Self Care Week

Kevin Barron Excerpts

Tuesday 22nd November 2016 Westminster Hall

[Sir Kevin Barron (Rother Valley) (Lab)]

I beg to move,

That this House has considered Self Care Week 2016.

It is a pleasure to serve under your chairmanship, Mr Walker. I am delighted to have secured this debate, timed to take place just after Self Care Week. As co-chair of the all-party parliamentary group on primary care and public health, I have taken an interest in self-care for some years. Self-care is essential for healthy living, and self-care certainly does not mean no care. Self-care is also essential for the future sustainability of the NHS.

There are two reasons why the Department of Health established Self Care Week in 2009, which is a national awareness week to support people to better look after their physical health and mental wellbeing. The Minister was not in office when the NHS was grappling with reforms and reorganisation in 2010, but at that time the Self Care Forum, a charity that aims to further the reach of self-care and embed it in everyday life, was asked to take over the organisation of Self Care Week. Since then, it has gone from strength to strength, with growing numbers of local and regional health organisations running events and activities across the country to support and educate people in their health.

The theme for the 2016 Self Care Week was improving people’s health literacy. According to the Royal College of General Practitioners, 60% of working-age adults find health information too complex to understand. That worrying statistic shows that there is an urgent need to empower people in their health and improve health literacy across the population. When people play a more collaborative role in managing their health and care, they are less likely to use emergency hospital services and more likely to stick to their treatment plans and to take medicines correctly. Those who are more involved are less anxious, more satisfied, less likely to complain and tend to enjoy better outcomes and a better quality of life than those who are less involved. It is awful jargon, but it is true, that person-centred care is good for healthcare professionals, too. As patient engagement increases, staff performance and morale sees a corresponding increase.

Earlier this year, the all-party group on primary care and public health carried out an inquiry into the NHS’s five-year forward view. We looked specifically at behaviour change information and signposting and concluded that poor health literacy was harming the nation’s health and contributing to the pressures on the national health service. In other words, the NHS is failing to harness the potential of patients to improve and maintain their own health.

To address that, we recommended that comprehensive health education should be included in the national curriculum to improve the health literacy of children, who are future health service users. That health education should go beyond the usual sex, relationships and drug education programmes and include, for example, information on the national health service, its history and structure and the right way to access services.

It is important that the elderly do not think that self-care ends when they move into a care home. They must be able to maintain their independence and live life to the full. A main component of that is ensuring that they are able to buy personal goods. I was therefore disappointed when I was contacted by a constituent who was concerned about the treatment of his mother-in-law in relation to the personal expenses allowance that people in nursing homes get. That allowance has not been raised at all, which means that, due to inflation, people have less money to spend. In an email to me, he said:

“Recently, as you will be aware, her annual pension and pension credit increased by 2.9% in line with inflation. However, the PEA remained at £24.90 per week. So in effect her increase in Pension and Pension Credit from Central Government was passed straight through to the Local Government and she has received zero increase. No doubt her personal items such as underwear, clothes, shoes sweets etc. will increase in cost this year leaving her actually worse off for the increase.”

It seems I have dropped this on the Minister—that was not my intention, but it is an opportune time to bring the case to his attention—but will he explain now or later why the personal expenses allowance was not raised in line with inflation or even further?

Health education needs to continue throughout life, particularly at key stages such as when people start university, have their first child or retire. That would help people to understand which parts of the NHS they should use based on their health needs and whether they need to access health services or could self-treat safely at home.

It may be an opportune time to mention this. I am one of the three Rotherham MPs and we have a scheme called social prescribing, which is contracted and paid for by the Rotherham clinical commissioning group. I understand that the team from the Rotherham social prescribing service, who I spoke to at a community function last Friday night, have spent some time with the Secretary of State, who has seen exactly what they do. They are helping people with long-term health conditions to use a wide variety of services and take part in activities provided by voluntary organisations and community groups; 1,600 different community groups are playing a part.

People do not always need medicines. Medicines play a part in people’s life where the health service does not engage, and we would not expect it to do so, but the scheme is about preventing people from going into the healthcare system. I know a lot is changing now in the plans being laid down at local level, which are advancing in Rotherham as well, but something like social prescribing is a good way of involving other people—not just the health service—in helping to ensure that people avoid, if at all possible, going into the health service.

Last week, the Proprietary Association of Great Britain—the trade association that represents the consumer health industry—published new research that found that 92% of people agree that it is important to take responsibility for their own health to ease the burden on the national health service. Despite that, 46% still visit their GP or accident and emergency with self-treatable conditions. Its research also found that 47% of people would not visit a pharmacist first for advice on a self-treatable condition, with 18% claiming that that is because they do not think pharmacists are as qualified as doctors or A&Es.

