SPEECH AND LANGUAGE THERAPY SERVICE ANNUAL REPORT

1 April 2013 –March 2014

Jennifer Lewin

Head of Speech and Language Therapy services

Val Scrase

Head of Children and Young People’s Services

Introduction

This is the fourth annual report of the Wiltshire children’s speech and language therapy service and aims to provide a brief outline of the activity undertaken by the service during 2013-14. The report summarises the local and national priorities and the delivery of the service to support children with speech language and communication needs across Wiltshire.

Undetected and/or untreated speech language and communication problems can lead to low levels of literacy, poor educational attainment and difficulties finding employment. In turn, this can lead to a perpetuation of the poverty trap and a cycle of health problems, including mental health and health inequalities. 10% of children have a speech and language difficulty. 60-70% of youth offenders have speech, language and communication needs that have not been identified in their early years.

The Wiltshire Speech and Language Therapy Service is commissioned jointly by NHS Wiltshire Clinical Commissioning Group.(CCG) and Wiltshire Council to provide a training and collaborative model of support to children with speech language and communication needs in Wiltshire. This new service commenced in May 2010 following a procurement process undertaken jointly by NHS Wiltshire CCG and Wiltshire Council. The contract was awarded to Wiltshire Community Health Services which in June 2011 successfully merged with Great Western Hospitals NHS Foundation Trust (GWH NHS FT).

Our service provides qualified, experienced and specialist speech and language therapists able to assess, support and manage children and young people with speech and language and communication difficulties. Speech and Language Therapists work in partnership with children and young people, their families and with other professions to reduce the impact of these difficulties on children and young people’s well being, to allow them to participate fully in daily life and to enable them to reach their full potential. The speech and language therapists are supported by a skilled team of speech and language therapy assistants.

Our vision is to provide...

  • A high quality service which is consistent across Wiltshire.
  • A flexible and dynamic service which responds to the needs of children with speech language and communication needs.
  • A service that works in partnership with colleagues and other agencies.
  • A service that has excellent leadership and staff with the highest clinical skills and training.

National strategic drivers

The Speech and Language Therapy Service (SLT) provides a model of service that has been developed following an intensive evaluation of national strategies and local health, educational, social and communication needs.

The national strategies stress the importance of early intervention and prevention, more choice and easier access to services, the reduction of inequalities, and the importance of supporting families. In addition there is a need for all statutory and voluntary services working with children and young people to work in partnership to ensure all these priorities are met.

In particular, the Bercow Report (DfE: 2008) made recommendations under five key themes:

  • Communication is crucial;
  • Early identification and intervention are essential;
  • There is a need for a continuum of services designed around the family;
  • Joint working is critical;
  • There needs to be consistency and equity across service delivery.

We believe that our model of service delivery meets the recommendations of the Bercow Report.

In March 2012 the Wiltshire Children and Young People’s Plan was published by the Wiltshire Children’s and Young People’s Trust. This three-year plan outlines the vision and high level outcomes for children and young people in Wiltshire. This Plan has identified the following three high-level outcomes for children and young people living in Wiltshire:

  • Prevention and early intervention
  • Raising aspirations and narrowing the gaps
  • Promoting healthy life styles.

Wiltshire wide Paediatric Speech and Language Therapy Service

The training and collaborative service model is now well embedded across Wiltshire. We have:

