Food Labelling and Allergies

Jon Cruddas Excerpts

Monday 15th May 2023 Westminster Hall

[Jon Cruddas (Dagenham and Rainham) (Lab)]

What we are talking about today matters a great deal to a great many people. Millions across the country suffer from some allergic condition: it is estimated that 44% of adults and 50% of children in the UK have one or more allergic disorders. While the prevalence, severity and complexity of allergies have increased on a global scale over the past 60 years, UK rates are among the highest in the world. There is a modern-day epidemic in allergy. I therefore very much welcome both petitions: one to appoint an allergy tsar as a champion for people living with allergies and the other in support of Owen’s law, a change in the law around allergy labelling in UK restaurants. I congratulate the organisers. Literally tens of thousands of people are mobilising and demanding a change both in public health and in corporate responsibility for labelling policy.

Why do we need an allergy tsar? No single person has overall responsibility for the wellbeing of allergy sufferers in the Department of Health and Social Care, NHS England or anywhere else in Government. There are no clear lines of accountability in relation to the overall NHS provision of allergy care. An allergy tsar would act as a champion for people living with allergies. As the national lead, the tsar would ensure that adults and children with allergies received appropriate support to prevent avoidable death and ill health. The lack of a national lead has been raised time and again by coroners at the inquests of those who have tragically died following severe allergic reactions. The need for an allergy tsar is supported by the National Allergy Strategy Group and across the allergy community.

[Andy Slaughter (Hammersmith) (Lab)]

I pose this question because my hon. Friend is an expert in the subject. There have been calls for a national allergy tsar for a long time. Does he understand why the Government are resistant to them?

[Jon Cruddas]

I will come on to that point. There have been 20 years of reports that agree about a common platform for policy change, and there is a unanimity across the community. It is bewildering that over the past 20 years, Governments have not responded in a proactive way, although over the past 18 months there have been a few changes, which I will come to later.

The need for an allergy tsar is supported by the National Allergy Strategy Group. In addition, the Natasha Allergy Research Foundation and the NASG are asking the Government to better support people with allergies through, first, an expert advisory group for allergy, which would actively support the growth and delivery of high-quality, comprehensive and geographically diverse allergy provision, and secondly a national allergy action plan.

[Margaret Ferrier]

A lack of societal awareness around food allergies is dangerous. For example, 600,000 people in the UK have coeliac disease, but there is a misconception that people choose to eat gluten-free food for its health and cosmetic benefits. Does the hon. Member agree that more needs to be done to ensure that the UK public are aware of the definition and dangers of different food allergies?

[Jon Cruddas]

I agree. I would suggest that that is part of the lack of an overall strategy and of key responsibilities at national level for making people aware about the differences and the public health needs across all our communities in every constituency that we represent here in Parliament.

The second part of the proposal is a national allergy action plan, which would join up GP and hospital allergy services, increase the number of specialist allergy clinics, train more specialist allergy doctors and consultants and provide mandatory training in allergies for all GPs. Owen Carey’s family want a change in the law to compel restaurants to state the allergens in their dishes, specifically on the face of main menus. That would build on Natasha’s law, which dealt with the ingredients and allergy listings on pre-packaged takeaway foods. Natasha’s law left an uneven situation in which people who buy pre-packaged foods have more protection than those who eat in restaurants, which is what the family are keen to sort out.

The family are also campaigning for better training for waiting staff, for more thorough and certified allergy and first-aid training and, as we have heard, for the proper recording of and a national register for anaphylaxis deaths. Those are all very sensible suggestions. Businesses are also responding: in March 2023, the bosses of 11 leading UK businesses, including Tesco and Sainsbury’s, called for clearer rules on food labelling following recent tragic and preventable deaths.

As for the general context, the figures speak for themselves. One third of the UK population, or 20 million people, are living with an allergic condition, and 5 million have a condition severe enough to require specialist care. Fatal and near-fatal reactions have increased over recent years. There has been a 615% increase in hospital admissions relating to allergic disease during the past 20 years. More than 200,000 people require the prescription of emergency adrenalin because of the severity of their allergic condition. Each year, births add 43,000 new cases of child allergy to the population in need. The figures are extraordinary.

What is so frustrating—touching on what my hon. Friend the Member for Hammersmith (Andy Slaughter) raised a few minutes ago—is that over the past two decades a series of reports have consistently demonstrated the prevalence of allergic diseases, the patient needs and the lack of UK service provision. The list of reports includes two Royal College of Physicians reports, in 2003 and 2010, on allergy: the unmet need. We had the 2004 House of Commons Health Committee report on the provision of allergy services, as well as the 2007 House of Lords Science and Technology Committee report on allergy. In autumn 2021, the all-party parliamentary group on allergy and the National Allergy Strategy Group published “Meeting the challenges of the National Allergy Crisis”.