It is clear that more needs to be done to educate people about the expertise of pharmacists—at this stage, I should say that I chair the all-party pharmacy group. My experience of the fitness of pharmacists to look after people without the need to bother doctors was not in this country. Many years ago, I was on holiday with my three young children in Spain. One of them fell ill and I asked the hotel staff how we could contact a doctor. They said, “Just go up the road to the pharmacist.” I went up to the pharmacist and it was extraordinary: we came away with the right medicines, which cured the condition pretty quickly and the holiday carried on.

I try to keep healthy myself, but that was the first time I had seen the expertise that pharmacists have and how they could help us. Pharmacists are expert health professionals who have a front-line role to play in giving people information and empowering them to take responsibility for their own health. I am sure the Minister agrees with that, as we have talked about pharmacies and the current situation with the pharmacy budget. He will be pleased to know that I will not bring that up today, but we have talked a lot about it. Better signposting to the pharmacy is necessary when we consider that 57 million people go to their GP and 3.7 million people go to A&E for ailments that only a few generations ago would have been safely treated at home with advice and medicines from a pharmacy.

Cambridgeshire and Peterborough clinical commissioning group reported in March that, over the Easter period, people visited A&E with splinters, broken nails, paper cuts and hiccups. I am certain that that is not particular to Cambridgeshire and Peterborough, and that we would hear similar reports from A&E departments up and down the country. I know that about 50 people came along to my own CCG in Rotherham last year because they had toothache. I have no doubt that those people will have passed a local pharmacy where they could have bought some reasonably cheap pharmaceutical products to get rid of the toothache in the short term, and so not clog up the A&E.

People are clearly confused about when and how to use the NHS and need help in knowing where to go. I know that work is being done to improve the non-emergency helpline, NHS 111, which is important. Every day NHS 111 sends to GPs and to A&E people who could just go to a pharmacy without waiting and without an appointment to get the help that they need. We need to make sure that people receive a consistent message about self-care, whether they look at NHS Choices online, call NHS 111, visit a GP or speak to a pharmacist.

I know other hon. Members want to speak, so I will sum up by saying that more has to be done to address the escalating demand on the national health service, to combat the general confusion about where to go in the system and to improve people’s ability to look after their own and their family’s health. Excellent though it is, Self Care Week alone is not enough, as I suggested earlier. The local activities and events taking place during Self Care Week are definitely part of the solution to empowering people and addressing the demand on the national health service, but a bigger, more co-ordinated programme of work is essential if we are to move the self-care agenda along quicker.

Our all-party parliamentary group concluded earlier this year that we need a national strategy for self-help, led by a Government Minister and a national director to ensure implementation. It should be designed to co-ordinate policies across Government Departments and throughout the NHS and public health at the national and local level. It should be designed to empower people and should lead to a self-care culture and a behaviour change, so that people know not to go to A&E or to a general practitioner with their splinters, understand what steps to take to avoid serious conditions and know how to avoid hospital emergencies by managing long-term conditions. We would all agree that that is essential, but it does not happen very often. More than 70% of national health service expenditure in this country is on people with long-term conditions. People normally have more than one, of course, which sometimes seems difficult to grasp.

It seems to me that these issues are plain to everybody. We need to tackle them and to shape the national health service around long-term conditions, and not let the national health service shape us on how we should present to it. That needs radical thinking but, the Minister will be pleased to know, not legislation. I sat on a Committee back in 2010-11 that was suspended for a while because of the turmoil over the national health service reorganisation that was happening at the time, which is the last thing we want now. However, we want people in the health service and elsewhere to recognise that things ought to change and can change, and that legislation is not needed for that to happen. We need to make sure that we see a population that is able to self-care for life.

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[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship, Mr Walker. I welcome this important debate and the fact that it has been secured during Self Care Week—

[Sir Kevin Barron]

Just after it.

[Mrs Hodgson]

Just after Self Care Week. I commend my right hon. Friend the Member for Rother Valley (Sir Kevin Barron) for securing this debate and for his excellent speech, which shows his deep knowledge of and passion for all matters relating to the health of our nation, especially with regard to preventive health measures. I thank him for that.

