Date lodged: 19 December 2016
To ask the Scottish Government when it will announce its decision on the recommendation to consolidate the national cleft surgery service on a single site.
Answered by: Shona Robison 20 December 2016
Having considered the evidence, and stakeholders views, I am approving the recommendation to consolidate cleft surgery on a single site at the Royal Hospital for Children Glasgow, subject to strong conditions being met. My decision is founded on the need to provide a safe and sustainable cleft surgery for all patients across Scotland.
The Royal College of Surgeons Edinburgh and the Royal College of Physicians and Surgeons Glasgow, both support consolidation of cleft surgery on a single site due to concern that a single surgeon service, as currently exists in Edinburgh, is not sustainable in the long term.
There are about 100 new cleft cases each year in Scotland. Expert guidance recommends that each surgeon should complete a minimum of 40 new cases each year to get the best outcomes. Therefore we only need a maximum of 3 surgeons in Scotland and the caseload should be distributed evenly between them to get the best outcomes for patients. Consolidating cleft surgery on the single site will ensure the even distribution of cases across all three surgeons.
This will ensure that patients receive the treatment they need, when they need it. The single team will enable them to work together more closely, sharing best practice and learning from and supporting each other, to continue to improve and provide equity in outcomes for all cleft patients wherever they happen to live.
Glasgow has the additional services needed to deal with complex cleft surgery such as paediatric cardiac surgery and complex airways management co-located on one site, whereas Edinburgh does not.
My decision relates to cleft surgery only.
The wider teams involved in cleft care - including speech and language therapy, orthodontists, ENT surgeons, and paediatric dentistry - will continue to be delivered locally as they are now, across Scotland.
Concerns about supporting the recommendation to consolidate cleft surgery in Glasgow have been strongly expressed by some MSPs and families, particularly from the east of Scotland. They were concerned that the loss of local cleft services and outreach clinics and in particular, the loss of the Edinburgh surgeon if the recommendation is supported. I am acutely aware of the strength of feeling on both sides, and I have given all views careful consideration. Therefore, in approving the recommendation to consolidate cleft surgery in Glasgow, I have set out a number of conditions that aim to address stakeholders’ concerns. The conditions attached to the decision follow:
There will be a transition period of 6 months after which progress towards achieving the single surgical team will be reviewed.
During the transition period, the Edinburgh surgeon will be expected to operate in Glasgow no more than the equivalent of one day per week. Although this could increase, if all parties felt it helpful to the development of clinical care as part of a single national service, with outreach clinics continuing to be undertaken locally.
Cleft surgery service data collection and audit must be more robust and more complete. Scotland will participate more actively in UK Cleft Audit to inform and drive improvement in patient outcomes.
The Edinburgh surgeon will remain an NHS Lothian employee contract during the transition period and will have an honorary contract with GGC.
The surgical team will ensure a consistent approach to outreach clinics across Scotland, with no deterioration in service.
Local multidisciplinary outreach clinics will be supported by the national cleft surgery service and will be scheduled in discussion with local clinicians to ensure that each patient has all the necessary care and assessment carried out locally, prior to their surgery and follow up thereafter. The aim is to be as person centred as possible and ensure that the patient is seen by all the necessary clinical staff - at one visit - and not be required to have multi-visits.
The number of local outreach clinics will not reduce in number and will very much be determined by patient need.
All three surgeons will be expected to work collaboratively to agree their job plans. NHS Lothian and NHS GG&C will oversee the job planning process to ensure it is fair and transparent
The first 6 months will be a transition period and the above will be subject to review following feedback from all concerned parties.
As commissioner of all national services including cleft surgery, National Services Division (NSD) will monitor the implementation/transition and provide feedback to me.