  • A single point of entry into the service – allreferrals and queries regarding the service are managed from Trowbridge Community Hospital.
  • A flexible and innovative service responsive to the needs of children and young people and families within Wiltshire.
  • Easy access to the service.
  • A service provided to children and young people delivered in their early years and school settings or their own home.
  • A telephone advice line accessed by parents and professionals for advice, signposting and acceptance of referrals.
  • Triage by experienced therapists at the point of referral.
  • A SLT website which provides current service information, an up to date database on advice and activities, and signposting for children and young people and their families and other professionals and associated agencies to interventions and support.
  • Improved communication to early year’s settings, children’s centres and schools through allocation of a LINK SLT to a cluster of schools.
  • A well-established narrative therapy programme provided to schools developed to ensure succession planning of the programme within the school.
  • A Wiltshire wide service for children with fluency and swallowing difficulties.
  • A comprehensive training package responsive to the needs of families, early year’s settings and schools.
  • Extensive knowledge and skills across all clinical areas e.g. AAC, dysphagia, autism spectrum, cleft palate.
  • Regional Makaton tutors.
  • Skilled and knowledgeable SLT Assistants supported with robust supervision.
  • Service designed and specifically targeted Video films for parents and carers.
  • Research indicates that in the UK the benefits of increased lifetime earnings generated by ensuring children with speech and language impairment received speech and language therapy nationally exceeds the cost of therapy by £741.8 million.
  • For every £1invested in the SLT intervention generates £6.5 in lifetime earnings.
  • Likewise speech and language therapy working with parents of children with autism between the age of 2 to 4 years also indicates a cost benefit with later reduction in service use and productivity gains for the family as a consequence of improved communication and independence, and for every £1 invested there is a return of £1.5.

Workforce

Underpinning all our work is our expert team of staff.

  • All our clinical staff are fully registered with the Health Professional Council (HPC) for speech and language therapists who determine the professional behaviours, regulatory standards and ethics expected of our therapists.
  • All our clinical staff are members of the Royal College of Speech and Language Therapists thus providing access to current evidence-based practice.
  • All our staff access clinical supervision and are managed within a robust clinical and professional leadership structure.
  • Our staff are fully supported by a systematic approach to training and continuing professional development which includes annual appraisal and a personal development plan. 100% of staff have had an annual appraisal and personal development plan in the last year.
  • Our services are fully registered and compliant with Care Quality Commission Standards (CQC) which set out the essential quality and safety standards in which we practice.
  • All our staff have enhanced DBSchecks.
  • We have an in depth knowledge of local communities and their health needs, and plan services accordingly.
  • We have developed and implemented evidence based and ‘best practice’ guidelines for assessment and care pathways to support the new model of service.
  • Our clinical services are supported by an infrastructure of professionals with expertise in finance, human resources, estates management, clinical performance and risk management, information management and technology.

The workforce teams are now fully established across Wiltshire as identified in the workforce service plans submitted to meet the agreed service model. These teams are led by a Professional Speech and Language Therapy Manager and Principals leading in the following areas:

  1. Early years and Additional needs. This position operationally manages the south and west teams and is responsible for:
  • Team leader in additional complex communication needs and dysphagia.
  • Team leader in Early Years.
  • Team lead in Assisted Augmentative Communication (AAC) and Learning Difficulties.
  1. School age children and training. This position operationally manages the north and east teams and is responsible for:
  • Team leader in social communication and Specific Learning Impairment.
  • Practice educator.
  • Team lead for fluency and hearing impairment.

The Speech and Language Therapy team is skill mixed to ensure the most appropriate skills and competencies to meet the service requirements. The team consists of the following NHS Agenda for Change bandings:

Band 8 Principal SLTs – 2.2 whole time equivalent (wte)

Band 7 Team Leaders – 5.79 wte

Band 6 Senior SLTs – 9.96 wte

Band 5 SLTs – 6.98 wte

Band 4 – 0.95 wte

Band 3 SLTAs – 4.85 wte

Band 3 admin team– 3.46 wte

33.19 wte funded

In total 49 clinical staff and 7 admin staff.

Maternity leave

2.00 wte Band 6

0.8wte Band 3 A&C

Bespoke continuing professional development ensures a high quality professional team well supported through supervision and line management. The flexibility in training and staff enables targeted skills responsive to local needs.

