National Strategy for Self-Care

Tuesday 26th April 2022 Westminster Hall

16:58

[Sir George Howarth (Knowsley) (Lab)]

I beg to move,

That this House has considered the potential merits of a national strategy for self-care.

As ever, Sir Charles, I am pleased to have this debate with you in the Chair. In October 2019, I chaired a roundtable event on self-care, which involved healthcare professionals, pharmacists and other experts. It was organized by the consumer healthcare association the Proprietary Association of Great Britain, and following the event we produced a report that the Minister, or at least the Minister who was supposed to be here—the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield)—is aware of. I am indebted to PAGB, the Juvenile Diabetes Research Foundation and Diabetes UK for the briefing they have provided for this debate.

It might be helpful if I define what I mean by self-care. Essentially, it is about the actions individuals take for themselves, on behalf of others or with others to develop, protect or maintain their health. It can be summarised as a spectrum that includes the promotion of everyday wellbeing, taking care of self-treatable conditions, and the management of long-term conditions. It is important, however, to point out that self-care is not no care. Those who need medical support on a more traditional basis should be entitled to that type of care.

The covid-19 pandemic has revealed the important role that self-care can play in reducing the burden on GPs and hospital A&E departments, so that those with the most serious ailments can be treated with greater urgency. Prior to the pandemic, it is estimated that 18 million GP appointments and 3.7 million A&E visits were for minor ailments, including a blocked nose, dandruff and travel sickness, at an estimated cost of £1.5 billion annually. A survey of frontline healthcare professionals carried out by the self-care academic research unit at Imperial College in 2021 indicated that 95% of those who responded felt that self-care was important during the pandemic, compared with 55% pre-pandemic. However, a further survey carried out by PAGB later in 2021 found that the percentage of members of the public saying that they were more likely to self-care had fallen from 69% in 2020 to 55%, which illustrates that the trend in that direction has reversed.

My key point in this debate is to highlight the necessity for a new national strategy for self-care. The previous such strategy, “Self-care—A Real Choice”, was published in 2005. Since then there have been many new developments and the case for a new strategy has been more clearly recognised.

Before I move on to describe what the elements of a new strategy might be, I will use the example of those with diabetes to illustrate how self-care can work well. Other conditions could also serve to make that point, but, to avoid taking up too much time, I will use this single example. JDRF has pointed out that 79% of the management of type 1 diabetes is carried out by the individual with the condition, often with the help and support of their families and carers. That makes type 1 diabetes a case study in how to successfully promote self-management. JDRF also draws attention to the need to invest in technology as a crucial benefit to the long-term sustainability of the NHS post-covid.

JDRF’s 2021 report, “Covid and Beyond”, concluded that people with type 1 diabetes who had access to relevant technologies felt more confident in managing their diabetes in the absence of routine NHS care and support. The charity Diabetes UK points out that diabetes is

“the fastest growing health crisis of our time”,

with the equivalent of one in 14 people—that is 4.9 million in total—living with the condition, and that it accounts for 10% of the NHS budget—that is a staggering figure—80% of which is spent on treating largely preventable conditions.

Diabetes UK draws attention to the fact that, to live well with diabetes, avoid complications and successfully self-manage diabetes, those living with the condition require five things: first, access to education about diabetes and how to manage it; secondly, emotional and psychological support, which is increasingly important; thirdly, access to technology to support self-management; fourthly, access to weight-management support when needed, and I will say more about that in a moment; and finally, facilitated peer support.

Typically, those with diabetes spend about three hours a year with their doctor, nurse or consultant, and a staggering 8,757 hours managing the condition themselves. As Diabetes UK points out:

“Managing diabetes day-to-day can be difficult. This is why it’s important people have the knowledge and skills to manage their diabetes so they can live well and avoid complications.”

[Alison Thewliss (Glasgow Central) (SNP)]

I appreciate what the right hon. Gentleman is saying and I understand that he has spoken to my constituent Scott Craig. Does he agree that there needs to be awareness of the risks, and training for people who are self-managing and for their families? I understand that my constituent’s husband’s device failed, leading to his untimely death. Does the right hon. Gentleman agree that there needs to be greater awareness of how these devices work and what people need to do should things go wrong?

