Jon Cruddas (Dagenham and Rainham) (Lab) I beg to move, That this
House has considered Allergy Awareness Week. This afternoon I will
raise a number of points about improving allergy services in the
NHS, but first I thank the Backbench Business Committee for
granting time for the debate. What we are talking about matters to
an awful lot of people. Millions across the country suffer from at
least one allergy. It is estimated that 44% of adults and some 50%
of...Request free trial
(Dagenham and Rainham) (Lab)
I beg to move,
That this House has considered Allergy Awareness Week.
This afternoon I will raise a number of points about improving
allergy services in the NHS, but first I thank the Backbench
Business Committee for granting time for the debate.
What we are talking about matters to an awful lot of people.
Millions across the country suffer from at least one allergy. It
is estimated that 44% of adults and some 50% of children in the
UK have one or more allergic disorders. While allergies have
increased globally in prevalence, complexity and severity over
the last 60 years or so, the UK rates are among the highest in
the world.
I pay tribute to the allergy community for its contribution
throughout the year, which was showcased during the recent
Allergy Awareness Week. I acknowledge the extraordinary work of
charities, research bodies, academics and health practitioners,
as well as numerous individuals and families, all fighting for
support and help on food labelling, NHS services, awareness in
schools and much more, given the extraordinary growth in allergic
conditions over the last couple of decades.
It is worth being clear from the outset what we are talking
about. An allergy is a hypersensitivity reaction, or an
exaggerated sensitivity, to substances known as allergens, which
are normally tolerated across most communities. Examples include
peanuts, milk, shellfish, cats, medicine and grass pollens. These
can trigger harmful antibodies and the release of inflammatory
chemicals, causing symptoms such as sneezing, itches, rashes and
falls in blood pressure, yet they may also cause narrowing of
airways, shortness of breath and wheezing, and swelling that, if
in the mouth, throat or airway, causes severe difficulty in
breathing and can be life-threatening.
There is a modern-day epidemic in allergy, one that I would argue
is neglected by the NHS. We are all aware of recent high-profile,
tragic cases of fatal anaphylaxis brought on by issues such as
food labelling, shortcomings in NHS service provision, and a lack
of public understanding across the wider community. Those recent
tragedies have brought all that into sharp focus, and they are
occurring with a regularity that should worry us all.
The figures speak for themselves. One third of the
population—some 20 million people in the UK—are living with an
allergic condition, and 5 million have a severe enough condition
to require specialist care. Fatal and near-fatal reactions
regularly occur due to foods, drugs and insect stings, and have
been increasing in recent years. There has been a 615% increase
in hospital admissions related to allergic disease in the last 20
years.
The percentages of children diagnosed with allergic rhinitis and
with eczema have trebled over the last 30 years. More than
200,000 people now require the prescription of emergency
adrenaline due to the severity of their allergic condition, and
each year new births add some 43,000 cases of child allergy to
the population in need. The figures are quite extraordinary.
Despite all that, specialist services delivered by trained
paediatric allergists are available to only a minority of those
with severe disease.
What is so frustrating for so many is that over the last two
decades a series of reports have consistently demonstrated the
prevalence of allergic disease, the patient need and the lack of
UK service provision. I will list some of the reports. There were
two Royal College of Physicians reports, in 2003 and 2010, on
allergy and the unmet need. The 2003 report was so disturbing and
so scathing that in 2006 the Department of Health conducted its
own review of allergy services. We also had a 2004 House of
Commons Health Committee report on the provision of allergy
services and a 2007 House of Lords Science and Technology
Committee report on allergy. In autumn 2021, the all-party
parliamentary group on allergy, alongside the National Allergy
Strategy Group, published “Meeting the challenges of the National
Allergy Crisis”.
All those reports consistently highlighted how allergy remains
poorly managed across the NHS due to lack of training and
expertise. All recommended significant improvement in specialist
services, as well as improved knowledge and awareness in primary
care. They all talked about the need for a national allergy
action plan, and for a national lead person responsible for
allergy services and provision at NHS England or the Department
of Health and Social Care—often referred to in shorthand as an
allergy tsar.
That is not to say that nothing has changed over the last 20
years. We have seen National Institute for Health and Care
Excellence guidelines on allergy and care pathways for children
with allergic disease. Natasha’s law came into force on 1 October
2021 to regulate labelling on pre-packaged food for direct sale.
But the truth is that very little has changed over the last 20
years, apart from the increased prevalence of the conditions.
The economic case for prevention-orientated allergy services is
strong. The estimated cost of allergy-related illness was
calculated in 2004 as £1 billion a year. Since then, admissions
to hospital with anaphylaxis have increased by 200% to 300%.
Primary care visits for allergy have increased, now accounting
for 8% of total GP consultations. Put simply, the complexity and
severity of allergy has increased, as has the number of patients
affected, placing huge strain on the system. Those are the basic
facts and change is long overdue. Beyond the statistics, for the
growing number of people living with allergic disease, their
conditions can have a significant negative impact on the lives
that they and their families live. It is frightening and
restrictive to live with a condition that could cause a severe or
life-threatening reaction literally at any time of the day.
