Speech and Language Therapy Annual Report 2013

1 April 2012 – 31 March 2013
Jennifer Lewin
Head of Speech and Language Therapy services.
Val Scrase
Head of Children and Young People’s Services.
This is the third annual report of the Wiltshire children’s speech and language therapy
service and aims to provide a brief outline of the activity undertaken by the service during
2012-13. The report summarises the local and national priorities and the delivery of the
service to support children with speech language and communication needs across
Undetected and/or untreated speech language and communication problems can lead to low
levels of literacy, poor educational attainment and difficulties finding employment. In turn,
this can lead to a perpetuation of the poverty trap and a cycle of health problems, including
mental health and health inequalities. 10% of children have a speech and language difficulty.
The Wiltshire speech and language therapy service is commissioned jointly by NHS
Wiltshire and Wiltshire Council to provide a training and collaborative model of support to
children with speech language and communication needs in Wiltshire. This new service
commenced in May 2010 following a procurement process undertaken jointly by NHS
Wiltshire and Wiltshire Council. The contract was awarded to Wiltshire Community Health
Services which in June 2011 successfully merged with Great Western Hospitals NHS
Foundation Trust (GWH NHS FT).
Our service provides qualified, experienced and specialist speech and language therapists
able to assess, support and manage children and young people with speech and language
and communication difficulties. Speech and language therapists work in partnership with
children and young people, their families and with other professions to reduce the impact of
these difficulties on children and young people’s well being, to allow them to participate fully
in daily life and to enable them to reach their full potential.
Our vision is to provide
A high quality service which is consistent across Wiltshire.
A flexible and dynamic service which responds to the needs of children with speech
language and communication needs.
A service that works in partnership with colleagues and other agencies.
A service that has excellent leadership and staff with the highest clinical skills and
National strategic drivers
The speech and language therapy service (SLT) provides a model of service that has been
developed following an intensive evaluation of national strategies and local health,
educational, social and communication needs.
The national strategies stress the importance of early intervention and prevention, more
choice and easier access to services, the reduction of inequalities, and the importance of
supporting families. In addition there is a need for all statutory and voluntary services
working with children and young people to work in partnership to ensure all these priorities to
be met.
In particular, the Bercow Report (DfE: 2008) made recommendations
under five key themes:
Communication is crucial;
Early identification and intervention are essential;
There is a need for a continuum of services designed around the family
Joint working is critical
There needs to be consistency and equity across service delivery.
We believe that our model of service delivery meets the recommendations of the Bercow
In March 2012 the Wiltshire Children and Young People’s Plan was published by the
Wiltshire Children’s and Young People’s Trust. This 3 year plan outlines the vision and high
level outcomes for children and young people in Wiltshire. This Plan has identified the
following 3 high level outcomes of children and young people living in Wiltshire:
 Prevention and early intervention
 Raising aspirations and narrowing the gaps
 Promoting healthy life styles.
Reviewing the service for 2012-13 it is clear that the speech and language therapy service
model improve outcomes in the first 2 outcome areas.
Implementation of the new Wiltshire wide Paediatric Speech and Language Therapy
2012-2013 been another very successful year for the Wiltshire SLT service and we believe
that the training and collaborative service model is now well embedded across Wiltshire.
We have:
A single point of entry into the service - all referrals and queries regarding the
service are managed from Trowbridge Community Hospital.
A Flexible and innovative service responsive to the needs of children and young
people and families within Wiltshire.
Easy access to the service.
A service provided to children and young people delivered in their early years,
school settings or their own home.
A telephone advice line accessed by parents and professionals for advice,
signposting and acceptance of referrals.
Triage by experienced therapists at the point of referral.
A SLT website which provides current service information, an up to date database
on advice and activities, and signposting for children and young people and their
families and other professionals and associated agencies to interventions and
Improved communication to early year’s settings, children’s centres and schools by
developing regular newsletters and bespoke visits.
A well-established narrative therapy programme provided to schools developed to
ensure succession planning of the programme within the school
A Wiltshire wide service for children with fluency and swallowing difficulties.
A comprehensive training package responsive to the needs of families, early years
settings and schools.
Research indicates that in the UK the benefits of increased lifetime earnings
generated by ensuring children with speech and language impairment received
speech and language therapy nationally exceeds the cost of therapy by £ 741.8
million, for every £1invested in the SLT intervention generates £6.5 in lifetime
Likewise speech and language therapy working with parents of children with autism
between the age of 2 to 4 years also indicates a cost benefit with later reduction in
service use and productivity gains for the family as a consequence of improved
communication and independence, and for every £1 invested there is a return of
Underpinning all our work is our expert team of staff.