[Sir George Howarth]

As the hon. Lady is aware, I spoke to her constituent about that point earlier today. She makes a good point and I agree with her, and I would add that it is important that those who use technology are properly trained in how to use it best. The devices need to be reliable, so that technology can provide effective help with these conditions.

Those with type 1 diabetes who also struggle with eating disorders experience problems if they omit to take their insulin in order to lose weight. I know that you are familiar with this issue, Sir Charles. The right hon. Member for Maidenhead (Mrs May) and I will shortly carry out an inquiry into this growing problem, with the support of JDRF. We hope to point to how self-care can play an important role in dealing with this worrying trend. Hon. Members may be aware that there is a storyline in the soap opera “Coronation Street” that covers this subject. It has not yet concluded, but it offers a helpful perspective of how the problem has arisen, what it is and what the dreadful consequences can be.

I will refer to the recommendations from the report following the roundtable I chaired in October 2019. First, the Department of Health and Social Care should develop a national self-care strategy. Secondly, NHS England and Improvement should explore the implementation of self-care recommendation prescriptions, to support clinicians to discuss self-care with patients and refer them towards it. Thirdly, primary care networks should consider ways to improve self-care in local populations as part of the development of the network across the local health system. Fourthly, NHS England and Improvement should enable community pharmacists to refer people directly to other healthcare professionals. That has become even more apparent during the covid-19 pandemic.

The fifth recommendation is that NHS England and Improvement should support moves towards community pharmacists being granted read and write access, to give them full integration and interoperability of IT systems as part of local health and care records partnerships, and promote national support for such data-sharing agreements. That would unlock the door to a hugely increased, positive role for community pharmacies. Sixthly, the Government and royal colleges should include in the healthcare professional curriculum and the national curriculum self-care modules that can be delivered sustainably by schools. Finally, NHSX should explore technologies that could be used to promote self-care and manage demand on the NHS.

Before concluding, I would be grateful if the Minister, or his colleague, could consider some questions. It is not necessary for them to be answered today; theyj could respond by letter if that would be more effective. First, will the Minister undertake to look closely at the recommendations for a new self-care strategy? Secondly, will he give consideration to the report’s seven recommendations, which I referred to earlier? Thirdly, will he agree to meet a representative group of healthcare professionals, other interested parties and me to discuss potential ways forward? Finally, will he meet diabetes charities, the right hon. Member for Maidenhead and me to discuss the relevance of the two conditions—it is often overlooked that type 1 and type 2 diabetes are two distinct conditions—and to explore how the condition can serve as an example for self-care management? I look forward to the Minister’s response.

[Sir Charles Walker (in the Chair)]

I thank the right hon. Gentleman for his speech and for the support that he has given to two of my constituents—Neal and Lesley Davison. Perhaps I might tag along to one of those meetings with him.

17:09

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to be under your stewardship, Sir Charles. I thank my right hon. Friend the Member for Knowsley (Sir George Howarth) for securing the debate.

We all know that people have self-cared in one fashion or another for thousands of years. Personally, I think that self-care starts with mental health, which can often be forgotten in strategies. The old Hippocratic approach was to be in a good frame of mind: a healthy mind produces a healthy body, and that is as pertinent today as it was more than 2,000 years ago. A self-care strategy should take a holistic approach that covers lifestyle, diet, as my right hon. Friend has said, and exercise, and a person’s state of employment is also a factor. They must all be taken into account by strategies dealing with self-care, because this is about not just people’s physical health, but their social and economic health.

On the point made by the hon. Member for Glasgow Central (Alison Thewliss) about self-care, I do not think that self-care means self-isolation as far as healthcare is concerned. It is about sharing care. It is also important that people use the healthcare system responsibly. Some referrals to GPs and hospitals could be considered inappropriate—I think my right hon. Friend the Member for Knowsley touched on that—with people turning up and putting a strain on the system. We have a personal responsibility to ensure that the health service is used in the most appropriate way. That is not to dissuade people or tell them not to go to the GP, but it is a factor that must be taken into account. There must be a system that assists in self-care so that people feel empowered and, crucially, safe, as the hon. Member for Glasgow Central referred to, when making decisions about self-care.

