Anaphylactic Shock

Part of the debate – in Westminster Hall at 1:00 pm on 13 February 2001.

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Photo of Phil Willis Phil Willis Shadow Spokesperson (Education) 1:00, 13 February 2001

In 1993, 17-year-old Sarah Reading died after eating a lemon meringue pie in the restaurant of a well-known departmental store. She suffered an anaphylactic shock--an extreme allergic reaction when blood pressure falls rapidly and the patient quickly loses consciousness. The simple dessert that she ate on that day contained peanuts, to which Sarah was fatally allergic. That is an extreme case, but is certainly not rare. In 1995, Louise Westlake was served bread containing walnut butter at a dinner in a Manchester hotel and died. She knew that she was allergic to nuts, but did not expect to find nuts in butter. Laura Thesher was 19 and in her second day at St. Catherine's college in Cambridge in 1998. The menu said:

"strawberry shortcake on red fruit sauce". The shortcake contained undeclared nuts, and three days later Laura was dead. Ross Baillie was a national athlete, but after a training session in Bath in 1999 he ate a coronation chicken sandwich. Nuts were used in it, but not declared, and he died aged 21.

It is estimated that about 1 million people suffer allergic symptoms that could be life threatening. One in 6,000 cases treated in casualty departments in our hospitals is the result of anaphylactic shock. One in 200 children are affected, and for some the threat to their lives is very real and constant. However, nationally too few allergy consultants are available, and the GPs in my constituency report that referrals for specialist allergy care is overwhelming, yet specialist care packages can make a life threatening condition manageable. Will the Minister tell the House what steps the Government are taking in the NHS plan to recruit and train consultants, and to offer a more rapid and sophisticated service in the treatment of allergies?

Part of the management of allergies is the avoidance of products that can cause anaphylactic shock. Avoidance is not helped by the quality and legibility of the allergen risk labelling. Far too many major United Kingdom food manufacturers fail effectively to communicate allergen risks on their products. The font may be too small, the information is often hidden under wrapping or away from the ingredients list, which is where sufferers will automatically look for information. It is crucial that labelling on foodstuffs and loose ingredients, particularly in restaurants and food chains, is not only mandatory but conforms to strict guidelines laid down by trading standards.

It is clearly nonsense that failure to declare a genetically modified ingredient when there is no proof of harm can result in a £5,000 fine, whereas the display of information about allergens when death is known to occur is an optional extra. Will the Minister tell us what steps are being taken to make food labelling for allergens mandatory, and to ensure that environmental health officers are effectively trained to carry out inspections of food premises?

For adults managing a life style with the possibility of anaphylactic shock, the risk is problematic but bearable. Tens of thousands cope with that problem every day, and most lead perfectly normal lives. They do so often with the help of an epipen auto injector or a similar device that enables a severe anaphylactic shock to be immediately stabilised with an injection of adrenaline until hospital treatment can be secured. The adrenaline epipen is a security policy that gives enormous comfort and security to allergy sufferers. Those at risk always carry their epipen, and a 10-second self-administered dose is usually sufficient to stabilise the condition.

However, failure to carry or have access to an epipen could prove fatal, as it was for Nicola Ratcliffe, a first-year student at Durham university. She ate an Indian meal with friends, and although she knew that she was subject to anaphylactic shock, she had left her epipen in her room. She died aged 18, before treatment could be administered.

The training of first aiders in the use of epipens and their availability when training has taken place could save a person's life in the workplace. It is on a par with a defibrillator. As recently as 5 February this year, the Health and Safety Executive supported work-based training by St. John Ambulance in the use of epipens in the workplace. Will the Department of Health consider extending first aid training to include the use of epipens in the workplace? Although no one would consider making them freely available, surely trained users in large food courts would be of particular value to the public.

The principle reason for seeking this debate is to highlight the problems faced by children subject to anaphylactic shock. It appears that children can and are being discriminated against. Only last month, Martha Atkins, a pupil at St. Paul's primary school in Radlett, was forced to move to another school because staff would not let her use an epipen in an emergency, and they refused to administer it themselves. Although such action by a school is rare, and Martha has now found a place in another school where staff will use an epipen in an emergency, the case highlighted the very real confusion that surrounds the treatment of anaphylactic shock in children.

