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House of Commons Hansard
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Allergy Awareness in Schools
14 March 2018
Volume 637

[Sir Christopher Chope in the Chair]

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I beg to move,

That this House has considered allergy awareness in schools.

It is a great pleasure to serve under your chairmanship, Sir Christopher, as we discuss the issue of allergy awareness. It is a serious issue, and I look forward to discussing it and hearing from the Minister later on. I will talk about the serious and growing problem of allergies and the challenges faced by those who have them, the portrayal of allergies in the media and how that shapes our attitudes, the horrendous incidents of allergy bullying in schools and the potential for fatalities, and what we can do to raise awareness in schools and beyond.

First, I feel I should declare an interest; I had my first allergic reaction when I was four years old. I walked to the shop with my grandmother, where we bought a bar of chocolate—a Marathon, which shows my age—and by the time we had walked back up to the end of the street I had vomited up the Marathon. When I was a small child, happily, that was as far as the allergy went. It was not life-threatening; it was certainly an inconvenience and something to be avoided, but it was not as serious as it later became.

When I reached my teenage years, the reactions became more serious and began to include swelling in my mouth and throat. That was when I was prescribed an EpiPen injector, which I carry, regularly updated, in my handbag to this day and take with me wherever I go. That is an important thing for anyone who has been prescribed an adrenaline injector to do.

The experience of going through an anaphylactic reaction is terrifying. It involves a whole-body physiological reaction. I start to get a tingle in my mouth if I have eaten something that has nuts in it. I feel almost a rasping at the back of my throat. That, for me, is the tell-tale sign, at which point I try to take action. I sometimes try to make myself sick, to expel whatever it is I have eaten, although I know that can sometimes be problematic. I never really know how serious the reaction will be; sometimes it is mild and can be treated with antihistamine, and sometimes it develops into full-blown anaphylaxis. It is difficult for me as an individual to know which it will be.

When it does become anaphylaxis, that is when the heart starts beating. I find it is quite similar to having an asthma attack, where breathing becomes incredibly difficult. My face swells up and changes colour to become a sort of red-purple, I have palpitations, and it is not a pleasant sensation. Ultimately I need the adrenalin injector and treatment in hospital; I thank the NHS and indeed the health services in countries around the world where I have experienced this, as I literally owe my life to them.

I know what it is like to experience it as a sufferer myself, but I also want to describe how one mother talked about having her toddler try a walnut sauce for the first time. She said:

“His mouth started to bubble and mini-hives appeared. I could see the hives getting bigger and spreading all over his cheeks, his ears, up the back of his neck and starting to go down his chest. On the car on the way to hospital, he started to cough and vomit everywhere in the backseat. My greatest fear started to kick in when the choking, vomiting and crying turned to utter silence. He had gone limp. I was saying ‘C’mon buddy. Wake up’”.

She says,

“‘This is it,’ I thought. ‘I’ve killed my boy’.”

That little boy received hospital treatment and lived, but I ask hon. Members to put themselves in that parent’s shoes—particularly for that first reaction, when they do not know what is happening, the anaphylaxis is so terrifying and the child is of an age where they cannot even tell them what their symptoms are and what they are experiencing.

At this point, I pay tribute to Nicky Forrest, a mum in my constituency who, in addition to all sorts of work on the parent council of a local school, runs a local support group for allergy sufferers and their parents so they can share their experiences, advise one another and campaign.

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The hon. Lady is making a powerful case. Does she agree that schools need to educate children and parents further, so that children who have allergies can socialise like any other child?

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Absolutely. As I can attest, having an allergy is a condition that can be managed and need not prevent someone from having a full life and taking part in school and all the educational opportunities, but that relies on a wider awareness of allergy. Indeed, living with allergy as an adult is the same.

