Health Committee

2 November 2004                                   No. 40, Session 2003-04




EMBARGO 00:01 TUESDAY 2 NOVEMBER 2004

The Provision of Allergy Services: Report Published

Chairman David Hinchliffe said:

"Allergies are one of the commonest diseases in the population, with 30% of adults and 40% of children now affected. Every year 10 million people in England will experience the symptoms of allergy.

The prevalence of allergy has increased greatly and rapidly in recent years, with the biggest increases coming in areas of serious and complex allergy. For example, until 1990 allergy to peanuts was rare; by 1996 one in 200 children were allergic to peanuts and this rose to one in 70 by 2002. The latest figures suggest that as many one in 50 children are allergic to nuts of all kinds. Similarly, in 1979, only two cases of latex allergy had been recorded, but now 8% of healthcare staff suffer from this condition. Anaphylaxis is now common and may cause life-threatening or even fatal reactions. Patients with anaphylaxis, food and drug allergy have particular difficulty in getting good advice and accurate diagnosis, which is vital to their health.

But we discovered that, despite the escalating scale of the problem, specialist allergy treatment was very difficult to access. Most GPs have little or no training in allergy and often fail to diagnose allergy properly or refer it to an appropriate specialist. Making such a referral in any case is often impossible for much of the country: there are only six full-time specialist centres for the treatment of allergy in the NHS, with none at all west of Bournemouth or north of Manchester, a geographical inequity which I find staggering. Indeed, there is only one specialist consultant per 2 million of the population as against one per 100,000 for a mainstream specialty such as gastroenterology. The absence of a specialist service means that patients, and even GPs, are often ignorant of the treatment options. Patients are instead given drugs, often for years and years, to manage symptoms, when one or two visits to an allergist could ameliorate their conditions, often without the use of drugs.

Most secondary care for allergy is provided by other specialists doctors such as dermatologists, chest physicians or immunologists. Whilst this can sometimes be appropriate, often the patient (especially ones with complex or serious allergy-about 3 million in all in the UK) would be better served by seeing a specialist allergist. Experts described the service as 'derisory' and ' a disgrace'. Patients in need of expert help waited for unacceptably long times. Care was 'a lottery' and depended on 'luck or persistence'. One of many case histories which the Committee heard about concerned a woman who almost died of anaphylaxis while under anaesthetic; she was treated as a heart attack case for some months until there was a proper diagnosis and she was made safe.

The Minister, Dr Stephen Ladyman, argued that there was no real evidence of unmet need since waiting lists were not unduly long in this area. But we were not at all convinced by this. No separate data are held for allergy; it is combined with figures for other illnesses, so the Department of Health does not have the full picture, as they eventually admitted. But much more importantly, we suggest the very absence of services is contributing to a perception of unmet need since there can be no waiting lists for clinics that do not exist. The National Code recently introduced to record allergy work in the NHS seems not to be being implemented in many areas.

Further, we have received worrying evidence to contradict the Minister's suggestion that if there is a service gap, Primary Care Trusts will simply commission additional services. Primary Care Trusts seem not to recognize a problem and are certainly not commissioning additional allergy services (no service; no data; therefore no problem seems to be their reaction). Bids for funding are being rejected, especially where these involve quite a large number of Trusts working together to make it possible to create a regional centre. Services can disappear overnight as there is no secure NHS underpinning.

Services for children are inadequate. They are often being treated in adult settings, contrary to the tenor of the National Service Framework for Children. Children are at the forefront of the allergy epidemic and yet there are even fewer specialists in paediatric allergy than adult allergy. While many schools do their best to support children with allergies they often struggle for lack of support from experts. There are good examples of better support for schools in areas where there is a specialist centre, such as Cambridge.

A solution needs to be found and we endorse many of the proposals set out in the very thorough report produced by the Royal College of Physicians Allergy: the unmet need (2003). Our key proposal is that all parts of the country should have a centre of expertise in allergy that patients in need and doctors requiring help can turn to. This will mean the NHS can make a start in putting things right. There should be a minimum of one specialist allergy centre in areas equivalent to each of the former NHS regions (serving populations of 5-7 million), each requires a minimum additional staff of 2 adult and 2 paediatric allergy consultants and appropriate support from specialist nurses and dieticians.

We also call, as an intermediate measure towards providing the sort of comprehensive allergy specialist service now available in many European countries such as Sweden or Germany, for a specialist allergy consultant to be in post in most major teaching hospitals.

To make this happen the Government needs to heed the advice of its own specialist workforce planners and increase the number of specialist doctor training posts in allergy. To address the difficulties faced in primary care (where most patients will, quite rightly, continue to be treated), we call for better training in allergy for GPs and the development of a cadre of GPs with Special Interest to give greater focus and expertise to the treatment of allergy in primary care.

Specialist allergy centres available to patients and their doctors right across the country will, if our proposals are implemented, provide the base and expertise for developments in the rest of the NHS and act as a resource for primary care for clinical training and education. The Royal College report set out its blueprint for this to be achieved, but so far little or nothing has been done. We call on the Government to produce a strategy document showing that it really is serious about tackling this disease burden. The Government has agreed there is a problem but hasn't yet faced up to it. At the moment, the NHS is not a national health service at all so far as allergy is concerned."

****************

The Health Committee will publish its Sixth Report of Session 2003-04 on The Provision of Allergy Services (HC 696-I) on Tuesday 2 November 2004 at 00.01 am.

There will be a press conference in Committee Room 6 at 10 am on Tuesday 2 November.

Confidential advance copies of the report, which will be embargoed until 00.01 am on Tuesday 2 November, will be available for collection on Monday 1 November between 11 am and 12 noon from the reception desk at Westminster House, 7 Millbank, London SW1. Advance copies of the report will also be made available to the Press from the Press Gallery, House of Commons at 11 am on Monday 1 November.

Witnesses' copies will be posted to them.

Volume II of the Report (oral and written evidence) will be published at 11:00 am on Tuesday 2 November as HC 696-II.  There will be no circulation of Volume II and it will not be available from the Committee Office.