Department for Education and Employment guidance says that children with medical needs

"have the same rights of admission to school as other children and cannot generally be excluded from school for medical reasons." Under section 166 of the Education Act 1993, a health authority must provide help to a local education authority and to a school to support the medical needs of a child. That help could include training in the use of an epipen. The Medicines Act 1968 allows the use of prescription-only medicines by injection in emergencies when life is threatened. The Health and Safety at Work, etc. Act 1974 places a duty on heads and teachers with regard to the health and safety of staff and children in their care.

However, the first aid at work regulations, which go back over 20 years and have not been amended in that time, do not permit invasive techniques, even in the case of anaphylactic shock, even though they are known to be an effective treatment and a life saver. There is no legal or contractual duty on school staff to administer treatment or supervise children when taking it, although there is of course a common law duty to act as any prudent parent would, and that includes administering medicines in an emergency.

The current state of affairs is totally unsatisfactory. Heads and teachers need to know exactly where they stand in law. Given that the Special Educational Needs and Disability Bill is about to enter the Commons, having gone through the Lords, will the Minister consider drafting a new clause specifically to include the emergency treatment of anaphylactic shock and the training of appropriate staff? That in itself would go a long way towards resolving the problem. Such a measure would not only clarify the present situation, but would enable teachers or support staff to be trained in the most simple of procedures and to be insured against any possible claim for negligence. Such clarification would bring huge comfort to thousands of parents and would remove from those children's minds the nagging doubts about the threat of an allergic reaction.

Finally, I want to draw the Minister's attention to the appalling situation surrounding Mathew Johnson, one of my young constituents. Mathew is 10 years old and suffers from a severe tree nut allergy. For the past four years he has been denied access to local authority leisure schemes--not because of his allergy, or because there is anything else wrong with him, but because of his need to use an epipen if he inadvertently goes into anaphylactic shock. The leisure centre staff say that Mathew can take part only if he is accompanied by a parent--both his parents work-or a trained nurse at the cost of £100 to £150 a day. Otherwise, he has been offered a place on a one-to-one scheme for children with learning or physical disabilities. That is totally inappropriate for a young boy who wants to play with his peer group and take part in activities.

Mathew is a normal child. He is not ill. There are thousands of Mathews up and down the country. There are 12 in my constituency alone, and I have been informed of others in Leeds, Birmingham, Croydon and Tonbridge. No child should be discriminated against in that way. It is a betrayal of the United Nations convention on the rights of the child, article 31 of which states:

"Every child is entitled to rest and play and to have the chance to join in a wide range of activities". The British Government have signed up to that article. Furthermore, Government policy supports an ever more inclusive society for our children. In paragraph 41 of "From Exclusion to Inclusion", David Blunkett is proud to say:

"We owe all children--whatever their particular needs and circumstances--the opportunity to develop their full potential." How hollow are those commitments if children subject to anaphylactic shock can be so easily discriminated against?

I understand the situation of staff leading leisure or sporting programmes or playgroups. They are placed in an impossible position. I do not object to their trade association instructing them not to use these invasive devices. The law should protect them, and they ought to be insured against negligence. They should also receive formal training. Things could be so different. Extending existing legislation and DFEE guidance to cover all local authority approved leisure and play schemes would help. Including specific regulatory provision in the Special Educational Needs and Disability Bill to include leisure and play schemes would certainly help. Ensuring that all first aid training includes the administration and use of epipens and similar devices would take away much of the mystery and mystique. Establishing a common code of practice that provides the basis for local authority legal cover for all staff using epipens, provided they have been trained, would solve the problem in a stroke. The outdated first aid at work regulations that do not permit invasive techniques, even for anaphylactic shock, clearly need to be updated.

Anaphylaxis is an increasingly common condition affecting children, and it is on the increase. It is easily managed with adrenaline. Surely a caring Government can manage their responsibility to those children affected.