Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 60 - 64)



  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 to ask?

  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 run.

  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.

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