1. CSAG II Research into the impact of the reorganisation of cleft services (NIHR) Jonathan Sandy

2. CSAG I – why did it happen? Jonathan Sandy Royal Colleges Department of Health Clinician Groups Parent and Patient Groups

4. Evidence – not much but Eurocleft – Comparison of 6 European Centers Data published in 1991

5. The Clinical Standards Advisory Group Cleft Lip and Palate

6. Process data Outcomes Patient and Parent views

7. CSAG Twelve Year Olds I II III Data is prior to 1998

8. Alveolar Bone Grafting Oslo n=157 CSAG

9. UK CSAG Data is prior to 1998

10. Intelligibility5 year olds12 year olds Normal19%47% Different30%34% Provokes Comment32%15% Unintelligible19% 4% Speech

11. Patient and Parent Satisfaction

12. Published in 1998

13. CSAG Compelling evidence from a detailed and meticulous study Recommendations unanimous Recommendations accepted by Government Recommendations consistent with centres from abroad

14. Recommendations 57 cleft units to be concentrated in 8-15 centres

15. Audit from 3 Regions Data from 2003

16. Audit from 3 Regions Data from 2003

17. Mike Wake Annals of The Royal College of Surgeons Increased volume = Improved Outcomes

18. Research Strategy  CFSGBI – Research and Audit Leads  Workshop in RCTs – March 2005  Funding opportunities – Healing Foundation

19. Research leads Andy NessSteveThomas Lifecourse DeterminantsNutrition and Cancer

20. The Research Team Sam Leary Charlotte Atkinson Andrea Waylen Alex Griffiths Martin Persson Statistics Nutrition Psychology Statistics Project manager More posts with NIHR programme…

21. NIHR programme  Workshops and strategy  Systematic reviews  Care and outcomes for cleft children

22. CSAG-II  Concentrate on 5 year olds for outcomes  Speech, hearing, oral health, dento – alveolar relations etc  Parental and team questionnaires  Process and infrastructure

23. Funding  Bill Shaw $6 million NIH  Andy Ness £3 million NIHR  Healing Foundation £2 million  MCRN support costs – Sally Davies