Allergy Awareness Week

Jon Cruddas Excerpts

Thursday 11th May 2023 Westminster Hall

[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.

--- Later in debate ---

[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.