Memorandum by Dr Katherine Sloper (AL
51)
1. INTRODUCTION
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.
2. PROVISION
OF LOCAL
ALLERGY SERVICES
(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.
3. INDEPENDENT
SECTOR
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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