All our clinical staff are fully registered with the Health Professional Council (HPC) for
speech and language therapists which determines the professional behaviours,
regulatory standards and ethics expected of our therapists.
All our clinical staff are members of the Royal College of Speech and Language
Therapists thus providing access to current evidence-based practice.
All our staff access clinical supervision and are managed within a robust clinical and
professional leadership structure.
Our staff are fully supported by a systematic approach to training and continuing
professional development which includes annual appraisal and a personal
development plan. 100% of staff have had an annual appraisal and personal
development plan in the last year.
Our services are fully registered and compliant with Care Quality Commission
Standards (CQC) which set out the essential quality and safety standards in which
we practice.
All our staff have enhanced CRB checks.
We have an in depth knowledge of local communities and their health needs, and
plan services accordingly.
We have developed and implemented evidence based and ‘best practice’ guidelines
for assessment and care pathways to support the new model of service.
Our clinical services are supported by an infrastructure of professionals with
expertise in finance, human resources, estates management, clinical performance
and risk management, information management and technology.
The workforce teams are now fully established across Wiltshire as identified in the workforce
service plans submitted to meet the agreed service model. These teams are led by a
Professional Speech and Language Therapy Manager and Principals leading in the following
1. Early years and Additional needs. This position operationally manages the south and
west teams and is responsible for:
Team leader in additional complex communication needs and dysphagia.
Team leader in Early Years.
Team lead in Assisted Augmentative Communication (AAC) and Learning Difficulties.
2. School age children and training. This position operationally manages the north and
west teams and is responsible for:
Team leader in social communication and Specific Learning Impairment.
Practice educator.
Team lead for fluency and hearing impairment.
The Speech and Language Therapy team is skill mixed to ensure the most appropriate skills
and competencies to meet the service requirements. The team consists of the following NHS
Agenda for Change bandings:
Band 8 Principal SLTs 2.2 whole time equivalent (wte)
Band 7 Team Leaders 6.43 wte
Band 6 Senior SLTs 8.96 wte
Band 5 SLTs 7.58 wte
Band 4 0.95 wte
Band 3 SLTAs and admin team 7.46 wte
Bespoke continuing professional development ensures a high quality professional team well
supported through supervision and line management. The flexibility in training and staff
enables targeted skills responsive to local needs.
To ensure that the workforce is of the highest calibre there is an ongoing training programme
to replace skills of staff that have left and to further enhance the skills of the team. Training
from Regional centres, Spires Cleft Palate Centre in Salisbury and the Regional Cochlear
Implant service Southampton enables the SLTs to maintain high levels of competencies in
these areas. Local interest groups provide feedback into the service of high level clinical
Two members of the team have embarked on a national leadership programme providing
them with the skills required for the development of innovative projects and succession
One member of the team is undertaking postgraduate training in accessing and enabling
research within the service and a further team member has been successful in obtaining an
academic placement to develop the skills of a service around cleft palate.
The service has enabled team building across the teams to ensure a service that is unified
and consistent.
The following table provides an overview of workforce performance for 2012-13 .
Staff Turnover April 2012-2013
4 leavers at 7.80%
Reasons for leaving
Leaving Reason
Retirement Age
Voluntary Resignation - Adult
Voluntary Resignation - Child
Voluntary Resignation - Other/Not
Voluntary Resignation - Relocation
3 Starters (2.1 WTE) 3 were fixed term contracts to cover Maternity leave – 2 were 9 month
contracts and 1 was a 10 month contract. One external contract was closed.
Sickness absence was at 1.07% (average 32.73 wte of staff over the year).There were no
disciplinary cases.
Performance for 2012-2013
Analysis by the Wiltshire Public Health Department of referrals into the SLT service
have shown that the referral rate in the most deprived areas is statistically higher than in
Wiltshire overall, ensuring the SLT services are targeting areas of higher need.
