Allergy Guidance for Schools

Alicia Kearns Excerpts

Tuesday 21st May 2024 Commons Chamber

[Alicia Kearns (Rutland and Melton) (Con)]

Thank you, Madam Deputy Speaker, for granting this important debate.

For too long, allergies have been seen as a personal issue to be managed by the individual affected. That needs to change. Allergies in school-age children are rising quickly, and around 45,000 people born each year will develop an allergy. School should be a safe space for our children to grow and develop, yet for those with allergies and their families the joy of education is too often compromised by safety and medical risk. There are 680,000 pupils in England with an allergy, so every classroom has at least one or two living with an allergy. Tragically, anaphylaxis occurs in educational settings more than in any other public space, and that shows in and of itself that we need to take action. We need to address this today—it has already gone on for too long—to give parents and children the confidence of knowing that our schools are allergy safe. If we do not, the consequences are truly heartbreaking.

Benedict Blythe from Stamford was a gifted child. He was able to complete a 24-piece puzzle by himself aged just one. He could match number cards by 18 months and create pie charts by the time he was school age. His mother Helen recalls purchasing him a book of the complete human nervous system in an attempt to quench his thirst for knowledge. By aged four, Benedict was a member of Mensa and practising maths at the level of a 10-year-old. He was a truly talented child, but it was his compassion and care for his family, and his infectious energy that made him just so loved.

Despite all his strengths, his life was marked by challenges stemming from his asthma and his allergies. As he began to try a wider range of foods, as all children do, Benedict suffered allergic reactions, first to baby rice, then to baby porridge and then to whey powder. What should have been a normal part of growing up saw him hospitalised. His family, through careful planning and care, worked out what he could eat safely. But while they could guarantee his safety at home, they had to trust others with Benedict when he went on play dates, mixed with other children and, eventually of course, went to nursey and school.

He was aware of his allergies. Like my nephew and so many others, he learnt to ask what was in a product before he ate. He was so cautious about he could and could not eat, but he also had to rely on those around him to keep him safe. Aged two, a nursery worker poured cows’ milk over his cereal, causing a severe reaction. The worker claimed he had been given oat milk and only admitted the mistake once young Benedict’s lips and tongue had begun to swell, and he suddenly stopped being able to breathe. The delay in admitting the mistake and beginning treatment for the reaction could have been fatal. However, tragically, that repeated itself when, aged just five, Benedict ate something at school that caused him to collapse, and he died the same day.

I know that the whole House will join me in honouring Benedict and recognising his unique character and intelligence. He dreamt of becoming a doctor, and I am sure he would have achieved that ambition and so much more. His story is every mother and father’s nightmare: the loss of their child, the pain so profound as to be unimaginable; their child going to school and just never coming home. Yet despite that nightmare, Benedict’s mother has endeavoured to ensure that other children can go to school safely, and I salute her for her fortitude and her strength.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Lady give way?

[Alicia Kearns]

I will happily give way to the hon. Gentleman, who has himself held debates on this important issue.

[Jim Shannon]

I commend the hon. Lady for raising the issue. She has told the story of young Benedict so well. She has honoured him and honoured his family, and we thank her for that. My second son is now a young man, but as a wee boy he had a number of allergies, so I understand the issue all too well: I understand the importance of controlling a boy’s diet and, indeed, the very life that he leads. Does the hon. Lady agree—in fact, I think she may be coming to this point—that given the increase in the incidence of allergic reactions, each school must have a trained member of staff on the premises at all times to know the signs and how to deal with them? Does she also agree—and here I look to the Minister—that the necessary funding uplift must be allocated in addition to existing school budgets?

[Alicia Kearns]

The hon. Gentleman is entirely right. The problem is that because the guidance is currently not mandatory, schools have completely different responses. At my nephew’s school, for example, there is a picture of every child with a severe allergy on the teachers’ board, so that every day when the teachers go in they know which children to be more alert to, and in an emergency they know exactly what to do because there is a commentary under each picture. That is the kind of response that we need, but yes, we will need more. We saw the Government act strongly and quickly in response to the need to install atrial defibrillators in schools, and I ask them to take the same approach in this regard. The number of children who have died of allergies in our schools is far higher than the number who have died of any sort of heart incident, so I really think that it is time for action.

[Shailesh Vara (North West Cambridgeshire) (Con)]

I congratulate my hon. Friend and constituency neighbour on securing this important debate, and on the fact that although Adjournment debates are normally lonely affairs, others are present for this one. Does she agree that the cost the Government would incur in helping schools to provide, for example, adrenaline pens is, in the overall scheme of things, very small indeed, and should not be a barrier to supplying schools with a little bit of extra cash to procure a few adrenaline pens which may save lives?

