Select Committee on Health Written Evidence


Memorandum by Asthma UK (AL 52)

INTRODUCTION

  1.  The following submission is produced by Asthma UK, the new name for the National Asthma Campaign. Asthma UK is the charity dedicated to:

    —  Improving the health and well being of people in the UK with asthma by building and sharing expertise about asthma.

    —  Asthma is serious. One person dies every seven hours from asthma in the UK, yet 90% of these deaths are preventable.

    —  Asthma is widespread, 5.1 million people have asthma in the UK—one in five households is affected, and if you don"t have asthma yourself, you will know someone who has.

    —  Asthma is controllable. 74% of people with asthma suffer symptoms needlessly.

    —  Approximately 12 million people in the UK are seeking treatment for allergy and it is estimated to cost the NHS £900 million a year.

  2.  Asthma UK works together with people with asthma, health professionals and researchers to develop and share expertise to help people increase their understanding of asthma and reduce the effect of it on their lives. We are working towards our vision of "Control over asthma today, freedom from asthma tomorrow."

  3.  Asthma UK is part of the Respiratory Alliance, an informal group of medical charities, organisations and professional bodies with an interest in the provision of respiratory healthcare services. In January 2003 the Alliance published a report "Bridging the Gap", part of which covered the provision of services for people with allergies and outlined the levels of service that people with allergies could reasonably expect from the NHS.[4] The full Bridging the Gap report can be found on the British Thoracic Society website (www.brit-thoracic.org.uk). Asthma UK has also endorsed the report of the Royal College of Physicians, "Allergy: the unmet need" published in June 2003 and several of the points noted below are from these two reports.

  4.  As our submission will show, there is clearly a need for better allergy services for people with asthma but also for people with anaphylaxis, nut and other allergies. The need for allergy services is therefore to provide a lead for research and education and for clinical care of those with difficult allergic problems which are often not organ specific.

Availability of Allergy Services (geographical distribution, access times and patient choice) and specialist services for patients with severe allergies

  5.  "Bridging the Gap" pointed out that before examining the current provision of allergy services in the UK we must first look at problems that exist in medical training. Currently, allergy is not part of the undergraduate medical curriculum at most medical schools and GPs receive virtually no formal training in allergy with current resources for post-graduate allergy training limited.[5]

  There are too few specialist allergy clinics within the UK (defined as consultant NHS allergists offering five allergy clinic sessions per week), with most located in the south east. Out-patient waiting lists for referral to these centres varies from three months to two years. Specialist provision is equivalent to one whole-time allergist per 2.1 million of the UK population, compared with one consultant per 90-100,000 for chest physicians.

  The report goes on to recommend that to address the geographical inequality in allergy provision, each of the NHS-regions should have a minimum of one specialist allergy clinic, consisting of at least two full-time allergists (or equivalent), a full-time specialist nurse in allergy, a half-time dietician with an interest in allergy and a minimum of one Calman specialist registrar in allergy (or two specialist registrars seeking dual accreditation in allergy and general medicine)

PRIORITIES FOR IMPROVING SERVICES

  6.  Why are allergy services important?

  For people with asthma, the latest British Thoracic Society/SIGN guideline (2004) on the management of asthma states that:

    —  allergy tests may be helpful in seeking causal factors, and in making a general diagnosis of atopy ii and that

    —  allergen avoidance measures may be helpful in reducing the severity of existing disease iii

  From the work we have done with the National Asthma Panel, we know that allergic triggers are common for people with asthma iv:

    —  45% identified dust

    —  35% said pollen

    —  32% said pets

  According to our research, 37% of people with asthma surveyed in the National Asthma Panel think that the NHS provides allergy testing to help identify triggers v, only 26% have been offered any allergy testing vi

  7. Asthma UK believe people with asthma should have the full support of the NHS in managing their condition. This includes providing allergy services where needed to help avoid known triggers. In primary care, patients should be diagnosed and their triggers identified and managed. These services need to be organised to provide maximum benefit to people with asthma. This would involve convenient access to a service appropriate to needs (ie through a pharmacy or primary care team) with adequate staffing and resource to meet the need. The developments within the NHS offer the opportunity for allergy services in a community setting—nGMS and pharmacy contracts, GpwSIs and practice based commissioning.

  But this all needs to be backed by appropriate training and support of health care professionals to ensure the safety of people with asthma (resuscitation facilities etc). In addition, it is important that GPs are able to interpret results and begin appropriate care and treatment with on-going support and advice for patients with potentially fatal allergies.

