Emergency Adrenaline

Question

Asked by

To ask His Majesty’s Government what assessment they have made of community access to emergency adrenaline following the authorisation of needle-free delivery methods.

My Lords, the Government welcome the approval of needle-free adrenaline delivery methods in July. The medicines regulator, the MHRA, recommended consideration of changes to legislation to allow the supply of and access to such methods of emergency adrenaline delivery, particularly in schools. The Government are currently considering that recommendation, as well as any changes to regulations that may be required. The Government may assess community access to emergency adrenaline as part of any legislative changes.

My Lords, as the mother of a severely allergic needle-phobic 17 year-old, the authorisation of needle-free adrenaline devices such as Neffy is a potentially transformative development. These products offer families vital peace of mind by enabling life-saving treatment without needles. The Natasha Allergy Research Foundation, for which I am a parliamentary ambassador, is urging better access to such treatments, but Neffy is currently available only privately. Could my noble friend the Minister confirm when it will be accessible on the NHS and whether wider rollout could improve adrenaline availability in public settings?

I very much understand my noble friend’s personal involvement in this area. I congratulate her on her work in promoting the availability of needle-free delivery of adrenaline, and I too welcome its approval. It is down to local area prescribing committees to provide advice to integrated care systems on whether to include new products such as nasal adrenaline and whether they should be included in local formularies. This takes into account available evidence, as well as any relevant guidance. Following this Question from my noble friend, I will seek a view from NICE as to whether it is considering developing guidance in this area, as I know she would find that helpful.

My Lords, it has been four years since the Commission on Human Medicines first examined widening public access to adrenaline auto-injectors. It is an excellent initiative, but it requires national co-ordination. What progress have the Government made in establishing a national lead for allergy—which some refer to as an allergy tsar—given their previous support for the idea?

We have been focusing our efforts, as I said, on whether changes to the law are required to allow wider access to, for example, adrenaline nasal sprays, which are a welcome development. Our focus is on that, rather than on the appointment of a tsar, to which the noble Earl referred. We will be establishing national clinical directors, and I am sure that this will be considered in that regard.

My Lords, with the disaster of poorly managed allergy, only 24 ICBs have been able to state the extent to which they have services, and none are able to state whether they have a specialist nurse and dietician. Will the Government use the opportunity of the single patient record to provide guidance to ICBs for commissioning, to make sure that those who have serious allergies, such as we have heard about, can get the advice and support they need and be guided to the most appropriate way to manage their allergy in the immediate emergency and in the long term?

I certainly agree with the noble Baroness that the single patient record gives us all sorts of absolutely key opportunities, including in this regard. It is important that we note how common allergies are—they affect nearly one-third of the UK population. Although in most people allergic reactions can be mild to moderate, in some cases they are severe. We need to cut that risk and, in particular, tackle the approximately 50 suspected cases of deaths each year that we currently have. I agree with her contention.

My Lords, following on from the previous question, new delivery methods are welcome but we need a workforce to implement them. As the noble Baroness said, it is concerning that not a single integrated care board currently holds the information on whether it has specialist allergy nurses employed in its area. How can the Government ensure that patients have access to these new treatments when local commissioners are failing to track, co-ordinate or prioritise the specialist skills needed to deliver them?

This is an important part of the availability, as the noble Lord has highlighted. The kind of issues under consideration when we look at the availability of these welcome products include, in addition to their ease of use without specialist training in community settings and their use through proper training, suitability for different age groups and the temperature sensitivity of the products. Training will be part of how we look at developing the workforce plan, but I take the point about assessing what training is needed when we think about where they will be available. That is very much part of our consideration.

My Lords, based on the statistics the Minister just cited about the number of lives that would be saved if emergency adrenaline was easily available in the community, can she say what training would be required? If the drug is given inadvertently to a person who is not in anaphylactic shock, what will happen?

The noble Lord raises a point on the practical and safety concerns that we would need to consider in widening access to adrenaline in the community. I should add that that would be regardless of the administration method. On his point, and following on from the question from the noble Lord, Lord Scriven, it is essential that training ensures safe administration, whatever the formulation, because we do not want to create an unsafe environment. The training will be appropriate to what is needed. However, I must emphasise that we are in the process of considering this, but with a positive outlook and an intent to provide.

My Lords, to be helpful to the Minister, I know she will not be able to give an absolute commitment at the Dispatch Box, but with the Government’s 10-year health plan focusing on digital integration, will she commit to embedding a national allergy register within the single patient record, which would deal with many of the issues noble Lords have raised on this Question?

I know that the noble Lord always seeks to be helpful. That is indeed a helpful suggestion, which I will gladly take away, but I will not be able to give a commitment, as the noble Lord is aware.

My Lords, I was a little unhappy with the answer to the question from the noble Lord, Lord Patel. My understanding, having seen medical students being given injections of adrenaline during a physiology class to see what would happen—in larger doses than you would probably need in this case—is that they might feel a bit faint. I would have thought that giving a non-injection method is even safer and that the likelihood of side-effects is much lower. Is that not fair?

I am sure that is fair and I certainly bow to my noble friend’s expertise in this regard. I thank him for that, and I thank the noble Lord, Lord Patel, for his question. However, I feel a little inadequate on the medical front here.