[Alicia Kearns]

My right hon. Friend is right, and I pay tribute to him for raising this issue during Prime Minister's questions only last week on behalf of Benedict and his family. Other countries have taken action, and we have the opportunity to do the same.

The Benedict Blythe Foundation has worked tirelessly under Helen’s leadership to investigate the issues facing pupils with allergies, and—most importantly—to make policy recommendations to solve them. That work culminated earlier this year with the publication of the REACT report, and I want to summarise its findings; it is the first time that the House will have heard them. The authors investigated 2,198 schools across England, 10% of the total, and found, concerningly, that a third of them had no clear policy on allergies—not that they had a reduced or non-mandatory policy, but that they had no policy at all. Many schools did not record allergy incidents accurately, and, most worryingly, half of them did not have lifesaving medicine on site. Only two years ago, a young child died at school because another child had thrown a piece of cheese at his face. His reaction was so extreme that he died that day. If he had had access to lifesaving medicine, that child would still be with us.

Extensive research has made it clear that allergy provision in schools is a lottery. Some schools go above and beyond to create an allergy-safe environment, but the lack of an allergy policy in others is absolutely wrong. I ask Members to imagine being the parent of a child with an allergy. How would they feel about sending their loved one to school not knowing whether he or she would be safe? Too many parents are not confident about sending their child to school, which unfortunately means that we are seeing too many children with allergies miss days of school. That is a priority for us to tackle. Following the pandemic, we know just how damaging it is not to have our children in school.

I am afraid that the root cause of these issues is a lack of clarity in the Department for Education guidance, and a lack of accountability mechanisms to ensure that existing guidance is followed. In the previous debate on this matter, which was organised by the hon. Member for Strangford (Jim Shannon), we discussed the need for that to be part of Ofsted inspections, because it should be part of the mechanisms. The medical conditions statutory guidance currently given to schools does not mention allergies specifically, and there is evidence that some schools consider allergies to be a dietary issue, rather than a medical consideration. That is just not good enough and, frankly, it is dangerous. Some 70% of schools do not have the recommended allergy safeguards in place, which demonstrates that having well-meaning guidance is just not sufficient. I therefore ask the Minister to consider issuing new, bespoke guidance to all schools on how to be allergy safe. That would not be onerous; it would simply require an email to go out to every single school in the country.

Drawing on extensive research and expert opinion, the REACT report has produced a set of safeguards that would ensure that our education system is safe for all pupils. First, it argues that every allergic reaction should be recorded and reported. I am not surprised that the Department for Education may well under-recognise the importance of this issue, because that is not taking place. It would allow schools with a high number of pupils with allergies to get more support, and it would give decision makers the information they need to make informed decisions and ensure the intelligent distribution of resources.

Secondly, all schools should have a specific allergy policy, including an anaphylaxis plan. Allergies are potentially life-threatening and are so common that they should have their own bespoke policy, separate from those for other medical conditions.

Thirdly, every school should have an individual healthcare plan for every child with an allergy, and it should be reviewed with a doctor. Seemingly mild allergies can quickly morph into severe reactions, and attempts at distinguishing between children on the basis of allergy severity are misled and potentially damaging. Just because a child is assessed as having a low allergy risk does not mean that they will not have a severe reaction one day. Mandating individual healthcare plans for every child with an allergy would create a safe environment.

Fourthly, funding should be given for every school to train its staff in how to administer adrenalin auto-injectors in an emergency. Each school should also keep a spare inhaler and antihistamine as part of a bespoke, allergy first-aid kit.

Fifthly, all school staff should receive basic training in allergy awareness management and emergency response, which is also about a duty of care for them. If I were a teacher, I would not want to operate in that environment if I did not know how to respond should a child in my care have a severe allergic reaction. It is vital that we give teachers the tools they need, and that we ensure that best practice is learned from schools with comprehensive allergy plans.

Finally, accountability mechanisms should be established to monitor and support schools as they implement their allergy plans. Sadly, as we have seen, there is already a gulf between what the Government recommend on allergies and what schools are actually implementing. As we introduce better and clearer guidance, we must ensure that it is followed across the country.

Adopting those policies would ensure that children with allergies can go to school safe in the knowledge that they will not be exposed to danger. There is no way to eradicate all risks when it comes to allergies, but we can make schools as allergy-safe as possible. Every parent needs to know that their child’s condition is not being ignored, dismissed, misunderstood or played down, and teachers also deserve that surety.

As my right hon. Friend the Member for North West Cambridgeshire (Shailesh Vara) pointed out, our international partners have shown that change is achievable. Sabrina’s law requires Canadian schools to provide allergy and adrenaline auto-injector training for all teachers and staff. Minnesotan law mandates that all allergic students have access to emergency medicine and an individual healthcare plan. The Allison Rose Suhy Act incentivises schools in Ohio to train both staff and students on allergy awareness. Elijah’s law ensures that daycare employees in New York are trained to recognise anaphylaxis and to administer adrenaline. Finally, Amarria’s law requires public schools in Virginia to stock adrenaline auto-injectors. There is no reason why children in the UK should face greater risks at school than their peers abroad. These allergy provisions have been common practice across the US, Australia and Canada for decades, and we now need to adopt them here.

