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That Mr. David Ashby and Mr. Jack Aspinwall be discharged from the Select Committee on the Parliamentary Commissioner for Administration and Mr. William Hague and Mr. Michael Lord be added to the Committee.-- [Mr. Dorrell.]

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Ambulance Dispute

11.35 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye) : On this day of action in support of our ambulance drivers and crews throughout the country --action which has focused on Westminster as well--it is with very great pleasure indeed that I present a petition signed by 40,000 people from all parts of the country in support of the case which the ambulance men are putting forward and urging the need for a speedy resolution of the dispute. They say :

Wherefore your petitioners pray that your Honourable House urge the Secretary of State for Health to use the good offices of ACAS and agree to arbitration in order to end this unnecessary dispute ; and urge the Secretary of State to provide a pay formula for the Ambulance Service similar to that for the other emergency services. It is my very great pleasure, on behalf of the 40,000 who signed this petition, to present it formally to the House.

To lie upon the Table.

Mobile Home Residents

11.37 pm

Mr. Elliot Morley (Glanford and Scunthorpe) : I wish to present a petition on behalf of 515 residents of mobile homes in the Glanford and Scunthorpe constituency. This petition was organised by Mr. J. E. Epps of 40 Main avenue with the help of a Mr. East.

The petition draws the Government's attention to the injustice that mobile home dwellers face with the imposition of the poll tax. Under the old system, the rates took into account the fact that those people who lived in mobile homes paid a site rent which covered such things as the installation of street lamps and the maintenance of the roads on the site. This, of course, is no longer taken into account in the poll tax. People on low incomes, many elderly people who have sold up to retire to mobile homes, many young families who cannot get a council house to rent and cannot afford to buy a home, live on these mobile sites, and this unfair and regressive tax falls very heavily upon them.

I give my wholehearted support to the petition.

Wherefore your Petitioners pray that you Honourable House will reconsider the effects and application of this unfair tax.

To lie upon the Table.

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Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Dorrell.]

11.38 pm

Sir Jim Spicer (Dorset, West) : I claim no special knowledge of the problems which can be, and indeed are, caused by our environment to many people in this country. Allergy symptoms are just one small part of a whole range of modern diseases, such as certain cancers, heart disease, multiple sclerosis and Alzheimer's disease, but there can be little doubt that environmental pollutants such as aluminium, pesticide residues, hydrocarbons and so on are factors in all these diseases.

My interest in allergy and other areas related to it stems entirely from my work within my constituency. I should like to give two specific examples from within that constituency.

The first relates to a young man called William Rudd, who was the son of very good friends of ours and who went to school with my daughters at a very early age. He grew up to be a great sportsman, a good athlete and a good all-rounder and scholar. In his late teens he developed major allergy problems which grew worse as he advanced into his 20s. The only effective treatment that could be provided for him--when I say "effective treatment", I do not mean treatment leading to a cure but treatment to contain the problem--was provided by Dr. Jean Monro.

However, the treatment was private and rather expensive. For many years, William's parents, who were farmers, struggled to raise the money to pay for it. I did my best to help. I am delighted that the local health authority eventually began to contribute to the cost of the treatment. Without the treatment, William's life would have been unbearable. Even with it, the outcome was that in his early 30s, having suffered from myalgic encephalomyelitis and total allergy for more than nine years, he took his own life. He had lived in a sterile environment, virtually on his own, throughout the nine years, and I think the strain and the stress became unbearable.

I turn to a happier history, again of a constituent, Miss Cathy Bailey. Until September 1987, she was teaching full time in Dorchester. Then she became ill. After nine months of visits to doctors and specialists, during which time she deteriorated in every way, she saw Dr. Jean Monro, who diagnosed ME, with multi-food and chemical sensitivities as well.

I first met Cathy in October 1988. By then, she was a truly pitiful sight. She weighed just under five stone, was incapable of working and was in total decline. Once again, I am delighted that West Dorset health authority turned up trumps and helped with the funding of her treatment. Without that help, she would not have been able to continue the treatment.

Cathy came to see me just two weeks ago. I have never seen such a startling transformation. Her weight is up to eight stone and she is back at work, although only part time. Without the support and understanding of West Dorset health authority, of our director of community medicine, who saw Cathy and understood what the problem was and how it should be treated, of Dorset education authority, which gave her full support, and of her own headmaster and her school, who carried her willingly and happily during the period of illness, and

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above all, without the treatment that she was given, I am convinced that by now she would have been a total invalid or dead.

I will let my hon. Friend the Minister have a note of Cathy's history because it relates clearly and concisely, with dates, not only the tremendous help and support which she was given by some people in the medical profession, but also the scepticism that she encountered from others in the profession, who said, "There's nothing wrong with you ; go away have a long walk, take more exercise and you'll be fine," or "Go to a psychiatrist who will sort you out, because it's all in your mind."

The difference in the attitude of the medical profession in Cathy's case is mirrored throughout the country. We all know that a large number within the medical profession will not accept that ME or allergy is an illness which requires careful and specialised treatment.

