Health Commissioners don’t really understand Speech and Language Therapy. Now Podiatry. That’s a community-based health service they can really get behind. The care pathway only has a few branches, and people progress through it quickly. Feet don’t have complex, multi-layered problems that require multiple assessment sessions. Feet’s parents don’t ignore appointment letters. Feet don’t spend the first three or four sessions being shy and refusing to engage. Feet need scraping, nails need cutting, advice regarding after care needs giving. In and out.
For a service to be easily commissionable, it needs to have measurable, positive outcomes. The gravity of communication impairment – the impact it can have on people’s lives, is enormous. We didn’t actually need the Bercow Report to tell us that. But scientifically linking that back to the block of sessions working on early attention skills in a nursery, or to the clinic-based sessions spent talking to parents about interaction styles, is something that Speech and Language Therapists are very bad at indeed.
The Royal College of Speech and Language Therapists is always on our back about proving our effectiveness, and rightly so. Their recent information-gathering exercise – a survey of SLTs in the NHS, has indicated (reported here in the Independent, yesterday) that:
some children were waiting up to a year to see a speech and language therapist (SLT), up from about 18 weeks three years ago. […] 52 per cent of SLTs reported budget cuts over the past year.
I’m surprised that there have been enough commissioners actively noticing SLT and bothering to make cuts. Their policy has generally been, in my experience, to ignore it and hope it goes away on its own. Services are being funded at the same levels as in the eighties, despite a massive growth in need, arising from what can only be described as a spiral of deprivation.
SLT just doesn’t sit right in the NHS. Of course, there are medical aspects to it – some children are so unwell, or their general level of functioning so low and flat, that they will never attend a mainstream school, and these children will always have a strong input from health services into all aspects of their lives. Other children known to SLT have medically-mediated problems, such as palatal insufficiency; or psychologically-mediated problems, such as the more obvious presentations of autism and Specific Language Impairment.
Outside of this though, schools are faced with intakes of children that have massive levels of delay in all areas, from self-care skills to communication. How helpful is it to medicalise just one aspect of that? It frustrates schools that parents do not take them to appointments, and actually, come September, when the new ‘Code of Practice’ for schools comes into place, that will no longer be a viable excuse when they explain why they have low speaking and listening levels in their school.
This is why schools are starting to fund their own therapist time. Once again, like everything, we have a hodgepodge of inequality, and early intervention is being forgotten. Hopefully Public Health Commissioners in Local Authorities will see more value in the work we do than the Community Health Services Commissioners did.