Health: Allergy (Science and Technology Committee Report)

My Lords, I, too, would like to pay tribute to the noble Baroness, Lady Finlay, both for opening this debate so expertly today and also for her chairmanship of the sub-committee. She has a degree of energy and expertise from which we were all able to benefit and she became a very close friend to every member of the sub-committee under her guidance. I recognise the splendid support that we had from our clerk, but would like to pay a particular tribute to our specialist adviser Professor Barry Kay, whose extensive knowledge and extremely experienced wealth of time in the field so greatly enhanced our work. I would like, in the brief time available today, to reflect on one aspect of our report—that is, the impact of allergy on children in school—and to highlight some of the problems and solutions which we proposed in our recommendations. As other speakers have commented, allergies can cause a very severe reduction in the quality of life for school children. Think for a moment about children with eczema. Ms Sarah Day, our witness from the Royal College of Nursing, spoke to us about the image problems of children with eczema, which can be deeply distressing to the child or young person, and can often lead to teasing and bullying from other children who do not understand the illness that causes the extraordinary appearance that many of them can exhibit. A survey by the Department of Dermatology at the Wales College of Medicine showed the devastating impact that severe eczema might have on the lives of children. Beyond the embarrassment, which for them is often the key part of the thing, there is also evidence of sleep disturbance and therefore impaired school performance. Think of children with severe asthma. They, too, suffer great underperformance in school, for many causes. Some 38 per cent of allergy sufferers had missed a considerable part of their schooling due to their asthma problems. Their sleep disturbance also made it hard for them to concentrate at school. Though less severe, the prevalence of hay fever among children also has a demonstrable effect on their performance, particularly in examinations. As we all know, GCSE and A-level examinations mainly fall in the peak hay fever season. A study of the impact of hay fever on exam performance by teenagers in the UK found that sufferers could drop a whole grade in their summer exams compared to the results of their mock examinations, which were taken in winter when their hay fever was not present. That drop in achievement can be caused both by the symptoms of hay fever and by the sedating antihistamines that are often given to them and which affect their long-term prospects, both of higher education and career development. This is not a small matter; children who may drop from a B to a C in their A-level results, for example, can fail to meet the offer that they have had from a university, and so miss out quite substantially on the university experience that they had planned for, and therefore be affected in their long-term future careers. Dr Paul Harrison, the director of the Institute of Environment and Health at Cranfield University, told us that children with asthma and allergic rhinitis often also opt out of sporting activities, so compounding their fitness problems. However, we received evidence that the awareness of the problems of hay fever sufferers and other allergy sufferers varied greatly, as did the way in which they were treated by their schools and local authorities. Some local authorities and schools allow special examination arrangements for sufferers, while others simply take no account of it at all. We recommended, therefore, that the Department for Children, Schools and Families should review the care given at school to hay fever sufferers and reassess the way in which they are supported during the exam season. Consistency of provision across schools and local authorities is a responsibility of the department; it is not enough simply to leave it to individual schools. We also feel very strongly that school nurses have a role in ensuring that children are not automatically given sedative antihistamines, which can impair their performance. I will return to school nurses in a moment or two. There are a small number of children whose allergies are even more life-threatening; children who are at risk of anaphylaxis, for example, a reaction to food such as nuts or to insect venom. The peanut allergy alone has increased dramatically in recent years, creating a real challenge for schools, where teachers may find themselves dealing with a life-threatening emergency of which they have absolutely no knowledge. The representative from what was then the Department for Education and Skills said rather dismissively that, ““It is a head teacher’s responsibility to ask themselves whether the cadre of teachers and support staff they have is able to deal with such an emergency””. I do not think that is good enough. I say to the Minister that to leave it to a lay head teacher to make such an assessment is not a response that one would expect from a responsible government department. Children at risk from anaphylaxis usually carry an adrenalin auto-injector. We usually call them EpiPens, although I understand there are also AnaPens. Under current DCSF practice, only the EpiPen prescribed for the child is held in the school. However, many of our witnesses felt strongly that schools should keep a stock of those generic auto-injectors available, for example, for a child who may have forgotten their EpiPen on that particular day or one who needed a second dose. We recommend that there should be clear guidance regarding the administration of auto-injectors to children with anaphylactic shock in the school environment. We also recommend to the Government that they should review the case for schools holding one or two generic auto-injectors. Overall, however, we were concerned at evidence that allergies were poorly managed in the school environment. At the heart of this is the lack of training, most crucially for school nurses but also for teachers, support workers and heads themselves. That we felt was the heart of the problem. The evidence we would have given showed that there was a real problem in the training of school nurses. The department representative seemed to assume that school nurses were the answer to all the problems and could deal within the school with any emergency that arose and could also help with the training of the lay staff. However, the evidence we had from the Royal College of Nursing spoke of funding cuts and shortage of staff among school nurses. There is also a problem where some school nurses are employed by the school directly and others are employed by the PCT and therefore their training needs can be dealt with in different ways: particularly those employed directly by the school have no one competent to assess their training needs and little money made available for them to update themselves in allergy treatment. There is a lack of expert knowledge within the school system of how to deal with this huge problem. The Government document Managing Medicines in Schools and Early Years Settings suggested that every child who suffers from any form of problem that leads to them needing medication during the school day should have an individual healthcare plan. While we welcome that suggestion, we note that the heads have insufficient medical knowledge themselves to know whether their staff can deal not only with the routine medicines but with emergencies. We think it is simply not enough to leave it up to the school and to the head to draw up this individual healthcare plan and then to implement it. We believe that the responsibility lies with Government to ensure that a health professional is available to make the assessments and to provide training where necessary. In the current shortage of school nurses and the difficulty of funding for their training, we fear that this is unlikely to happen. Our recommendation therefore is that the department of children’s schools and families should audit the level of allergy training that school staff receive and should take urgent remedial action to improve this training where it is required. The impact of allergies on school performance as the life chances of many young people is immense and far-reaching. It is therefore disappointing to find that, as with most of the sub-committee recommendations, the Government response was so half-hearted. While agreeing with the Committee’s conclusions, no action was proposed, whether on the training required by staff, the storing of generic auto-injectors or the timing and arrangements of key examinations. It is not good enough. If, as we were told by our expert witnesses, allergy among children is of epidemic proportions and likely to grow, there is no excuse for us to stand back and leave it to lay people in schools and an overstretched school nursing service to deal with a national problem affecting thousands of children’s lives. For me, the saddest comment that we heard from one of our continental experts on our visit was, "““We are simply amazed at the contrast between the world-class quality of your UK allergy research and the dreadfully low quality of your UK provision to patients””."