Allergy Services

– in the House of Commons at 5:55 pm on 29th November 2007.

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Motion made, and Question proposed, That this House do now adjourn. —[Liz Blackman.]

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Photo of Jo Swinson Jo Swinson Shadow Secretary of State for Scotland, Liberal Democrat Spokesperson (Scotland) 6:00 pm, 29th November 2007

I am delighted to be able to introduce this debate on allergy services. Allergy comes in many varied forms and guises. It can be mild or severe; it can affect one organ only or several parts of the body; its severity can vary over time; and there can be a single allergic cause, or several. By their nature, allergies are complex. We certainly need to carry out further research into how they work, in order to improve the way we treat and even prevent allergy and to bring better quality of life to allergy sufferers.

At this point, I feel that I should declare an interest, having suffered from allergies since a very young age; indeed, I recently completed the Loch Ness marathon in aid of the charity The Anaphylaxis Campaign. I have a severe reaction if I eat any nuts, which results in the onset of anaphylaxis and an emergency trip to hospital The excellent work of charities like The Anaphylaxis Campaign and Allergy UK in raising awareness of allergies and providing support to sufferers should be commended.

The first myth to dispel is that allergies are a niche issue. Recent research consistently shows huge increases in both the amount and seriousness of allergies occurring in society. In this House, many Members have experience of allergies either personally or within their families, and indeed recently I was delighted to be a founding officer of the new all-party parliamentary group on allergies, along with the hon. Members for Dagenham (Jon Cruddas) and for Eccles (Ian Stewart).

In truth, this is an area of urgent concern, an issue of major proportions and a matter that the Royal College of Physicians has seen fit to label an "epidemic". Against this backdrop of growing seriousness, I want to use this timely debate to ask why there is such a lack of urgency from the Government to tackle what is, in terms of our future health needs in this country, a sleeping giant.

Rates of allergy in this country are among the highest in the world. An estimated 30 per cent. of the population have an allergic disease—that is 18 million people. Among children, this figure rises to 40 per cent. In any one year, 12 million people—a fifth of the population—will seek allergy treatment. All the evidence indicates that the amount and seriousness of allergies is increasing rapidly. The Royal College of Physicians has estimated that there has been a threefold rise in incidents of allergy in the last 20 years.

Severe and life-threatening allergies are now more common, with increasing numbers of children affected in particular. Peanut allergies, previously rare, now affect one in 70 children. Latex allergies now affect 8 per cent. of health care workers, whereas before 1979 only two cases had been reported. Hospital admissions for anaphylaxis have increased sevenfold in the last decade.

The financial cost of allergy to the health service and the economy as a whole cannot be ignored. More than 12.7 million working days are lost each year as a result of asthma alone, and Asthma UK has placed the total annual cost of asthma to the economy at £2.3 billion. Adverse drug reactions account for 5 per cent. of all hospital admissions, and 15 per cent. of in-patients have a hospital stay prolonged as a result of drug allergy. Allergic disease accounts for 6 per cent. of GP consultations and 10 per cent. of the GP prescribing budget. The cost of allergy to the national health service has been estimated at £1 billion.

Figures can be persuasive, but it is often people's individual experiences that make the most compelling case. This quote comes from one serious allergy sufferer:

"My quality of life is non-existent. I know this may sound extreme to a lot of people but I would be prepared to lose an arm and a leg if it meant my asthma would go away. I face daily restrictions in every aspect of my life. I don't have enough breath to push a trolley around the supermarket. I'm not allowed on an aeroplane and it's impossible for me to get travel insurance. Winter is also a problem for me—I can't go outside because the cold air can set off my asthma."

A couple of my constituents who suffer from a latex allergy came to see me. Eleanor McKendry previously worked in the NHS where she developed the allergy and so is no longer able to work in her trained employment. She even finds attending out-patient appointments as a patient a challenge, owing to the lack of provision of latex-free environments, even within our hospitals and health care services. Lesley Shannon, another constituent, faces a daily game of Russian roulette even when she goes to do her grocery shopping. She has found that supermarkets often have latex balloons that advertise in-store promotions but which can trigger a life-threatening reaction if she is anywhere near them.

