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I have set out the evidence that makes it clear beyond doubt that we are facing an allergy epidemic. Increased numbers of allergy sufferers, increased severity of allergies and especially pronounced evidence among children are all symptoms of the problem. I have set out the recommendations of the Royal College of Physicians as well as those of the Committees of both Houses. They centre on the need to increase consultant numbers and the provision and geographical equity of
specialist allergy clinics, and to improve the training of GPs in allergy diagnosis and treatment.
I have also covered the Government’s reaction to the problem, both through their responses to the Select Committee reports and their review, which was published last year. They amount to an admission that there is a problem, as well as a commitment to assess how to deal with it, but unfortunately little more than that.
I would like to ask the Under-Secretary to answer some further questions. Does she agree that there is a considerable gap between the necessary measures recommended by independent reports into allergy services and the steps that her Department has so far proposed to take? How seriously does she take the allergy epidemic that we face? We must remember that we are talking about a problem that affects 18 million people in this country. Does she think that enough is being done about it? Does she genuinely believe that local primary care trusts are best placed to combat the allergy epidemic? We all understand the notion that solutions are best delivered in response to local needs—and we want our health care services to be locally accountable—but, given the constraints faced by PCTs on budgets and through centrally driven targets, coupled with the lack of strategic central guidance on allergy, I fear that there will be little incentive for them to make tackling allergy their prime concern.
I look forward to the Under-Secretary’s comments.
6.13 pm
The Parliamentary Under-Secretary of State for Health (Ann Keen): I congratulate the hon. Member for East Dunbartonshire (Jo Swinson) on her success in the Speaker’s ballot and on choosing allergy services as her subject. It is clearly close to her heart and it is an important topic to debate. I thank her for bringing to our attention an issue that affects so many people in our country.
I pay tribute to the hon. Lady’s gallant fundraising efforts, especially for the Anaphylaxis Campaign, which plays an important role in supporting people who are affected by anaphylaxis. I am a former nurse and have been on the receiving end of patients admitted in anaphylactic shock, so I recognise the obvious fear and anxiety felt in that situation.
As the hon. Lady is acutely aware, I take very seriously allergic reactions to pollen, pets, foods and a range of other agents that she mentioned, and in particular reactions to latex among NHS staff. The number of people suffering from allergic reactions has trebled in the past 20 years and a third of the population are estimated to suffer from an allergy at some point in their lives. The severity of the reaction ranges from mild to severe and potentially life threatening, and the treatment options reflect that huge range.
Many people choose to self-diagnose and treat. Others may require treatment from their GP surgery or in specialist clinics. Many experience serious consequences because of their allergy. Each year there are more than 3,000 hospital admissions for anaphylaxis alone. Allergic conditions represent a huge challenge, not just for our health care system, but for society as a whole. In addition
to the obvious health effects, allergic reactions can make the most simple and everyday activities difficult—including even eating in this House, as the hon. Lady said—and can pose a major risk to an individual’s health and well-being.
The timing of this debate is opportune, as the hon. Lady acknowledged. On 27 November, the Government published their response to the House of Lords Science and Technology Committee report on allergy. We welcomed the Committee’s report, which highlighted the fact that the issue needs to be addressed by a range of stakeholders, including the Government. We recognise the importance of allergies and are committed to helping to alleviate the burden of allergic disorders. The Command Paper that we published on Tuesday highlights some of the strategies that are being developed and implemented to address the challenge illustrated in the Committee’s report. I shall touch on those later.
The Lords Committee inquiry into allergy is of course not the first time that allergy issues have been scrutinised by a parliamentary Committee. In 2004, the Health Committee published a report of its inquiry into the provision of allergy services. That report reflected earlier findings published by the Royal College of Physicians in 2003, namely that serious problems existed in the provision of allergy services.
In response to the Health Committee’s report, we carried out a review of the available data and research on the epidemiology of allergic conditions, the demand for and provision of treatments, and the effectiveness of interventions. Working closely with stakeholders—people with allergies and their families, patient groups, clinicians and representatives from the independent sector and industry—we sought to identify actions that could be taken at local and national levels to improve services for allergy.
The review was crucial as a first step towards building a programme of improvements that would be based on sound evidence and reflect the views of stakeholders. The review report, which we published in July 2006, highlighted the range of existing service provision for allergy. That provision includes more than 90 allergy clinics in England led by a range of specialists, including allergists, respiratory physicians and dermatologists, as well as services provided by general practitioners, the mainstay of allergy care. I note the hon. Lady’s point about GP training, which I hope we will take note of in Ara Darzi’s report on chronic conditions.
The Department of Health’s review identified good practice across the wide range of services available for people with allergies, and the spectrum of skills and competences of clinicians involved in their care. To take just one example, clinical immunologists at the Royal Victoria infirmary in Newcastle oversee a nurse-led allergy clinic, in which a nurse will see a complete referral and go through the whole treatment process without having to consult a doctor.
In their reports, both the Health Committee and the Royal College of Physicians made the case for a model of care that would be driven and funded from the centre. In taking forward our improvement and reform agenda, we have moved away from a top-down management approach, as we develop a devolved and self-improving health service, where the main drivers of change are patients, commissioners and clinicians. Indeed, the Department’s review concluded that one of the key
levers for change for allergy services in the future will essentially continue to be for local rather than national level action.
