National Strategy for Self-Care

Debate between Karin Smyth and Peter Dowd

Tuesday 26th April 2022 Westminster Hall

[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?

Elective Surgical Operations: Waiting Lists

Debate between Karin Smyth and Peter Dowd

Tuesday 20th April 2021 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered waiting lists for elective surgical operations.

It is a pleasure to see you in the Chair, Ms McVey. Covid-19 has had a “calamitous impact” on patient access to surgical care. That is the view of the Royal College of Surgeons of England and it is what I want to focus on today. The Government need to receive that a message loud and clear. It is a message that needs to be repeated time and again, that cannot and should not be ignored, and that resonates with millions of people. I look forward to the response from the Minister, who I know takes this matter seriously.

The Government are not responsible for covid, but it is the Government’s responsibility to mitigate its effects through a variety of interventions. The question is whether they have fulfilled that responsibility. I imagine that the independent public inquiry will help us pin down that particular question. Let us hope that, as and when it happens, it is independent and full. The Royal College of Surgeons represents about 30,000 members in the UK and worldwide and, in this respect, it has a pretty good insight into the current calamitous situation facing millions of people, as it puts it.

I am sure it will be helpful if I contextualise the current situation facing patients. The most recent waiting time statistics published by NHS England on 15 April 2021 are worrying, but if taken with the hidden statistics, the position becomes almost overwhelming in magnitude. That is the challenge for the NHS, the Department of Health and Social Care, NHS England and, of course, for the Government’s commitment to ensure that the NHS gets all the resources it needs, as promised by the Prime Minister. I know that trusts and clinical commissioning groups, as well as NHS England, Public Health England, the Department of Health and Social Care and other NHS-related bodies have worked hard over the past year to ensure that services are being delivered as best they can, notwithstanding the unprecedented circumstances. My reason for initiating this debate is to highlight issues of concern. It is a challenge for us all.

What do the statistics say? A record 4.7 million patients were waiting for hospital treatment in February 2021. There were nearly 400,000 patients waiting for more than a year, which compares with just 1,643 people waiting for more than a year in February 2020. That is a significant rise, if ever there was one. Only 64.5% of patients waiting for hospital treatment were treated within 18 weeks in February against the Government’s target of 92%, which was last achieved five years ago. In total, 387,885 people are now waiting for more than 18 weeks. Those patients are our constituents. Each and every one of us will have numerous patients or would-be patients affected by this dire situation.

In my clinical commissioning group area, which covers my constituency and that of my hon. Friend the Member for Sefton Central (Bill Esterson), there were 1,374 people who had been waiting a year or more to be seen in February, compared with eight in April last year. It is a huge increase. All specialities are affected, but notable ones are ophthalmology, trauma and orthopaedics. It is important to note that what is not included is the impact on overdue follow-up activity and routine surveillance outside referral treatment.

We cannot overestimate the strains and stresses that such waiting puts on patients and their families, who do not know whether they will get the operation that is needed, or when it will happen. That point about what the situation means for patients was clearly made by the Royal College of Surgeons. There is a breakdown from NHS England, by specialty, which illustrates the situation that we and, more importantly, millions of our constituents face. In the trauma and orthopaedics surgical specialty that I have mentioned, more than 600,000 people are waiting, including 288,000 who have been waiting for 18 weeks or more and 84,000 who have been waiting a year for treatment. The percentage treated within 18 weeks, compared with the 92% target, is 52%. The figures are much the same for general surgery: 394,000 people waiting, with 60% treated within 18 weeks. I will not go through all the figures—I think hon. Members get the gist.

Such waits affect people in a variety of ways, mentally and physically. There is the obvious issue of pain that can be persistent, draining and debilitating for month after month. Also, of course, there are psychological effects such as distress or worry about deterioration in health, and concerns about the impact on a person’s employment status and the financial costs that might follow from the loss of a job, and subsequent loss of income. Of course, there will be an impact on family members or carers, who in turn have to cope or deal with the impact on the patient. There is the worry that an extended wait for surgery will bring more risks of deterioration in the patient’s condition. In certain situations the patient might need more complex surgery later. Moreover, there is always the concern that in certain circumstances a patient might die while waiting for an operation or other intervention. Those are serious, substantive and worrying issues that we, and particularly patients, must all face.

The parlous state of pre-covid waiting lists has made the covid situation worse, but it is not just a question of the impact of covid on lists. There is also the matter of underlying issues faced by the NHS, which covid has greatly exacerbated. In November 2020, making a comparison with 2019, the Health Foundation estimated that there were 4.7 million “missing patients”, as it calls them, who have not been referred for treatment. In other words, if 75% of those patients were included, the waiting list could grow to 9.7 million in 2023-24. That simply reaffirms the point that I made earlier about the need to plan now.