All the reports have consistently highlighted how allergy remains poorly managed across the NHS because of a lack of training and expertise. All have recommended significant improvement in specialist services as well as improved knowledge and awareness in primary care. They have all talked about a national allergy action plan and the need for a national lead person responsible for allergy services—an allergy tsar. Yet in truth, very little has happened in 20 years. Change is long overdue.

Beyond the statistics, we are talking about a growing number of people living with allergic disease. Their condition can have significant and negative impacts on their lives and those of their families. It is frightening and restrictive to live with a condition that can cause a severe or life-threatening reaction at any time.

The reports that I mentioned, spanning 20 years, have all agreed on four key recommendations for change: a national plan for allergy, which would involve making allergy a priority and investing in a national plan led by a designated Department head, a national tsar; specialist care, which would involve expanding the specialist workforce as a priority; in primary care, ensuring that all GPs and other healthcare professionals have knowledge of allergic diseases; and, in terms of commissioning, ensuring that local commissioners understand the allergy needs of their population.

As I mentioned, I want to acknowledge some progress over the last year. The previous care and mental health Minister—the right hon. Member for Chichester (Gillian Keegan), who is now Secretary of State for Education—demonstrated real commitment in this area, and since 2021 we have established a work programme and an ongoing dialogue between civil servants and representatives from the NASG to support the development of a national plan. I hope that that work continues. It should be the right of every allergy sufferer to receive a quality standard of care, and every sufferer should be able to be confident about the food that they consume in restaurants, as is the case under the arrangements that successfully operate in other countries, such as the Irish Republic.

In December 2022, the Food Standards Agency executive said that as a result of the need to respond to the deadline imposed by the Retained EU Law (Revocation and Reform) Bill, it had to delay its planned work on Owen’s law. Supporting the petition this afternoon will, we hope, put pressure on the Department for Environment, Food and Rural Affairs to force the FSA to prioritise its work on Owen’s law before another person dies unnecessarily.

I congratulate all the organisers of both petitions and urge the Government to respond favourably to them, because lives literally depend on it. Government action is important, and I hope that the Government can back both petitions this afternoon.

Allergy Awareness Week

Jon Cruddas Excerpts

Thursday 11th May 2023 Westminster Hall

[Jon Cruddas (Dagenham and Rainham) (Lab)]

I beg to move,

That this House has considered Allergy Awareness Week.

This afternoon I will raise a number of points about improving allergy services in the NHS, but first I thank the Backbench Business Committee for granting time for the debate.

What we are talking about matters to an awful lot of people. Millions across the country suffer from at least one allergy. It is estimated that 44% of adults and some 50% of children in the UK have one or more allergic disorders. While allergies have increased globally in prevalence, complexity and severity over the last 60 years or so, the UK rates are among the highest in the world.

I pay tribute to the allergy community for its contribution throughout the year, which was showcased during the recent Allergy Awareness Week. I acknowledge the extraordinary work of charities, research bodies, academics and health practitioners, as well as numerous individuals and families, all fighting for support and help on food labelling, NHS services, awareness in schools and much more, given the extraordinary growth in allergic conditions over the last couple of decades.

It is worth being clear from the outset what we are talking about. An allergy is a hypersensitivity reaction, or an exaggerated sensitivity, to substances known as allergens, which are normally tolerated across most communities. Examples include peanuts, milk, shellfish, cats, medicine and grass pollens. These can trigger harmful antibodies and the release of inflammatory chemicals, causing symptoms such as sneezing, itches, rashes and falls in blood pressure, yet they may also cause narrowing of airways, shortness of breath and wheezing, and swelling that, if in the mouth, throat or airway, causes severe difficulty in breathing and can be life-threatening.

There is a modern-day epidemic in allergy, one that I would argue is neglected by the NHS. We are all aware of recent high-profile, tragic cases of fatal anaphylaxis brought on by issues such as food labelling, shortcomings in NHS service provision, and a lack of public understanding across the wider community. Those recent tragedies have brought all that into sharp focus, and they are occurring with a regularity that should worry us all.

The figures speak for themselves. One third of the population—some 20 million people in the UK—are living with an allergic condition, and 5 million have a severe enough condition to require specialist care. Fatal and near-fatal reactions regularly occur due to foods, drugs and insect stings, and have been increasing in recent years. There has been a 615% increase in hospital admissions related to allergic disease in the last 20 years.

The percentages of children diagnosed with allergic rhinitis and with eczema have trebled over the last 30 years. More than 200,000 people now require the prescription of emergency adrenaline due to the severity of their allergic condition, and each year new births add some 43,000 cases of child allergy to the population in need. The figures are quite extraordinary. Despite all that, specialist services delivered by trained paediatric allergists are available to only a minority of those with severe disease.

