CLAPA has written to the Government to warn that ending specialist training fellowships for cleft surgeons could pose a serious risk to the future sustainability and safety of cleft care in England.
We were alerted to the risk when The Telegraph published excerpts from a Royal College of Surgeons of England letter to the Department of Health – stating the decision to cut Training Interface Group (TIG) fellowships “with no warning or consultation” risked leaving the NHS without future doctors trained for complex procedures, including cleft lip and palate.
TIG fellowships are highly specialised NHS training programmes, which take place across multiple specialities and multidisciplinary teams at the end of a surgeon’s training – such as plastic surgery, ENT surgery, and oral and maxillofacial surgery for trainee cleft surgeons. The Royal College has warned that if no new surgeons enter the TIG training programmes it could lead to fewer NHS surgeons being able to take on complex work, including cleft surgery, when current surgeons retire.
Letter to the Secretary of State
In a letter to Wes Streeting MP, Secretary of State for Health and Social Care, CLAPA’s Chief Executive Claire Cunniffe said:
“Removing TIG fellowships without a robust national alternative threatens to weaken the pipeline of future cleft surgeons and threaten the consistency and quality of care that patients rely on.
“For patients and families affected by cleft, treatment is not a single intervention but a lifelong pathway of care.
“High-quality outcomes depend on surgeons with deep, highly specialised expertise developed through structured training pathways that sit across multiple surgical disciplines.”
TIG fellowships have historically provided an important national training pathway for surgeons entering cleft care. Any uncertainty in training pathways risks undermining patient safety and long-term clinical outcomes, including speech and dental issues.
High-quality outcomes depend on surgeons with deep, highly specialised expertise developed through structured training pathways that sit across multiple surgical disciplines.
CLAPA’s letter demands the Government and NHS England urgently set out what will replace the TIG fellowships, to ensure the continued training of high-quality cleft surgeons.
The letter sets out four major concerns: potential implications for patient safety and long-term surgical outcomes; long-term workforce sustainability within small specialised cleft teams; potential growing regional inequality if training pathways become inconsistent or unclear; and uncertainty during transition from TIG fellowships for current trainees, which may discourage them from considering a career in cleft surgery.
Surgeons’ response
The Surgical Clinical Excellence Network of the Craniofacial Society of Great Britain and Ireland membership includes all cleft surgeons working in England.
Guy Thorburn, consultant plastic surgeon and the network’s chair, said:
“Ending TIG fellowships is a backwards step for cleft surgery. 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 specialties, and cannot be learned properly or safely without dedicated training. Removing TIG without a clear, equivalent replacement puts patient safety, workforce sustainability and long-term outcomes at risk.
It risks taking us back to the 1980s, before there was a clear, structured and nationally recognised pathway for training cleft surgeons.
“Given the backlog that exists in Children Surgical waiting lists, having properly trained surgical consultants is vital. They’re able to treat a larger volume of cases with fewer complications, meaning better outcomes and less operations for our patients and helping bring down that waiting list and the cost for the NHS.”
CLAPA is waiting for a response from the Secretary of State and hoping to meet with him, or a member of his ministerial team, to discuss these concerns – and ensure the voice of the cleft community is considered when decisions about the future of surgical training are made.
Please see below for our official Position Statement on this situation, and a link to the letter sent to Rt Hon Wes Streeting MP, Secretary of State for Health and Social Care:
CLAPA Position Statement: Ending of Training Interface Group (TIG) Fellowships for Cleft Surgeons
CLAPA is deeply concerned by the decision to end Training Interface Group (TIG) fellowships for cleft surgeons. This decision presents a serious risk to the future sustainability, safety and quality of cleft surgical care in the UK.
This decision was taken without consultation with the cleft community or cleft clinical teams. At present, neither CLAPA nor cleft services have clarity on what, if anything, will replace the TIG pathway, creating significant uncertainty for trainees, services and patients.
Cleft surgeons are highly specialised clinicians whose training sits at the interface of Oral and Maxillofacial Surgery, ENT Surgery and Plastic Surgery. TIG fellowships have played a vital role in supporting this complex pathway, enabling surgeons to develop and demonstrate competence across overlapping specialties and life-long cleft care.
The loss of this structured national training route risks weakening the cleft surgical workforce and narrowing the future training pipeline.
From a patient safety and outcomes perspective, this is particularly concerning. Cleft surgery involves complex, staged interventions delivered over many years, often from infancy into adulthood. High-quality outcomes rely on surgeons with deep specialist expertise and experience. Any dilution, fragmentation or uncertainty in training pathways risks undermining safety, long-term outcomes, ability to meet the requirements of the National Service Specification and continuity of care.
There are also serious workforce planning implications. It is unclear whether a formal workforce or impact assessment has been undertaken to understand how ending TIG fellowships will affect the future supply of cleft surgeons. Without a clear, funded and nationally recognised replacement, there is a real risk of future shortages, increased pressure on existing surgeons, and reduced resilience within cleft services.
CLAPA is also concerned about equity of access. A weakened or inconsistent training pipeline risks exacerbating regional variation, with some areas struggling to recruit or retain appropriately trained cleft surgeons. This would undermine the principle of equitable access to high-quality cleft care regardless of where someone lives.
There is currently no clarity on transition arrangements or timescales. It is unclear how new cleft surgeons will be supported, or whether there is a risk of a gap in training capacity while new arrangements are developed. This uncertainty risks deterring future trainees from entering an already demanding and highly specialised field.
There are also unanswered questions around funding, governance and accountability. It is unclear where responsibility for cleft surgical training now sits at a national level, how any replacement pathway would be funded, or how standards would be monitored and enforced without the TIG framework.
CLAPA is clear that if TIG fellowships are ending NHS England, the Department of Health and Social Care and the Government must urgently set out what is replacing them. Any replacement must be transparent, nationally consistent, adequately funded, and provide training that is equivalent to or stronger than the TIG pathway. Crucially, it must protect patient safety and secure the long-term stability of the cleft surgical workforce.
CLAPA will be actively engaging with the government decision-makers to press for clarity, accountability and action. The cleft community cannot afford uncertainty or erosion of specialist expertise.