Examination of Witnesses (Questions 120
- 127)
THURSDAY 17 JUNE 2004
PROFESSOR STEPHEN
HOLGATE, PROFESSOR
ANDREW WARDLAW,
PROFESSOR JOHN
WARNER AND
DR LAWRENCE
YOULTEN
Q120 Mr Amess: I think you have answered
my second point, but I will still ask it, and, you will be pleased
to know, gentlemen, when it comes to the evidence session with
a minister or ministers, we will be able to put those points directly
to test the robustness or otherwise. Primary care trusts are really
still in an embryonic state and they are being asked to do a great
deal, but it does seem to be the case that there is not enough
understanding or knowledge of allergies generally. The Cancer
plan, introduced into the NHS to meet national improvements in
cancer care, has been funded centrally. What are your comments
on that?
Professor Holgate:
Yes, and it is very successful. We are looking for a much smaller
version of that. Allergy is a discipline that would lend itself
very nicely to the GPSI system and specialists within groups of
general practices that could concentrate effort and involve some
nurses working in primary care, but, as we keep saying, we need
to train these people. As a speciality we would very much like
to train these people and we are doing our best to do it but,
at the moment, GPSIs and allergy are not a priority. We have GPSIs
in diabetes, and in other areas. So one step government could
take is to recognise this as an area that they might be able to
support allergy specialists in the secondary care sector.
Professor Warner:
If I may say, there is no lack of interest from GPs in this. We
now run a full allergy MSc in Southampton, and the highest number
of people who are applying to go on that MSc are GPs. So there
is enormous enthusiasm there. They recognise that there is a need
to improve their skills; the problem is when they go back to their
PCTs again there is no priority for allergy, and they just have
to attend to doing the general work and cannot necessarily even
indulge in the extra skills that they have gained from doing an
MSc.
Q121 Mr Amess: So Members of Parliament
need to ask their primary care trusts what they are doing on this
particular issue?
Professor Warner:
Yes.
Professor Wardlaw:
We have asked them, and the answer is they are doing nothing.
Q122 Mr Amess: What did you say,
seven out of 20; is that right?
Professor Wardlaw:
I think 30 MPs have written and I think twelve got replies, and
all twelve had a variety of responses—it is in my evidence—but
they are either complacent or ignorant.
Mr Amess: There are 659
of us, not 30! This is a tiny sample. I was not one of the 30
asked!
Q123 Chairman: I suspect that the
patient groups that were here earlier giving evidence will be
writing to their 659 MPs! Professor Holgate, you have referred
to some of the things which need to be done which are in the Royal
College of Physicians' recommendations. A number of recommendations
have been made to the Department. We, of course, will be seeing
the Minister. Perhaps you could tell us what response you have
had from the Department to those recommendations?
Professor Holgate:
We sent a letter to Dr Ladyman which outlined our plan, which
was really a recapitulation of what is in the RCP Allergy: the
unmet need report, but translates it into what we can do over
the next year or so, as opposed to trying to look at the longer
term. As yet, we have not received a reply from that. You have
a copy of the letter we wrote as evidence, I think, there.
Q124 Dr Taylor: Is that the one of
17 May?
Professor Holgate:
Correct. We are awaiting a reply that gives our view of making
a start over the next twelve to eighteen months.
Q125 Chairman: Perhaps we may be
get a reply before you do when we see the Minister. I wonder if
any of my colleagues have any other questions or whether there
is anything you would like to add?
Professor Warner:
There were some questions you asked earlier on about schools and
issues that relate to that. Clearly, there should be a sort of
net-working which involves all the agencies that are caring for
individuals, whether that be adults or children, and if there
is a clinic established, an allergy clinic established, then it
is possible to train school nurses, to provide the training for
the schools to be able to handle the problems effectively. We
do it in Southampton. We have a special group that regularly trains
all the school nurses and gives them the materials to go and cascade
the information around schools, and it has been very successful.
In fact, we have even done a research programme to look at the
outcomes in relation to asthma, and it really has been effective
in improving care considerably, and the papers are about to be
published on that. So it is possible that you have to have the
core of the service there to start off with to deliver it. There
is some recommendation coming out within the national service
framework for children and the medicines component of that. I
sort of insinuated myself onto that group in order to make sure
that there was some recommendation about the way in which medications
for allergic disease were handled in schools. So that will be
included in the recommendations.
Q126 Chairman: At the end of the
day, it is going to be teachers, classroom assistants and others
who will be in the front line?
Professor Warner:
Yes; but there is a problem of indemnity for those people, and
also their job descriptions; and there are many teachers who are
recommended by their unions not to take responsibility because
they are not covered.
Q127 Chairman: The reason for my
question earlier on is that it is six or seven years ago now that
we did our report on children's health but that there was a real
problem there?
Professor Warner:
There is still one. There is no lack of willingness, again, but
they need to have some kind of structure that allows them to be
able to do it. The concept within the medicines group of the children's
NSF is that newly appointed staff should be offered contracts
which include a component of delivering medications, for instance.
Obviously, those people would have to have appropriate training,
but it would be a perfectly reasonable way of ensuring that that
was effectively delivered in schools.
Chairman: Could I thank
all of our witnesses, both yourselves and the earlier group, for
attending.
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