Herefordshire and Worcestershire
Special Educational Needs and Disabilities (SEND) Information, Advice and Support Service (IASS) covering Herefordshire and Worcestershire.
 
Listed under ME/Chronic Fatigue Syndrome   in the Worcestershire County Council SENDIASS support *A - Z*
Information

• Website: The ME Association
• Website: Tymes Trust

 
 
TYMES TRUST’s four page pdf
Response to the DoHSC Consultation Interim Delivery Plan on ME/CFS, begins with TYMES Trust appreciates the time and dedication of everyone contributing to and compiling the DHSC My full reality: the interim delivery plan on ME/CFS.  For too long this devastating illness has been shrouded in controversy; far too many Children, Young People and their Parent/Carers (and some professionals) have been harmed by ignorance and misunderstanding of the illness, resulting in inappropriate medical care, social care, education provision, child protection proceedings and professional gaslighting.
 
The recent changes within the NICE guidelines, and this UK Department of Health and Social Care Interim Delivery Plan on ME gives us some long-awaited hope; however, we have some reservations and comments.  Overall, the plan is positive, and the crucial task of re-education (if implemented appropriately) will certainly support system improvement and support professionals to deliver individualised, quality, care and understanding to those living with ME.
The needs of children and young people are different to those of adults. Ideally, discussions and planning for children and young people should be progressed as an independent section within the Interim Plan.  The changes within the plan need to be implemented with a sense of urgency to avoid further harm and subsequent declining health for our children and young people as ME has a huge negative impact at such a vulnerable stage of life.
 
TYMES TRUST also list their recommendations, including the fact that “a firm diagnosis of ME is needed as early as possible to ensure protection from disbelief and needless pressure from education and Social Services.”  TYMES Trust concurs with the comments and responses of their fellow Forward ME members including The ME Association, 25% Group, BRAME , ME Research UK.
 
 
All Party Parliamentary Group on SEND.  The Inaugural meeting of MPs to re-establish the All Party Parliamentary Group (APPG) on special educational needs and disabilities (SEND) took place on Wednesday 16 October 2024. It was standing-room only due to the level of interest from MPs and a long list of others who couldn’t attend but wish to be members of the group.
 
We are pleased to confirm that NAHT will again be providing the secretariat for the group. Olivia Blake MP was duly re-elected to chair of the group, along with Greg Stafford MP, Shockat Adam MP and Jen Craft MP, who were elected as vice-chairs,with a full list of 42 MP members.
The meeting discussed the previous work of the group, focusing on the importance of early intervention and had a brief discussion about next steps. The meeting was cut short by the division bell during a busy day in parliament.  The group will now be re-registered as an APPG and we will be arranging next steps and will keep you all up to date with progress and details of future meetings.  The officers of the group are now as follows:

APPG officers
Olivia Blake, Labour, Sheffield Hallam
Greg Stafford, Conservative, Farnham and Bordon
Shockat Adam, Independent, Leicester South
Jen Craft, Labour, Thurrock
 
The membership of the group are listed with this announcement, and include Chris Bloore, MP Redditch.

• You can follow the APPG for SEND on X via @appg_send
• To join the APPG for SEND mailing list, please click here
• If you or your organisation would like to speak at an upcoming meeting of the APPG for SEND, please express your interest here

•  A.P.P.G  •  Children  •  Forward ME  •  Government U.K.  •  M.E. Association  •  MP  •  N.I.C.E.  •  Tymes Trust  •  Worcestershire County Council  

Updated downloadable information from the ME Association (MEA).
 
The ME Association: 2024 Autumn Covid Booster Information
October 21, 2024
 
Even though Covid-19 hasn't gone away, many people have been returning to normal or near normal life.  However, while official statistics indicate that levels of Covid infection are still fairly low this reflects the fact that very little testing is being carried out.  There are new variants of the virus still appearing, hospital admissions remain a cause for concern, and other indicators of Covid in the community confirm that Covid is still causing problems.
 
