Table 2.

Summary of findings and key learning points from the present study.

Theme identified	Summary of findings	Key learning points
Theme 1: The Impact of Covid-19 on the Provision of Cleft Care in the UK	Some cleft lip and/or palate (CL/P) teams were better equipped to cope with Covid-19-related restrictions than others Some families had chosen to pay privately for their child's primary CL/P operation(s) New surgical protocols require families to self-isolate and test for Covid-19 prior to treatment commencing Community-based support was considerably reduced All professionals reported concern about the delays in CL/P care for new families and about what long-term impacts this would have In most CL/P teams, both research and audit ceased in favor of clinical priorities	The pandemic has highlighted existing inequities across regions The increase in private treatment may cause longer term challenges for follow-up Some families may struggle to adhere to these additional protocols CL/P professionals had to go above and beyond to ensure a basic level of community-based support was offered Psychological screening and support may be needed for families who have been impacted by the delays to treatment Reducing the long-term physical and psychological impact of delayed CL/P care on new families should be a priority Without ongoing research and audit, the community could lose valuable information about the impacts of the pandemic
Theme 2: The Impact of the Pandemic on Professionals’ Mental Health	Professionals were exposed to a high level of personal and professional distress Professionals reported a considerable degree of “moral injury” at not being able to deliver an optimal service	Opportunities for psychological screening and support for professionals should be a key consideration of the recovery effort A tiered system of moral injury prevention and intervention is indicated
Theme 3: Professionals’ Reflections on the Future of CL/P Care	Professionals were concerned about newly imposed guidelines stipulating that CL/P surgeries were “low” priority Remote contact with families can improve access and attendance, but can also impose unwanted barriers The pandemic created more team camaraderie and a greater appreciation for colleagues Funding was a key future concern among professionals Professionals were concerned about the further impacts of an additional “wave” of the pandemic	The psychological impact of treatment delays on families should be taken into consideration, and efforts to “catch up” on waiting lists should be supported A hybrid approach to CL/P appointments may offer a helpful solution in future Personal growth, resilience, and improved team connections can arise from challenging situations if managed well Ongoing efforts are needed to evidence the rationale for continued services There is a need for CL/P service providers to implement adaptive strategies and to prepare for the possibility of future service disruption