What is so frustrating for so many is that over the last two decades a series of reports have consistently demonstrated the prevalence of allergic disease, the patient need and the lack of UK service provision. I will list some of the reports. There were two Royal College of Physicians reports, in 2003 and 2010, on allergy and the unmet need. The 2003 report was so disturbing and so scathing that in 2006 the Department of Health conducted its own review of allergy services. We also had a 2004 House of Commons Health Committee report on the provision of allergy services and a 2007 House of Lords Science and Technology Committee report on allergy. In autumn 2021, the all-party parliamentary group on allergy, alongside the National Allergy Strategy Group, published “Meeting the challenges of the National Allergy Crisis”.

All those reports consistently highlighted how allergy remains poorly managed across the NHS due to lack of training and expertise. All recommended significant improvement in specialist services, as well as improved knowledge and awareness in primary care. They all talked about the need for a national allergy action plan, and for a national lead person responsible for allergy services and provision at NHS England or the Department of Health and Social Care—often referred to in shorthand as an allergy tsar.

That is not to say that nothing has changed over the last 20 years. We have seen National Institute for Health and Care Excellence guidelines on allergy and care pathways for children with allergic disease. Natasha’s law came into force on 1 October 2021 to regulate labelling on pre-packaged food for direct sale. But the truth is that very little has changed over the last 20 years, apart from the increased prevalence of the conditions.

The economic case for prevention-orientated allergy services is strong. The estimated cost of allergy-related illness was calculated in 2004 as £1 billion a year. Since then, admissions to hospital with anaphylaxis have increased by 200% to 300%. Primary care visits for allergy have increased, now accounting for 8% of total GP consultations. Put simply, the complexity and severity of allergy has increased, as has the number of patients affected, placing huge strain on the system. Those are the basic facts and change is long overdue. Beyond the statistics, for the growing number of people living with allergic disease, their conditions can have a significant negative impact on the lives that they and their families live. It is frightening and restrictive to live with a condition that could cause a severe or life-threatening reaction literally at any time of the day.

Each report I mentioned concludes that allergy has largely been ignored and is poorly managed across the NHS due to a lack of training and expertise. The core problem is the very small number of consultants in adult and paediatric allergy, and the fact that most GPs receive no training in allergy. That basic mismatch between the rising demand and the poor service needs correction. There are only 11 specialist allergy training posts for doctors in England and only two qualify each year, despite the 2004 report recommending some 20 years ago that 40 doctors a year should qualify. There are too few consultants, and only 40 adult allergists and a similar number of paediatric allergists working in a very small number of allergy centres.

The day-to-day reality is that NHS patients face a postcode lottery. They are hampered by wrong referrals and re-referrals, or they get no referral. They face denial of choice and of the benefits of the improvement in allergy care. In short, there is significant unmet need. Paradoxically, the UK is one of the world’s leaders in allergy research.

The reports that I have referred to, which span some 20 years, offer an agenda for change. All four contain basic recommendations; there are themes that recur all the time. First, we need a national plan for allergy. We should make allergy a priority and invest in a national plan led by a designated Department of Health and Social Care civil servant or NHS lead with sufficient authority to implement change—a national clinical director for allergy.

Secondly, there is a need for specialist care. We should expand the specialist workforce as a priority and ensure that training programmes prioritise allergy so that specialists of the future are appropriately trained and can deliver safe care.

Thirdly, we need to ensure that all GPs and healthcare professionals in primary care have knowledge of allergic disease, that allergy is included in the GP curriculum and exit examination, and that allergy education is improved for already qualified GPs in ongoing professional appraisal. On a positive note, I should add that the Royal College of General Practitioners has recently added allergy to new GP exams, which is a welcome intervention.

Fourthly, we need to ensure that local commissioners understand the allergy needs of their populations. Commissioners should ensure access to adult and paediatric allergy consultants and allergy pathways.

Allergy remains a small specialism; not only do patients not know where to turn, but healthcare professionals themselves often do not know the best pathway to send their patients on. GPs receive so little training and the responsibility for managing adult allergy services remains unclear and ambiguous.

Every sufferer should have a right to receive quality care. To achieve that, Allergy UK has developed a patients’ charter, in consultation with patients and clinicians, to deliver a gold standard of patient rights and care for those living with allergic disease. It calls for a healthcare system that recognises allergy as a chronic long-term condition and provides continuity of care and timely diagnoses. It should not be beyond our collective wit to provide that, yet recent NHS reforms may mean that we are heading in a very different direction.

Today, 42 statutory integrated care systems, each with an integrated care board and an integrated care partnership, are responsible for planning and funding NHS services. It was recently announced that allergy services would be commissioned by ICBs and not centralised. What does that mean for the postcode lottery in the system and for the development of a national plan?

