NHS: Patients with Allergies

Question for Short Debate

13:00:00

Asked by

To ask His Majesty’s Government what steps they will take to ensure that patients with allergies receive timely and comprehensive care from the NHS.

My Lords, I am pleased to have the opportunity to consider this challenging issue with noble Lords who have kindly put their name down for this debate. I am grateful to the staff of the House of Lords Library for their helpful briefing as well to those charitable organisations that have contacted me with a wealth of useful background information. At the start, I want to explain where my close interest in this issue arises. My 16 year-old daughter was diagnosed with multiple allergies as a baby. Thankfully, she has grown out of most of them, and I will never forget the astonished smile on her face when, having grown out of her egg allergy, she had her first bite of chocolate cake. Unfortunately, her severe allergy to peanuts has continued, and her father and I have twice seen for ourselves the reality of anaphylaxis, watching helplessly as our daughter suffered. We are fortunate that in all other ways she is a fit and healthy teenager, but every time I read, as we all will have, about the death of a child or a young person from an allergic reaction, I weep for the parents. We will all have been moved by the tragic story of Natasha Ednan-Laperouse, who died at 15 after an allergic reaction to the sesame seeds hidden inside a baguette. It has been inspiring to see how Natasha’s parents set up a charity to improve the outlook for allergy sufferers in future. In fact, the findings of a pioneering Natasha clinic trial led by researchers at the University of Southampton, University Hospital Southampton and Imperial College London are already transforming the lives of some children with severe milk and peanut allergies. Allergy UK kindly briefed me about the scale of the problem across the country. More than 100,000 people were admitted to hospital for anaphylaxis over the 20 years to 2018, which tells us that an otherwise completely healthy person is more likely than not to be admitted to hospital following an extremely frightening allergic reaction during the course of today’s short debate, and, most distressingly of all, the data shows that the next death from anaphylaxis is likely to happen in less than seven weeks from now. As noble Lords will understand, every such death strikes what I can only describe as terror in a parent’s heart. Noble Lords can imagine what I am feeling when I ask, “Have you got your EpiPens?” every single time my daughter leaves the house. When my daughter was only a baby, her GP, who was concerned about her eczema, referred her to an allergy research study at Evelina London Children’s Hospital just across the river from here, part of the wonderful Guy’s and St Thomas’ NHS Foundation Trust. Both there, and at the trust’s paediatric allergy clinic, she received wonderful care over the next 15 years. I subsequently learned that the trust is a World Allergy Organization centre of excellence, as is Southampton, which demonstrates that England has some of the world’s pre-eminent specialist clinical and research allergy centres. These specialist centres are few in number and are clustered in the south-east. A child like my daughter, living near to a renowned specialist centre, will have access to cutting-edge research, along with the clinical benefit, while others elsewhere will not have access to even basic specialist services. Even where, as at Guy’s and St Thomas’, children and young people have the chance to get the services that should be available to all, once they start to transition to adulthood, support largely disappears. Services for adults are very limited indeed. I was amazed to learn that medical training includes only four hours on allergies—contrast that with 46 weeks on gynaecology for all doctors. I certainly do not want that reduced, of course, but I do want allergy training to match it. The amount of research into allergies is pitiful when compared to other health conditions. Wonderful though the work of the Natasha Allergy Research Foundation is, does it not rather shame us that Natasha’s parents had to persuade food retailers to pay for life-changing research? I am delighted to learn that the new Government are working on a 10-year national allergy strategy, and I ask my noble friend the Minister to make sure that this is used to increase training and research significantly in future. However, my experience, both as a mother and as a non-executive director in the NHS for 20 years, has brought me to the realisation that there is a yawning gap in the way in which the NHS responds to the needs of those patients who are no longer children but not yet fully adults. The transition from one to the other is challenging in many ways. Teenagers develop independence by taking risks and learning to deal with the consequences. It is important for them to do so; indeed, their brains continue to mature until they are 25. What does that mean for teenagers with severe allergies? In the absence of effective treatments—I go back to the shortage in both capacity and research—the only way to avoid anaphylactic shock is to minimise the risk: never leaving home without two EpiPens; never eating food that might, for example, have been cooked in peanut oil; and always checking the ingredients of everything that you eat, even—perhaps especially—at a party in someone’s house, where the alcohol may be flowing freely and the lights may be down low. When my daughter was a young child, she had an anaphylactic shock in hospital as a result of the testing of her condition by the allergy specialist medical team. As her father and I watched on in horror, the consultant who led the team treating her with adrenaline and steroids asked, after she was over the emergency, whether he could borrow my phone for a moment. He calmly took photos of her, pale and silent and not moving on the hospital bed. When we later asked him what on earth he had been doing, he invited us to look ahead to her later, teenage years. When you transition from childhood to adulthood, you do take risks, but having a constant reminder on your phone of the reality of anaphylaxis might just save your life. In preparing for today’s debate, I have been able to explore this issue with the Natasha Allergy Research Foundation and, through it, with Dr Claudia Gore at Imperial College Healthcare. As a tertiary allergy service, Imperial continues to treat many young people until they turn 18, but, elsewhere, young people are discharged or referred on to adult services at 16. In the words of the foundation, the result after that is a real “postcode lottery”. Many of the young people with whom Dr Gore works have other comorbidities, including, in many cases, mental health issues such as depression and anxiety and, in some cases, special educational needs and disabilities. These can make it much harder for them to navigate the world safely and manage their allergies appropriately. This is on top of the fact that adolescence brings all manner of challenges, even without additional medical concerns. Having transition services that understand young people and the changes they are going through in that phase of their life, as well as the move towards independence, would be hugely beneficial in helping them navigate the world as someone with severe allergies. Dr Gore is clear: there is a real lack of age-specific life or support resources for adolescents. So, we need more people with expertise in allergy, but we also need more people experienced in transition as a specialism in and of itself, because helping young people navigate adulthood with a medical condition can play a big role in improving their outcomes. The phrase that Dr Gore used, which stuck with me, was: “Transfer is an action; transition is a process”. In other words, young people need support to begin preparing for that transition in advance of the move up to adult services, and they continue to need to be supported. She made three other key points. First, there is a real pressure point here for the NHS because lots of young people are approaching the cut-off point at which they will transition into adult services, where specialist allergy care is sorely lacking. Where there is no specialist adult allergy service to discharge to, it typically ends up with GPs, many of whom lack training in allergies. Secondly, there is not enough expertise on healthcare transition and there is a lack of resource on helping young people with allergies with the key life skills that they will need. Thirdly, in view of how common allergy conditions are in the UK, integrated care boards need to have more allergy care in place, possibly operating in a similar way to how asthma care works currently. So, just as important as more training and research for the new national allergy strategy is the development of an NHS service for patients transitioning from childhood to adulthood. The benefits of specialist health services for those between the ages of 16 and 24, say, could go well beyond sufferers of severe allergies, but where better to start than a condition whose treatment relies completely on persuading those afflicted by it to manage their healthcare and personal risks? I hope that my noble friend the Minister will commit to meeting me, along with the Natasha Allergy Research Foundation and expert medical advisers, to discuss the way forward.

