Updated August 2011
Schools as commissioners of speech and language therapy services
This paper sets out why addressing speech, language and communication difficulties is vital to meet
a range of schools’ priorities, and discusses models for commissioning speech and language therapy
services. The Royal College of Speech and Language Therapists have produced quality standards,
which provide guidelines to help schools to commission speech and language services which are safe
and effective. Their document is available at:
www.rcslt.org/speech_and_language_therapy/commissioning/schools_as_commissioners
This is one of a number of papers, prompted by discussions with commissioners in children’s and
health services, which the Communication Champion hopes that commissioners may find helpful.
The papers, and case studies from local areas, are available on the Champion’s website, at
www.thecommunicationcouncil.org/commissioning and www.thecommunicationcouncil.org/casestudies.
The Communication Champion, for children and young people aged 0-19 in England, was appointed
by Government in response to the 2008 Bercow Report on services for children and young people
with speech, language and communication needs (SLCN). A key role for the Champion, who is
independent of Government, is to assist commissioners and providers to develop services that
improve outcomes for children with SLCN, including through spreading good practice.
The issue
Only a fifth of children with speech, language and
communication needs reach the expected levels for
their age in both English and maths at age 11
Only 10% get five good GCSEs
including English and maths
Two thirds of 7-14 year olds with serious
behaviour problems have language impairment
Two thirds of young offenders
have language difficulties
Language and communication difficulties represent a substantial problem in the community.
Nationally, one in six children have difficulty in learning to talk and understand, according to a 2009
You Gov poll of parents of children aged 1-7; amongst boys this figure is 22%. 7% of five year olds
nationally – on average two or three in every classroom – have difficulty in speech and language.
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In areas of high social deprivation the percentage of children with difficulties is considerably higher
than this. More than half of children starting nursery school in socially deprived areas of England
have delayed language - while their general cognitive abilities are in the average range for their age,
their language skills are well behind.
Speech, language and communication is the most common type of special educational need in
primary-aged children. Over a quarter of all mainstream-educated primary school children at School
Action+ or with a Statement have speech, language and communication as their primary need, and
this percentage is rising year on year.
Schools as commissioners
Headteachers consistently report that speech and language difficulties are an increasing problem in
their intake, and that local speech and language therapy services are overwhelmed and unable to
provide individual help for all the children referred. There is evidence, too, that an individual therapy
response may not, for many children, be the most effective form of intervention.
In these circumstances, a growing number of schools across the country are, either singly or in
clusters, beginning to find new ways of working with therapy services to improve their provision for
their children. In many cases this involves the school or cluster commissioning additional support
over and above a core offer provided by the NHS or the local authority.
This paper sets out the benefits to be achieved from such arrangements, and the factors that need
to be considered when purchasing additional services.
The benefits
Attainment
Good speech and language skills predict school attainment.

Only a fifth of children with speech, language and communication needs reach the expected
levels for their age in both English and maths (2009). Only 10% get five good GCSEs including
English and maths (2009).

Vocabulary at age 5 is a very strong predictor of the qualifications achieved at school leaving age
and beyond (Feinstein and Duckworth, 2006)

Early speech, language and communication difficulties are a very significant predictor of later
literacy difficulties (Snowling et al, 2010).

At the age of six there is a gap of a few months between the reading age of children who had
good oral language skills at 5, and those with poor oral language skills at 5. By the time they are
14, this gap has widened to five years’ difference in reading age (Hirsch, 1996) .

Research has shown that primary-aged children with poor reading comprehension made greater
improvements when provided with an intervention to develop their oral language than they did
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when provided with an intervention directly targeting reading comprehension skills (Snowling et
al, 2010).

A number of recent Ofsted reports note that a common feature of the most successful schools
surveyed was the attention they gave to developing speaking and listening (Ofsted 2010, 2011)
As headteachers know, the barrier for many children in achieving Level 4+ in English at the end of
Key Stage 2 is their lack of oral language to support reading comprehension and writing. There is also
evidence that good oral language skills contribute significantly to attainment in maths.
Behaviour and wellbeing
Speech and language skills also predict behaviour and wellbeing. Good language skills act as a
‘protective factor’ which reduces the likelihood of poor school attendance, truancy, delinquency and
substance misuse (Snow, 2000).

Two thirds of 7-14 year olds with serious behaviour problems have language impairment (Cohen
et al, 1998).

Two thirds of young offenders have speech, language and communication difficulties, but in only
5% of cases were they identified before the offending began (Bryan, 2008).