So, as we have been regularly pointing out on ME Association social media, people still need to take sensible precautions to reduce the risk of catching Covid and should seriously consider having a Covid Autumn booster.
NHS UK website information on all aspects of the autumn Covid booster - including how to book an appointment, different vaccines, common side effects.
 
The MEA continued by giving a link to the NHS Covid-19 vaccine website, plus a detailed letter from -
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS.
 
You can download PDF files of these items.

• Template: Covid Autumn Booster Vaccine (2024)
  
• Template: Flu Vaccine (2024-25)
• Flu Vaccination and ME/CFS (2024-2025)

 
 
 
Updated Booklet: Flu Vaccination & ME/CFS 2024/25
October 11, 2024


Flu vaccination is important because, although flu is often unpleasant, it can be dangerous. This is especially so for anyone with certain chronic health conditions, including ME/CFS. And with Covid still around, a combination of flu and Covid could be even more serious.
As there is no simple yes/no answer as to whether people with ME/CFS should have a flu vaccine, the purpose of this information is to supply you with everything you need to know about flu vaccines and ME/CFS. You and your doctor can then decide whether you ought to have this protection.
 
 
 
The ME Association (MEA) publicised the Guardian’s article at the end of October.
The cost of restricting COVID boosters in the UK could be huge 
October 31, 2024
Britain has closed its eyes to long Covid - which means it will ravage even more lives and livelihoods
Devi Sridhar -The Guardian
 
Extracts
The trauma of those pandemic years is burnt into our minds. But, whether we want to deal with it or not, Covid-19 is still affecting all of us, and circulating at fairly high levels in Britain this month. While community surveys are no longer conducted by the Office for National Statistics to estimate overall cases, hospital data from England indicates that the weekly hospital admission rate for Covid-19 is at 4.64 for every 100,000 people, with the north-east region at 8.91.
 
The longer legacy concerns people who had and cleared the infection, but are still suffering - what is usually referred to as Long Covid.
Recent concerns about economic inactivity are tied to the growing percentage of those unable to function due to Long Covid. A study in the Lancet in August 2021 estimated that 22% of people with long Covid were unable to work, and 45% were on reduced hours.
 
A recent study in the New England Journal of Medicine found that vaccination strongly reduces the chance of serious problems of Long Covid. The study found that the incidence of experiencing symptoms one year after infection decreased during the pandemic from 10.42 cases for every 100 people for unvaccinated individuals in the pre-Delta period, to 3.5 cases a 100 people for vaccinated individuals in the Omicron period. They estimate that roughly 72% of the reduction in Long Covid was due to the vaccines, while 28% was linked to changing variants. 
 
But very few groups in the UK are eligible for a 2024 autumn booster: adults 65 and older; residents in care homes; frontline NHS and social care workers; as well as those in high-risk groups.
The general population can get the Covid-19 vaccine, but it’s pricey, at nearly £100 a dose at Boots, for example. Compare this with the private cost of a flu jab at just under £22.
Looking at other countries’ policies, the UK is the outlier in continuing to restrict free boosters to certain groups. Constrained NHS budget means decisions have to be made on a cost-benefit basis, but avoiding the population-level effects of illness would not only benefit the individual but also the NHS and wider economy.
Read Full Article on The Guardian

•  Coronavirus (COVID 19)  •  M.E. Association  •  National Newspapers  •  N.H.S.  •  N.I.C.E.

The Worcestershire M.E. Social Group’s "Symptoms of M.E./CFS" Information Sheet has been updated, with the "Symptoms for Suspecting ME/CFS" Section of Myalgic Encephalomyelitis (or encephalopathy) / chronic fatigue syndrome: diagnosis and management: NICE guideline [NG206], published on 29 October 2021, now included on the reverse.  The updated “Symptoms of M.E./CFS” Information Sheet contains the original first page (with the header and footers updated), plus an extract from the 2021 ME/CFS NICE Guideline overleaf.

