Select Committee on Health Written Evidence

Memorandum by Dr Katherine Sloper (AL 51)


  I am Dr Katherine S Sloper and I work as a Consultant Paediatrician at Ealing Hospital NHS Trust, Uxbridge Road, Southall, in a busy district general hospital in North West London. I am also Honorary Clinical Senior Lecturer in the Imperial College School of Medicine, and I am involved in teaching undergraduate medical students, doctors in training and postgraduate doctors, and I also take part in research activities. I am a General Paediatrician with special interests and training in allergies, in addition to respiratory medicine and immunology. I trained in the allergy clinic at Middlesex Hospital (Professor Jonathan Brostoff) in London as part of my Paediatric training. While in receipt of a research training fellowship in the immunology department at Middlesex Hospital, I studied clinical and immunological changes in allergic children with atopic dermatitis (eczema), and was awarded a Doctorate of Medicine (DM) from Oxford University for my thesis on this work. After further training in General Paediatrics and Respiratory Paediatrics (at The Royal Brompton) I was appointed as Consultant Paediatrician at Ealing Hospital in 1988. I have developed a Paediatric Allergy and Asthma service within Ealing Hospital, as well as working in an honorary basis in the Paediatric Department at the Royal Brompton Hospital.


    (a)  Adult services: there is none in the local hospital and patients have to travel to a tertiary centre.

    (b)  Paediatric allergy services based on Ealing Hospital: serves the local community (seeing patients mainly from the Boroughs of Ealing, Hounslow and Hillingdon) and a few from Harrow. This service provides a secondary level specialist service for patients with moderate to severe allergies. The service offered by our Specialist Paediatric Allergy Centre includes management of a full range of allergic disease, diagnostic testing, day case challenge testing, advisory service including allergen avoidance, primary and secondary allergen prevention, coordination with the community school nursing service for management of children at risk of anaphylaxis in nursery's and school's, specialist dietetic service, education and local source of advice for General Practitioners. We do not have facilities for immunotherapy. We cover the wide range of atopic dermatitis, asthma and wheezing, allergic rhino- conjunctivitis, food allergies, multiple food allergies and children at risk of anaphylaxis. Allergic conditions are present in up to a fifth of all children, with about 5% of children needing advice from these specialist services.

    The out patient allergy service at Ealing Hospital is run by myself with a Specialist Community Paediatric Sister (based in the Hospital team) backed up by a colleague, and she also acts as the Specialist Asthma Sister for the children in the hospital and surrounding area. We have the support of a paediatric dietician who attends all the clinics, and our day case ward are experienced in assisting with allergy testing and day case challenges with allergens. Training support for the community school nurses and general primary support is organised through myself and the specialist community sister.

    The paediatric allergy clinic runs weekly in conjunction with the paediatric asthma clinic, and we have an additional monthly clinic for new referrals. The clinic is held in Ealing Hospital, but some of the support to families by the Specialist Community is carried in homes and schools. We receive referrals from local General Practitioners and practice nurses, school nurses. At present there is no identified separate funding for this service, and the waiting list is between 13 and 15 weeks for new patients.

    (c)  I have discussed the availability of allergy services for adults with Dr William Lynn, Medical Director, Ealing Hospital NHS Trust. He asked me to report to you that in his opinion and experience the services available for adults are grossly inadequate in this part of London. He knows of instances where patients requiring investigation for life threatening allergies could not have an appointment in the nearest specialist allergy clinic for adults (St Mary's) for many months.

Priorities for Improving Services

  The incidence of allergies and in particular potentially fatal allergies such as that to peanut, has been increasing rapidly in this country and worldwide over the past 20 years. Research has shown that patients with such serious allergies need to be followed up from time to time in specialist clinics to support the initial management plans and follow the progress of their allergies. Allergic patients tend to have illnesses affecting a number of systems, often more than one at the same time (such as skin, chest and gastrointestinal disease), and the allergy clinics need to have adequate funding to provide this support role for these patients, and to give advice to their primary carers such as General Practitioners. Our local PCT has not recognised allergy services as a separate entity with defined funding provision, although there is an ever increasing demand for us to give advice and treat such local patients and their families for this illness which is not well understood by the general population and where there is much misleading advice available. We regularly train nurses and other support staff from the community both locally and nurses training from other centres. However, there are no Specialised Paediatric Specialist Registrar posts in allergy to help develop the services which will be needed in the future, and our clinic could be part of a specialised training programme if paediatric allergy were recognised as an important individual specialty (rather than one treated in different ways by different specialists). I recognise that central resources to go into new SpR training posts in allergy and central support for new Consultant allergy posts.

  Our specialist allergy clinic links into the London Paediatric Allergy Group which has been set up recently, and I am and the other staff in the department are closely involved with liaison with other specialist allergy services in London including those in tertiary units. The need for regular liaison and training meetings needs to be recognised within job plans for Consultants and associated staff, but is not adequately recognised at present.

  The Ealing PCT Commissioning Department was not aware of the unmet or increasing needs for patients locally who have serious allergies. They are now interested in exploring with me how the community and hospital can support each other in developing allergy services, and we will be meeting together to look at these services. The Ealing PCT Commissioning Department has not identified the need for allergy services apart from recognising that some patients were seen in the allergy clinic at St Mary's Hospital. They did not know that there was a local Paediatric Allergy Department. They do not fund any local adult service, and I know from the experience of patients who have asked me about it, that adults have not been able to have any specialist local advice.

  PCT is involved with planning with the hospital (Acute Sector) for local paediatric needs. The Paediatric Consultants in Ealing Hospital are finding it very difficult to cover the many increasing roles that they have with the clinical load (acute and chronic disease), staff training and community support as well as liaison work as part of clinical networks with tertiary centres. As the new Paediatric Clinical Director at Ealing I will be including the need for the work we cover in the department in providing a specialist allergy service to be recognised when the overall Consultant Paediatric service development is being reviewed.

  I would be willing to give oral evidence to the Committee.


  I have some experience in treating patients with allergic diseases in the private sector. My approach to patients in both sectors is the same in terms of investigation and treatment. However, I recognise that there is a need for clinical governance and auditing of work to be developed in the same way that it has been developed over the last few years in the National Health Service. The long waiting list for the local allergy services means that many children are seen by a number of therapists in the independent sector. Some of these services offer treatment which are not evidence based, and on occasions dangerous to patients (for instance research has shown that a significant proportion of creams prescribed for eczema from some alternative health workers in London have contained a high level of cortical steroids unknown to the patients, given the potential of severe long term side effects. Mechanisms need to be developed to make sure that there is a consistency of reproach in the NHS and independent sector, that we can each learn from the other in our approach.

  With facility to increase local services here we would be able to give better support to our local patients and practitioners in management of allergic diseases, using treatments within the framework of clinical guidelines (which is how we work from our clinic) and with known doses of properly researched drugs.

  Both and severe allergies carry a mortality in both childhood and adult life and there, and therefore it is vital that patients should have access within a reasonable length of time to knowledgeable specialist allergy service.

  The evidence above is my personal opinion, but I fully support the views of the British Society of Allergy and Clinical Immunology for which I am a long standing member.

June 2004

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