The policies set out by the Benedict Blythe Foundation in the REACT report show how we can not just match international standards, but surpass them and make the UK the safest place in the world for pupils with allergies to attend school. This is a condition on the rise. More and more children have allergies, and we need to take action. I therefore ask the Government to commit to producing Benedict’s law, and to meet me to discuss how it can be implemented. We are not looking at significant costs or wanting to put more duties on teachers. We want to make sure that teachers feel that they are in a safe workplace where they can take the action needed to do what they care about most: protecting and supporting their children and young people to become strong adults with bright futures ahead of them.

In memory of Benedict Blythe and in honour of his mother Helen’s tireless advocacy, we should ensure that no pupil with an allergy and their family ever again have to choose between feeling safe and medical safety and taking up education. No parent should live in fear that their child will not come home from school one day as a result of a condition that can be prevented. There is no reason for any child to die in our schools of an allergy. We just need simple allergy policies, adrenaline auto-injectors and to take action. We can save lives by taking action now. I thank the Minister in advance for his consideration, and I look forward to hearing his response.

--- Later in debate ---

[Damian Hinds]

I am grateful to my right hon. Friend, and I acknowledge the gravity of what he says. Of course, we are talking about conditions that can be very varied, and the responses that are called for can be quite different. Schools know their pupils almost best; they, working with parents, who absolutely know their children best, are in the best place to enact that. I want to be clear that the guidance that accompanies what I have just been outlining is statutory guidance supporting pupils with medical conditions. It is not voluntary, and governing bodies must have regard to it when carrying out their duties.

[Alicia Kearns]

I apologise for intervening on my right hon. Friend because I know that he wants to make progress, but this might be something that he could commit to today. The problem, as I set out in my speech, is that too many schools think that allergies are a dietary issue, not a medical issue. If the next mailer to all schools reiterated that we see allergies very clearly as a medical condition, and reminded them of their statutory duties, that could go a long way to forcing all schools to take the action that he rightly says that they can take. This would not be as top-down; it would reiterate the regulations, and allow schools to take the action that they need to.

[Damian Hinds]

My hon. Friend is absolutely right to talk about awareness and understanding, and the role of communication in that. I will speak a little more about communication, but there is always more that we will need to do. Of course, I would also be happy to continue the conversation with her about how best we do it.

The guidance makes it clear that schools should ensure that they are aware of any pupils with allergies, and should have processes in place to ensure that the allergies can be well managed. Practices to identify children with such needs could include wristbands, or, as my hon. Friend said, having a photograph of the child alongside details of their allergy in the kitchen or serving area of the school. I stress again that individual schools are best placed to work with parents to put in place the most effective responsive system.

In addition to the section 100 duty, schools are subject to other requirements. In the UK, food businesses must inform consumers if they use any of the 14 mandatory allergens as ingredients in their food. How allergen information should be provided depends on whether the food is prepacked, non-prepacked or prepacked for direct sale. This includes food provided by institutions such as school caterers, who have a responsibility to protect the people in their care. As colleagues may know, rules on the provision of food labelling are set out primarily in the retained 2014 regulations, and these include a requirement to identify the presence of any of those 14 mandatory allergens to consumers.

The Department for Education also works closely with the Food Standards Agency, which provides free food allergy and intolerance training online. This offers practical advice to local authority law enforcement officers and anyone wanting to learn more about food allergies, such as those working in the food manufacturing and catering industries. The FSA also offers a whole host of other training, technical documents and guidance.

Turning to auto-injectors, these can be vital when a child is suffering an allergic reaction. To support schools in meeting the needs of children with allergies, the Government passed the Human Medicines (Amendment) Regulations 2017, which allow schools to obtain and hold spare adrenaline auto-injectors for administration to pupils in an emergency. The Department for Health and Social Care has produced guidance on the use of adrenaline auto-injectors and emergency inhalers in schools, including the purchase of spares. The guidance makes it clear that any adrenalin auto-injectors held by a school should be considered a back-up device, rather than a replacement for a pupil’s own adrenalin auto-injector.

Beyond this, families have a vital role to play in managing their child’s condition. We are very clear with schools that no one will know a child’s needs as well as their parents, and that schools should work closely with parents. The parents of children with allergies will work with medical professionals and other organisations to plan for and navigate their child’s specific needs. Parents should be fully consulted and engaged in any discussions relating to their child’s allergy.

