Browse Month

June 2014

Cuts hit Speech Therapy in the NHS

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.

Child development in the Mail

Like many rational human beings, I visit the Daily Mail website from time to time, not for the toxic celebrity sideshow, but for the “human interest” stories – the people who eat gravel when they’re stressed, the people who spend their benefits on gucci handbags, you know the kind of thing.

Beyond this rather tragic form of diversion, I enjoy trying to squeeze some intellectual value out of their stories which touch on language development:

This was a small scale (just 65 families), unpublished American study which seems to have relied on parent interview rather than direct observation. This study reports a statistically significant link between increased touchscreen use and decreased language development, a link that is backed up by my experience and by conversations I’ve had with my colleagues. The study also fails to identify any positive effects from so-called “educational games”. This topic is crying out for a bigger study, and a better reporting system. Perhaps an app could be developed which could monitor a child’s touchscreen use in a more reliable manner.

Faced with a stream of essentially meaningless syllables, how exactly do babies learn where words start, where words end, and what words mean? Researchers from Purdue University postulated that a simple touch on the knee might guide a child towards making these kind of judgements. They put together a rather cunning experimental design to prove that this was indeed the case. The study is due to be published in Developmental Science. Quite what any of this has to do with ‘tickling’ I have no idea (although tickling is indeed a noble thing to do to a baby).

“Top Lib Dem” Ed Davey scored some political capital with this rather obvious little sound bite. People seem to agree with Ed in the comments (although, unsurprisingly, one commenter takes the opportunity to blame the terrible over-population in the UK). Many commenters make the link with the rising incidence of asthma. It’s not just about what children are breathing in though. Shuttled around at knee height they get very little taste of what it means to interact meaningfully with the world. They are strapped in for the ride, unwilling subjects of the wild experiment on child development we seem to be running here in this autistogenic Western society.