Public lecture “Is centralisation a panacea for all services?”

Since the implementation of centralised services in the United Kingdom 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, how does this affect patients? Little research has attempted to capture the patient perspective.

The views of adults who have undergone treatment both pre- and post-centralisation were sought, and the evidence suggests 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. There are other benefits regarding research and treatment efficiency.

However, do all services show similar improvements if their care is centralised?

There are arguments against centralising all care and these are based primarily on access for patients as well as deskilling decentralised units. Healthcare providers will also seek evidence that there are economic benefits in re-organisation of services as well as seeking improvements in outcomes. High income countries may realise benefits from centralisation but these may not apply to low and middle income countries.

In his lecture Professor Jonathan Sandy will discuss the benefits and challenges of centralisation from the views of health professionals and the effects of this on patients.

Biography:

Jonathan Sandy is a Professor in Orthodontics and previous Dean of the Faculty of Health Sciences at the University of Bristol.

Jonathan is also part of the Lifecourse Epidemiology and Population Oral Health Research programme at the University of Bristol. He supported the National Institute for Health Research (NIHR) funded programme (Cleft care UK) where researchers evaluated the impact of the centralisation of cleft services following the recommendations made by the Clinical Standards Advisory Group (CSAG) in 1998.

The study repeated and extended the original CSAG survey by reviewing the treatment and outcomes of children born with complete unilateral cleft lip and palate. It also examined the characteristics of cleft teams, and the economic impact of the centralisation of cleft services. Results of this study showed significant changes and improvements in overall cleft care in the UK since centralisation.

RSVP by Sunday 16 February