I know from experience how terrifying an anaphylactic reaction is. Symptoms develop quickly, within minutes of exposure to the allergen. I get an unpleasant tingling sensation in my mouth and throat, which is soon replaced by swelling, and breathing becomes incredibly difficult. At the same time, my forehead and palms start to sweat, feeling clammy, and I come over all feverish. My heart rate speeds up, prompting a feeling of panic that is not helped by the fact that I find it difficult to draw breath. That is a terrifying enough experience for me, an adult who has experienced it before. I understand my condition and know what I have to do—get to hospital, where I will be treated successfully. I also know that I am carrying an emergency dose of adrenalin in my handbag if I should need to take that en route to the hospital. How much worse must it be for the parent of a baby or young toddler who cannot explain their symptoms if the child goes from being perfectly okay to life-threateningly ill within a short space of time? That is what people face.

There are many difficulties. First, the range of allergens is broad. Common food allergens include nuts, fish, seeds, milk and kiwi fruit. There are many others, too. There are also chemicals, latex, dust, pollen, house mites and grass—the list goes on. Identifying the allergen can be difficult, and avoiding it is sometimes impossible.

I have given the examples of Eleanor trying to avoid latex in health centres and Lesley trying to avoid it in shops. As someone with a nut allergy, I can assure hon. Members that ensuring I do not eat any nuts is no easy task. Companies seem to be more aware of their responsibilities, but rather than providing helpful information, more often there is a generic statement that the product may contain traces of nuts. I challenge hon. Members to look at the back of packets next time they do their shopping—they will see just how many products carry such warnings. Even in the catering outlets in the House, a legal disclaimer at the bottom of every menu states that nothing can be guaranteed nut-free. I wonder where I am supposed to eat.

Many issues surrounding allergy must be addressed, and I hope that the all-party group will do so over the coming months. That needs to be done not only with the Department of Health but with those in charge of housing, the environment and business regulation. However, I want to focus on the right course of action for the Department of Health to tackle this growing and potentially fatal condition.

Four key reports from recent years inform the allergy debate. The first, produced by the Royal College of Physicians in 2003, puts into stark relief just how urgent the allergy epidemic has become. Worryingly, it states that, for allergy patients, the health service is

"failing to meet the most minimal standards of care".

It paints a picture of a service in which GPs deal with the majority of allergy cases, despite having no clinical training in allergies, and in which patients are referred to a succession of different specialists, resulting in confusion and inadequate treatment.

The overriding criticism in the report is of the shortage of specialist allergy expertise. The whole UK has just six fully staffed allergy clinics, unequally distributed with a strong south-eastern bias. There is a major shortage of specialists with expert knowledge. It is reckoned that there is one consultant in a mainstream medical specialty per 100,000 members of the population; the equivalent figure for consultant allergists is one per 2 million.

The report's recommendations are clear: to create more consultant posts and funded training posts in allergy, to form the basis of a genuinely national allergy service for the NHS, to set up regional allergy centres with appropriate staff levels, and to ensure even distribution across the country by locating at least one such centre in each former NHS region.

The second report was published in 2004 by the Select Committee on Health. It mirrored many of the points made in the 2003 report. It, too, identified a lack of training and expertise in allergies among health professionals in primary care. It also found that the level of allergy expertise at consultant level was inadequate and called the distribution of just six allergy centres "manifestly inequitable". The Select Committee supported the royal college's proposal for a specialist allergy centre in each former NHS region, with a minimum of two adult and two paediatric allergy consultants. Long term, it argued that allergy should have a full specialist consultant work force, as is the case in many other countries, with an extra 10 training posts introduced year on year.

The Government's response to the Health Committee's report pledged a review of allergy data and demand for treatment. Disappointingly, however, it failed to address directly any of the Committee's recommendations, whether on GP training, consultant numbers or specialist allergy centres. I hope that perhaps today the Under-Secretary can respond to the specific points that the Committee's report raised.

In 2006, the Department of Health published its review, as it said it would in response to the Health Committee report. However, again, those hoping that the Government would act on the Health Committee recommendations were left wanting. Despite conceding that people with allergies often feel let down by the poor service that they receive, finding that some people can wait three to nine months for an appointment to see a consultant and even stating that

"a significant number of deaths could potentially be prevented" by an improved service, the review's recommendations fall short of what was hoped for.