Each report I mentioned concludes that allergy has largely been
ignored and is poorly managed across the NHS due to a lack of
training and expertise. The core problem is the very small number
of consultants in adult and paediatric allergy, and the fact that
most GPs receive no training in allergy. That basic mismatch
between the rising demand and the poor service needs correction.
There are only 11 specialist allergy training posts for doctors
in England and only two qualify each year, despite the 2004
report recommending some 20 years ago that 40 doctors a year
should qualify. There are too few consultants, and only 40 adult
allergists and a similar number of paediatric allergists working
in a very small number of allergy centres.
The day-to-day reality is that NHS patients face a postcode
lottery. They are hampered by wrong referrals and re-referrals,
or they get no referral. They face denial of choice and of the
benefits of the improvement in allergy care. In short, there is
significant unmet need. Paradoxically, the UK is one of the
world’s leaders in allergy research.
The reports that I have referred to, which span some 20 years,
offer an agenda for change. All four contain basic
recommendations; there are themes that recur all the time. First,
we need a national plan for allergy. We should make allergy a
priority and invest in a national plan led by a designated
Department of Health and Social Care civil servant or NHS lead
with sufficient authority to implement change—a national clinical
director for allergy.
Secondly, there is a need for specialist care. We should expand
the specialist workforce as a priority and ensure that training
programmes prioritise allergy so that specialists of the future
are appropriately trained and can deliver safe care.
Thirdly, we need to ensure that all GPs and healthcare
professionals in primary care have knowledge of allergic disease,
that allergy is included in the GP curriculum and exit
examination, and that allergy education is improved for already
qualified GPs in ongoing professional appraisal. On a positive
note, I should add that the Royal College of General
Practitioners has recently added allergy to new GP exams, which
is a welcome intervention.
Fourthly, we need to ensure that local commissioners understand
the allergy needs of their populations. Commissioners should
ensure access to adult and paediatric allergy consultants and
allergy pathways.
Allergy remains a small specialism; not only do patients not know
where to turn, but healthcare professionals themselves often do
not know the best pathway to send their patients on. GPs receive
so little training and the responsibility for managing adult
allergy services remains unclear and ambiguous.
Every sufferer should have a right to receive quality care. To
achieve that, Allergy UK has developed a patients’ charter, in
consultation with patients and clinicians, to deliver a gold
standard of patient rights and care for those living with
allergic disease. It calls for a healthcare system that
recognises allergy as a chronic long-term condition and provides
continuity of care and timely diagnoses. It should not be beyond
our collective wit to provide that, yet recent NHS reforms may
mean that we are heading in a very different direction.
Today, 42 statutory integrated care systems, each with an
integrated care board and an integrated care partnership, are
responsible for planning and funding NHS services. It was
recently announced that allergy services would be commissioned by
ICBs and not centralised. What does that mean for the postcode
lottery in the system and for the development of a national
plan?
Allergy UK reports that 93% of ICBs responsible for commissioning
services to support the allergic community have not even the
scantest picture of the potential needs of their populations in
terms of allergy services. Not one ICB held data on whether there
were any specialist allergy nurses or dieticians in its
region.
As it is, specialist allergy services are very limited outside
the south-east. Two hospitals in the south-east—Guy’s and St
Thomas’s, and Southampton General—are accredited as World Allergy
Organisation centres of excellence, but even those living in the
south-east of England struggle to access decent care and the
right care. The north and the west of England, along with Wales,
are especially deprived of services. As I mentioned, there are
only 40 adult allergy consultants in the UK and even fewer
paediatric allergy specialists. That is equivalent to one adult
allergy specialist per 1.3 million of the adult population. As
far back as 2003, the Royal College of Physicians advised that
200 consultant adult allergists were required.
I do not want to sound too negative, so I will point to two
important recent developments. The first is an example of what
can be done on the ground. Allergy UK recently invested £500,000
in a research project with the University of Edinburgh to trial a
new nurse-led allergy centre in primary care. Thirty-eight
clinical practices were allowed to refer patients to two
specialist allergy nurses, who held six clinical sessions each
week.
The trial resulted in 426 patients being referred to the
specialist allergy nurse clinics, of whom 53% were young people
and adults with a history of anaphylaxis or suspected
anaphylaxis. Three hundred and eighty-three of the patients seen
in a clinic would otherwise have been referred on to secondary
care. Only 5% of those had an onward referral to secondary care.
Eighty-two per cent. said they had seen improvements in their
allergic conditions since attending the clinic, which is a very
positive result.
The trial demonstrated that a nurse-led, primary care- based
allergy clinic can work for patients and take pressure off other
NHS services. Allergy UK is now calling for each ICS to have a
fully funded specialist allergy service with a specialist allergy
nurse and one specialist dietician. That sounds to me like quite
a practical intervention that could achieve a lot very
quickly.
