Memorandum submitted by Nuffield Hearing
and Speech Centre, Free Royal Free Hospital NHS Trust
Observations from Mrs Pam Williams, Principal
Speech and Language Therapist and Dr Breege Mac Ardle, Consultant
in Audiological Medicine at the Nuffield Hearing and Speech Centre,
RNTNE Hospital, Royal Free Hospital NHS Trust. This is a National
Centre of Excellence for second opinions on the assessment, diagnosis
and management of children with severe speech and language disorders.
Our Trust also provides a unique Speech and Language Unit for
children aged four to seven years with very severe speech and
language disorders. All children who attend the Unit have a statement
of SEN and are paid for by their local LEAs or a combination of
LEA & PCT. The speech and language therapy department has
produced and published an internationally recognised treatment
resource for children with severe speech disorders, entitled "The
Nuffield Centre Dyspraxia Programme" (1985; 1992; 2004).
Our department receives up to 40 requests per week by telephone,
e-mail and letter from parents and professionals for advice about
how to meet children's speech and language therapy needs.
Despite clear evidence based research that provision
of direct ongoing speech and language therapy is effective for
children with severe speech disorders, most local speech and language
therapy services do not provide this direct therapy, which can
be required over many years. If children's needs are not met they
can have difficulties throughout their school years and this may
have long-term consequences for their future employability and
ability to participate in society.
Most children with primary speech and language
disorders are placed in mainstream school.
Without a statement of SEN, children are placed
on School Action or School Action Plus and only receive a speech
and language therapy programme, set by a qualified speech and
language therapist, but delivered by an untrained teaching assistant/LSA.
Many schools have difficulty in delivering IEPs
effectively, due to frequent changes of speech and language therapists
or vacant posts. Only a very small number of LEAs/individual schools
employ speech and language therapists directly and so are dependent
on local PCTs to provide a service.
Families struggle currently to obtain a statement
of SEN, because the children are identified as only having one
area of need. However, not only can these children not communicate,
they struggle to access the curriculum, cope emotionally, academically
and socially. Research has shown that as a group they are very
much at risk of having literacy acquisition difficulties.
Even when children acquire a Statement of SEN
(often after a long struggle by parents), direct speech and language
therapy is frequently not identified in Section 3. This is despite
case law, which has confirmed that speech and language disorders
should be regarded as an educational need.
We see many parents in a high state of distress
as they cannot get their child's needs recognised or met. Many
parents are not aware of the current legislation or their child's
rights. Local services frequently do not inform them of supportive
national or local voluntary organisations. Most have no idea that
they may be entitled to claim Disability Living Allowance.
We often see parents who are paying for expensive
private speech and language therapy for their child to compensate
for lack of appropriate local provision. In many cases this is
causing great financial hardship or is only possible through the
support of extended family.
When parents become aware of the current legislation,
they often have to fight very hard and pay considerable sums of
money (eg up to £10,000) to bring the LEA to Tribunal in
order to have their child's needs recognised and obtain appropriate
speech and language provision and placement.
For the children with the severest difficulties,
mainstream school is not appropriate. They need to be placed in
specialist Units/Schools across the educational age range.
Many primary level Speech and Language Therapy Units
have limited speech and language therapy cover (despite their
name) and there are all too few secondary level Units. We are
very concerned that a number of special schools, which cater for
children with severe speech and language problems have already
shut or are under threat of closure, including our own Unit, because
of the current inclusion policy.
Increased recognition by LEAs of
the nature and the emotional, social and academic consequences
of speech and language disorders.
Increased acknowledgement that children
with severe speech and language disorders require regular, direct
and long-term speech and language therapy.
Speech and language therapy services
need to be reviewed and must be considered as an educational provision
for school aged children.
More commitment by education, health
and social services to inform parents about choices, the current
legislation and local and national support organisations.