The review finds that incomplete research makes it difficult to establish compelling evidence of the need for and quality of allergy services, and raises problems with drawing up a strategic national view of how services should be developed. We are told that the Department will ask local health commissioners to establish levels of need for allergy services, allow strategic health authority work force planners to explore scope for additional training places and ask for development of National Institute for Health and Clinical Excellence guidelines on allergy to be considered. Given that that response was made in 2006, I hope that the Under-Secretary will take the opportunity to update the House on the action that has been taken on those recommendations.

The House of Lords Science and Technology Committee report on allergy was published in September this year. Again, the findings are familiar. The report's recommendations echo those of the Royal College of Physicians and the Health Committee, especially on the need for specialist allergy clinics and improved GP training. Helpfully for the purpose of the debate, the Government's response to the Lords report was published earlier this week.

The response reinforces the Department's determination to devolve decision making on allergy care and avoid developing a strategic overview of allergy services. It states that

"local need is what will determine how allergy services should be provided", placing the responsibility for allergy services squarely in the lap of primary care trusts.

On GP training, the response notes that no allergy-related guidance topics have been included in the NICE work programme yet. It states that the Department of Health

"is not responsible for setting curricula for health professional training", but, clearly, the Under-Secretary knows that she can bring her influence to bear. What does she intend to do to ensure that our GPs receive the training they need to diagnose and treat allergies swiftly and effectively, especially given that more and more people are coming through their doors who need that expertise?

I have set out the evidence that makes it clear beyond doubt that we are facing an allergy epidemic. Increased numbers of allergy sufferers, increased severity of allergies and especially pronounced evidence among children are all symptoms of the problem. I have set out the recommendations of the Royal College of Physicians as well as those of the Committees of both Houses. They centre on the need to increase consultant numbers and the provision and geographical equity of specialist allergy clinics, and to improve the training of GPs in allergy diagnosis and treatment.

I have also covered the Government's reaction to the problem, both through their responses to the Select Committee reports and their review, which was published last year. They amount to an admission that there is a problem, as well as a commitment to assess how to deal with it, but unfortunately little more than that.

I would like to ask the Under-Secretary to answer some further questions. Does she agree that there is a considerable gap between the necessary measures recommended by independent reports into allergy services and the steps that her Department has so far proposed to take? How seriously does she take the allergy epidemic that we face? We must remember that we are talking about a problem that affects 18 million people in this country. Does she think that enough is being done about it? Does she genuinely believe that local primary care trusts are best placed to combat the allergy epidemic? We all understand the notion that solutions are best delivered in response to local needs—and we want our health care services to be locally accountable—but, given the constraints faced by PCTs on budgets and through centrally driven targets, coupled with the lack of strategic central guidance on allergy, I fear that there will be little incentive for them to make tackling allergy their prime concern.

I look forward to the Under-Secretary's comments.

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Photo of Ann Keen Ann Keen Parliamentary Under-Secretary (Health Services), Department of Health 6:13 pm, 29th November 2007

I congratulate Jo Swinson on her success in the Speaker's ballot and on choosing allergy services as her subject. It is clearly close to her heart and it is an important topic to debate. I thank her for bringing to our attention an issue that affects so many people in our country.

I pay tribute to the hon. Lady's gallant fundraising efforts, especially for the Anaphylaxis Campaign, which plays an important role in supporting people who are affected by anaphylaxis. I am a former nurse and have been on the receiving end of patients admitted in anaphylactic shock, so I recognise the obvious fear and anxiety felt in that situation.

As the hon. Lady is acutely aware, I take very seriously allergic reactions to pollen, pets, foods and a range of other agents that she mentioned, and in particular reactions to latex among NHS staff. The number of people suffering from allergic reactions has trebled in the past 20 years and a third of the population are estimated to suffer from an allergy at some point in their lives. The severity of the reaction ranges from mild to severe and potentially life threatening, and the treatment options reflect that huge range.

Many people choose to self-diagnose and treat. Others may require treatment from their GP surgery or in specialist clinics. Many experience serious consequences because of their allergy. Each year there are more than 3,000 hospital admissions for anaphylaxis alone. Allergic conditions represent a huge challenge, not just for our health care system, but for society as a whole. In addition to the obvious health effects, allergic reactions can make the most simple and everyday activities difficult—including even eating in this House, as the hon. Lady said—and can pose a major risk to an individual's health and well-being.

