National Strategy for Self-Care

I beg to move,

That this House has considered the potential merits of a national strategy for self-care.

As ever, Sir Charles, I am pleased to have this debate with you in the Chair. In October 2019, I chaired a roundtable event on self-care, which involved healthcare professionals, pharmacists and other experts. It was organized by the consumer healthcare association the Proprietary Association of Great Britain, and following the event we produced a report that the Minister, or at least the Minister who was supposed to be here—the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield)—is aware of. I am indebted to PAGB, the Juvenile Diabetes Research Foundation and Diabetes UK for the briefing they have provided for this debate.

It might be helpful if I define what I mean by self-care. Essentially, it is about the actions individuals take for themselves, on behalf of others or with others to develop, protect or maintain their health. It can be summarised as a spectrum that includes the promotion of everyday wellbeing, taking care of self-treatable conditions, and the management of long-term conditions. It is important, however, to point out that self-care is not no care. Those who need medical support on a more traditional basis should be entitled to that type of care.

The covid-19 pandemic has revealed the important role that self-care can play in reducing the burden on GPs and hospital A&E departments, so that those with the most serious ailments can be treated with greater urgency. Prior to the pandemic, it is estimated that 18 million GP appointments and 3.7 million A&E visits were for minor ailments, including a blocked nose, dandruff and travel sickness, at an estimated cost of £1.5 billion annually. A survey of frontline healthcare professionals carried out by the self-care academic research unit at Imperial College in 2021 indicated that 95% of those who responded felt that self-care was important during the pandemic, compared with 55% pre-pandemic. However, a further survey carried out by PAGB later in 2021 found that the percentage of members of the public saying that they were more likely to self-care had fallen from 69% in 2020 to 55%, which illustrates that the trend in that direction has reversed.

My key point in this debate is to highlight the necessity for a new national strategy for self-care. The previous such strategy, “Self-care—A Real Choice”, was published in 2005. Since then there have been many new developments and the case for a new strategy has been more clearly recognised.

Before I move on to describe what the elements of a new strategy might be, I will use the example of those with diabetes to illustrate how self-care can work well. Other conditions could also serve to make that point, but, to avoid taking up too much time, I will use this single example. JDRF has pointed out that 79% of the management of type 1 diabetes is carried out by the individual with the condition, often with the help and support of their families and carers. That makes type 1 diabetes a case study in how to successfully promote self-management. JDRF also draws attention to the need to invest in technology as a crucial benefit to the long-term sustainability of the NHS post-covid.

JDRF’s 2021 report, “Covid and Beyond”, concluded that people with type 1 diabetes who had access to relevant technologies felt more confident in managing their diabetes in the absence of routine NHS care and support. The charity Diabetes UK points out that diabetes is

“the fastest growing health crisis of our time”,

with the equivalent of one in 14 people—that is 4.9 million in total—living with the condition, and that it accounts for 10% of the NHS budget—that is a staggering figure—80% of which is spent on treating largely preventable conditions.

Diabetes UK draws attention to the fact that, to live well with diabetes, avoid complications and successfully self-manage diabetes, those living with the condition require five things: first, access to education about diabetes and how to manage it; secondly, emotional and psychological support, which is increasingly important; thirdly, access to technology to support self-management; fourthly, access to weight-management support when needed, and I will say more about that in a moment; and finally, facilitated peer support.

Typically, those with diabetes spend about three hours a year with their doctor, nurse or consultant, and a staggering 8,757 hours managing the condition themselves. As Diabetes UK points out:

“Managing diabetes day-to-day can be difficult. This is why it’s important people have the knowledge and skills to manage their diabetes so they can live well and avoid complications.”

I appreciate what the right hon. Gentleman is saying and I understand that he has spoken to my constituent Scott Craig. Does he agree that there needs to be awareness of the risks, and training for people who are self-managing and for their families? I understand that my constituent’s husband’s device failed, leading to his untimely death. Does the right hon. Gentleman agree that there needs to be greater awareness of how these devices work and what people need to do should things go wrong?

As the hon. Lady is aware, I spoke to her constituent about that point earlier today. She makes a good point and I agree with her, and I would add that it is important that those who use technology are properly trained in how to use it best. The devices need to be reliable, so that technology can provide effective help with these conditions.

Those with type 1 diabetes who also struggle with eating disorders experience problems if they omit to take their insulin in order to lose weight. I know that you are familiar with this issue, Sir Charles. The right hon. Member for Maidenhead (Mrs May) and I will shortly carry out an inquiry into this growing problem, with the support of JDRF. We hope to point to how self-care can play an important role in dealing with this worrying trend. Hon. Members may be aware that there is a storyline in the soap opera “Coronation Street” that covers this subject. It has not yet concluded, but it offers a helpful perspective of how the problem has arisen, what it is and what the dreadful consequences can be.

