Memorandum by Dr Tim Wallington (AL 65)
On behalf of many colleagues in Clinical
Immunology and particularly those members of the South of England
and Wales Clinical Immunology Audit Group, I am writing in response
to the recent call for submission of information to the Health
Select Committee inquiring into the provision of Allergy Services.
We have produced a brief document which we hope
will help the Committee understand how Allergy Services are provided
by the NHS in England and the role played by Clinical Immunologists
in that provision. Also, our assertion that in response to the
unmet and increasing need for Allergy services the plan should
be that they grow in a balanced way, various medical specialities
collaborating in the process.
We are available to answer the detailed questions
of the Committee and so that current information is available,
over the next few weeks we plan to conduct an audit of the Allergy
Services that we provide and the pressures they are under, according
to the criteria that the Select Committee has set out. We have
a meeting of the UK Clinical Immunology Audit Groups planned for
7 October, where the data gathered can be discussed and a joint
report finalised. We hope that this exercise will prove useful
to the Select Committee as well as ourselves in managing our work
and fit with the Committee's working timetable for this inquiry.
SOME BRIEF
INITIAL INPUT
FROM THE
CLINICAL IMMUNOLOGY
COMMUNITY
There are a number of issues pertinent to the
provision of Allergy Services by the NHS:
— Allergy has become much commoner
in both children and adults and is the cause of both significant
mortality and morbidity.
— The expectations of the public of
their health care system have risen very significantly over the
years especially as regards perceived ill health where a diagnosis
and treatment are expected and "allergy" is often blamed.
— Current allergy services are not
coping with this demand.
Against this background it is not surprising
that there is a demand both from patient support groups and professionals
specialising in the field for a program of action to improve the
situation.
Clinical Immunology has developed significantly
as a NHS specialism over the past 20 years and provides a large
proportion of NHS allergy services at secondary level. Clinical
Immunologists receive specific training for this during their
Speciaist Registrar years and it is one of the key areas of clinical
practice in which as consultants they are expected to maintain
competence. Clinical Immunologists, while endorsing the findings
and recommendations of "Allergy, The Unmet Need, a blueprint
for patient care." Published by the Royal College of Physicians
in June 2003, are concerned that any plan to improve NHS provision
for allergy should recognise the services that are currently provided
and how they interrelate. A "map" is provided as part
of this short paper that outlines these arrangements. Being pragmatic,
we believe that progress can be made most quickly by building
on this foundation and at the same time as growing the speciality
of Allergy strengthening the relationship between it and the other
specialities involved so as to sustain targeted research, identify
good practice and make sure that it is applied across the relevant
services.
Clinical Immunology is keen to make direct representation
to the Select Committee and will make detailed data available
when it is needed. As an aid to that process the Clinical Immunology
community will conduct an audit of the allergy services against
the criteria for information set out by the Select Committee which
will be available in the autumn for all those concerned to consider.
In the NHS services for patients with allergies
tend to be provided by clinical teams specialists in the system
(such as the chest in asthma) involved. Increasingly there is
sub specialisation within these teams such that one specialist
sees the allergy. Over the past 20 years Clinical Immunology has
grown as a speciality and services are available in major medical
centres across the UK. Specialists in Clinical Immunology are
trained both to provide professional direction to diagnostic immunology
services and manage patients with illness mediated by abnormality
of the immune response including allergy. Most Clinical Immunology
services provide Allergy services which tend to see patients where
more than one system is involved (such as anaphylaxis) The numbers
of patients seen by these services has grown rapidly in recent
years. Up to now the speciality of Allergy stand alone is provided
in a few teaching hospitals usually in an academic setting. Certain
of these services are world leaders in research. They are all
seen by clinical teams delivering allergy services as setting
standards of best clinical practice and a resource for training
as well as for tertiary referral of difficult cases.
Overall allergy services are underprovided in
the UK. Waiting lists for outpatient consultations are long. A
preferred solution might be to build on the alliance of services
for Allergy mapped out above rather than focus on just one element
of the services currently available.
May 2004
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