Allergy UK reports that 93% of ICBs responsible for commissioning services to support the allergic community have not even the scantest picture of the potential needs of their populations in terms of allergy services. Not one ICB held data on whether there were any specialist allergy nurses or dieticians in its region.

As it is, specialist allergy services are very limited outside the south-east. Two hospitals in the south-east—Guy’s and St Thomas’s, and Southampton General—are accredited as World Allergy Organisation centres of excellence, but even those living in the south-east of England struggle to access decent care and the right care. The north and the west of England, along with Wales, are especially deprived of services. As I mentioned, there are only 40 adult allergy consultants in the UK and even fewer paediatric allergy specialists. That is equivalent to one adult allergy specialist per 1.3 million of the adult population. As far back as 2003, the Royal College of Physicians advised that 200 consultant adult allergists were required.

I do not want to sound too negative, so I will point to two important recent developments. The first is an example of what can be done on the ground. Allergy UK recently invested £500,000 in a research project with the University of Edinburgh to trial a new nurse-led allergy centre in primary care. Thirty-eight clinical practices were allowed to refer patients to two specialist allergy nurses, who held six clinical sessions each week.

The trial resulted in 426 patients being referred to the specialist allergy nurse clinics, of whom 53% were young people and adults with a history of anaphylaxis or suspected anaphylaxis. Three hundred and eighty-three of the patients seen in a clinic would otherwise have been referred on to secondary care. Only 5% of those had an onward referral to secondary care. Eighty-two per cent. said they had seen improvements in their allergic conditions since attending the clinic, which is a very positive result.

The trial demonstrated that a nurse-led, primary care- based allergy clinic can work for patients and take pressure off other NHS services. Allergy UK is now calling for each ICS to have a fully funded specialist allergy service with a specialist allergy nurse and one specialist dietician. That sounds to me like quite a practical intervention that could achieve a lot very quickly.

Secondly, I want to acknowledge some progress in the Department over the last year and a half. The previous Minister for care and mental health, the right hon. Member for Chichester (Gillian Keegan), demonstrated real commitment in this area, and I put on the record our appreciation for what she did. Since autumn 2021, we have established a work programme and an ongoing dialogue between civil servants and representatives of the National Allergy Strategy Group.

The NASG has held several meetings with the long-term conditions team in the DHSC to discuss the need for a lead and expert advisers to support on development of a national plan for allergy. A proposal and terms of reference have been drafted, and they are currently within the DHSC. The hope is that those discussions will continue and move forward so that an expert group can be established in the very near future. That could be one of the most significant outcomes of the last 20 years. I commend the Government for that, and look forward to the Minister—I hope—recommitting to that programme of work and partnership working this afternoon.

I could have discussed many other issues today, including labelling, allergies in schools, and the regulation of products in takeaways and restaurants. On Monday, we will have a chance to discuss some of that territory when we debate the two e-petitions relevant to this debate. The first, e-petition 589716, calls for the appointment of an allergy tsar as a champion for people living with allergies. Over 20,000 people have signed it to date. The second, e-petition 585304, relates to “Owen’s law,” a change in the law on allergy labelling in UK restaurants. I think over 13,000 people have signed that petition to date. I congratulate the organisers. Tens of thousands of people are mobilising and demanding change, and businesses are responding too: in March 2023, the bosses of 11 leading food businesses, including Tesco and Sainsbury’s, called for clearer rules on food labelling following recent tragic and preventable deaths.

Next year marks the 20th anniversary of the publication of the Health Committee’s landmark report, “The Provision of Allergy Services”. The report recommended implementing a “modern allergy service” with specialist allergy doctors and a focus on primary care. Simply put, the vast majority of those recommendations remain unmet. We have lost 20 years, and nothing has really changed. On behalf of the many millions of people suffering from allergy conditions, I urge the Government to acknowledge allergy as a public health priority. Lives, as well as the quality of life of many of our fellow citizens, depend on it.

--- Later in debate ---

[Jon Cruddas]

I thank the Minister and my hon. Friend the Member for Bristol South (Karin Smyth) for their positive words, as well as others who contributed to the debate. It seems that across the political aisle there is common agreement about the escalating problem and the need for viable remedies, as well as a basic right to proper care for all our fellow citizens experiencing those problems. They should not have to wait any longer.

I will make one political point. There is an election coming, and if a party was to really grip this issue and prioritise it, they could achieve much, given the sense of an epidemic out there. I do a lot of work in this area, and as soon as I talk about it I am inundated with people’s experiences. I have listened to colleagues in the Chamber, and am struck by the number of people with direct personal experience of the issue. It speaks to what is happening in the country. Any political party that could tap into that could gain much from it—but enough of the low politics.