Many people have not referred themselves during covid to their GP. Getting a slot has often been challenging, to say the least. That element could become a significant factor in relation to cancer surgery: it has been estimated that the number of patients with suspected cancer referrals fell by 350,000 compared with the same period two years ago. That point was made not only by the Royal College of Surgeons but by other health-related organisations. The Royal College of Surgeons is not an outlier, and if the Government do not recognise the calamitous situation that patients now face, they will be ill-equipped to resolve it. I do not suggest that they are in danger of putting their head in the sand; but they are, if they are not careful, in danger of underestimating the scale of the crisis facing the country.

[Karin Smyth (Bristol South) (Lab)]

I take my hon. Friend’s point about the Government not putting their head in the sand, but I think he referred to the need to plan. Is the real issue that while perhaps they are not putting their head in the sand they need to demonstrate that they are starting to plan right now?

[Peter Dowd]

That is a fair point, and I will touch on it later. I know that the Minister is well aware of the situation and has his own challenges in getting the point home to his colleagues in the Treasury, among others. We will give him the support that he needs when he has those conversations.

In terms of support to weather this crisis, the Government cannot put the brakes on this vital area of public expenditure. Given the figures I have outlined, it is better to pre-empt this tsunami, because once it comes, it will be all the more damaging. Putting it right after the fact will be more expensive, more difficult and lives will be in danger, not to mention the ongoing economic impacts for the nation. If we have learnt anything from the covid-19 crisis, it is the point made by my hon. Friend the Member for Bristol South (Karin Smyth) that assessment and planning, followed by focused, comprehensive action, are required.

I have set out the issues as many in the health field have them set out. They are not my figures, they are not made up, they are in the public domain. The Minister knows the organisations concerned, as do hon. Members, so I will not list them.

I have attempted to be as concise and factual as possible and to set the scene, but there is a second element: how the issue can be tackled. The rest of my time will be spent on that. Again, this is not me making this up—is is not the hon. Member for Bootle’s version. It is, in a sense, the health organisations’ view. In this respect, the Royal College of Surgeons has set out a clear way in a comprehensive fashion. Other royal colleges and health organisations have expressed their views too. I have no doubt that the Minister will listen to those voices, which will be helpful and constructive. However, they are also unambiguous in their view of the need for the Government to act now with specific proposals that go beyond a balance-sheet approach. I believe the time for details and proposals is fast approaching.

I want to highlight four recommendations. The first is increasing NHS bed capacity. For many years in the run-up to the pandemic, the NHS was far too close to capacity. It was running hot, to use that phrase. International comparisons, which I acknowledge do not tell the full story, but do give a partial story, show that the UK has 2.5 hospital beds per 1,000 people, which is well below the OECD average of 4.7, and behind countries such as Turkey, Slovenia and Estonia. Remember, beds have been reduced from 108,000 in 2010-11 to 95,000 in 2021.

Secondly, during the pandemic the Royal College of Surgeons of England called for the setting up of green or covid-light sites with a separation of elective surgery from emergency admissions. As the college says, there is, “evidence of the risks to patients if covid-19 is contracted during or after surgery, including a greater risk of mortality and pulmonary complications”. In this regard, covid-light sites are critical to process ongoing planned surgery, given that patients and staff are segregated from situations where those who have the virus are treated. In addition, there is a regime whereby patients self-isolate and test negative before any surgical intervention is in operation. Meanwhile, staff without symptoms are regularly tested.

The third recommendation is for surgical hubs. During the pandemic, professionals have worked in partnership to provide mutual aid during periods of intense pressure, thereby enabling a seamless process of surgical intervention. Because of the multi-agency, multidisciplinary co-operation, trusts have also been able to designate certain hospitals as surgical hubs. As such, a capacity for particular types of elective procedures has been facilitated through skills and resources coming together in one place in covid-secure environments. While this hub model, as it is called, is not a total solution, it is none the less a practical way to enable many geographies and surgical specialities such as orthopaedics and cancer to work together.

The fourth recommendation is support for patients, and I touched on that earlier. Again, the Royal College of Surgeons has welcomed the prioritisation of patients in NHS England’s 2021-22 priorities and operational planning guidance. None the less, I agree that we need to go further and provide more guidance about how to develop and expand the options to address those waiting longest, and to ensure that health inequalities are tackled throughout the plan.

In my view, there should also be cross-departmental work on more comprehensive support for those directly affected by covid isolation requirements and people whose livelihood is threatened by longer waiting lists. Before I go on to summarise the four recommendations I have just put to Members, I emphasise that I am aware, and appreciate, that NHS England and NHS Improvement have been working on an elective recovery frame- work covering workforce logistics, clinical prioritisation, patient focus reviews, waiting list validation and patient communication. I welcome that, as will other hon. Members. I acknowledge that the NHS has completed almost 2 million operations and other elective care in January and February this year, and non-urgent surgery times have begun to recover.