Schools will also need to ensure that the parents or carers of children with food allergies or intolerances are given information about the allergenic ingredients used in the foods available. Good communication between parents and schools on allergies and pupils’ needs is essential to keep children safe while in school.

My hon. Friend the Member for Rutland and Melton referred to the role of Ofsted, further to the points made by the hon. Member for Strangford, and the importance of schools having a clear allergies policy and involving parents in discussions about the needs of their children. Ofsted inspectors gather a wide range of evidence to make their judgments, and evaluate the experience of individuals or groups of individuals, which can include the experiences of pupils with medical needs, if the issue is raised by parents or pupils. In an inspection, inspectors will assess the effectiveness of safeguarding at the school, which includes the extent to which pupils with specific needs and vulnerabilities are kept safe. The safeguarding culture is also explored by speaking to leaders and staff about their work and the messages that pupils receive through the curriculum.

During last November’s Westminster Hall debate on pupils with allergies, my hon. Friend the Member for Rutland and Melton informed the House that she would write to all schools in her constituency to ask them to adopt the voluntary schools allergy code, co-created by the Benedict Blythe Foundation, the Independent Schools Bursars Association and the allergy team. Taking her lead, Ministers in the Department for Education instructed officials to share a link to the code in our fortnightly email bulletin to schools issued on 1 March. That communication also reminded school leaders of their duties concerning pupils with allergies.

For younger children, the early years foundation stage framework sets the standards that all registered early years providers must meet for the learning, development and care of children from birth to age five. The EYFS states:

“Before a child is admitted to the setting, you must obtain information about any special dietary requirements, preferences and food allergies that the child has, and any special health requirements.”

Providers must have a policy and procedures for administering medicines, and they must have systems for obtaining information about a child’s medicine needs and for keeping this information up to date. Training must be provided for staff where the administering of medicine requires medical or technical knowledge.

Within all early years settings, there is a requirement for at least one person with a current paediatric first aid certificate to be on the premises and available at all times when children are present, and they must accompany children on outings. The PFA criteria are clear that the training should include being able to help a baby or child who is suffering from anaphylactic shock.

Last September, we changed the adequate supervision requirement in the early years foundation stage to be explicit that adequate supervision while children are eating meals means that children must always be in sight and hearing of an adult, rather than within sight or hearing. This will help practitioners to see the signs of an allergic reaction as soon as they are present, and it will allow them to act quickly.

The new early years educator level 3 qualification criteria will also come into force in September, ensuring that early years practitioners have an understanding of allergies and anaphylaxis. In April 2024, the Department published nutrition content on the “help for early years providers” online platform. The content includes a section on allergies and anaphylaxis to help early years providers prevent allergic reactions, to recognise the signs and symptoms of an allergic reaction or anaphylactic shock, and to know what to do if they occur.

On 22 April, the Department launched a consultation on the safeguarding requirements in the EYFS. One of the proposals is the inclusion of a safer eating section, which includes requirements for all staff to be aware of the symptoms and treatments for allergies and anaphylaxis, and to obtain allergy action plans for children with allergies. We plan to publish our response to that consultation in the autumn.

I have outlined the various pieces of legislation and guidance that cover allergies in school. Given the complexity and individual nature of food allergies, the Government’s view is that it would not be appropriate for the Department for Education to legislate for food providers to cater for all requirements. However, through legislation, the minimum standards for school food have been clearly set out. Beyond that, headteachers, school governors and their caterers are best placed to make decisions about their school food policies that take into account local circumstances.

[Alicia Kearns]

I think we find ourselves in absolute agreement that schools should own their own allergy policies. Perhaps the Minister can reiterate from the Dispatch Box his request for schools to bring forward allergy policies focused specifically on the children who have allergies. They need to hear a clear instruction from the Minister at the Dispatch Box. We are clearly in agreement: schools should be leading on allergy policies in their schools, but the freedom of information research done by the Benedict Blythe Foundation shows that not enough of them do so.

[Damian Hinds]

I agree. As I said earlier, understanding and awareness are vital, and communication is what gives rise to them. That is why, following my hon. Friend’s lead, we issued a communication by email. I totally accept that there will be more to do, and I am more than happy to carry on that conversation with her.

Overall, we feel that the existing mix of national requirements and local flexibility is the appropriate approach to this complex and extremely important issue, though we always keep the policies under review. We welcome feedback on how we can better support schools’ implementation of them. I am pleased that DFE officials now sit on the expert advisory group for allergy, convened by the Department for Health and Social Care, and the National Allergy Strategy Group, which recommends priorities for allergy policy across Government. I encourage stakeholders to feed any ideas and points on these issues to officials via that route. I conclude by thanking once again my hon. Friend the Member for Rutland and Melton for bringing forward this important debate.

Question put and agreed to.