That is why awareness and education are so important—even more so because the prevalence of allergies in our society is growing. It is now estimated that about 2% of children have a nut allergy; of course there are many other allergens as well, so if we include other foods the percentage is higher. Last year in England there were more than 1,900 food-related hospital admissions for anaphylaxis. The anaphylaxis hospital admission rate increased sevenfold between 1992 and 2012. The UK is not alone in that, as there are other countries where the prevalence of allergies is growing, but we need to recognise it as a serious health issue. Indeed, it can be fatal. Data over the same period from 1992 to 2012 showed 124 fatalities were likely to be due to food-based anaphylaxis, 48 of which were school-aged children. For one in six of those school-aged children who died, the reactions occurred in school or another educational environment. The role of schools in this is crucial.

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The hon. Lady is making an excellent speech. Since the Human Medicines (Amendment) Regulations 2017, adrenalin auto-injectors can be held by schools, but it is crucial that the education goes to teaching staff, who are reluctant to use them as well. Will she comment on that?

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I certainly will. I praise the change to the regulations, which is a positive thing. It would be great if schools had some help with the cost of the injectors, because they go out of date; they typically last from a year to 18 months before they have to be replaced, and they can cost from £30 to £100 each, but the change is very helpful.

The hon. Lady is right about the training element. I was scared about using my own EpiPen. I carried it for years before I used it, and I used to go to hospital if something happened because I was petrified about what would happen if I used it. The first time I used it, I was on a parliamentary trip looking at human rights issues in Chechnya, and it was not safe to go to hospital because we had to go everywhere under armed guard. I was in a situation where I had to use the EpiPen, and I was really scared. Nicole, a wonderful woman from the human rights group who was with me, held my hand. We read the instructions and we did it together.

It started to work really quickly, and the relief and the experience of doing it have made me say to other people with EpiPens, “If you’re experiencing your reaction, use it. Then go to hospital, absolutely, but use that EpiPen, because it starts to work right away and delay can be fatal.” I know the experience I had is probably shared by others, but it is not the best medical advice. The more we can train and encourage people that it is a positive thing to do and will bring relief to someone who is having that kind of reaction is important.

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I thank the hon. Lady for introducing today’s debate. I too declare an interest, because my 15-year-old son has a severe peanut allergy. We have gone through life having to manage it since he was seven. I have only praise for my son’s primary school, which managed the medications and the out-of-date medications when the date was coming up. My worry and concern, not just for my son but for others in the same position, is secondary school, because things completely change. There are 1,000-plus pupils in the school, including teenagers who are difficult to manage and seem to think, “It’s okay, we can manage this.” My son’s reaction is so severe that if somebody else in the room has a bag of peanuts he reacts and needs his medication. I will get to the point: we need to inform other pupils and teachers of the seriousness of this.

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I absolutely concur. That is why this wider awareness is important. Of course individuals need to have the information to manage their own condition, but particularly in those teenage years it can be more difficult for people. They feel a bit more awkward when they are eating out, because they might be perceived to be making a fuss. It is not making a fuss, but that is how it can feel in a group negotiating all sorts of adolescent relationships. For others to understand the seriousness of this is incredibly important.

There is not always a blanket ban on allergens. Schools make their own decisions. Some schools in East Dunbartonshire have become a nut-free zone, but that does not have to be the approach that is always taken—it depends on the specific risk being managed. However, reporting in the media is an important part of how we look at allergies, and food allergy and food intolerance are often conflated. Food intolerance, in particular, can get a pretty bad press.

We know that it is an issue at the school gates and on play dates, where parents of children with allergies can be viewed as neurotic or over-protective. Eating out can be a minefield. Improvements have been made in food labelling over the years, thanks largely to the European Union, which has driven that. Now the key allergens are listed in bold on the back of packets—they are very clearly marked. Indeed, since the 2014 regulations came in, we have the right to that information when eating out, about what food ingredients are going into what we are about to eat.

Restaurants, however, can easily become complacent. We had a prosecution, thankfully, which showed at least that the criminal justice system would take this seriously. An Indian restaurant owner, who had a cavalier attitude to safety, was jailed for manslaughter after a customer died from a nut allergy, because the restaurant had taken the liberty of swapping almond powder for a cheaper one containing peanuts and had not included that information on the menu.

