Centralisation of cleft lip and palate services in the UK: The views of adult 'returners'

2018 
Background: Since the implementation of centralised services in the UK for those affected by cleft lip and/or palate (CL/P), several studies have investigated the impact of service rationalisation on the delivery of care. While large-scale quantitative studies have demonstrated improvements in a range of patient outcomes, and smaller studies have reported on the benefits and challenges of centralisation from the views of health professionals, little research has attempted to capture the patient perspective. Further, few studies have investigated the views of adult ‘returners’ who have undergone treatment both pre- and post-centralisation. Methods: Qualitative data relevant to the subject of this paper were extracted from two previous larger studies carried out between January 2013 and March 2014. A total of sixteen adults born with CL/P contributed data to the current study. These data were subjected to inductive thematic analysis. Results: The findings suggest that centralisation of CL/P services has considerably enhanced the patient experience. Specifically, the overall standard and coordination of care has improved, service delivery has become more patient-centred, and access to professional psychological support and peer support has greatly improved patients’ capacity to cope with the associated emotional challenges. Conclusions: The data collected provide additional insight into the impact of centralisation from the perspective of a largely unexplored patient population. In combination with other literature, these findings are also relevant to future efforts to centralise other specialist services around the world. Keywords: centralisation, adult, patient perspective, qualitative, healthcare
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