13:09:00

My Lords, I congratulate—with my horrible squeaky voice—the noble Baroness, Lady Ramsey, on securing this debate today. My concern is not so much adolescents as children. In my hotel room this week, I was interested to find a card explaining what to do in the case of anaphylactic shock. This suggests to me that the concern about, and the volume of cases of, serious reactions to allergies is on the up, as well as the seriousness with which the hotel group took its responsibility towards its guests. Indeed, that is borne out by the facts: an estimated 21 million people—just under one in three of us in the UK—live with one or more allergies. For most of us, this can be managed and is not severe, but for some it can be life-threatening, as the noble Baroness has said. In the UK, between 1998 and 2018, more than 100,000 people were admitted to hospital for anaphylaxis, a life-threatening allergic reaction. While the number of hospital admissions has increased in recent years, the number of deaths, I am glad to say, has decreased. Allergy UK advocates three policies to improve NHS services for people who suffer from allergic reactions. The first is to have an allergy nurse and dietician at primary level for each UK health region. That does not seem a huge ask to me but, apparently, there is a postcode lottery for specialist allergy services. Secondly there should be a national register to consolidate patient data across the country and track allergy diagnoses. Clearly, this would enable the identifying of areas where additional services were needed. Thirdly, prescription costs should be removed for those living with allergies to address the additional costs people face when managing their allergies. The estimated total cost is £3,000 per year; I tried to quantify that but had to give up. Suffice it to say that removing at least the prescriptions costs would be a very reasonable thing, because people live with these conditions. Earlier this week, there was a reception for people interested in allergies by the Benedict Blythe Foundation. Benedict, a little four year-old, collapsed at school and died from anaphylaxis. Helen, Benedict’s mum, whom I met this week, has been campaigning for all schools to have the recommended allergy safeguards in place. Teachers need to be able to manage the average one to two pupils with an allergy in each class, but many feel underprepared to be able to deal with a child experiencing an anaphylactic reaction. Every teacher should feel prepared. Every parent delivers their child to the care of the school every schoolday. Surely it is the duty of the school to take care of the health and well-being of that child above all else and to hand them back to the parent at the end of the day as fit and healthy as when they went in. After all, if an individual hotel room can have a notice explaining what to do in the case of an anaphylactic reaction, should not all teachers who care for the children of others have that basic knowledge too?

