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29 Nov 2007 : Column 540

Jury education is vital; the myths need to be dispelled. I have listened to what other Members have said, particularly the Opposition Front Bencher, the hon. Member for Beaconsfield (Mr. Grieve), many of whose comments were completely wrong. The Liberal Democrats have got it right. Jurors have to sit through training on their first day, when they are shown videos, given leaflets and told all sorts of things. People can do it; leaflets to guide people, not necessarily only in rape cases, but in any cases, could easily be produced. Generally speaking, however, people know what robbery is, but there are still myths around rape. The myths that there were when I was working on women’s magazines are still there now, and we must tackle them if we are to convict more rapists.

Over the years, I have heard all sorts of things about rape cases—“She wasn’t upset enough,” “She wasn’t traumatised,” or “She was truanting from school.” Such allegations get thrown in to cast aspersions on a person’s character. If the victim did not run away, fight back or scream, or if they knew the accused, or had had a drink or a joint, people almost believe that there was contributory negligence. That implies that the woman—such cases largely involve women, although not always—somehow brought it on herself. We owe it to justice to spell out that issue so that jurors know that those are all myths.

If we are to consider the court experience, we need to do an awful lot more work on consent and what constitutes consent. Again, it is almost as if there were contributory negligence—“She accepted a lift from him,” or “She went for a drink with him, got in the car and went back to the flat; she knew what was going to happen.” People believe that such prior activities constitute consent. That issue has to be spelt out to jurors far more explicitly.

We must also consider the test of being beyond reasonable doubt. That needs to be spelled out to juries, particularly in these kinds of cases. I am sorry to say this, but far too many defence barristers say to people, “If you have any doubt”. The test is whether something is beyond reasonable doubt, not any doubt.

The victim statement should be given to the jury when it retires to consider its verdict. At the moment, only the alleged rapist’s statement is given to the jury. If it is a long trial or there are multiple defendants—if, say, it is a gang rape—we only get their version, not the victim’s. If the victim’s version was given, we would serve justice very well.

My hon. and learned Friend the Solicitor-General has done a good job. If anybody has been through these experiences and wants to get in touch with me, I am happy to listen to their experiences.

5.55 pm

The Solicitor-General: With the leave of the House, Madam Deputy Speaker.

Something very queer went wrong with the clock earlier; it seemed to go in two directions at once. I told the hon. Member for East Dunbartonshire (Jo Swinson) that I would deal with “Map of Gaps”, the report by End Violence Against Women, and I will do so now. I have immense respect for End Violence Against Women. Liz Kelly, the chief researcher on that document, is going to serve on our group of experts,
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which aims to produce some myth-busting information and to advise on how it might be put before juries. The research in “Map of Gaps” is a useful snapshot of local services for women who have suffered violence, and it shows some significant gaps.

Contrary to the assertions of the hon. Member for Mid-Bedfordshire (Mrs. Dorries), our funding of support services for those who have suffered from violence against women has increased enormously—from £250,000 annually in 1997 to £3 million now. She really needs to think, read and understand that the Government whom she supported did nothing about domestic violence and nothing about rape. Unfortunately, the speeches by Conservative Members indicate that their attitudes have not changed. I agree that Rape Crisis centres need securer funding. We have a stakeholder group working with Rape Crisis, and we have rolled over its victims fund financing for another year to help it to secure its funding, which will ultimately have to be local.

My hon. Friend the Member for Luton, South (Margaret Moran) made the good point that the 5.7 per cent. conviction rate hides a lot of variations. Some police forces manage as high as 13 or 14 per cent., others less than 1 per cent. We now have a Home Office unit working with the police to spread best practice. That should help considerably, practically and quickly. I am grateful for the broad welcome for the document given by the hon. Member for Cambridge (David Howarth). I agree that previous sexual history and its admission continue to be an issue.

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I welcome the doughty support of my hon. Friend the Member for Calder Valley (Chris McCafferty). I welcome, too, the sensitive response to jury service that my hon. Friend the Member for Cleethorpes (Shona McIsaac) demonstrated. She has talked to me about that issue several times, and she has confronted the issues on the front line that we are trying to develop policy to deal with.

I was disappointed by the responses of the hon. Members for Beaconsfield (Mr. Grieve) and for Rugby and Kenilworth (Jeremy Wright), who made poor contributions cautioning me that we must not bend the rules against defendants at a time when we are trying to make trials fair for victims as well—a long-term and profound need that they continue to be unwilling to address. It was clear that the hon. Member for Beaconsfield had either not read the document or misunderstood it, because video evidence will not be forced on to any rape complainant, but will be a matter of choice on the face of the document. Furthermore, I am afraid that his inept or deliberate attempt to textually criticise a paragraph in the document to try to undermine what the Government intend to do reflects badly on the Opposition, on a total lack of interest, despite the leadership of the right hon. Member for Witney (Mr. Cameron). We will continue to champion the rights of rape victims.

