Cleft

Programme aims

The programme is aimed at those who wish to extend their clinical expertise in cleft lip and palate care within Evelina London.

The aims of the programme include:

• The opportunity to have direct experience and exposure to our surgical team in the operating theatre, multidisciplinary cleft team clinics, individual cleft clinical specialists (e.g. dental, specialist nursing, orthodontic, speech therapy, psychology) and ward rounds within a unique cleft service
• Access to the clinical nurse specialist team to view their work in the community and in the hospital alike
• If possible, attendance at outreach multidisciplinary team clinic
• Participation in multidisciplinary team meetings
• Access to departmental seminars and teaching sessions as well as any and national meetings / conferences that align with your visit
• The opportunity to develop networks and close links for future close working relations through peer mentorship throughout the programme from a named mentor
• The opportunity to complete specialty projects and research with a view to submission for peer review

Individual weekly timetables will be created depending on each visiting professional’s requirements and will certainly involve access to the multidisciplinary clinics and those run by the individual cleft specialists in dental, clinical nurse specialist, orthodontic, speech therapy and psychology.

A Certificate of Attendance will be awarded to visitors upon the end of their programme.

Format

The Cleft programme is delivered within the hospital work place and it includes exposure to clinics, inpatient ward rounds, multidisciplinary team meetings, depending on the length of programme that visitors request.

Visiting professionals will be aligned with supervisors from within the clinical teams who will facilitate agreed learning and development needs. We would expect visiting professionals to be totally integrated in the day to day service within our cleft team.

We will also provide visitors with the opportunity to get involved in research and improvement projects.

Who can apply

This programme is intended for non-U.K. clinicians from any of the specialities linked to the cleft team including senior residents or attending consultants with an interest in cleft lip and palate care.

Visitors have the choice of applying for a hands-on attachment or observership programme. Those wishing to apply for a hands-on attachment must have GMC registration. You can apply for GMC registration directly through the main GMC website, alternatively The Royal College of Physicians run a medical training initiative which facilitates GMC registration and provides sponsorship for a Tier 5 visa. You can find out more about their Medical Training Initiative by visiting their website.

Programme duration

It is recommended that in order to get the most out of the Cleft programme, that visiting professionals undertake an observership placement of at least 2 weeks. However, the programme’s duration can be tailored to the specific learning requirements of those visiting the Trust

Cleft service

All children born with a cleft lip and/or palate in Surrey, Kent, Sussex and south London are referred to our service based at Evelina London. This may be following a diagnosis of cleft lip made at the 20 week scan during pregnancy or after birth. The CNS team respond to the referrals within 24 hours, providing an on call service at weekends and Bank Holidays.

Older children that have palate problems but who do not have an obvious cleft may also be referred. These may be identified from symptoms such as frequent nasal regurgitation as a baby and/or nasal sounding speech as the child gets older.

Surgery to repair the baby’s cleft is carried out at Evelina London and adult surgery is provided at GSTT. Outpatient clinics are held at our purpose built cleft unit at St. Thomas’ Hospital and at our six regional outreach clinics.

Around 140 new babies born with cleft lip and/or palate are referred to our service every year. Adults who have previously received treatment are also referred to us as we also host a comprehensive adult service.

Surgical treatment

In the UK, most centres work to the same protocol:

• the cleft lip is usually repaired between three and six months of age
• the palate is usually repaired from six to 12 months of age

These are procedures that are both completed under a general anaesthetic and the child will often be in hospital for one or two nights after their surgery.

Cleft lip and palate outpatient clinics

Our headquarters are based at:

• London – St Thomas’ Hospital

We have full outreach clinics at:

• Brighton – The Royal Alexandra Children’s Hospital
• Canterbury – The Kent and Canterbury Hospital
• East Grinstead – The Queen Victoria Hospital
• Gillingham – Medway Maritime Hospital
• Guildford – The Royal Surrey County Hospital
• Worthing – Worthing Hospital

Clinical Nurse Specialists (CNS)

Following antenatal diagnosis of an orofacial cleft, one of the clinical nurse specialists will make contact with the referring hospital / family within 24 hours of referral, to answer any initial questions, and to arrange an appointment to offer information, support and help to prospective parents. Families are seen again nearer to the expected date of delivery, to develop a plan for feeding following birth.

