I spoke in the Member's Debate in Parliament last night, in support of the retention of Specilaist Surgical Cleft Services in Edinburgh. The text of my full speech is below, and you can view the video of my speech here: goo.gl/tEVviJ


I appreciate the opportunity to take part in this debate on the centralisation of cleft lip and palate surgery, and I thank Miles Briggs for bringing this important issue to the Parliament. I have an interest in the matter, because I have constituents who will be directly affected by the proposal to move the service.


The minister will be aware that the current provision of specialist cleft surgical services at the Royal hospital for sick children in Edinburgh is exemplary. The recent consultation and report, which found that the best decision would be to centralise services in NHS Greater Glasgow and Clyde, does not take fully into consideration the impact that the change would have on families who rely on the service in the east of Scotland.


We must also take into consideration that the service that is provided in Edinburgh is led by a pioneering and world-class surgeon, whose record of excellence speaks for itself. In Edinburgh, a multidisciplinary team works side by side with patients and the surgeon to ensure that everything runs smoothly and progress is made after every surgical event. Patients know that they can rely on the hospital to get the job done. Those are all valid reasons why the Government should consider ensuring that support services are retained in Edinburgh.


I can say with confidence that my constituents who will be directly affected by a move are dismayed that the service will not be provided as close to them as they need it to be. I have a great deal of sympathy for them in opposing the service’s move to Greater Glasgow and Clyde, and I ask that centralisation plans be paused, to allow for further consideration and to ensure that the specialist expertise, knowledge and care that have been built up in Edinburgh are not lost.


I understand that change can be a good thing and that there are financial pressures on NHS boards throughout the country. It is my opinion that, in this instance, having a surgical team in a single area bodes well for the provision of services in the long term. However, the removal of services from Edinburgh presents a geographical deficit and the real possibility that world-class surgeons will not be able to relocate.


I have been in touch with my constituent for some time about her concerns over the proposal, and I have raised the issue with the cabinet secretary on more than one occasion. It is understandable that my constituent is worried about the impact that the move will have on her family in the short term. Patients who must move from one area to another sometimes feel as if they have to start again. The moving of clinical notes from one health board area to another might give staff in the new area insight into the patient and their history, but that does not mean that staff really know the patient. All the relationships that have been built up, sometimes over many years, potentially have to be rebuilt from the ground up.


If I put myself in the position of a young child who is facing surgery to enable them to have a better quality of life, I can see that surgery must be a very daunting prospect. The upheaval of having to be treated in an unfamiliar hospital must be an added and perhaps unnecessary stress.


I have been contacted by retired consultant plastic surgeon John Howard Stevenson. He was adviser to the chief medical officer on cleft surgical services, and was clinical director of specialist services in NHS Tayside, which included the disciplines in reconstructive plastic surgery and dentistry that are crucial to successful outcomes in cleft lip and palate reconstruction. During his period in office, services were centralised in Edinburgh and Miss Felicity Mehendale was appointed consultant with responsibility for those patients.


Mr Stevenson wrote to me to say that the clinical evidence supports the retention of services in Edinburgh and that the service that that world-class surgeon has built up in Edinburgh is not only one of the best in the United Kingdom but recognised as being of an international standard. He wrote, of Miss Mehendale:


“Since her appointment, she has developed a service for patients with cleft lip and palate in Edinburgh serving the East of Scotland which has delivered the highest quality of service as evidenced by the internationally agreed outcome standards within this discipline.


These results ... clearly demonstrate consistently higher results than anywhere else in Scotland and on a par with the best Internationally; to achieve these, it is essential to build up a close team involving specialties such as speech therapy, and Felicity has been very successful in building up and maintaining such a team; further, patients and their families have the highest regard for her and her team.


To relocate cleft services from Edinburgh, centralising in Glasgow, will undermine an outstanding service, and goes against the overwhelming clinical evidence—which, surely, must always be the defining factor in deciding where a service should be located—which unequivocally confirms Edinburgh as the base from which patients undergoing cleft lip and palate repair in Scotland can expect the best outcomes.”


Presiding Officer, I realise that I am out of time, although I had more to say.



I urge the cabinet secretary to seriously consider the option of retaining this world-class service in Edinburgh.

Copyright © Angus MacDonald MSP 2017

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