Secondly, I want to acknowledge some progress in the Department
over the last year and a half. The previous Minister for care and
mental health, the right hon. Member for Chichester (), demonstrated real
commitment in this area, and I put on the record our appreciation
for what she did. Since autumn 2021, we have established a work
programme and an ongoing dialogue between civil servants and
representatives of the National Allergy Strategy Group.
The NASG has held several meetings with the long-term conditions
team in the DHSC to discuss the need for a lead and expert
advisers to support on development of a national plan for
allergy. A proposal and terms of reference have been drafted, and
they are currently within the DHSC. The hope is that those
discussions will continue and move forward so that an expert
group can be established in the very near future. That could be
one of the most significant outcomes of the last 20 years. I
commend the Government for that, and look forward to the
Minister—I hope—recommitting to that programme of work and
partnership working this afternoon.
I could have discussed many other issues today, including
labelling, allergies in schools, and the regulation of products
in takeaways and restaurants. On Monday, we will have a chance to
discuss some of that territory when we debate the two e-petitions
relevant to this debate. The first, e-petition 589716, calls for
the appointment of an allergy tsar as a champion for people
living with allergies. Over 20,000 people have signed it to date.
The second, e-petition 585304, relates to “Owen’s law,” a change
in the law on allergy labelling in UK restaurants. I think over
13,000 people have signed that petition to date. I congratulate
the organisers. Tens of thousands of people are mobilising and
demanding change, and businesses are responding too: in March
2023, the bosses of 11 leading food businesses, including Tesco
and Sainsbury’s, called for clearer rules on food labelling
following recent tragic and preventable deaths.
Next year marks the 20th anniversary of the publication of the
Health Committee’s landmark report, “The Provision of Allergy
Services”. The report recommended implementing a “modern allergy
service” with specialist allergy doctors and a focus on primary
care. Simply put, the vast majority of those recommendations
remain unmet. We have lost 20 years, and nothing has really
changed. On behalf of the many millions of people suffering from
allergy conditions, I urge the Government to acknowledge allergy
as a public health priority. Lives, as well as the quality of
life of many of our fellow citizens, depend on it.
1.46pm
Mr (Old Bexley and Sidcup)
(Con)
It is great to see you in the Chair today, Ms Ali. It is a
pleasure to speak in today’s important debate on allergy. I
congratulate and thank the hon. Member for Dagenham and Rainham
() for securing it, and I echo many of the sentiments
that he expressed. I thank all the excellent campaigners across
the UK whose lives have been impacted by allergies, especially
those families who have tragically lost loved ones and continue
to campaign to raise public awareness and to lobby for policy
changes. They are an inspiration to us all.
As the Member of Parliament for Old Bexley and Sidcup, let me
also highlight the crucial and often lifesaving work of Allergy
UK, which is based in Sidcup and supports individuals and
families across the country via a range of allergy-related
guidance and services. Those include a helpline and a dietician
service to help the parents of young children who have symptoms
of food allergy and have not yet been referred to a dietician. I
had the privilege of visiting the hard-working team in Sidcup
last year to see its work at first hand. I am very sorry that
Carla will soon be leaving, and I thank her for her fantastic
leadership and all her hard work for the all-party parliamentary
group on allergy.
As we have heard already, an awareness among patients and in the
NHS of how allergies can impact our health can be a matter of
life and death. That is why I support Allergy UK’s mission for
everyone in the UK to take allergy seriously. I must admit that I
never did so before I met the team and allergy experts from
across the country. After I mentioned that I suffer with hay
fever each year, they gave me more information on the various
types of pollen than my brain could digest, and lots of great
advice on how to manage my allergies. If they are watching today,
I promise them that I did listen—I am sniffling a lot less than I
would normally at this time of year.
Mine is just one relatively minor case, and hay fever is a common
example of an allergy. Living with any kind of allergy is
challenging and can impact the quality of a person’s life, but
food allergies can trigger very severe reactions and, without
emergency treatment, present a risk to life. Understanding that
is vital, not just for patients but for medical
professionals.
It is estimated that 41 million people in the UK live with
allergic disease and that 50% of children are affected by one or
more allergic disorders. However, there is a significant gap in
both awareness and healthcare services for those affected by this
disease of the immune system. That is why I signed the patient
charter,and why I back Allergy UK’s campaigns to raise awareness,
including in schools, and to introduce allergy nurse and
dietician services in GP practices.
Regional integrated care boards have a clear role to play in the
new NHS structure in helping to close that gap. I look forward to
hearing more from my hon. Friend the Minister about how the
Government can support that endeavour with the significant money
being allocated to the NHS to help to improve health outcomes,
and how the Government can address the estimated £1 billion
annual cost of NHS prescriptions to help to manage allergy
symptoms and the increase in hospital admissions highlighted by
the hon. Member for Dagenham and Rainham.
The service specification sets out that providers should deliver
a diagnostic package for the investigation of suspected allergic
diseases, including initial consultation and follow-up in a
dedicated allergy clinic and specialised allergy tests, but the
evidence is clear that we need more specialists across the
country to avoid a postcode lottery for individuals and families.
