I wrote and published my blog post on Recommending Direct Speech Therapy 2 days ago and have been knocked for six by the number of comments on my LinkedIn; Facebook page; Facebook groups I shared it in and on Instagram page. I have received zero negative comments however I have received some messages from colleagues currently in the NHS who have expressed concerns re my post in creating a Us Vs NHS SLT clinicians. This was never my intention and on this note I have offered to post the below response from a NHS SLT:
A response to “Recommending direct speech therapy-Cardiff Speech Therapy”: By an NHS Speech and Language Therapist.
I have to admit when I read through this blog post, I agreed with the sentiment behind the words but my first thought was there is a commonality here that perhaps isn’t so clear…whether seeking support from the NHS or an Independent Speech and Language Therapist, there is no difference in the therapists desire for the children to have the best support, reach their potential in life and for their families to feel involved in this. The fact that the professional integrity of the NHS therapist to wantto put the child first, above anything else, is possibly ever in doubt is disheartening. What is lacking from this view is that it is the needs of many not the few that this therapist is thinking of. Neither is there any difference in the skill set or experience of the therapists, some of whom have dedicated their working lives to the NHS.
What we don’t share in common is this struggle in allocating the “gold standard” that we would all want to recommend as the best approach- direct speech therapy intervention. Working within the NHS and Local Education Authorities means spending public funds; there isn’t a separate pot of money that has each child’s name on it, that is exactly calculated to cover every last contact they may require with a Speech Therapist. There is one budget that has to be shared between the many…and when I say many, there are 1000’s of children who need Speech and Language Therapy.
How then do you make the pennies go further, how do we get more pounds in the first place? It’s ok saying every child should get everything they need paid for and provided, or even to stretch to some form of direct intervention for all children with an EHCP (just because the SEN code of practice promotes it doesn’t mean it is automatically possible to achieve.)
Well why not? Why, because in the current financial climate, with the NHS and local councils over stretched financially in every which way, it is simply unrealistic to only accept the “gold standard” and nothing less. What about the silver standard or even bronze standard? Could we be more willing to compromise until funding improves (come on Government get it right) and realise we are doing the best we can with what we have and sharing it out as much as possible? Surely it’s better than no service at all? If we were to start over promising direct therapy we’d end up in a right mess; it’s swings and roundabouts. See less children and give them more or see more children but give them less…how do you decide? I guess it’s easier to pass judgement though when you’re sitting on the other side of the fence and can request all the funding you need.
Don’t misunderstand me, we absolutely weigh up what provision should be offered to each child based on their needs and this is sometimes direct therapy. However, if we have even the smallest bit of confidence that we can provide the child with a reasonable level of support in a way that takes up less time and money then we would recommend that first. The key message here is that one way or another NHS/L.A speech therapy is a limited resource…FACT.
The approach within NHS Speech Therapy has to be different therefore from Independent Speech Therapy because we have to work within our limitations whilst also trying to achieve the best outcomes for the children. This however, does not necessarily mean that what can be offered is categorically less effective, it just looks different and may require more collaborative working.
It is more cost effective to work at a universal service level for children with speech and language needs – training education staff, parents and caregivers to become the child’s therapist; this releases funds to work more directly with the children where it is felt there is not adequate reassurance that their intervention will be supported sufficiently or the therapy approach cannot be taught or understood by someone without specialist knowledge/training. It also ensures that more people are aware of Speech and Language difficulties which makes a big difference to a wider range of children…as they say “it is better to understand a little than misunderstand a lot.”
The main challenges are and still remain to be the lack of consistency between each NHS trust (area within the country) as each trust has a different pot of money, are trialling different approaches, are struggling to recruit therapists, have badly designed, non existent or under funded joint commissioning agreements with the local authority or are overwhelmed with the amount of children with speech and language needs in their area. We are starting conversations about this with the people who can make a change; this is not being overlooked, we are raising these concerns both locally and nationally and striving for better…this is always a priority.
By nature, a Speech and Language Therapist is a caring individual and will undoubtedly find working within the restraints of the NHS challenging but we do it because the children matter and because public funding is quite often their only option. We will fight for them to access the best service possible whilst keeping a service alive at all and we will do it with a smile because we love our jobs and are passionate about the children we work with.
Time is an expensive commodity so don’t waste a single appointment, turn up, give your therapist as much information about your child as possible, take notes on what the therapist is recommending, ask questions and highlight what support you feel your child needs (remembering we may only get to meet them once in one environment.) If your therapist recommends termly reviews with a programme of resources for you to work with, discuss this with them, seek the advice you need to do this, we are only too willing to help…trust me! Look after us NHS Speech Therapists, we work extremely hard, we have huge responsibility on our shoulders for so many children and families and we are on your side.
Many thanks,
An NHS Speech Therapist who cares and is trying their best each and every day!