A crisis in allergy?
29. In a Westminster Hall debate on NHS allergy services
in October 2003, the Public Health Minister, Melanie Johnson MP,
acknowledged that these services "needed improvement"
and that "we are starting from a very low base indeed".
According to a survey cited by the Royal College of Paediatrics
and Child Health, more than 80% of GPs thought that NHS hospital-based
allergy services were "of poor quality".
30. Numerous memoranda attested to serious deficiencies
in the current service. Professor Stephen Durham, a consultant
in allergy and respiratory medicine at the Royal Brompton Hospital,
described allergy services as "grossly inadequate in the
face of this serious public health problem that affects around
30% of the UK population".
For Professor Adnan Custovic and Dr Andrew Bentley of the North
West Lung Centre the current lack of any specialist service in
their area was "highly unsatisfactory".
Dr Chris Corrigan, a reader and consultant in respiratory medicine
and allergy at Guy's, King's, and St Thomas' suggested that the
"availability, geographical distribution and access times
for NHS allergy services" were "woefully poor countrywide".
The BSACI/NASG joint submission used the word "vestigial"
to describe allergy services.
Dr Gideon Lack said that the sharp growth in allergy in the population,
coupled with enormous pressures on scant services, constituted
a "national catastrophe".
The RCP described allergy services as "totally inadequate",
contending that NHS services could not cope with the rising amount
and severity of allergy.
Dr Nasser, in written evidence, suggested that the NHS had been
"wrong footed" by the epidemic. Patients were only rarely
tested for allergy and many were told that there were no allergy
clinics and that they would simply have to "cope with their
Andrew Wardlaw, President of the BSACI, summed up the view of
the great majority of health professionals giving evidence when
he told us:
For a disease which is one of the commonest diseases
in the UK, which
causes so much morbidity and a certain
amount of mortality, the service is utterly derisory, and if you
compare it, there are something like 26 full-time allergists in
the UK, and really we should be able to have the same as chest
physicians and dermatologists, where there are 500. Quite honestly
I think it is a disgrace.
31. The general picture of provision reflected in
our evidence from a wide range of health professionals, points
to a service which is under-resourced and overstretched, one where
the basis for improvement and growth only exists in a limited
number of locations across the country, and in which specialist
care is provided largely by consultants in other clinical specialties
developing an interest in allergy to cover the gap. This account
was reinforced by the correspondence we received from patients
and the evidence of the allergy charities. We were told in graphic
detail of the many problems experienced by those seeking help
from the services, which were caused by a lack of provision for
allergy and a lack of understanding of the clinical need, including
access restrictions, withdrawal of services, inequality of service
provision by location, people being driven into unregulated assessments
and service use, poor and inappropriate diagnoses being given
and inadequate treatment and advice for patients.
32. When the RCP assessed allergy services, in Allergy:
the unmet need, published in 2003, it found strong evidence
of deficiencies in the delivery of care in the primary care sector,
and a lack of specialist care in the secondary and tertiary sectors.
Specialist care was completely absent in large parts of the country.
The RCP also found a dearth of both training places for new consultants
and of funded posts for any who were trained. It was their considered
judgement that the best starting point for meeting the growing
need for allergy services was to establish specialist centres
of excellence in each region; use these to act as a focus and
point for training primary care; and train a whole generation
of specialist allergists for whom posts should be created to give
allergy equivalent status to other specialties.
33. In this report, we analyse the evidence we have
received to see how convincing the arguments are for a major reorientation
within the NHS to create a high-quality allergy service. In chapter
2 we assess the quality of allergy services in primary, secondary
and tertiary care and in the independent sector. In chapter 3
we look at the capacity of the NHS to deliver services. We turn
in chapter 4 to possible levers for change to address the problems