National Strategy for Self-Care

Charles Walker Excerpts

Tuesday 26th April 2022 Westminster Hall

[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.

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

[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.