Cleft palate late diagnosis

13th December 2012

 

I welcome the report released today that highlights a difficult problem that surgeons and cleft teams working in this area have been aware of for some time. Since cleft palate alone is not usually visible on the routine ultrasound that mothers have during pregnancy, we are reliant on the condition being detected quickly by the obstetric or children’s doctor teams in maternity units throughout the country. Unfortunately, despite all babies being examined routinely at this stage, it is sometimes not easy to see the whole palate unless considerable care is taken with the examination. With all the joy surrounding the delivery of so many children, this important aspect of examination can slip though the net, and from time to time babies can suffer from difficulty feeding and subsequently speaking normally until the condition is corrected.

Our cleft team includes nurse specialists who not only visit far and wide to see new babies at an early stage, but also take some responsibility for delivering educational sessions for midwives and others throughout our region. Despite this, staff in delivery units and paediatric teams are constantly changing, and the process of education is never ending, much like painting the Forth Bridge! Because cleft palate can be quite difficult to visualise in some circumstances (especially if another condition makes examination less easy), it is probably that we will never completely eliminate the late diagnosis of some babies’ condition. However, we, along with all cleft teams and others involved in the care of the newborn, will continue to strive to improve the service across the UK and aim to maintain the delivery of what is already probably the finest management of cleft children around the world. 

The reports today do seem to make more of this matter than is probably reasonable.  Although there is some delay for a certain number of families, these children usually remain in the safe care of the maternity units, and the majority are seen within a short period of time – even though that might be beyond the arbitrarily imposed UK cleft team’s guidelines of 24 hours. There will always probably be some circumstances in which it proves difficult for the nurse specialists or other cleft team member to reach the baby within 24 hours, but the ‘hub & spoke’ network of cleft care across the UK usually means that there will be someone with an acceptable level of skill to be present in a reasonable time. It is the more prolonged delay in diagnosis that gives us most cause for concern, and efforts will be renewed to address this problem in coming months. 

I would welcome the opportunity to meet with representatives of the midwifery, obstetrics and gynaecology, and paediatric specialties to discuss further how this matter might be addressed.

Tim Goodacre
Chair, Professional Standards Committee
 

 

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