EXECUTIVE SUMMARY
1. In 2005 The Scottish Medical and Scientific Advisory Committee ( SMASAC) established a Working Group to review progress against the SMASAC "Report on Immunology and Allergy Services in Scotland (2000)", specifically in relation to allergy services. The Working Group has found little evidence of strategic developments in the intervening period, although modest improvements have taken place in the number of consultants and nurse specialists involved in allergy. The burden of allergic disease in Scotland, as in other parts of the UK, is high and current service provision is clearly failing to meet the needs of many patients in terms of knowledge at primary entry points to the NHS and access, particularly to specialist services.
2. This Report identifies a number of key barriers to the delivery of high quality equitable allergy services for both children and adults in Scotland, including:
- insufficient numbers of medical specialists and trainees in the system
- insufficient numbers of other healthcare professional staff adequately trained in allergy, including general practitioners, nurses, dietitians and pharmacists
- lack of accessible information for patients, carers and the general public to support understanding and self-management of allergic disease
- a fragmented service with no clear linkages between primary, secondary and tertiary allergy care provision
- need for better promulgation of evidence based practice e.g. patient referral protocols, care pathways for children and adults, and a standardised approach to clinical management through national guideline development
- need for improved data collection and audit as tools to better healthcare planning and delivery
- need for more research into allergy, particularly in areas where information and knowledge are deficient.
3. The Working Group believes that these barriers could be overcome by taking a reconfigured approach to the delivery of allergy services which maximises potential for improvement in the context of developing healthcare frameworks in NHS Scotland. In the case of adults, the model of Regional Managed Clinical Networks ( MCNs) is recommended. MCNs have the clear potential to build incrementally on existing resources, particularly manpower, to improve service delivery. The Report acknowledges that Regional Managed Clinical Networks will need effective operational structures and enthusiastic clinical leadership and investment, underpinned by robust linkage to relevant NHS Boards, if allergy is to achieve the priority it merits in terms of health service planning and delivery in the future.
4. In relation to paediatric allergy, the Working Group also recommends a Managed Clinical Network approach, this time at national level, linking a number of Regional Allergy Centres. These initiatives would provide better access to existing expertise and act as a focus for improved service delivery and for development of diagnostic and therapeutic services not currently available in Scotland, including adolescent transition arrangements linked to adult allergy care structures.
5. Improved data collection, analysis and links across datasets are required if truly effective health service planning for allergic disease is to be achieved in Scotland. It is proposed that a Working Group is set up to identify ways in which current data and information deficiencies can be addressed.
6. Chapter 7 includes a number of subsidiary, but nonetheless important, recommendations, many of which could be taken forward through the vehicle of Managed Clinical Networks. The Working Group commends this report to NHS Boards and Regional Planning Groups in Scotland as a pragmatic way forward to not only provide better access to allergy services, but also to improve the quality of those services for both children and adults.