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Self Care Week

Volume 617: debated on Tuesday 22 November 2016

[Mr Charles Walker in the Chair]

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.

It is a pleasure to serve under your chairmanship, Mr Walker. May I start by thanking the right hon. Member for Rother Valley (Sir Kevin Barron) for bringing this timely debate, and also for his clear and detailed explanation of his position?

For my part, I supported Self Care Week last week by treating the latest winter cold I have picked up with a couple of lozenges and a few hot toddies. My hon. Friend the Member for Rutherglen and Hamilton West (Margaret Ferrier) has set me a challenge to get through the debate without coughing; I have to confess I have failed already. However, I will repeat the dosage later on tonight.

We have heard that self-care is the act of looking after one’s own physical or mental health, and that that extends to treating common illnesses with over-the-counter drugs and managing long-term conditions. We know that 80% of all care in the UK is actually self-care, and most people feel comfortable managing everyday minor ailments themselves, particularly when they feel confident that they have been successfully treated before using over-the-counter medicines.

Self-care is a fundamental part of healthcare—and Self Care Week provides an opportunity for us to encourage people to engage in self-care in a wide variety of areas—but it is important for us to get the balance right between managing conditions that are self-treatable and knowing when to get professional medical help. The right hon. Member for Rother Valley stated some examples in which it was clearly inappropriate to go to accident and emergency, and it is getting that balance right that we have to promote.

Self-care need not be as lonely as the term suggests. Often, conditions that can be self-managed are done so with support, be that from health professionals, organised support groups or advice from community pharmacies; people are not out there on their own with self-care. There are many good examples of such support across my constituency, covering a range of conditions and ailments. Eczema Outreach Scotland, which is based in Linlithgow, is a support charity for families affected by eczema. While it does not provide medical advice, it helps affected families in many ways, from practical advice to emotional support. As we know, one of the most common conditions experienced is joint pain, and the central arthritis self-help group, which meets in Grangemouth, organises outings, hydrotherapy and exercise sessions to assist sufferers.

Obviously, self-care for mental health is just as important as for physical conditions. In Bathgate, there is the West Lothian bipolar self-help group, which helps people affected by that common condition to share advice and insights on getting back into work and staying fit. Another example is the West Lothian health and social care partnership, which brings together NHS Lothian and West Lothian Council. It runs the superb “Eatright West Lothian” scheme, which aims to promote good nutrition and healthy eating, which can assist with many different conditions.

It is worth noting that the Self Care Forum recommended the following top tip:

“Involve the local pharmacists and community nurses in giving the same advice and support for self care; and work with the local pharmacists to ensure that their triage of common problems is similar to that in the practice.”

That is not quite the way I would have worded it, but I agree wholeheartedly; it is very good advice. Community pharmacists can only give out certain medicines and products, although the benefits of that can be massive, as it can cut the workload of GPs and other NHS staff across the country. The Scottish Pharmacy Board stated that, in 2015-16, more than one in 10 GP consultations and one in 20 A&E attendances could have been managed by community pharmacists utilising the minor ailment service.

Some 1,200 pharmacies throughout Scotland provide a range of services on behalf of the NHS. As well as dispensing prescriptions, they offer four new NHS pharmaceutical care services which have been gradually introduced since 2006—the minor ailment service, the public health service, the acute medication service and the chronic medication service. Those new services involve pharmacists in the community more in the provision of direct, patient-centred care, with every community pharmacy in Scotland having patients registered for the minor ailments service by 31 March 2015.

The minor ailment service allows people to get advice and free treatment on issues such as, but not exclusive to, acne, headaches, athlete’s foot, head lice, backache, indigestion, cold sores, mouth ulcers, constipation, nasal congestion, cough pain, diarrhoea, period pain, earache, thrush, allergies, sore throat, threadworms, hay fever, warts and verrucae; in fact, pretty much everything that is covered with self-care. Nearly 18% of the population of Scotland are registered for the minor ailment service—a total of 913,483 people. More than 2.1 million items have been dispensed under it, accounting for some 2.2% of all items dispensed by community pharmacies in Scotland.

