SALT

We are lucky in the UK. Healthcare is free at the point of use and by and large access to it is very good.  Some provision, however, is uneven, with a clear weighting away from paediatric and towards adult (and old age) services.  If I were cynical, I might suggest that this is because paediatric patients, especially those with complex needs, do not vote and may never be in a position to exercise their vote.

Take Speech and Language therapy for example.  R has an obvious need – she is non verbal.  Her need for Speech and Language input is explicitly stated in her Coordinated Support Plan, a document which outlines the services that R should be provided with in order for her to access education.

Speech and Language therapy (or SALT) for children falls within the shadowlands of the NHS, part funded by the NHS and part funded by the council education department.  The service is delivered at school. (When R was very little, she couldn’t access it at all as she wasn’t granted a specialist nursery placement. Without the nursery placement, the waiting list was more than 18 months for a triage appointment.)  I understand the benefits of providing this service at school – reduced travel time for staff and/or parents, fewer missed appointments and the ability to support the teaching staff to apply appropriate strategies in the classroom.  All of this I understand.  What I don’t understand is the reluctance to fund this service at a level that is in any way useful.

At well over 100 pupils, R’s school is large for a special school.  Virtually all of the pupils at the school require SALT at some level.  A rough calculation would suggest that across the school day, allowing for snack time and lunch, a SALT could comfortably see 9 or 10 pupils – lets call it 10.  This allows for a bit of report writing and interaction with the class teachers.  So, if 100 pupils receive input one day a week that would require 100 sessions over 5 days.  So, R’s school needs at least two full time members of staff.  Ideally, the children would be seen more than once a week.  So, not less than four full time members of staff then.  The sums aren’t hard.  Why then, when the allocation is made, does the school only have the equivalent of a single SALT three days a week?  The consequences of this miserable allocation are that no one gets a satisfactory service.  The caseload is quite simply too much.  R has yet to receive a single set of targets after nearly four years at the school.  Apparently targets have been set.  They have never been communicated to us or to her teachers, presumably because there is no time available to do this.  Reports are never written. And despite a formal complaint – which was upheld – the service has not improved. It’s clear that it won’t improve until it is adequately resourced.

By contrast, adults with acquired speech and language impairments are well served. The service which they receive is differently organised and differently funded but the nagging suspicion remains that the primary difference is that children are lower priority.  I am genuinely baffled by this.  Politicians should surely be able to recognise that it is potentially going to cost them far more to support a young person for the length of their life than an older person.  The more that the young person can be supported towards independence, then, the greater the saving to the public purse in the longer term. But perhaps, politicians are only thinking as far as the next election, and R and her school mates won’t be voting any time soon.

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