There are resources available to support healthcare professionals
in making referrals to specialist services, including guidance
from the British Society for Allergy and Clinical Immunology, the
National Institute for Health and Care Excellence and the Royal
College of Paediatrics and Child Health, but we must continue to
promote them to medical professionals.
We have made progress in recent years. The most obvious example
is Natasha’s law, which came into force on 1 October 2021. It
requires all food retailers and operators to display full
ingredient and allergen information on every food item they sell
pre-packed for direct sale. That gives the millions throughout
the UK who are living with food allergies and intolerances better
protection and more confidence in the food they buy. I again
thank all the campaigners across the country, including Natasha’s
family and Allergy UK, as we continue to raise awareness and make
vital calls, not just in Allergy Awareness Week but throughout
the year.
1.51pm
(Pontypridd) (Lab)
It is an honour to serve under your chairship, Ms Ali, and to
follow the hon. Member for Old Bexley and Sidcup (Mr French). I
hugely congratulate and thank my hon. Friend the Member for
Dagenham and Rainham () for securing this really important debate. I am
pleased that this important issue has been given the attention in
Parliament that it deserves. As my hon. Friend said, on Monday
colleagues will be debating two widely signed petitions on food
labelling and allergy healthcare. Given that Allergy Awareness
Week was just a few weeks ago, it is right that colleagues come
together this afternoon to mark its importance.
I put on the record my heartfelt thanks to the campaign groups
and individuals who got in touch with me ahead of this debate,
including Owen’s Law, Allergy UK and the Natasha Allergy Research
Foundation. It is thanks to their tireless hard work, often
following tragic events, that we are to have this important
series of debates over the coming days.
Marking Allergy Awareness Week gives us a timely opportunity to
discuss an important issue that affects thousands upon thousands
of people, if not millions, every year. Often, their difficulties
go unnoticed. A shocking one in three people in the UK are living
with some sort of allergic condition, and sadly that figure rises
to one in two among children. I know that all too well because
this issue is personal to me: when my son Sullivan was six months
old, my husband and I made the terrifying discovery that he is
severely allergic to peanuts. He had to be rushed to hospital,
which would make any mother’s stomach drop with fear. I am
pleased to report that he is now a happy, healthy four-year-old,
but we will forever need to pay extremely close attention to what
he eats and comes into contact with. Hundreds of parents across
the UK can speak of similar experiences.
I was shocked to learn that there has been a massive 600%
increase in allergy-related hospital admissions in the past 20
years, but despite that massive influx there are just 40 adult
allergy consultants across the whole UK. That equates to one
allergy specialist per 1.3 million adults.
Ahead of today’s debate, a constituent emailed me to share her
experiences of caring for her son, who has severe allergies: he
is allergic to milk, wheat, egg, soy and peanuts and to pollen
and dust mites, among many other things. As I am sure hon.
Members can imagine, her son’s condition has massively affected
his quality of life, as well as hers as a mother. Navigating
daily life is a constant struggle for my constituent and her son
in ways that those of us who do not live with debilitating
allergies give little thought to. She told me that her son’s
ability to participate in activities that other children
routinely enjoy has been completely hampered by his condition. It
is a truly heartbreaking situation for all involved. One of the
main barriers that my constituent and her son face is the
complete lack of joined-up thinking across services, including
education, healthcare and hospitality. She feels that there is a
real lack of awareness and understanding of what her son requires
in order to be given the basic opportunities that we take for
granted. Among those everyday issues is food labelling in
hospitality.
I am pleased that one of the petitions to be debated next week is
on Owen’s law, which would see stronger regulation on allergy
labelling in restaurants. For colleagues who are not aware, Owen
Carey tragically died of anaphylaxis in 2017 after eating chicken
marinated in buttermilk, to which he was severely allergic. On
the menu at the restaurant he ate at, the chicken was erroneously
listed as plain grilled. Owen’s family have been tirelessly
campaigning for a change in the law, and they have my full
support.
I welcome the fact that the UK Government stated last year that
the Food Standards Agency was considering how to improve food
labelling, and I am pleased that Labour has acknowledged the
importance of clearly labelled allergen information, but for many
families, such as my constituent and her son, action is urgently
needed now, not at some point down the line. The current
regulations require hospitality businesses to provide consumers
with information about 14 allergens, but, crucially, the format
in which that information is to be conveyed is not specified in
law and can vary greatly in certain restaurants.
Owen’s law would ensure that accurate allergen information is put
on the face of restaurant menus and that there is more stringent
training for staff. Together, these simple measures would make an
enormous difference and prevent any further tragic deaths like
Owen’s. The changes would also make a small but significant
difference to the lives of those who are blighted by allergies
and anaphylaxis. For my constituent and her son, clear and
standardised allergen labelling would make navigating the
otherwise extremely difficult experience of attending any
restaurant just that little bit easier.
