Numbers refer to those in the uncorrected transcript of oral evidence of 1 July 2004.

  [Related subjects have been brigaded together for ease of reference].

Q148

  Dr Taylor raised a specific issue about the Brompton Hospital. My officials have made enquiries, and now understand that there has never been a Professor of Allergy at the Brompton. There are a number of consultants who specialise in the area and—in fact—the Royal Brompton has a number of internationally acclaimed allergy experts among its honorary consultants; but not a "Professor of Allergy" as such.

Q180; Q181

  The Committee wanted to know about the incidence of anaphylaxis; whether GP practices are equipped to respond to such attacks; and how many kits for the self-administration of adrenaline are issued.

  The best estimate available to the Department is that one person in 3,500 is at risk of anaphylaxis. When someone is identified as being at risk, their GP will—if appropriate—prescribe a self-administration adrenalin kit, and teach the patient (or their carer) in its effective use in the event that they should be exposed to the trigger agent (for example, food that has been contaminated with peanuts).

  In 2003, 99,000 self-administration kits (Epipen and Anapen)—with a net ingredient cost of £4.792 millions—were dispensed in community pharmacies against prescriptions written by GPs.

  In rare cases anaphylaxis can be triggered by immunisation administered by a GP or the GP's practice nurse; for example, "flu vaccines are contra-indicated for people who are hypersensitive to eggs because the recommended strain is grown in chick embryos. Practices administering such vaccines therefore monitor patients for about 30 minutes after administration, and—should a patient with no previous diagnosis of hypersensitivity to eggs—display symptoms of anaphylaxis, the practice will treat them with adrenalin (and, as appropriate, anti-histamine and oxygen).

  The new GMS Contract rewards and provides incentives for the provision of high quality care, the Quality & Outcomes Framework (QOF) includes:

  Medicines Management; the practice possesses the equipment and up-to-date emergency drugs to treat anaphylaxis.

  This helps to ensure that patients suffering anaphylaxis—whether as an adverse reaction to vaccination, or as a result of animal bite, insect sting or other exposure—can access the necessary emergency treatment, quickly and close to home.

Q197; Q198

  Mr Amess pressed me on the numbers of posts for specialists, and whether there are any unfilled posts.

  Whilst the Department appreciates the need for expansion in the allergy workforce, this need must be considered alongside the priority for increasing numbers in shortage specialties such as histopathology and radiology, which are critical for the delivery of Cancer services and for achieving Access targets.

  The large number of competing priorities for a limited number of centrally funded National Training Numbers (NTNs) has naturally resulted in some specialties being disappointed with the final outcome. It is true to say that no specialty has had its ambitions for centrally funded posts fully met.

  Modelled projection of growth has shown that the allergy workforce will not expand without an increase in funded training numbers and growth has been negligible over recent years. As recognition of the need to increase the workforce, I can confirm that allergy was allocated an additional centrally funded post in 2004-05 and a further post has been allocated for 2005-06. There are also other ways to create Specialist Registrar posts. Trusts can either make further use of existing training opportunities (which is cost-neutral) or have the opportunity to fund posts locally. To date, no Trusts have opted to increase the workforce through these means.

  My officials are currently liaising with the Lead Dean for allergy to determine the implementation status of the 2004-05 centrally funded post, which has been allocated to Leicestershire, Northamptonshire and Rutland WDC. Allergy has been allocated a centrally funded post in 2004-05 and a further post in 2005-06.

  A large number of allocated training posts are not filled by trainees.

  In 2003-04, there were six allergy training posts, of which one was unfilled. This is because recruitment has not yet taken place, but an exercise is planned, with appointment due before December 2005.

  The specialty needs 10 funded numbers in 2005-06 and a further 10 in 2006-07 to establish a credible workforce.

  At the specialty review meeting on 30 March 2004, key allergy stakeholders put forward the case for 10 centrally funded NTNs in 2005-06 and a further 10 posts in 2006-07. It was acknowledged that these increases would significantly boost the allergy workforce. However, it was made clear at the meeting that these requirements must be considered in the context of funding and training opportunities available and the priorities for all medical specialties. Allergy representatives were informed that their requirements could not be regarded as a definite future allocation.

Q200

  Mr Amess asked for an update following a meeting I had with Jon Cruddas earlier this year.

  At the meeting with Jon Cruddas in January, we discussed the fact that the training of doctors was a matter for the Royal Colleges; and that the Government doesn't make decisions on how money is spent locally on provision of services. Devolving power to the front line means that PCTs commission services locally.

  I explained that the Long Term Conditions NSF and the Children's NSF would cover generic conditions which would benefit allergy sufferers, and that—at the end of the year—Ministers would need to decide whether other NSFs were needed.

  I undertook to look into whether NICE could include guidelines on allergy services in their forward work programme; and also to ask the CMO to consider an Action Plan, similar to the Plan produced for epilepsy (with the Allergy Alliance, if they were willing to contribute their expertise).

July 2004