In conclusion, I echo what colleagues have said and thank the allergy community. We were going to have this debate in Allergy Awareness Week, but it got bumped for reasons relating to the coronation. That is a pity, but I am glad that we have given an airing to some of the issues. I put on record the appreciation that we all have for the practitioners and healthcare professionals dealing with allergy; for Allergy UK; for members of the National Allergy Strategy Group; for Anaphylaxis UK; for the Natasha Allergy Research Foundation; for the researchers in the area seeking new remedies; and for the insights of all the families and campaigners fighting on behalf of those with allergic conditions. That will be echoed by many MPs from across the House on Monday. Those people do a fantastic job, but they need help—lives depend on it.

Question put and agreed to.

Resolved,

That this House has considered Allergy Awareness Week.

Irish Diaspora in Britain

Jon Cruddas Excerpts

Thursday 17th March 2022 Commons Chamber

[Jon Cruddas (Dagenham and Rainham) (Lab)]

Like all Members, I thank my hon. Friend the Member for Rochdale (Tony Lloyd) for securing this debate, which is possibly the first Backbench Business debate in this Chamber to focus specifically on the Irish in Britain. I have known him for more than 25 years and am acutely aware of his political skills, but to secure this debate on St Patrick’s Day, in the middle of the Cheltenham festival, which is promising another greenwash of wins for Irish trainers, and following the biggest Irish victory in Twickenham history says something about his tacit political skills of timing; it is an extraordinary gift and we appreciate it today, with this debate. On acknowledgments, I should also stress the role of my hon. Friend the Member for St Helens North (Conor McGinn), whom I know will be immensely proud to be replying for our party this afternoon. He performs incalculable work on behalf of the Irish in Britain today and wider UK-Irish relations. He does a great job, and long may it continue.

This is undoubtedly an important debate, allowing us to demonstrate our support for the Irish in Britain, and how the Irish are recognised and valued as a core part of British society, fundamental to its economic and cultural life. As has been said, that cannot be expressed simply in a numbers game of Irish nationals in the UK, given the countless millions of second and third-generation Irish who have shaped the character of this country, informed by their family identity, culture and heritage. Yet the importance of this debate goes beyond general statements of support, partly because it is more personal for those children of Irish immigrants, brought up within Irish families in this country, who have become Members of this Parliament. Let me give full disclosure: my family come from Donegal. My wife sits in the other place, and her family come from Mayo and Galway. They all came over in the 1950s, for reasons of work. Many of us also represent communities with very strong Irish traditions and cultures.

Much debate of this debate might well focus in on the needs of the Irish community in this country. Undoubtedly that is correct, given that, as my hon. Friend has mentioned, an estimated 10,000 Irish in England may be suffering from dementia and that death by suicide is disproportionately high in this community, as are some of the effects of cancer-related diseases. Those are all vital issues, but today is also an opportunity to highlight not just the community’s needs, but the fundamental contribution of the Irish in creating and shaping Britain’s economy and society over many decades. That extends throughout Britain and throughout this city—it is not confined to Brent, Camden and Islington. Dagenham, 13 miles from our debate, is a good example of that. For it is impossible to understand Dagenham without an intimate appreciation of patterns of Irish migration in the creation of community, which is a story played out over many decades and one that is still strong today.

I am fortunate to be writing a history of my community, and 7 November 2021 marked the 100th anniversary of the birth of modern Dagenham. Exactly 100 years earlier, the first house was completed on the Becontree estate; 27,000 new homes, containing over 100,000 residents and spread over 4 square miles of marshland, would follow by 1935; this was the largest council estate in the world. In 1931, the Ford Motor Company relocated from Manchester’s Trafford Park to Dagenham. The site offered deep-water port access, allowing for bulk coal and steel shipments on a much larger scale than the Manchester Ship Canal did. The 475 acre riverside site became Europe’s largest car plant, with 4 million square feet of floor space. By 1953, it employed 40,000 direct workers, and 11 million vehicles and over 40 million engines have rolled off the line.

I raise that because when the plant first opened in 1931 so many men from Leeside in Cork got work there that some oral histories suggest that the county accent predominated on the factory floor. Later in the ‘30s, when tractor manufacturing in Cork was terminated and transferred to Dagenham, thousands more followed. When these Cork migrants returned for a holiday, with their trendy clothes and money, they were affectionately known as “Dagenham Yanks”. It was the beginning of a link between the two places that remains as strong today—it is an industrial link that uprooted Irish villages and planted them into what was then Europe’s largest factory and on to its largest estate. That pattern of migration continued throughout the whole of the last century; estimates suggest that well over 10,000 Irish migrants have worked for Ford in Dagenham over the years, laying down strong local roots and family connections.