The Natasha Allergy Research Foundation secured a monumental
victory in changing the law on pre-packaged food labelling
following the tragic death of Natasha Ednan-Laperouse in 2016,
but it is absolutely right to say that we have so much more work
to do to prevent us from letting vulnerable people down any
further. The foundation is now calling for the appointment of an
allergy tsar at the heart of the NHS to champion people with
allergies across the UK and ensure that they receive appropriate
support. I would welcome that move.
I hope that the Minister is able to feed back to her colleagues
in the Government on the proposals as far as NHS England is
concerned. I also invite her to set out a timeline for when we
can expect Owen’s law to be implemented. Allergies can ruin
lives, but often that is forgotten by so many. I sincerely hope
that the Minister recognises the severity of this issue. I look
forward to working with her and her Government to tackle the
issue at its root, once and for all.
1.56pm
(Linlithgow and East Falkirk)
(SNP)
May I express my gratitude to the hon. Member for Dagenham and
Rainham () for securing today’s debate and for the
comprehensive manner in which he opened it? He said much that I
can agree with. Indeed, there is not that much left to say,
because it was a very comprehensive introduction.
I am grateful to the patient charity Allergy UK for its very
informative briefing ahead of the debate and for its sterling
work over more than three decades in raising awareness and
supporting people living with allergies, who represent a
significant proportion of the population across these islands.
Allergy Awareness Week was held from 24 to 28 April and was
initiated by Allergy UK, which is urging every NHS integrated
care board in the UK to appoint at least one allergy nurse and
dietician. Allergy UK believes that this measure would enhance
the standard and the promptness of the care, advice and support
available to allergy sufferers. It is hard to disagree with that.
We really must ensure that all people living with allergies can
access the best possible care and support, and we must recognise
that rising food prices are having a disproportionate impact on
many of those with allergies. We must also acknowledge that
climate change, which is extending the length of the pollen
season, is having an adverse effect on many people.
Across the UK, 21 million people have an allergy. That is one of
the highest rates in the world. We have seen an increase of 650%
in hospital admissions for allergic conditions over the past 20
years, which is truly staggering. An allergy is the immune
system’s reaction to normally harmless substances such as pollen,
food or house dust mites, which can trigger an adverse response
in allergic individuals, ranging from localised itching to
potentially fatal anaphylaxis. According to Allergy UK, the most
common causes of allergic reactions are pollen from trees and
grasses; proteins secreted from house dust mites; mould; food
such as peanuts, tree nuts, milk and eggs; pets such as cats and
dogs, and other furry or hairy animals; insects such as wasps and
bees; and even medicines. It is quite a lengthy list.
I have been fortunate not to have any allergies. Looking back on
my life, I do not recall allergies being on the same scale as
they are now. When I was a young man, I was sent to school with
peanuts as a treat on occasion. I thought that was great, but we
would never dream of doing it now.
The world has changed quite dramatically, and not for the best.
Allergies are very common in children; some go away as a child
gets older, but not all do. We know that fewer pensioners have
allergies and that incidence is significantly higher among
under-35s. It has also been suggested that we may be paying the
price for being too hygienic and insufficiently exposed to
bacteria that would help to train the immune system. Sometimes in
life it seems that you can never win.
In Scotland, most allergic conditions are treated through primary
care. The Scottish Government are committed to ensuring that
people living with an allergic condition receive the care they
need when they need it. GPs in primary care are at the heart of
the healthcare system. The Scottish Government are investing in
multidisciplinary teams to increase the capacity in primary care,
which will allow patients to be seen at the right time by the
right person.
Asthma continues to be the most common allergic condition,
accounting for 69% of the approximately 5,100 allergy-related
hospital admissions each year in Scotland. The Scottish
Government are providing guidance to education authorities,
health boards and schools to fulfil their obligations to students
and their healthcare requirements. In December 2017 they
published guidance for supporting students’ healthcare needs,
including a section on allergic reactions and anaphylaxis. I
think we would probably all benefit from knowing a bit more about
what to do if someone is exposed to that situation. I would be
lost if it happened in front of me in my office, so I think there
is a lesson there for all of us. We need to know more and to be
able to help when something goes wrong.
Food is a large factor. I welcome the new legislation, which has
been referred to as Natasha’s law, requiring food businesses in
Scotland and throughout the rest of the UK to label all
pre-packed food for direct sale with a complete ingredient list.
The law, which came into effect in October 2021, was implemented
after the sad death of 15-year-old Natasha Ednan-Laperouse, who
suffered a fatal allergic reaction to a pre-packed sandwich
containing undeclared sesame seeds. It applies to products such
as pre-wrapped sandwiches, fast food and daily items such as
cheese and meat that are already wrapped for service. The Food
Standards Scotland chief executive, Geoff Ogle, said:
“This is a huge step in helping improve the quality of life for
around two million people living with food allergies in the
UK—with 200,000 of those living here in Scotland.”
I echo his comments. I also echo the calls from other Members to
see more progress with Owen’s law so that anyone can eat out
safely.
Grocery prices are continuing to climb, and those with allergies
or special dietary requirements are being disproportionately hit.