The Worcestershire M.E. Support Group produced a ‘Symptoms of M.E./CFS’ information sheet well over twenty years ago, and it continues to be available on our Group’s website in the About M.E. section.  Many people have found this information sheet useful when describing how they feel, and explaining their situations to doctors. 
 
 
The ME Association’s (MEA) website contains symptoms information from the NICE Guideline, including -
 
ME/CFS Symptoms and diagnosis

• ME/CFS and Long Covid Overview
  
• ME/CFS Symptoms & Diagnosis
  
• ME/CFS Further Information
  
• NICE Guideline ME/CFS
  

 
Also the MEA have given Key symptoms with explanations that should all be present for a diagnosis of ME/CFS including -  Debilitating fatigue;  Post-exertional malaise;  Unrefreshing or disturbed sleep;  and Cognitive difficulties.  The MEA website also contains sections on:  Other common symptoms;  Referral to ME/CFS Specialist;  and Severity of ME/CFS.
 
 
Action for M.E. (AfME) explain -
Range of symptoms
Everyone who experiences M.E. has a different pattern of illness, and symptoms and severity can fluctuate and change over time.  M.E. is not "feeling tired."
The 2021 NICE guideline for M.E. for health professionals in England and Wales instead talks about "debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest."
While it’s important to find out more about the range of symptoms experienced by different people with M.E. - it is also important to know that people with M.E. may only experience a few of them and at varying levels of severity.  Always get new symptoms checked by your doctor, as they may be unrelated to M.E. Women often find that symptoms worsen at different times in their menstrual cycle.
 
AfME give detailed explanations on -  Feeling generally unwell;  Sleep disturbance;  Pain - (If pain, especially muscle pain, is more of a problem than fatigue, fibromyalgia may be an issue);  Cognitive difficulties, sometimes collectively called "brain fog";  Problems with the nervous system;  Digestive problems;  Intolerance and increased sensitivity:
 
 
ME Research UK (MERUK) also has a useful section on ‘What is ME?', and explain that ME/CFS is an illness affecting many different parts of the body, which can last for a long time in some people.
 
MERUK give detailed information on -  The main symptoms;  What is the cause?;  Living with ME/CFS;  How is ME/CFS diagnosed?;  What treatments are available?;  The role of ME Research UK;  More information about ME/CFS. 
 
MERUK state - For a more detailed explanation of ME/CFS, its symptoms and treatment, we recommend the website of the US Centers for Disease Control and Prevention.
 
 
BACME (British Association of Clinicians in ME/CFS)
In BACME’s response (pdf) to the 2021 NICE Guidance on ME/CFS, Bacme, stated that the NICE guideline provides information regarding diagnosis including the importance of recognising the key symptom of Post-Exertional Malaise.
 
This response also states that “The symptoms of ME/CFS are not caused by deconditioning. This guideline marks the move away from using GET programmes for treating ME/CFS.  This is a move the majority of BACME members working in NHS specialist services have already made.

•  Action for ME  •  M.E. Association  •  MERUK  •  N.I.C.E.

Letters from Worcester MP and NHS H&W.  Plus, NHS H&W Advert.
 The Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Herefordshire & Worcestershire Health and Care NHS Trust Service.  This is a specialist part-time service that now delivers support and treatment to people with ME/CFS within community settings across Herefordshire and Worcestershire. 
 
Letters from Worcester MP and NHS H&W
At the end of June we received a letter from Robin Walker MP for Worcester, who had been in touch with NHS Herefordshire & Worcestershire (NHS H&W) on our Group’s behalf, regarding concerns about the decommissioning of the local ME/CFS diagnosis service.  The response from Simon Trickett, Chief Executive of NHS Herefordshire and Worcestershire ICB, explained the current situation with the diagnostic pathway for patients with suspected ME/CFS.

