Speech and language therapy provision in England is sliding into crisis. As Chair of the Unite committee representing speech and language therapists, I get countless reports of service cuts, pay cuts and redundancies.
This is an area where clinical issues and trade union issues go hand in hand. We’re seeing a ‘dumbing down’ of clinical care, with worse services being offered to patients and clients. How come? There’s less and less continuing professional development available to speech therapists, and if we want specialist training we often end up paying for it ourselves. Trusts are driving through redundancies of specialist therapists and clinical leads, or are replacing senior and specialist therapists with newly qualified staff when posts fall vacant. There’s a growing trend towards professional managers (i.e. people with a clinical background as speech and language therapists) being made redundant and replaced by generic managers – so decisions on jobs, services and training are taken by people with no understanding of the clinical implications.
The result has been a disaster. Pay and conditions for therapists get steadily worse. Therapists are left struggling with impossible workloads. Standards of clinical care go down and down. This isn’t the story in every Trust of course – but it’s a very, very common picture. It’s no wonder that morale amongst speech and language therapists is at absolute rock bottom. My blog from March this year links to Unite’s submission to the ‘Bercow Review’ – a detailed national review of speech and language therapy services for children. Our evidence was of a profession in deep trouble.
The final report of the independent review – known as the Bercow Report – was published yesterday. John Bercow is a Tory MP, oddly enough, but has produced a serious document with some excellent recommendations. It’s clear that he understands and cares about the needs of children with communication disorders. The report and Executive Summary are both worth a look.
Bercow condemns the current postcode lottery for speech and language therapy services. He recognises the need for adequate staff and resources to deliver high quality services. He is clear about the need for specialist staff and clinical leaders – a welcome alternative to the crude use of skill mix driven by a desire to cut costs. Bercow suggests tha
There are many other valuable recommendations. This is a really good report. The Government has been embarrassed into allocating an immediate £12 million to implement the proposals, with another £40 million to come.
The report will also be a practical tool for trade unionists. I’ve already had a discussion with a speech and language therapy workplace rep in London about using Bercow’s conclusions to challenge the service cuts now going through in her own Trust. Reps on the Union’s national committee for speech and language therapists have agreed that we will be putting together a guide for union activists on how to use these national recommendations to oppose local cuts and restructuring.
So is this all we need to do? Sadly, the answer is ‘Of course not’. John Bercow accepts the commissioner-provider split in the NHS. He doesn’t challenge privatisation, fragmentation, and ‘marketisation’. The drive now is no longer towards clinical excellence, but towards services that sell or services that are cheap. If Bercow’s recommendations become an excuse for the private sector to muscle in on speech and language therapy provision, the results are likely to be a disaster for service users and clinicians alike. Bercow calls for joint working, and for a continuum of services around the family, but fails to explore the impossibility of planned and integrated care delivered by fragmented and market-driven services.
And an obvious point, of course, is that the current erosion of high quality services in speech and language therapy is mirrored by the exact same process taking place in physiotherapy, occupational therapy, health visiting and so on. Children need these services too. As a speech and language therapist, of course I want to see benefits for my own profession. But let’s not kid ourselves that it’s possible to sort out speech and language therapy provision in isolation from the rest of the NHS.
There’s a broader industrial and political fight to be had here. The NHS in England is being dismantled by a Government driven by a bizarre neoliberal ideology that puts profits for big business a good deal higher than patient care. It’s time for our unions to seriously challenge this nonsense.