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The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
I thank my hon. Friend the Member for Don Valley (Nick Fletcher) for introducing this debate and for doing an excellent job of setting out the issues, and I thank all hon. Members who contributed. I found myself making copious notes; there was a lot for me to take away and work on. I also thank the thousands of individuals who signed the petitions that triggered this debate, which show the strength of the desire and the demand to improve treatment for those who suffer from allergies. Above all, I thank the victims’ families and friends who are here in the Public Gallery. I am terribly sorry for your loss; it was awful to hear about. I pay tribute to you and thank you on behalf of the Government for all the work that you have already done to improve safety and make sure that others do not suffer in the way you have suffered.
I will set out some of the work that is under way on different aspects of the issue in the Department of Health and Social Care and the Food Standards Agency. Food businesses are all under the same legal obligation to provide information at the point of sale indicating the presence of the 14 major allergens. Natasha’s law, which the Government introduced in 2021, requires all pre-packed direct-sale food such as grab-and-go sandwiches to have a label that shows the ingredients and allergens. That is important in helping people with allergies to feel confident that they are choosing safe food.
There are about 2.6 million people with food hypersensitivities in the UK. As hon. Members have pointed out, that number is rising. It includes people with food allergies, intolerances and conditions such as coeliac disease, which my mother suffers from, so I have some sense of the challenges facing people with that condition. The Food Standards Agency is working to address the needs of those consumers so that they can make safe and informed choices about the food they buy. For people with a potentially life-threatening reaction to certain foods, that trust is much more important.
The Carey family are already driving awareness on the issues that people with life-threatening allergies face. The FSA has met the Carey family several times in the past few years and it recognises the positive impact that the Owen’s law campaign is having. We need to consider changes to the law carefully to ensure that there are better safety outcomes for allergen sufferers and to avoid unintended consequences for consumers.
As hon. Members have mentioned, a workshop is taking place at the start of June with the families and others to look at how we can go further. To answer the question asked by my hon. Friend the Member for Winchester (Steve Brine), the FSA team have been over to Ireland to look at its law and study how it is working. I am not in a position to make an announcement today, but I am struck by the fact that everyone involved agrees that there is room to do better. Nothing is off the table at this point.
There are a number of issues relating to improving labelling for people with serious allergies. They are not arguments against doing anything; they are just issues that we must grapple with as we work out how to make progress. One is how we avoid potentially dangerous out-of-date information on menus, particularly for smaller restaurants, which change their ingredients more frequently. We cannot have false reassurance. When I worked in a Chinese restaurant, I was often sent out to a supermarket to find ingredients on the day, and that would often change what was in what we were serving up. Small businesses absolutely cannot have out-of-date information on menus.
Mrs Sheryll Murray
Will the Minister explain how some small outlets in my constituency list the allergens on their menus when, as he says, doing so is an obstacle?
Neil O’Brien
To reiterate what I said at the start of my remarks, I am mentioning some of the issues that we have to solve, not presenting them as insuperable obstacles to doing what a lot of people are calling for.
Another challenge that we have to grapple with, and are grappling with, is how to avoid some smaller businesses taking away a lot of choices for people with allergies by simply labelling too many items as containing allergens. Such businesses may have small kitchens that work with lots of different products and multiple allergens. We cannot take away lots of choices for people with allergies; we want them to have the freedom of choice that everyone expects to enjoy, but to have safety at the same time.
Dr Cameron
The Minister is making some good points, but on his last point, even if some outlets are being over-cautious, surely it is more sensible to be over-cautious than to put people’s lives at risk.
Neil O’Brien
That is a perfectly reasonable point. Of course, safety has to come first; I am merely laying out some of the challenges that we are grappling with as we think about Owen’s law and how we go further.
