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

Clinical Teams in SWEDEN

Göteborg Linköping Malmö Örebro

Stockholm Umeå Uppsala

Population
Approximately 8.8 million.

Health Service
Central government lays down basic principles for health and medical services through laws. 23 county councils and three municipalities decide on the allocation of resources to the health services and are responsible for the overall planning of the services. The county councils and municipalities also own and run hospitals and health centres. In addition, medical care is also provided to some extent by private doctors and physiotherapists and at a few private hospitals.

The county councils are entitled to levy a proportional tax on the income of their residents and the county council revenue arises from these taxes. Other significant income is from central government in the form of grants and payments, other revenues and patients’ fees. In-patients have to pay a specific fee per day in hospital but for children under the age of 16 no fee is charged. Each county council sets its own fees for out-patient care. To limit the cost to the patient there is a ceiling so that patients do not have to pay more than a specific sum in any one 12 month period. Health services are provided on equal terms and are easily accessible to all. Quality committees at management level are working to produce systems to develop and improve the quality of health care.

Further information is available at: www.sos.se

Cleft Care Organisation
Around 200* babies with clefts of the lip and/or palate are born each year in Sweden. Modern treatment of cleft lip and palate was initiated after the second world war when patients began to be referred to plastic surgeons. Before this they were treated by general or paediatric surgeons. During the late 1940’s and early 1950’s almost all patients were operated either in Stockholm or in Göteborg, however in 1960 with the development of several new specialities in medicine, Sweden was divided into seven regions, each with a hospital having all specialities including plastic surgery. In this way cleft treatment began to be provided by seven cleft teams, each with specialists in plastic surgery, ENT, phoniatrics, speech pathology and orthodontics. Training for cleft specialists is provided within the team.

The National Cleft Palate Craniofacial Association meets every second year. A national parent’s organisation incorporating the regional associations for parents has been established and publishes a quarterly magazine. Since 1991 all patients with clefts treated, have been centrally registered with details of the malformation and surgical treatment received as a way of looking at outcome. From 1999 all treatment received will be registered. All treatment is free of charge with assistance for travel costs and loss of income for hospital visits.

Challenges to Attaining the Eurocleft Consensus Recommendations
With seven treatment centres in existence, regions with a small population may be treating only 10-15 new patients per year. This low number gives cause for concern with regard to building reliable routines and protocols and for the training of new specialists. There has been participation in intercentre comparisons and involvement in a current randomised surgical trial.

Future Plans
The main area of development in Sweden’s cleft care is the formulation of a National Registry holding details of patients with clefts and their treatment. All patients are to have their records registered at 5, 10 and 19 years of age so that outcome can be compared and standards monitored.

* Number of clefts per annum reported by national representative for Sweden