Total referrals to the paediatric SLT service
2,029 an increase of 3% on
Numbers of new referrals triaged
2,029 = 100%
Total discharges from the paediatric SLT service
Total current case load of the paediatric SLT service
3,134 (snap shot in March
Total face to face contacts
40,291 (increase of 8.9% from 2011-12)
Total number of children seen by the SLT service
Total face to face contacts by location
Total activity contacts
68% community (schools/early years settings/
children’s centres) 32% health premises
41,709 an increase of 2% on 2011-12
Referral Source
There was an increase in referrals during 2012-13, with an increase in referrals from GPs of
26%, from HVs of 17% and an 11% increase in family/self referral. There was a slight
decrease in referrals from Early Years settings and consultants.
SLT beyond Consultant
trust borders
Health visiting
Pre-school source of referral 2012-13
Primary school
There was an increase in referrals during 2012-13 of 23% from school staff with a slight
decrease in referrals from GPs and fewer transfers in to Wiltshire.
Primary school source of referral
Early Years/Nursery
Health visiting
Other therapist
0% 0%
Secondary school
There was a 9% increase in consultant referrals in 2012-13
Secondary school source of referral 2012-13
SLT beyond
trust borders
The waiting list is monitored on a weekly basis. 77% seen in under 8 weeks, 19% seen in 8
to 12 weeks, 4% over 13 weeks, 96% seen before 13 weeks.
Waiting times for clients seen in 2012-2013
Number of clients
Under 8 weeks
8 to 12 weeks
13+ weeks
The average active monthly caseload for the whole service is 3,210
Caseload split by age, a snap shot in time (March)
Annual Caseloads Split by Age 2011-12
Pre school 2011-12
Primary 2011-12
Secondary 2011-12
The total number of children discharged from the service was 2,480 with the main outcome
being “intervention complete”.
Partnership working.
Working in partnership with a wide range of other professionals and agencies is key to a
successful service model and to a communication rich environment within which children can
develop their communication skills. One example of this is the success of Wiltshire children
in working securely within the Scales of Communication, Language and Literacy – this is a
measure of using language for communication and thinking, linking sounds and letters,
reading and writing with an average development at the foundation stage in education.
Wiltshire is 2% above the national average, achieving 68%.
The percentage working securely within the Early Learning Goals in Communication
Language and Literacy has increased 6% from 62% in 2011 to 68% in 2012.
The BLAST (Boosting Language, Auditory Skills and Talking), a programme rolled out by the
Speech and Language Therapy service across all early Years settings in Wiltshire, targets
children with delayed language and communication skills will have contibuted to this
The speech and language therapy service has developed a Tribunal pathway to support
parents, carers and professionals in meeting the needs of the child or young person with
special educational needs. The central philosophy of this pathway is to ensure that there are
skilled therapy staff with a depth and knowledge of their specialist areas, a competent and
well trained team team around the child and a curriculum that has been adapted to meet the
child or young person’s needs Resolution through mediation is the most effective outcome.
Each tribunal is reviewed to ensure that any learning is used to develop and enhance the
service provision for all children.
Feedback from service users.
We encourage feedback from all users of the service including parents, and all compliments,
comments and complaints are monitored through our governance meetings.
In 2012-13 we received no complaints on the service.
There were 52 written compliments concerning individual cases were received by the service
with numerous verbal compliments. Examples received include:
“Thank you so much for your helpful e-mail. I have noticed a difference in his speech
already!” Mother of a child
“I would definitely recommend this group to others as I feel it very beneficial to the kids….”
Mother of a child attending a group.
“We preferred the evidence of (GWH NHS FT SLT)… And agree with her that such
extensive provision is not needed for xxxxx. We prefer her evidence because she has
engaged in considering speech and language provision for xxxxx over an extended period
and so can speak from her experience as to what has proved effective.” Judgement from a
tribunal ruling.
“Our speech and language therapist for our area is XXXXX she is exceptional and together
we work well together therefore enabling the child to make progress or refer on for more indepth assessment” SEN intervention manager .
“Many thanks for getting back to us so quickly, this is much appreciated” parents
“…. Called today and said the vocabulary sheets you sent were brilliant. She would like to
discuss with you the possibility of putting these ideas on her website.” Parent of a child on
the autism spectrum
“lovely support from the speech and language therapist, the schools have put things in
place, set targets based on the reports and the school has been very proactive with the
advice given.” Parent
“… I would like to thank xxxx personally for all the hard work and dedication she has
demonstrated over the years: her efforts will never be forgotten” Headteacher
“ XXXX is doing exceptionally well and I'm proud of his achievements and we as a preschool
and XXX parents have appreciated all your help…. We are very pleased with his progress”
early years SENCo
“.. We are still smiling from having such a wonderful visit this morning. I know it is a long
road ahead but we are so proud of xxx and the progress he is making thank you for all your
support and patience” Parent
“The reports are very thorough easy to read and extremely helpful in supporting my
diagnostic work” Paediatrician..,.