Simon Trickett advised that the service has not been decommissioned by NHS Herefordshire and Worcester, but the CFS service is under considerable pressure due to recruitment difficulties.  He pointed out that this is having a significant impact on Herefordshire and Worcestershire Health and Care Trust’s (HWHCT) ability to safely deliver the service to its patients, and unfortunately the service can only accept patients who have been officially diagnosed with ME/CFS at present.
 
The letters from Robin Walker MP, and Simon Trickett, both refer to a suggested alternative pathway for people who are experiencing ME/CFS pain - the Specialist Pain Management Programme.
 
 
Plus, NHS H&W Advert. (from MEA website)
The ME Association (MEA), raised concerns,
Herefordshire and Worcestershire ME/CFS Service - Feedback Required.
July 10, 2023
Concerns are, not surprisingly, being raised with us about a job advert for this service and some of the information on the cause of ME/CFS on the website for this service:
More information on the Herefordshire and Worcestershire ME/CFS Service
BMJ job advert


ME Association Comment
Dr Charles Shepherd , Trustee and Hon. Medical Adviser
Concerns include:
In particular, is the use of the term ‘incremental pacing' - as this is not a term that is used in the new NICE Guideline on ME/CFS.
The new NICE Guideline makes it clear that incremental increased in activity, along with graded exercise therapy, are no longer recommended (in section 1.11.14 – Box 4).
The development of ‘psycho-educational interventions' for both patients and carers is also concerning as it is not clear what this means.
Service website
It is very disappointing to find in the various information leaflets that some of the main (but unproven) causes of ME/CFS are listed as:
Personality
Childhood trauma
Beliefs and attitudes
Excessive rest
Mood disorders
However, there is no mention of any biomedical abnormalities involving the brain, muscle, endocrine and immune systems.
Again, this information is not consistent with current thinking on the cause of ME/CFS, or the new NICE guideline on ME/CFS.
 
Feedback required
Before taking this any further with the NHS Trust it would be very helpful to have feedback from anyone who is using/has used this NHS referral service. Please email: [email protected]
 
Update 10.07.23
The Herefordshire and Worcestershire ME/CFS Service responded:

Dr Charles Shepherd has sent the following email:
 
Dear Herefordshire and Worcestershire NHS Trust
Thank you for withdrawing this job advert so quickly and agreeing to review the content of your website information on the causes and management of ME/CFS - hopefully bringing this into line with all the information and recommendations in the new NICE guideline on ME/CFS.
As you will have noted from our social media announcement I was intending to contact you once we had received some feedback from our members on your ME/CFS referral service.
Whilst there has been some positive comments on our Facebook page coverage there are several issues of concern that need to be addressed.
 
In particular:

1. Some GPs do not appear to know that this referral service even exists.  This has resulted in some people with ME/CFS being referred to Bath, Bristol or Birmingham for secondary care. And some have not been able to obtain a referral for expert help with either diagnosis or management.
2. The use of various Work Sheets - we know from previous discussion with our members that most people with ME/CFS find these are time-consuming to complete and are not particularly helpful in their management.  This is a view that I would share.

 
The ME Association produces a wide range of information on all aspects of ME/CFS for both patients and doctors.
The following (free to download) publications may be of interest and we would be happy to supply paper copies if required:

• Summary of Key Points from the NICE Guideline
• Diagnosing ME/CFS – The Importance of an Early & Accurate Diagnosis
• Long Covid and ME/CFS – Are they the same condition?
• Activity and Energy Management and Pacing

Our new booklet on pain management will be available shortly.
Kind regards, Dr Charles Shepherd,  Hon Medical Adviser
Member of the NICE guideline committee on ME/CFS
 
 
Worcestershire ME Support Group
(Our Group’s Website Blogs & Information): 2023.01.07 - 2023.04.15

Our Group’s blogs of 15 April, 9 March, and 7 January give information received from Marina Townend, Specialist Occupational Therapist/ Team Lead, of the Worcestershire & Herefordshire ME/ Chronic Fatigue Syndrome and Post-Covid Syndrome services.  Marina has been updating us on the situation at the Herefordshire and Worcestershire NHS ME/CFS Local Services, and responding to our queries.  Marina’s updates have included “Changes to the Worcestershire NHS Service, following the revised NICE (The National Institute for Health and Care Excellence) Guidelines, published in October 2021”.
 