The timing of this debate is opportune, as the hon. Lady acknowledged. On 27 November, the Government published their response to the House of Lords Science and Technology Committee report on allergy. We welcomed the Committee's report, which highlighted the fact that the issue needs to be addressed by a range of stakeholders, including the Government. We recognise the importance of allergies and are committed to helping to alleviate the burden of allergic disorders. The Command Paper that we published on Tuesday highlights some of the strategies that are being developed and implemented to address the challenge illustrated in the Committee's report. I shall touch on those later.

The Lords Committee inquiry into allergy is of course not the first time that allergy issues have been scrutinised by a parliamentary Committee. In 2004, the Health Committee published a report of its inquiry into the provision of allergy services. That report reflected earlier findings published by the Royal College of Physicians in 2003, namely that serious problems existed in the provision of allergy services.

In response to the Health Committee's report, we carried out a review of the available data and research on the epidemiology of allergic conditions, the demand for and provision of treatments, and the effectiveness of interventions. Working closely with stakeholders—people with allergies and their families, patient groups, clinicians and representatives from the independent sector and industry—we sought to identify actions that could be taken at local and national levels to improve services for allergy.

The review was crucial as a first step towards building a programme of improvements that would be based on sound evidence and reflect the views of stakeholders. The review report, which we published in July 2006, highlighted the range of existing service provision for allergy. That provision includes more than 90 allergy clinics in England led by a range of specialists, including allergists, respiratory physicians and dermatologists, as well as services provided by general practitioners, the mainstay of allergy care. I note the hon. Lady's point about GP training, which I hope we will take note of in Ara Darzi's report on chronic conditions.

The Department of Health's review identified good practice across the wide range of services available for people with allergies, and the spectrum of skills and competences of clinicians involved in their care. To take just one example, clinical immunologists at the Royal Victoria infirmary in Newcastle oversee a nurse-led allergy clinic, in which a nurse will see a complete referral and go through the whole treatment process without having to consult a doctor.

In their reports, both the Health Committee and the Royal College of Physicians made the case for a model of care that would be driven and funded from the centre. In taking forward our improvement and reform agenda, we have moved away from a top-down management approach, as we develop a devolved and self-improving health service, where the main drivers of change are patients, commissioners and clinicians. Indeed, the Department's review concluded that one of the key levers for change for allergy services in the future will essentially continue to be for local rather than national level action.

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Photo of Jo Swinson Jo Swinson Shadow Secretary of State for Scotland, Liberal Democrat Spokesperson (Scotland)

I accept the Minister's premise that it is important to have local drivers for health care, but some aspects surely need to be driven by a national strategy—for example, the number of training places that are to be provided for consultants and junior doctors, so that our allergy specialists of the future can be trained. I am worried, given the present rate of training, that we will end up with fewer allergy specialists than we have now, because of the number that will retire in the coming years. What will the Minister do to expand the number of training places in specialist allergy services?

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Photo of Ann Keen Ann Keen Parliamentary Under-Secretary (Health Services), Department of Health

I take the hon. Lady's point very seriously. The management of chronic conditions is part of Lord Darzi's review. During that review, we are looking at work force planning, training and specialist skills, and in particular, at raising the role of the specialist nurse in this area. That is why it is so important that we understand local needs, and that the consultation is driven by local people and local clinicians.

The Department's review concluded that one of the key levers for change for services for allergy in the future will, essentially, continue to be for local rather than national level action. It is for local health commissioners to consider the need for local services in light of local priorities. The evidence presented in the report of our review should help them to do so. The new report by the Lords Science and Technology Committee adds to that evidence base.

We published the commissioning framework for the acute sector last year, and followed it with the commissioning framework for health and well-being, which was issued as a consultation document this March. PCTs have to carry out a local needs assessment, identify gaps or inadequacies in provision, and then produce a strategic plan for their health community. One of the key requirements of this process will be to ensure that patients and the local community are properly involved in the process of deciding priorities. Through patient choice and expert commissioning, local communities will be able to determine the type and quality of services that they require in order to deliver better health care.