13:14:00

My Lords, it is a pleasure to follow the noble Baroness, Lady Burt, and I thank my noble friend Lady Ramsey of Wall Heath for securing this important debate. I declare an interest as a member of the All-Party Parliamentary Group on Allergy. Allergy can be a life sentence. There is an epidemic which is going unnoticed. An estimated one-third of the UK population live with allergies, but the number of people living with serious food allergies more than doubled between 2008 and 2018, with the largest increase seen in young children. Symptoms vary, but in the most serious cases reactions can be life-threatening and, in heartbreaking incidents, lead to death. I commend the work of allergy charities which campaign to raise awareness and offer advice to those caring for and those living with this life-threatening condition. I support Anaphylaxis UK and champion Allergy UK in its call for an allergy nurse and dietician at the primary care level within every integrated care system, as the noble Baroness, Lady Burt, has already mentioned. The Natasha Allergy Research Foundation, which was set up by her parents following her tragic death, has campaigned for better food labelling and now plans to launch a new education programme which will provide free resources to nurseries and primary schools so that children with allergies are safe and can participate fully in the classroom. I congratulate the Times on choosing the foundation as part of its Christmas charity appeal. There is growing concern about the safety of children with allergies in school, and the recent report sponsored by the Benedict Blythe Foundation, mentioned by the noble Baroness, Lady Burt, reveals that many schools still do not have an allergy policy in place, despite a legal requirement to do so. Almost half of schools do not hold their own life-saving medication, and too many staff remain untrained to administer them. It cannot be left to charities alone to deal with the allergy crisis; the Government have a key role to play, and I want to turn to the recommendations in the report Meeting the Challenges of the National Allergy Crisis produced by our APPG and the National Allergy Strategy Group. These include an allergy tsar, or lead, who can ensure that the national allergy strategy is implemented across government. It has followed several other key reports in the last 20 years, and all have consistently highlighted how allergy remains poorly managed across the NHS due to a lack of training and expertise. There is a need for significant improvement in specialist services, as well as improved knowledge and awareness in primary care. With 5 million people living with severe conditions requiring specialist care, hospital admissions due to allergies are rising, and prevalence rates for allergy in the UK are among the highest in the world, especially among the young, yet specialist services delivered by paediatric allergists are available to only a minority of those with serious disease. There is a postcode lottery of care. The complexity and severity of allergy is placing a huge strain on the NHS, made worse by the small number of consultants in adult and paediatric allergy and the lack of training for GPs, who remain the front-line service for children and adults suffering reactions. Can the Minister give an update on whether this is being addressed in the NHS workforce plan? Our report proposed a minimum of 40 additional training posts for allergy, as well as a minimum of four consultant adult allergists and two paediatric allergists in every major teaching hospital and large conurbation. It also called for all GPs and healthcare professionals in primary care to have knowledge of allergic disease, both in initial training and ongoing professional appraisal. Each GP practice should have a health visitor and/or a practice nurse trained in allergy support. As most patients are still managed in primary care, this is where resources should be placed. Local health commissioners should understand the allergy needs of their population and ensure access to adult and paediatric consultants. I was shocked to read in the Lancet this September that people from lower-income areas were least likely to be prescribed adrenaline autoinjectors. As a mother of an anaphylactic son, I know how vital it is to carry these life-saving devices. I welcome the Government’s commitment to allow the Expert Advisory Group for Allergy, established in 2023, to continue to identify priority areas for improving the quality of life of people with allergies. I look forward to the outcome of the National Allergy Strategy Group’s consultation to produce a much-needed 10-year strategy to address the issue of allergy in the UK. In conclusion, I very much hope that my noble friend the Minister can give a positive reply to the many calls for the Government to appoint a national allergy lead this year.