One of the few private estates in Dagenham, the Rylands estate, just opposite the factory gates, was literally built to house thousands of Cork Ford workers. In the 1940s and 1950s, thousands more Dagenham Yanks were attracted to the expanding assembly plants. When the engine plant that Ford retained with Dunlop in Cork closed in 1983, many thousands more came across the water throughout the ‘80s. The social impact of this migration has been immense not least in the promotion of Irish culture and heritage. In the local pubs and drinking clubs, such as O’Gradys, the Casa and, right outside the plant gates, the Mill House Social Club, Dagenham was known as Little Cork, a place of tripe and drisheen, spiced beef, Beamish and Murphy’s. The term “Murfia” was coined to describe the Corkonian-controlled network of work and political connections, patterns of family and kinship, and extensive cultural, sporting and faith-based communities.

Local Gaelic Athletic Association clubs flourished, and there was a deep-rooted connection between the Ford paint shop and Tomas McCurtain’s GAA club. This was partly the product of an Offaly man named Bill Flanagan, who supervised paint contractors and was always eager to hire good hurlers and footballers for McCurtain’s. Many of them originated from Dromina in County Cork, through the influence of the legendary Timmy O’Sullivan, a main contractor who relocated half the village. Sadly, he died in 2014, but he is still a legendary figure. He even convinced the Cork hurling team, including Christy Ring, to travel over to play McCurtain’s in the ’60s, and Bertie Ahern regularly came down to present jerseys.

The wider character of Dagenham was informed by the GAA, the pipe bands, the Irish language classes, the music and the dancing, and they have remained enduring features of the Dagenham culture for decades. I make these points not out of some sense of romantic nostalgia but to acknowledge the extraordinary economic, social and cultural contribution of the Irish community in Dagenham and its wider role in powering manufacturing across this city and the manufacturing economy of the country over many decades. The Irish were indispensable in the creation of our community in Dagenham, which has helped to define the industrial history of this country and this city.

Locally, things have changed—car assembly finished in the early 2000s—but this debate speaks to what is being made in Dagenham today, with new industries emerging that promise once again to strengthen the economic links between the two countries. For instance, Hackman Capital Partners—the owner of what will be the largest film and TV studio in London when it opens in Dagenham in a few years—has just acquired two Irish film studios, in Wicklow and Limerick.

In recent years, Irish migration has slowed, yet the community retains a strong Irish identity, with extraordinary numbers of second and third-generation Irish alongside a healthy number of older Irish residents, who are well represented in the churches, the union branches and groups such as the Irish Pensioners Forum of East London, a social and cultural group for older Irish people partly funded by the Emigrant Support Programme, which does some fantastic work for communities up and down this country. Such networks of support, advice and kinship—in the local clubs, societies and groups—have been critical in the response to covid. The sense of fraternity that is the hallmark of the Irish in Dagenham has really been a blessing for us.

Today’s debate gives me the opportunity to acknowledge, in Dagenham’s 100th year, the role of the Irish in the creation and sustaining of Dagenham. They remain a cornerstone of the local community. I have told just one story to illustrate the indispensable quality of the Irish community in this country, which we can honour and treasure today.

Allergy Research and Treatments: Government Support

Jon Cruddas Excerpts

Wednesday 9th March 2022 Westminster Hall

[Jon Cruddas (Dagenham and Rainham) (Lab)]

I rise to make a couple of quick points.

I commend my hon. Friend the Member for City of Chester (Christian Matheson) on his outstanding speech. He mentioned the scale of allergic disease and the epidemic that we are witnessing across the country, and he listed some of the tragic deaths from anaphylaxis. While welcoming Natasha’s law, he acknowledged how much more needs to be done on research and treatment.

In this regard, the recent report, “Meeting the challenges of the National Allergy Crisis”, made four general recommendations on treatment: first, as my hon. Friend mentioned, a national plan for allergy, led by a designated civil servant or NHS lead; secondly, an expanded specialist workforce to ensure training programmes that prioritise allergy; thirdly, to ensure all GPs and healthcare professionals in primary care have adequate knowledge and training about allergic issues; and fourthly, ways for local commissioners to understand and address the allergy needs of their local populations.

My hon. Friend touched on all those points, but he also opened up new ground in this debate on the question of research, which I welcome. We could eradicate allergies with appropriate financial support and Government backing. The £2.2 million from the Natasha Allergy Research Foundation is vital. I commend the family on everything they have done over the last few years. They are literally matching total Government research spend. As my hon. Friend said, surely we can do better than that and become a global leader in research to overcome this epidemic.

I have spent many years engaging with Ministers from different Governments on this subject, Sir Charles, but the present Minister has already demonstrated real commitment to this agenda. Consequently, we have a work programme and an ongoing dialogue between civil servants and representatives from the National Allergy Strategy Group. I commend the Minister for this, but I urge her to go further and faster, and positively respond to the comments made by my hon. Friend the Member for City of Chester on research expenditure. Lives depend on that, as well as the quality of life of many millions of our fellow citizens.