In Scotland, we recognise just how important community pharmacies are. The Scottish National party Scottish Government are helping to explore new ways for community pharmacies and other primary care services to aid self-care within our communities. The SNP Scottish Government are committed to supporting and developing local GP and primary care services, and have just announced a three-year, £85 million primary care fund to help to develop new ways of delivering healthcare in the community, which will involve pharmacists delivering aspects of patient care.

In conclusion, I welcome the recent words that we have heard from the UK Government that they want to copy the Scottish Government’s approach to community pharmacies and the minor ailment service. I thoroughly recommend that model to everyone, because we have found it to be very good and effective to date. I also welcome the opportunity to take part in today’s interesting and good-natured debate, which I hope will help to promote self-care further to the wider public audience.

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—

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.

First, I congratulate the right hon. Member for Rother Valley (Sir Kevin Barron) both on leading the charge on this issue and on his work in the APPG. This has been a shortish debate, but there were very good speeches from all hon. Members. In fact, I agreed with much if not all of the speech given by the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and I will come on to that.

The right hon. Member for Rother Valley rightly talked about the impact that self-care needs to have on demand in the health service. He used a very important phrase that is spot on: in the course of his remarks, he asked why we are not doing more to try to shape the NHS around long-term conditions, given that, as he rightly said, some 70% to 80% of total NHS expenditure relates to long-term conditions, such as diabetes, chronic pain and dementia. As he also rightly said, increased longevity means that more and more people are living with more and more of those conditions. We need to deal with long-term conditions—this relates to a point made by the hon. Member for Linlithgow and East Falkirk (Martyn Day)—on a preventive basis, on a care plan basis, and not necessarily on an ad hoc, repair basis; I think that was the word that he used. Those points are spot on and are why we need to continue to do better in the whole area of self-care.

It is worth reflecting on why, in many ways, the moment for self-care has arrived. The Self Care Forum has been doing a lot of work in this area for a number of years, but I think that there are several reasons why self-care is particularly critical at the moment. One is demography. We are getting older. That is a good thing, but the consequence is that about 1 million more people aged over 75 will be around in 2025. We will have more long-term conditions. That is just a natural feature of ageing. Those long-term conditions are precisely where self-care gives us the biggest bang for our buck, because there is absolutely no need to continue going to see the GP all the time. People have talked about pharmacies, and I will talk about that.

Another reason is that there is a general perception in the population that people are more empowered vis-à-vis their own health and what they will accept from health professionals. We often hear of people saying, “Well, it’s not a question any more of the doctor telling me what I should do, but of having a discussion with the doctor about that.” Where that takes us to, in terms of our expectations of the health service, is a whole load of things around choice and, in particular, personalisation. Self-care also has a role to play in that. Part of it is about not just clinical outcomes, which is where we have come from historically, but out-turns that consider the general wellbeing of an individual.

The right hon. Member for Rother Valley made the point about social prescribing as a big part of that, and it absolutely is. Increasingly, it is important not just that patients with diabetes manage glucose levels and all that goes with that, but that they exercise. It might be just as appropriate for them to be referred to a football team or to talk to someone else with diabetes, in a mentor group. Frankly, social prescribing needs to be commissioned by CCGs as much as some of the clinical things that have happened in the past.

Another area that has made self-care even more prominent, and which is a component of it, is technology. We have not talked yet about technology, but there is a lot more out there. It ranges from people just being able to look at Google, see what is wrong with them and take a view—that can be dangerous and is not always to be recommended, but nevertheless it empowers people in a way that did not exist at one time—to some 900,000 applications to do with health and fitness that have been developed. I believe that iTunes alone has 47,000 health apps. People who are interested in all that stuff—and possibly more IT literate than I am—can use all those, and they do. The combination of those things has meant that the whole ethos of “Doctor knows best” is giving way to much more of a dialogue and a care plan orientation, and a big part of that care plan will be self-care.