Following postnatal diagnosis of an orofacial cleft, one of the clinical nurse specialists will visit the baby and parents within 24 hours of referral, to make a comprehensive assessment of the baby. The CNS will develop a feeding and cleft management plan with parents, medical and nursing staff, and offer information and support to parents of babies born with a cleft.

The CNS team works closely with the nursing and medical staff in the maternity unit at St Thomas’ Hospital and also at our partner maternity units around our regional network.

The cleft Clinical Nurses Specialists help manage the baby’s care both in hospital and following discharge home into community. They CNS continues to see the family at home to support parents and monitor and manage their baby’s feeding, growth and development.

The CNS team provide specialist cleft support in addition to the routine care that the midwife and health visitor offer.

The CNS team also provide peri-operative support, assessing the baby’s readiness for surgery, ensuring investigations are carried out appropriately, and liaising with other health professionals. The team provides ongoing support through admission, surgery and post-operative assessment and care.

Speech and language therapy

Children born with cleft lip and palate or isolated cleft palate, are seen for assessment by a specialist speech and language therapist.

If a child has a cleft lip only, individual appointments with the speech team are not required. However we are always available at the cleft clinics, if parents have any concerns about their child’s speech

Monitoring speech and language

Around the time of palatal surgery parents will be given early advice regarding speech and language development. This is often around the time that their child is starting to babble so we will discuss ways to encourage sounds and give information on how the palate works during speech.

We see children at set stages of their development for speech assessment to assess the development of their speech sound system and to monitor their velopharyngeal function for speech:

• 2 years old, so we can begin to see how their speech and language is developing
• 3 years old for further speech assessment.

We will also carry out speech recordings of a child when they attend their cleft clinic appointment at the ages of five and possibly at 10, 15 and 20.

Depending on a child’s needs, at any stage of their development we may offer:

• Assessment appointments
• Speech sound therapy
• Diagnostic therapy
• Specialist objective investigations of their velopharyngeal function for speech.

Restorative/Paediatric Dentistry and Orthodontics

Children with a cleft lip/palate are introduced to the children’s dentist or orthodontist when they visit the cleft palate clinics.

The children’s dentist helps children with a cleft maintain healthy teeth. This is done by giving lots of preventive dental advice from very early on in the child’s development right through to 16 years. We will liaise with the child’s local dentist and will help to provide any necessary treatments.

Beyond 16 years old, patients may also access our adult restorative dental care services where required and receive options to manage their concerns. The restorative dental care required for some groups of patients, particularly adult patients who are returning to access the cleft service, can often be complex and require a multi-disciplinary approach.

The orthodontist monitors the growth and development of the child’s teeth and jaws and coordinates the taking of photos, models and x-rays throughout the child’s development. The specialist orthodontic team may provide care at the cleft headquarters for orthodontic treatment or they may liaise with another cleft specialist orthodontist in a partner hospital unit nearer to the child’s home.

Clinical Psychology

The Clinical Psychology team within the South Thames Cleft Service provides psychological support for individuals and the families of individuals with cleft lip and/or palate.

The Clinical Psychologists meet with individuals experiencing difficulties in relation to cleft which have either a direct or indirect impact on their psychological well-being and aim to provide a specialist support service which specifically addresses the range of cleft-related difficulties commonly encountered.

Some of the issues that may be addressed can include helping ante-natal and post-natal concerns (including support around the diagnosis of cleft), helping individuals to deal with other people’s questions and comments or bullying and teasing, difficulties with confidence and self-esteem, appearance concerns, decision making and treatment planning, support around surgery, anxiety and worries and low mood.

Example Timetable

Fees

A course fee per week will be applied; this fee excludes accommodation and travelling expenses. To find out the fee amount please email [email protected].

Please note

Clinicians are able to offer bursaries or discounted placements on an individual basis. This is at the discretion of the Directorates of GSTT and does not affect the terms and conditions of the Visiting Professional Programme agreements.