National Strategy for Self-Care

Peter Dowd Excerpts

Tuesday 26th April 2022 Westminster Hall

[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.

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[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?

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[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.