It was interesting that you chose to lead an article on the centralisation of cleft palate services with a comment that patients will have to travel further to access treatment ("Plan to centralise treatment for children with cleft palate", September 30).
Although this is the case, given that cleft palate treatment for all Scottish patients is available only in Glasgow and Edinburgh, centralisation is unlikely to make a difference to journey times of much more than an hour.
These procedures are highly specialised and performed on a small number of children, and it makes sense to concentrate national expertise in a unit doing as many of these procedures as possible. Success in surgery is a team sport, and requires as much familiarity as possible with procedures from surgeons, anaesthetists, nursing staff, and other members of the hospital team to maximise the chance of a positive outcome.
A small increase in journey times for a relatively small number of patients and parents is a price worth paying if it means operations are taking place in a concentrated centre of excellence; that is where I would like my child to have their operation, were they ever in that situation, rather than in a peripheral hospital performing a specialised operation a few times a year.
Dr Alistair Maddock,
18 Auldhouse Road,
Glasgow.
2.
With regard to your article, I wonder if individual surgical outcomes are being considered, given that any proposed changes are said to be only for best patient care.
Will all outreach clinics really be preserved? How much money will this review have cost, only to destroy services which NSD have actually said provide "good outcomes across the country"?
I wonder how the process has engaged with the families it will affect, as there seems to have been minimal patient consultation?
Such changes to services should always be driven by what is best for the patient and family.
From personal experience, I know of two families who have benefitted from the first-rate care at Edinburgh Royal Hospital for Sick Children, and have not needed any further surgery. I do not know if either have been made aware of the proposed changes.
Joyce Morton,
45 Victoria Park Drive North,
Glasgow.
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