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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.

Childcare is in a total mess in the UK and we're going to make it worse

BBC News – Childcare: One in four providers ‘make loss’
BBC News – Childcare review launched as nursery reforms urged

I think it’s fair to say that childcare is in a bit of a crisis here in the UK (although I’m sure that Scotland and Wales are somehow absolutely perfect like usual). Parents pay huge sums for childcare (and four or five times as much in London as elsewhere, I read today) and places for some 2- and all 3- year olds are centrally funded at one of the highest cost-levels in Europe. Yet nursery managers are apparently taking home an average of £13,500 a year and the workforce, despite all the training they have to trundle through, and despite the sheer complexity of trying to squeeze a child into the EYFS, they get the minimum wage in almost every case. It’s not much compensation for the sheer weight of responsibility heaped on these people from both directions – upwards from busy parents and downwards from nervous law-makers.

The same thing can be seen in social care for the elderly. Councils pay quite large sums, private tenants’ cross-subsidy to the council-funded tenants is frankly eye-watering (my grandmother pays £900 a week for what seems to me to be rather hands-off care), and once again it doesn’t seem as though the people who own care homes are bothering the rich list particularly.

Another thing these two sectors have in common is the fact that hardly anyone ever has anything positive to say about the people on the ground providing the care. Today the problem is the fact that nursery workers and childcarers in general lack an A-level equivalent qualification, and that their literacy and numeracy skills are inadequate.

Admittedly there must be something very wrong with the numeracy skills in a sector where some settings have taken it upon themselves to pay 92p a pint for milk… but I digress…

Was it the the Swedish model or the Finnish model we were meant to be following? I forget. We failed either way.

The first component of these models must have gone unnoticed by the legislators when they were on their jollies in Scandinavia. They were presumably overawed by the settings they saw, and the top-class early educators they met, without considering the fact that the countries who get childcare right can afford to do so because they make full use of the adults (neighbours, family) in the community to deliver informal child care the rest of the time. Of course in this country, even two female police officers can be prevented from looking after each other’s children because they are not registered as childminders. We need to do something to develop ours into a compassionate society where people do things for one another simply because they can and because they want to. Certainly we could start by getting rid of any legislation that prevents us doing so. We overpay for care in this country because we don’t, or can’t, care enough for one another without being given some sort of financial jolt to do so, or without having a badge that says we’re allowed to.

The second component of these models was the one they focused on, but again they didn’t look deeply enough. These settings understand that young children learn from play, from direct experience and from each other. In many countries in Europe, sit-down learning starts well after a child reaches 7 years of age. In the former Czechoslovakia, it used to be, if your child couldn’t draw a circle clockwise and anticlockwise, and if he couldn’t touch his left ear with his right hand, and his right foot with his left hand, he wasn’t made to sit in a classroom to learn. Here we have taken on the bits of the system we like, without actually considering the experience of the child. Some reception teachers understand that it is too much to expect children to adopt a rigid learning plan just because they happen to be turning five years of age before some random day or other. Likewise, some nursery staff understand that a total absence of structure is confusing for young children. But the bulk of children in this country experience the shock of transition from Child-Led (read “child-left”) Play to ‘sit-down and listen’ without any consideration for where they are in their development. In this country we have the option of holding a child back a year. But one day that child has a serious dose of reality coming their way when they have to get back into their correct year group before a change of school.

So to get back to the original point – the supposed need for early years’ staff to be educated to A-level level. I couldn’t care less if they can’t read a story to the child. What I want to know is, can they make a story up off the top of their heads and tell it in an exciting manner? Can they leap into the child’s world and instinctively offer intellectual morsels that draw the child’s thinking onwards through the proximal zone of their development? Can they spot something the child is doing today that they weren’t able to do last week? Do they know what the child likes to do? Do they enjoy doing what the child enjoys doing? Are they able to make the child understand that they enjoy getting involved in what they are doing? Do they even like children?

None of these things (apart from the last one) are easy. It is precisely because delivering child-led learning, to a skeleton curriculum, on the hoof, pitched perfectly to arouse a group of disparate souls is so difficult that we have lost our way in childcare in the UK. It takes a special person to be able to nurture children in all domains, to understand them and to love them, and with every policy review we get further and further away from getting early “education” right.

When we find our workforce, they may or they may not have additional skills in administration and accounting. It could not be any less relevant for the children.