Memorandum by Dr Andrew Clark (AL 49)
I am a consultant paediatric allergist in
Addenbrookes NHS Trust, Cambridge, a tertiary centre. I work with
two colleagues who specialise in allergic diseases of adults.
1. The prevalence of allergy is rising and
demand greatly exceeds the supply of specialised care to children
with severe and complex allergy (asthma, food allergy, anaphylaxis,
hay fever and eczema). Only six paediatric allergy consultants
serve the childhood population of the UK (11.6 million in 2002).
My post is the only one north of London, yet I receive no NHS
funding and my position is supported by a limited tenure academic
grant (to expire in 2007). Currently, many children with severe
and complex allergy are cared for by general practitioners or
general paediatricians whose training and expertise are variable
and therefore quality of care for these children depends on where
they live, with children in the north and West of the country
being at a significant disadvantage. To illustrate the demand
for specialised paediatric allergy services a recent survey showed
that between February and May 2004, there were approximately 1,000
allergy consultations in our clinic. Nearly 360 consultations
(36%) were for children, and two thirds of these were for peanut
or nut allergy—a severe and complex allergy, requiring regular
(usually annual) reappraisal. Resolution of nut allergy is unusual
and this large group of children require annual review appointments
for many years.
2. A core principal of The National Service
Framework for Children is that professionals who care for children
in hospital should be appropriately trained and experienced. Interpreted
in the context of allergy this implies that children with complex
and severe allergy referred to tertiary level clinics should be
cared for by paediatric allergists. Currently this is not the
case. Overall, we are referred over 500 new paediatric allergy
patients per annum, of whom at least 300 will require annual follow
up appointments and year-on-year; this adds a significant extra
workload. As a consequence, even in our specialist centre, not
every child can be reviewed by a paediatric allergist.
3. There is a need for improved under-and
post-graduate training in allergy. The creation of more consultant
posts in paediatric allergy together with recognition of specialist
training will improve the care of children with severe allergy
and facilitate the spread of expertise and knowledge from tertiary
to primary care, improving provision of allergy services for all
children.
May 2004
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