When I was a junior SLT in the NHS I was always given the “tribunal families” i.e. the families that had spent an arm and a leg on independent reports and legal fees in order to access the appropriate placement (school) and therapy provision (SLT / OT / PT) for their child.
These children tended to have quantified direct Speech and Language Therapy provision in their Statements (still Statements in Wales and now Education Health Care Plans in England) and it was my role to follow this provision to a tee which tended to mean that these children were seen significantly more often than other children with similar needs.
At the time in my career, well over a decade ago, I wasn’t expected to contribute to Statutory Assessments but as I developed my specialism, within Autism Spectrum Disorders, my role changed. I distinctly remember writing my first SLT report which would serve as advice towards a child’s Statement and my NHS Supervisor at the time explaining the different ‘levels’ that I could recommend:
– A half-termly SLT programme review.
– A termly SLT programme review.
– A 6 monthly SLT programme review.
When I asked about direct SLT sessions it was explained to me that the SLT department we worked in did not provide direct therapy recommendations. Regrettably, with my inexperience and naivety at the time, I did not question what I was told and I swiftly went on to choose a level of SLT ‘intervention’ for the child and submitted my report.
Bearing in mind that I worked across 5 different NHS localities in the first 5 years of my career (swiftly moving up the banding system) I noticed that, on the whole, whilst the ‘levels’ that were used in advice reports above were similar across the teams there was also a vast difference from one team to the next as to the models of direct and indirect therapy being delivered. Speech & Language Therapy was very much a postcode lottery.
As my confidence as a clinician grew and I gathered more and more anecdotal evidence that direct Speech and Language Therapy can effect positive change, and as my banding / specialism grew, my reports no longer required supervisor / managerial ‘approval’ to be submitted and I began to recommend quantified and specified advice re therapy (as legally I now know we should have been doing from day one) in addition to SLT programmes; review periods and the level of specialism expected for the treating SLT.
Having met my (now) wife and moved to South Wales I resigned from my NHS SLT role and began to increase my independent SLT work from part-time to full-time as NHS roles in Cardiff were few and far between. Working wholly for myself at the time I reminded myself that my whilst I now had more time and flexibility to more thoroughly assess the children in my care, and learn a hell of a lot more about the SEN Code Of Practise, the way I wrote my reports would continue on the same track. I have continued to work this way, fine tuning my reports via excellent constructive feedback from several Solicitors specialising in Education Law over the past decade.
My gripe nowadays is that when I assess a child who has been known to an NHS SLT over 99% of the time the NHS SLT has not carried out a complete assessment of the child’s Speech, Language and Communication Needs and their ‘levels’ of SLT intervention recommendations have decreased from the low starting point over a decade ago. I totally appreciate that resources are incredibly stretched however, as a Speech and Language Therapist, my biggest concern is that, as an example, each of the 60 children’s NHS SLT reports I have analysed and contested in 2019 none of them recommends any direct therapy whatsoever and the vast majority (90%) recommend that the child is discharged with advice. The remaining 10% are provided with a SLT programme delivered solely by a Teaching Assistant with no hours to model or monitor by a qualified Speech & Language Therapist.
Don’t get me wrong: I love the NHS and there are some absolutely fantastic Speech and Language Therapists who work incredibly hard in the NHS. However, if Speech and Language Therapists continue to recommend that Speech and Language Therapists should not provide direct Speech and Language Therapy, and that a Teaching Assistant / Learning Support Assistant (who are amazing at supporting a SLT programme under careful supervision) can provide the therapy to the child, then the funding required to employ Speech and Language Therapists will only decrease. If you state you are not required to work with children and adolescents with Speech, Language and Communication Needs as clinicians then you will cease to exist in the NHS.
Looking across the world to America; Canada; Australia; New Zealand and South Africa (all places where the standard of SLT is known to be high) clinicians advocate direct Speech and Language Therapy intervention.
May I also add that, as ex-Chair of the Association of Speech & Language Therapists in Independent Practise (ASLTIP), I noted it was apparent that ex-NHS Managers (that had either resigned from the NHS or retired and began working as independent SLTs) had started to provide direct Speech and Language Therapy to children and adolescents. Funny that.