I urge the UK Government to better support people with allergies
during the cost of living crisis. Statistics from January this
year show that households with specific dietary requirements can
be paying up to 73% more for their food than those who do not
need to buy “free from” products, according to analysis by the
allergy team. Pea milk is £2 per litre, roughly 50% more
expensive than cows’ milk. Gluten-free penne pasta at Morrisons
jumped by 125% in 12 months, from 60p in January 2022 to £1.35
this January. The cost of Sainsbury’s Nurishh vegan cheddar-style
cheese slices alternative increased by 67% from £1.50 to £2.50,
while the cost of Alpro soya growing-up milk at Asda increased by
27% from £1.50 to £1.90. For a lot of people who have no
alternative, that is simply not affordable.
In Scotland, people who have been clinically diagnosed with
coeliac disease or dermatitis herpetiformis—I probably pronounced
that as badly as I typed it last night—can receive a range of
gluten-free food on prescription at no charge. Perhaps the UK
should look at that. There is more that each of our nations need
to do for the increasing numbers of people who are living with
allergies. That does not just go for health treatments; we must
also tackle the cost of living and climate change.
2.03pm
(Bristol South) (Lab)
It is a pleasure to serve under your chairship, Ms Ali. I pay
tribute to my hon. Friend the Member for Dagenham and Rainham
() for securing this debate and for his continued
commitment to this issue. The petitions that are coming forward
highlight the level of concern and interest in this area. It is
right that we are debating it in this place.
We are witnessing a burgeoning rise in allergic disease in the
UK. This country is in the top three in the world for the highest
incidence of allergies. One third of the UK population are living
with a condition and, perhaps more worryingly, 50% of children
are affected by one or more allergic disorders. They are
stressful and worrying conditions, with continual and often
costly adjustments to guard against allergic reactions. In a few
tragic cases, they can be fatal. Allergies can cause not only
symptoms such as sneezing, itches, rashes and falls in blood
pressure, but airway narrowing, shortness of breath, wheezing and
swelling, which in the mouth area leads to severe difficulty in
breathing and can be life-threatening.
As we have heard, allergies are most common in children. As my
hon. Friend said, it is terrifying when people, particularly
children, are rushed to A&E, sometimes with tragic results.
My hon. Friend the Member for Pontypridd () highlighted her
experience with her own child, and it is something that I too
have witnessed with a family member.
We have heard about the too frequent fatalities, mostly of young
people, including Natasha Ednan-Laperouse. It is thanks to her
parents and others that full ingredient and allergen labelling on
pre-packed food for sale was introduced in October 2021. We pay
tribute to them and to all families who have raised awareness in
such circumstances. It is not something that any parent would
want to have to do.
We have also heard about the incredible rise in hospital
admissions over the past 20 years. I agree with the hon. Member
for Linlithgow and East Falkirk () that it was perhaps not
recognised much when we were at school. The growth has been quite
phenomenal. The hon. Member for Old Bexley and Sidcup (Mr French)
has found out what we have all found out: that the great
privilege of coming to this place is learning so much from our
constituents and campaigners about issues that we may not have
been aware of, and being able to present them in this place.
We now know that there are only 40 allergy consultants in the UK,
and even fewer in paediatrics—the equivalent of only one per 1.3
million of the adult population. As far back as 2003, the Royal
College of Physicians advised that 200 consultant allergists were
required. Despite further warnings and criticism over the past
two decades, the provision is wholly inadequate. The first Health
Committee report highlighting the inadequacy of service was in
2004. In 2006, there was a report so scathing that the then
Labour Government’s Department of Health conducted a review. In
2007, 2010 and 2021, we had further reports from the House of
Lords Science and Technology Committee, the Royal College of
Pathologists and most recently the APPG, all of which further
acknowledged the continued failures without much progress.
After 13 years, we look forward to the Minister giving us a bit
of hope for the future. It is vital that there are allergy
services across all integrated care systems, but as we heard from
my hon. Friend the Member for Dagenham and Rainham, more than
half of ICBs have said that they do not hold that data and are
not across the issues in their own populations. Last year, the
then care Minister, the right hon. Member for Chichester (), said that
“we will continue to support people living with allergies through
NIHR research and exploring and investing in new
treatments.”—[Official Report, 9 March 2022; Vol. 710, c.
134-135WH.]
We would welcome an update from today’s Minister on what steps
have been taken to ensure that allergy services are available in
all ICS areas.
The NHS’s capacity to tackle allergic disease has been lowered by
the unprecedented pressures it is facing under this Conservative
Government. More than 7 million people are waiting for NHS
treatment, compared with more than 4 million before the pandemic.
They are waiting in pain and discomfort, on record waiting lists,
and there are staff vacancies of more than 100,000. Those
awaiting treatment for allergies face long wait times as well as
delayed diagnosis and treatment. That, in turn, increases the
chance of more severe allergic reactions developing, which will
often require admission to secondary care— something that none of
us should want to see. Again, that is increasing the pressure on
services by taking up time in A&E and is resulting in more
expensive treatments.
