Alder Hey Children's Hospital
The Liverpool Craniofacial Unit
Who we are?
The Liverpool Craniofacial service was designated in 1997 having been founded in the 1980’s by Roger Cudmore a Paediatric General Surgeon with an interest in Neurosurgery and Oldrich Pospisil, a consultant in Maxillofacial Surgery with an interest in Craniofacial Surgery. In 1991 Roger Cudmore’s involvement with the service was taken over by Paul May a Paediatric Neurosurgeon with an interest in craniofacial surgery and in the succeeding 6 years the service was built up to the point that it was sufficiently proximate to the craniofacial standards at the time that in the final round of designation the Unit received a Supraregional status from the National Specialist Commissioning Advisory Group in 1997.
Since then the Unit has gone from strength to strength increasing the number of cases that it does and their complexity, innovating new techniques developing outcome measures and promoting patient experience.
The Unit today is fully compliant with all of the National Craniofacial Standards, has a comprehensive team who are able to meet all of the challenges for craniofacial patients and aims to provide the highest quality to craniofacial patients across the full spectrum of the specialism.
What we do?
Out Team has been constructed to meet the needs of the Craniofacial Contract which covers all forms of craniosynostosis, craniofacial syndromes, complex clefts and encephaloceles.
Having said that many of our team members have other sub-specialty interests. We also provide a specialist autologous ear reconstructions services through a multidisciplinary ear reconstruction team, a complex facial deformity service for management of facial asymmetry including from Treacher Collins Syndrome, Hemi-facial Microsomia, Neurofibromatosis and Vascular anomalies, a complex skull base reconstruction team for management of paediatric skull based tumours, a facial reanimation service and a trauma reconstruction service.
We look after all of our patients from birth to adulthood and our patients are provided with the opportunity to transition to adult services at the appropriate time. We have close relationships with Aintree University Teaching Hospitals and the Walton Centre for Neurology and Neurosurgical Care and are able to discharge complex reconstruction services in both of those sites.
Alder Hey Children's Hospital
About Alder Hey:
Alder Hey Children’s NHS Foundation Trust provides care for over 275,000 children and young people every year. Alder Hey delivers clinical excellence for all children, for routine illnesses as well as very complex and rare conditions.
One of four stand alone children’s hospitals in the UK, it is a national centre for neuro and craniofacial surgery, a regional centre for burns injuries and a Centre of Excellence for children with cancer, heart, spinal and brain disease. The Trust is one of only four epilepsy surgical centres in the UK and one of only two accredited major trauma centres in the North West. Alder Hey is also a respiratory Extracorporeal Membrane Oxygenation (ECMO) surge centre and is in all options put forward to be a national centre for cardiac surgery under the ‘Safe and Sustainable’ review. It became the first UK Centre of Excellence for Childhood Lupus in 2010.
Alder Hey is the first accredited Investing in Children hospital in the UK. It has a dedicated patient experience programme which includes the award winning Alder Hey Arts involving music therapy, dance programmes, storytelling and animation projects. It is also one of a few hospitals to have a Children and Young Person’s Forum.
In October 2015 Alder Hey moved into a new state-of-the-art hospital, ‘Alder Hey in the Park’. It was built with input from children and young people and provides a purpose-built, unique and world-class healing environment for children and young people. It has 270 beds, including 48 critical care beds for patients in ICU, HDU and Burns, together with 16 digitally enhanced operating theatres. The majority of children and their families will have their own room with en-suite facilities and each ward will have its own kitchen providing freshly cooked food to order.
Europe’s only hospital in a park, the unique design of the building will provide a pleasant healing environment for children and young people. Almost all bedrooms have park views and patients will have easy access to play areas on and outside their ward.
Alder Hey is supported by The Alder Hey Children’s Charity which was launched in 2012 and has supported the building of the new hospital. For more information visit www.alderhey.nhs.uk and www.alderheycharity.org
Getting in touch
We adhere to the model of one service on 4 sites and take referrals from GP’s, secondary providers and tertiary providers. In addition we are happy to hear from patients directly and while we will always encourage a GP referral we are happy to provide advice on how best to facilitate this particularly when, as has been our experience, patients have been incorrectly told that they cannot have a referral.
‘I think my child has a Craniofacial Condition’ – What Next?
The first step is to get in touch with us, which is most easily done through your GP, Paediatrician or if necessary at our email address provided below. Once we have understood what the problems are we can then advice on the next steps which may involve a review in one of clinics and we take things from there.
