Select Committee on Health Minutes of Evidence

Memorandum by Dr Shuaib Nasser (AL 72)

  I am an accredited consultant allergist and respiratory physician and work full time at Addenbrooke's Hospital in Cambridge in one of only six specialist allergy clinics in the UK. This Select Committee's inquiry is timely and I welcome the opportunity to give evidence. It is important that Committee listens most closely to the patients who are in need of good quality allergy treatment that is difficult to access in the UK.

  The NHS has been wrong-footed by the unexpected allergy epidemic. Current provision of allergy services are patchy and inadequate and in the main provided by doctors with only limited allergy training. Many are struggling to keep pace with the ever-increasing numbers of referrals, often to the detriment of their own services. Most do not the have the facilities or experience to investigate complex multi-system disorders outside their own focussed area. For example, there are only a handful of hospitals able to investigate drug allergy. Today's NHS must acknowledge that numbers of patients with allergy are not only increasing at an alarming rate but have also become more complex with more severe and often life-threatening conditions. These inefficient practices are likely to lead to longer waiting lists for ENT operations, dermatology out-patients, chest clinic appointments etc. Furthermore, the next 5-10 years will see the advent of new and expensive bioengineered pharmaceutical agents capable of remarkable health benefits in targeted individuals with allergy. Without an extensive network of trained specialist allergists in each region with the ability to identify the subset of patients to benefit, it is likely that the NHS budget will further spiral out of control.

  Many of the patients I see in clinic have been told that there aren't any allergy clinics and they have to cope with their symptoms. Others are told that there is little point in being referred as "nothing can be done anyway" or that the "tests are too dangerous". Persistent patients may eventually be referred to organ-based specialist such as ENT surgeons for rhinitis, dermatologists for eczema and urticaria and respiratory physicians if their predominant symptoms are asthma. They may be given advice on the management of one of their symptoms but it is rare for allergy tests to be carried out or an attempt made to find the underlying cause. It is not often appreciated that treatment of rhinitis in certain types of asthma is mandatory in order to improve asthma control. Children with asthma die because of an allergy to a pet but this is never discovered. A chest physician may then refer the patient on to an ENT surgeon for rhinitis or to a dermatologist if the patient has urticaria. This method of treating interrelated and often interdependent conditions is clearly inefficient but also bad medicine. It fails to recognise that one symptom may be improved by treating another and that in a particular patient all allergic symptoms may have a common cause. One often hears a sigh of relief from a patient eventually seen in an allergy clinic and their allergy disease diagnosed, explained and managed. This is not the NHS that our patients expect or deserve and is frustrating for health professionals who see well-developed allergy services in other parts of Europe.

  I sincerely hope that the Health Select Committee consider recommending the following:

       1.  Improve training from Medical Schools upwards in order to improve allergy services especially in Primary Care.

       2.  Immediate central funding for substantial numbers of Specialist Registrar training posts in Allergy.

       3.  Guarantee to centrally fund new consultant posts in Allergy starting when the specialist registrars have completed their training.

  Finally, 12 of our patients were contacted by telephone by an experienced lay colleague and selected in order to illustrate the range of disorders dealt with by an allergy clinic. On the following pages, brief summaries are presented together with a synopsis of the telephone interview and a comment at the end of each case. The overriding message is that allergic disorders affect everyday lives and must be taken seriously. Patients often spend years attending inappropriate clinics before they find a specialist allergy clinic and may then have to travel great distances. A modern, vibrant and thriving NHS cannot be seen to offer good medical care to the determined few.

3 June 2004

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