This debate is especially important, as it is the first time we have had a dedicated debate on self-care in a very long time. We heard an excellent contribution from the hon. Member for Linlithgow and East Falkirk (Martyn Day). Before we hear from the Minister, I want to look at the issue of self-care and the wider picture of preventive measures through the lens of the cultural shift in the NHS away from care and repair to prevention and wellbeing promotion. I will also look at how aspects of current Government policy, such as the cuts to public health funding—I know I keep banging on about that, but it is important—is detrimental to our shared vision for an improved NHS and to achieving a healthier nation.

When NHS England’s “Five Year Forward View” was published just over two years ago, we were promised a radical upgrade in prevention and public health. That belief in reshaping the approach of the NHS and our health services away from a sickness alleviation service towards a wellbeing service that promotes healthier lifestyles choices, improved wellbeing and the prevention of ill health through behavioural change is supported across the NHS and in wider society.

That shift is paramount when we see the NHS in a state of crisis, with longer A&E waiting times and GP appointments becoming harder and harder to come by. One in four patients wait at least a week to see their GP. My husband had to wait three weeks to see the GP because it was not an emergency, but he thought it was an emergency; sometimes we do not know, and it is up to the doctor to decide what is important and what is not.

Some parts of the NHS are at crisis point. That is not a party political point at all; it is supported by health organisations such as the Nuffield Trust and the Health Foundation, which professed this time last year that the NHS was at risk of a “catastrophic collapse”. If the worrying trends in waiting times that I have described are ever to be reversed and we are to save the NHS, we need to have a wholesale rethink about the way we approach health policy. Prevention must be the key, and self-care should be a central part of that reconsidered approach.

Self-care is about empowering people and patients to maintain their own health through informed lifestyle choices, better awareness of symptoms and better awareness of when it is important to seek professional advice—for example, for possible cancer symptoms, where early diagnosis is absolutely crucial and a matter of life and death—and when an ailment can be treated by someone themselves in the appropriate manner by talking to their community pharmacist, as my right hon. Friend the Member for Rother Valley described on the occasion of a family holiday. With improved confidence, people can take control of their own health or long-term conditions much better and make decisions that are far better for the NHS.

It is completely understandable that when we are unsure about the cause of symptoms or the best course of treatment or care, our first port of call is the NHS. However, being more aware of how we can treat ourselves and having preventive practices in place that reduce the prevalence of ill health will help go some way towards pulling the NHS back from the brink. The NHS is a trusted bastion, but sadly we are seeing more and more people accessing NHS services when there is no need and when a chat to one of our excellent community pharmacists would have sufficed—for example, in the cases we have heard about today of splinters, paper cuts, hiccups or broken nails. A bit of common sense is all that is needed, certainly not a trip to A&E.

In 2014, A&E departments across the country dealt with 3.7 million visits for self-treatable conditions such as those mentioned today, as well as the common cold, flu or muscle pain, combined with 52 million visits to the GP for similar conditions. It is no wonder people cannot get an appointment when some people are going to see their GP for that sort of thing. That has an estimated cost to the NHS of more than £10 billion over the past five years, which is not a small or insignificant amount of money.

Self-care is a crucial preventive measure that must be developed further to ensure that the NHS is as resilient as possible and can respond in more effective and meaningful ways to the nation’s health. With all that in mind, it is deeply worrying that the vision set out in the “Five Year Forward View” has progressed little or not at all. That is seen most clearly through the Making Every Contact Count initiative, which aims to make NHS staff members an important part of boosting awareness of healthy living, rather than only administering healthcare to the sick. It is a fantastic initiative. In theory, that strategy can go far in addressing issues around lifestyle choices such as smoking, drugs, diet and alcohol consumption by just adding a one or two-minute conversation when a healthcare professional already has someone in front of them.

It is worrying that the progress and roll-out of that scheme is patchy, despite there being lots of good practice across the country, such as the social prescribing service in Rotherham that my right hon. Friend talked about. Where such system change is flourishing and showing that it can support a reduction in pressures on NHS services such as A&E and GP practices, it should be encouraged, and the roll-out should be far more substantial.

I hope the Minister can give us some reassurance on three key asks for the Make Every Contact Count initiative: first, that we see progress made on the scheme in the new year, as promised by Professor Fenton from Public Health England during the second oral evidence session for the APPG on primary care and public health inquiry; secondly, that best practice is made more readily available to improve provision across the country through the Self Care Forum’s database of best practice; and thirdly, that he commits to ensuring CCGs prioritise implementation of the scheme in their local areas and that training is provided for staff, to equip them to provide consistent self-care messaging.

It should not go without saying that there are examples across the country that show the innovative and positive impacts of improving self-care, such as a scheme in my own neck of the woods in South Tyneside—the neighbouring borough to my own—where a borough-wide conversation has been developed that shifts away from asking, “How can I help you?” and instead asks, “How can I help you to help yourself?”