13:19:00

My Lords, I thank my noble friend Lady Ramsey of Wall Heath for this debate and for such an excellent introduction. I associate myself with every point made by my noble friend and the noble Baroness, Lady Burt, and my noble friend Lady Healy. There is a strong view, from those who have some understanding of this matter, on the need to take significant action to upgrade where we are. I state my interest, which is pretty similar to many others in that I am the father of two children who have allergies—one to a much more severe extent. I feel acutely that we were incredibly fortunate, when first finding out that one had a severe allergy, that we were in the unusual circumstance of having adequate medical care to support him. I always worry what would have happened if we were not in such a position at that stage, and I am sure that is the terror many parents experience when they first find out. In this country, there has been a massive increase in allergies, for a variety of reasons, as research has shown. The extent to which this condition has increased—including hospital stays for severe incidents, which has gone up to 25,000 according to recent data—is a matter of not inconsiderable concern. Many points have been made, but I will say that, in relation to NHS provision, for anyone who has gone through this process, the system, in moving from children to adolescents to adults, is really not clear. More importantly, it is distorted around different parts of the country, as is the provision of specialist care, and it is extremely difficult for GPs to manage this. We have to rethink how we do that. We also have to consider more carefully the situation with autoinjectors. It was only a short while ago that the UK was out of provision of the most significant autoinjector. We had to buy one which was not allowed in many other countries because it was ineffective. Even today it remains a very significant issue, in many circumstances, that the injectors either fail or are inadequate for the situation. That comes down on many occasions to needle size and the size of body that it has to go into. The Government really have not taken enough into consideration on what we should do on autoinjectors, and I urge them to do so. It is important that the Government increase their work with industry. We saw in the tragic case of Natasha how Pret a Manger responded extremely well. There are willing partners out there and the Government could play a crucial role with them. There are many location-specific issues, such as the provision of autoinjectors on airlines and trains, and as illustrated by the Benedict Blythe Foundation, which has done tremendous work on this, the most significant location outside a home is school, so we need to make sure we have all the right provisions there. On some of the treatments, desensitisation therapy can be effective, but we have woefully inadequate provision for it on the NHS, and, even then, it is geographically specific. There is still an awful lot yet to do. The work of some of the organisations, such as the Natasha Allergy Research Foundation, in advocating for some of these courses has been groundbreaking, as has its research. I too am very pleased that it has been selected again for the Times this year. Underlying that, the idea of introducing a tsar is essential and one the Government must give serious consideration to, simply because of the range of things that are needed through the entire journey that someone—and their parents—facing an allergy will go through. Having something that connects it is essential, and if there was one thing that I wish the Minister would take away from this discussion, it is understanding that piecemeal measures will be insufficient. We need something which will shepherd this as we face an ever-increasing demand on dealing with allergies across the NHS and, if something was to be done, then appointing a tsar would be an extremely welcome addition.

