Allergy care must not be left to the NHS postcode lottery
3 min read
The Health Bill, currently being scrutinised in the House of Lords, would allow ministers to determine which specialised services are commissioned nationally and which fall to Integrated Care Boards (ICBs).
But with serious gaps in specialist allergy provision across England, any further transfer of commissioning responsibility risks worsening an already unacceptable postcode lottery.
This should give the Government pause for thought. Transferring further responsibility to ICBs without first establishing whether they have the expertise and capacity to commission adequate allergy services would be a serious mistake, potentially putting patients at risk.
This is why I have put forward my amendment to the Health Bill. It would require an assessment of the adequacy and geographical distribution of specialist allergy services, an evaluation of ICBs’ commissioning capacity, and consultation with clinicians, patients and organisations representing people affected by allergic disease.
This is by no means an attempt to obstruct NHS reform or undermine local decision-making. It is a safeguard to ensure that any reform improves patient care rather than entrenching existing inequalities, especially in something as important as allergy care.
Unfortunately, allergy is too often treated as a minor condition, one that patients can manage themselves. The reality is very different.
More than 20 million people in the UK live with some form of allergy, including around 40 per cent of children. In England alone, there are around 25,000 hospital admissions a year on average due to allergy complications, and for some it can be fatal. Hospital visits from anaphylaxis trebled between 1998 and 2018, whilst food allergy diagnoses doubled in the decade to 2018.
For many allergy sufferers, effective care requires more than an appointment with a GP. Patients may require specialist assessment, diagnostic testing and coordinated care across primary, community and secondary services. As allergy often overlaps with asthma, eczema and other conditions, complex cases need multidisciplinary expertise and clear referral pathways.
Yet specialist provision is unevenly distributed across England, with significant gaps outside London. Where local services are absent, patients can face longer referral pathways, additional travel and inconsistent access to treatment. Across the UK, there are only around 50 consultant adult allergists.
The National Allergy Strategy, published in April 2026, sets out an ambition for equitable access to high-quality, lifelong allergy care. It follows decades of warnings about shortages of specialists and inadequate allergy training across the wider health workforce.
Ministers may argue that ICBs understand local needs best, but local autonomy means little without the expertise, workforce and infrastructure to deliver care. Specialist allergy services often cross ICB boundaries, requiring regional provision and clear referral pathways. Local commissioning cannot solve national workforce shortages.
You cannot devolve specialist capacity that does not exist.
My amendment does not dictate commissioning models or mandate new clinics. It simply requires the Government to assess specialist capacity, geographical inequalities and ICBs’ readiness to commission, informed by clinicians and patients, before transferring responsibility for allergy services.
If ministers are confident the system is ready, the assessment required by this amendment should present no difficulty. If important information about service provision or commissioning capacity is missing, that is all the more reason to establish it before proceeding.
NHS reform should be measured by whether it delivers better outcomes and fairer access, not simply by whether responsibilities have been transferred.
People living with allergic disease deserve high-quality care wherever they live. Parliament has an opportunity to ensure that changes to commissioning support the National Allergy Strategy’s ambition rather than undermine it.
We should not entrench an existing postcode lottery in NHS commissioning structures. Before any further responsibility for allergy services is transferred, the Government must demonstrate that ICBs have the capacity, expertise and support to commission the care patients need.