NHS Allergy Services

Jon Cruddas Excerpts

Friday 29th October 2021 Commons Chamber

[Jon Cruddas (Dagenham and Rainham) (Lab)]

I rise to make a series of points about improving allergy services in the UK and to speak in support of numerous recommendations made this week by the all-party parliamentary group on allergy and the National Allergy Strategy Group in their report, “Meeting the challenges of the National Allergy Crisis”. I will begin on a positive note and say how much the allergy community appreciated the fact that the Minister made time in her busy diary to receive the document at her Department on Wednesday morning. She spent time talking to children living with multiple allergies, as well as health professionals and charities. We hope that that will be the beginning of an ongoing dialogue.

Allergy is a hypersensitivity reaction or an exaggerated sensitivity to substances—allergens—that are normally tolerated. Examples include peanuts, milk, shellfish, cats, medicines and grass pollens. They can trigger harmful antibodies and the release of inflammatory chemicals, causing symptoms such as sneezing, itches, rashes and falls in blood pressure, yet they may also cause airway narrowing, shortness of breath and wheezing, and swelling which, if in the mouth, throat or airway, causes severe difficulty in breathing and can be life-threatening.

The simple truth is that there is a modern-day epidemic in allergy—one neglected by the NHS. Recent high-profile tragic cases of fatal anaphylaxis have brought shortcomings in NHS service provision, and a lack of wider public understanding of allergy, into sharp focus. This week’s report therefore calls for a new national strategy to help the millions of people across the UK affected by allergic disease. It also calls for an influential lead for allergy—some have labelled it an allergy tsar—to be appointed who can implement such a strategy.

By way of background, we have been here before, and quite regularly. Over the past two decades, a series of reports have reviewed the prevalence of allergic diseases, consequent patient need and UK service provision. The list includes earlier reports from the all-party parliamentary group that I am fortunate to chair, plus two Royal College of Physicians reports in 2003 and 2010, the first titled, “Allergy: the unmet need”. The 2003 report was so scathing that in 2006, the Department of Health conducted “A review of services for allergy”. We have also had a 2004 Commons Health Committee report on “The Provision of Allergy Services”, as well as the 2007 House of Lords Science and Technology Committee report, “Allergy”. All have consistently highlighted how allergy remains poorly managed across the NHS due to a lack of training and expertise. All recommended significant improvements in specialist services, as well as improved knowledge and awareness in primary care.

That is not to say nothing has changed. We have seen National Institute for Health and Care Excellence guidelines on allergy and care pathways for children with allergic disease, but very little has changed. Allergy remains under-resourced across the national health service, so once again this week’s document makes similar arguments and recommendations to earlier reports. We do not apologise for that, because so little has changed over the past 20 years. Actually that is not entirely the case. Something significant has changed over the past two decades: there has been a dramatic upsurge in the numbers of those affected by various allergic conditions across the country.

The figures speak for themselves. Around one in three people, which is 20 million of our fellow citizens in the UK, have an allergy-related disorder. A significant amount of that is severe or complex, whereby one patient can suffer several disorders, each triggered by different allergens. Five million have conditions severe enough to require specialist care. Fatal and near-fatal reactions occur regularly due to foods, drugs and insect stings and have been increasing over recent years. Hospital admissions due to allergy rose by 52.5% in the six years to 2017-18. Admissions with anaphylaxis—rapid onset and often life-threatening reactions—rose by 29%. It is estimated that one in 1,333 of the population in England has experienced anaphylaxis at some point in their lives.

Prevalence rates for allergy in the UK are among the highest in the world, especially among the young. Some 40% of children in the UK have been diagnosed with some form of allergy. Each year, new births add 43,000 cases of child allergy to the population in need, yet specialist services delivered by trained paediatric allergists are available to only a minority of those with serious disease. One in four adults and about one in eight children in the UK has allergic rhinitis, which includes hay fever and animal and house dust mite allergy. That is roughly 16 million people. They are four times more likely to suffer from asthma, eczema and food allergy. The percentage of people diagnosed with allergic rhinitis, asthma and eczema has trebled over the past four decades.

The overall economic case for prevention-oriented allergy services is very strong. The estimated cost of allergy-related illness in 2004 was £1 billion. Since then, there has been a 200% to 300% increase in anaphylaxis-related admissions. The starkest figure is that primary care visits for allergy have increased to account for 8% of total GP consultations. Put simply, the complexity and severity of allergies have increased, as well as the number of patients affected, placing huge strains on the system. Those are the basic facts. Change is long overdue.