We have also got to take into account those people who cannot self-care and need support from family or carers who are, in effect, proxy self-carers, if I may use that phrase. A strategy must also include a safety net for people who are not in a position to self-care as much as they would like.

The World Health Organisation has an excellent prospectus on self-care. It straddles many different cultures and countries, but broadly talks about self-management, the use of self-testing and, importantly, self-awareness, which goes back to one or two of my earlier points.

I welcome the 2019 clinical consensus statement on self-care, which sets out seven recommendations, as touched on by my right hon. Friend the Member for Knowsley. More recently, “Realising the potential: Developing a blueprint for a self-care strategy for England” sets out nine themes.

In the current climate there are huge stresses on the health service and on people’s mental health and, subsequently, their physical health, partly because of covid and partly because of their individual social and economic circumstances. A care strategy must take into account societal movement and those social and economic factors that impinge on people’s health, so that, in helping people to self-care, we must also have a net in place to ensure that that self-care is safe.

[Sir Charles Walker (in the Chair)]

I will call the shadow Minister shortly. There is usually a five-minute limit for the Opposition spokesperson, but as we have quite a long time left, if the hon. Lady would like to speak for longer, she can do so, although she is under no obligation to do that. I am sure the Minister would not mind either.

[The Minister for Health (Edward Argar)]

It is like being back in Committee.

17:15

[Karin Smyth (Bristol South) (Lab)]

Yes, indeed. Having sat opposite the Minister in Committee and when ping-ponging with Lords amendments, I am sure I can dredge up an awful lot to talk about for a very long time, but I will not do that. That would be unfair, although we might have another opportunity to do that tomorrow.

It is a pleasure serve under your chairmanship, Sir Charles, and I congratulate my right hon. Friend the Member for Knowsley (Sir George Howarth) on securing this debate. There are not many hon. Members here, but that belies the fact that this subject is of interest to an awful lot of people. As my hon. Friend the Member for Bootle (Peter Dowd) outlined, it covers not only physical health but mental health, and deserves time to be discussed.

As my right hon. Friend the Member for Knowsley said, self-care refers to long-term conditions and preventive health measures. It is an important component for healthy living. We all need to be clear that self-care is not passing responsibility that should be with professionals to the individual, or that we are using self-care to prop up our increasingly underfunded health and social care systems. We need to look at self-care in a positive sense, as has been discussed, as empowering people and patients to know and understand their own bodies and their own physical and mental health, but also to know how to manage the many things that life throws at us all along the way, and to do that from a young age.

Self-care is about lifestyle choices, but also about better awareness of symptoms and when it is important to seek professional advice. Our professional systems should be set up with that in mind, starting with empowering people and not telling them all the time what they should be doing or expecting them to be at the end of a professional opinion. There are many examples, but with cancer symptoms, early diagnosis is crucial and we know that can be a matter of life and death. We also need to understand when an ailment can be treated by someone themselves, and when to do that, or by talking to community pharmacists, as has been mentioned and which I will say more about as I go on.

My right hon. Friend the Member for Knowsley talked eloquently and from experience about diabetes, which is an important area. We know how many people have diabetes, what a huge area it is for the health service and how important education and self-management strategies are for people with diabetes. Before the pandemic, I worked a lot with Diabetes UK in my constituency and across Bristol, as I did in my previous life as a health service manager, to support those important local groups of people coming together. Those groups support individuals, share professional information and empower people very well. We all look forward to the results of my right hon. Friend’s work with the right hon. Member for Maidenhead (Mrs May). We wish them well and offer our support for that work in any way we can.

My area, like many other constituencies, has high levels of health inequality. I recognise the importance of improving health literacy as a way of supporting people to help them tackle some of those health inequalities themselves.

As the Minister would expect me to say, after a decade of Tory mismanagement of the NHS, with long waiting lists before the pandemic and staff shortages, record numbers of people are waiting for care. Self-care is essential for the future sustainability of the NHS. Through empowering people to take control of minor ailments, we can focus NHS resources on those who need them most.

[Peter Dowd]

Does my hon. Friend agree that organisations such as those in the voluntary, community and faith sector have been absolutely fantastic in supporting people over the last two years and have enabled them to self-care as part of their healthy lifestyle, at a time when the NHS has been under huge stress?

