Ten years on from MP John Bercow’s landmark review of children’s speech, language and communication needs (SLCN), children’s charity I CAN and the Royal College of Speech and Language Therapists have carried out their own review.
The new review asks what has changed and what challenges remain for the 1.4 million children and young people in the UK with SLCN.
Catherine Gaunt met Jean Gross, the chair of Bercow: Ten Years On, at the Talk To Your Baby conference.
What do you hope to achieve with the review?
There is a wave of interest in early language, particularly language before the age of five. This is an opportunity to catch the wave. Through the report’s recommendations we want to make children’s early communication as much a priority for the nation as obesity or dental health.
Communication is a life skill that’s vital for children’s future. We tend to just take it for granted that children learn to communicate. The further you get away from the early years sector, the more it’s taken for granted, and it isn’t a given. We want to get the whole nation to understand communication is vital.
What are your key concerns?
The original report highlighted a postcode lottery of provision and it’s still there. The postcode lottery in the health service has got worse, because of the pressures on the NHS. When funds are tight and when you get rationing, you get different policies from different clinical commissioning groups who commission speech and language therapy because they have to ration services. There’s a lot of evidence in the report of rationing in areas; for example, no speech and language therapy beyond the age of seven, or only for children with the highest needs. If you have an Education, Health and Care plan, you’re much more likely to get provision than if you don’t.
We can identify children with SLCN, we have great provision in early years, but there are some children who need help from a speech and language therapist, and our evidence in the review is it’s a struggle to get specialist help. Only 12 per cent of parents had their child’s SLCN identified by a professional. That means the parents are spotting it. It means that in all the dealings with the system from GPs to health visitors to early years, no-one’s said to parents, ‘I think something’s not quite right.’
It might be because practitioners are worried to share concerns with parents. A lot of parents said they were told, ‘He’s a boy, he’ll grow out of it’, or ‘Let’s just wait and see.’ I just don’t buy that. If the child’s language development isn’t on track, there’s something we can do. It doesn’t mean even they need a speech and language therapist or very different activities in an early years setting. Parent-child interaction therapy is very effective and involves working with parents to show them how to very quickly respond to their child.
What about funding?
We highlight concerns about funding for speech and language services, funding for local authority teams, and funding for health visitors. There is no place to hide. The different groups that once may have picked up gaps in funding, all are strapped for cash and more likely to say it’s someone else’s job. Health may say it’s education’s job to pick up support for children, education that it’s health’s job. There’s a risk of less collaboration.
But we heard evidence from many areas that said what we need to do is have health and public health and the local authority and schools and settings pooling money to commission speech and language therapists together – the right sort of therapy service that doesn’t just see children in clinics, but which trains practitioners in early years settings to support most children. Most children don’t need the most expert help, they can get help from health visitors and practitioners, but it does rely on good leadership.
Nearly three-quarters of health visitors report a rise in the number of children with SLCN, but around half report a reduction in speech and language therapy services…
There have been cuts to health visitor posts, but Government has promised a funded programme of health visitor training. The Communication Trust still has a year’s funding to pilot some health visitor training in SLC, so if that pilot’s successful through Public Health England and the Department for Education, we could see that extended.
In Greater Manchester, health visitors are not just doing a one-year check, they’re doing one at 18 months. It’s not national, but there is a big gap, at a peak period for children’s language development, with a check at age one and a check at what might be two-and-a-half. Our report recommends Public Health England look at strengthening those reviews and at when they happen. There are things that can be picked up at a one-year review – if a child isn’t pointing or using gesture, that might be a red flag.
Are the two-year-old checks working?
They are certainly not universal, partly because there aren’t enough health visitors to do reviews, partly because the families themselves may not see the need or may not be reachable. The most recent Government figures show that nearly a quarter of eligible two-year-olds nationally have not had the mandatory health visitor review that includes assessment of their speech and language – a higher figure than the comparable period in the previous year.
How well integrating the two reviews is going is very variable across the country. There’s a big issue about simple sharing of data between health and data that’s held by settings. It’s a massive statutory opportunity that children should get this check.
SLCN and mental health
We’ve highlighted the link between mental health needs and SLCN. We know 81 per cent of children with social and emotional problems prove to have SLCN. The Government is developing a mental health strategy for children and we want to make sure with our recommendations it has a strong element of provision for children’s communication needs. First, many children with mental health needs – four-fifths of them – also have communication problems. Second, treatments for mental health problems are talking therapies, but what use is a talking therapy if you have difficulty in understanding complicated language?
We have an amazing case study in the report called ‘No Wrong Door’ where they found that over half of children in care or on the edge of care have communication difficulties. The project employs a speech and language therapist. It’s made a huge difference, they’re getting really good outcomes for children. Having speech and language therapists working with children in care and youth justice, also in mental health teams, seems to have a very direct and positive impact.
Tell us about ‘did not arrive’…
Something really dear to me is when children are referred for help to speech and language therapy and are often categorised as DNA – ‘did not arrive’ – if their parents don’t bring them. We asked speech and language services, ‘What happens if a child does not arrive?’, and almost 100 per cent told us they discharge them. It’s NHS rules. It’s another way of rationing. And that is our most vulnerable children, whose parents may not remember appointments, or may not be able to afford the bus to get to a clinic.
In Nottinghamshire, they have stopped calling these missed appointments DNA and call them ‘was not brought’. Essentially, they’re saying, this child could be at risk. If they weren’t brought, we need to do something about it, we need to do a home visit, we don’t discharge them. Nottinghamshire has the Home Talk programme, so children whose families may not find it easy to go to appointments in clinics get help through a home visit.
We talked to people who work with youngsters who are involved in the youth justice system. Many of those young people were once referred to a speech and language therapist, but they were DNA, went to the bottom of the waiting list, would have to re-refer. We shouldn’t discharge children – we find them, we follow up.
We have a chapter in Bercow to say we should target towards outcomes, not outputs. It’s not about measuring how many face-to-face contacts you have with a child or how many children are on the waiting list. What we should be counting is by what percentage is children’s language improving.
BERCOW: TEN YEARS ON–KEY FINDINGS
The review heard from more than 2,500 people in England, with a focus on evidence from the front line, from local practice and experiences of children and families.
- Just 29 per cent of parents and carers felt involved in how their child’s support was planned.
- Only 12 per cent of parents realised that their child was struggling to communicate because a professional told them.
- 50 per cent had to wait more than six months for their child to get help.
- Only 15 per cent of respondents felt speech and language therapy was available as required.
- Just 23 per cent of people felt information about speech, language and communication was easily available.
Recommendations are wide-ranging and include:
- Clear information should be developed for parents, and support for speech, language and communication (SLC) should be recognised as essential to improving social mobility, health inequality and employment.
- A new cross-government strategy for children with SLC at its core should be developed, and plans to improve provision for children and young people’s mental health should recognise the importance of SLC needs.
- To make sure children and young people get the support they need wherever they live, local areas should be provided with data on estimated SLC needs.
- The DfE should make SLC and identification of SLC needs a core requirement of Level 2 in early years and fund national training for education staff.
- Replace ‘did not attend’ (DNA) with ‘was not brought’ (WNB) and a follow-up process.
Source:Bercow: Ten Years On, www.bercow10yearson.com