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Alder Hey Children’s Hospital is home to a world-renowned craniofacial department, one of only four in the UK treating life-threatening congenital skull and facial abnormalities. With a rise in referrals, they are over-subscribed, and neurosurgeon Chris Parks, who leads the craniofacial surgical team, faces a non-stop workload. Chris always works hand in glove with Ben Robertson, one of just three paediatric maxillofacial surgeons in the UK. But this partnership is about to be broken up, as Ben is soon leaving to return to his native Australia. It takes 23 years’ training to become a maxillofacial consultant specialising in cranio surgery, and there is currently no-one experienced enough to replace Ben, putting extra pressure on the department’s waiting lists.

Eighteen-month-old Violet has been a patient at Alder Hey since birth and needs major skull-reconstructive surgery. She has craniosynostosis, a rare condition that can cause her skull to twist, pulling her brain in one direction. Without corrective surgery, she is at risk of seizures and severe brain damage. Violet will be in theatre for the whole day as her entire skull is removed and then reshaped. It is one of the most complex – and expensive – surgeries that Alder Hey performs.

For the first time in seven years, the cranio team have a chance to renegotiate the financial contract with the NHSE to secure more funding for the service. The department is funded to perform 80 major and complex operations a year, but they are doing 120 of these highly specialised, long and expensive surgeries. This means they are running a £750K deficit each year – which must be absorbed by the hospital itself. Chris is aware that this cannot go on indefinitely.

Ram Dhannapuneni is one of Alder Hey’s leading cardiac surgeons. He also looks after children who have pectus, a congenital defect that means a child’s breastbone either protrudes outwards or is sunken in. It affects one in 1,000 children and although rarely causing medical problems, some children suffer bullying and are so self-conscious that they stop all physical activity and can suffer from depression and even self-harm.

Ram can perform a simple surgery to return the breastbone to ‘normal’. But in his clinic, he must inform 18-year-old Lewis that as his sunken chest is causing no medical complications, he can no longer provide the procedure to fix it. NHS England withdrew funding for this operation a year ago because most cases are cosmetic. Ram is very frustrated that the service has been stopped. He fears that children who are depressed and self-harming will have nowhere to turn, as the operation will only be available privately at a cost of upwards of £10,000. Although NHS England have withdrawn funding, if Lewis was from Wales or the Isle of Man, it would still be possible.

Alder Hey also runs a satellite craniofacial clinic in Belfast, where two-year-old Jack’s congenital skull condition was first diagnosed. Jack has flown to Liverpool with his parents for a second major operation to expand and advance his forehead by 2cm, so that his growing brain has enough room within his fused skull. For parents Elaine and Richard, they will have to get used to a completely different-looking boy. Often after such a radical procedure, parents experience a deep loss and go through a grieving process, but they are determined that come what may ‘whatever way he is, he’s our wee boy and he’s special inside and out’.

Hospital is a co-production with the Open University.