England’s children urgently need a new, accountable, speech and language strategy

With Royal College of Speech and Language Therapists chief executive, Kamini Gadhok MBE, and Caroline Wright, policy adviser for children and young people in England

England’s children urgently need a new, accountable, speech and language strategy

Ask any parent about the availability of adequate speech and language services in their area and you’re likely to hear, “What speech and language service?” Indeed, last week England's Children’s Commissioner published a shocking report illustrating the “postcode lottery” of spending on speech and language services (SLT) by councils across the country. While just £16.35 was spent on each child in the top-spending 25% of local authorities (LAs), the bottom quarter parted with only 58p per child. And neither of those figures pays for much SLT.

It was the first time data had been brought together to show how much local areas spend on SLT services. There is also no no single body to hold to account for that spending. While many children will never need speech therapy or input, children with SEND or those in deprived areas very often do. That adds up to nearly one in five children starting their school lives lacking the expected communication skills. These risible amounts of spending leave children waiting months to be seen, or never receiving support at all. It’s not unusual for parents to be told SLT input just isn’t available in primary, and it’s very rarely available in secondary without an Education, Health and Care Plan (EHCP) spelling out provision legally required.

Understandably, the Royal College of Speech and Language Therapists (RCSLT) is more than a little concerned. Today, we hear from its chief executive, Kamini Gadhok MBE, and Caroline Wright, RCSLT policy adviser for children and young people in England about what they think of the Children’s Commissioner report and its implications.

The Autism Show

We need to talk – so let’s speak up for SLCN

By Royal College of Speech and Language Therapists chief executive, Kamini Gadhok MBE, and Caroline Wright, policy adviser for children and young people in England

We’ve all known for some time that many speech and language therapy services for children and young people are hugely over-stretched. We know because our members have told us – many have shared with us their stories of frustration when they can’t give children and young people the support they need.  It’s one of the reasons we decided, in partnership with children’s communication charity I CAN, to enter into the Bercow: Ten Years On review of provision for children with speech, language and communication needs (SLCN). The review, published in March 2018, confirmed that this was the experience of parents too:  almost three quarters of the parents and carers we asked said it was difficult to get help for their child with SLCN. 

The disparity is startling

Now thanks to the Children’s Commissioner for England we have independent data on spending which backs up our claims, and shines a light on the reasons why this situation exists. The new report – We Need To Talk: Access to speech and language therapy – found enormous levels of variation in spending between areas in England, with the top 25% spending at least £16.35 per child, and the bottom 25% spending 58p or less per child. The postcode lottery which was identified in The Bercow Report in 2008, and then again in Bercow: Ten Years On, is clear for all to see.

Even when the analysis looked at spend in relation to the number of children in each area with SLCN as their “primary type” of special educational need, the disparity was there, with the top 25% of local authorities spending at least £291.65 and the bottom 25% spending just £30.94. And that’s before you consider the tens of thousands of children with a different “primary type” of need – autism or deafness for example – who also need speech and language therapy to thrive.

While we wouldn’t expect every area to be spending the same amount – some areas will have greater levels of need, or will have higher costs due to geography – the level of spending in the lowest areas is simply unacceptable. It’s no wonder that in a survey conducted by YouGov this year on behalf of the RCSLT and I CAN, 59% of parents of children with SLCN said they had to fight to get the support their child needed.

Joint commissioning still lacking

Another key finding of the report was that only half of areas were jointly commissioning speech and language therapy services, despite the expectations of the Children and Families Act. We are often asked whether speech and language is education or health. The answer is that it is both, and much more, which is why joint commissioning for SLCN is absolutely crucial.

Perhaps most worryingly of all, the Children’s Commissioner found that almost six out of ten areas in England saw a real-terms reduction in spending on speech and language therapy over the last three years. These short-term cuts are likely to have long-terms implications for children and young people with SLCN, increasing their risk of poor mental health and unemployment. In the report Keeping Kids Safe, the Children’s Commissioner herself has highlighted speech and language therapy as an intervention which could help to reduce the risk of gang violence. We need decision makers to take a longer view.

In response to We Need To Talk, a Government spokesperson said: “Speech and language therapy gives children in need the best start in life.” We couldn’t agree more – and we have been pleased to work with the Department for Education and Public Health England to support their plans to reduce the word gap in areas of social disadvantage where there are higher levels of need, and to improve early identification of SLCN. But this is not enough – 10% of children have long-term SLCN and are likely to need some level of support from speech and language therapy throughout their school years and beyond.

New government strategy needed for accountability

That’s why we fully support the Children’s Commissioner’s recommendation that a renewed Government strategy is needed to hold areas to account for the support they provide. Requiring local areas to have a joint strategic plan which assesses the level of SLCN in their area, and outlines the joint commissioning plans to meet that need, will ensure that speech, language and communication is given the priority it deserves, and start to end the inequity we currently see. 

We’re optimistic that the prospect of the Children’s Commissioner repeating the exercise in two years, this time with the added inclusion of figures for each local authority and clinical commissioning group, will encourage local areas to make positive changes. We’ve already heard about speech and language therapists who have used the report as a lever to secure meetings with commissioners. We’ll be encouraging more members to have these conversations locally.

The time for action is now, and - despite the current uncertainty about the future Prime Minister – we know there are opportunities that the Government could grasp, such as the upcoming spending review and the implementation of the NHS Long Term Plan. In March, to mark the one year anniversary of the Bercow: Ten Years On report, we launched a campaign on Twitter asking everyone who cares about children’s speech, language and communication - including speech and language therapists, teachers and parents and carers - to come together and ask the Government to take urgent action. We hope you will join with us to #SpeakUpForCommuncation and #SpeakUpForSLCN

About the guest authors

Kamini Gadhok MBE has been Chief Executive of the Royal College of Speech and Language Therapists (RCSLT) since December 2000. Her primary role is to deliver service change by building strong partnerships with key stakeholders across Government, charities, other professional bodies and the Health and Care Professions Council.

Caroline Wright is Policy Adviser at the Royal College of Speech and Language Therapists (RCSLT), where she leads on children and young people’s policy in England. Caroline had a key role in the Bercow: Ten Years On review, and has supported the development of guidance for speech and language therapists on their roles and responsibilities under the Children and Families Act.

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