Self Care Week

David Mowat Excerpts

Tuesday 22nd November 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

First, I congratulate the right hon. Member for Rother Valley (Sir Kevin Barron) both on leading the charge on this issue and on his work in the APPG. This has been a shortish debate, but there were very good speeches from all hon. Members. In fact, I agreed with much if not all of the speech given by the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and I will come on to that.

The right hon. Member for Rother Valley rightly talked about the impact that self-care needs to have on demand in the health service. He used a very important phrase that is spot on: in the course of his remarks, he asked why we are not doing more to try to shape the NHS around long-term conditions, given that, as he rightly said, some 70% to 80% of total NHS expenditure relates to long-term conditions, such as diabetes, chronic pain and dementia. As he also rightly said, increased longevity means that more and more people are living with more and more of those conditions. We need to deal with long-term conditions—this relates to a point made by the hon. Member for Linlithgow and East Falkirk (Martyn Day)—on a preventive basis, on a care plan basis, and not necessarily on an ad hoc, repair basis; I think that was the word that he used. Those points are spot on and are why we need to continue to do better in the whole area of self-care.

It is worth reflecting on why, in many ways, the moment for self-care has arrived. The Self Care Forum has been doing a lot of work in this area for a number of years, but I think that there are several reasons why self-care is particularly critical at the moment. One is demography. We are getting older. That is a good thing, but the consequence is that about 1 million more people aged over 75 will be around in 2025. We will have more long-term conditions. That is just a natural feature of ageing. Those long-term conditions are precisely where self-care gives us the biggest bang for our buck, because there is absolutely no need to continue going to see the GP all the time. People have talked about pharmacies, and I will talk about that.

Another reason is that there is a general perception in the population that people are more empowered vis-à-vis their own health and what they will accept from health professionals. We often hear of people saying, “Well, it’s not a question any more of the doctor telling me what I should do, but of having a discussion with the doctor about that.” Where that takes us to, in terms of our expectations of the health service, is a whole load of things around choice and, in particular, personalisation. Self-care also has a role to play in that. Part of it is about not just clinical outcomes, which is where we have come from historically, but out-turns that consider the general wellbeing of an individual.

The right hon. Member for Rother Valley made the point about social prescribing as a big part of that, and it absolutely is. Increasingly, it is important not just that patients with diabetes manage glucose levels and all that goes with that, but that they exercise. It might be just as appropriate for them to be referred to a football team or to talk to someone else with diabetes, in a mentor group. Frankly, social prescribing needs to be commissioned by CCGs as much as some of the clinical things that have happened in the past.

Another area that has made self-care even more prominent, and which is a component of it, is technology. We have not talked yet about technology, but there is a lot more out there. It ranges from people just being able to look at Google, see what is wrong with them and take a view—that can be dangerous and is not always to be recommended, but nevertheless it empowers people in a way that did not exist at one time—to some 900,000 applications to do with health and fitness that have been developed. I believe that iTunes alone has 47,000 health apps. People who are interested in all that stuff—and possibly more IT literate than I am—can use all those, and they do. The combination of those things has meant that the whole ethos of “Doctor knows best” is giving way to much more of a dialogue and a care plan orientation, and a big part of that care plan will be self-care.

What is the Government’s response? That is the challenge that we received from the hon. Member for Washington and Sunderland West. I suppose there are two areas. There is the whole general area of public health. I will not get into a discussion about the relative size of budgets and all the rest of it, other than to say that the Opposition’s position on where we should spend more money versus less money in the health service and anywhere else would be stronger if occasionally they agreed that in some areas it is right to spend less in order to spend more in other areas. If their position is that we must always spend more money on everything, their comments may be taken by Ministers with a bit more of a pinch of salt. I merely say that in passing.

In terms of awareness and education, the right hon. Member for Rother Valley made a good point, which I had not thought of, about health education in schools being a step up from other types of education. There does need to be more awareness, and I will mention a small thing that I became aware of recently. One of my responsibilities is dementia, and I had not realised that obesity is a major factor in someone’s likelihood of getting dementia. I know that now, and perhaps everyone else in the Chamber also knows it, but I suspect that many people do not; I do not think why obesity and dementia go together is that intuitive. That is an example of the need for awareness.

Let me talk about the sorts of things that the Government need to encourage and are encouraging. We have a campaign on stopping smoking—Stoptober. We have “Everybody Active, Every Day” and Change4Life, which involve people taking control of their diet and how they live. I talked about dementia, and there is the dementia friends initiative. There are some 1.7 million dementia friends now. Dementia has become the condition that most people die of in the UK, and dealing with that will be a real challenge in the years ahead.

That is about public health, but we have a whole stack of things to do with clinical outcomes. We have put into the NHS mandate a clear requirement for it to improve its response to long-term conditions, with a clear requirement for self-care to be part of that. That includes the need for more personal health budgets. Some 4,000 people now have a personal health budget; those budgets are analogous to personal care budgets. Our target for 2020 is between 50,000 and 100,000 people having such budgets. That is about choice and about control. Various tools are available for patient activation and to help patients understand the sorts of choices they can make day to day. NHS England has a target of 1.8 million people accessing tools, as well as being assessed on where they see themselves on the self-care spectrum and what they are doing about it.

It is worth talking briefly about the STP process. The shadow Minister made the point that we spend too much on acute healthcare in this country and not enough on primary care, on mental health and on the self-care options that we are talking about, including pharmacy, which I will talk about. The STP process is a precise attempt to make self-care happen in a structured bottom-up way. If the Opposition oppose the STP process at every turn, as opposed to acting as critical friends, which is how all MPs should act, they oppose what could be some very sensible, thought through and locally driven reforms to healthcare that may well result in higher budgets for prevention, which is a point that she made, and a tilt away from our spending so much of our budgets on secondary care and hospitals, which are very expensive.