Question put and agreed to.


29 Nov 2007 : Column 543

Allergy Services

Motion made, and Question proposed, That this House do now adjourn. —[Liz Blackman.]

6 pm

Jo Swinson (East Dunbartonshire) (LD): I am delighted to be able to introduce this debate on allergy services. Allergy comes in many varied forms and guises. It can be mild or severe; it can affect one organ only or several parts of the body; its severity can vary over time; and there can be a single allergic cause, or several. By their nature, allergies are complex. We certainly need to carry out further research into how they work, in order to improve the way we treat and even prevent allergy and to bring better quality of life to allergy sufferers.

At this point, I feel that I should declare an interest, having suffered from allergies since a very young age; indeed, I recently completed the Loch Ness marathon in aid of the charity The Anaphylaxis Campaign. I have a severe reaction if I eat any nuts, which results in the onset of anaphylaxis and an emergency trip to hospital The excellent work of charities like The Anaphylaxis Campaign and Allergy UK in raising awareness of allergies and providing support to sufferers should be commended.

The first myth to dispel is that allergies are a niche issue. Recent research consistently shows huge increases in both the amount and seriousness of allergies occurring in society. In this House, many Members have experience of allergies either personally or within their families, and indeed recently I was delighted to be a founding officer of the new all-party parliamentary group on allergies, along with the hon. Members for Dagenham (Jon Cruddas) and for Eccles (Ian Stewart).

In truth, this is an area of urgent concern, an issue of major proportions and a matter that the Royal College of Physicians has seen fit to label an “epidemic”. Against this backdrop of growing seriousness, I want to use this timely debate to ask why there is such a lack of urgency from the Government to tackle what is, in terms of our future health needs in this country, a sleeping giant.

Rates of allergy in this country are among the highest in the world. An estimated 30 per cent. of the population have an allergic disease—that is 18 million people. Among children, this figure rises to 40 per cent. In any one year, 12 million people—a fifth of the population—will seek allergy treatment. All the evidence indicates that the amount and seriousness of allergies is increasing rapidly. The Royal College of Physicians has estimated that there has been a threefold rise in incidents of allergy in the last 20 years.

Severe and life-threatening allergies are now more common, with increasing numbers of children affected in particular. Peanut allergies, previously rare, now affect one in 70 children. Latex allergies now affect 8 per cent. of health care workers, whereas before 1979 only two cases had been reported. Hospital admissions for anaphylaxis have increased sevenfold in the last decade.

The financial cost of allergy to the health service and the economy as a whole cannot be ignored. More than 12.7 million working days are lost each year as a result
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of asthma alone, and Asthma UK has placed the total annual cost of asthma to the economy at £2.3 billion. Adverse drug reactions account for 5 per cent. of all hospital admissions, and 15 per cent. of in-patients have a hospital stay prolonged as a result of drug allergy. Allergic disease accounts for 6 per cent. of GP consultations and 10 per cent. of the GP prescribing budget. The cost of allergy to the national health service has been estimated at £1 billion.

Figures can be persuasive, but it is often people’s individual experiences that make the most compelling case. This quote comes from one serious allergy sufferer:

A couple of my constituents who suffer from a latex allergy came to see me. Eleanor McKendry previously worked in the NHS where she developed the allergy and so is no longer able to work in her trained employment. She even finds attending out-patient appointments as a patient a challenge, owing to the lack of provision of latex-free environments, even within our hospitals and health care services. Lesley Shannon, another constituent, faces a daily game of Russian roulette even when she goes to do her grocery shopping. She has found that supermarkets often have latex balloons that advertise in-store promotions but which can trigger a life-threatening reaction if she is anywhere near them.

I know from experience how terrifying an anaphylactic reaction is. Symptoms develop quickly, within minutes of exposure to the allergen. I get an unpleasant tingling sensation in my mouth and throat, which is soon replaced by swelling, and breathing becomes incredibly difficult. At the same time, my forehead and palms start to sweat, feeling clammy, and I come over all feverish. My heart rate speeds up, prompting a feeling of panic that is not helped by the fact that I find it difficult to draw breath. That is a terrifying enough experience for me, an adult who has experienced it before. I understand my condition and know what I have to do—get to hospital, where I will be treated successfully. I also know that I am carrying an emergency dose of adrenalin in my handbag if I should need to take that en route to the hospital. How much worse must it be for the parent of a baby or young toddler who cannot explain their symptoms if the child goes from being perfectly okay to life-threateningly ill within a short space of time? That is what people face.