13:24:00

My Lords, it is a pleasure to speak in this short debate on this important subject. I congratulate my noble friend Lady Ramsey of Wall Heath on obtaining the debate and on her excellent opening speech, and I am very pleased to follow my noble friend Lord Mendelsohn. It is a surprising fact that one in three people in the UK live with allergies—perhaps it will not surprise any of us in the Room now, having heard the opening speeches. I am one of those 21 million people, as I have a number of food allergies or intolerances, which have increased over the last 30 years. My allergies are not as serious as the ones that cause an anaphylactic reaction, but they do affect day-to-day living, as I have to avoid wheat gluten, rich dairy products and—at this time of year perhaps the most difficult exclusion—chocolate. Avoiding allergens in products at home has become a little easier. Thirty years ago. it was very hard to avoid wheat, which is often in many products with ingredients labelled as starch but which is often wheat starch. I learned to cook with different flours, as I am sure every parent with a child with allergy learns to do, but they often had to be bought at health food shops. Now, large supermarkets have a section for “free from” or “made without” products and stock a range of gluten-free flours. At this point, it is worth explaining to those who are not in this world that these products are very expensive indeed. Small loaves cost more than £3, and many of the flour products are very expensive, so the point made about low-income families is very pertinent. However, the most difficult aspect of day-to-day living with allergies is avoiding allergens in food when eating out, including at work and at school, buying food when travelling or on holiday and buying food from takeaways, because in that situation you have to rely on a shop selling food knowing which ingredients are in the products. It relies on chefs, kitchen staff, waiters and baristas playing their part in faithfully recording requests to avoid allergens and passing that information on to the staff preparing food or drinks, but that does not always happen. An article in the Times highlighted that more than 50 young people, including a child of nine, have died in less than a decade as a result of severe allergic reactions to food or drinks bought in restaurants, cafés, shops or schools. We have heard in a number of colleagues’ speeches about Natasha Ednan-Laperouse, who died aged 15 after eating a Pret a Manger sandwich which contained sesame. As we have heard, her parents have campaigned on the issues in her case and been told of many deaths of other young people—almost all of which, it seems, were avoidable. They were shocked to hear of so many avoidable deaths. Her father Nadim said: “When Natasha was growing up we didn’t know any other parents whose children were food-allergic and she was the only one in her primary and secondary school … Then we received thousands of letters when it became public from people who said, ‘We fear every day what happened to your child will happen to ours’”. He also said that the common themes in the stories they were told by parents included a lack of understanding among catering staff about allergies and how serious they can be, or a human error meaning that they were given the wrong food product. As we have heard, Natasha’s parents’ campaigns have been focused on two areas: Natasha’s law, an important measure that came into force in 2021, tightening legislation to force outlets that package their own food products on-site to provide a full list of ingredients on the labels, with any of the top 14 allergens, including milk, nuts, eggs and sesame, highlighted; and, as we have heard, the Natasha Allergy Research Foundation is funding a £2.7 million immunotherapy trial across six hospitals that aims to gradually desensitise patients to their allergens through everyday foods. On the number of cases, it is worth saying that, as an MP, I had two local cases within one year of young people who tragically died after eating food containing allergens, despite in both cases the young person or their parents describing their allergies and being assured by waiters and serving staff that the food they were eating was safe for them. Allergy UK tells us in its excellent briefing that 62% of people with allergies say it affects all aspects of their lives, and I am sure all of us who are contributing here can appreciate that, but among adults with anaphylaxis 40% experience post-traumatic stress disorder because, as my noble friend Lady Ramsey said earlier, it strikes terror in parents’ hearts. Allergy UK also tells us that, despite hospital admissions for people with allergies being 615% up in the last 20 years and rising sharply among children, we have only 40 specialist allergists in this country. As we have heard, specialist services are not well spread across the country; the pattern is distorted. The NHS underutilises preventive strategies such as early allergen introduction; and treatments like immunotherapy have been rejected due to perceptions of the high short-term cost, despite the fact that immunotherapy drastically reduces the high cost of future emergency admissions and hospitalisations. I join Allergy UK in hoping that the Labour Government may be more receptive to preventive strategies, and I would be grateful if the Minister could give us an update on any possible new preventive strategies for allergies. I also ask my noble friend to look at the call from Allergy UK for the Government to introduce a specialist allergy nurse and dietician at primary care level within every integrated system. With 21 million people living with allergies and so many avoidable deaths of young people and hospitalisations due to allergens, I hope the Government can agree to look at the gaps in allergy management within primary care.

