Directory of European Resources > Eurocleft Clinical Network > Registered Clinical Teams > Spain

Clinical Teams in SPAIN

Barcelona (Hospital Sant Joan de Déu) Barcelona (Hospital Universitario Materno Infantil Vall D'Hebron) Bilbao Cordoba

La Coruña Madrid (Hospital Materno Infantil 12 de Octubre) Madrid (Hospital Niño Jesus) Madrid (Universidad Europea)

Murcia Palma de Mallorca Santiago de Compostela Tenerife Valencia

Population
Approximately 39.1 million.

Health Service
In each autonomous community there is a health service encompassing all centres and services. Each community health service is organised around geographical units or health areas. The National Health System provides services for the whole population with costs being met by a mix of government funds, user contributions and fees for certain services eg. pharmacy. There is a National Quality Assurance Programme.

Cleft Care Organisation
Spain has approximately 651* new cases of cleft lip and/or palate per year. The National Health Service in Spain provides surgical treatment, however orthodontic treatment and speech therapy are not generally provided in the hospitals. Treatment is also given privately by individual surgeons without any team participation. A recent survey of cleft treatment in Spain reports that primary surgery is being performed equally by plastic, paediatric and maxillofacial surgeons. 36% of surgeons operate less than 10 new cases per year.

Challenges to Attaining the Eurocleft Consensus Recommendations
Since 2000, there is a national craniofacial association for professionals and also a parents’ association (AFILAPA) however, past deficiencies still exist and there are few well-organised teams. Primary surgery is being performed by many surgeons, some with limited experience and without follow up. Cleft teams are not officially recognised and where they do exist it is due to individual efforts since there is no tradition of team culture. Few groups include orthodontists and speech therapists as members of the team. Orthodontic treatment is not covered by the public health system and in speech therapy there is a general lack of contact with hospital specialists, treatment being given mainly in schools or in a private setting. Few centres use instrumental diagnosis of velopharyngeal incompetence. There is no national registry or regional computerised records and no audit of results. There have been no studies of outcome of care, no intercentre studies and no involvement in clinical trials.

Future Plans
The proposals of the Eurocleft Clinical Network have been presented to various groups of cleft professionals in Spain and as a result the Spanish Association for Facial Clefts was formed in March 2000. It is envisaged that the association will be a starting point to promote the much needed changes in the organisation of care. Although central government has been approached there has not to date been a response.

* Estimated number of clefts per annum using World Fact Book figures of 39.1 million population, birth rate of 9.99 per 1,000 population and assuming incidence of clefting at 1:600.