We treat all forms of craniosynostosis, complex craniofacial syndromes, encephaloceles and craniofacial clefts and mal-position of the eyes as well as the services mentioned above.
Our policy as a Supraregional Service is to offer an appointment to anyone who chooses to exercise their right to come to our service with a craniofacial condition irrespective of which part of the UK they come from. We do this in an open way and are committed both to providing an accessible service as well as balancing patients wishes to come to our service against interests which they may have in attending a regionally more local service. On this basis we would always advise patients to seek an opinion with their nearest craniofacial provider first and on this basis we aim to work with patients and families on a partnership model aimed at providing as much choice as possible to families presenting with craniofacial
Maintaining Quality of Care
Quality of Care
Quality of care and safety of service are of paramount importance to the Craniofacial Service at Alder Hey. Specific initiatives developed at Alder Hey include a 10 year rolling programme of blood transfusion use in craniosynostosis surgery, the innovation of 3D photography as a tool for judging outcome in craniofacial surgery and the use of patient experience tools like FABIO for receiving and acting on feedback about our craniofacial service.
In addition to these initiatives we comply with all of the National Craniofacial Standards, attend meetings, contribute nationally and internationally to craniofacial research and also provide a range of local teaching and support activities in order to promote best practice in craniofacial care within our region.
We are always interested in interacting with the community of users of craniofacial services and we are very proud to be invited to present our service at the annual Headlines Patient Support Group Meeting in Coventry this year and have done so on a number of occasions in the past.
How is Quality of Care Maintained?
We maintain quality of care from initial presentation and throughout the patient journey. At its highest level we aim to do this by constructing our service according to the set standards and monitoring within the quality standards of Alder Hey Children’s Hospital and within the value structure to which we adhere within our organisation.
On a more face to face level we aim to be an accessible, friendly, confident and expert service which gives assurance to patients that they will be able to trust us to do the best for them in every circumstance.
This begins with a referral and a commitment to review patients in a timely fashion where possible so that the simplest treatment programme can be used if a patient has a time critical condition. We use a variety of clinics ranging from nurse led clinics to fully multidisciplinary clinics where the patient and family will meet the whole team and we aim to use information leaflets where possible. Multiple opportunities to ask questions, a specialist set aside time with our specialist nurses and access between visits by email or telephone if anxieties arise are always provided.
All patients get regular head measurements, radiological assessments when necessary, respiratory assessment, 3D photography almost always, genetic screening, speech & language and developmental assessments according to set protocols and feeding and hearing assessments together with a package of dental care, such that we aim to maximise the potential for every child who presents to the service no matter the complexity of the condition. This includes support of essential functions including breathing, seeing, hearing and feeding as necessary, and often from the outset in complex conditions.
We pride ourselves on our safety record in theatres, our transfusion data, our outcomes according to head measurements and other measures of quality and our commitment to improving the service all of the time.
Ultimately quality of care can only be maintained and improved through a culture of transparency and openness and we are committed to listening to our patients and families and improving the service in areas where they have told us that it needed improving. This again is a partnership model which we aim to foster at all points of the service.
We have a comprehensive team consisting of a core group of Neurosurgeons, Maxillofacial Surgeon and Plastic Surgeons with support from Ophthalmology, ENT, Hand Surgery, Genetics, Orthodontics and Dentistry, Radiology and Respiratory Medicine. In addition Speech & Language, Psychology and Specialist Nursing and input are made available to all patients presenting to the service.
We have the privilege of operating in a state of the art theatre equipped with an intraoperative MR scanner and supported by a team of specialist theatre staff and anaesthetists.
Pictures and short biographical details of our team members are provided.
The Multidisciplinary Team
Christian Duncan graduated in 1991 from University College Dublin and undertook basic surgical training in Dublin, gaining his general fellowship in 1995. He undertook higher surgical training in plastic surgery in the UK in 1996 and pursued fellowships in Tissue Engineering at the School of Dentistry in Birmingham, Craniofacial Surgery in the West Midlands Supra Regional Craniofacial Unit and Aesthetic Surgery at the Wellington Hospital, London. He was awarded an MPhil for research in tissue engineering of skin in 2002.
He was appointed as a consultant Plastic Surgeon at the renowned Alder Hey Children’s Hospital in 2004 where he was lead plastic surgeon and lead burns surgeon for 4 years. He joined the Merseyside Supra Regional Craniofacial Team in 2005 and became the clinical lead of that team in 2010.