“I would like to pass on to you that I found her truly excellent. Her knowledge was very good,
her interaction with XXXX was excellent and she explained her findings to me in a
professional and understandable way…. It is clear she cared about her job and indeed cared
about XXX “ Parent,
The head teacher at this specific school was very pleased with the narrative package and
has said he would recommend it at the next head’s meeting. An example of the impact of
this intervention not only narrative but literacy can be seen in the example below
Following 4 weeks of narrative therapy the results below indicate a significant impact on his
literacy skills.
Monitoring Quality of Service Delivery.
To ensure that a quality service continues to be delivered and to ensure that the service is
meeting local needs a comprehensive annual audit programme is delivered which is agreed
with partner agencies and commissioners. In 2012/13, the following audits were completed:a) User satisfaction survey of current SLT target sheet system.
An online survey was established with a link from the SLT Website and paper versions
available to those who preferred this method of access. The aim of the survey was to
evaluate the target sheets provided to the team around the child (TAC) following
79 responses were received and analysed.
86% of respondents indicated very positive responses to the target sheets. on all questions
with the exception of whether the target sheets fitted it with home and school activities where
77% agreed or strongly agreed that they fitted well around other school and home activities.
The resources and activity packs were appreciated and useful. The audit was compliant
Areas of good practice:
1. Educational settings/parents gave very positive comments about the SLT service and or
their individual therapist, suggesting that there are good relationships within the team around
the child and with parents.
2. The recommendations on the target sheets were considered practical and fitted in with
school practice.
3. Targets provide the settings and parents with a means of measuring a child’s progress.
4. The layout and clarity of information given in the target sheets was appreciated by
5. Some settings have designated staff to deliver the SLT programmes. These staff have
had additional training and this appears to be an effective way of meeting the children’s
Audits always provide an opportunity for improving services and the following
recommendations have been developed from this audit:
1. SLTs need to avoid jargon and give greater explanations on comments, targets and
2.What is written needs to be accessible to all members of the TAC and needs to be legible.
3. Each child needs to have an appropriate number of targets set.
4. The target sheets need to be dated.
5. Documents need to be circulated quickly.
6. It is important to think about school processes and link activities to the school context.
7. Encourage the TAC to seek further advice if they are unsure.
8. There needs to be consistency across the service
b) Service user survey - Pre-school triage
The aim of this survey was to evaluate whether the triage assessment undertaken at
entrance into the service is informative to parents and carers and whether the speech and
language therapist provides the best possible introduction to the SLT service.
Parents of preschool children completed a short questionnaire at the end of each triage
appointment for 2 months from the beginning May to the 6 July 2012.
80 questionnaires were distributed and 69 were returned.
100% felt the environment chosen for the triage appointment was suitably child friendly.
100% confirmed that the speech and language therapist gave them a clear explanation of
what they were doing and why.
98% felt they were able to ask questions and raise concerns with the speech and language
98% confirmed that the SLT gave a clear explanation of what was to happen next and the
support their child would receive.
96% indicated that the SLT gave helpful and useful strategies to be used to develop their
child’s speech and language skills.
94% were aware of how to contact the speech and language therapy department.
93% of parents rated their overall satisfaction with the triage appointment as good.6% as
adequate and1% as poor,
93% felt the time they had to wait for an appointment was just right, 7% felt they had waited
too long ( those that reported that their wait was too long were evaluated further and it was
identified that there had been a delay in the department receiving the referral. This
emphasises the importance of referrers making the referral as soon as possible after
The results of this survey are very encouraging and demonstrate that therapists provide
clear explanations about the outcome of the assessment and future management of the
child. Families feel supported, the environment - is child friendly, and the service is
The SLT department however cannot be complacent and the standards of service delivery
will be constantly monitored in response to service user views.
c) Phonology care pathway
This was a re-audit of the phonology care pathway undertaken in January 2011 and was
undertaken to ensure that therapists were complying with the previous recommendations.
These recommendations were that the SLTs are to be familiar with the phonological care
pathway and demonstrate evidence in the case notes of rationale for their diagnosis of delay
or disorder. The SLTs are to identify whether the sounds are stimulable and to record their
observations on the intelligibility of the child’s speech.
