Health: Allergy (Science and Technology Committee Report)

My Lords, the noble Baroness who initiated this debate and chaired the committee which produced this important report has, not for the first time, rendered a very considerable service to the House, to medicine and, above all, to those afflicted by illness. This allergy report was produced by the Science and Technology Committee before I joined it but, invited by the noble Baroness to participate in the debate, I said that I would speak of the experience of my own family and of the difficulty of finding general practitioners with the knowledge and time needed to provide the right diagnosis for a wide range of complaints. On reading the report, I found that the experience of my wife exactly bore out some of the most crucial evidence received by the committee and underlined the importance of some of its key recommendations. Going back to the early 1960s, after the birth of our first child, my wife felt the kind of pain all over her body that one suffers from a poisoned finger. Our unsympathetic GP said that it was probably postnatal depression and that she should see a psychiatrist. She was finally diagnosed by a patient and understanding doctor as suffering from an allergy to cow’s milk. She consulted Professor Jonathan Brostoff, who gave evidence to the committee, one of the leading experts on food allergy and food intolerance. Some years later, after I had become an MP, she suffered from sores in her mouth, constant sore throats and swollen glands, was fed with antibiotics and told to lead a less stressful life. A wise doctor in Abergavenny, feeling sure that it was a food allergy, questioned her closely and suggested that it might be tomatoes. He was right. A long time later, suffering muscle weakness and aching joints, she finally found that she was suffering from an allergy to wheat. Today, when vineyards and wine companies are speeding up the maturing process of wines by adding sulphites, my wife has joined many others unable to drink wine. Talking to friends about these experiences I have often referred to the doctors who did come up with answers as being members of an increasingly rare breed, the first class diagnostic physician with the knowledge and time to come up with the right diagnosis. The committee, in Chapter 9 of the report, identifies the poor clinical service provided for allergy sufferers in this country. It quotes the 2004 report of the House of Commons Select Committee on Health which said: "““Those working in primary care lack the training, expertise and incentives to deliver services … Many of the deficiencies in primary care are matched by weaknesses in secondary and tertiary care””." The Commons committee recommended that the GP curriculum should include allergy training and that specialist allergy clinics should be developed across the country as centres of good practice for the training of primary care staff. The report we are debating today reveals a shocking state of affairs. It is astonishing that it should be necessary for parliamentary committees to suggest that allergy training for GPs should be necessary. It is disturbing that witnesses report that the knowledge of allergy in primary care is poor and refer to minimal training. As if that was not bad enough we are told that there is a shortage of allergy consultants—and of expertise among consultants to whom GPs are likely to turn. On a visit to the allergy clinic at Addenbrooke’s Hospital, committee members were told that it was a struggle to convince local commissioners to invest in allergy training and services because allergy was not yet recognised as an important subject. Allergy UK, a leading allergy charity, reported that for patients, "““the major problem is the lack of knowledge at primary care level. GPs do not recognise allergic symptoms when presented with them due to a lack of training in allergy””." A consultant allergist at the Royal National Throat, Nose and Ear Hospital told the Committee that: "““‘In medical schools the amount of allergy training is absolutely minute, if it exists at all’””." Another doctor, making the same point, went on to say that when it comes to postgraduate training, "““‘there are so few allergy specialists in the country, there is no one to undertake teaching’””." Paragraphs 9.28 to 9.31 of the report provide a damning indictment of the current situation. Its second volume, which contains all the evidence received, adds powerfully to that indictment. The key recommendations on allergy centres—those described by the noble Baroness when opening the debate—in Paragraphs 9.40 to 9.46 of the report, on NICE clinical guidelines in Paragraph 9.47 and on education in Paragraph 9.48, demand a full and adequate response. However, the Government response to all these recommendations is deeply depressing. They refer to a review carried out by the Department of Health and then make use of that review to justify one of the most inadequate responses ever given to a report by a Select Committee of this House, made much worse because, effectively, it is also a response to a committee of the other place that came to similar conclusions. They argue that, "““lack of baseline data … published examples of whole systems modelling of services … analysis of the effects of active demand management of patient flows in allergy care … absence of agreed service models and protocols””," and, "““the presence of differing perspectives of professional groups””," make it impossible to make meaningful comments on the existing and desirable capacity of services for allergy. Surely that is not an adequate response to the recommendations but an admission that the Department of Health has failed to do its job. If all those business jargon phrases that I have quoted identify work that should have been done, the question is why it has not been done and why the information is not available when provision of services is identifiably inadequate and huge sums of taxpayers’ money is being put into the health service. One thing is absolutely certain: with that kind of guidance, few with regional responsibilities will make a positive move to improve the service and provide the allergy centres that the report recommends. We are told that none of the allergy-related, "““topics has been judged to be of sufficient priority against other proposals to warrant inclusion in NICE’s ... programme””." That represents a combined failure by both NICE and the department to address priorities that have been identified by two parliamentary committees on the back of a mass of evidence. As to education, I suppose that we are expected to find comfort from the statement that the Department of Health, "““does share a commitment with statutory and professional bodies that all health professionals are trained, so that they have the skills and knowledge to deliver a high quality health service to all groups of the population with whom they deal””," even though the department first washes its hands of responsibility for setting curricula for health professional training. However, it really is not good enough to be fobbed off with the feeble comment that the department, "““would encourage the Royal Colleges to work together with the bodies responsible for medical training at all levels, in order to ensure that the knowledge and expertise of those working with people with allergies are enhanced””," and with the recommendation that, "““early attention should be focused on the knowledge and skills of all clinical staff””." If I appear angry and impatient, it is because I am. That anger and impatience are shared by a large number of professors and consultants in the field, many of whom signed a devastating letter to the Times, which appeared on 31 January. Today we are considering a report that identifies grave shortcomings in the knowledge and training of a large number of health professionals, who as a result are unable to provide the quality of service that is, I am sure, their ambition and the understandable and justified expectation of their patients. It is the job of Ministers to ensure that shortcomings, when identified, are remedied. It is they and not others who should be held responsible if remedies are not found. With a Minister rightly described in the debate as highly qualified, perhaps at long last there is hope.