[Karin Smyth]

I absolutely agree. The pandemic has been a terrible time for most of us, but it has provided the opportunity to look at, and to trial in real time, different ways of working with and helping people. A lot of third-sector organisations have been able to use technology, particularly in rural areas, so that people no longer have to travel to centres if they do not want to. Such organisations have been supporting people to use more online communication methods, and people have been coming together in more localised settings and been supported in a different way.

From my many years in the health service, I know that getting online appointments organised and, as the hon. Gentleman has heard me say before, managing things—for example, dermatology—using online services was a really hard task. We have now gone through that process and need to learn the lessons from the pandemic. It is a unique opportunity to promote self-care as an essential part of healthy living. We have heard from my right hon. Friend the Member for Knowsley about the numbers involved. People are keen to take this opportunity to promote self-care and improve our understanding of, and confidence in, our own health, so that people can access the right service at the right time, and we ensure that our highly professional health service and specialist services are well used.

I would like to mention local pharmacies in my constituency of Bristol South. Bedminster pharmacy has been commended several times—it has the most commended pharmacy team in the United Kingdom—by national awards. I echo the points that have been made about pharmacies, which are often overlooked by other professional organisations. Some primary care services in different parts of the country are better than others at working together across the piece. I certainly hope that is a feature of the new integrated care systems, which have a huge opportunity to support pharmacies properly so that they can do their day-to-day work.

[Sir George Howarth]

My hon. Friend makes a good point about community pharmacies and the potential they offer. Does she agree that in the past the potential of community pharmacies has been underused, just as the capacity of GP and A&E services has been overused? It is not just about sloughing off the responsibility to somebody else; it is a matter of using the expertise that already exists.

[Karin Smyth]

Absolutely. I refer back to one of my favourite pieces of legislation, the Health and Social Care Act 2012; one of the many terrible things that that Act did was to demote the role of pharmacists in local communities and affect the support they were given by primary care trusts. In my area, we had a huge team supporting pharmacies who were very much part of that local community offer. I hope that the integrated care systems recognise that that was a mistake. We have lost a decade and really should be working much more closely together. Pharmacies exist in most areas and are easy for local people to access. They can give people confidence to look after themselves and the literacy that I mentioned.

It is vital that people receive a consistent message about self-care when they look at NHS services online, call 111, or visit a GP or local pharmacist, and that requires local systems to work together. A national self-care strategy would help to embed consistency across the country. As has been mentioned, self-care is a continuum that covers adopting healthy lifestyle choices and managing long-term health conditions, be they mental or physical. We must ensure that health literacy and targeted actions to tackle health inequalities take account of the systemic barriers in place for many people who wish to live a healthier lifestyle, particularly given the rising cost of living. I look forward to hearing from the Minister about how the Government’s upcoming White Paper on health inequalities will consider the issue.

We need to remember that self-care is for everyone at all stages of life. Educating children through programmes in school is an important part of that. As I said earlier, the confidence to manage our own health with appropriate support is as important for someone in a care home as it is for a parent looking after a new baby or for children growing up, particularly those growing up with long-term conditions.

Empowering and enabling us all to take charge of our health, be that through using digital interventions, improving health literacy or providing greater support for self-care, is important not only for the long-term sustainability of the health and care service, but for patients. We must ensure that the system does not inadvertently disempower people or result in gaps in the care pathway. I very much look forward to hearing the Minister’s thoughts on this.

[Sir Charles Walker (in the Chair)]

Minister, you have been seeing rather a lot of the right hon. Member for Maidenhead (Mrs May) recently, so no doubt you are looking forward to your next meeting with her.

17:25

[The Minister for Health (Edward Argar)]

It is always a pleasure to serve under your chairmanship, Sir Charles, and a particular pleasure to serve opposite the hon. Member for Bristol South (Karin Smyth), the shadow Minister. We spent many happy days in Committee on the Health and Care Bill, even if we were not in full agreement. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), within whose portfolio this would normally sit, has just been answering a debate in the Chamber, which is why I am responding to this debate.