13:30:00

My Lords, I thank the noble Baroness, Lady Ramsey of Wall Heath, for introducing this debate. I also thank the noble Lord, Lord Mendelsohn, and the noble Baroness, Lady Keeley, whom it is a pleasure to follow, for bringing this issue to life with personal stories that go beyond the statistics and bring home exactly what we are talking about today. Allergy services in the UK are at a critical juncture. As my noble friend Lady Burt said, with more than 21 million people affected, allergies are no longer a niche issue. They represent a public health issue, from life-threatening anaphylaxis to chronic conditions such as allergic eczema. These conditions profoundly impact individuals, families and the NHS yet, despite this growing prevalence, the UK’s allergy care system remains inadequate. The Government must act to bridge these gaps and create a robust, equitable allergy care framework, with the Government and the NHS at the helm of these reforms. Let us acknowledge the scale of the problem. Hospital admissions for allergic reactions have increased by 615% in the past 20 years. As other noble Lords have said, shockingly, there are only 40 specialist allergists; that is one for every 525,000 patients. For patients, this translates into a postcode lottery of care, with many waiting more than 18 months for appointments. Primary care also faces significant challenges, with most GPs lacking adequate allergy training. This leads to unnecessary referrals, misdiagnosis and poorly managed conditions. The strain is particularly acute for children and young adults. Food allergies, which can be fatal, are rising sharply in children, yet there is a severe lack of specialist support during the critical transition from paediatric to adult services, as other noble Lords have said. What priority will the Government put on these transition services? The gaps in care are not just a human tragedy; they are an economic burden as well. Allergy care costs the NHS more than £1 billion annually in emergency admissions, prescription costs and referrals. Addressing this crisis requires systematic change, not piecemeal change, with the Government and NHS having to play pivotal roles. I ask the Minister: what will the NHS do urgently to expand the workforce? This includes increasing the number of specialist allergists and immunologists, as well as training GPs and nurses in allergy management. A promising model was demonstrated in a pilot project by Allergy UK, where nurse-led clinics reduced waiting times from 18 months to just four to eight weeks. Some 95% of cases were managed successfully in primary care, saving not just lives but costs. What is the Government’s view on this pilot being rolled out nationally? Additionally, the Government should allocate targeted funding to recruit and train more allergy specialists. Investing in allergen immunotherapy services is also critical. Although they are costly up front, these treatments prevent severe reactions and reduce long-term healthcare expenses. As many other noble Lords have said, we need to appoint a national allergies tsar or clinical director to lead a co-ordinated strategy. This role would oversee data collection, resource allocation and policy implementation—and, to put it bluntly, it would knock heads together to make sure that action happens. What is the Government’s view on appointing such a clinical director, and is there a timeframe for doing that? Empowering primary care is vital to reduce pressure on specialist services. This can be achieved by embedding allergy-trained nurses and dieticians in every integrated care system, as other noble Lords have said. These professionals would manage routine cases, leaving specialists to handle the more complex ones. Where will the move from hospital care to community care fit in within the 10-year plan? The absence of robust reporting systems for allergic reactions is another glaring gap. A mandatory near-miss reporting system for anaphylaxis, akin to the system in place in Australia, would allow us to identify emerging risks and act upstream. Will the Government look at such a mandatory near-miss reporting system? Lastly, we must focus on prevention. Early allergen introduction and proactive eczema management in children have been proven to reduce lifelong allergy risks, yet these strategies remain underutilised. Will the Government prioritise funding for education campaigns and preventive measures? Improving allergy services is not just about saving lives; it is about improving the quality of life for millions of people. By investing in specialist care, empowering primary care and adopting preventive strategies, we can take important steps to transform allergy care.

13:36:00

