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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 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 (Gillian Keegan), 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.
Mr Louie French (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 (Jon Cruddas) 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.
Alex Davies-Jones (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 (Jon Cruddas) 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.
Martyn Day (Linlithgow and East Falkirk) (SNP)
May I express my gratitude to the hon. Member for Dagenham and Rainham (Jon Cruddas) 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.
Karin Smyth (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 (Jon Cruddas) 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 (Alex Davies-Jones) 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 (Martyn Day) 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 (Gillian Keegan), 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.
The Minister for Social Care (Helen Whately)
It is a pleasure to serve under your chairmanship, Ms Ali. I thank the hon. Member for Dagenham and Rainham (Jon Cruddas) 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 (Alex Davies-Jones) 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.
Jon Cruddas
I thank the Minister and my hon. Friend the Member for Bristol South (Karin Smyth) 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.