What is the Government’s response? That is the challenge that we received from the hon. Member for Washington and Sunderland West. I suppose there are two areas. There is the whole general area of public health. I will not get into a discussion about the relative size of budgets and all the rest of it, other than to say that the Opposition’s position on where we should spend more money versus less money in the health service and anywhere else would be stronger if occasionally they agreed that in some areas it is right to spend less in order to spend more in other areas. If their position is that we must always spend more money on everything, their comments may be taken by Ministers with a bit more of a pinch of salt. I merely say that in passing.

In terms of awareness and education, the right hon. Member for Rother Valley made a good point, which I had not thought of, about health education in schools being a step up from other types of education. There does need to be more awareness, and I will mention a small thing that I became aware of recently. One of my responsibilities is dementia, and I had not realised that obesity is a major factor in someone’s likelihood of getting dementia. I know that now, and perhaps everyone else in the Chamber also knows it, but I suspect that many people do not; I do not think why obesity and dementia go together is that intuitive. That is an example of the need for awareness.

Let me talk about the sorts of things that the Government need to encourage and are encouraging. We have a campaign on stopping smoking—Stoptober. We have “Everybody Active, Every Day” and Change4Life, which involve people taking control of their diet and how they live. I talked about dementia, and there is the dementia friends initiative. There are some 1.7 million dementia friends now. Dementia has become the condition that most people die of in the UK, and dealing with that will be a real challenge in the years ahead.

That is about public health, but we have a whole stack of things to do with clinical outcomes. We have put into the NHS mandate a clear requirement for it to improve its response to long-term conditions, with a clear requirement for self-care to be part of that. That includes the need for more personal health budgets. Some 4,000 people now have a personal health budget; those budgets are analogous to personal care budgets. Our target for 2020 is between 50,000 and 100,000 people having such budgets. That is about choice and about control. Various tools are available for patient activation and to help patients understand the sorts of choices they can make day to day. NHS England has a target of 1.8 million people accessing tools, as well as being assessed on where they see themselves on the self-care spectrum and what they are doing about it.

It is worth talking briefly about the STP process. The shadow Minister made the point that we spend too much on acute healthcare in this country and not enough on primary care, on mental health and on the self-care options that we are talking about, including pharmacy, which I will talk about. The STP process is a precise attempt to make self-care happen in a structured bottom-up way. If the Opposition oppose the STP process at every turn, as opposed to acting as critical friends, which is how all MPs should act, they oppose what could be some very sensible, thought through and locally driven reforms to healthcare that may well result in higher budgets for prevention, which is a point that she made, and a tilt away from our spending so much of our budgets on secondary care and hospitals, which are very expensive.

NHS England has produced a book about self-care that was printed last week. “Realising the value” is about empowering people to make their own decisions about medicine and care and engaging in the community. There is a lot in the book, which was produced by Nesta, that is valuable and good. I guess it is an attempt to embed some of the things that we have been talking about. National Voices, the Health Foundation and voluntary organisations were involved in it.

Social prescribing is a large part of the initiative, which is about peer groups and making sure that people who have a diabetes issue are not overwhelmed by concerns about losing a limb and about glucose levels changing. It is about managing all of those types of things and ensuring people look at their own diet and at whether they are doing enough exercise or sport and are in a group of like-minded people with the same issues. If I were diagnosed with diabetes, it would be valuable to me to talk to people who had had it for a few years. That is as valuable as going to see the doctor and his telling me what I should be doing.

The right hon. Member for Rother Valley made the point that roll-out is patchy. In truth, many things are patchy. All we can do in the centre is try to encourage CCGs to consider the advantages of what they have in terms of their own business case: a reduction in the number of visits to GPs and so on.

On the role of pharmacy, the hon. Member for Linlithgow and East Falkirk rightly said that I was on record as saying that we have something to learn from where Scotland is in pharmacy. I will say it again: I think we have. We are doing our own review in England—the Murray review—of the services we want to see in pharmacies over the next few years. I have absolutely no hesitation or compunction in saying we could learn from Scotland. I do not take a “not invented here” view. A phrase I always used at work was “steal with pride”. If there are bits in the Scottish model that we can take and steal, we will.