My Lords, I begin by thanking the noble Baroness, Lady Ramsey of Wall Heath, for securing this important debate, as well as for having some discussions before the debate so that I could better understand the issue. I am also grateful to the House of Lords Library for its briefing and to others who have sent briefings. The noble Baroness and the noble Lord, Lord Mendelsohn, spoke passionately about their personal experiences as parents, and especially about the care that patients with allergies receive during the transition from childhood to being considered adults. I myself know family members whose children decided to go to a local university rather than go elsewhere because they knew that their local hospital had the best treatment and were not sure what the treatment would be like if they moved to another university town. Other noble Lords have alluded to a postcode lottery. The noble Lord, Lord Scriven, said that such stories bring the statistics to life, but it is really important for us to talk about numbers. I read one report, I think by ITN, which said that 44% of adults in the UK have at least one allergy, but that includes asthma; other noble Lords have said it is one in three. Whatever the figure, it is far too high. We have seen, as the medical journal the Lancet has found, that the rate of food allergies has increased over the past decade. The noble Lord, Lord Mendelsohn, also mentioned that. Plenty of those with allergies can continue to live normal lives, but there are an ever-increasing number of people whose allergies are debilitating. They cannot eat certain foods, and they are unable to use certain medications. They must constantly scan the list of ingredients of the food they wish to eat, either by reading the small print on labels or accessing companies’ or third-party websites, or, as the noble Baroness, Lady Keeley, said, they have to pay more for gluten-free or other foods according to their dietary requirements. This may seem obvious, but food is one of humankind’s basic needs. It is an integral part of our daily lives, and so it is only right that we take the necessary steps to help those with allergies. It was reassuring to hear from the noble Baroness, Lady Burt, about the advice that was in her hotel room should you encounter someone suffering a severe allergic reaction. The question is how we spread that from hotel rooms to schools and more places. The noble Lord, Lord Mendelsohn, and the noble Baroness, Lady Keeley, spoke about the sad story of Natasha Ednan-Laperouse, who tragically died in 2019 due to anaphylactic shock. Her case led to the so-called Natasha’s law, requiring all foods to carry a list of ingredients. I am proud, and I am sure that noble Lords are grateful, that swift action was taken by the previous Government. Indeed, it is a measure that has since helped countless sufferers of allergies to understand the food that they are consuming and the harms that they may cause. We know, however, that more needs to be done. It is therefore welcome that the new Government are developing an allergy strategy. But what of the National Health Service’s role? As noble Lords will be aware, before the general election, Allergy UK published a list of steps that it wanted the new Government to take. As the noble Baroness, Lady Healy, has said, one proposal was that there should be an allergen specialist or dietician at the primary care level—the rationale behind this being that it would allow those with allergies to access specialised care, no matter where they may live. This seems a common-sense proposal, since it would enable those living with serious allergies to seek help with managing their allergies early in the process of diagnosis so that they can have a better quality of life and are not unnecessarily constrained by their allergies. Noble Lords will also understand that there are resource constraints and that the Government of the day have to consider carefully where they allocate taxpayers’ money, given competing demands. I want to reassure the Minister that I understand from my time as a Minister the difficulties due to resource constraints and, sometimes, the practicalities of implementation, but that does not stop noble Lords asking the questions. Is this a policy idea that has been discussed within her department and with the NHS to work out its feasibility? I would be grateful for her assurances. Like other noble Lords, I too wonder what more can be done within existing NHS structures. Some of the information is there, but how do we spread it nationally from ICB to ICB? How do we get it into schools? How do we get it beyond the hotel rooms? How do we make more people aware, so that when it is announced on a flight that nuts will not be served on a flight because someone has an allergy we avoid the collective groan and hear more understanding of those who suffer from these conditions? Can the Minister explain what plans there are for all clinicians, including in primary care, secondary care and accident and emergency departments, as well as for other hospital employees, to be suitably trained and made aware of how to deal with patients who have serious allergies, as the noble Lord, Lord Scriven, alluded to? Has any thought been given to an allergy tsar, as the noble Lord, Lord Mendelsohn, mentioned? What safeguards are in place to ensure that no one with allergies slips through the net and is administered medication that contains ingredients they should not take? The noble Baroness, Lady Keeley, and the noble Lord, Lord Scriven, spoke about preventative strategies. What explicit preventative strategies are the Government and the NHS considering? I know that all noble Lords are grateful to the noble Baroness, Lady Ramsey of Wall Heath, for securing this important debate and we look forward to the Minister’s responses.