Beyond the statistics, for the growing number of people in the UK living with allergic disease, their condition can have a significant negative impact on their lives and their families’ lives. It is frightening and restrictive to live with a condition that could cause a severe or life-threatening reaction at any time. Despite the shocking statistics, each of the reports that I have mentioned concludes that allergy has largely been ignored and is poorly managed across the NHS owing to a lack of training and a lack of expertise.

The core problem is that there are a very small number of consultants in adult and paediatric allergy, while most GPs receive no training in allergy at all. The basic mismatch between rising demand and poor service supply needs correction. There are only 11 specialist allergy trainee posts for doctors in England, despite the 2004 report’s recommendation of a minimum of 40. Only two qualify each year—fewer than in Lithuania, which has a population of 3 million.

The tiny number of allergy trainees is a bottleneck, stifling growth of the specialty. Shockingly, despite repeat submissions over 20 years to the workforce bodies responsible for trainee numbers, there has been very little increase. There are also too few consultants, only 40 adult allergists and a similar number of paediatric allergists working in a small number of allergy centres across the country.

Most general practitioners receive no training in clinical allergy, either as medical students or in their specialist GP training. The consequences for NHS patients are that they face an extraordinary postcode lottery across the country; that they are hampered by wrong referrals and re-referrals, or get no referral; that they are denied choice and the benefits of improvements in allergy care; and that there is significant and enduring unmet need.

The new training programme in allergy from August 2021 combines allergy with a different specialism in clinical immunology, but the danger is that that will further dilute and downgrade the quality of allergy specialist training. Meanwhile, on the ground, there is growing evidence of a reduction in some allergy services, with closures or restrictions, mainly among secondary care providers, because they are so overburdened.

Paradoxically, the UK is world-leading in allergy research and UK allergy guidelines are highly regarded internationally, yet failure to invest in clinical services nationally means that NHS provision is inconsistent, is often poor and in many areas falls far below that in other developed countries. More generally, the covid-19 pandemic has highlighted a new need for allergists to support the vaccine roll-out. The major new workload that arose—investigating anaphylaxis and suspected allergic reactions to the covid-19 vaccines and providing advice on safe vaccinations—has been delivered by a small cadre of allergists, building on their drug allergy expertise.

All these issues, and the resulting lack of effective allergy care, need to be recognised and corrected by NHS England and Health Education England. Basically, the report makes four recommendations for action. The first is a national plan for allergy, making allergy a priority, investing in a national plan led by a designated Department of Health and Social Care civil servant or NHS lead with sufficient authority to implement change—a national clinical director of allergy—and bringing together medical professionals and patient support organisations to develop the strategy and improve allergy services. The report details a list of organisations that might be involved in the delivery of training programmes to meet allergy need and provide the education across primary care that is needed for health visitors, dieticians and other healthcare professionals.



The second recommendation is on specialist care: to expand the specialist workforce as a priority, and to ensure that training programmes prioritise allergy, so that specialists of the future are appropriately trained and can safely deliver care. It proposes a minimum of 40 additional training posts for allergy, and a minimum of four consultant allergists for adults and two paediatric allergists in every major teaching hospital and large conurbation.

The third recommendation is on primary care: to ensure that all GPs and healthcare professionals in primary care have knowledge of allergic disease; to ensure allergy is included in the GP curriculum and exit examination; to improve allergy education for already qualified GPs in ongoing professional appraisal; and to appoint a health visitor and/or a practice nurse in each practice with sufficient training to be responsible for allergy. Again on a positive note, some of this is beginning to happen. The Royal College of General Practitioners has recently added allergy to new GP exams.

The fourth recommendation is on commissioning: to ensure that local commissioners understand the allergy needs of their population. It says that it is not adequate to assume that other specialties can deliver specialist allergy care; that commissioners should ensure access to adult and paediatric allergy consultants, and allergy pathways; and that national commissioners should ensure national agreements on commissioning, including for immunotherapy, drug allergy investigation and so on.

In conclusion, I hope that the Department will seriously consider the report and its recommendations. Supporting the growth of the allergy speciality would give more patients access to accurate diagnosis, which should surely be expected in a modern national health service. We can all agree that patient safety, the prevention of severe life-threatening reactions and the control of chronic disease are paramount. More specialist allergists are essential to support primary and secondary care, and to improve integrated care, keeping more patients out of hospitals. This would in turn tackle the geographical inequalities and lack of access to specialist allergy services. A relatively small investment would be an effective multiplier and deliver wider dividends.

Such a model would result in better care for patients in line with the NHS long-term plan. The Government and the NHS should give allergy the priority it deserves and recognise the true burden that it can place on those affected, their families and wider communities. They should not have to wait any longer. This report offers the solutions to the problems and makes sensible, achievable recommendations for change. We look forward to them being implemented.