I am delighted that, in west Dorset, there are many dedicated people. As a result of their experience of this new and largely unknown problem, a chair in environmental medicine has been established at the Robens Institute at the University of Surrey. Professor William Rae has been appointed to the chair, and he plans to undertake a wide range of investigations into this field. A former colleague of ours in the House, the Earl of Ancram, is the president of the Environmental Medicine Foundation, and a constituent of mine, Lady Colfox, is its chairman.

In a few short minutes, it is not possible to do more than to touch upon the many and varied problems that arise from these conditions, but I know that almost every hon. Member has constituency experience of those problems. Early-day motion 288, tabled by my hon. Friends and me, bears witness to that fact : within two or three weeks it had been signed by 184 hon. Members.

I ask my hon. Friend and her Department to undertake to have a long hard look at this subject and in particular to study, and, it is to be hoped, give support--both physical and financial--to the work of the Environmental Medicine Foundation, which is being so ably led by Professor Rae.

11.46 pm

The Minister for Health (Mrs. Virginia Bottomley) : We are all indebted to my hon. Friend the Member for Dorset, West (Sir J. Spicer) for raising this important subject. It is clear from the examples that he gave and from his history of involvement in the Environmental Medicine Foundation that my hon. Friend has taken responsibility for championing the cause of those suffering from such conditions and for drawing their problems to the attention of the House.

In recent years many people have become interested in allergies. Such concerns are increasingly shared by doctors as well as by those people who suffer from allergies of various kinds. We all live in an increasingly complex environment in which there are many substances that may affect us as we go about our everyday life.

Many people--the precise number is unknown, but it may be 10 per cent. of the population--suffer from some kind of allergy. Of course, one problem is that the label "allergy" is now attached to a number of apparently unrelated symptoms and problems of varying degrees of seriousness. Some of those with a so-called allergy may be reacting to a period of stress or some kind of emotional problem. Such people may be difficult to treat or manage.

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Others are demonstrably allergic to a variety of substances. A variety of treatments can be offered, including avoidance of exposure to that substance or substances and treatment aimed at producing symptomatic relief.

It is a measure of the increasing importance that the medical profession gives to allergy that clinical immunology and allergy has now been accepted as a separate speciality. My hon. Friend referred to the difficulty of getting sufficient medical recognition for the subject, but I hope that he will agree that there has been progress. The Royal College of Physicians recommended that the speciality should be recognised in 1987 and subsequently the joint committee on higher medical training gave its approval. Before that time it was incorporated under the heading of general medicine, and lost in a variety of other subjects. Of course, this did not mean that there was no NHS treatment for allergy. Then, as now, there were a number of hospital consultants who took a special interest in the subject. Treatment for allergies is widely available under the NHS. Less serious cases, which are perhaps in the majority--for example, people with one of the milder allergic reactions to a particular kind of food such as shellfish or who suffer from hay fever--are treated satisfactorily by their general practitioners or even by over-the-counter remedies. Where symptoms are more serious or more prolonged, a GP may refer the patient to a hospital consultant if that is considered to be necessary.

I am happy to say that there are about 45 specialist NHS clinics located in various places around the country. Such clinics are not the only ones equipped to investigate the cause of allergic reaction in individual cases, and recommend treatments. Many other specialists outside these clinics take an interest in various kinds of treatment for allergies, and provide it under the NHS. These will include chest specialists. Allergy is so important for their work that training in allergy is a mandatory part of their postgraduate training. The postgraduate training of dermatologists, paediatricians, ear, nose and throat surgeons and gastro-enterologists also includes a component of study of allergy and they can and do provide treatment. I recognise the points made by my hon. Friend and that there are times when patients feel that they have not been given the consideration and respect that their circumstances require. However, we are continuing to see further progress in the significance and priority that is given to allergy.

Following the recognition of allergy as a specialty, the position has continued to improve. The joint planning advisory committee, which advises the Department of Health on medical manpower, last looked at the position of senior registrars in 1988. At that time it recommended that the number of senior registrars in clinical immunology and allergy should double, from five to 10. It is due to review the position again in 1991. I know that my hon. Friend will regard that with close interest.

Only yesterday the Department issued an executive letter on rehabilitation and clinical immunology and allergy informing health authorities that the specialties of rehabilitation and clinical immunology and allergy will be recognised as separate clinical specialties for manpower purposes. Employing health authorities will therefore need to change the designation on the contracts of those doctors currently in post practising in those specialties. It also

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reminded health authorities that in 1987 the Royal College of Physicians recommended that each district should have a physician in immunology and allergy either in a system-based specialty such as thoracic medicines or, for example, a general physician with a special interest.

Sir Geoffrey Johnson Smith (Wealden) : Will my hon. Friend state clearly whether those provisions will lead to increased funding for the additional posts? She mentioned funding a moment ago.

Mrs. Bottomley : My hon. Friend will be well aware that there has been a substantial increase in resources for the Health Service in recent years. The specific allocation of resources is, of course, a matter for the district health authorities in conjunction and discussion with the regional health authorities. The requirement from the Department that manpower is more explicitly defined and the greater recognition of the specialty will mean that those planning service provisions will inevitably have the subject drawn to their attention more effectively.

