ii. Short Clinical Guidelines on:

• What is the most effective method of diagnosing anaphylaxis of any cause in adults and children.
• What is the most effective method of follow-up treatment of a patient following an anaphylactic reaction.

These are being discussed at NICE's Topic Selection Committees and we are awaiting feedback about their decision. I would like to reassure you that these proposals will be given very serious consideration, should they be given the Topic Selection Committee approval for progression.

Also last month, Skills for Health published the National Occupational Standards (NOS) for allergy at the British Society for Allergy and Clinical Immunology conference. The NOS Will help to improve standards of care for patients, through providing access to on-line training for all healthcare professionals involved in providing care for patients with allergies. They will also help to ensure that these patients are given timely and appropriate care. The NOS are in the final stages of preparation and should be on the Skills for Health website in the near future.

The Royal College of Paediatrics and Child Health have provided the Department of Health with their report from the scoping work they undertook regarding the development of a care pathway for children with allergic symptoms. We have asked them to take forward the next stage of this work to develop and publish the actual care pathway. This will be an invaluable tool for clinicians in managing children with possible and actual allergic reactions. We hope that this work will be completed next year.

The Council on Toxicity has also commenced discussion to discuss its advice on peanut avoidance and consider whether this should be amended in light of new evidence. The minutes from their meetings are available at http://cot.food.gov.uk/cotmtgs/cotmeets/. We anticipate that the Council will provide its advice to the Department of Health by the end of the year.

The House of Lords report of its inquiry on allergies also recommended that a lead Strategic Health Authority should be established. Following an open tender exercise in May this year, the North West SHA was given the role of leading on allergy services, with a remit of championing improvements in allergy services across the NHS and specific responsibility for working with stakeholders to develop a pilot allergy centre.

To turn to your queries regarding allergy workforce, as you correctly state, we have increased training posts by an additional 5 allergy and 5 immunology posts. As you will be aware, workforce planning in the NHS is managed and led at a local level by the Strategic Health Authorities (SHAs) taking into account the national policy direction. Therefore, it is their responsibility to create posts for allergists where they feel the speciality is needed. According to data from the General Medicine Group of consultants in the NHS Information Centre workforce census, there were 18 allergy consultants (FTE 16) as at September 30 2007. In 2004, there were 26 allergy consultants (FTE 18). The Paediatric consultants are not divided into sub-groups in the census so it is not possible to give the figures for those working with allergies in children.

As a result of the NHS Next Stage Review, the Department is looking at how to ensure that workforce planning is aligned with the new models of care. Given that the majority of allergy patients are seen and managed in primary care, the focus of education and training should be on GPs. The NOS developed by Skills for Health, together with the development of care pathways and clinical guidance, will help enhance the knowledge and expertise of primary care staff caring for patients with allergies.

You also query what work is being taken forward to establish allergy centres. The Government recognises that people with complex allergies need and deserve specialist advice and support to help them to maximise their health and well-being and investment in the NHS will help deliver service improvements, including allergy services, across the board. However, the responsibility for commissioning of allergy services rests with individual Primary Care Trusts (PCTs) and it is for them to ensure that they are commissioning services sufficient to meet local need.

You will be aware that PCTs have to set priorities for investment and reform across a range of service areas including allergy. We have recognised that allergy services have not always been given the focus that they require, which is why we have appointed NHS North West to lead improvements in allergy services. The intention is that NHS North West will explore and develop models that can be shared with the rest of England that will deliver improved patient care for people with allergic diseases.

I am pleased to report that considerable progress is already being made towards the delivery of a pilot allergy centre. With the support of PCTs in the region, NHS North West have asked the North West Specialised Commissioning Group (NWSCG), through the North West Specialised Commissioning Team (NWSCT), to co-ordinate the work programme that will be required to commission this service. The NWSCG had already established, in January 2008, a Task and Finish Group (TFG) to review specialised allergy services in the region. The TFG, with a membership drawn from clinicians, service managers, commissioners, public health professionals and third sector organisations, has developed proposals for a network based approach to allergy care in the North West for adults and children and young people. The proposal is to create linked paediatric and adult services, delivered from a number of locations across the region, co-ordinated by an allergist lead. The proposal builds upon previous investment, in addition to the costs of service provision through contract prices, by the NWSCG in allergy services. It is anticipated that the allergy network arrangements will be in place for April 2009. It is our view that if a region such as the North West can deliver on this agenda and lead by example in establishing an integrated service other areas of England will follow.

I hope that this has helped reassure you that the Government is still actively committed to improving the lives of patients with allergies and the services we provide for those living with the condition.

15 December 2008