Memorandum by Dr Gideon Lack (AL 32)
1. I am an NHS Consultant in Paediatric
Allergy and Immunology at St Mary's Hospital, London where I lead
the Paediatric Allergy Service. I am also Senior Lecturer at Imperial
College London. I am writing to you regarding the lack of Paediatric
Allergy Services in the UK. This is a subject that is very important
to me. Our St Mary's Paediatric Allergy Service based at St Mary's
Hospital in Paddington provides both a secondary service to local
general practitioners and a tertiary service to paediatricians
and other specialists nationwide.
2. I was appointed to the post of consultant
in paediatric allergy nine years ago on the basis of perceived
clinical need and the belief that this would be financed through
GP fund-holding practices and ECR funding. This did indeed prove
to be the case and we very rapidly built up three paediatric allergy
clinics and over the course of two years demand was such that
the waiting list for new appointments given was in excess of 12
months. At that point there clearly was a need to expand the allergy
service but with new government NHS targets our long waiting list
became a liability to the Trust. It was necessary to rapidly bring
down our waiting lists. This was done through a series of allergy
drives where extra clinics were set up to see more allergy patients.
This temporarily decreased the waiting list but each time it climbed
back up again. Given that many of our patients were highly complex
and required follow up appointments our follow up waiting list
is up to one year. This is completely unacceptable. Finally we
have been forced to only accept GP referrals locally. If a GP
from out of area refers to us an appropriate patient with complex
allergies we cannot see that patient unless that patient is referred
to us through a paediatrician. This creates a further unnecessary
additional burden on the NHS in other areas.
3. It is clear that there are completely
inadequate paediatric allergy services in the UK at the present
time. With four specialist paediatric allergy centres in the UK,
run in large part on academic rather than NHS funding, this is
clearly an unacceptable situation. Our Trust has been extremely
supportive, helping to organise allergy waiting list drives and
employing paediatric allergy nurses. However, with allergy not
being on the list of NHS priorities we have had no choice but
to cut back on the referrals we see. I enumerate below points
that are of specific concern.
3.1 Paediatric allergy services are virtually
non-existent in the UK in contrast with countries such as Sweden
where there are 96 paediatric allergists for a far smaller population.
3.2 Waiting list times for patients are
3.3 Children are suffering the consequences
of not seeing paediatric allergy specialists in three ways.
3.3.1 Firstly they are denied proper diagnosis
and care. These children are at risk of anaphylactic reactions
(one in 50 children in the UK are allergic to peanut and similar
numbers of children are allergic to tree nuts).
3.3.2 Secondly these children suffer nutritional
consequences in the absence of adequate nutritional advice. They
exclude multiple foods and have compromised diets. We have seen
children with rickets, growth failure, developmental disorders
and severe psychological problems all because they failed to receive
proper specialist advice at the right time.
3.3.3 The third way in which these children
suffer damage is that their parents are unwillingly forced into
the hands of dangerous alternative practitioners who run private
clinics where non-validated and often dangerous practices are
used. I know of instances where patients have been morally blackmailed
to receive expensive treatments that are potentially life threatening.
The situation is analogous to the days when young pregnant women
were forced into the hands of back-street abortion clinics.
3.4 I have been seeing increasing numbers
of children with life-threatening anaphylactic episodes where
the child and family have never received proper advice for years.
3.5 Children with allergies often have multiple
symptoms affecting different organ systems. Instead of being taken
care of by paediatric allergists they are sent to general paediatricians,
gastro-enterologists, respiratory specialists, dermatologists
and ENT specialists. This fragmentation of speciality care is
detrimental to the patient, resulting in multiple NHS appointments
and numerous days taken off work by the parents. This is an unnecessary
waste of NHS services. A recent survey of A&E visits at St
Mary's Hospital over one year showed that a least 6% were directly
attributable to an acute allergic problem. Compared to children
who presented to the A&E without an allergic diagnosis, those
children who presented with allergic problems were admitted to
hospital almost twice as frequently and were referred for outpatient
paediatric subspecialty care or for GP follow-up twice as frequently.
This clearly demonstrates how allergic problems are imposing a
hidden burden on both acute and outpatient, hospital and community
NHS services. An integrated approach to the care of these children
is not taken and it is not unusual for these children to be receiving
multiple steroid preparations through different routes without
taking into account the overall medication that this places on
the child and adverse health consequences.
3.6 The incidence and prevalence of allergies
in children continue to rise. The last 10 years has witnessed
a doubling in the prevalence of peanut allergy to a rate of 1.5%-2%.
We have just completed a survey in the London school area showing
that 2% of children aged five to 18 years suffer peanut allergy,
1% suffers sesame seed allergy, 2% suffer nut allergies and in
total 6% of UK children have suffered allergic reactions to foods.
3.7 In view of the chronic nature of allergic
disease, the increase in paediatric allergic disease will spill
over into increased adult allergic disease: young children and
adults facing a life of chronic food allergies, eczema, asthma
and hay fever. We are only starting to feel the economic burden
that this places on society.
3.8 There are virtually no centres that
practice paediatric allergy in the UK and no training posts or
consultant posts to enter. Thus an area with a huge unmet clinical
need cannot be adequately provided for. Despite large numbers
of interested paediatric trainees there are no training posts
or consultant posts to which they can aspire.
4. In short, the situation is a national
catastrophe. In view of the above a national service framework
needs to be established for paediatric allergic services nationwide.