Crisis in Speech & Language Therapy?

On Tuesday night, I sent an email request around speech and language therapists requesting information on what was happening in their own Trusts. This was in response to a request to Unite from the BBC. The journalist had picked up both on the forthcoming Bercow Review of speech and language therapy, and the extent to which SLTs are being seen as a ‘soft target’ for cuts.

It remains unclear if the BBC will be interested in taking the story any further. I really hope they do. The feedback from many therapists was heart breaking. Comments included: ‘We can barely function’, ‘Staff morale is at rock bottom’, ‘We are undervalued’, ‘We are being dumped after a lifetime of dedication to the profession’. Many therapists reported that the pressure they work under is making them ill.

This is a very brief summary, anonymised here to protect individuals.

There are now direct redundancies amongst SLTs. Service managers seem to be particularly vulnerable, with several reports of redundancies amongst senior colleagues. It’s obvious that too many decision makers don’t understand why clinical management – by senior colleagues who understand clinical issues – is so important to us. One Highly Specialist SLT has just been handed her redundancy notice. The justification? Apparently school-age children with complex language disorders no longer need support – an early preventative approach will work just fine.

Pay is being driven down. Job descriptions are rewritten to match lower pay bands. One Trust has replaced Band 8s with Band 5s! Vacancies are routinely left unfilled, or replaced with posts of a lower grade.

Children with the most severe speech and language disorders are losing out. Specialist units are being closed down. An AAC service continues to offer high quality assessment for communication aids – but finds community SLTs have no time to train users and their families, so clients suffer.

Many, many SLTs report workloads that prevent them doing their jobs adequately. Unfilled posts leave the remaining clinicians desperately plugging the gaps. One area has lost over a fifth of their staff. Clients and patients are being put at risk. Acute dysphagia (eating and drinking) therapists report real clinical risk, with too many patients and inadequate time to provide a safe service. In one paediatric service, children are now waiting up to a year to be seen – a long time in the life of a young child.

Training budgets have simply gone in many places. Therapists pay for their own training when they can afford to, while others go without. The loss of professional leadership is another key issue. Over time – unless we can reverse this – we’re looking at a steady ‘dumbing down’ of standards of clinical care. Outsourcing is an increasing threat, with numbers of Trusts gearing up to hand over their provider services to external suppliers. Newly qualified therapists are still finding it very hard to get a job, and are often working under immense pressure when they do.  Bureaucracy and targets and reported ‘pointless emails from people with the word strategic in their job title’ interfere with clinical work.  

What was clear from many comments was the immense pride that we still have in our profession and the work that it does, and the overwhelming commitment that we have to our clients and patients. What’s happening to the NHS is wrong, because it stops us delivering the high quality care that we are trained to provide. Some SLTs, out of despair, have left the NHS to work privately. This is understandable. I also think it’s not the way forward. The NHS is damaged but still here, it offers essential care to millions of people, and it’s still worth fighting for. A good place to start the fight is the 3rd November demonstration in defence of the NHS.

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