How then could a report which was compelling and driven by detailed and meticulous research struggle with implementation? The recommendations of the CSAG report , were after all unanimous from the Committee itself, the recommendations were accepted by the Government and by most professional groups. This centralisation of care is not unique, there are good examples from European countries that show this is a sensible way forward. It is also supported by the active patient/parent group, the Cleft Lip and Palate Association (CLAPA). The recommendation on volume for surgeons is in line with current World Health Organisation thinking