I will refer to the recommendations from the report following the roundtable I chaired in October 2019. First, the Department of Health and Social Care should develop a national self-care strategy. Secondly, NHS England and Improvement should explore the implementation of self-care recommendation prescriptions, to support clinicians to discuss self-care with patients and refer them towards it. Thirdly, primary care networks should consider ways to improve self-care in local populations as part of the development of the network across the local health system. Fourthly, NHS England and Improvement should enable community pharmacists to refer people directly to other healthcare professionals. That has become even more apparent during the covid-19 pandemic.

The fifth recommendation is that NHS England and Improvement should support moves towards community pharmacists being granted read and write access, to give them full integration and interoperability of IT systems as part of local health and care records partnerships, and promote national support for such data-sharing agreements. That would unlock the door to a hugely increased, positive role for community pharmacies. Sixthly, the Government and royal colleges should include in the healthcare professional curriculum and the national curriculum self-care modules that can be delivered sustainably by schools. Finally, NHSX should explore technologies that could be used to promote self-care and manage demand on the NHS.

I thank the right hon. Gentleman for his speech and for the support that he has given to two of my constituents—Neal and Lesley Davison. Perhaps I might tag along to one of those meetings with him.

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.

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.

It is like being back in Committee.

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.

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?

I absolutely agree. The pandemic has been a terrible time for most of us, but it has provided the opportunity to look at, and to trial in real time, different ways of working with and helping people. A lot of third-sector organisations have been able to use technology, particularly in rural areas, so that people no longer have to travel to centres if they do not want to. Such organisations have been supporting people to use more online communication methods, and people have been coming together in more localised settings and been supported in a different way.

From my many years in the health service, I know that getting online appointments organised and, as the hon. Gentleman has heard me say before, managing things—for example, dermatology—using online services was a really hard task. We have now gone through that process and need to learn the lessons from the pandemic. It is a unique opportunity to promote self-care as an essential part of healthy living. We have heard from my right hon. Friend the Member for Knowsley about the numbers involved. People are keen to take this opportunity to promote self-care and improve our understanding of, and confidence in, our own health, so that people can access the right service at the right time, and we ensure that our highly professional health service and specialist services are well used.

I would like to mention local pharmacies in my constituency of Bristol South. Bedminster pharmacy has been commended several times—it has the most commended pharmacy team in the United Kingdom—by national awards. I echo the points that have been made about pharmacies, which are often overlooked by other professional organisations. Some primary care services in different parts of the country are better than others at working together across the piece. I certainly hope that is a feature of the new integrated care systems, which have a huge opportunity to support pharmacies properly so that they can do their day-to-day work.

My hon. Friend makes a good point about community pharmacies and the potential they offer. Does she agree that in the past the potential of community pharmacies has been underused, just as the capacity of GP and A&E services has been overused? It is not just about sloughing off the responsibility to somebody else; it is a matter of using the expertise that already exists.

Absolutely. I refer back to one of my favourite pieces of legislation, the Health and Social Care Act 2012; one of the many terrible things that that Act did was to demote the role of pharmacists in local communities and affect the support they were given by primary care trusts. In my area, we had a huge team supporting pharmacies who were very much part of that local community offer. I hope that the integrated care systems recognise that that was a mistake. We have lost a decade and really should be working much more closely together. Pharmacies exist in most areas and are easy for local people to access. They can give people confidence to look after themselves and the literacy that I mentioned.

It is vital that people receive a consistent message about self-care when they look at NHS services online, call 111, or visit a GP or local pharmacist, and that requires local systems to work together. A national self-care strategy would help to embed consistency across the country. As has been mentioned, self-care is a continuum that covers adopting healthy lifestyle choices and managing long-term health conditions, be they mental or physical. We must ensure that health literacy and targeted actions to tackle health inequalities take account of the systemic barriers in place for many people who wish to live a healthier lifestyle, particularly given the rising cost of living. I look forward to hearing from the Minister about how the Government’s upcoming White Paper on health inequalities will consider the issue.

We need to remember that self-care is for everyone at all stages of life. Educating children through programmes in school is an important part of that. As I said earlier, the confidence to manage our own health with appropriate support is as important for someone in a care home as it is for a parent looking after a new baby or for children growing up, particularly those growing up with long-term conditions.

Empowering and enabling us all to take charge of our health, be that through using digital interventions, improving health literacy or providing greater support for self-care, is important not only for the long-term sustainability of the health and care service, but for patients. We must ensure that the system does not inadvertently disempower people or result in gaps in the care pathway. I very much look forward to hearing the Minister’s thoughts on this.

Minister, you have been seeing rather a lot of the right hon. Member for Maidenhead (Mrs May) recently, so no doubt you are looking forward to your next meeting with her.

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.