Just a few months ago, top chef Raymond Blanc was at the BBC Good Food Show. He said:

“We are a kitchen not a hospital. Of course, now, if you don’t have an allergy, you’re nobody… It’s a very great fashion to have a food intolerance.”

I really think we do not need comments like that. They rather undermine his other claims to take diners with allergies seriously.

That attitude is really familiar to people with allergies. There is either the excessive response: “Well, you’ve got an allergy. We cannot possibly serve you, because we can’t guarantee anything, so, frankly, just go away and never eat out.” Or there is the response, equivalent to that eye-roll, which assumes that someone is making a fuss about nothing, and then they people not check the ingredients properly and that is when fatalities can happen. Many hon. Members will be aware of the case of Amy May Shead who, in 2014, was left with permanent brain damage when she suffered anaphylactic shock and cardiac arrest after consuming a dish that contained nuts in a restaurant when she was on holiday.

I have also raised the issue of parents of children with allergies being afraid when flying abroad, because they are worried about an allergic reaction happening in the air. I raised that at Transport questions and recently met campaigners and the Minister for aviation to discuss how to take that forward. Part of this is about the airlines getting their act together, but it is also about the air hostesses and air hosts on the plane having a wider understanding of allergies, so that they do not have the kind of really insensitive reactions that were reported by some parents. In one case, somebody made requests for an announcement to be made and had been deemed to be an over-protective parent. When the child and his mum got off the flight, the air host said, “See, we didn’t kill you, did we?” When we hear stories like that, we realise how far we have to go in raising awareness. This is quite a difficult issue to categorise. There are issues around health, education, transport and media, so it requires cross-governmental working.

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Is it not the case that it is impossible to separate the question of allergies in schools from wider paediatric allergy support in the communities? The postcode lotteries are creating problems with access to suitable specialist support, as well as blood tests and so on. The work of the Department for Education and of the Department of Health and Social Care needs to go hand in hand.

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I absolutely concur with the hon. Gentleman. I would argue that this is a public health issue that needs to involve all Government Departments. I thank him for the important work he does with the all-party parliamentary group for allergy. Perhaps I will spy in the Chamber a few hon. Members whom we might approach to become members of that group.

Some schools take the action of banning nuts on the premises following a risk assessment. When that happened in Exeter a few months ago, we were greeted by this headline on the Mail Online:

“‘The only nut ban should be the head’: Parents blast primary headteacher’s ‘ridiculous’ proposal to completely bar nuts from school grounds”.

That focuses on the anger and outrage of parents, rather than the potential threat to the lives of children in the school. These articles are often written in a way that encourages outrage on the part of readers, as if children with allergies are somehow an inconvenience to everybody else.

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I thank the hon. Lady for informing us on this subject. I do not have a nut allergy, nor do I know anyone with a nut allergy, but I have met people who are concerned not just about allergies in school, but about other medical conditions such as diabetes. They are concerned about the ability of staff to be available to help if a child gets into difficulties at school. The issue is not only training for schools, but monitoring and enforcement, perhaps by Ofsted, to ensure that those training plans are in place and that kids can have access to everything, including sports and all the other things that they would like to do in school.

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I quite agree with the hon. Lady. Indeed, my sister has had type 1 diabetes from a very young age. The ability of schools to incorporate children with a range of conditions and ensure there is wider awareness, so that those children can play a full part in the life of the school, is really important.

On Friday, Sony’s new film “Peter Rabbit” will be released in the UK. The villain of the piece, Tom McGregor, is allergic to blackberries. One scene in the movie shows the rabbits—our beloved Peter Rabbit—deliberately pelting a blackberry into Tom’s mouth with a slingshot. Tom goes into anaphylactic shock, before stabbing himself with an EpiPen and then collapsing.

