Self-Care Matters: How to improve health outcomes and build a stronger NHS
As the National Health Service struggles to cope with limited resources and rising demand, could self-care be a solution? Geoffrey Lyons reports
In February, health minister Steve Brine told The House that nobody should be surprised if he and his colleagues argue for more NHS funding. "Bluntly, it's what we've done every year, year-on-year since we came to office." Four months later, Brine’s wish came true in the form of a £20bn a year spending boots to help the beleaguered health service deal with the dual pressures of increased demand and dwindling resources – a topic hotly debated as it celebrates its 70th anniversary this month.
To mark the anniversary, The House partnered with global life sciences company Sanofi to host a roundtable discussion on the importance of self-care, and how such a deceptively simple solution has tremendous potential to free-up resources and improve health outcomes.
“We think of self-care as the holy grail of sustainable healthcare,” says Professor Matthew Cripps, whose job as director of evidence-based practice at NHS Rightcare is to identify policy actions that can ultimately improve health outcomes. “Policy is made up of inputs and outputs,” he says. “With self-care, the input is more decision-making and the output is better health.”
Chris Mummery, Sanofi’s head of northern & southern Europe consumer healthcare, says he’s lucky to have been taught the merits of self-care at a young age. “My mother was a nurse, and she drilled into me the importance of taking control of my health,” he says. But for society as a whole to embrace self-care, stakeholders need to work together to raise awareness. “It’s only going to work if there’s a collaborative discussion between industry leaders, policymakers and patient groups,” he says.
Mummery and others believe there are significant barriers to making self-care more commonplace. Alison Reid, chief executive of the IBS Network, says there’s often a failure on the part of GPs to diagnose conditions that can be managed independently. “If you signpost people with IBS, then we can help support them in managing,” she says. “But we’re just not getting through.”
Carla Jones, Chief Executive of Allergy UK, has the same frustration. “Many people come to us because they are self-caring, but the problem is that they’re also self-diagnosing,” she says. “If you have an estimated third of the population with allergies, we need to get that first part of the problem right, and that’s diagnosis,” she says.
The roundtable participants are unanimous in believing that more should be done to ease the burden on GP practices and A&E services by encouraging visits to the local pharmacy. “The best relationships are where the GP is also promoting the pharmacy,” says Shilpa Shah, pharmacist area manager for Lloyds Pharmacy South East London. “But where we want to go is to have people come to us first, and then go to their GP.”
James Lindsay, head of corporate communications at Phoenix Medical, thinks much can be learned by looking north. “Have a look at Scotland,” he says. “If you want to provide pharmacy services in Scotland, the GP does the diagnosis but the ongoing management of that patient rests with the pharmacist.”
Part of the problem is that pharmacies are not commonly recognised as the easiest point of access. Malcolm Harrison, chief executive at Company Chemists Association, says that patients want to go where they know they’ll get a full range of treatment. “Ultimately they know that the lights are always on at A&E, and that’s the problem because the costs are high and that’s a bottleneck that the NHS has to deal with,” he says.
Alister Huong, head of pharmacy experience at Boots UK, thinks that changing people’s default views towards pharmacies must ultimately be a collaborative effort. “We need to put some structures in place with the support of everyone involved,” he says, stressing the importance of educating people on the advice and services that pharmacists offer. “We need to put the community pharmacist in people’s minds. When we do that, we won’t hear any more radio broadcasts about sending people to the GP.”
But even when patients understand how they can benefit from pharmacy services, they often still won’t go. That’s because, as Nikki Milne, Sanofi’s head of sales and trade marketing UK argues, there’s sometimes an element of shame involved in making the visit. “If someone has severe headache pain, they don’t feel worthy enough to ask for advice,” she says.
Julie Cooper MP, shadow minister for community health, says patients sometimes have a “niggling worry” that they don’t have the confidence to raise an issue with the pharmacist. Reid of IBS Network can vouch for this. Not only do people who suffer from IBS often feel embarrassed by their symptoms – “nobody wants to speak to a pharmacist about a bit of wind,” Reid says – they’re also often made to feel, by GPs especially, that the source of their illness is an inability to cope. “There’s a feeling of shame that they’re not coping and they’ve been told that they need to cope,” she says.
Baroness Jolly, Liberal Democrat spokesperson for health issues, says the issue often boils down to whether the patient has a prescription. “When you don’t have a prescription, you don’t feel you have the right to ask questions,” she says.
While these cultural barriers may take time to erode, there’s a physical barrier that could be knocked down immediately: the counter. Heidi Wright, policy and practice lead at the Royal Pharmaceutical Society, says RPS is “pushing more and more” for the pharmacist to get out from behind the counter and engage more with patients.
Dr. Roberto Labella, head of medical affairs for Sanofi’s Northern and Southern Europe Consumer Healthcare division, is completely on board with this idea. “What you see in Europe is that there really isn’t a counter,” he says. “You see pharmacists strolling through talking with patients and taking time to answer questions. If you change physical environments you can change behaviours immediately.”
But it’s not just the counter that’s the problem – it’s what pharmacists are doing behind the counter that’s keeping them from engaging with patients. John Smith, chief executive at the Proprietary Association of Great Britain, argues that pharmacists are spending too much time dispensing prescriptions. “90% of a pharmacist’s profits come from prescriptions,” he says. “And that needs to change.” Wright agrees, making the point that pharmacy funding models need to better incorporate the services they provide.
The general consensus is that small tweaks like these can go a long way in fostering a culture in which self-care is a more favoured option. The hope, ultimately, is that this would culminate in substantial savings for the NHS and observable improvements in people’s health.
To help aid the roundtable discussion, Sanofi commissioned Kantar TNS to survey 1,200 members of the public about self-care. They found that:
- The pharmacist is the most often chosen source of advice regarding minor ailments and conditions
- 65% of respondents said they go all or some of the time to the pharmacist for advice on minor self-treatable conditions or ailments
- Googling symptoms is the most popular method for advice and access
- 20% of respondents don’t seek advice from any source
- Women are more likely than men to seek advice from a pharmacist