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
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