Emeritus ProfessorJohn Warner, OBE, FMedSci

I have 4 principle research themes:
Early Life Origins of Allergic Sensitisation and Disease;
Food Allergy and Intolerance;
Allergic Airway Disease:
Integrated Healthcare for Children

The latter theme is unashamedly included because there is a huge gap between generation of knowledge and application in clinical practice. The current approach is the generation of management guidelines. Those involved in generating the guidelines, including me, expected that publication would lead to improved outcomes. As my research was focused on respiratory medicine and allergy, I established an international paediatric asthma guidelines group and subsequently served on the British Thoracic Society and the Scottish Intercollegiate Guidelines Network asthma guidelines steering committee; the Global INitiative for Asthma (GINA): and Allergic Rhinitis and its Implications for Asthma (ARIA). However, there is little or no evidence that guidelines have improved national or international outcomes. Successive reviews of asthma deaths reveal the same shortcomings to care. Royal College of Physicians and Government reports on UK allergy care highlight the many unmet needs.
Most guidelines concentrate on systematic reviews and meta-analysis to justify recommendations, but fail to take account of patient values and expectations. The failure to address patients’ perspectives is likely to compromise both the relationship with their doctor and impair reaching agreement on strategies for management. Concordance is a better descriptor of this process rather than compliance or adherence because to achieve the ideal, an accord must be reached between doctor and patient, that then is more likely to lead to appropriate concordance. The discord between doctor and patient could be described as “a shared misunderstanding”, which inevitably leads to poorer outcomes. We ignore patient experience at our peril. Evidence based medicine requires evidence based implementation and its failure constitutes the 3rd translational gap.
One of the few positive outputs from a DH report was a request submitted to the Royal College of Paediatric and Child Health (RCPCH) to consider developing integrated care pathways for children with allergic diseases. I was asked to produce a scoping document which was approved, and funding was provided to establish a multi-disciplinary working group. I led the successful completion and publication of evidence-based pathways for all the common allergic conditions affecting children and young people. However, the DH despite funding the project notified RCPCH that it would not endorse the recommendations. The message from 16 years of political approaches is that the only way to achieve change is by taking personal responsibility for action and negotiating within one’s own locality. Hopefully by demonstrating impact, change could be sustained and cascaded nationally and beyond.
The advent of the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for NW London provided the opportunity to implement integrated care pathways for children with allergic diseases. Our project, known as “Itchy sneezy wheezy” has achieved notable success at a local level with reduced accessing of unscheduled care for exacerbations with consequent reduced costs without compromising quality, and with enhanced patient experience. It is now being implemented in several regions in UK including Sheffield. I have subsequently worked on a World Allergy Organisation working group to make recommendations for implementation of allergy care pathways world-wide.
For 5 years, until 2019 I was the academic theme lead for the Early Year’s theme of the CLAHRC for NW London and applied my experience, gained in allergic diseases, to improve care for those with Sickle Cell Disease.