Mr Duncan performs between 70 and 80 mostly transcranial craniofacial cases per annum and leads 5 multidisciplinary craniofacial clinics per month in one of the busiest craniofacial units in the world. He regularly chairs craniofacial sessions for the British Association of Plastic, Aesthetic and Reconstructive Surgeons and has been an invited speaker at numerous advanced training courses.
His clinical interests include all aspects of craniofacial surgery, particularly for congenital anomalies. Research interests include tissue engineering, cell delivery systems, bone cements and clinical outcome assessment using 3D photography.
Specialities-Paediatric neurosurgery, Craniofacial Surgery, Pituitary Surgery and Skull base Surgery. I have been a member of the craniofacial team since 2006 and I have been running adult multidisciplinary pituitary clinic since 2008.
My clinical and research interests are in craniofacial surgery and endoscopic anterior skull base surgery. I have been active in presenting and publishing scientific papers in my field of interest.
Sasha works in Paediatric Neurosurgery at Alder Hey and Fetal Medicine Unit at Liverpool Women’s Hospital.
Her clinical interests include Epilepsy Surgery, Craniofacial Surgery, Fetal Central Nervous System Anomalies and Antenatal Counselling and General Paediatric Neurosurgery.
Chris Parks has been working as a Consultant Paediatric Neurosurgeon in Alder Hey Hospital since 2013. He subspecialises in craniofacial surgery, paediatric spinal disorders, neuro-endoscopy and paediatric neuro-oncology.
He attended Imperial College at St Mary’s Hospital Medical School in Paddington, London. He did basic surgical training in the Wessex region before completing a neurosurgical training programme in the North West. Following this he did a fellowship in Paediatric Neurosurgery in Alder Hey Hospital and has travelled to Units in Rotterdam, Memphis and Uganda in order to further his experience.
Read dentistry and medicine in London, followed by surgical training posts in London, Sussex, Plymouth and Liverpool, including a travelling fellowship in Oslo. He was appointed consultant maxillofacial surgeon in Liverpool in 1995, with a sub speciality interest in management of facial deformity. He worked in the Liverpool paediatric craniofacial unit at Alder Hey hospital since 1995, before during and after designation as a supra regional service, and developed the technique of distraction osteogenesis in Liverpool both for craniosynostosis and for first and second branchial arch anomalies and other conditions. He has developed, with colleagues, a service for management of microtia and acquired ear deformity requiring ear reconstruction, providing the surgical reconstructive procedures. Other areas of practice include orthognathic surgery and management of nasal deformity, developing a nasal MDT with colleagues at Aintree hospital. He leads the adult craniofacial service based at Aintree Hospital.
Su graduated in New Delhi, India, in 1995. Her surgical training in ENT was in the West Midlands and the Mersey region. In 2006, she was Paediatric ENT Fellow for a year at Great Ormond Street Hospital, London. She followed this with a Royal College of Surgeons Travelling Fellowship to other Centres of Excellence in Paediatric ENT in the USA. She became a Consultant in Paediatric ENT at Alder Hey in 2007.
Her specialties and areas of interest are paediatric airway problems and surgery, the ENT aspects of Craniofacial conditions, Microtia and Bone Anchored Hearing devices (BAHDs) and middle ear disease in children.
She is a member of the Supra-regional Craniofacial Team at Alder Hey as well as the Multidisciplinary Microtia Team. She runs a bone anchored hearing aid clinic, a dedicated clinic for children with Downs syndrome and oversees a nurse-specialist delivered rapid access tongue tie clinic.
Bsc Hons Clinical Language Science, RCSLT, HPC registered
Wendy graduated in 1994 as a speech and language therapist (SALT). Working initially in the community for 3 ½ years, she started working at Alder Children’s Hospital in 1997. Wendy has advanced training in dysphagia management in paediatrics.
Wendy is the lead SALT for the craniofacial service and deputy lead for the SALT department at Alder Hey.
Wendy’s areas of specialty include speech, language and feeding difficulties for children with congenital craniofacial conditions, acquired brain injury and neuro oncology. As well as providing an inpatient service for children from birth, with acute feeding difficulties.
Wendy co-runs weekly multidisciplinary feeding clinics for children with congenital cardiac disease and regular videoufluroscopy clinics with consultant radiologists.
Wendy also chairs the regional Head Injury Rehabilitation Team meetings on a weekly basis as part of the multi-disciplinary rehabilitation team.