National Strategy for Self-Care

Edward Argar Excerpts

Tuesday 26th April 2022 Westminster Hall

[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 ---

[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.