Examination of Witnesses (Questions 160
- 179)
THURSDAY 1 JULY 2004
RT HON
DR STEPHEN
LADYMAN MP AND
MRS PATIENCE
WILSON
Q160 Dr Naysmith: Since you have
read the evidence that was given to the Committee previously,
you know that there are people who disagree with that?
Dr Ladyman: Absolutely, and that
is what I have said; I started off by saying that there is not
a consensus on this.
Q161 Dr Naysmith: You are not accepting
that model?
Dr Ladyman: No. The only point
I was trying to make to you as a Committee was that the people
who you see are part of a consensus, but they are not part of
a wider consensus, and some of the people who have given you written
evidence have given contrary viewpoints, and they are possibly
equally valid.
Q162 Dr Naysmith: Can we agree on
roughly three million? I know we have been arguing about figures
for about 20 minutes or so, but three million is a rough estimate
of severe allergy?
Dr Ladyman: Yes. I am happy to
accept the figures that are in the Royal College's report as probably
the best.
Q163 Dr Naysmith: So they need specialist
care of one sort of another, whether it is in a clinical allergy
centre or not?
Dr Ladyman: Yes.
Q164 Dr Naysmith: At this point I
want to read out two or three statements that were made in the
Westminster Hall. Melanie Johnson said in October 2003, "We
agree NHS allergy services need improvement," and that the
Department had taken the provision of these services very seriously
indeed; that they were starting from a low base and had some way
to go. That was in October, recognising that there was a problem.
So what has happened since? There was recognition there was a
problem, and has anything been done to improve that?
Dr Ladyman: I think what she was
suggesting was that clearly this is a growing problem; it has,
as has been identified, become increasingly severe and the NHS
needs to keep pace with both the change in medical knowledge and
the change in prevalence of the condition, and that is what we
are attempting to do. The sorts of things that we are doing, for
example, we are talking to the National Institute for Clinical
Excellence as to whether there are any pieces of work that they
ought to be doing to help us, and one of the things we need to
be chatting to them about is the possibility that they may provide
a guide about anaphylaxis, for example. So we are talking to them
about what needs to be done. We are talking to the Food Standards
Agency about the work that they can help us with. We have the
National Health Service Improvement Agency working on these issues.
We have the Health Care Commission starting to inspect. We have
the new Standards for Healthcare, which are being published—the
Core Standards are going to be published shortly. We have the
National Service Framework for Long-Term Conditions, which comes
out at the end of the year, which focuses on neurological conditions,
but is being written in such a way as to provide a lot of help
for people with other chronic conditions. We have the announcements
that the Secretary of State has made recently about chronic disease
management. We are moving forward on all those areas. We have
the Expert Patient Programme, where we are moving forward to try
and help people self-manage the condition. So we are working forward
on a whole raft of areas.
Q165 Dr Naysmith: I have to put this
question to you: that there is a lot of talking going on, there
is no doubt, from what you have said, and much discussion, but
is there any action taking place in setting things up?
Dr Ladyman: It is easy to say
that there is a lot of talking going on, but all of these things
emerge in action. When we produce the New Core Standards, for
example, then commissioners have to work with them and commission
services accordingly. The Royal College's blueprint document itself
has stimulated commissioners to look at the commissioning of local
services; that is why they wrote it, that is why we welcomed it.
The work that you are dong will stimulate commissioners to commission
new services and to check that they are actually meeting their
waiting times and that they are meeting the need that has been
identified. I think there is a lot going on on the ground. I do
not know if Mrs Wilson would like to add anything specific?
Mrs Wilson: I think there is quite
a lot set out in the NHS Improvement Plan, which is putting a
new emphasis on moving away from focusing on acute conditions
and tackling acute conditions to actually making real changes
for people who live with conditions that can affect them their
whole lives. That includes allergies, obviously, as well as eczema,
as well as some of the other conditions like the muscular-skeletal
disorders.
Q166 Dr Naysmith: We have been told
that there are some treatments that can, if not cure, make life
very much more bearable for people, so they do not necessarily
have to go on chronically, for the rest of their lives, seeing
a specialist.
Mrs Wilson: Is this about desensitisation?
Q167 Dr Naysmith: No, drug treatments
that are helpful. I am attacking a little you categorising them
as chronic diseases.
Dr Ladyman: Drug regimes we make
available to people, once it is identified that a drug can help.
I think it is £100 million a year we spend on drugs for people
with allergies.
Mrs Wilson: And we have done a
number of technology assessments around drugs in this area.
Q168 Dr Naysmith: I was not attacking
what you were saying, but perhaps pigeon holing chronic disease
sufferers for the rest of their lives.
Dr Ladyman: Where the disease
is treatable it will be treated.
Q169 Dr Naysmith: They are almost
curable, some of them.
Dr Ladyman: One would hope so.
Q170 Dr Naysmith: I am not a great
one for desensitisation therapy, personally.
Dr Ladyman: I decided not to go
through it, as well!
