Memorandum by Lancashire Teaching Hospitals
(AL 40)
SUMMARY
It is proposed that given the geography of the
North West the model of Allergy Care should include three foci
for Allergy in the North West each based within Strategic Health
Authorities (SHA). Lancashire Teaching Hospitals (LTH) is based
in the Cumbria and Lancashire SHA and has a significant infrastructure
for allergy and it is essential that the current expertise is
recognised and used in developing the Allergy Services in the
North West. The specialist and complex allergy already performed
at LTH should be consolidated by the appointment of a Consultant
Allergist with appropriate support such as specialist allergy
nurse and dietitian. This would ensure that the Allergy Model
is patient-focused providing equitable access to specialist allergy
services for all patients in the SHA. The model should allow patients
from Barrow, Lancaster, Blackburn, Burnley and Blackpool to be
seen in their local hospitals, and those who need specific immunotherapy
only need to travel to Preston. In addition the allergy centre
should work with PCTs so that they could offer Advice and Treatment
Centres for common allergic disease like hay fever, in the
community. LTH is of the opinion that Paediatric Allergy Services
should be included in any allergy strategy and the proposals by
LTH would support and strengthen the existing paediatric allergy
services already provided by LTH. Laboratory support for allergy
services should be consolidated into one laboratory in the hospital
where specialist expertise is situated.
BACKGROUND
1.1 It is recognized that access to and
the provision of high-quality care for patients with allergic
disease is unsatisfactory in the UK. The provision of allergy
services North West is no exception to this.
1.2 The geography of the North West is such
that we would recommend that an allergy centre be sited in each
of the three Strategic Health Authorities within the old North
West Region.
1.3 The Cumbria and Lancashire SHA is geographically
large and the patient should have the choice to attend an allergy
centre closer to where they live. For example it would be inappropriate
for a patient living in Barrow-in-Furness to attend an allergy
clinic in Manchester.
1.4 At present Lancashire Teaching Hospitals
(LTH) provide Allergy services to most of the Cumbria and Lancashire
SHA. This service is provided by a multidisciplinary team consisting
of a Consultant Immunologist, a Consultant Otolaryngologist and
there is increasing involvement of a Consultant Paediatrician.
1.5 The LTH have provided significant clinical
and laboratory services for allergy in the Lancashire and Cumbria
SHA for several years. Much of the infrastructure required for
allergy is already in place and clinics, including the provision
of immunotherapy and management of more complex and severe disorders,
already occur. A consultant Immunologist has three clinical sessions
per week devoted to allergy and the Consultant Otolaryngologist
has one clinical session per week devoted to allergy. There is
significant referral between the consultants and Nurse support
is present.
1.6 The current level of service provided
by LTH already includes specialist and complex allergy services.
1.7 In addition, the Pathology department
in the LTH has one of the largest Immunology departments in the
country providing a comprehensive in-vitro allergy diagnostic
service.
1.8 The Clinical Immunology Department based
at Royal Preston Hospital has been providing allergy services
to the whole of the Lancashire and South Cumbria area for many
years.
1.9 At the moment the Allergy service in
Immunology is consultant led. The clinic not only offers diagnostic
services and professional advice regarding allergen avoidance
in allergic diseases but also offers conventional specific immunotherapy.
The Preston allergy clinic is one of four centres in the whole
of the Northwest region that offers this form of therapy for various
allergic diseases. This clinic, unlike some others that specialise
in organ based allergic disease, offers a full range of allergy
services. The allergic diseases that are seen include, seasonal
and perennial rhinoconjunctivitis, atopic asthma, food allergy
and food induced anaphylaxis (nut allergy, etc), insect sting
anaphylaxis, drug allergy, and assessment of patients who have
had reactions during anaesthesia, urticaria and angio-oedema.
The consultant also closely liaises with school health nurses
and community paediatricians from the Chorley and Preston areas
regarding the management of children with peanut allergy and other
serious food allergies.
1.10 Presently a joint clinic is being set
up with a Paediatrician in order to see children with allergic
diseases, with the aim of providing specialist services for children.
1.11 The Clinical Immunology department
has seen a large number of patients with a range of allergic diseases.
A range of procedures are carried out routinely; skin prick tests,
intradermal tests, food challenges, training for self-injectable
adrenaline and specific immunotherapy for bee venom, wasp venom,
grass pollen and on specific cases, for animal danders.
1.12 The Clinical Immunology department
receives a significant number of referrals from hospital consultants
and some general practitioners in the Lancashire and South Cumbria
region.
