Health: Allergy (Science and Technology Committee Report)

My Lords, I greatly enjoyed the debate. As my noble friend and others have declared their allergic reactions, I probably should declare my own. I am a hay fever sufferer and, for years, living from April to July has always been hell, although my asthma is certainly not as severe as that of my noble friend. First, I congratulate the noble Baroness on securing today’s debate. I also congratulate her on the excellent work on allergy produced by the House of Lords Science and Technology Committee, which she chaired so ably. As my noble friend Lord Haskel pointed out, allergies affect the lives of millions of people in this country. Around one third of the population suffers from an allergy at some point in their lives and there are people in the House today, as we have heard, for whom this issue is of personal as well as national importance. The establishment of the All-Party Parliamentary Group on Allergy, of which the noble Baroness is a vice-chair, will help us make further progress. I wish the group success for their reception on 14 May. As the noble Baroness is aware, allergies are common and on the increase. In addition to the obvious health effects, allergic reactions can make unavoidable daily activities very difficult. They can compromise a sufferer’s performance at work and, as we have heard, hinder children’s educational progress. Clearly, allergic conditions represent a huge challenge, not just for our healthcare system, but for society as a whole. It is for these reasons that the Government welcomed the committee’s report, which highlighted very clearly that allergy is an issue that needs to be addressed by a wide range of stakeholders. Noble Lords will be aware that in 2006, the Department of Health published a report of its review on allergy services. The review looked at the epidemiology of allergic conditions; the demand for, and provision of, treatments; and the effectiveness of interventions. This review was a crucial first step in building a programme of improvements that would be based on sound evidence, and would reflect the views of patients and healthcare providers. We are pleased that it was published in time to inform the inquiry led by the noble Baroness. Our review concluded that one key lever for changing allergy services in future will be local rather than national action. However, I sympathise with what I have heard today and the reasons so eloquently articulated throughout the House. I will take forward some of the suggestions made, but I still believe that we need to engrave in the NHS at a local level a self-improving system to deal with today’s problem of allergies, as well as with other challenging long-term conditions such as dementia that we have debated in this House and that our NHS will face over the next decade. The report of the inquiry led by the noble Baroness made a number of recommendations to improve allergy services further. In their response, the Government committed themselves to taking action. Ann Keen, the Minister with lead responsibility for improving allergy services, recently met the noble Baroness to explore how we can work together to take forward the recommendations in the report. As we heard, she made a personal commitment to this report. Due to the pressure of time today, it will not be possible to run through every recommendation and all the actions that have been taken. I shall therefore focus on the committee’s key recommendations and on some of the specific issues raised today, setting out what we are doing to address them. A lead strategic health authority should be established to take forward the development of a pilot allergy centre on a hub-and-spokes model. We agree that services need to be better organised if they are to meet patients’ needs. Long-term conditions such as allergies are on the increase, and the Government feel that it is vital to change the disease management pattern in primary care if services are to be fair, safe and effective. Noble Lords are aware that, as part of my ministerial commitment, I spend most of my time providing leadership to the next stage review. I assure the House that that review will be looking at how we can build an infrastructure in primary care to take advantage of some of the innovations discussed here today. We are also in the process of exploring the feasibility of that approach with interested parties. As part of the consultation process, Professor Sir Bruce Keogh, our recently appointed NHS medical director, has written to all SHA chief executives asking them to declare whether they are interested in taking on this very important role. I have no doubt that Manchester will be a very strong contender. However, there are 10 strategic health authorities and I think it is only fair that they are all asked who should take on the leadership role. The process has started and will be completed soon. I turn to the issue of workforce planning and education and training, in which my noble friend Lord Bhattacharyya has personal experience. The noble Lords, Lord Taverne and Lord Crickhowell, raised the issue of our educational needs and competences in the service. The noble Lord, Lord McColl, highlighted the fact that last year we were able to create an additional five centrally funded training posts for allergy and a further five for immunology. In total, that is 10 posts. If the current figure is 12, that is near enough a 90 per cent increase in our training numbers. I have no doubt that we need to do significantly more, and we will continue to remind the workforce review team of the need to consider increasing training numbers in relation to allergy as part of its annual review programme. We have also encouraged the royal colleges to work with other bodies responsible for medical training to enhance the knowledge and expertise of those working with people with allergies. No doubt we all agree that the first contact that a patient makes is in the primary and community services, and if the competences for managing some of the demand from our patients out in the community are lacking, we have to do something about that. That issue is very close to my heart. I feel strongly that it should be part of our reform of primary and community services so as to meet some of the future demands on the service. As part of the annual review process, we have also endorsed the need for more training numbers for allergy. I have asked deaneries and trusts to examine whether they need to commission more local training posts for allergy. We also commissioned Skills for Health to work with stakeholders to develop national occupational standards for allergy for the UK in order to improve the quality and consistency of patient care. We anticipate that the standards will be published and implemented this summer. As well as training, health professionals need the tools to enable them accurately to diagnose and treat patients. We commissioned the Royal College of Paediatrics and Child Health to scope and develop care pathways for children with allergy symptoms. These will help to ensure that children displaying possible allergic reactions are given timely and appropriate care. I now turn to another area close to my heart, that of research. I have no doubt that I should declare my interest, still working in a university and carrying out research. The noble Earl, Lord Selbourne, eloquently highlighted the importance of research and reminded us of the committee’s