Select Committee on Health Sixth Report



Allergies affect around 30% of the adult population and 40% of children. The prevalence, severity and complexity of allergy in the population is rapidly rising. Perhaps as many as one in 50 children in England are now allergic to nuts—almost a quarter of a million children. Anaphylaxis, which may be fatal, is now much more common.
We find serious problems exist in the current provision of allergy services. Those working in primary care lack the training, expertise and incentives to deliver services. We call for these deficiencies to be addressed. We recommend that a network of primary care allergy providers be created with a named lead for allergy in each Primary Care Trust. We ask for improved incentives for GPs to treat allergy and for better training. We recommend that a framework is developed to facilitate the introduction of allergy into the GPs with Special Interest programme, and for the Department of Health (the Department) to support this initiative. Without an adequate specialist service, primary healthcare professionals do not receive the necessary clinical training, nor are they supported when managing more complex cases within primary care. Further, they are not able to refer the most serious or complex allergy appropriately.
Many of the deficiencies in primary care are matched by weaknesses in secondary and tertiary care. Such secondary care for allergy as presently exists is largely performed by organ-based specialists, for example, dermatologists. There are only six full-time specialist allergy centres, with none at all north of Manchester or west of Bournemouth. The majority of funding for specialist services flows from academic sources rather than the NHS.
Current provision we describe as manifestly inequitable, and we endorse the proposal of the Royal College of Physicians that there should be a minimum of one specialist allergy centre in areas equivalent to each of the former NHS regions, serving populations of five to seven million, with a minimum staff of two adult and two paediatric allergy consultants (supported by paediatric nurse specialists); two full-time nurse specialists; and one half-time adult and one half-time paediatric dietician. While this specialist service is being developed we believe Strategic Health Authorities (SHAs) should co-ordinate provision to assess where unmet need is greatest. In the longer term we would like allergy to have a full specialist consultant workforce, as is the case in many other countries, and call for each major teaching hospital to have a consultant-led service. This is our key recommendation and will provide the specialist expertise and infrastructure, on which all other elements to develop a national allergy service within the NHS will depend.
We believe that the creation of a specialist allergy service nationwide will do much to improve the care of children with allergies, many of whom are being treated inappropriately in adult settings. Such a network, linked to a community paediatric team, will allow for better support for schools, but in the meantime we call for SHAs to ensure that community paediatricians liaise with major allergy centres for advice on management of children at risk in schools, and for schools and local education authorities to be guided by best practice protocols produced by Department for Education and Skills and the Anaphylaxis Campaign.

Much poor and even dangerous practice exists in the independent sector. We note that the remit of the Healthcare Commission currently extends only to those facilities providing medical treatment and call for it to be required to inspect organisations providing diagnostic services.
Dr Stephen Ladyman MP, the Minister with responsibility for allergy provision, disputed that there was clear evidence of unmet need. However, we find that the data on patient waiting times are flawed and call for the comprehensive introduction of the National Code to record allergy services. We also believe that the very absence of specialist services is contributing to the perception that there is not unmet need, as there can be no waiting lists for clinics that do not exist. Where specialist services become available they very soon come under considerable pressure even from the local population. Given the serious inequality of access to allergy specialist services we believe there would be merit in the National Specialist Commissioning Group treating the specialist allergy services as national services, eligible for specific NHS funding. We welcome the Minister's suggestion that he should ask the Chief Medical Officer to prepare an action plan to find ways of stimulating the commissioning of allergy services by PCTs, and we look forward to its publication, which we hope will take account of the conclusions of our report.
To provide allergy with a specialist workforce we recommend that training provision for adult allergy should be increased with an additional 10 posts in 2005 and a further 10 in 2006, with a similar number being provided for paediatric allergy. The Department will need to endorse and underwrite the creation of additional consultant posts for trainees to move into.
Finally, we call on the Department to issue a strategy document in response to our proposals and those contained in the Royal College of Physicians report Allergy: the unmet need (2003), to show that it takes seriously the growing problem of allergy, and to provide a catalyst for change.

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Prepared 2 November 2004