Victims of bullying and those who are both bullies and victims are more likely to have had
limited early language skills than other children (Gutman and Brown, 2008)

Without effective help a third of children with speech, language and communication difficulties
need treatment for mental health problems (Clegg et al, 1999).
Employability

The changing jobs market means that communication skills, along with influencing skills,
computing skills and literacy skills, have shown the greatest increase in employer-rated
importance over the last 10 years (UK Commission for Employment and Skills, 2009.

47% of employers in England report difficulty in finding employees with an appropriate level of
oral communication skills (UK Commission for Employment and Skills, 2009).
Narrowing the gap
A school strategy to promote improved speech, language and communication skills is vital in
narrowing gaps between outcomes for disadvantaged children and their peers. Language skills are a
critical factor in social disadvantage:

On average a toddler from a family on welfare will hear around 600 words per hour, with a ratio
of two prohibitions (‘stop that’, ‘get down off there’) to one encouraging comment. A child from
a professional family will hear over 2000 words per hour, with a ratio of six encouraging
comments to one negative (Hart and Risley, 2003).
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
Low income children lag their middle income counterparts at school entry by nearly one year in
vocabulary. The gap in language is very much larger than gaps in other cognitive skills
(Waldfogel and Washbrook, 2010).

Vocabulary at age 5 has been found to be the best predictor (from a range of measures at age 5
and 10) of whether children who experienced social deprivation in childhood were able to ‘buck
the trend’ and escape poverty in later adult life (Blanden, 2006).
Effective models
The most effective schools plan support for speech, language and communication at three ‘Waves’ –
just as they do for literacy and maths – high-quality classroom teaching for all children (Wave 1),
help for those who can catch up with their peers as a result of structured and time-limited small
group interventions (Wave 2), and more intensive and individualised help from specialists for
children with significant difficulties (Wave 3).
Wave 1
Wave 2
Wave 3
Everyday practice in settings and classrooms
that develops communication skills
Small group additional intervention
Individual intervention with a trained and
supported teaching assistant
Intensive intervention on an individual basis
with a trained language specialist
All children
Just below age-related
expectations
Struggling
Lowest attaining
Schools, or clusters of schools, can purchase time from their local speech and language therapy
service to enhance their provision at all three ‘Waves’.
In some local authorities, Education Improvement Partnerships (clusters of primary schools) buy in
services. In others, the clusters opting for this type of service include one or more secondary schools,
with their primary partners.
In other authorities, individual schools negotiate additional time from the therapy service, choosing
to have up to one day a week of dedicated time.
In one local authority, the Schools Forum agreed to topslice the Dedicated Schools Grant to provide
a universal, dedicated speech and language therapy service to all 54 mainstream primary schools in
the authority. The service includes





Setting up and training support staff to run language stimulation and language for thinking
groups from Reception up to Year 6 – initially involving joint delivery with the support staff,
but later just the provision of ideas, plans and resources for support staff to continue
running the groups independently
Working with class teachers to develop the listening and attention skills of the whole class.
Running workshops for education staff on specific areas of speech and language difficulties
Organising accredited training for support staff to develop their knowledge and skills to
support children with speech, language and communication needs in the classroom.
Supporting schools to identify children with speech, language and communication difficulties
by offering classroom observations, screening assessments, and teacher/teaching assistant
drop in sessions.
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

Providing teaching staff with strategies for supporting children who are already on the
therapists’ caseload, within the classroom setting
Working with parents to raise their awareness of speech and language difficulties, and how
they can support their children’s speech and language development, by running coffee
mornings, drop in sessions and training workshops
External evaluation undertaken by a nearby university has shown significant improvements on
standardised test s of language skills for children taking part in language stimulation groups.
The evaluation also used before and after questionnaires from class teachers to assess attention
and listening skills, understanding spoken instructions, use of sentences and vocabulary, and
children’s social interaction skills with peers. Significant positive changes were found on all
measures.
Factors to consider
Schools need to be aware that simply buying in time from a single speech and language therapist will
not of itself mean that their children will be able to access a full range of services. Speech and
language therapy services usually employ centrally a number of specialists who can support their
colleagues with more complex cases, by providing training and advice or by doing direct work with
the child. Examples are children with autism, or hearing impairment, or who stammer. Therapists
also, like any other professional, need to be part of a system of professional supervision and
support. The most effective arrangements are therefore those where schools have a service level
agreement with a speech and language therapy service to provide this professional support and
access to specialisms.
Options for schools as commissioners include:

Commissioning (buying in) extra speech and language therapy (SLT) time from the local SLT
service via a Service Level Agreement that sets out what each party will provide

Collaborating with nearby schools to jointly commission extra SLT time from the local SLT service
via a Service Level Agreement that sets out what each party will provide

Becoming part of NHS/local authority commissioning arrangements, providing part of the total
funding and helping to shape a tripartite service specification for the SLT service.
Office of the Communication Champion
February 2011
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