10 active cases were randomly selected from across the Wiltshire paediatric community
caseload; - only children with a primary speech problem were included in the audit.
In 80% of the cases phonological processes had been identified
All children were appropriately placed on the caseload.
80% Of the case notes identified either disordered or delayed speech
Observations on the child’s intelligibility was made in 70% of the cases
Clear management decisions were made in100% of the cases.
80% Of the cases reviewed had been seen more than once and there was evidence
of the child’s progress and decisions about the future. 20% of the cases were triage
cases and the children had only been seen once
100% of the cases were active.
There was a marked improvement since the previous audit but there was non-compliance in
six out of eight of the standards and there will be re-audit of this pathway in December 2013
to allow time to embed the standards.
All therapists will be familiar with the phonological care pathway
All therapists involved in the differential diagnosis will show evidence in the case
notes of their rationale e.g. typical versus atypical simplification processes.
All therapists will determine whether phonemes are stimulable.
All therapists will make observations on the child intelligibility
d) Audit of the communication environment and special schools
This audit was carried out to evaluate the conduciveness of the environment to
communication within special schools in Wiltshire and to begin work towards having
consistent communication environments based on best practice to enable students to
achieve their communication potential
Two of the four schools eligible for inclusion in the audit chose to participate and 10
elements of communication were evaluated.
1. Each school had a communication policy
2. Each school had an abundance of accessible information, for example, timelines,
pupil passports, and school charters some targeted to the children and young people
and some to the staff
3. There was a high level of evidence of joint planning between the teacher and speech
and language therapist.
4. There was a high level of evidence of use of target sheets.
5. One school had an established augmentative and alternative communication process
(AAC) and the other school was in the process of developing their own system .
6. Staff training. In one school 75%of staff were trained in the use of PECS(Picture
exchange communication system) and 85% in Makaton and 80% In intensive
interaction, Staff in the other school were trained in all the these areas but there was
no record of the number of staff trained.
The results of the audit will be shared with Head teachers and Communication leads of each
school and a process for sharing good practice across the schools will be identified.
Future audits would benefit from having a wider planning group in place. It would also be
useful to extend the audit to look in depth at a sample of children and young people and how
their communication targets and strategies are incorporated into lesson plans.
e) Audit of the dysphagia pathway
The aim of this audit was to assess the consistency of service delivery in dysphagia
assessment and management across the paediatric caseload
10 sets of case notes from across the County were evaluated for compliance with the SLT
dysphagia care pathway.
This audit was non-compliant in the following areas and will be re-audited in June 2013:
Not all cases had completed referral forms and background information forms were not
included in the case notes. In some cases the triage decision was not recorded in the case
notes. The risk of aspiration was not always recorded and although clear management plans
were in place the rationale for this was not recorded in all the case notes.
Areas of good practice
All case notes and complied with the standards for case note recording
All speech and language therapists have recorded a clear management plan and follow up.
Referral forms need to be completed with accurate information
Triage decisions need to be recorded at the point of triage
Background information forms are required to be completed in all cases
Increased detail for the rationale for case management is to be recorded in the files
The level of risk of aspiration needs to be recorded.
Child’s view of their speech and language therapy assistant
An evaluation of the speech and language therapy assistant’s intervention from the
perspective of the child was undertaken and the results used to promote improved practice.
Areas of good practice
It was encouraging to find that the speech and language therapy assistants are well liked by
the children in the survey and that they deliver therapy and intervention in an enjoyable way.
From the child’s perspective they felt that the activities initiated by the therapy assistant were
carried over into the activities of the school day in 63% of cases and into the home
environment in 58% of cases. This would need to be compared with actual evidence of ‘carry
The success of this audit will be taken further over the next year to continue to explore the
most successful ways of eliciting the views of children and young people to inform planning
and delivery of interventions.
Hidden communication needs in older children diagnosed as being on the
Autistic spectrum – shared factor
It is of concern that some children do not have their significant communication needs
identified until age 8 yrs or older. An audit was undertaken to try and understand the reasons
for this.
The files of 38 children with social communication difficulties identified as being referred into
the service over the age of eight years were analysed. Children with language levels within
the normal range were excluded from further analysis as were children referred purely by the
paediatrician for assistance with the diagnosis of autism spectrum. A ‘deep dive’ analysis
was carried out on 10 files across the age range.
Key issues from this audit
Within the audit cohort there seemed to be a profile of good/better expressive language skills
and weak language understanding. This might explain why the children’s needs were not
identified earlier. Adults tend to gauge a child’s understanding by reflecting on the
expressive language used by the child.