Those initiatives need funding and encouraging from Government to succeed. However, what we are currently seeing has been described as a frustrating and perverse approach to preventive measures, with cuts to public health funding of £200 million in last year’s Budget, along with an average real-terms cut of 3.9% each year to 2021, announced in last year’s autumn statement. Hopefully tomorrow we will see our new Chancellor go some way to rectifying and reversing that; we can live in hope, unless the Minister has some insight into what the Chancellor will announce. We will keep our fingers crossed.

The Minister is well aware of my opinion on those cuts, because we discuss them every time we meet, and the need to rethink the whole approach, but it is not only me saying this. Only recently, the Health Committee, chaired by the hon. Member for Totnes (Dr Wollaston)—who I am sure would have been here today if not for the health debate coming up in the Chamber very soon—uncovered serious concerns about the finances and funding of the NHS and public health. In a letter to the Health Secretary in October, the Committee said:

“All the indicators suggest that demand is continuing to grow and that we need to go further on prevention”.

I could not agree more. These cuts are a false economy and are exacerbating the situation within our health services. We are seeing funding directed to our crisis-ridden A&E departments, which are having to crisis-manage failures that could have been addressed a lot sooner.

The Minister needs fully to understand that to make cuts to one part of our health service without considering the impact on other parts is leading us down the road to rack and ruin. To give him some understanding of the cuts, I suggest that he look at the Health Committee report “Public health post-2013”. The Select Committee does good work, but the Chair is not here to hear me highlight all this work. The report that I have just mentioned highlights research by the Association of Directors of Public Health, which found that local authorities are planning deep cuts to public health services due to the cuts coming from central Government to local authorities. It shows a marked rise for 2016-17 compared with 2015-16.

The Government need to have a wholesale rethink of the funding of the NHS and public health services that sees a redirection to prevention, which will go some way towards addressing many of the problems in our health service that are now being documented weekly. I hope that the Minister takes some time in his response to consider the points that I have raised in relation to public health funding and how current actions are failing the vision of the five year forward view and the health of our nation. Self-care needs properly to be funded and supported to be innovative, so that we ensure that the continuing crisis facing the NHS can be reversed. We cannot continue as we are, because our NHS is too precious to let it fail. The health of the nation needs to be protected, where possible, to enable people to lead long, happy and fulfilling lives.

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[Sir Kevin Barron]

The hon. Member for Linlithgow and East Falkirk (Martyn Day) and my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) mentioned groups in their areas that help people with long-term conditions, and those are a resource that we should use. My hon. Friend spoke about prevention, and that is right; we need it. The need for the NHS and taxpayers’ money will never stop if we cannot turn around the health of the nation. Population health is something we must attend to.

As for the minor ailment scheme that the hon. Member for Linlithgow and East Falkirk described, we have one in my area; I hope that they will be rolled out nationally. However, I wonder how many people know that really they should go to the pharmacist. Pharmacies are open all the time—at the weekend as well—but people drive past them to the A&E. We need to look at that issue.

The Minister spoke about health education and there is no doubt in my mind about it: as a Rotherham MP I know about the problems caused by not having good sex education and, more importantly, personal relationship education in our system. We have it now, having gone through the awful child sexual exploitation experience of practically two decades in Rotherham. It seems to me that it is also important to have continuing health education, including educating people about the system and where to engage with it.

On sustainability and transformation, on Friday morning this week the Rotherham MPs will have a meeting with the lead person on the issue from South Yorkshire, Sir Andrew Cash. On 16 December we will visit a pilot scheme running in the constituency of my hon. Friend the Member for Rotherham (Sarah Champion). There is a group of 30 patients and two or three GP surgeries who are working with other health professionals in the acute and primary sectors, and other organisations such as Voluntary Action Rotherham, which runs social prescribing. They are going to run a pilot to see how well it is possible to look after people and improve population health.

I do not want to get dragged too far on to this point, but the Minister talked about referring people with long-term conditions to football teams. I hope that is not a slight on Rotherham United, which is at the bottom of the championship at the moment, some eight points adrift, as it were. I have been a supporter for nearly 60 years and will continue to be one, but I think now and again one or two of them might have some problems that need sorting out—with the pharmacist or others.

We have had a short but good debate, in which we recognised that self-care and preventive healthcare will be crucial to the future of the nation and its people.

Question put and agreed to.

Resolved,

That this House has considered Self Care Week 2016.