I will endeavour to do justice to the very important points that the right hon. Member for Knowsley (Sir George Howarth) raised in his speech. I will do something, which, even within my own portfolio, would cause my officials to wince—and I suspect that the same may happen given that this falls within somebody else’s portfolio—which is that, notwithstanding the wonderfully well written notes that my officials have provided me with, I may well say what I think on this subject and respond to the specific points that have been raised in the course of this debate. This could be career limiting, but we will see.

The right hon. Member made a powerful speech. Essentially, the way in which he illustrated through the prism of a particular condition of diabetes a number of the points that could be applied more broadly across the spectrum of self-care was particularly helpful to hon. Members. Although we may not have a huge quantity of hon. Members in this Chamber today, what we do have is quality, judging by the contributions that we have heard.

The right hon. Member is absolutely right, as is the shadow Minister, that, in talking about self-care, we must be very clear that we do not see it as an alternative—an either/or—to medically qualified support or other forms of support. The two parts of the system should work hand in hand. Indeed, I see it as a continuum. I have seen the work done by PAGB, the Self-Care Forum and others on that self-care continuum. We start at one end with education, which I will turn to in a moment. The pure end of self-care is around diet, daily calorie intake, and the simple lifestyle changes that can make a big difference to our own health and the risk of our contracting illnesses or diseases. Those lifestyle and dietary factors may not be for everyone given the nature of particular conditions, but, by and large, are within the control of the vast majority of us.

At the other end of that continuum, we have things such as major trauma, or treatment for illnesses such as cancer or cardiac conditions where medical care, and often hospital-based care is essential. Then there is that space in the middle around self-treatable conditions. There are the minor ailments where people might be able to self-care, but where, as the hon. Member for Bristol South put it very well, some might need some confidence or advice to be able to do so.

There is also the management of acute conditions and long-term conditions, which, I suspect, will entail a degree of professionally qualified medical care, but, equally, a degree of self-care based on that advice as well. We have that spectrum—that continuum—and it is important that we view it in that way. The ability to turn to the right type of support at the right time is crucial to maximising the benefits and opportunities for individuals in self-care.

Through the pandemic, we have seen the opportunities to innovate. They were opportunities forced on us by the circumstances in a dreadful situation, but, none the less, there have been ideas and innovations that have come out of that pandemic. We have seen also the consequences of demand within our healthcare system, particularly at GP practices, at accident and emergency, and at urgent treatment centres. Notwithstanding the record investment by this Government in our NHS, and notwithstanding the record numbers of staff in the NHS, we do see pressures. An effective and proportionate self-care approach that people feel confident in can play a key part in helping to manage the pressures, where people go to the most appropriate point to be treated.

Empowerment is key—people understanding and being educated in their choices and the implications of their choices, through public health messaging. There is a telling statistic, although it may be a little out of date—I was discussing this with some officials earlier this week: 43% of the population do not feel fully confident in understanding health information conveyed in words. The figure leaps to 61% of people who do not feel fully confident in understanding information about their own health and their choices when the information contains words and numbers. That signifies that there is a lot more work for us to do.

[Sir George Howarth]

I am encouraged by the first part of the Minister’s speech that he gets this, as I was by the response of my hon. Friend the Member for Bristol South (Karin Smyth) on the Front Bench. The Minister is right that people who have long-term conditions—or, for that matter, the general population—need to understand better what they can do for themselves. It is not always obvious to people what they can do. It is also important—I referred to the recommendations—that medical practitioners understand these issues in their initial training and that they are kept up to date on the potential. Otherwise, people are operating in a fog, without understanding the potential. I am sure the Minister will agree that those things are important.

[Edward Argar]

I entirely agree that for health professionals, having up-to-date and refreshed knowledge is hugely important. In my current role and my previous role at the Ministry of Justice, I have looked at this point when considering domestic abuse and domestic violence. GP practice staff are often the first people to get an indication that something is wrong—not necessarily because a patient presents saying so, but because of the nature of their injuries or what they present with. Up-to-date knowledge across a range of areas is hugely important.

The hon. Member for Bristol South is right that education cannot start too early for forming good habits, and that, through school and beyond, it is important to educate people about the choices they make and the impact of those choices. That is not the so-called nanny state; it is about people being given the information to make an informed and educated choice for themselves and the benefit of their health. Another key element is confidence. People need information, but they also need to be confident to take a decision on that basis and to know where to go if they are not sure. I will turn to community pharmacies in a moment.