Will the Minister explain what her Government are doing to tackle
the waiting times for diagnosis and treatment? Last year, the
then Minister also stated:
“The FSA is currently undertaking a programme of work to improve
the quality of life for people living with food hypersensitivity
and provide support to make safe, informed food choices to
effectively manage risk.”—[Official Report, 9 March 2022; Vol.
710, c. 134WH.]
Those are words that I am sure today’s Minister recognises.
Again, we would all welcome an update on where that work has got
to.
There is hope for people living with an allergy. Given the right
amount of research funding in the next couple of decades,
treatments can be found that will potentially eradicate many
allergies. I would be grateful if the Minister set out what
action is being taken to support forward-looking research into
potentially lifesaving treatments.
2.09pm
The Minister for Social Care ()
It is a pleasure to serve under your chairmanship, Ms Ali. I
thank the hon. Member for Dagenham and Rainham () for securing a debate on this important issue, and
for his continued work advocating on behalf of those with
allergies, particularly through chairing the all-party
parliamentary group on allergy.
Millions of people, many of them children, are affected by
allergy, so I am sure that the points raised by hon. Members will
resonate with families across the country. My brother has asthma,
which at times has had a severe impact on his life, and which can
be very frightening. I also have a close cousin who has multiple
food allergies; I remember that when we were children, those
allergies could be worrying or even frightening. Members here and
many people across the country have experience, whether directly
or through close family and friends, of allergies that can make
life really difficult and at times very scary.
Among other things, the hon. Member for Dagenham and Rainham
spoke about the huge number of people affected by allergies,
their increasing prevalence, and the resulting increasing need
for healthcare and support. He also spoke about how frightening
and restricted life can be for people living with a severe
allergy, and the need for more specialist NHS staff and
generalist allergy training. He acknowledged that the UK is a
world leader in allergy research, and I heard his several clear
asks for Government support for people affected by allergies.
My hon. Friend the Member for Old Bexley and Sidcup (Mr French)
is a hay fever sufferer, but he spoke today because his
constituency hosts Allergy UK, which does very important work to
raise awareness of allergies, and to support people with
allergies and their families. He spoke of the importance of
diagnostic services, the need for specialists, and the variation
across the country in the services and support available. He also
spoke about the progress we have made in recent years, which
includes, very importantly, the introduction of Natasha’s law,
which has improved food labelling. I thank him for the work he is
doing to raise awareness of allergies and their impact on
people’s lives.
The hon. Member for Pontypridd () spoke about her
personal experience with her son, and how she found out about his
allergy. It must have been extremely alarming to find out, when
he was only six months old, how allergic he is to peanuts; I can
imagine that that was just at the point when he might have been
moving on to solid foods. Parents do not know what they will find
out. I can imagine how alarming it must have been to rush to
hospital with such a small child. Clearly, there are things that
must make life difficult day to day for her son, but I am glad
that it sounds as though he is doing well after that very
frightening experience. She also talked about the hard work of
campaign groups, including the amazingly effective campaigning of
families who have tragically lost loved ones as a result of their
allergies. She also spoke about the huge increase in hospital
admissions in the last 20 years of people who have severe
allergic reactions.
Like the hon. Lady and other hon. Members, I recognise the work
of all the organisations that support people with allergies,
including charities such as Allergy UK, Anaphylaxis UK and the
National Allergy Strategy Group, which has been instrumental in
ensuring that the voices of all those affected by allergy are
heard across Government.
This debate has the heading “Allergy Awareness Week”, but it
would be remiss of me not to take this opportunity to mention, as
other hon. Members have done, other allergy debates happening
next Monday, involving the Under-Secretary of State for Health
and Social Care, my hon. Friend the Member for Harborough (Neil
O’Brien), who has responsibility for primary care and public
health. One debate that he will respond to next Monday will cover
vital issues about food safety, which have been raised in this
debate. I will refrain from talking at too much length about
those issues, because I know that he will cover them
substantially on Monday.
That being said, I pay tribute to the work being done to support
better food labelling, which is being spearheaded by families who
have been bereaved following the tragic deaths of their children
from severe anaphylactic reactions. Their campaigning has already
led to Natasha’s law, introduced by the Government in 2021. I
hope that it will protect and reassure those living with
allergy.
Allergy Awareness Week’s focus on allergy support from GPs and
specialist staff makes a lot of sense. Most people can be treated
through locally commissioned services, for which integrated care
boards are responsible, and GPs clearly play a crucial role as
the first point of contact for many people with allergies. We
know the huge demand for primary care services and the pressures
that GPs are under. That is why the Government are investing in
and increasing the primary care workforce. In fact, we already
have a quarter more staff in primary care than we did in 2019,
and 2,000 more GPs.
Looking ahead, we have increased the number of GP training
places. Last year, the highest ever number of doctors accepted a
GP training place; there were over 4,000 trainees—up from around
2,500 in 2014. That means that there will be more GPs who can be
the primary care point of contact for those with allergies. In
recent years, there has also been a 100% fill rate for doctors in
the two relevant specialist training pathways—allergy and
immunology. Many hon. Members spoke about the importance of
specialists in this area.