 
New MEA Booklet:
Pain Management in ME/CFS by Dr Charles Shepherd 
July 14, 2023
 
Dr Charles Shepherd, Hon. Medical Adviser to the ME Association, has written a new booklet on Pain Management in ME/CFS. It can be purchased for £1 from the website shop along with a full range of literature covering other important topics including more detailed information on prescription drugs for pain relief that Dr Shepherd also refers to in this new booklet.
 
Introduction
Although a small but significant minority of people with ME/CFS experience little or no pain during the course of their illness, the majority - probably around 75% - do. When pain occurs, it can do so in several different forms and with varying degrees of severity.
Knowing what causes pain in any condition can obviously be very helpful in the way it is managed. However, in the case of ME/CFS, no significant research has been carried out into the cause. We therefore know very little about why some people with ME/CFS suffer severe and persistent pain and others have low levels of pain or no pain at all.
 
When it comes to pain management, the best we can do right now is to work on the basis that there may be faults in the way in which messages about pain from various parts of the body -  muscle, joints, abdomen, etc - are transmitted up the spinal cord to centres in the brain that control how we respond to pain.
Equally, it’s also possible that the way in which these pain control centres in the brain dampen down pain is also at fault. And this is why, in addition to conventional pain-relieving drugs, doctors sometimes prescribe drugs that normally have other uses but affect chemical transmitter systems in the brain.
Despite pain being such an important part of ME/CFS, this is one symptom that tends to receive very little attention in medical descriptions of the illness.  Consequently, pain is a key symptom that is often not managed very well by health professionals.
 
This MEA article on their website, explains “What sort of pain occurs in ME/CFS?”, plus the “Topics covered in this booklet”
 
 
The new Myalgic encephalomyelitis (or encephalopathy)/ chronic fatigue syndrome: diagnosis and management. NICE guideline [NG206] was published in October 2021.
 
See also from our website -
 
NICE ME/CFS: new Guideline (New downloadable Publications).
19/1/2022
 
NICE ME/CFS: new Guideline (Reactions).
25/11/2021
 
NICE ME/CFS: new Guideline now Published
29/10/2021

•  Hereford  •  Local News 
•  M.E. Association  •  MP 
•  N.H.S.  •  N.I.C.E. 
•  Worcestershire 
•  Worcestershire M.E. Social Group

The Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) Herefordshire & Worcestershire Health and Care NHS Trust webpage was updated in January, with information included on our ME/CFS Local Services webpage update blog.      
This is a specialist part-time service that delivers support and treatment to people with ME/CFS within community settings across Herefordshire and Worcestershire.
 
 
At the end of March, we received further information from Marina Townend, Specialist Occupational Therapist/ Team Lead, of the Worcestershire & Herefordshire ME/ Chronic Fatigue Syndrome and Post-Covid Syndrome services, updating us on the situation at the Herefordshire and Worcestershire NHS ME/CFS Local Services, and responding to our queries.  Marina hopes to be with us at our next Worcestershire M.E. Social Group Afternoon Café Meeting (see end of this blog).
 
