Written evidence submitted by The Royal College of Speech and Language Therapists

(SFC0042)

1. Performance of the system

1.1 Over a prolonged period, speech and language therapy services have not been adequately funded to meet the growing need from children and young people with special educational needs and disabilities. As far back as 2017, Ofsted and CQC reported that therapy services were too overstretched to deliver what was needed, funding having not kept up with the rising number of referrals.[1] In 2019 the Office of the Children’s Commissioner reported a ‘postcode lottery’ of spending, with huge variations across different areas, and most areas reporting a real-terms decrease in spending between 2016/17 and 2018/19.[2] In the intervening years, the situation has only worsened, with services’ ability to meet need being significantly impacted since the pandemic.

2. The overall picture on the support available and outcomes achieved for those with SEN

2.1 The gap between available resource and that which is required to meet need means that there are large numbers of children on waiting lists for speech and language therapy; in August 2024 almost 5,000 children had been waiting over a year for their initial appointment.[3] Some NHS speech and language therapy services are now commissioned only to provide therapy for children with education, health and care plans (EHCPs); many more have such limited capacity there is little resource available for children and young people on SEN support. Understandably, more parents are requesting an EHCP as the only way to access speech and language therapy for their child.

2.2 In many areas, speech and language therapists (SLTs) have large caseloads and feel their ability to deliver quality care is compromised. As a result of workload pressures, SLTs are choosing to leave the NHS, or in some cases, leave the profession altogether. A recent scoping study commissioned by the Department of Health and Social Care and published by King’s College London (KCL) which looked at the demand and supply of therapists working in SEND described their wellbeing as “under pressure and fragile”. This is creating huge challenges for services which are struggling to retain staff and recruit to vacant posts, with the result that waiting lists cannot be tackled, the workload pressures on the remaining staff increases, and children’s needs go unmet.

3. Government action to create a sustainable SEN system and restore confidence

3.1 The EHCP system as it currently stands is unsustainable. The answer must be to improve early intervention and SEN support for children and young people in the early years and mainstream schools. It should not be the case that a child has to have an EHCP in order to access speech and language therapy. Services must be commissioned to work in ways which support prevention and early intervention, as part of a system-wide approach to supporting speech, language and communication needs.

3.2 Providing timely access to speech and language therapy for children and young people on SEN support may mean some of them will not need an EHCP. It should result in improved outcomes for the child, a better experience for the family, and reduced pressures within the wider system. In the long term it should reduce costs for society. Below are some quotes from parents and professionals which illustrate this point:

“Unless you get early intervention you are creating issues for the future that could have been easily avoided with the correct amount of support at an early age… if I hadn’t taken charge (and had the ability to go private) [it] would have cost FAR more financially and to society as a whole than frontloading the required support for 3-4 years when needed.” (Parent)

“On multiple occasions I’ve worked with young people and families who have told me if only their communication difficulties had been picked up earlier then they wouldn’t have spent years being passed around other health, education and social care services. Some ending up admitted to psychiatric wards, some ending up detained in police custody.” (Speech and language therapist)

3.3 While transforming the system will take time, there are some pilot initiatives which could be extended or expanded relatively quickly.

• The Early Language Support for Every Child (ELSEC) Pathfinder programme is an example of an initiative in the previous Government’s SEND and AP Improvement Plan, which we believe could provide evidence and a roadmap for how to improve early intervention and support for children with mild to moderate SLCN, through utilising the speech and language therapy assistant (SLTA) workforce. Importantly the programme is funded jointly by the DfE and NHS England, demonstrating what can be achieved when education and health work closely together. While the programme is in the early stages of roll out, feedback from the areas involved is that they are optimistic that it could deliver positive outcomes for children and young people. If this is the case, we hope that the DfE and NHS England will be able to recommend the approach be expanded, providing guidance and funding to enable implementation.

• The Alternative Provision Specialist Taskforce (APST) pilot is also a positive development. APST is a workforce model which builds capacity and skills in AP schools. Taskforces are teams of co-located specialists, including speech and language therapists, based on-site within schools, undertaking integrated, child-centred work with pupils, as well as sharing their expertise and embedding their practice within the whole school. While the evaluation of the pilot will not be published until 2025, an Ofsted report of one of the schools in the pilot found that “The work of the taskforce makes a huge difference for pupils. Experts in speech and language, mental health, youth justice and youth working form a highly effective and efficient partnership. They quickly identify the specific needs of pupils. They help pupils and their families to understand why pupils might have found things difficult in the past. Pupils get the right support to be successful.”[4]

• We also welcome the Partnership for Inclusion of Neurodiversity in Schools (PINS) pilot which is bringing together health and education staff, to “create environments that better meet neurodiverse children’s needs, ensuring they are able to thrive as part of their wider cohort”. Participating schools can receive five days’ worth of support from specialists such as speech and language therapists to upskill staff - moving “away from an emphasis on individual interventions and instead work towards approaches to teaching and learning that work for the whole cohort”. Importantly, PINS is a joint programme from the DfE, DHSC and NHS England and requires joint working from schools and Integrated Care Boards locally.

3.4 In the longer term, cross-government action is needed to address the workforce challenges for children and young people with SEND. The RCSLT’s latest vacancies survey found that 19% of speech and language therapy posts in England are currently vacant.[5] The fundamental issue relating to workload must be addressed in order to improve staff retention, particularly within the NHS. Without addressing this issue, the SEND system will remain unable to support children’s outcomes or build parents’ trust. Any action by the Department for Education must be joined up with the NHS Long Term Workforce Plan, which in turn must ensure that its modelling includes demand scenarios for community children and young people’s speech and language therapy services.

3.5 Action must also be taken to improve joint commissioning. The KCL scoping study[6] referenced earlier in our response found that the design of commissioned services was discretionary and highly variable, with “myriad commissioning challenges” including:

• Misalignment between commissioning criteria and service demand
• Broadly framed contracts and a lack of precision in service specifications
• A multiplicity of commissioners and providers creating a fragmented therapy workforce.

To overcome this, the DfE should work jointly with DHSC and NHS England and professional bodies to:

• Provide quality standards for commissioners which specify that services should support prevention and early intervention, including for children and young people on SEN support, and through working with families and the wider workforce.
• Issue system guidance which sets out a clear expectation that support for children’s speech, language and communication should be jointly commissioned, with accompanying accountability measures.

3.6 We also need to see changes to initial teacher training, to ensure that all teachers are able to identify and support children with special educational needs and disabilities, including those with speech, language and communication needs. With the right strategies and environment, many children and young people with SEND could thrive without the need for specialist intervention.

4. About the Royal College of Speech and Language Therapists (RCSLT)

The RCSLT is the professional body for speech and language therapists, speech and language therapy students and support workers, with more than 20,000 members across the UK. Speech and language therapists are an integral part of the children’s workforce, working alongside parents/carers and with other professionals across education, health and social care to support children with speech, language and communication needs, and/or those with eating, drinking and swallowing difficulties.

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