In summary, there are four recommendations arising out of the narrative. Recommendation one: the Government should urgently invest in increasing bed and critical care bed capacity across England. Recommendation two: the Government should consolidate covid-light sites in every integrated care system region, and ensure that at least one NHS hospital acts as a covid-light site in each integrated care system in England. Recommendation three: the Government should widen adoption of the surgical hub model across all English regions for appropriate specialities, such as orthopaedics and cancer. Recommendation four: all integrated care systems should urgently consider what measures can be put in place as soon as it is practical to support patients facing long waits for surgery. I would like to put on record my thanks to the Royal College of Surgeons for its advice, information and support in relation to this matter.

Finally, the whole question of workforce-related issues—numbers, pay, conditions at work—needs a comprehensive, fair, equitable and inclusive review. The Secretary of State can initiate a wholesale review of organisational structures in the NHS in the middle of this crisis, which is causing angst and concern across the NHS—we cannot pretend that is not happening. He can therefore initiate a review of the terms that I have suggested.

Many lessons need to be learned from this crisis. I stress the value, commitment and professionalism of all staff in the NHS. Staff across all professions, disciplines and sectors are feeling drained after a year of hard, unrelenting work and we need to thank them for that. Without them, in particular, this country would be in an even worse social and economic predicament than it already is. We owe it to them to ensure that they get all the support they need to support the rest of us. Who could disagree with that?

Cities and Local Government Devolution Bill [Lords]

Debate between Karin Smyth and Peter Dowd

Wednesday 14th October 2015 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

As a former leader of a metropolitan council, I welcome devolvement and the powers it brings, in my case to a city region. The reality is that the genie is out of the lamp and cannot be put back in—and nor should it be. This is not a question of if, but when and how, and no one is being forced to take part. As for the question of transparency and negotiation, it does not take Sherlock Holmes to work out what those powers might be, and I will touch on them later.

There are of course concerns, but they must not be allowed to cause delay and there must not be further prevarication. It is not as though these powers and responsibilities do not already exist. They do exist, but usually in the hands of civil servants and even on occasion in the hands of Ministers. Devolution allows for local decision making at a sub-regional level on issues of importance to the future of the areas concerned. There is the question of the election of a city regional mayor in my area.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend’s experience is very valuable in this matter. Bristol is the only core city to support an elected mayor. Does he agree that the citizens of Bristol deserve the right to reverse that decision at any point and that the Lords amendments to this Bill offering Bristolians that opportunity are to be welcomed?

[Peter Dowd]

I take the view that local areas should have the widest ability to make their decisions, and if Bristol wants that, that is a matter for Bristol to pursue. My personal view is that I would rather have a local decision maker in the form of a metro mayor than a decision maker 200 miles down the M6 in an office not many yards away from here. I would prefer the decisions to be made in Merseyside in my case. There are alternatives, however. The Manchester model offers a way forward, and there may be variations on the theme.

I am interested in the responsibilities and powers that are devolved—issues around economic development, the question of transport, potentially strategic planning, skills and employment, questions around business planning, certain European issues, possibly further education, the careers service, and certain Department for Work and Pensions responsibilities. The NHS has been mentioned. The reality is that most NHS services are delivered at a local level and many decisions are made at a local level, and I think it is a question of teasing out how those decisions can be made at a local level but in the context of a city region. I recognise there are concerns about things like specialist services, but I do not think they are insurmountable, and I think they are issues that we have to tease out and discuss. Yes, they are going to be challenging, but we must not brush them under the carpet and pretend we cannot deal with them, because we can. So, yes, there are challenges, but they can be overcome. The list of potential powers to be devolved goes on and on, and it is, as they say, a question of horses for courses.

Reference has been made to collaboration, and collaboration does currently take place. When I was leader of a city region council, we collaborated all the time, day in, day out. But of course without the powers that devolvement brings, that collaboration can only go so far, as is the case with resource.

That brings me to the elephant in the room: the question of resource and the devolvement of that resource, and then of course the equity of resource. This is about the allocation and then the equity of the allocation. I ask that the allocation of resource be appropriately equitable.

The reality is that this train is about to leave the station. My area wants to be on that train—not at any cost or at a cost that would denude us of crucial resources, but we need to grasp this opportunity. This does not preclude any discussion of subsidiarity, however. Indeed, it should start the process of subsidiarity from local authorities down to town councils and parish councils, of which there are many in my council area.

If the Bill will secure better and sounder economic cohesion, I will support it. If it will liberate local government to even a small degree compared with how it was 100 years ago, I will support it. If it will give a fair allocation of resources, I will support it. However, as Anne Brontë said:

“There is always a ‘but’ in this imperfect world.”

I do not want to heap too much praise on the Secretary of State, because I do not want him to be moved just yet, but I give him credit for moving this issue on.