 
Changes to the Worcestershire NHS Service, following the revised NICE (The National Institute for Health and Care Excellence) Guidelines, published in October 2021
Marina informed us -
We have gone through the changes in the revised guidelines as a team, and developed an action plan to ensure that we are following them.  Some of these actions are still work in progress as I'm sure you can appreciate that it is time-consuming, and we are already under a huge amount of pressure carrying out our day-to-day work. However, we check in each team meeting to make sure these have not been forgotten and are still progressing.
Actions included changing our language to ME/CFS from CFS/ME (in written format and when speaking), updating our referral protocol and service literature to ensure that they reflect new guidelines, developing a workshop for carers, and compiling a care and support plan.  We are in on-going conversations with our commissioner about medical cover and also regarding how we work with people who are severely affected.
We were not offering CBT or GET as a 'cure' for ME/CFS so our approach to therapy has not changed - we see these interventions as beneficial for some people, at the correct time, and if applied in an appropriate manner. 
 
 
The Current Worcestershire NHS ME/CFS Specialist Services, -
We recently mentioned to Marina -
On the NHS ME/CFS Service webpage, it states - “we work as a multi-disciplinary team with Occupational Therapists, Physiotherapists and Psychologists”.
Marina’s response included -
We have Nikki Mills (Physiotherapist) working in the Post Covid team 1.5 days/week.  She doesn't cover ME/CFS, but will offer guidance and resources to the team at times.  We are very much hoping to recruit a physiotherapist still and are in the process of going to recruitment again.
The PCS service also has access to Carrie Garrett, a Speech and Language Therapist, who offers us approximately 1 session/month.
 
 
Diagnosing Long Covid
Marina informed us -
Diagnosing Long Covid is more straight forward than ME/CFS, and GPs seem to feel more comfortable with this as many people have had a positive Covid test, or recognise the symptoms of the Covid virus.  If other possible causes of on-going symptoms have been ruled out, Long Covid is diagnosed by the GP.
This situation is likely to change, however, as testing is reduced, and new variants have different symptoms which are maybe less recognisable as Covid-19.  We anticipate that there will be more referrals to the ME/CFS service, and hope that the distribution of funding will reflect this.  It is one of the reasons why it has been decided that the PCS service should sit under the umbrella of the ME/CFS service, to allow some flexibility with this.  Referral to the PCS service is mainly via GPs, but other clinicians sometimes refer as well.
 
 
Previous news from Marina Townend is available from our blog last month.
 
 
Next Month
Marina informed us -
I am hoping to come to the Social Group on 10th May.  I look forward to seeing you again and will be very happy to answer any questions then. 


Please join us, when we look forward to greeting Marina at our next Afternoon Café Meeting. This will be held during ME Awareness Week on Wednesday, 10 May, from 2.00 - 3.30 pm, in the Next Café, above the Next store at the Elgar Retail Park, Blackpole, Worcester, WR3 8HP.
 
Our recent Worcester Afternoon Café Meetings blog, gives future dates, and further information.
 
 
The new Myalgic encephalomyelitis (or encephalopathy)/ chronic fatigue syndrome: diagnosis and management. NICE guideline [NG206] was published in October 2021.
 
See also from our website -
 
NICE ME/CFS: new Guideline (New downloadable Publications).
19/1/2022
 
NICE ME/CFS: new Guideline (Reactions).
25/11/2021
 
NICE ME/CFS: new Guideline now Published
29/10/2021

•  Hereford  •  Local News 
•  Meetings  •  N.H.S. 
•  N.I.C.E.  •  Post COVID Syndrome (Long COVID)  
•  Worcestershire  •  Worcestershire M.E. Social Group

Invite your MP to join the next meeting of the All Party Parliamentary Group on ME.  Explain your experiences to your MP, especially since the new NICE guideline was published in October 2021.
 
The meeting previously planned to be held in March, was postponed. 
 
The ME Association (MEA) now state  -
The next meeting of the All-Party Parliamentary Group (APPG) on M.E. will be the Annual General Meeting on Wednesday 10 May 2023 at 2pm.  In addition to reconstituting the APPG, the AGM will include:

• a one year-on review of the implementation of the new NICE guideline including a presentation from Action for M.E. on the results from a Freedom of Information request regarding the implementation of the revised NICE Guideline responded to by 106 ICB’s and NHS Trusts.
• a discussion of support for those with severe ME
• consideration of our workplan for the coming year.
• Minutes of the AGM will be shared in accordance with APPG rules.