NHS England has produced a book about self-care that was printed last week. “Realising the value” is about empowering people to make their own decisions about medicine and care and engaging in the community. There is a lot in the book, which was produced by Nesta, that is valuable and good. I guess it is an attempt to embed some of the things that we have been talking about. National Voices, the Health Foundation and voluntary organisations were involved in it.

Social prescribing is a large part of the initiative, which is about peer groups and making sure that people who have a diabetes issue are not overwhelmed by concerns about losing a limb and about glucose levels changing. It is about managing all of those types of things and ensuring people look at their own diet and at whether they are doing enough exercise or sport and are in a group of like-minded people with the same issues. If I were diagnosed with diabetes, it would be valuable to me to talk to people who had had it for a few years. That is as valuable as going to see the doctor and his telling me what I should be doing.

The right hon. Member for Rother Valley made the point that roll-out is patchy. In truth, many things are patchy. All we can do in the centre is try to encourage CCGs to consider the advantages of what they have in terms of their own business case: a reduction in the number of visits to GPs and so on.

On the role of pharmacy, the hon. Member for Linlithgow and East Falkirk rightly said that I was on record as saying that we have something to learn from where Scotland is in pharmacy. I will say it again: I think we have. We are doing our own review in England—the Murray review—of the services we want to see in pharmacies over the next few years. I have absolutely no hesitation or compunction in saying we could learn from Scotland. I do not take a “not invented here” view. A phrase I always used at work was “steal with pride”. If there are bits in the Scottish model that we can take and steal, we will.

On the direction of travel, the right hon. Member for Rother Valley chairs the APPG and he knows my view is that we need to move pharmacies away from predominantly dispensing and being paid for dispensing into a model with many more services in it. That is what we are determined to do. As we go through the process, that is what we will do. A fund of £300 million between now and 2020 has been set up. There is a lot of opportunity, and the hon. Member for Linlithgow and East Falkirk gave us some examples. We have announced two things already: the urgent medicine supply service and NHS 111. If someone is out of medicine, particularly if they have a long-term condition and have not had their prescription revalidated, NHS 111 has historically told them to go and see an out-of-hours GP or even an A&E service in order to meet a doctor to get the problem sorted. We are changing the script so that 200,000 calls a year will be directed to pharmacies, which will be empowered to make a judgment about the patient and will write the prescription and dispense the medicine. That is a big change and that is exactly where we need to go.

We heard from the hon. Member for Linlithgow and East Falkirk about the national minor ailments scheme. In England, we are now committed to rolling that out nationally by April 2018 so that the list of minor ailments that the hon. Member for Linlithgow and East Falkirk talked about will be treated in pharmacies in England. The pharmacist will be paid separately for the consultation and any dispensing that comes from it.

Another service-based activity in pharmacies was announced two weeks ago by Simon Stevens: the sore throat pilot. Pharmacists can do a test to determine whether someone’s sore throat is a bacterial or a viral issue. If it is bacterial, they will send someone to a doctor so that they can have antibiotics prescribed. If it is viral, they will not. As that service is rolled out nationally, it will save 800,000 GP consultations a year, but this all also relies on awareness and all that goes with that.

Diabetes self-care is a big area on which we can make progress. Diabetes is a growing problem and people will benefit greatly from individual care plans and social prescribing. We have changed the GP contract so that when GPs identify type 1 or type 2 diabetes, they put the person on a structured education course. GPs are now being paid for the numbers of people they get on to such courses. A big part of those education courses is explaining better to people how they can self-care.

I was going to talk about technology—I have probably spoken for long enough, but perhaps I will deal with some of the various points that were made. The right hon. Member for Rother Valley asked about the personal allowance in care homes, which he is right to say was not uprated. I will get back to him on the rationale for that. I suspect the reason is, as we know, that the care sector is under financial pressure. However, the money was not cut, but went to the rest of the adult social care budget. A judgment has to be made about what is adequate and where money is best spent, but I will write to him with a fuller answer to his question.

The right hon. Member for Rother Valley also talked about the need for a national strategy on self-care. I have been a Minister for about four months now. My general learning point would be that we need fewer strategies and more implementable plans, and I suspect the right hon. Gentleman would agree. We need to do things, and there are some things that are quite sensible. I have talked about some of them, but they need to happen. We need to go further and faster.

I agreed with much of what the hon. Member for Washington and Sunderland West said. She talked about a wholesale rethink, which is what we are trying to do with the STP process. The Opposition would do well to not necessarily oppose every part of that, but to act as critical friends, as all MPs must. She made good points about making every contact count. She talked a lot about common sense, which I completely agree with. I guess she will not be surprised to know that I am not going to talk to her about the autumn statement; all I will say on money is that the UK now spends more on health as a proportion of GDP than the OECD average. It is about one percentage point less than France and Germany; that is about where we are, and it is clearly critical that we look properly at every area of expenditure and maximise its value. I believe we did so with pharmacy, and we are trying to do it with the STPs, as regards the difference between secondary care and primary care.

The hon. Member for Linlithgow and East Falkirk made the point that in the thrust towards self-care—which is right—we must still be careful to say that people sometimes need to see a doctor. Sometimes there is something serious wrong. Too many people go to the doctor too often with trivial things; but on the other hand people do not always know when they have the initial symptom of something serious—it can be something that looks benign, or a lump or something. It is important to understand that GPs are there to look after such things. We need to be aware of that in the drive towards self-care. I thank the hon. Members who spoke in the debate.