13:41:00

My Lords, I start by congratulating my noble friend Lady Ramsey not only on securing this highly relevant debate but on shining a light on this important matter. I thank all noble Lords for their considered contributions, which were given through experience and with empathy. As noble Lords have observed, there has been a significant rise in hospital admissions for anaphylaxis over the last two decades and it is clear how increasingly significant this matter is. That means that it is incumbent on us to lift our commitment to improving outcomes. Anyone with an allergy, and anyone close to somebody with an allergy, knows only too well the considerable challenges and risks in everyday life, as we have heard. Very sadly, there are tragic cases of those who die from severe allergic reactions that could have been prevented. On behalf of all noble Lords, I give my heartfelt condolences to those who have lost a loved one because of a severe and sudden allergic reaction. I thank my noble friends Lady Ramsey and Lord Mendelsohn for speaking about their children’s allergies and their experiences as parents. I also thank my noble friend Lady Keeley for making reference to her own experience. Noble Lords understand just how serious allergies can be, and the worry and anxiety, rooted in reality, that parents and loved ones feel. I too want to pay tribute to then outstanding charities that support people living with allergies in the UK, including Allergy UK, Anaphylaxis UK and the Natasha Allergy Research Foundation. They all do vital work in raising awareness, providing information and support, and funding research. Work is ongoing across government, the NHS, voluntary organisations and patient representative groups to consider how allergy care and support could be improved. Noble Lords made reference to the Expert Advisory Group for Allergy, which was established last year, met again just last week and continues to bring together all key stakeholders in order to inform where we go next. I am most grateful to that group. In addition, last year the MHRA launched a safety campaign to raise awareness of anaphylaxis and provide advice on the use of adrenaline autoinjectors, which have also been mentioned in the debate. A toolkit of resources for professionals to support the safe and effective use of AAIs has also been produced, along with new guidance on their use. The guidance clearly states that prescribers should prescribe two AAIs to ensure that patients always have a second dose available. I am very pleased that Palforzia, a new treatment for peanut allergy, was approved by NICE in 2022 for those up to 17 years old to help reduce the severity of allergic reactions. The NHS is now legally required to fund this medication for eligible patients, in line with the recommendations of NICE. That means it is opening up a way for thousands of children and young people to access the medication through the NHS. This Government are committed to improving care for people with allergies and ensuring that they get the care and support they need at the right time and access to the latest treatments. I am aware of the inequalities that my noble friend Lady Ramsey referred to in accessing allergy services. I very much acknowledge the points raised by noble Lords, particularly in respect of the workforce, delays to treatment and care, and lack of information and support that some patients have unfortunately experienced. I consider that to be a situation that cannot continue. Noble Lords have referred today to the 10-year health plan to reform the NHS, and I am glad that noble Lords, including the noble Lord, Lord Scriven, spoke about the move from treatment to prevention. It is also about moving healthcare from hospital to the community, as well as analogue to digital. A core and central part of our 10-year plan will be the workforce, as referenced correctly by my noble friend Lady Keeley and the noble Lord, Lord Scriven, among others. In our work to prepare for the workforce that we need now and in future, it is vital that we train and get the right staff, technology and infrastructure in place. In acknowledging the points made, I absolutely recognise the need for a multidisciplinary-team approach in this area. That will be part of our considerations. I remind the Committee that this Government have made a commitment that 92% of patients should wait no longer than 18 weeks from referral to treatment within the first term of this Government. That includes those waiting for allergy treatments. As a first step towards this, following the Budget, we will be delivering an additional 40,000 appointments this week to cover operations and scans and appointments themselves. With regard to the point about the national lead on allergy services, I understand that there is a need to do more, as raised by the noble Lord, Lord Scriven, my noble friends Lord Mendelsohn and Lady Keeley, and the noble Lord, Lord Kamall. I am absolutely aware that there is no national lead with overall responsibility for allergy services, and of the reasons why noble Lords have raised it. My colleague Minister Gwynne is putting this under active consideration and I will certainly ensure that I raise not just this point, which has been made so regularly to him, but the other points raised in this debate. I will also raise with him the reference made by the noble Lord, Lord Scriven, to rolling out a pilot. On the point about a meeting, raised by my noble friend Lady Ramsey, I am glad to say that Minister Gwynne met the Natasha Allergy Research Foundation just last week to discuss how care and support can be improved. The department is obviously working closely with Professor Sir Stephen Powis, the national medical director at NHS England, and, as I said, there is active consideration of the point about a national lead. I will alert my honourable friend Minister Gwynne to the point about further meetings. Once diagnosed, and with a management strategy in place—my noble friend Lady Healy spoke to this point —patients with allergies may be able to be cared for through routine access to primary and secondary care. The Royal College of GPs has added allergy training to the new curriculum and, to support existing GPs, it has developed an allergy e-learning resource. As noble Lords will know, this Government seek to bring back the family doctor, especially for those who would benefit from seeing the same clinician regularly; obviously, that includes those with allergies. On the transition from paediatric to adult services, which was raised by a number of noble Lords, including my noble friend Lord Mendelsohn, I absolutely acknowledge the challenge there. NICE has published guidance on the transition that we are speaking about, including recommendations on transition planning, support both before and after the transfer, and the development of transition infrastructure. I turn to some of the additional points made in the debate; I will be pleased to write to noble Lords on the ones that I do not answer. My noble friend Lady Ramsey mentioned research. Research into allergies is funded through NICE—no, it is not. It is funded through the NIHR; I am on it. It always welcomes funding applications. We have also invested in research infrastructure; for example, Southampton Hospital is participating in a three-year trial funded by the Natasha Allergy Research Foundation. My noble friends Lady Ramsey and Lady Healy, as well as the noble Lord, Lord Kamall, referred to a strategy on allergies. Let me clarify the situation: the National Allergy Strategy Group is developing a strategy, which will come to the department. We will consider it, and its recommendations, carefully. The noble Baroness, Lady Burt, mentioned appropriate provision in schools in order to protect children with allergies. The Department for Education recently reminded schools of their legal duties and highlighted the Schools Allergy Code. Regulations now allow schools to obtain and hold spare adrenaline autoinjectors, and there is guidance on that. On the important matter of prevention, as noble Lords will know, we are committed to moving from treatment to prevention. Some research shows that feeding the most common allergy-causing foods to babies and infants before the age of 12 months may prevent or reduce the chance of them developing food allergies. We will continue to look at that. I am most grateful for this debate, which has shone an important light on this issue. I can commit to us continuing to work on this matter to improve things for those who suffer from allergies and those who are near to them.

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Sitting suspended.