Q171 Dr Naysmith: One last question
in this area. You have suggested that you do not accept this idea
of referring people on to clinical allergy centres for everyone,
and yet this is something that has been a successful model in
the National Health Service, and is recommended for cancer services.
Dr Ladyman: What I am saying is
that care for individuals needs to be tailored for the needs of
that individual, and for some people it will be the right solution
to send them to such a specialist, and we certainly need a number
of such specialists and specialist centres to deal with this increasing
problem. All I am saying is that there are alternative routes
and it is for clinicians to make decisions about which is the
most appropriate route for their patient.
Q172 Dr Naysmith: What I am saying
to you is that there was a time, not very long ago, when the results
in treating a number of cancers was not very good—below
the European average—and we deliberately set up cancer Tsars
and all sorts of things, and the results are improving dramatically.
There is a need which has been established for allergy services.
Could we help that problem by having something similar?
Dr Ladyman: I accept that entirely,
but the reason that by concentrating cancer treatment in specialist
centres they managed to improve outcomes was because they created
centres of excellence, where the doctors were able to share information
and were thereby able to remain at the forefront of technology
and the subject, and therefore guarantee people the best sort
of treatment. Some of the specialist centres in allergy are doing
exactly that, and that is why they are tying on the back of academic
institutions, because that is a very important place for them
to be in order to stay at the forefront. That does not mean to
say that the only place that you can be treated for cancer is
in the local centre of excellence. If I could pluck the example
out of my own area, the centre of excellence is in Maidstone,
but many of my constituents who have treatment will be treated
in the local hospital in Margate, even though the expertise is
being delivered from Maidstone. So it is no different from the
solution that you are talking about.
Q173 Dr Naysmith: There are still
places where the GPs have more specialists to whom they are going
to refer their patients, either Maidstone or Margate.
Dr Ladyman: That is the responsibility
then of commissioners in that area to ask themselves whether that
is acceptable and how they are going to commission that specialist
service in that area. I note the very clear indication in the
Royal College's blueprint that many of the specialist services
are in the south and southeast of England, and there is limited
geographical variation of them.
Q174 Chairman: Not in Yorkshire.
A population bigger than Wales and not one.
Dr Ladyman: Exactly, and that
must be something that local commissioners in those areas take
seriously.
Q175 Mr Amess: There seems to be
enormous disparity with the figures that have been submitted in
such a way, frankly, that it seems to make the whole situation
incredible. For instance, the number of referrals in the Department's
submission appeared to be very low. We are told over 2,000 written
GP referrals in the quarter, so that is 8,000 a year. Yet one
large allergy clinic alone might be receiving 2,000 to 3,000 referrals
a year. Analysis of the BSACI website indicates that altogether
something like 50,000 cases a year can be dealt with at the clinics.
These are huge disparities. So, Minister, are you confident that
the Department is serving you well with these figures? I am not
seeking to embarrass you but these are extraordinary disparities.
Dr Ladyman: As I said, in order
to get the total figure for people being referred as a result
of allergy we would have to do an analysis of the referrals to
dermatology clinics; we would have to do an analysis of the referrals
to respiratory lung disease specialists; we would have to do an
analysis of referrals to dieticians; as well as doing further
analysis on the immunology and allergy figures that we have given
you. We would then have to add up all of those numbers and then
we would be able to come to you and say, "Here is the totality
of people who have a specialist referral for allergy and here
is how long they have to wait." We simply do not have those
figures. What we have are the aggregated figures that show the
aggregated waiting times in those specialities, and we have the
figures that we have given you, which are the joint figures between
immunology and allergy. I will wait with interest as to what your
report says, and if you come to the conclusion that we need to
do more analysis of this data I will reflect on that, and if I
decide to do more analysis of this data I shall pray in aid your
report when I am standing at oral questions and you object to
the fact that I am collecting the data.
Q176 Mr Amess: Do you feel at the
moment that a more accurate collection of data is a waste of valuable
resources?
Dr Ladyman: I think that is certainly
something that we have to take very seriously.
Q177 Mr Amess: It does slightly cast
doubt on the method of recording these elements. I am a little
puzzled and, frankly, slightly worried about it all.
Dr Ladyman: I think you have hit
on an alternative route to getting this information that we may
need to reflect upon, that, maybe, without adding to the total
amount of data collected, there is a way in the future, given
this increasing problem, that we can clarify the existing collection
of data to be a bit more specific in this area, and therefore
not add to the total amount, but I am not in a position to give
you those figures now. It would not be a quick process, nor would
it give you figures in the future.
Q178 Mr Amess: It is something you
might look at?
Dr Ladyman: Absolutely, I am happy
to look at it, yes.
Q179 John Austin: I accept the answer
you have given to David and the very clear response you gave to
my question earlier, but the National Allergy Strategy Group wrote
to the Department in November of last year and have not had a
response. Perhaps you could find out why.
Dr Ladyman: Perhaps they should
have written to me!
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