Speaking up on speech therapy

23/09/2009 by Steve Barclay.

A striking feature of a number of public services is how little information there is in the public domain.  Those using a service, and taxpayers paying the bill, have few facts available to assess the quality of the service provided.  After being contacted by a constituent regarding the lack of speech therapy for his child, I have tried to bring a little transparency below on what is happening on this locally.

The Government‘s target is 18 weeks between a referral from a GP to the first treatment.  The longest a child in Cambridgeshire has currently been waiting is 90 weeks for their first speech therapy session.  The average time spent on the waiting list across Cambridgeshire is 30 weeks, three months over the Government‘s target.  60% of children in Cambridgeshire have been on the waiting list longer than the national target. 

A full time speech therapist works 36 or 37 hours a week, of which 80% of their time is clinical including travel time to schools, with 20% involving administration.  There are currently around 42 fully qualified speech therapists in Cambridgeshire, with up to 3,500 children waiting or accessing the speech therapy service.  It is a heavy case load per therapist, with only so many hours for one to one sessions.  The risk is that as resource is moved to bring the waiting list down there will be even less scope for one to one therapy or time with a fully qualified therapist. 

Within North East Cambs, there is one qualified speech therapist covering March and Chatteris, supported by a specialist one day a week and a further therapist 2 days a week.  They have to cover 83 children needing support, with a further 39 children on the waiting list.  34 children in March and Chatteris have been waiting longer than the Government target of 18 weeks from GP referral to their first therapy session.

In Wisbech, there is a full time specialist and a full time assistant, with a further part time therapist.  They have to cover 112 children needing treatment, with a further 30 on the waiting list, of which 9 children in Wisbech have been waiting longer than the Government target.

Despite these pressures on front line services, there is some good news.  Whilst 700 children in Cambridgeshire are currently on the waiting list, last year it was 1,300!  How many people locally were aware last year that 1,300 children were waiting for speech therapy? What does that say about transparency around the delivery of public services?  Such delays matter - not least when a child starts school and is struggling to speak with their teachers and classmates.

Despite as a country now spending over £100 billion a year on the NHS, it is interesting how today many children no longer have access to the benefit of the one to one sessions that used to be the norm.  Instead speech therapy is often delivered via Teaching Assistants who complete a 10 week course with an hour‘s training plus homework, a visit from a speech therapist once a term or every half term, or through work with a therapist in group sessions. I have not yet seen any data on whether a much lower percentage now gain access to one to one treatment with a fully qualified therapist, but the large demand for speech therapy suggests this may be the case. That is not to say that in some cases a group session or the support of a teacher assistant is not sufficient, but one to one support will often be preferred by parents.

It is good news that the waiting list across Cambridgeshire, and locally, has come down over the last year.  Extra funding has helped, although it has not adequately closed the gap with demand.  The average wait before the first treatment of 30 weeks is still far above the Government target and up to 90 weeks in the worst case.  Problems clearly remain in delivery of speech therapy across Cambridgeshire.

As for the case raised with me by the concerned constituent, the good news is that this has now been investigated.  Confirmation has been received today that he does qualify for one to one speech therapy sessions.  There is no explanation as to why despite the clinical need this treatment was not provided at all last year, other than that the service moved on 1^st Sept 2009 from Peterborough to Cambridge.  Moving forward he will now receive the skilled support of a speech therapist attending his school, alongside the attention of a much valued teaching assistant.  It will make a real difference.

More generally, this highlights the challenge we face across the public sector as all political parties now acknowledge the need for significant spending cuts.  The Conservative Party has made it clear that we will increase NHS spending. However there will also be more demand, not least from an older population and expensive new treatments.  The current Government has spent billions which has not been matched by delivery, as shown locally with issues like speech therapy.  Greater transparency is needed to ensure money gets to the front line and is not wasted.  More speech therapists in Fenland and East Cambs are certainly needed, and an NHS budget of over £100 billion should be delivering them. 

Posted in Speech Therapy, NHS, March, Chatteris, Wisbech | No Comments »