Memorandum by Dr Amolak Bansal (AL 60)
INTRODUCTION
I work as a Clinical Immunolgist and Allergist
within the Department of Immunology at the St Helier Hospital
in Carshalton, Surrey, which is part of the Epsom and St Helier
University Hospitals NTIS Trust. I run the immunology and allergy
service within this Trust and also at the Kingston Hospital, Kingston,
Surrey and the allergy service at the St George's Hospital in
Tooting. The catchment area for our allergy referrals is extremely
large and includes much of South West Thames, Surrey borders and
parts of Middlesex. At the St Helier Hospital I am joined by one
further consultant in immunology and allergy. We also employ two
nurses both of whom divide their work between immune deficiency
and allergy. There are no supporting personnel at Kingston Hospital
or at St George's Hospital.
1. While the allergy service at the St Helier
Hospital offers a comprehensive range of diagnostic and therapeutic
strategies, it is lacking in nursing personnel who are entirely
devoted to the management of patients with allergic disease. Additionally,
there are no in-patient facilities for the investigation and management
of those patients with severe allergic disease or those who suffer
anaphylaxis. Investigation of suspected drug allergy is also woefully
inadequate, mainly because each of the senior staff do not have
sufficient time to devote to the very lengthy and complicated
investigations that these patients require. Desensitisation therapy
is offered only at the St Helier Hospital and here too there are
insufficient staff to cope with the increasing demand. The lack
of facilities for desensitisation therapy makes it virtually impossible
for those patients living far away from St Helier to comply with
the demands of this therapy. This, of course, excludes desensitisation
therapy on the basis of the patient's post code.
2. In order to improve the provision of
allergy services there is an urgent need to increase the number
of trained allergists and also nurses specialising in this field.
In particular, the number pf paediatric allergists certainly needs
to be increased as there are less than a handful around the country.
For the Epsom and St Helier University Hospitals NITS Trust that
includes the Queen Mary's Children's Hospital, this is the area
that requires most attention. Here my waiting list appears to
be increasing very rapidly despite numerous attempts to bring
this down. For the adult clinics, there is again a need for at
least one fully funded nurse specialising in allergic disease.
The same is also true for the allergy clinics I run at St George's
and Kingston Hospitals. Only in this way can the ever increasing
number of patients with allergic disease be seen, investigated
and managed within a clinically acceptable time frame.
3. For the Kingston Hospital clinic, the
local PCT's have withdrawn their support and referrals are vetted
by the PCT with those that require treatment being sent to my
St Helier Hospital clinic. This obviously presents many problems
for patients in this area, especially the young and the elderly
who have considerable distances to travel. I therefore believe
that PCT's should be encouraged to support allergy services at
their local hospital even though PCT leaders may feel that patients
with cardiac disease or cancer deserve the greater attention.
For the future, practice nurses within GP surgeries should be
encouraged to perform skin prick testing and educational programmes
of the sort that I hope to organise at St Helier Hospital, need
support.
June 2004
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