There are two other broad points to highlight—mental and emotional health—which the hon. Member for Bootle (Peter Dowd) quite rightly highlighted. I hope that all of us in this place agree, and that it is understood more broadly in society, that we cannot look at physical health in isolation. All elements interact with and impact on each other. We need to be fully cognisant of that and of the broader determinants of health and health inequalities, be they social, economic or health factors. There are a whole range of impacts on individuals and their overall health.

We need to ensure that people have access not only to information, but to the technology and kit to be able to manage their condition. During the pandemic, virtual wards have become more prevalent. For example, there are pieces of kit that monitor oxygen levels in blood and report back to the GP to give an early indication. That is just one example of how technology can assist, and it expanded rapidly of necessity.

I will turn to the recommendations in the report, speak a little about community pharmacies, which have quite rightly been highlighted, and then turn to the request of the right hon. Member for Knowsley for a meeting—always an easy point to respond to when one is not the Minister responsible. It is always nice to be able to commit other colleagues to meetings, but I will also address the issues in my own right.

I hear what the right hon. Member for Knowsley says about the need for a specific strategy, but I would sound a slight note of caution. It is often the case that the first call in a particular area of policy is, “We need a strategy around this”, and I am slightly cautious about having a multiplicity of strategies without bringing together a whole range of actions. That may be a point that the right hon. Gentleman wishes to raise with my hon. Friend the Member for Lewes, who I will commit to meeting him in a moment.

On that specific recommendation, self-care is an integral part of the NHS long-term plan, which we are looking at at the moment in the light of the experiences and impacts of covid, and the community pharmacy contractual framework—the five-year deal running to 2024. For that reason, I merely sound a note of caution about an additional national strategy, because over the past two and a half—almost three—years, what I have often seen in the Department of Health is a strategy for a particular issue or area of care that does not always interact with other elements of the system or take into account just how complex that landscape is. The right hon. Member for Knowsley is aware of that point from his many years in this House, but I merely sound a slight note of caution.

[Peter Dowd]

The Minister is making an important point. However, I am sure he also recognises that there are already lots of things out there in the care continuum he spoke about: the health literacy toolkit, the e-learning programme on health literacy from Health Education England, the health literacy support hub, guidance on physical health and mental wellbeing in schools, the community pharmacy contractual framework to which he referred, modules on self-care for minor ailments and successful self-care, and so on. Part of a strategy, if that is what we want to call it, is trying to bring all those things together. On top of that, does the Minister agree that in the plan, so to speak—the “Realising the Potential” document—there is a reference to how

“There should be a cultural shift among healthcare professionals, towards wellbeing and away from the biomedical model of care”?

It is about trying to fit those things together in a coherent strategy, if that is what we want to call it.

[Edward Argar]

The hon. Gentleman is seeking to find a way through some of these points in his typically dexterous way. Suggesting “a strategy, if that is what we want to call it”, leaves open the option for my hon. Friend the Member for Lewes to consider other ways in which the same thing might be achieved. I do not want to prejudge the conclusion that she will come to, but I will ensure that she receives a transcript of this debate.

[Sir George Howarth]

I hear what the Minister says. To be honest, I am not overly fussed about what we call it. My concern is that the Government—and, for that matter, the rest of us—are able to draw on the experience of patients, clinicians, and all those in the healthcare system to examine how we can do things better. If the Minister wants to call it something else, I am not here to have a row with him about that; I am here to try to make some progress.

[Edward Argar]

I am grateful to the right hon. Gentleman for that typically courteous intervention. A lot of what we are seeking to do in this area comes back to the refresh of the NHS long-term plan, which will have to happen in the context of what we have seen during the pandemic. The hon. Member for Bristol South highlighted the health inequalities White Paper, which will come forward in due course. There is a genuine opportunity to use that White Paper to draw a number of these elements together.