The number of people with allergies is set to increase even
further, and NHS England takes into account future and current
demand when considering the training needs of the workforce. Hon.
Members will know that NHS England is soon to publish the
long-term NHS workplace plan, which will include projections for
the number of doctors, nurses and other healthcare professionals
needed in five, 10 and 15 years’ time.
Specialist allergy services are provided for patients with severe
allergic conditions, or those who have common allergic conditions
but require specialist treatment. Those services are jointly
commissioned by NHS England specialised commissioning and
integrated care boards, in line with the published “Prescribed
Specialised Services Manual”. Specialised services must comply
with the relevant specification. For allergy, that includes the
need for physicians, dieticians and nurses who are trained in
allergy, and who keep up to date through continuing professional
development on specialised allergy services. As Allergy UK’s
patient charter outlines, it is crucial that people with
allergies have access to quality care, underpinned by skilled
healthcare professionals, and can access services wherever they
live.
There have been calls over recent years—I have heard them echoed
today—for stronger leadership on allergy. I am pleased to take
this opportunity to outline the allergy leadership that we
already have in place. In October 2022, Dr Claire Bethune was
appointed national speciality adviser for specialised immunology
and allergy. Dr Bethune chairs the NHS England clinical reference
group that provides clinical advice and leadership on the
specialised immunology services, and advises on how specialised
services can best be delivered.
Clinical reference groups, through their patient and public voice
members, rightly ensure that patients and the public are involved
in any changes to the commissioning of special services. The
specialised immunology and allergy services clinical reference
group is commencing a review of the specialised allergy services
specification. The outcome will be an updated specification that
references up-to-date guidance and takes into account the latest
evidence base. It will clearly define the standards of care for
commissioned specialised services, and notably will cover the
transition to adult services.
That work is not the only thing we are doing to support children
and young people with allergy. The National Institute for Health
and Care Excellence has produced a range of guidance to support
the care of people with allergies, including specific guidance on
food allergy in under-19s. The guidance covers assessing and
managing food allergy in under-19s, including referral to
secondary or specialist care as appropriate. It has
recommendations on what information and support should be
provided to the child or young person and their family. That
includes signposting to the invaluable work done by organisations
such as Allergy UK and Anaphylaxis UK, which have a wealth of
information on how to live well with an allergy.
NICE also has more specific guidance available on diagnostics and
specific treatments for allergies. That is not limited to food
allergies. I urge all those who are involved in the care of
people with allergies to familiarise themselves with the
information available. The NICE guidance, alongside the service
specification and training materials I mentioned, represent a
comprehensive portfolio of resources that healthcare
professionals and commissioners can draw on to ensure that people
with allergies receive the right care to live healthy and
independent lives.
I hope that hon. Members will be reassured by some of the
measures that I have outlined. I assure them that the Government
are committed to a high standard of ongoing care and support for
the many people in this country living with allergies. Together
with the Minister who has responsibility for primary care and
public health, my hon. Friend the Member for Harborough, I will
continue to look at what more we can do to address the needs of
the huge and growing number of people affected by allergies, and
at the asks of hon. Members. Finally, I thank all hon. Members
here for their work in keeping the spotlight on this important
issue, so that allergy awareness remains constantly in the public
eye, not just in Allergy Awareness Week each year.
2.20pm
I thank the Minister and my hon. Friend the Member for Bristol
South () for their positive words, as
well as others who contributed to the debate. It seems that
across the political aisle there is common agreement about the
escalating problem and the need for viable remedies, as well as a
basic right to proper care for all our fellow citizens
experiencing those problems. They should not have to wait any
longer.
I will make one political point. There is an election coming, and
if a party was to really grip this issue and prioritise it, they
could achieve much, given the sense of an epidemic out there. I
do a lot of work in this area, and as soon as I talk about it I
am inundated with people’s experiences. I have listened to
colleagues in the Chamber, and am struck by the number of people
with direct personal experience of the issue. It speaks to what
is happening in the country. Any political party that could tap
into that could gain much from it—but enough of the low
politics.
In conclusion, I echo what colleagues have said and thank the
allergy community. We were going to have this debate in Allergy
Awareness Week, but it got bumped for reasons relating to the
coronation. That is a pity, but I am glad that we have given an
airing to some of the issues. I put on record the appreciation
that we all have for the practitioners and healthcare
professionals dealing with allergy; for Allergy UK; for members
of the National Allergy Strategy Group; for Anaphylaxis UK; for
the Natasha Allergy Research Foundation; for the researchers in
the area seeking new remedies; and for the insights of all the
families and campaigners fighting on behalf of those with
allergic conditions. That will be echoed by many MPs from across
the House on Monday. Those people do a fantastic job, but they
need help—lives depend on it.
Question put and agreed to.
Resolved,
That this House has considered Allergy Awareness Week
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