Under our new proposals, it is for the district health authorities to plan to meet the health needs of those resident in their population and it may well be that individuals will wish to take up with their district health authority the question of what arrangements it has made and what contracts it has placed for the special treatment of patients with allergic problems. From 30 September 1990 health authorities will need to have amended the contracts of doctors in post practising in clinical immunology and allergy and to record them separately which will mean that there is greater clarity about the availability of those with the skills to undertake this work.

There are some National Health Service clinics with long waiting times before a first appointment is given. I know that my hon. Friend the Member for Dorset, West is well aware of the problem. Sometimes the general practitioner may consider that the treatment available does not meet a particular patient's needs. In such cases, it is always possible for the GP to refer to another consultant elsewhere. If a hospital consultant takes the view that in his clinical opinion the facilities available are not suitable for a patient, it is always open to him to ask the responsible health authority if it will agree to finance treatment for an NHS patient in a suitable private facility. This is the case in my hon. Friend's example. The health authority's response to such a request will depend on its assessment of priorities within the available resources. Where the treatments are given in a private facility there is often the clear requirement that they should have been subjected to rigorous scientific evaluation.

In today's modern world, there is a wide variety of allergy. Hay fever is an allergic reaction to pollen grasses and to trees such as the silver birch. Many people have been worried that oil seed rape--noticeable because of its bright yellow colouring--has increased the severity of their hay fever. Studies are currently being undertaken to see whether that is the case. Others are worried that they are allergic to various kinds of food or to the additives used in the preparation of food. Some people are convinced, for example, that children's behaviour and hyperactivity may be associated with additives and other dietary factors. People who think that they or their

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children are affected may wish to purchase foods which are additive free or do not contain additives which create a problem.

To enable those who wish or need to avoid certain additives to do so, all additives, with the exception of flavourings, must be specifically identified by name or serial number on the ingredients list of pre-packaged foods. The E prefix used with the serial number means that it is one of those permitted for use throughout the EEC. My hon. Friend the Member for Dorset, West drew attention to environmental medicine and Professor Rea at the University of Surrey at Guildford. As a Member of Parliament with a neighbouring constituency to Guildford, I am well aware of the work of the Robens Institute. On many occasions it has identified particular areas of concern and has pioneered work on the subjects on which it has focused attention. The work of the Robens Institute covers several important areas and the new initiative, to which my hon. Friend drew attention, is arousing interest.

The advance of medical science in this country depends on the traditions of publication and scrutiny by the scientific community. I look forward to seeing the publication of the works of Professor Rea and others working with him. The Department of Health would naturally be prepared to consider the implications of any new ideas of confirmed effectiveness and validity for the development of patient care in the NHS, as it would the results of any other relevant work. My hon. Friend will be aware that the Medical Research Council is the main agency for the disbursement of public funds on medical research. I was previously a member of the Medical Research Council and I cannot speak too highly of its ability to scrutinise and allocate resources. It will be up to the EMF to apply to the MRC for support of its work.

In August we wrote to the chairman of the EMF concerning the specialist chemical analyses required for the work of the EMF. We explained that facilities for the analysis of blood for very low concentrations of chemicals, including pesticides, are available in the United Kingdom at the UK Atomic Energy Authority establishment at Harwell at commercial rates. I hope that it will be possible to follow that up.

Many people, on the basis of their experience or that of a friend or relative, believe strongly that environmental medicine, in the sense used by the foundation, can help in the treatment of various conditions. The two examples that my hon. Friend gave from his constituency experience make it clear how poignant some cases are and how desperate the sufferers and their families are for help. It is important that treatments are subject to careful scientific scrutiny and analysis. If fresh insights from any form of practice are to show their potential, they must be submitted to the highest possible standards of assessment and verification. It is scientific, not political or managerial, judgment which is at issue. The key to progress on this initiative must be the reaction of the medical and scientific community to careful evaluation of the work of the EMF. The development of medicine and science in this country has depended on this process. Those with new ideas have to subject them to the rigorous scientific scrutiny of their peers, followed by independent confirmation, before they are put forward for wider acceptance. I am sure that that continues to be the right way forward.

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I pay tribute again to my hon. Friend. He has raised a subject of great importance to the House. I should also like to thank my hon. Friends the Members for Leicestershire, North-West (Mr. Ashby) and for Wealden (Sir G. Johnson Smith), who are also present. They have made clear their interest in the subject and in the progress in the work that has been undertaken. I know that individual constituency cases have been brought to my hon. Friend's attention for which assistance and relief have been provided.

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Allergies can be enormously distressing to the patients suffering from them and to their families. We must carefully monitor developments in medical science which move us towards the successful treatment of those distressing conditions. I shall certainly continue to watch carefully the work undertaken, and I hope that my hon. Friend the Member for Dorset, West and I will have further discussions on this subject.

Question put and agreed to.

Adjourned accordingly at Twelve o'clock.

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