SEN0451

Written evidence submitted by Ms Bethan Mort

My name is Bethan Mort, I am a speech and language therapist (SALT).  Since graduating in 2009 I have worked for 4 NHS trusts, 1 large independent provider (Words First Ltd) and 2 Local Authorities in head of service positions.  I have worked predominantly in London, but also West Wales, and currently Southend where I am Head of SEND Therapies.

In the interest of brevity, I have written my thoughts in bullet points across therapies in SEND, and then SEND in general.  With more time I would have loved to have written something more formal and included more data, however there just isn’t time.  I have written my thoughts scrappily, apologies!

Therapies

-          SALT is mentioned in a huge proportion of section Fs.  We are by far the biggest external provider of statutory support.  Most local authorities do not capture the size of this demand, nor the outcomes in a meaningful way.  In Redbridge, and now Southend I have been working with SEND colleagues to capture the current statutory commitment for SALT, OT and physio.  In Southend approx. 40% of our EHCPs have SALT hours quantified in section F, equating to 4,000 hours per year.  I do not know of any other LAs or trusts who have measured/tracked this, in all my networking and questioning.

-          I have seen many LAs and NHS trusts tracking number of children on SALT caseloads who have EHCPs, however this is a misnomer.  The number of hours per child needs to be tracked as this will tell us the true size of the caseload (e.g. one child could have a quantification of 2 hours, one could have 30 hours per year.  This will have different impact on staffing levels)

-          Despite being a regular contributor to EHCPs, SALTs do not follow any set formula or recommended dosage for any type of needs.  I completely agree that provision should be lead by the CYP’s needs and not standardised, however as a result there is huge variation in statutory commitments.  I have EHCPs stating 3 hours per year of SALT, and others with well over 100 and this provision is not reflective of their need.

-          DFE needs to work with RCSLT on recommended dosage for SALT.  RCSLT are woefully behind the times on this front.

-          Alongside a lack of tracking on the size of statutory caseloads, outcomes are also not tracked accordingly.  In Redbridge I was working with the therapies team to track at annual review the proportion of outcomes which had been met, and whether the quantification was increasing, decreasing or remaining static.  I could use this information to project future caseloads, and establish the efficacy of our work.  I was not in this role long enough to fully measure this, but the process was put in place on my watch.

-          I have seen recommendations made by SALTs and OTs pushing back on schools to provide support at a universal/targeted level, offering advice sheets, programmes, and phone numbers to call ‘if needed’.  This type of support does not work.  Schools are often not able to take this on if it is not already in place, there is a duty of care on therapists to support schools to put this in place before discharging children, but I never see this happen.  In Southend there is an OT resource called the sensory toolkit, which is given to schools when they have children with sensory needs.  This falls down in a few weeks, schools do not know what sensory needs are and so do not know to use this resource for advice, the toolkit is 84 pages long, and so is completely inaccessible. 

-          I am currently working with a team of mostly SALT assistants lead by a SALT and a specialist OT to support schools in Southend to embed good practice at a universal and targeted level. I am learning at every step of the process that schools are not currently ready or able to take on recommendations, new interventions etc without a huge amount of hand holding.

-          In order to put some targeted groups in place in our schools we have had to;

• Complete baseline surveys and observations in every school to establish where the gaps are
• Train up SALTAs to deliver targeted interventions
• Provide briefing sessions and guides for SENCOs
• Provide training sessions for LSAs and class teachers at multiple times and dates to be accessible
• Create a framework for the interventions to include training, and links back to the home and classroom.  We know from the research that without this in place, impact is minimal
• Create outcomes measures looking at whether the groups have impact on the children they support, the staff who have been trained, and on whether the school is able to continue the piece of work

-          The DFE currently has a project doing a similar piece of work in select areas of the country (ELSEC), however they have not put parameters in place for the types of intervention, and how to measure the outcomes.  They have also only focussed on early years.  Far more guidance is needed and I feel the way it has been set up is a wasted opportunity.

-          SALT workforce is currently in a dire state.  It took me 4 rounds of advertising to recruit 1 SALT to my team, and I had to compromise by having someone fill this role remotely, and part time, which is of limited use to the service which has a focus on being visible and present in our schools.  The RCSLT is tracking this with a quarterly survey, but the questions in the survey completely miss the mark, they need to be asking what we are doing to mitigate the vacancies, whether we have given up trying to recruit or watered down the service and absorbed the vacancy.  I don’t get anything meaningful from the survey and so have stopped contributing to it, I’m sure many others feel the same.

-          The SALT workforce has decreased for several reasons (female, childbearing workforce, leaving the profession, going over to the private sector) but the last reason, going to the private sector is having the most impact on statutory services.  Private therapists are making all sorts of recommendations to be included in section Fs, and without a strong enough public sector workforce to contribute, or defend at tribunal, these are making the way into EHCPs, and then the only SALTs able to provide these quantifications are private therapists. 

-          It is my experience that tribunal judges on the whole do not understand the evidence base for therapies, and LAs/Trusts are often unable to defend, or unwilling.  This leads to huge quantifications being recommended by independent therapists which they are, ironically, then needed to be commissioned to deliver it as core services cannot meet the demand.  I have seen tribunals go in the way of independent therapists too many times to count, and more regulation in the private sector is needed, as at the moment, those who pay the most, get the most.

-          When an EHCNA request is sent to NHS therapies, if the child is not known to them, they respond saying this, they do not consider if the child needs to be known to the service, they are not answering the question.  If they can see from the paperwork that there are potential needs in their area they should accept the request as a referral and submit evidence.

SEND

-          Teachers are the missing link in the graduated approach.  They have the least SEND training and have the CYP for the biggest portion of the day.  They need much more investment, in training and when in the job.  The need is only increasing and they need to be brought up to speed.

-          I would like to remove the label SEMH as it is still a catch all for behaviour.  Most kids with ‘SEMH’ could have their needs described by communication and cognition, possibly sensory.  ASD as a main area of need should also be considered for change, as again – the other areas of need are covered by their presentation.

January 2025