I am conscious that the right hon. Member for Knowsley had six other key recommendations, which I will address briefly. I will say a little bit about community pharmacy before I turn to meetings. He raised the issue of building on the successful community pharmacist consultation service, and exploring additional pathways to access that service through the implementation of self-care recommendation prescriptions to support GPs and other professionals to appropriately refer patients to self-care. Rather than taking the issue of community pharmacy separately, I will address it in response to this point, because that is probably the neatest way to do so.

I fully recognise the value of community pharmacy, and the hon. Member for Bristol South also rightly highlighted its importance. My first official engagement when I took on this job in 2019 was to attend, in lieu of the Pharmacy Minister at the time, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), the Pharmacy Business Awards ceremony, which recognised community pharmacies that had done amazing work in their communities, such as the one the hon. Member for Bristol South highlighted.

As constituency Members of Parliament, we all know the depth of expertise and local knowledge that our community pharmacies bring to the communities they serve, and we know just how well regarded they are by our constituents as friendly, accessible sources of advice. Constituents do not have to be there first thing in the morning, and they do not have to make an appointment. They can stroll in and talk to a pharmacist who can give them genuinely helpful advice, without having to wait. I put on record my gratitude, and I suspect that of all hon. Members, to community pharmacies.

We are increasing our potential to expand the Community Pharmacist Consultation Service to urgent treatment centres and A&E departments. It has already taken just shy of 184,000 referrals from GPs, which, as hon. Members have suggested, is of benefit to our general practitioners, who can better manage their workload, given that some people do not need to see a GP. We are promoting the uptake of that service and incentivising its use through the GP contractual arrangements. Negotiations with the PSNC on what community pharmacy will deliver in 2022-23 as part of the five-year deal are ongoing, and hon. Members would not expect me to prejudge those negotiations. As soon as they conclude, we will announce the arrangements so that Members can consider and scrutinise them as they see fit.

The right hon. Member for Knowsley talked about primary care networks. I know the value of primary care networks. My own GP in Leicestershire is actively involved in the PCN. We saw their potential to do amazing things during the pandemic when they supported our communities with the vaccination programme and in a whole range of ways. He is right to highlight their potential to consider ways to improve self-care in their local populations as part of their network development. I hope that the soon-to-be-statutorily-constituted ICSs and ICBs will also take that very seriously, obviously subject to the other place and their deliberations later this evening.

I know from my own GP, who I regularly speak to, that many local health systems are proactively exploring upstream prevention initiatives across the health and care system and looking for further partnership opportunities to support people to improve their overall health and care outcomes. Clinical commissioning groups—soon to be ICSs—and NHSEI regionally also have the option to commission a local minor ailments service in addition to CPCSs. I hope they will explore those options as they go forward—particularly ICSs.

The fourth recommendation was that NHSEI should enable community pharmacists to refer people directly to other healthcare professionals where self-care is not appropriate, enhancing the role of pharmacists as a first port of call for healthcare advice. I entirely agree with that. There is an educational point as well in making people aware that they can go to their pharmacists. Equally, all community pharmacists are required under the terms of service to signpost people to other health and social care providers and support organisations as appropriate. There is, I suspect, more we can do in that space, but I think we have an extraordinary resource there at our disposal. NHSEI is accelerating efforts to enable community pharmacists to populate medical records and give them full integration into operability of IT systems as part of LHCR partnerships and national support for data sharing.

Data and the sharing of data in this space is, as all hon. Members know, a vexed and complicated subject, but when got right, it holds incredible potential for improving health outcomes and care. NHSX is leading the Government’s plans that will see the development of interoperable NHS IT systems that integrate health and care records, while of course considering issues that the hon. Member for Bristol South brought up in Committee when we were discussing similar matters—issues such as patient consent and data security.

We are very clear in our view that community pharmacy must play an enhanced role in the healthcare of our country, and it is our responsibility and NHS England’s responsibility to help support that. The right hon. Member for Knowsley made two final recommendations about meetings. The Government should promote a system-wide approach to improving health literacy, including working with royal colleges to include self-care modules in healthcare professionals’ training curricula and continuous professional development. I touched on that point in my response to his intervention. I have had many helpful and positive meetings with the royal colleges. I seek to meet them regularly—perhaps not as regularly as I would like, given the pressure of business in this place at times—because they have a depth of knowledge that is incomparable and incredibly useful.

