Children born with a cleft lip and palate could face lifelong complications under plans to scrap specialist training, doctors have warned.
Surgeons say poor cleft surgery can leave children with permanent speech difficulties, problems with eating and drinking, and the need for repeated operations.
Concerns about the future of specialist training were first revealed by The Telegraph earlier this month, when senior surgeons warned that funding for highly specialised fellowships had been withdrawn.
Doctors and patient groups now say the decision risks undermining care for children born with cleft conditions, and risks “taking us back to the 1980s”.
The warnings centre on Training Interface Group (TIG) fellowships – highly specialised posts taken at the end of training for surgeons performing complex procedures spanning several disciplines.
Earlier this month, the Royal College of Surgeons of England wrote to the Department of Health and Social Care, along with a dozen other organisations, warning that the axing of central funding would put patients at risk.
Doctors say the programmes have been central to ensuring surgeons have the expertise needed to carry out delicate operations on very young patients.
Cleft lip and palate are among the most common congenital facial differences and require treatment beginning in infancy, with most children typically having surgery in their first year of life to repair the lip and palate.
Further procedures are often required later in childhood to support speech development, dental health and facial growth, leading to years of hospital appointments.
Specialists say the quality of the earliest operations is crucial because they influence how a child’s speech, eating and facial development progress over many years.
‘Backwards step’
Guy Thorburn, the chairman of the Surgical Network of the Craniofacial Society of Great Britain & Ireland, said ending the fellowships would be a “backwards step for cleft surgery”.
He said: “It risks taking us back to the 1980s, before there was a clear, structured, and nationally recognised pathway for training cleft surgeons.
“Cleft surgery is complex, sits at the interface of multiple specialities, and cannot be learned properly or safely without dedicated training.
If surgery is not carried out optimally, children can develop speech that is difficult to understand, leading to years of speech therapy and sometimes further corrective surgery.
Mr Thorburn added: “Removing TIG without a clear, equivalent replacement puts patient safety, workforce sustainability, and long-term outcomes at risk.”
Some patients also develop a fistula, a hole between the mouth and nose, which can cause food or drink to pass through the nose, making eating and drinking uncomfortable or painful.
Further operations are often needed to repair the defect.
Children born with a cleft may also have gaps in the gum that require bone grafts during childhood. If these procedures are unsuccessful, teeth may not grow into the correct position. This can lead to complex orthodontic treatment, pain and additional surgery later in life.
‘Lifelong pathway of care’
Claire Cunniffe, the chief executive of Cleft Lip and Palate Action, said specialist training was essential to maintain standards of care.
“For patients and families, cleft treatment is not a single operation but a lifelong pathway of care,” she said. “That requires surgeons with deep, specialist expertise developed through structured training that sits across multiple surgical disciplines.”
Tim Mitchell, the president of the Royal College of Surgeons of England, said: “TIG Fellowships have been a vital part of training cleft surgeons, ensuring they gain the highly specialised skills needed to deliver safe, high-quality care for children with cleft lip and palate. Ending national support for these posts without a clear alternative risks undermining the future workforce for cleft services.
“The same concerns apply across other complex surgical areas – from head and neck cancer to major trauma and breast reconstruction. A coordinated national approach is essential to make sure patients continue to have access to surgeons with the advanced expertise these services rely on.”