Even as we work on these issues and think about how we go further in providing information, we are getting on with improving training and knowledge for people in the food industry. Since September 2020, 380,000 people have signed up for allergy training through the FSA, which is a huge improvement in the provision of information and the correct treatment of people with severe allergies. Over the past 22 years, the FSA has invested about £22 million into researching these issues. Its scientific and social research, which improves the understanding of the views of those who are affected, of food businesses and of other key stakeholders, underpins our approach. To underline what I said a few moments ago, although I am not making an announcement today, nothing is off the table. We continue to look at and work on these issues at pace.
Let me turn to some other issues that have been raised in the debate. We have heard the calls for an allergy tsar, a form of leadership to advocate on behalf of those with serious allergies and their families. We already have parts of that leadership role in place, although, to address the point made by the hon. Member for Hammersmith (Andy Slaughter), that responsibility is not squarely on one individual’s shoulders. We will look closely at the proposal and at how we get to a more joined-up approach. The hon. Member asked directly whether I would meet with expert groups and those representing families who have been affected. The answer is yes, absolutely. I am extremely keen to meet and learn from those who have done lots of work on the subject.
It is worth setting out a bit about how the current NHS England operation works and what it is doing, although I recognise that that operation is not what those who are campaigning for a single joined-up tsar are asking for. In NHS England, there is a clinical reference group chaired by the national specialty adviser, Dr Claire Bethune. The group provides clinical advice and leadership on specialised immunology and allergy services. Its members include clinicians, commissioners, public health experts and patient and public voice members to try to capture the insights of those who are most affected by the issues. The members use their combined knowledge and expertise to advise NHS England on the optimal arrangements for the commissioning of specialised services. That advice includes the development of national standards in the form of service specifications and policies. As hon. Members know, those are tremendously important in defining what NHS services must be available.
The CRG is in the process of commencing a review of the current service specification for specialised allergy services. The output of that review will be an updated specification that makes reference to up-to-date guidance and takes account of the very latest evidence to clearly define the standards of care for commissioned specialised services, including transition into adult services.
The CRG is just one tool that we have at our disposal to address the multifaceted challenges that people with allergies face. Officials across Government are working with the National Allergy Strategy Group to consider how we can work more effectively together through things like an expert advisory group for allergy. The arguments that I have heard today will strike a chord with many people listening across the country. I am certain that it is right that we continue the conversation about how to work in a more joined-up way in future.
On ensuring that we have the right mix of staff to support people with allergies, in recent years there has been a 100% fill rate for doctors going into the two most relevant training pathways, allergy and immunology. NHS England will continue to identify priorities for investment in this space, in line with the expressed service priorities of the NHS across all medical specialties and the wider workforce. That work will be complemented by the forthcoming long-term workforce plan that we have commissioned NHS England to develop for the next 15 years, which we have committed to publishing shortly. It will include projections for the number of doctors, nurses and other professionals that will be needed in five, 10 and 15 years’ time, taking full account of improvements in productivity and the need for particular specialisms and skilled people to deal with things like immunology and allergy.
Most people with an allergy can be cared for in primary care settings, with services planned and commissioned by their local ICB. Specialised allergy services, however, are also provided for patients with the most severe allergic conditions, or those who have common allergic conditions for which conventional management has failed or for whom specialised treatments are required. In the current financial year, 2023-24, those services are jointly commissioned by NHS England specialised commissioning integrated care boards, in line with the published service specification.
All patients have access to those specialised services. Specialised services are required to be compliant with the service specification, including the need to have physicians, dieticians and nurses who are specially trained in allergy or have had long specialist expertise in the practice of allergy management and have up-to-date, continuing professional experience. All that work is serving to improve the lives of millions of people who have been affected to a greater or lesser degree by allergy.
There is clearly much more that remains to be done. The Government and those who have personal experience and great expertise working together will be central to driving forward continuing improvements, building on the work that has already been done and the changes that have been made. In future, we want to work closely with those who are most affected to improve the care and service provision for those who have serious allergies, so that they can live full, meaningful and safe lives.