Public Health England, when it was around, undertook a programme of work to improve health literacy across the country, and the Office for Health Improvement and Disparities will continue to work on that issue. The pharmacy integration programme will deliver a further almost £16 million-worth of post-registration training. That investment will equip pharmacy teams across primary care so that they are better prepared to support wider integrated healthcare delivery and expand their role in providing clinical care to patients. A pharmacist independent prescriber can provide autonomously for any condition within their clinical competence, with the exception of certain controlled drugs, particularly for the treatment of addiction. To become an independent prescriber, pharmacists must complete additional qualifications, which last typically six months, before they can prescribe.

In 2021, the General Pharmaceutical Council introduced new professional standards for initial education and training to ensure that the next generation of pharmacists is equipped with essential clinical skills. A key theme running through all the contributions today is that, when a resource is used, there can still be an untapped element of it that can be better utilised to provide support, alongside education, self-care and all the things we can do as individuals, to provide confidence and professional expertise.

NHSX should evaluate the use of technologies that have been developed during the covid-19 pandemic, and develop them to cover a wider range of minor ailments to promote self-care and manage demand on the NHS. I alluded to one example that we are working on. The Department is working with NHS Digital and NHS England and Improvement to encourage innovation and enable new approaches and organisations to support services and collaborate effectively.

I hope that, as someone whose policy area this is not, I have addressed at least in outline some of the right hon. Gentleman’s key recommendations. He made specific requests about meetings. I am always wary about that, because I have discovered that when I have meetings with my right hon. Friend the Member for Maidenhead (Mrs May) and you, Sir Charles, I come out having agreed to something or changed the direction of a policy, after being persuaded by both of you. I know that the right hon. Member for Knowsley is equally persuasive. With that in mind, I am happy to ask the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, to arrange to meet the right hon. Gentleman, my right hon. Friend the Member for Maidenhead and you, Sir Charles, to discuss this issue more broadly.

The right hon. Member for Knowsley also asked for a meeting with Diabetes UK and the relevant Minister. I will certainly pass that on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes. In the context of the elective recovery work and my work with the NHS more broadly, I have met a number of charities in the course of developing the elective recovery plan and since we published it. I am always happy to meet charities and other organisations that do so much not only to educate people and campaign on issues, but sometimes to press us in particular directions. They always do so with good intentions and to support people. In that context, I have also met trade unions and other bodies, because I believe that a collaborative approach in this space is useful. I will pass the request on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, but if the right hon. Member for Knowsley feels that this could also fall within the ambit of elective recovery or of my role as Minister sponsoring the NHS long-term plan, I will of course, framed in that way, also be happy to meet Diabetes UK—I have met many charities in recent months.

If that does not provide the right hon. Gentleman with immediate agreement on what he called on the Government to do, I hope it provides him with some reassurance of just how seriously we take this issue and the recognition of just how important self-care is for each of us as individuals, for our constituents, for our healthcare system and indeed for this country. And I am very grateful to him for bringing the matter before the House today.

[Sir Charles Walker (in the Chair)]

I call Sir George to sum up, for no more than two minutes.

17:49

[Sir George Howarth]

Thank you, Sir Charles, for calling me to sum up.

First, I thank everybody who has taken part in this debate: my hon. Friend the Member for Bootle (Peter Dowd), the hon. Member for Glasgow Central (Alison Thewliss), my hon. Friend the Member for Bristol South (Karin Smyth), who is the shadow Minister, and the Minister himself. As I had hoped it would be, it has been a constructive debate. Although the Minister did not quite go as far as agreeing with me on every single point that I made, he showed a degree of understanding and presented what he had to say as constructively as everybody else’s contribution was. He was unfailingly polite, although I have learned through bitter experience that Ministers can be unfailingly polite and then go away and forget all about the matter that has just been discussed. However, I am sure that will not be the case now.

I am grateful and I see this debate not as the end of a process but as its beginning, and I am pleased that the Minister has nodded in agreement with that comment. And believe me, we will take up his offer of various meetings to progress these matters, including with your good self, Sir Charles.

[Sir Charles Walker (in the Chair)]

Well, that debate was a pleasure to chair; it really was.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of a national strategy for self-care.

17:51

Sitting adjourned.