Allergy Services

Speech by Jo Swinson MP on Thu 29th Nov 2007

Jo Swinson (East Dunbartonshire, Liberal Democrat)

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.