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an Economist Intelligence Unit business healthcare

Cleft Lip and Palate



East Midlands Specialised Commissioning Group



‘Service designation’ describes the rational selection of a provider or providers of a service for a defined local population. The process needs to be both evidence-based and consultative and is critical to the efficient commissioning and delivery of health services. If done robustly - by systematically collecting and analysing epidemiological, market and effectiveness data relating to the service, and with stakeholder input - it allows commissioners to drive improvements in quality and efficiency. It enables commissioners to develop transparent, clinically credible and quality-focused procedures to identify and work with the best providers and collaboratively agree the future direction of a service.


The problem

EMSCG commissioned Bazian to provide an evidence-based report to inform the process of designating Cleft Lip and Palate Services in their region.


Our solution

Bazian undertook a multipart analysis to address the needs of the EMSCG. A systematic review of the evidence was undertaken to generate a picture of the ideal service model. This was assessed in relation to the current model of service provision in the region, defined through consultation with specialists and third party sources. We also conducted a health needs assessment and epidemiological review and modelling exercise to estimate the current and future demand for CF services. We provided a set of draft quality indicators and service standards (grounded in the evidence), including recommendations for information reporting, which could be used to help inform commissioning decisions.

The empirical evidence for treatments of cleft lip and palate is limited. Consequently, the discussion of ideal care was largely and transparently based on expert opinion, much of it sourced from the grey literature. It was important that the findings, particularly the set of quality indicators and service standards, were fully endorsed by providers of cleft care in the region. This was particularly important with cleft lip and palate because of the weak scientific base for best practice. Our document was therefore seen as a focal point for collaborative discussion between commissioners and providers, with the shared aim to deliver a clinically optimal, practical and continuously improving service that is appropriate for the population it serves.


The outcome

In order to ensure that the cleft lip and palate service in the East Midlands remains of the highest possible standard, we encouraged the EMSCG to:

  • fill in the gaps around the current service that is being provided in the East Midlands (patient pathway, service model etc)
  • involve cleft surgeons and other specialties and stakeholders in a consensus process to agree on a set of quality indicators and standards using our evidence-informed suggestions as a framework
  • test the draft standards for acceptability, reliability, validity, sensitivity to change and feasibility (e.g. through audit and qualitative methods)
  • assess current providers against agreed standards
  • progress discussions around data collection specific to CLP surgeons (e.g. specialty code in HES data) so that activity and costs can be better tracked