On the direction of travel, the right hon. Member for Rother Valley chairs the APPG and he knows my view is that we need to move pharmacies away from predominantly dispensing and being paid for dispensing into a model with many more services in it. That is what we are determined to do. As we go through the process, that is what we will do. A fund of £300 million between now and 2020 has been set up. There is a lot of opportunity, and the hon. Member for Linlithgow and East Falkirk gave us some examples. We have announced two things already: the urgent medicine supply service and NHS 111. If someone is out of medicine, particularly if they have a long-term condition and have not had their prescription revalidated, NHS 111 has historically told them to go and see an out-of-hours GP or even an A&E service in order to meet a doctor to get the problem sorted. We are changing the script so that 200,000 calls a year will be directed to pharmacies, which will be empowered to make a judgment about the patient and will write the prescription and dispense the medicine. That is a big change and that is exactly where we need to go.

We heard from the hon. Member for Linlithgow and East Falkirk about the national minor ailments scheme. In England, we are now committed to rolling that out nationally by April 2018 so that the list of minor ailments that the hon. Member for Linlithgow and East Falkirk talked about will be treated in pharmacies in England. The pharmacist will be paid separately for the consultation and any dispensing that comes from it.

Another service-based activity in pharmacies was announced two weeks ago by Simon Stevens: the sore throat pilot. Pharmacists can do a test to determine whether someone’s sore throat is a bacterial or a viral issue. If it is bacterial, they will send someone to a doctor so that they can have antibiotics prescribed. If it is viral, they will not. As that service is rolled out nationally, it will save 800,000 GP consultations a year, but this all also relies on awareness and all that goes with that.

Diabetes self-care is a big area on which we can make progress. Diabetes is a growing problem and people will benefit greatly from individual care plans and social prescribing. We have changed the GP contract so that when GPs identify type 1 or type 2 diabetes, they put the person on a structured education course. GPs are now being paid for the numbers of people they get on to such courses. A big part of those education courses is explaining better to people how they can self-care.

I was going to talk about technology—I have probably spoken for long enough, but perhaps I will deal with some of the various points that were made. The right hon. Member for Rother Valley asked about the personal allowance in care homes, which he is right to say was not uprated. I will get back to him on the rationale for that. I suspect the reason is, as we know, that the care sector is under financial pressure. However, the money was not cut, but went to the rest of the adult social care budget. A judgment has to be made about what is adequate and where money is best spent, but I will write to him with a fuller answer to his question.

The right hon. Member for Rother Valley also talked about the need for a national strategy on self-care. I have been a Minister for about four months now. My general learning point would be that we need fewer strategies and more implementable plans, and I suspect the right hon. Gentleman would agree. We need to do things, and there are some things that are quite sensible. I have talked about some of them, but they need to happen. We need to go further and faster.

I agreed with much of what the hon. Member for Washington and Sunderland West said. She talked about a wholesale rethink, which is what we are trying to do with the STP process. The Opposition would do well to not necessarily oppose every part of that, but to act as critical friends, as all MPs must. She made good points about making every contact count. She talked a lot about common sense, which I completely agree with. I guess she will not be surprised to know that I am not going to talk to her about the autumn statement; all I will say on money is that the UK now spends more on health as a proportion of GDP than the OECD average. It is about one percentage point less than France and Germany; that is about where we are, and it is clearly critical that we look properly at every area of expenditure and maximise its value. I believe we did so with pharmacy, and we are trying to do it with the STPs, as regards the difference between secondary care and primary care.

The hon. Member for Linlithgow and East Falkirk made the point that in the thrust towards self-care—which is right—we must still be careful to say that people sometimes need to see a doctor. Sometimes there is something serious wrong. Too many people go to the doctor too often with trivial things; but on the other hand people do not always know when they have the initial symptom of something serious—it can be something that looks benign, or a lump or something. It is important to understand that GPs are there to look after such things. We need to be aware of that in the drive towards self-care. I thank the hon. Members who spoke in the debate.

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.


That this House has considered Self Care Week 2016.

Sitting suspended.