There are many difficulties. First, the range of allergens is broad. Common food allergens include nuts, fish, seeds, milk and kiwi fruit. There are many others, too. There are also chemicals, latex, dust, pollen, house mites and grass—the list goes on. Identifying the allergen can be difficult, and avoiding it is sometimes impossible.

I have given the examples of Eleanor trying to avoid latex in health centres and Lesley trying to avoid it in shops. As someone with a nut allergy, I can assure hon. Members that ensuring I do not eat any nuts is no easy task. Companies seem to be more aware of their responsibilities, but rather than providing helpful information, more often there is a generic statement
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that the product may contain traces of nuts. I challenge hon. Members to look at the back of packets next time they do their shopping—they will see just how many products carry such warnings. Even in the catering outlets in the House, a legal disclaimer at the bottom of every menu states that nothing can be guaranteed nut-free. I wonder where I am supposed to eat.

Many issues surrounding allergy must be addressed, and I hope that the all-party group will do so over the coming months. That needs to be done not only with the Department of Health but with those in charge of housing, the environment and business regulation. However, I want to focus on the right course of action for the Department of Health to tackle this growing and potentially fatal condition.

Four key reports from recent years inform the allergy debate. The first, produced by the Royal College of Physicians in 2003, puts into stark relief just how urgent the allergy epidemic has become. Worryingly, it states that, for allergy patients, the health service is

It paints a picture of a service in which GPs deal with the majority of allergy cases, despite having no clinical training in allergies, and in which patients are referred to a succession of different specialists, resulting in confusion and inadequate treatment.

The overriding criticism in the report is of the shortage of specialist allergy expertise. The whole UK has just six fully staffed allergy clinics, unequally distributed with a strong south-eastern bias. There is a major shortage of specialists with expert knowledge. It is reckoned that there is one consultant in a mainstream medical specialty per 100,000 members of the population; the equivalent figure for consultant allergists is one per 2 million.

The report’s recommendations are clear: to create more consultant posts and funded training posts in allergy, to form the basis of a genuinely national allergy service for the NHS, to set up regional allergy centres with appropriate staff levels, and to ensure even distribution across the country by locating at least one such centre in each former NHS region.

The second report was published in 2004 by the Select Committee on Health. It mirrored many of the points made in the 2003 report. It, too, identified a lack of training and expertise in allergies among health professionals in primary care. It also found that the level of allergy expertise at consultant level was inadequate and called the distribution of just six allergy centres “manifestly inequitable”. The Select Committee supported the royal college’s proposal for a specialist allergy centre in each former NHS region, with a minimum of two adult and two paediatric allergy consultants. Long term, it argued that allergy should have a full specialist consultant work force, as is the case in many other countries, with an extra 10 training posts introduced year on year.

The Government’s response to the Health Committee’s report pledged a review of allergy data and demand for treatment. Disappointingly, however, it failed to address directly any of the Committee’s recommendations, whether on GP training, consultant numbers or specialist allergy centres. I hope that perhaps today the Under-Secretary can respond to the specific points that the Committee’s report raised.

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In 2006, the Department of Health published its review, as it said it would in response to the Health Committee report. However, again, those hoping that the Government would act on the Health Committee recommendations were left wanting. Despite conceding that people with allergies often feel let down by the poor service that they receive, finding that some people can wait three to nine months for an appointment to see a consultant and even stating that

by an improved service, the review’s recommendations fall short of what was hoped for.

The review finds that incomplete research makes it difficult to establish compelling evidence of the need for and quality of allergy services, and raises problems with drawing up a strategic national view of how services should be developed. We are told that the Department will ask local health commissioners to establish levels of need for allergy services, allow strategic health authority work force planners to explore scope for additional training places and ask for development of National Institute for Health and Clinical Excellence guidelines on allergy to be considered. Given that that response was made in 2006, I hope that the Under-Secretary will take the opportunity to update the House on the action that has been taken on those recommendations.

The House of Lords Science and Technology Committee report on allergy was published in September this year. Again, the findings are familiar. The report’s recommendations echo those of the Royal College of Physicians and the Health Committee, especially on the need for specialist allergy clinics and improved GP training. Helpfully for the purpose of the debate, the Government’s response to the Lords report was published earlier this week.

The response reinforces the Department’s determination to devolve decision making on allergy care and avoid developing a strategic overview of allergy services. It states that

placing the responsibility for allergy services squarely in the lap of primary care trusts.

On GP training, the response notes that no allergy-related guidance topics have been included in the NICE work programme yet. It states that the Department of Health

but, clearly, the Under-Secretary knows that she can bring her influence to bear. What does she intend to do to ensure that our GPs receive the training they need to diagnose and treat allergies swiftly and effectively, especially given that more and more people are coming through their doors who need that expertise?

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