We have considered, with the National Institute for Health and Clinical Excellence, the scope to develop definitive clinical guidelines for allergic conditions. We have commissioned Skills for Health to develop with stakeholders national occupational standards for the UK for allergy, and commissioned the Royal College of Paediatrics and Child Health to scope the development of care pathways for children with allergic symptoms. We have also endorsed the need for more training numbers for allergy as part of the annual review process. We have asked deaneries and trusts to consider the possibility of increasing local training posts for allergy, and invited key research funders to note the gaps in the research evidence highlighted in the review.

Some of these actions are referred to in the Government's response to the House of Lords report. The focus of the Lords inquiry was wide-ranging and explored the impact of allergy not only on the health service but on society and the economy as a whole. Nevertheless, at the core of the Committee's report were a number of recommendations of direct relevance to this evening's debate—not least those relating to the provision of specialist allergy centres and work force capacity and capability, which I know are of particular concern to many people, including the hon. Member for East Dunbartonshire and, I would guess, my hon. Friend Mr. Joyce.

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Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. It is customary in these debates for Members to ask the permission of the Member whose Adjournment debate it is, and of the Minister, before intervening. I wonder whether the hon. Gentleman has done that.

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Photo of Sylvia Heal Sylvia Heal Deputy Speaker

That is fine. Thank you.

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Photo of Eric Joyce Eric Joyce PPS (Rt Hon John Hutton, Secretary of State), Department for Business, Enterprise & Regulatory Reform

I congratulate Jo Swinson on securing this important debate. A number of my constituents have raised this issue with me. They have also been extremely complimentary about the organisation Allergy UK and, in particular, about those little cards that it issues containing information in many different languages. This is a small but important point. Those cards enable people to travel around the world with information on the things that they are allergic to in their pocket. Several of my constituents have come up to me individually and been very complimentary about Allergy UK, and I wanted to put that on the record.

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Photo of Ann Keen Ann Keen Parliamentary Under-Secretary (Health Services), Department of Health

I thank my hon. Friend for raising that point and for the important work that he and the hon. Lady do on the all-party group on allergies.

The Committee's proposal to establish a lead strategic health authority for allergy merits careful consideration and we shall explore the feasibility of that approach with interested parties, including strategic health authorities and specialised commissioning groups. If a lead SHA were established, it would need to evaluate with its PCTs and in light of local needs and priorities whether a pilot allergy centre would be more beneficial to people suffering from allergies than other possible models for enhancing local services. The spirit behind this is to show the hon. Lady the extent to which flexibility could be delivered around allergy services.

In our own review of allergy services, we acknowledged that there would continue to be a need for a critical mass of allergy specialists. We have been able to create an additional five centrally funded allergy training posts this year and five immunology posts as well. We have asked the NHS to look at whether it needs to commission more local training posts. We have also recognised the importance of GPs and others in primary care having sufficient clinical knowledge.

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Photo of Jo Swinson Jo Swinson Shadow Secretary of State for Scotland, Liberal Democrat Spokesperson (Scotland)

The Minister is being very generous. She says that she has asked the NHS to report back on whether it feels the need for more training posts, so can she clarify when the response from the local NHS is expected?

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Photo of Ann Keen Ann Keen Parliamentary Under-Secretary (Health Services), Department of Health

I am happy to write to the hon. Lady, as I do not have that information at the moment.

Work on national occupational standards to provide a competence framework for all staff is also very important, as was mentioned earlier. In terms of professional education, the Lords Committee's recommendations are consistent with our review. We would encourage the royal colleges to work together with the bodies responsible for medical training at all levels to enhance the knowledge and expertise of those working with people with allergies.

In conclusion, the hon. Lady has raised many important points this evening. We welcome this debate and share her desire to see that people living with allergic conditions receive the services they need and deserve. Reforming health care is all about finding out the facts, identifying the problems and facing up to the challenges with strategic solutions, which we have sought to do through our review of allergy services. Our response to the House of Lords inquiry demonstrates, I hope, our continued commitment to improving allergy services. I can assure the hon. Lady that the Government will continue to provide support and encouragement to the health service to ensure that that happens. I would also encourage the hon. Lady and my hon. Friend the Member for Falkirk to continue with their excellent work on the all-party group.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes past Six o'clock.

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