What do we make of that? I suppose we could argue that it shows that allergies can be dangerous, but I would take the view that for a popular children’s character to be light-heartedly encouraging behaviour that threatens the life of someone else, who is at risk of anaphylaxis, is unacceptable. Imagine that there was a scenario in which Peter Rabbit decided to start throwing knives at someone. We would not think that was acceptable viewing for young children in the cinema. What message does this send to children about how we treat people who have allergies and anaphylaxis? What message is going to be taken by the children who go to see that film and who have an allergy?

Apparently, Sony recognises that food allergies are a serious issue and that its film

“should not have made light”

of Peter Rabbit’s arch-nemesis being allergic to blackberries,

“even in a cartoonish…way.”

However, it is that cartoonish, slapstick portrayal that is the problem—it trivialises allergies in that way. I have written to Sony to request that in addition to that apology, that scene should be cut from the film when it is released. I think it has done that in one country. I hope that the Minister will add his voice to that request, because the truth is that children suffering from allergies experience that kind of onslaught in school.

Allergy bullying is a real problem. According to a recent study, more than a third of children and teens with food allergies have been bullied specifically because of their food allergies, usually by classmates. Sometimes that includes physical threats with foods. The consequences can be fatal. Last year, Karan Cheema, a 13-year old boy, died from a severe allergic reaction to cheese. Reports say that he was being bullied and that classmates might have flicked cheese at him or rubbed cheese on his neck. That sort of allergy bullying happens all the time. Only this weekend I saw a tweet from another worried parent whose son, aged nine, was confronted by an 11-year old threatening to throw a Snickers bar in his mouth. Two years previously, the same boy had threatened to throw peanuts at that little boy during a football session. We see more stories of allergy bullying in schools. It is far too much of a problem, and it needs to be addressed.

Schools have an important role to play in raising awareness. The spare EpiPens in schools project is positive, but more needs to be done through first aid training, health and safety training and raising awareness in schools of food allergy, and, indeed, other allergies. I hope that the Minister can give us more details about how his Department can help schools to get this right, so that children who have allergies and their classmates, are well-equipped to deal with these issues, and so that children do not feel ostracised or are bullied because they have this particular health condition.

Excellent work has been done by organisations such as Allergy UK and the Anaphylaxis Campaign, to look at how schools can improve the work that they do. Allergy UK has produced the school allergy action group toolkit, to help with awareness policies. Those efforts are to be commended. I hope that the Minister agrees with that.

In conclusion, changing people’s attitudes is never easy. It requires persistence and an holistic approach across Government. We face considerable challenges in altering perceptions of allergy in the media, in the school playground, in restaurants and right across society. Incorporating allergy and anaphylaxis awareness into first aid training as part of a new-look personal, social and health and economic education would be an excellent start. Training on these issues within teacher training would also be helpful. I hope that the Minister will enlighten us further on what he and his colleagues in other Departments can do to improve this issue.

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I congratulate the hon. Member for East Dunbartonshire (Jo Swinson) on securing this debate. I would like to thank everyone present for their contributions to this valuable discussion.

I have twins who are now 21, one of whom is asthmatic. The hon. Lady talked eloquently and passionately about her own experience, and having an anaphylactic fit is similar to an asthma attack. We also have a five-year-old. In her school, the teachers clearly do things properly. Last week at breakfast, she was planning to have her best friend over for a play date and she said, “Daddy, my friend’s got a dairy allergy, so we have to make sure we’ve got the right food at home.” That brought home to me how complex it is, thinking about what food to give a five-year-old, to avoid what sadly happened to Karan in Ealing.

The hon. Lady spoke passionately about how the media handle this stuff. Yes, Sony has apologised, but I have looked at some of the comments linked to those media stories with people saying, “What’s the big deal? This is just a cartoon—a CGI movie. Get a life!” Actually, it is about life. Sometimes we have to step back for a second and not be so selfish as to think that everybody without an allergy has the right to everything, while people with allergies should be excluded.