  8.  The role of allergy testing in asthma

  Allergy tests such as skin prick testing can help to identify specific triggers and allergen avoidance measures can help in the management of asthma symptoms. There are several things that healthcare professionals can do to improve services specifically related to asthma. Asking about triggers, which the person with asthma has noticed worsen their condition is an essential part of management. This might include prompting questions regarding exacerbations after viral infections, occupational exposure, premenstrual worsening or worsening after use of aspirin, or deterioration in certain seasons or after exposure to certain animals. As a rule, allergy testing is by no means essential for most people with asthma and allergy testing can only play a positive role when it is:

    —  conducted in the appropriate clinical setting, by a trained professional and; and

    —  the results will influence choice of treatment or management by the health professional, or if the outcome is likely to change the behaviour of the person with asthma.

  Not all people with asthma have allergies as a trigger and this is reflected in the current SIGN/BTS Guidelines that don't suggest as forming part of general diagnosis. Allergy testing is something that people with asthma are asking for, but the evidence we have from the Asthma UK Adviceline is often to determine whether or not they are positive to dogs or cats so that if they are negative to these they can go out and buy a dog or cat. However this could be dangerous as allergies often develop according to how often a person is exposed to a particular allergen and they could develop an allergy to cats and dogs even though they were originally negative on skin prick testing. Allergy testing does not aid diagnosis of asthma but may help to identify a person's asthma triggers. Therefore it may not be appropriate for all people with asthma to be tested but may be useful for some people with asthma.

GOVERNANCE AND REGULATION OF INDEPENDENT SECTOR PROVIDERS, AND LINKS BETWEEN THE NHS AND THE INDEPENDENT SECTOR

  9.  Asthma UK is concerned that the number of independent clinics that offer services without proper regulation. Claims of benefit from non-standard approaches to allergic disease are often made by independent clinics and commercial organisations. This can lead to those with allergies spending money unnecessarily. Added to this, some alternative therapies can be harmful and few have been subjected to satisfactorily rigorous evaluation. This subject is extensively reviewed with regards to allergic asthma in the British Asthma Guideline.

CONCLUSION

  10.  Allergy testing can be of use in helping people with asthma mange their asthma. However, lack of capacity and availability of allergy testing in the NHS leads many people with asthma to seek services in the poorly regulated independent sector. People with asthma should therefore be offered the option of allergy testing within the NHS, which would help them to properly manage their asthma. This means increasing the availability of these services by the NHS but also ensuring that GPs and practice nurses are aware of the role that allergy testing plays in managing asthma. Ultimately this will enable these and other healthcare professionals to understand more about asthma and help them to make informed decisions about when a referral to a specialist would be appropriate.

NOTES AND REFERENCES:  i  Bridging the Gap 2003i Reasonable expectations for patients with rhinitis and other allergies (Respiratory Alliance. Bridging the gap. 2002)

Patients with symptoms consistent with an allergic condition have a right to be taken seriously by primary healthcare professionals

Education of primary healthcare professionals on allergic conditions

Collection of a careful history encompassing all potential manifestations of allergic conditions and evidence of atopy in other family members

Consideration of the impact of symptoms on patient quality of life

Patient with a potential allergic condition have a right to investigation of potential triggers and education on allergen avoidance

Allergen testing by appropriately trained healthcare professionals in primary or secondary care (as appropriate and according to local service configuration)

Education of patients about avoidance of allergens as a way to control symptoms

Patients with allergic conditions have a right to appropriate management

Awareness of possible manifestations of allergic disease, with appropriate treatment in line with management guidelines

Specifically asking all patients with rhinitis about asthma symptoms, and all patients with asthma about rhinitis symptoms, and ensuring that management of each manifestation takes the other into account

Education of patients about warning signs for severe allergic reactions, with appropriate actions to take

Patients with allergic conditions have a right to integrated healthcare services

Care in the primary sector for the majority of patients (ie diagnosis, identification of triggers and management)

Referral to specialist allergy services when appropriate (eg for allergen testing where this cannot be carried out in primary care, or for suspected occupational asthma)

Multidisciplinary care (eg dietetic advice, respiratory specialists, specialist nurse support)On-going support and advice for patients with potential fatal allergies

  ii  2.2 Feb 2003 version

  iii  3.2.1 Feb 2003 version

  iv  NOPWA

  v  Asthma Panel 2003

  vi  Asthma Panel 2003

June 2004








4   Bridging the Gap 2003. Back

5   Bridging the Gap 2003. Back


 
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