Select Committee on Health Written Evidence

Memorandum by Dr Gideon Lack (AL 32)

  1.  I am an NHS Consultant in Paediatric Allergy and Immunology at St Mary's Hospital, London where I lead the Paediatric Allergy Service. I am also Senior Lecturer at Imperial College London. I am writing to you regarding the lack of Paediatric Allergy Services in the UK. This is a subject that is very important to me. Our St Mary's Paediatric Allergy Service based at St Mary's Hospital in Paddington provides both a secondary service to local general practitioners and a tertiary service to paediatricians and other specialists nationwide.

  2.  I was appointed to the post of consultant in paediatric allergy nine years ago on the basis of perceived clinical need and the belief that this would be financed through GP fund-holding practices and ECR funding. This did indeed prove to be the case and we very rapidly built up three paediatric allergy clinics and over the course of two years demand was such that the waiting list for new appointments given was in excess of 12 months. At that point there clearly was a need to expand the allergy service but with new government NHS targets our long waiting list became a liability to the Trust. It was necessary to rapidly bring down our waiting lists. This was done through a series of allergy drives where extra clinics were set up to see more allergy patients. This temporarily decreased the waiting list but each time it climbed back up again. Given that many of our patients were highly complex and required follow up appointments our follow up waiting list is up to one year. This is completely unacceptable. Finally we have been forced to only accept GP referrals locally. If a GP from out of area refers to us an appropriate patient with complex allergies we cannot see that patient unless that patient is referred to us through a paediatrician. This creates a further unnecessary additional burden on the NHS in other areas.

  3.  It is clear that there are completely inadequate paediatric allergy services in the UK at the present time. With four specialist paediatric allergy centres in the UK, run in large part on academic rather than NHS funding, this is clearly an unacceptable situation. Our Trust has been extremely supportive, helping to organise allergy waiting list drives and employing paediatric allergy nurses. However, with allergy not being on the list of NHS priorities we have had no choice but to cut back on the referrals we see. I enumerate below points that are of specific concern.

  3.1  Paediatric allergy services are virtually non-existent in the UK in contrast with countries such as Sweden where there are 96 paediatric allergists for a far smaller population.

  3.2  Waiting list times for patients are unacceptable.

  3.3  Children are suffering the consequences of not seeing paediatric allergy specialists in three ways.

  3.3.1  Firstly they are denied proper diagnosis and care. These children are at risk of anaphylactic reactions (one in 50 children in the UK are allergic to peanut and similar numbers of children are allergic to tree nuts).

  3.3.2  Secondly these children suffer nutritional consequences in the absence of adequate nutritional advice. They exclude multiple foods and have compromised diets. We have seen children with rickets, growth failure, developmental disorders and severe psychological problems all because they failed to receive proper specialist advice at the right time.

  3.3.3  The third way in which these children suffer damage is that their parents are unwillingly forced into the hands of dangerous alternative practitioners who run private clinics where non-validated and often dangerous practices are used. I know of instances where patients have been morally blackmailed to receive expensive treatments that are potentially life threatening. The situation is analogous to the days when young pregnant women were forced into the hands of back-street abortion clinics.

  3.4  I have been seeing increasing numbers of children with life-threatening anaphylactic episodes where the child and family have never received proper advice for years.

  3.5  Children with allergies often have multiple symptoms affecting different organ systems. Instead of being taken care of by paediatric allergists they are sent to general paediatricians, gastro-enterologists, respiratory specialists, dermatologists and ENT specialists. This fragmentation of speciality care is detrimental to the patient, resulting in multiple NHS appointments and numerous days taken off work by the parents. This is an unnecessary waste of NHS services. A recent survey of A&E visits at St Mary's Hospital over one year showed that a least 6% were directly attributable to an acute allergic problem. Compared to children who presented to the A&E without an allergic diagnosis, those children who presented with allergic problems were admitted to hospital almost twice as frequently and were referred for outpatient paediatric subspecialty care or for GP follow-up twice as frequently. This clearly demonstrates how allergic problems are imposing a hidden burden on both acute and outpatient, hospital and community NHS services. An integrated approach to the care of these children is not taken and it is not unusual for these children to be receiving multiple steroid preparations through different routes without taking into account the overall medication that this places on the child and adverse health consequences.

  3.6  The incidence and prevalence of allergies in children continue to rise. The last 10 years has witnessed a doubling in the prevalence of peanut allergy to a rate of 1.5%-2%. We have just completed a survey in the London school area showing that 2% of children aged five to 18 years suffer peanut allergy, 1% suffers sesame seed allergy, 2% suffer nut allergies and in total 6% of UK children have suffered allergic reactions to foods.

  3.7  In view of the chronic nature of allergic disease, the increase in paediatric allergic disease will spill over into increased adult allergic disease: young children and adults facing a life of chronic food allergies, eczema, asthma and hay fever. We are only starting to feel the economic burden that this places on society.

  3.8  There are virtually no centres that practice paediatric allergy in the UK and no training posts or consultant posts to enter. Thus an area with a huge unmet clinical need cannot be adequately provided for. Despite large numbers of interested paediatric trainees there are no training posts or consultant posts to which they can aspire.

  4.  In short, the situation is a national catastrophe. In view of the above a national service framework needs to be established for paediatric allergic services nationwide.

May 2004

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