The hon. Lady spoke about transport. British Airways no longer provides nuts on its flights, which I think is the right thing to do. I do not have a nut allergy—I love eating nuts—but I am in no way concerned that it has taken them off the menu. Think about the number of flights, children and holidays—that is a better way of doing things, and it provides lots of other nutritious and good food.

In the short time that I have been in post as Minister for Children and Families, I have been truly inspired by the commitment shown, at all levels in the school sector, to children from a wide range of backgrounds and with a wide range of needs. I have visited early years providers and local authorities and seen the exemplary work that many of them are undertaking to support some of our most vulnerable children and members of society. Colleagues mentioned the inspection regime. Under its inspection framework, Ofsted requires inspectors to pay particular attention to children with allergies and to gather evidence about pupil welfare and how well needs are met by individual schools, and it will evaluate the experience of particular individuals and groups, including those with medical needs.

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At the moment it is completely voluntary for schools to hold an EpiPen. Will the Minister look into ensuring that all schools have such devices?

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Currently, governing boards have an obligation to put forward a clear strategy for what a school is doing for children with allergies. My understanding is that they have to have two EpiPens, not one—one and a spare—but I will hold a roundtable to look at what more we can do to ensure that happens in every school.[Official Report, 18 April 2018, Vol. 639, c. 1MC.]

Our vision is that every child, no matter what their background or ability, should play an active part in their school community. The hon. Member for East Dunbartonshire mentioned that just because a child happens to have an allergy, they should not feel excluded from a trip, visit or any other activity at school. We want all children to reach their full potential and to receive the right support to succeed in their education and as they move into adult life. We recognise the importance of supporting pupils with medical conditions at school, and I share her concerns about instances of poor practice that have the potential to place pupils at risk.

With regards to statutory duty, in the Children and Families Act 2014 we introduced a duty on governing boards of schools in England to make arrangements to support pupils with medical conditions. That is a clear signal to schools that supporting pupils with medical conditions is important. I hope that through the roundtable we can see how to improve that further.

The guidance is based on existing best practice and sets clear expectations on schools. It covers a range of areas, including the preparation and implementation of school policies for supporting pupils with medical conditions and the use of individual care plans. It also covers staff training, medicines administration, consulting with parents and collaborative working with healthcare professionals.

The Government understand that food allergies can be complex and worrying for parents. That is why we have set out minimum standards for school food through legislation, with the latest school food standards coming into force in January 2015. We expect headteachers, school governors and their caterers to make effective decisions about their school food policies that take into account the needs of all their pupils.

I want to address an issue that has not come up in the debate but is equally important. Schools have a legal requirement to offer free school meals to all pupils in reception, year 1 or year 2 whose parents want them, and we expect them to make every effort to ensure that pupils with allergies are able to benefit from that entitlement. In all but exceptional circumstances, schools and their caterers are expected to take into account factors such as the type of diet required by the child with allergies, the number of children in a similar position and the cost of making suitable foods.

Like many colleagues, I was shocked and horrified to hear about Karan, who sadly passed away. The case is under investigation, so it is difficult for me to say too much about it. However, it is important to remember that this case could have been bullying. The hon. Lady was right to condemn the messaging to young people that it is okay to tease other children over their allergies and that it is a bit of harmless fun. That is completely wrong.

In conclusion, I am grateful to the hon. Lady for highlighting this issue this afternoon. We have much to be proud of in how we have moved forward to address the medical conditions of pupils in schools, but I recognise that there may be much more that we can do. I have arranged a roundtable with the Health Conditions in Schools Alliance to discuss in detail the issues that it feels still need to be addressed, to ensure that every young person has the best opportunity to reach their full potential. I am open-minded about what will hopefully be put in front of me. I will take my learning from this debate to that roundtable and ensure that we consider the issue of allergies in the round, alongside those of other medical conditions in schools. I feel incredibly privileged to have been placed in this role. I am aware that the system often seems to be stacked against those who need more help, and I want to make sure that all vulnerable children have the support to achieve in school and to progress successfully into adulthood.

Question put and agreed to.