1.13 The Royal Preston Hospital also hosts
specialist services for otolaryngological allergy by a
Consultant Otolaryngologist, Mr J de Carpentier, who also has
a special interest in rhinitis and is a member of the British
Society of Allergy and Clinical Immunology.
1.14 There is close collaboration between
the consultants regarding patients of mutual interest.
2. LABORATORY
SERVICES PROVIDED
BY THE
LANCASHIRE IMMUNOLOGY
SERVICE
2.1 The Lancashire Immunology Service is
one of the largest immunology Laboratories in the UK and is based
within the Pathology Directorate at LTH. It provides an extensive
range of routine and specialist immunology for the local Trust
and for several Trust in the Lancashire and South Cumbria area.
2.2 The Lancashire Immunology Service provides
an extensive in vitro allergy diagnostic service. Total
IgE and specific IgE assays are performed in-house, and are about
to be fully automated. At the present time some 80-100 allergens
are kept in stock, tests involving more esoteric allergens are
referred to a Protein Reference Unit. A total Clinical and Laboratory
service is performed for Trusts in Preston, Chorley, Blackpool
and Morecambe Bay, while rare allergens are tested for Blackburn.
2.3 The department is one of the larger
in vitro allergy services in the UK. A significant proportion
of the work comes from the Clinical Allergy service operating
from RPH and hence it serves patients drawn from an even wider
area.
2.4 An interpretive service is provided
and this is particularly used by GPs whose understanding of the
significance of allergy testing results is sometimes limited.
2.5 It is proposed that as part of the Pathology
Modernisation Programme, Laboratory support for allergy services
is consolidated within one centre in the SHA. This would ensure
economies of scale and a focus for interpretatative expertise.
3. AEROBIOLOGY
SERVICES (POLLEN
COUNTING)
3.1 As part of its clinical and laboratory
allergy service the Immunology Department at LTH offers a full
pollen counting service for the benefit of hay fever sufferers.
The Preston Laboratory in the only laboratory to offer this service
in the Northwest. It is one of 14 European Aeroallergen Network
sites in the UK, which count a full range of pollen grains (grass,
weeds and trees) for about 11 months of the year. Data from Preston
is fed via the Pollen Research Unit at University College Worcester
into the European database at Vienna. The service is self-financing
by selling the data to news media and pharmaceutical companies
for research and monitoring.
4. THE ALLERGY
FRAMEWORK
4.1 The development of a framework for an
adult allergy network in the North West is supported.
4.2 It is recognised that the provision
of allergy services in some geographical areas of the NHS is poor
and that there is a huge unmet need. It is also recognised that
there are few consultants and few trainees in Allergy. There are
not enough Allergists in post or in training to meet the allergy
needs of the UK in the short and medium term. Existing allergy
services must therefore be used to continue with the patient care
whilst ensuring adequate training is available to train the allergists
of the future. It is therefore critical that existing expertise
is used to develop the Allergy support in the UK.
4.3 LTH have a significant infrastructure
for allergy and it is essential that the current expertise is
recognised and used in developing the Allergy Services in the
North West. The current service and LTH includes many specialist
and complex allergy service and this expertise should be developed
for patient care and the training of Allergists.
4.4 The geography of the North West is such
that there is a risk that if allergy centers are too remote from
the population of Cumbria and Lancashire then the allergy service
would not be patient-focused and will not provide equity of access
for these patients.
5. PROPOSALS
5.1 It is proposed that given the geography
of the North West, the model of Allergy Care should include three
foci for Allergy in the North West. This would ensure that the
Allergy Model is patient-focused providing equitable access to
specialist allergy services for all patients in the North West.
5.2 It is proposed that the existing Allergy
expertise in the LTH is consolidated and is used as part of the
Allergy Strategy. The model should allow patients from Barrow,
Lancaster, Blackburn, Burnley and Blackpool to be seen in their
local hospitals, and those who need specific immunotherapy only
need to travel to Preston.
5.3 It is proposed that the complex activity
already performed at LTH should be consolidated by the appointment
of a Consultant Allergist with appropriate support such as a specialist
allergy nurse and dietitian.
5.4 In addition it is proposed that the
allergy centre should work with PCTs so that they could offer
Advice and Treatment Centres for common allergic disease
like hay fever, in the community.
5.5 It is important that the model recognises
the importance of supporting and developing a paediatric allergy
service. Paediatric allergy services are already provided by LTH
and it is proposed that the development of specialist allergy
centres should address paediatric allergy services.
5.6 It is proposed that once the allergy
service is consolidated, LTH should be involved in the training
of SpRs in Allergy.
June 2004
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