Progress On Allergy Services: How Can We Do More

Main Category: Allergy
Also Included In: Immune System / Vaccines
Article Date: 24 Jun 2010 - 12:00 PDT

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The 2007 House of Lords (HoL) Science and Technology Committee inquiry into allergy recommended practical steps to improve allergy services by developing expert centres to lead cost-effective service improvement. A new report shows that although there has been limited progress in some areas of allergy care, in the majority of areas it has been slow or non-existent, despite a huge commitment by allergy specialists, patients and professional societies.

The working party of the Royal College of Physicians and Royal College of Pathologists, supported by the British Society of Allergy and Clinical Immunology, took evidence from a wide variety of sources including professional and patients groups to measure progress against the 2007 report. It concluded that cost-effective solutions were still not being implemented, despite the best efforts of the limited number of allergy experts. This has become even more relevant in the current financial crisis.

'Allergy Services: Still not meeting the unmet need' details limited progress in some areas since the 2007 report - dietary advice to pregnant women has improved, short NICE guidelines on food allergy in children have been produced, ten medical training posts established, and a pilot allergy centre in the North West region has been nominated and is yet to be evaluated, but clear barriers to progress remain, and most of the other important recommendations have not been implemented. The report findings include:

- Still not enough allergy specialists to meet clinical need and train other healthcare professionals, and ineffective use of the existing cadre of expertise

- Impaired leadership of allergy services, due to lack of a networked and managed Infrastructure

- No improvements on the serious hazards of inappropriate food labeling

- Patient engagement remains underused and should be strengthened at local and regional level

- Little progress on improving governance and training in the management of allergy in primary and non-specialist services, or in the clinical governance of complementary practice

- A huge potential to do better in a cost effective way even in the current financial climate

The lack of progress against the recommendations is underlined by the views of patients or professional groups. A repeat survey of GPs reported no perceived improvement in access to specialist service provision. The continued lack of patient involvement, combined with inadequate investment, leadership, organisation, networking, and the failure to appoint a critical mass of staff, both specialist and non-specialist, has led to a situation hardly better than that prior to the 2007 report.

The working party makes a series of specific recommendations which have become even more important in the light of the financial crisis, highlighting the need for:

- Leadership at every level of commissioning and providing services to make the most cost-effective use of a scarce resource
- Better engagement of patients and patient organisations in enhancing care and designing services
- A single lead SHA/commissioner to act as a national resource for networking, service evaluation, and to drive improvements in care
- Development of validated outcome measures and service accreditation standards
- Professional leadership from physicians, professional organisations and medical royal colleges

Baroness Ilora Finlay, chair of the working party and chair of the 2007 HoL report , said:

"Allergy causes great distress, particularly to children and their families, and can blight people's lives. Bringing the key players together and recognising the need for expertise in managing complex allergy can dramatically improve quality of life and help patients control their disease."

Dr Bill Egner, secretary to the working party and representing the Royal College of Pathologists and the British Society for Immunology Immunology, said:

"This report offers an ideal opportunity to engage patients and physicians in positive action to improve services with the support of Government.

"We can do better and allergy services can still improve despite the current financial climate. A coalition of partners from patients to specialists are ready and willing, they merely need appropriate facilitation of clinical leadership and intelligent direction from the Department of Health and PCT Commissioners to make it a reality.

The report documents the "can-do" attitude of the allergy community and the wealth of experience that could be utilised to spread better care, but for its inappropriately low prioritisation in the eyes of commissioners.

If you want more cost effective services there is no better place to start than allergy. In this era of uncertainty it would be good for the NHS to focus on what positive change is possible, instead of constantly hearing about what is not"

Notes

Recommendations for action:

This report recommends that further actions are needed from the Department of Health (DH), primary care trusts (PCT), local health boards (LHB), strategic health authority (SHA) commissioners, providers of allergy services, and patients, in order to provide cost-effective improvements in allergy care, despite the current funding crisis.

We emphasise the need for better allergy services and more allergy specialists (which has not yet been addressed), but also the importance of ensuring that all existing services are identified and supported in the interim, by enhanced interaction with allergy specialists.

We highlight the depth of commitment from managers, physicians and nurses, to the provision of better care for patients with allergic disease, and the untapped well of support and input which can be provided by patient organisations to enhance existing care and to design service improvements.

We highlight the real practical difficulties in engaging multiple providers and commissioners on a service improvement project which lacks appropriate drivers, such as DH direction/facilitation or incorporation into Quality and Outcomes Frameworks (QOF).

We recommend that the DH designate a single lead SHA, acting as a national resource to collate and coordinate the improved networking and service evaluation of all the regional allergy services and networks. We recommend that each SHA should ensure that PCTs support initiatives to improve allergy care in collaboration with local hospitals, to improve the provision of care closer to home, and to support their general practitioners, consultants and nurses in delivering the best possible care in the most effective way. The House of Lords (HoL) model of multidisciplinary allergy services, led by allergy specialists, remains the recommended model, adapted to local circumstances. Local initiatives to work towards this should be supported.

We highlight how far the individual initiatives deviate from the ideal recommendations of the HoL report, and the lack of validated outcome measures or service accreditation standards which would allow improved measurement of the need and the quality of services provided. Initiatives from the Joint Committee on Immunology and Allergy of the medical royal colleges, as well as other professional societies and services, have initiatives to develop such measures and standards, and to share protocols and good practice. Further development and validation of these initiatives should be supported.

We emphasise the key role of professional leadership from physicians, professional organisations and medical royal colleges in developing such mechanisms to evaluate service quality and supporting improved service provision. We recommend that this group reconvene in 2-3 years to ensure progress.

The financial future for the health service is set to be very different from the climate in which the HoL report was written. A specialty like allergy, which is currently underresourced and under-supplied, is especially vulnerable and must be protected. The quality of existing patient services in allergy can be improved by expanding allergy specialist leadership.

Source:
Royal College of Physicians of London
Royal College of Pathologists
British Society for Allergy and Clinical Immunology

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