Accessing Treatment
In the United Kingdom, public health provision for treatment of pectus conditions is different across all devolved nations. Depending on which nation you live in, different treatment may be available to you or restricted.
We believe that every person living in the UK with a pectus condition deserves equal access to treatment. As a charity, we advocate for more accessible treatment across all UK nations.
Please see the map below to find out where the nearest specialist pectus clinic is it you.
Find out more about what treatment is available in your home nation, below.
NHS England
If you live in England and are struggling to get your GP to refer you or your child for further testing or treatment for a pectus condition, we advise that you print off the current referral pathway and present it to your GP.
Conservative Treatment
In England, access to conservative treatment is slim. Most specialist pectus clinics do not have funding to provide psychological support, and are only able to offer physiotherapy to inpatients who have just had corrective surgery.
Access to non-surgical devices is a postcode lottery, where funding is decided locally by each region's Integrated Care Board.
Currently, we know of the following hospitals which offer treatment on the NHS:
Vacuum bell therapy for pectus excavatum:
Southampton Children’s Hospital
Sheffield Children’s Hospital
Leeds Children’s Hospital (regional patients only)
James Cook University Hospital, Middlesbrough (regional patients only)
St Bart’s Heart Centre, London
Birmingham Children’s Hospital
New Cross Hospital, Wolverhampton
Chest bracing for pectus carinatum:
St George’s Hospital, London
Southampton Children’s Hospital
Sheffield Children’s Hospital
Leeds Children’s Hospital
James Cook University Hospital, Middlesbrough
St Bart’s Heart Centre, London
Birmingham Children’s Hospital
Royal Manchester Children’s Hospital
New Cross Hospital, Wolverhampton
Surgical Treatment
The current NHS England guidelines state that corrective surgery is only available for pectus excavatum patients with “very severe physiological symptoms”. The specific eligibility criteria that patients need to meet can be found in the Interim Clinical Commissioning Urgent Policy Statement.
If you have pectus excavatum and your clinician thinks your chest is severe enough to meet the NHS England criteria, they will put you forward for the National MDT (multi-disciplinary team meeting). At this meeting, test results, scans and images will be considered by a group of surgeons and consultants, who will agree whether you qualify for surgery on the NHS.
If you do qualify for surgery, you will be referred to one of three national pectus centres, who will perform the corrective procedure:
St Bartholomew’s Hospital, London
James Cook University Hospital, Middlesbrough
Alder Hey Children’s Hospital, Liverpool (paediatric patients only)
Surgery to correct Pectus Carinatum is not commissioned by NHS England.
NHS Scotland
NHS Scotland is known for it’s excellent paediatric service which prioritises early intervention with conservative treatment: The Scottish National Chest Wall Service. This paediatric service runs out of the Royal Hospital for Children in Glasgow, for patients aged 16 years and under. More information about the Scottish National Chest Service is available here.
Adult patients in Scotland can request a referral to the Department of Cardiothoracic Surgery at the following hospitals:
Golden Jubilee National Hospital, Glasgow
Royal Infirmary of Edinburgh
Aberdeen Royal Infirmary
Conservative Treatment
Children seen at the Scottish National Chest Wall Service will be triaged to determine the severity and effects of their pectus deformity. In the first instance, The Scottish National Chest Wall Service prioritises early intervention with conservative treatment. This might involve speaking with a psychologist or seeing a physiotherapist. It may also involve working with an orthotist to try vacuum bell therapy (for pectus excavatum) or dynamic chest bracing (for pectus carinatum). The service prides itself on the success of its conservative treatment, which leads to fewer patients having to have surgical treatment in the future.
NHS Scotland does not fund vacuum bell therapy or dynamic chest bracing for adult patients.
In some cases, patients may be able to access clinical psychology or physiotherapy as part of their treatment, but this is most likely to be those patients who are having pectus surgery.
Surgical Treatment
NHS Scotland does commission pectus surgery for children under 16. Most of the children having surgery through the Scottish National Chest Wall Service will have failed to achieve a correction using non-surgical devices, like the vacuum bell or chest brace. The majority of patients with pectus excavatum will have surgery using the NUSS procedure, whilst more complex patients or those with pectus carinatum will be offered the modified Ravitch procedure.
Adult patients in Scotland can be offered surgery at all three hospitals with adult clinics. Eligibility for Scottish patients is not as strict as it is in NHS England, but patients must undergo testing to determine the severity of their deformity. Surgery is typically only offered to patients with severe deformities who exhibit physiological and psychological symptoms.
NHS Wales
In Wales, patients can of all ages can attend the Department of Cardiothoracic Surgery at the University Hospital of Wales, in Cardiff, to see Miss Malgorzata Kornaszewska.
Conservative Treatment
NHS Wales does not fund access to conservative treatment for patients with pectus excavatum or carinatum. Patients are advised to purchase devices (like the vacuum bell and chest brace) privately and request an NHS follow-up at the University Hospital of Wales in Cardiff, where they will be fitted and supervised with the wearing of the self-purchased device, on the NHS.
Surgical Treatment
In Wales, surgical treatment is available on the NHS for severe cases of pectus excavatum and pectus carinatum. We are not aware of any specific criteria used to determine which patients are eligible for surgery in Wales. Those considered eligible will receive treatment at The University Hospital of Wales in Cardiff.
HSC Northern Ireland
Patients with pectus conditions in Northern Ireland can be seen through HSC at the Royal Victoria Hospital in Belfast by Professor Niall McGonigle.
Conservative Treatment
In Northern Ireland, patients are unable to access the vacuum bell and chest brace through HSC, and are encouraged to visit a private clinic or purchase a device privately.
For some patients with Pectus Carinatum, HSC has funded paediatric referrals to the Scottish National Chest Wall Service in Glasgow, so that patients can access the dynamic chest brace.
Surgical Treatment
Surgical treatment is available for patients with pectus excavatum and pectus carinatum in Northern Ireland. However, we are aware that the general wait time for surgery starts at eight years. The majority of patients in Northern Ireland who have surgery through HSC have the modified Ravitch procedure.