Next year marks ten years on from the Bercow Review, a government review into services for children and young people with speech, language and communication needs (SLCN).
With the anniversary on the horizon, NHS chief executive Rob Webster, who leads a trust which delivers SLCN services, reflects on progress over the past decade and what needs to happen next.
The first word my daughter used was “more”. She was signing using Makaton (a method of communication using signs and symbols), with a move observed from her brother, George, who also used Makaton in support of his speech development. We laughed with surprise and delight at the communication between them and us. My son’s development had been reinforced through word cards, shapes, portage and access to speech and language therapy.
Language can be something delayed in children with Down Syndrome and George now has really strong communication skills, thanks to lifelong efforts between different professionals, agencies and the family.
George is one of 1.4 million children in the UK who have a long term, persistent speech, language and communication need (SLCN). The sheer scale of this issue – alongside the evidence that good support helps manage the impact on learning, social skills, behaviour and emotional development – means that services to support SLCN should be a high priority.
Every joint strategic needs assessment will set out the local need. Are these services then a feature of local plans and strategies that free up the potential of over 1 million children?
In 2008, a ground-breaking government review laid bare the reality of life for children and young people with SLCN. The Bercow report: A review of services for children and young people (0–19) with SLCN led to a promise of change and improvement.
Among other things, we saw the appointment of a government communication champion, and the creation of the Better Communication Research Programme and a national year of communication. The result was some important and innovative changes to the way support for children’s SLCN was planned and commissioned.
The 2012 Health and Social Care Act led to a fracturing of commissioning for some services and for some families and some patients. For children, for example, there are now multiple commissioners for a single pathway of care. This is very apparent in SLCN.
Add to this the natural drift that can occur as newer priorities come along, then impetus gets lost. The financial environment for councils and the NHS is the most challenged for a generation. Times have changed since 2008.
Now, nearly ten years on, as chief executive of a trust that delivers SLCN and as the lead CEO of a local sustainability and transformation plan, I have joined as a panel member of Bercow: Ten Years On, a new review that will be asking what has changed ten years later.
The focus will be on what difference the review has made for children and young people with SLCN. Crucially, the ways that services for this group of children and young people are commissioned will form a core area of investigation.
Communication is a fundamental part of being human. It’s a focus of our early development, and children’s speech, language and communication needs can be identified early by health visitors and other professionals. Needs can be supported in early-years settings, at home and at school by speech and language therapists. Children with severe needs may need assistive technology for daily communication.
This means commissioning can be complex – potentially involving one of more of the following: a specialist health commissioner, local authority commissioner, representative from a clinical commissioning group or indeed an individual school.
Commissioners then work with a range of people – including families, charities, NHS bodies, schools and the private sector. Not surprisingly one of the key recommendations from the 2008 review was the need for effective joint commissioning of services for children and young people with SLCN.
A recent survey carried out by the Royal College of Speech and Language Therapists found joint commissioning arrangements to be patchy, varied and inconsistent. Only 41 per cent of therapists reported arrangements in place to jointly commission support from health, education and social care in their local area. This is despite statutory guidance which outlines requirements for joint commissioning of provision between education, health and social care within a local authority area, as well as a jointly commissioned local offer in each local authority area.
In recent joint local area special educational needs and disabilities inspection reports, speech and language therapy is mentioned in around a third of reports. This means that in two-thirds of local area inspections there is no mention of something fundamental to realising the potential of the children involved.
Statute and inspection do not always drive changes in behaviour and are blunt instruments in change. What’s also in play is the tendency for integrating services and commissioning.
Collaboration and joined up public services is a mantra that we can all sign up to. It drives efficiency and stops duplication and frustration for families. For SLCN, it can help support children to deliver their full potential.
When George spoke last year at the Royal Society of Medicine about his life as a 15-year-old with Down Syndrome, it was a culmination of support from health, education and social care that helped put him there. And hours and years of therapy.
As the Bercow: Ten Years On consultation gathers momentum, how effective is joint commissioning of services for children and young people with SLCN in your area? Who is leading? Are these fundamental life skills prioritised in your plans?
The review will be looking to learn from good practice and evidence of what is happening on the ground for children and young people. Your views are welcome and may help fulfil the potential for over 1 million people. Send your thoughts to email@example.com or take part in a short online survey (closing June 2017).
Rob Webster is chief executive of South West Yorkshire Partnership NHS Foundation Trust. Follow him and the trust on Twitter @NHS_RobW @allofusinmind
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