An interim report reviewing services for children and young people aged 0-19 years with speech, language and communication needs

• BACKGROUND:

In August 2007 John Bercow MP was asked to lead a review of provision of services and to suggest how reforms could be implemented. The interim report was submitted in March 2008 and the full report will be ready in July 2008.

The report uses the term SLCN (speech, language and communication needs) to describe children and young people who have difficulty in some aspect of communication, and recognises the importance of the environment where the individual plays, learns, communicates and lives as well as the specific needs of the child.

This report is the first review of SLC services in 7 years and emphasises that SLC are essential life skills for all children and young people which underpin the achievement of all five of the Every Child Matters outcomes. This is the Government’s programme to improve the services supporting children and young people from all backgrounds by 1.being healthy, 2. staying safe, 3. enjoying and achieving, 4. making a positive contribution and 5. achieving economic well being.

It also will link into how the OFSTED REVIEW in 2009 might contribute to improving arrangements for the provision of services for children and young people with SLCN, including the range of service provided through funding delegated to schools.

This review was commissioned because the Government knows there is widespread dissatisfaction over access to services for children and young people with SLCN. Many parents contributing to the review reported their frustration highlighting that there is often no “system” as such and that service provision is something of a “postcode lottery”.

• HOW EVIDENCE FOR THE REPORT WAS GATHERED;

Evidence for the report was gathered in three ways:

1. An online consultation questionnaire “Call for Evidence” issued in October 2007 received over 2,000 responses by the January 2008 deadline, including almost 1,000 replies from families.

2. Consultation groups were staged to hear views both about communication difficulties in general and from parents, children and young people themselves in locations across the country.

3. Visits to children’s’ centres, nurseries, primary and secondary schools across the country which included meetings with many children and young people with their parents, teachers, special needs co-ordinators, classroom assistants, speech and language therapists together with primary care trust and local authority staff.

• THE FOCUS OF THE REPORT:

The report focused on three key issues

1. The range and composition of services needed to meet the communication needs of children and young people aged 0 – 19 years in an affordable way.

2. How planning and performance management arrangements together with better co-operation nationally and locally between health and education services can spur beneficial intervention.

3. What examples of best practice can be identified as templates for the wider roll-out of services across the country.

• THE FIVE THEMES OF THE REPORT:

The report contains five key themes summarised below:

• THE CONTENT OF THE REPORT;

The five key themes are addressed in the three main chapters of the report.

CHAPTER ONE looks at families’ views of services for children and young people with SLCN

CHAPTER TWO looks at joint commissioning of services for children and young people with SLCN

CHAPTER THREE investigates providing the right workforce, leadership and accountability for services for children with SLCN

Information for this came from the questionnaire and meetings that were held across the country as outlined earlier in this summary.

The feedback is widely documented in the report and makes interesting reading. There are some instances of excellent practice, where people felt the needs of the children and young people were recognised and dealt with appropriately. However some of the recurring themes are as follows:

• Not enough information available about communication difficulties and the support that is available

• More specialist support is required for children and young people with complex SLCN

• Parents have to pay for services themselves, for example purchasing equipment such as Picture Exchange Communication Systems (PECS) or funding speech and language therapy privately

CHAPTER TWO: JOINT COMMISSIONING OF SERVICES

This part of the report draws on the Every Child Matters framework, which aims to help local planners and commissioners jointly design a unified framework. Although joint commissioning arrangements are being encouraged by the government a recent national evaluation showed this was more likely to happen with social and health services than with education.

Services were commissioned with little or no outcomes in mind, so there is insufficient clarity as to how performance of a service can be gauged. It is also essential to take into account the changing needs, or evolving requirements of local populations. Some examples given include an increase in the identification of autistic spectrum disorders and the growing incidence of babies and young children living longer with complex communication and/or swallowing needs.

Part of this chapter focuses on the number of people passing through young offender institutions of whom at least 60% are estimated to have difficulties with SLC. The early years services are also examined and show that while there are a large number of specialist units within mainstream schools they can only cope with a small number of pupils.

There is a need to develop the right skills through training of staff and ensuring specialist help is available. Continuity of care is seen as important as often turnover of personnel means care can be fragmented.

Accountability is also seen as a problem. At a national level it was highlighted as a problem by 68% of the respondents in the relevant section of the questionnaire, and at a local level by 40%.

• CONCLUSIONS OF THE REPORT:

The purpose of the report is to keep the best and improve the rest. In order to do this it is imperative to embrace the main principles which are enshrined in the report.

• Communication is a priority
• Early identification and intervention are essential
• A continuum of services, designed around the family, is needed
• Joint working is critical
• The current system is characterised by high variability and a lack of equity – the postcode lottery needs to be tackled and a strong care offer is made to all children and young people with SLCN

Next steps:

• A national campaign to raise the importance of SLC
• Bolstering Children’s Trusts
• Providing an audit tool for local needs assessment
• Offering guidance for commissioners of SLC services
• Considering the benefit of a child centred pathway to inform the commissioning process
• Considering Ministerial responsibility
• Reflecting on how to establish strategic leaders responsible for services at a local level
• Thinking how OFSTED can improve the monitoring of SLT services
• Strengthening competences in the children’s workforce
• Studying the case for early assessment for language and communication of all children and young people
• Aiming to identify what provision of speech and language therapy at all levels is required

The Bercow report is thorough and detailed in its presentation. This summary merely outlines the main topics which are discussed and highlights what are considered to be the important points of the review. For more information please look at the report on-line at:

Jane Gregory BA, BSc

Specialist Speech and Language Therapist