Examination of Witnesses (Questions 60
THURSDAY 17 JUNE 2004
Q60 Mr Amess: I just feel it is hilarious
really. If we concentrate our minds on hay fever, as soon as Wimbledon
is on everyone gets hay fever. There is a new product being pushed
and you go to the GP and whatever is there he will shove at you,
they give you steroids, etcetera. In the really serious cases,
you have to go obviously to the hospitals, but how can this happen
fairly quickly and easily when the hospitals are being asked to
do so much now and we are trying to produce a report with recommendations
which we could challenge ministers to act up but to do it fairly
quickly? How can it happen?
Dr Nasser: I think you are looking
for a quick fix to something that has been creeping upon us for
the last ten to 20 years. Sometimes the quick fix is not the best
way forward. We have been suffering for quite a long time, the
patients have been suffering for quite a long time, it is important
to get it right. If you go for a quick fix, you end up with something
that is not of the best quality. It is important, as some of my
colleagues here have said, that we improve education. It has to
start from the beginning. It is important that we have good allergy
centres throughout the country. It takes five years to train a
registrar in allergy. This is post-qualification. It is important
that we train up a substantial number of them and then be able
to tell them, "Look, we will then have consultant posts in
each region of the country, to have allergy centres in each region
of the country." This can happen. We should have specialist
paediatric allergists who can be trained in two or three years.
Once we have this network of specialist doctors in allergy, then
everything else falls into place, and the education for general
practitioners, for nurses will then fall into place. You mentioned
that there is not a bottomless pit. This is not expensive. This
is not going to cost an enormous amount of money.
Q61 Mr Amess: Really?
Dr Nasser: Absolutely, and with
the increased efficiency this may hardly cost anything at all.
Seeing four or five doctors for your allergy problem is an extremely
inefficient way of practising. If you have to go to see an ENT
surgeon, who could be operating instead, and he then talks to
you about your hay fever, that is not an efficient use of resources.
He then has to refer you on to a different specialist, a dermatologist,
to a chest physician, to a paediatrician. That is inefficient.
It is far better to have one doctor who can sort out the majority
of your problems. This is not going to cost a lot of money.
Q62 Mr Amess: Is it not going to
cost a lot of money, administering all these drugs?
Dr Nasser: If you think of the
economic benefit, if you think of the number of drugs that they
no longer have to take once desensitised . Once a drug allergy
has been properly identified the number of mishaps that are then
avoided, the reduced number of emergency visits to hospitals,
the reduced number of admissions to hospitals, all of this will
probably be funded very easily by the improved efficiency. I have
got absolutely no doubt about it.
Q63 Dr Taylor: Can I pick up the
point about undergraduate training. We have heard that it is pretty
inadequate. Is it better in places like Liverpool, Cambridge and
London, where they have got allergy clinics, or are there good
examples of undergraduate training elsewhere? Is that a fair question
Dr Nasser: It is probably not
a fair question to ask me, because I only know about Cambridge.
It probably is a little better in Cambridge, but it could be even
better, but I cannot speak for the other centres.
Q64 John Austin: In your evidence
you have read a number of case studies of people who have actually
got to Addenbrooks in the end, but one you have highlighted, a
78-year old lady who has been erroneously on steroids for 20 years
because of a bad diagnosis, or whatever . . . We recognise that.
Has this paucity of provision in terms of specialist allergy services,
too few services available and long waits, caused many, many people
with allergies to go into the independent sector and many to try
alternative and complementary therapies? I was quite surprised
when I went to see my chiropractor about my spinal problems that
it says that chiropractic could be successful for people with
hay fever. That was not something I was aware of, but I would
like to know from your point of view as a clinician and the point
of view from the patient perspective how the independent sector
has fared and whether you put any improvements on complementary
and alternative therapies?
Dr Nasser: I think it is important
that any practice that we support and administer in the National
Health Service is evidence-based. I am not against alternative
treatments, and I think that patients should have a choice, but
they should not have a choice between nothing and alternative,
complementary medicine; they should have a choice between coming
to see a specialist allergist, who will give them the choice to
have something that is evidence-based and, on the whole, pretty
effective, and if they then do not want that, then I am perfectly
happy for them to go elsewhere, but right now they do not have
a choice and that is why the private sector is doing so well,
and that is not the way the National Health Service should be
Mrs Simmons: We believe that people
should have a choice. I agree with Dr Nasser that it is very often
because people cannot get a referral to see a proper specialist
that they end up in the hands of some practices that worry us
enormously. We have more than one case where people have lost
their life-savings and have been told to sell their homes. That
is very, very worrying. I think that the private sector has a
lot that it can offer and I think it would be good if it could
work hand in hand, but we have to accept that, unfortunately,
the growth in allergy has been very, very good news for some bad
companies' bank balances.
Chairman: Any further questions? Can
I thank the three of you for a very interesting session; we are
most grateful to you. If there are issues following this session
that you feel you want to write into us about, add to any evidence
or pick up some points that were raised, please feel to get back
to us. If you want to remain for the rest of the session, we will
be pleased to have you. Thank you very much.