To ensure that the workforce is of the highest calibre there is an ongoing training programme to replace skills of staff that have left and to further enhance the skills of the team. Training from Regional centres, Spires Cleft Palate Centre in Salisbury and the Regional Cochlear Implant service Southampton enables the SLTs to maintain high levels of competencies in these areas. Local interest groups provide feedback into the service of high level clinical developments

  • Two staff completed the national leadership training “Nurse First”.
  • One staff member was successful in securing funding to complete MSc modules in Cleft palate.
  • A further team member, one of the speech and language therapy assistants was awarded a prestigious Trust Star award, for outstanding performance.
  • A speech and language therapist has achieved regional tutor status as Makaton (signing) Tutor.

The following table provides an overview of workforce performance for 2013-14.

Staff Turnover April 2013-2014

4 leavers at 7.69%

Reasons for leaving

Leaving Reason / WTE / Headcount
Retirement Age / 0 / 0
Voluntary Resignation - Adult Dependant / 0 / 0
Voluntary Resignation - Child Dependant / 0 / 0
Voluntary resignation promotion / 0.92 / 1
Voluntary Resignation - Other/Not Known / 1 / 1
Voluntary Resignation - Relocation / 1.3 / 2
Total / 3.22 / 4

Recruitment

8 Starters (6.4 WTE) all are now substantive posts.

Sickness absence was at 1.59%

There were no disciplinary cases.

Performance for 2013-2014

Total referrals to the paediatric SLT service / 2,257 (increase of 10% on 2012-13)
Numbers of new referrals triaged / 2,257 = 100%
Total discharges from the paediatric SLT service / 2,286
Total face-to-face contacts / 45,196 (increase of 7% on 2012-13)
Total face-to-face contacts by location:
  • Community
    (schools / early years settings / children’s centres)
/ 68%
  • Health premises
/ 32%
Total activity contacts / 46,974 (increase of 11.2% on 2012-13)

For 2013-14 the child face to face activity took place 31% of the time in health premises,

2% at home,

67% in the community

Referral Source – Pre-school

The majority of referrals are made by pre-school settings and then by Health Visitors.

Referral Source – Primary school

When children attend schools the majority of referrals are made by the school and by consultant paediatricians. The latter are most likely to be referred with concerns regarding social communication.

Referral Source – Secondary school

At secondary school the majority of referrals are from paediatricians, again these young people may well be referred for concerns regarding social communication. Schools are the next most likely to refer in to the service.

Discharge Reason

73% of pre-school children were discharged from the service with their intervention complete with 11% failing to attend.

A higher percentage of school children are discharged with their intervention completed than pre-school and very few did not attend appointments.

The total number of children discharged from the service was 2,289 with the main outcome being “intervention complete”.

Waiting List

The waiting list is closely monitored on a weekly basis by the Principal team ensuring that children do not breach the waiting times.

Completed Waiting list pathways
Under 8 weeks / 8-12 weeks / 13-17 weeks / 18+ weeks / Total
April / 134 / 44 / 3 / 0 / 181
May / 124 / 28 / 6 / 0 / 158
June / 124 / 34 / 9 / 1 / 168
July / 140 / 31 / 4 / 0 / 175
August / 126 / 28 / 4 / 0 / 158
September / 150 / 34 / 2 / 0 / 186
October / 117 / 11 / 2 / 0 / 130
November / 99 / 16 / 0 / 0 / 115
December / 104 / 5 / 0 / 0 / 109
January / 207 / 23 / 2 / 0 / 232
February / 162 / 37 / 2 / 0 / 201
March / 144 / 31 / 0 / 0 / 175
2013-2014 / 1631 / 322 / 34 / 1 / 1988
% / 82% / 16% / 2% / 0% / 100%

he waiting list is monitored on a weekly basis. 82% seen in under 8 weeks, 16% seen in 8 to 12 weeks, 2% over 13 weeks, 98% seen before 13 weeks.

The largest part of the caseload are primary aged children with pre-school the next largest.

