I have been a part time Consultant Allergist in Liverpool for 17 years. I run the allergy service at the Royal Liverpool and Broadgreen University Hospital NHS Trust (RLBUHT) and at The Royal Liverpool Children's NHS Trust (Alder Hey).

BACKGROUND OF THE LIVERPOOL ALLERGY SERVICES

  There has been an Allergy Service in Liverpool for over forty years. With the reorganisation of the hospitals in the city in 1978, the service moved to the Royal Liverpool Hospital. At that time, there was a full time consultant allergist, a part time consultant allergist (three sessions), a full time receptionist/secretary, a full time nursing sister, a clinical assistant (two sessions), and a consultant ENT surgeon who did one allergy clinic/week. The full time consultant allergist did two sessions at Alder Hey Children's Hospital, and the clinical assistant did another two sessions at Alder Hey. When the sister retired, her role was taken over by the clinic sister in charge of that area, with adequate trained nursing support. During this time, in recognition of the wide catchment area of referrals to the clinic (approximately two thirds were from outside Liverpool), the unit was given District Managed Regional status and funded by the Regional Health Authority. In the early 1980s, the ENT surgeon retired and his successor took no part in the allergy service. In 1987, when the part time consultant retired, the three consultant sessions and four clinical assistant sessions were combined to make a half time (five and a half sessions) consultant post, which I have held since that time. With reorganisation of the Health Service, funding for the service was devolved to the individual NHS Trusts who both put it under the umbrella of the medical directorate. In the mid 1990s, we gained approval for a training post. The waiting time for a routine appointment in both trusts was about three to four months. However, in 1997, the full time consultant retired, both trusts decided that their priorities lay elsewhere, and he was not replaced. The waiting times increased.

  At the RLBUH I was assisted by two senior registrars in Immunology and funding was obtained from the PCT's for an allergy nurse, though I suspect that the funding was geared to waiting lists rather than Allergy per se. As I am only part-time, we no longer have approval for an allergy trainee. One senior registrar gained a post elsewhere, the other filled the Consultant Immunologist vacancy that arose at RLBUH and, whilst required to do one allergy session, chose to do two. The waiting times for a first appointment continued to increase. At a time when the waiting times were over three years for a routine first appointment, referral guidelines were issued by both Trusts. In 2000 we carried out both clerical and clinical validation of the waiting lists but, by April 2001, they still stood at one hundred and three weeks. Therefore, an executive decision was taken to close the clinic to all but urgent referrals, and additional Waiting List Initiative clinics were done to bring the time down.

  In May 2003 the North West Specialised Commissioning Group agreed to endorse proposals for the establishment of a North West-wide clinical network for adult allergy services, including a full time allergist, an allergy specialist nurse and dietetic support in Liverpool. Specialised Commissioning leads have agreed to work with local PCT's to progress plans but with an expectation that "additional resources are unlikely to be required until 2005-06"!

AVAILABILITY OF SERVICES

  We still only see urgent referrals at RLBUHT, clinically validating all referral letters. There are five consultant clinics/week (three Allergist led, two Immunologist led), two nurse led clinics, a joint allergy/anaesthetic clinic once a month and an immunotherapy service. Waiting time is within the 17 week target.

  At Alder Hey, although in 2001 a Paediatrician agreed to do one clinic/week and an Advanced Nurse Practitioner transferred from other responsibilities to do two clinics, we still struggle to keep within the seventeen week target.

  There is still no dedicated dietician support for any of the allergy services.

  The only other allergy provision on Merseyside is a paediatric allergy clinic in Warrington once a month and another at Arrowe Park Hospital, Wirral, once a month, both run by Paediatricians with an interest in the subject.

  This history shows that the resources for allergy need to be identified and their funding ring-fenced so the service may continue and develop, despite the changing fashions of the time, whims of the management and the personal preferences of future incumbents.

May 2004