Jo Swinson: I accept the Minister’s premise that it is important to have local drivers for health care, but some aspects surely need to be driven by a national strategy—for example, the number of training places that are to be provided for consultants and junior doctors, so that our allergy specialists of the future can be trained. I am worried, given the present rate of training, that we will end up with fewer allergy specialists than we have now, because of the number that will retire in the coming years. What will the Minister do to expand the number of training places in specialist allergy services?
Ann Keen: I take the hon. Lady’s point very seriously. The management of chronic conditions is part of Lord Darzi’s review. During that review, we are looking at work force planning, training and specialist skills, and in particular, at raising the role of the specialist nurse in this area. That is why it is so important that we understand local needs, and that the consultation is driven by local people and local clinicians.
The Department’s review concluded that one of the key levers for change for services for allergy in the future will, essentially, continue to be for local rather than national level action. It is for local health commissioners to consider the need for local services in light of local priorities. The evidence presented in the report of our review should help them to do so. The new report by the Lords Science and Technology Committee adds to that evidence base.
We published the commissioning framework for the acute sector last year, and followed it with the commissioning framework for health and well-being, which was issued as a consultation document this March. PCTs have to carry out a local needs assessment, identify gaps or inadequacies in provision, and then produce a strategic plan for their health community. One of the key requirements of this process will be to ensure that patients and the local community are properly involved in the process of deciding priorities. Through patient choice and expert commissioning, local communities will be able to determine the type and quality of services that they require in order to deliver better health care.
We have considered, with the National Institute for Health and Clinical Excellence, the scope to develop definitive clinical guidelines for allergic conditions. We have commissioned Skills for Health to develop with stakeholders national occupational standards for the UK for allergy, and commissioned the Royal College of Paediatrics and Child Health to scope the development of care pathways for children with allergic symptoms. We have also endorsed the need for more training numbers for allergy as part of the annual review process. We have asked deaneries and trusts to consider the possibility of increasing local training posts for allergy, and invited key research funders to note the gaps in the research evidence highlighted in the review.
Some of these actions are referred to in the Government’s response to the House of Lords report. The focus of the Lords inquiry was wide-ranging and explored the impact of allergy not only on the health service but on society and the economy as a whole.
Nevertheless, at the core of the Committee’s report were a number of recommendations of direct relevance to this evening’s debate—not least those relating to the provision of specialist allergy centres and work force capacity and capability, which I know are of particular concern to many people, including the hon. Member for East Dunbartonshire and, I would guess, my hon. Friend the Member for Falkirk (Mr. Joyce).
Mr. Eric Joyce (Falkirk) (Lab): I thank my hon. Friend for giving way—
Madam Deputy Speaker (Sylvia Heal): Order. It is customary in these debates for Members to ask the permission of the Member whose Adjournment debate it is, and of the Minister, before intervening. I wonder whether the hon. Gentleman has done that.
Mr. Joyce: I have indeed, Madam Deputy Speaker.
Madam Deputy Speaker: That is fine. Thank you.
Mr. Joyce: I congratulate the hon. Member for East Dunbartonshire (Jo Swinson) on securing this important debate. A number of my constituents have raised this issue with me. They have also been extremely complimentary about the organisation Allergy UK and, in particular, about those little cards that it issues containing information in many different languages. This is a small but important point. Those cards enable people to travel around the world with information on the things that they are allergic to in their pocket. Several of my constituents have come up to me individually and been very complimentary about Allergy UK, and I wanted to put that on the record.
Ann Keen: I thank my hon. Friend for raising that point and for the important work that he and the hon. Lady do on the all-party group on allergies.
The Committee’s proposal to establish a lead strategic health authority for allergy merits careful consideration and we shall explore the feasibility of that approach with interested parties, including strategic health authorities and specialised commissioning groups. If a lead SHA were established, it would need to evaluate with its PCTs and in light of local needs and priorities whether a pilot allergy centre would be more beneficial to people suffering from allergies than other possible models for enhancing local services. The spirit behind this is to show the hon. Lady the extent to which flexibility could be delivered around allergy services.
In our own review of allergy services, we acknowledged that there would continue to be a need for a critical mass of allergy specialists. We have been able to create an additional five centrally funded allergy training posts this year and five immunology posts as well. We have asked the NHS to look at whether it needs to commission more local training posts. We have also recognised the importance of GPs and others in primary care having sufficient clinical knowledge.
Jo Swinson: The Minister is being very generous. She says that she has asked the NHS to report back on whether it feels the need for more training posts, so can she clarify when the response from the local NHS is expected?
Ann Keen: I am happy to write to the hon. Lady, as I do not have that information at the moment.
Work on national occupational standards to provide a competence framework for all staff is also very important, as was mentioned earlier. In terms of professional education, the Lords Committee’s recommendations are consistent with our review. We would encourage the royal colleges to work together with the bodies responsible for medical training at all levels to enhance the knowledge and expertise of those working with people with allergies.
In conclusion, the hon. Lady has raised many important points this evening. We welcome this debate and share her desire to see that people living with allergic conditions receive the services they need and deserve. Reforming
health care is all about finding out the facts, identifying the problems and facing up to the challenges with strategic solutions, which we have sought to do through our review of allergy services. Our response to the House of Lords inquiry demonstrates, I hope, our continued commitment to improving allergy services. I can assure the hon. Lady that the Government will continue to provide support and encouragement to the health service to ensure that that happens. I would also encourage the hon. Lady and my hon. Friend the Member for Falkirk to continue with their excellent work on the all-party group.
Adjourned accordingly at twenty-seven minutes past Six o’clock.
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