Health: Allergy (Science and Technology Committee Report)

My Lords, this is a first-class report, as has been mentioned several times; it is highly professional, lucid and well illustrated, and the House is rightly grateful to all those who have taken part, especially to the chairman, the noble Baroness, Lady Finlay of Llandaff. The report draws attention to the centre for the study and treatment of allergy, which emanated from Guy’s Hospital, which is where I continue to work. The centre is directed by Professor Tak Lee, and it is known as the MRC-Asthma UK Centre. It is the only centre of its kind in the country. It is a collaboration between the MRC, Asthma UK, King’s College, Imperial College, the hospitals of Guy’s and St Thomas’s, King’s, Royal Brompton and St Mary’s. As the report says, "““all the organisations had been able to combine their research strengths into one cohesive strategy for the first time””." The centre also works with general practices in east London. It focuses on teaching, research and patient care. Many more similar centres are required urgently throughout the country, as has been said, and that has been the verdict of several recent reports. All have emphasised that there are fewer allergy centres in the UK than in Europe and the USA yet nothing seems to have been done to increase capacity. Ministers have made the excuse that it is the fault of the PCTs whose job it is to make these decisions. But Ministers know that PCT's have never been accused of understanding complex subjects like allergy. As has been mentioned, the Times newspaper headline of 26 September stated, "““Britain ‘is the laughing stock of Europe’ for its neglect of allergy cures””." Ministers need to give a lead. We desperately need a big drive from the top. Irrespective of any single centre that may be created in the future, right now there are some departments around the country that have critical mass and already fulfil many of the criteria that the report recommends for a centre; for instance, Cambridge, Southampton, the Royal Brompton with St Mary’s, and Leicester. For a relatively small amount of extra investment one could create a number of allergy centres as envisaged by the report: for example, the extras that would be required would be a half-time dietician, one full-time specialist nurse and one paediatric and one adult allergist. We also need to put money into trainee slots; there are only 12 of these, known as SBRs, in the whole country—one for every 5 million of us. That is totally inadequate to provide, first, a network of NHS services uniformly across the UK and, secondly, the leadership for training a future generation of allergists. While some academic allergy trainee posts have been created—this is very welcome—the numbers are still insufficient to make a significant impact on clinical allergy service provision especially in paediatrics, as the noble Viscount, Lord Simon, mentioned. The numbers simply could not meet the recommendations of their Lordships’ report. Why not move some of the excess unfilled training numbers in other specialties into allergy? Will the Minister tell the House why that cannot be done in the next month? Of course, any increase in trainee numbers needs to be matched by an increase in the number of consultant posts to build capacity. The charity Asthma UK has drawn attention to the large number of hospital admissions in England for patients with an asthmatic attack. My noble friend Lord Colwyn mentioned that from April 2006 to March 2007 there were over 67,000 emergency admissions, 40 per cent of which were for children under 16. It estimates that 75 per cent of those admissions could be avoided with good asthma care. Professor Tak Lee emphasises that there are many professionals treating patients with asthma but they concentrate on treating the symptoms but fail to look for the cause of the asthma, failing to hunt for an allergic basis for the problem. That is why it is so important to have allergy experts involved in the care of these patients. Accurate diagnosis is so important, as the noble Lord, Lord Bhattacharyya, stressed. I was especially interested in the section on allergy in the school environment, where the problem of hay fever during examinations is discussed and mentioned by the noble Baroness, Lady Finlay, and the noble Baroness, Lady Perry. For many years I have advocated that one solution would be to hold the examinations in March or April. However, the congenital snag hunters have always dismissed this out of hand, as is done in paragraph 5.25 of the report, where a senior civil servant stated that, "““the structure of the school year is based upon centuries of history … It would not be practical to suggest an alteration of the examination timetable purely to benefit hay fever sufferers””." Have we not heard that before? That civil servant seems to have forgotten that the examination system has been radically altered dozens of times in the past 60 years. Perhaps he is unaware that the baccalaureate exam is held in May, and the GCSE drama examination was held in April this year by some of the examination boards. It is not only hay fever sufferers who would benefit from that change, but the thousands of candidates who suffer intolerable heat in the height of summer in poorly designed examination halls, even in quite expensive public schools. A sauna can be an enjoyable experience but not in the middle of a crucial examination which will determine one’s career for life. There would be other advantages—for instance, the summer term could be spent by pupils engaged in more practical work to prepare themselves for citizenship, charitable enterprises and so on. And the examiners could complete their tasks before the summer holidays. This would have a further advantage in that it would allow the universities to make final decisions on their entries before August and do away with the need to allocate provisional places—which creates chaos. Another aspect of the report deals with the most dangerous of all allergies; namely, anaphylactic shock. This may be caused by many different antigens, including peanuts, drugs, insects and so on. In order to deal with this hazard and forestall disaster, those who are known to be susceptible are provided with the devices that have already been mentioned—EpiPen and Anapen. There is confusion about who can help the child in school and whether anyone should do. The report rightly recommends that staff should be taught about how to deal with these emergencies and have clear guidance. Potential sufferers have to carry the adrenalin themselves, as well as it being available in school. As this is so important, can the Minister assure the House that what must be a relatively straightforward matter is sorted out quickly without resorting to umpteen meaningful, ongoing working parties and committees, which the Minister and I used to call group psychotherapy meetings when we worked together in surgery? This subject brought to the surface some strange comments in the report. One witness, at paragraph 5.35 suggested that these adrenalin auto-injectors were overprescribed. He said, "““of countless prescriptions I have written over the last 12 years for such devices only one has ever been used””." Perhaps that witness should have been asked how many of the fire extinguishers in his area had been used in the past 10 years. I always have in my pocket ampoules of adrenalin and hydrocortisone with a syringe and needle. These are probably the only drugs that are required immediately—and there is never time to get them. Recently, I was presented with two patients in anaphylactic shock due to the stings of French hornets. Had I not been carrying these essential drugs, one of the patients might well have died; although of course one can never be certain. Medicine and prophecy are two quite separate subjects. To many people it is a puzzle how anaphylactic shock actually kills the patient. The cardiovascular system is greatly impaired, blood pressure drops to the boots, and the excess fluid which rapidly collects in the tissues obstructs the larynx because the fluid cannot escape downwards, as the lining is firmly attached to the vocal cords. Finally, several noble Lords have described the key recommendations of the report in detail. My question is: when will the Government implement these recommendations, so that Britain will no longer be the laughing stock of Europe?