2013-14 Speech and Language Therapy Business plan

The business plan has been completed and can be found on

It has been a very busy year for the department. Some of the projects we have worked on include developing a pathway for access to preschool groups across Wiltshire through the early years triage, ensuring that vulnerable children with speech language and communication needs in remote areas are supported. Reviewing the activity packs provided with some of the intervention strategies, ensuring that there is an equitable approach to managing services into complex needs resource bases,. The service has designed a Wiltshire wide tool for observing quality communication environments across early years and school-age settings; this is bespoke to Wiltshire and based on recognised national work. The service worked with Wiltshire Council to develop a robust process around statutory assessment that links into the single assessment framework. A continual piece of work is evaluating the learning that arises from the speech and language therapy service involvement in tribunals. A regular review of caseloads ensures that there is an equitable service across Wiltshire.

Dragon’s Den

Representatives of the Speech and Language Therapy Deptpitched for funding to the Dragon’s Den at GWH. They were successful in acquiring £22,000 for a joint bid for three projects.

  1. Baby Chat in Wiltshire

This project designed and distributed 20,000 leaflets and 2000 posters across Wiltshire. The posters encouraged parents and carers to talk to their babies and toddlers during daily routines. They were eye catching and carried simple messages, designed to remind parents of the importance of communication as the foundation for building relationships. There was a link through to the SLT website for further advice. Posters were deployed in Clinics, hospitals, libraries, Children’s’ Centres and in some Business premises!

  1. Towards talking Teenagers

Two therapists ran an Enhancing language and communication in secondary schools (ELCISS) programme in two Wiltshire schools. They worked intensively with 13 teenagers with known communication difficulties focusing on enhancing their vocabulary development and/or narrative skills. They were supported by teaching assistants from within the school in order to enable them extend the programme into the school in future. The initial findings indicate that the pupils improved in many aspects of their narrative and communication skills; this will impact on the pupil’s performance and achievement in schools.

Pupil’s comments:(I’m better at) “working with people”.

“I always use my best talking in class now”.

(Now I’ll) “be confident and listen more”.

SENCo comment:“The running of the programme allowed support staff time to develop positive relationships with pupils and increase their awareness of appropriate challenges for them.”

  1. Communication station

Ten teaching videos were produced on key aspects of developing communication skills in children. The videos are short, concise, modern and parent friendly. The key topics covered were:

  1. Let’s Play - Supporting Early Interaction and Communication – top tips on how to encourage communication through play.
  2. Helping Your Child Understand Language: One Information Carrying Word
  3. Helping Your Child Understand Language: Two Information Carrying Words
  4. Helping Your Child Understand Language: Three Information Carrying Words
  5. Let’s Get Moving with Action Words – shows ways to teach and encourage children to use action words in everyday situations.
  6. Saying Simple Sentences –educates viewers about the key parts of a simple sentences and demonstrates activities to try to encourage children to use simple sentences.
  7. Exploring Speech Sounds – educates viewers on the different speech sounds in English and how we make them, hand signs for the sounds and shows ways to encourage sound making in everyday play.
  8. Blending In – demonstrates activities to help children blend single sounds with vowels.
  9. Visual Supports – demonstrates how to use choice boards, visual timetable and language jigs to support children.
  10. It’s All Fun and Games – showing motivating games to motivate children in their speech and language activities

These videos can be accessed via a link and a QR code which can be included in an email, report, target sheet or given directly on a printed business card. The communication station enables parents and professionals easy access to specific areas that provides an explanation of how to help their child and models of ways to achieve this.

Working in partnership with a wide range of other professionals and agencies is key to a successful service model and to a communication rich environment within which children can develop their communication skills.

Wiltshire Council is a pathfinder council for implementaion of the new staturoy processes as outlined in the Children and Families Bill. The SLT service has worked with Wilshire Council towards the education, health and care plan, “Statutory My Plan” and local offer, ensuring collaborative practice with health and education .