recommendation that further research should be undertaken to increase understanding of allergic causes. Work is being taken forward across government to increase our knowledge of these conditions. For example, the Medical Research Council and the Food Standards Agency are collaborating to fund a major new clinical intervention study on the effects of early weaning on food allergy. In addition, the National Institute for Health Research has provided some £4.7 million over five years for research on asthma and allergy. The noble Earl also raised the issue that more research needs to be carried out on early exposure and long-term cohort studies. Again, the NIHR has funded a project on primary prevention of asthma by allergen avoidance in infancy. The subjects were recruited antenatally and are now 17 and 18 years old. The occurrence of asthma and allergic diseases will be assessed and reported in due course. The other issue raised by the noble Earl, which again is extremely important and very much part of the next stage review, is how we can get a closer interaction between clinical need and the research excellence that we have achieved and in which we lead in this important field, not just nationally, but internationally. One of the review’s enabling themes is to see whether we can find the right incentive for closer collaboration. Most of us know that we have created the first academic health science centre in this country. I have no doubt that your Lordships will agree that in a further such collaboration, bringing the two together, the power will be much greater than the sum of its parts. We need to exploit that for the future. Over the past few years, the National Institute for Health and Clinical Excellence has also produced a number of appraisals of allergic conditions and clinical guidelines for atopic eczema. Immunotherapy was another issue that was strongly debated today by the noble Lord, Lord Soulsby. We are and will be working with NICE to develop more focused allergy topic proposals, which will feed back into the NICE topic selection process. These include proposals for health technology appraisals of immunotherapy, as the committee recommended. I am sure that the committee's report will strengthen the proposals and I will liaise with my ministerial colleagues to make sure that they are given the high level of ministerial commitment that they deserve. The fourth set of recommendations focused on food. The Food Standards Agency has been running training workshops to raise awareness of food allergy issues among enforcement officers. The noble Lord, Lord May, also raised the issue of the peanut allergy. The evidence base on avoidance of peanuts in early life and the subsequent development of peanut allergy has changed since the Government issued advice in 1998. The Food Standards Agency has therefore commissioned a review of the scientific evidence that has become available since that time. This adds to the study being conducted by Professor Lack—until recently, a colleague of mine at Imperial who has now moved to King’s—which is due to finish in 2012. The noble Lord, Lord May, also raised the issue of how we could get a stronger coalition to tackle some of the research needs in this area. The UK Clinical Research Collaboration exists to co-ordinate strategic approaches to research funding. The major funders of this scheme include the Department of Health, industry, research councils and charities—including the Wellcome Trust. I have no doubt that, through the leadership of OSCA, we can bring the debate around research and development in allergy very much to the forefront of the CRCs. Finally, the committee recommended that the Department for Children, Schools and Families should review the care and support that children suffering from hay fever receive in schools, particularly through the exam period, as the noble Lord, Lord McColl, highlighted. The Joint Council for Qualifications already advises examination boards that pupils who suffer from hay fever may be given special consideration when taking examinations. We may have to reinforce that. Government guidelines clearly exist; the matter is addressed in Managing Medicines in Schools and Early Years Settings. Let me move on to some of the other issues that were raised during this informative debate. The noble Baroness, Lady Perry, referred to EpiPens in schools. Managing Medicines in Schools and Early Years Settings states that early years settings, schools, local authorities and primary care trusts should, "““review their current policies and procedures””," to, "““ensure that all school staff are clear about what to do in … a medical emergency””." In relation to allergies or anaphylactic shocks in the school setting, it says that, although the Government do not expect school staff to be medical professionals, those giving or helping with medical treatment should be trained and insured to do so. It is for local authorities and schools to work with primary care trusts to ensure that staff, including school nurses, are trained in the appropriate methods. The noble Lord, Lord Rea, and the noble Baroness, Lady Barker, asked how we could improve food allergen labelling and referred to the UK’s influence on the EU review. The Food Standards Agency will negotiate the new EU proposal on behalf of the UK Government to ensure that allergic consumers are able to make informed choices about the foods that are safe for them. The noble Lord, Lord Colwyn, and the noble Baroness, Lady Barker, talked about the important role of complementary medicine in relation to allergic conditions. Some might be aware of the steering group on the statutory regulation of acupuncture, herbal medicine and traditional Chinese medicine, chaired by Professor Pittilo, which is due to report to Ministers shortly. We will consider the next steps forward in light of the working group’s recommendations. I have no doubt that its recommendations will also be of great interest to the all-party parliamentary group. The noble Lord, Lord Colwyn, talked about SNOMED—systemised nomenclature of medicine—clinical terminology. The training requirements to ensure the proper use of SNOMED CT relate to the development of detailed care record systems by local service providers as part of the national programme for IT. SNOMED CT is being built into the systems and training will be a local responsibility associated with their deployment. I have no doubt that that will also capture the incidence of allergies out in the community. The noble Lord, Lord McColl, also asked about the availability of EpiPens. In the year to 30 September 2006, which is the most recent year for which I have figures, up to 165,000 prescriptions for EpiPens were dispensed in the community in England at a cost of £8 million. EpiPens are out there but I have no doubt that we can do more to ensure that they are there when the need arises, rather than just being prescribed in the community setting. In conclusion, the debate this afternoon has raised many important issues about allergies and how the NHS could meet the high standards that patients have a right to expect. I hope that our response to the House of Lords inquiry and the actions that we have taken demonstrate our continued commitment to improving allergy services. I have no doubt that there is more to be done, but I can assure your Lordships that the Government will continue to provide support and encouragement to the health service to ensure that this happens.