 
We'd be really grateful if you could invite your MP to attend.  Your MP can get further information by emailing Carol Monaghan, MP (Chair of the APPG on M.E.).
Action for M.E. and The ME Association jointly share the secretariat responsibility for the APPG. 
 
A template letter for your use, is also available on the MEA website.
 
 
At the end of April 2022 our Worcestershire Social Group Blog announced - Decommissioned - ME/CFS Service at Worcestershire Acute Hospital .  If this has affected you, or you have any other concerns, this is your opportunity to let your MP know?
 
 
The new Myalgic Encephalomyelitis (or Encephalopathy)/ Chronic Fatigue Syndrome: Diagnosis and Management. NICE guideline [NG206] was published in October 2021. 
See from our website -
 
NICE ME/CFS: new Guideline (New downloadable Publications).
19/1/2022
 
NICE ME/CFS: new Guideline (Reactions).
25/11/2021
 
NICE ME/CFS: new Guideline now Published
29/10/2021

•  Action for ME  •  A.P.P.G 
•  M.E. Association  •  MP 
•  N.I.C.E.  •  Parliament U.K. 

Invite your MP to join the next meeting of the All Party Parliamentary Group on ME.  Explain your experiences to your MP, especially since the new NICE guideline was published in October 2021.
 
The ME Association (MEA) give details -
Invite your MP to join the next meeting of the All-Party Parliamentary on M.E
March 8, 2023
The next meeting of the All-Party Parliamentary Group (APPG) on M.E. will be the Annual General Meeting on Tuesday 21 March 2023 from 3:30pm-4:30pm. In addition to reconstituting the APPG, the AGM will include:

• a one year-on review of the implementation of the new NICE guideline including a presentation from Action for M.E. on the results from a Freedom of Information request regarding the implementation of the revised NICE Guideline responded to by 106 ICB’s and NHS Trusts.
• a discussion of support for those with severe ME
• consideration of our workplan for the coming year.
• Minutes of the AGM will be shared in accordance with APPG rules.

 
We'd be really grateful if you could invite your MP to attend.  Your MP can get further information by emailing Carol Monaghan, MP (Chair of the APPG on M.E.). 
Action for M.E. and The ME Association jointly share the secretariat responsibility for the APPG. 
 
Template email included by the MEA., for your use.
 
 
At the end of April 2022 our Worcestershire Social Group Blog announced - Decommissioned - ME/CFS Service at Worcestershire Acute Hospital .  If this has affected you, or you have any other concerns, this is your opportunity to let your MP know?
 
Plus recent local news:
Worcestershire NHS ME/CFS Local Services News
 
The Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) Herefordshire & Worcestershire Health and Care NHS Trust webpage was updated in January, with information included on our ME/CFS Local Services webpage update blog.
 
Plus, we’ve received further information from Marina Townend, Specialist Occupational Therapist/ Team Lead, of the Worcestershire & Herefordshire ME/ Chronic Fatigue Syndrome and Post-Covid Syndrome services, updating us on the situation at the Worcestershire NHS ME/CFS Local Services, and responding to our queries.
 
 
The new Myalgic encephalomyelitis (or encephalopathy)/ chronic fatigue syndrome: diagnosis and management. NICE guideline [NG206] was published in October 2021. 
See from our website -
 
NICE ME/CFS: new Guideline (New downloadable Publications).
19/1/2022
 
NICE ME/CFS: new Guideline (Reactions).
25/11/2021
 
NICE ME/CFS: new Guideline now Published
29/10/2021


•  Action for ME •  A.P.P.G •  Hereford •  Local News 
•  M.E. Association •  MP •  N.H.S. •  N.I.C.E. 
•  Parliament U.K. •  Worcestershire