Memorandum by University of Mancheser
(AL 1)
1. AUTHOR OF
THE MEMORANDUM
Peter David Arkwright works as the only Consultant
Paediatric Immunologist within the North West Region of England.
He is employed by both the University of Manchester (five half
days a week) and the Central Manchester and Manchester Children's
University Hospital NHS Trust (six half days a week) and helps
to provide a specialist service for the care of children with
severe or persistent eczema as well as severe and unusual allergies.
2. BURDEN OF
ALLERGY IN
CHILDREN
The Government Health Committee is obviously
aware of the extent and real increase in allergic diseases (eczema,
asthma, hay fever, specific allergies to foods, and other environmental
triggers) within the UK population over the last few decades.
The size of this health problem will not be reviewed in this memorandum.
3. SUMMARY
This memorandum covers the type and availability
of allergy services for children in the North West region, particularly
the supply of specialist services for children with severe allergies.
It also addresses the major factors that determine the demand
for these services. It does not address the paediatric services
for children with eczema, asthma and hay fever, which are currently
distributed amongst GPs and a variety of specialists including
general paediatricians, dermatologists, respiratory paediatricians
and paediatric otolaryngologists.
4. CURRENT SPECIALIST
PAEDIATRIC ALLERGY
SERVICES WITHIN
THE NORTHWEST
OF ENGLAND
There is one weekly specialist paediatric immunologist
led clinic for management of children with severe allergies in
the whole of the northwest region. It is based at St Mary's Hospital,
Manchester. The clinic is run on alternate weeks by Dr P D Arkwright,
a Consultant Paediatric Immunologist and Dr R Pumphrey, a Consultant
Adult Immunologist and an internationally recognised expert on
anaphylaxis, who has for 20 years collaborated with paediatricians
in providing this service but who has no formal training in paediatrics.
The clinic is supported by one specialist adult immunology nurse
with training in allergy but not paediatrics. With the present
staffing levels the service is unable to meet Government recommended
waiting time initiatives. Royal College of Paediatrics guidelines
recommend that children should be seen by doctors and nurses trained
in paediatrics and this clinic only partly meets this recommendation.
Booth Hall Children's Hospital, also within the Central Manchester
and Manchester Children's University NHS Trust, runs an oral food
challenge service for the region with a current capacity of assessing
one child per week. One specialist community paediatric allergy
nurse specialist covers training of teachers in schools within
the region. The NHS Trust presently does not have the financial
resources or impetus to expand this current service.
5. CURRENT NON-SPECIALIST
PAEDIATRIC ALLERGY
SERVICES WITHIN
THE NORTH-WEST
OF ENGLAND
Children with severe allergies are also seen
by paediatricians with an interest in paediatric allergy working
in a number of District General Hospitals in the region, including
Wythenshawe (1), Booth Hall Children's Hospital (2), Tameside
(1), Stepping Hill (1), Macclesfield (1), Leighton (1), Barrow
on Furness (1) and Billinge (1). Immunologist/Allergist assistance
is provided in some of these clinics by Dr Richard Pumphrey. None
of these paediatricians have recognised formal sub-specialist
paediatric training in paediatric immunology/allergy. Their expertise
is based on clinical experience over their career
6. FACTORS DETERMINING
DEMAND FOR
PAEDIATRIC ALLERGY
SERVICES
The demand for paediatric allergy services is
driven by two factors over and above the prevalence of allergic
diseases in the community: (1) public awareness and (2) public
knowledge of the management of allergy. Many allergies are mild
and management involves the common sense avoidance of the triggering
factor. In contrast, public awareness is often based on information
provided by patient/parent self-help groups and the media, groups
that are likely to highlight the more severe or even fatal allergic
reactions, which are rare. There is currently minimal specialist-lead
public education on the management of allergy. The result is a
high demand on the allergy service to provide basic as well as
more complex patient-by-patient/parent management of these diseases.
7. RECOMMENDATIONS
FOR ACTION
(1) SUPPLY: The currently available specialist
NHS service for the management of children with severe allergy
in the North West of England is negligible. Immediate expansion
of both medical and nursing personnel is required to provide adequate
care for children with this problem in the region. Development
of regional centres of excellence which have a critical mass of
staff and services is to be preferred to a small fragmented service
in many towns and cities. (2) DEMAND: A government funded paediatric
allergy/immunology specialist led national education programme
should be set up to provide the public with practical guide to
management of mild allergies. More than any other factor, this
is likely to be the most cost effective means of reducing an ever-increasing
demand on the current paediatric allergy services.
8. I am happy to provide oral evidence on
the topic of paediatric allergy within the UK if this were to
be required.
May 2004
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