Many children were described as ‘having friends’ by school or parents, and again this may
be why they were older before their social communication difficulties were identified.
A number of children were diagnosed with Asperger’s syndrome or ‘atypical’ or ‘sociable’
autism, again this could explain why the children’s needs took longer to be explored.
There was no significant pattern in the profile of schools referring late which , suggests that
the reason the children’s language needs are missed is more to do with individual features
than school’s understanding and knowledge
Most of the children were referred into the service via a paediatrician.
It is more common when carrying out social communication assessments for SLTs to find
different levels of concern reported by school and parents, with more significant concerns
reported from home e.g. anxiety or behavioural issues.
Children on the autism spectrum can often show a strong desire to ‘do the right thing’ which
may lead to the children masking their difficulties in school.
High anxiety levels were a commonly reported theme
Areas of good practice
Where diagnosis was sought, children had been diagnosed by the paediatricians
within a year of initial assessment by the SLT service.
Formal assessments were carried out ensuring judgements were made using a
range of clinical dataSeveral children did not require ongoing SLT in put after
follow up, suggesting that schools were working well with the therapist and
children to help them develop their language skills.
The main recommendations from this audit are to work with the schools special educational
needs service to:
 Create a screening tool to help identify hidden language needs in children.
 Create intervention programmes for schools to help and support children who find
it hard to understand language rich lessons.
Evaluation of summer fluency group
The aim of this audit was to evaluate the effectiveness of the fluency group as a form of
intervention for children and young people of 10-16 years who have dysfluent
There were eight regular participants in the group, all of whom were male. The audit results
were very positive and found that:
100% of the participants knew what strategies to use to help towards more fluent
100%of the participants reported feeling positive or more positive about their
100% of participants identified they were able to stammer in an easy way/and or
didn’t find stammering hard.
Areas of good practice
In line with recommendations from the Royal College of speech and language
therapists children of 10-16yrs are now offered group intervention to target
dysfluent speech.
All participants showed a greater knowledge of the strategies they can use to
develop more fluent speech.
Parents of the children and young people recognise the beneficial effects of the
group on their children.
The following service improvements have been planned following this audit:
 Some of the children and young people continue to find talking to other people in
various speaking situations difficult, so more time will be spent in addressing
these issues in future groups using solution focused brief therapy.
 The session for parents was well received and will be offered as routine in future.
 Group participants with additional special educational needs require a higher ratio
of therapists to children and young people in order to effectively support them
through the range of activities and this will be put in place in future groups. .
Training Programme 2012 – 2013
The Paediatric Speech and Language Therapy Team have delivered a wide range of
courses as part of the core offer of training agreed by commissioners for 2012 – 2013. The
training packages have aimed to support a mixed audience including parents, teachers,
teaching assistants, Early Years professionals and Health Professionals. Some of the
courses have been delivered ‘under license’ and are published training programmes. This
includes the Derbyshire Language Scheme, the Makaton Beginners’ Workshop and Early
Bird programme for Parents. Other courses have been written by our department to address
the training needs of members of the ‘Team Around the Child’ across Wiltshire. In all
approximately 1700 hours have been assigned to deliver the core training offer to 450
attendees. The programme has been fully implemented across Wiltshire and has been
highly successful and well evaluated.
Health Visitors
Teaching Assistants
Senco/Class Teacher
Evaluation of the training provided demonstrates a high level of participant satisfaction.
“I felt this day was very informative ...it is a vast area and I felt I have gained some
Would you recommend this course to your colleagues?
100% replied “yes”
“Good pace, good resources /handouts. Opportunities for questions. Super course, am
looking forward to expanding my knowledge and understanding.”
Speech and Language Link setting model
There are over 550 early years and school aged educational settings across Wiltshire. The
challenge for the SLT department is to ensure that it meets the needs of all children with
speech language and communication difficulties attending these settings by collaborating
with the ‘team around the child’ and through delivering training. In order to be as effective as
possible a ‘link setting’ model has been established. Each educational setting now has a link
SLT who represents the service and sees all children in the setting regardless of their
diagnosis or difficulties. Exceptions to this occur when therapists with additional
postgraduate training are required to support children who have swallowing difficulties or
problems with fluency.
This model of service delivery supports equity of caseload size across Wiltshire, reduces
time and cost of travelling prevents duplication, and ensures that each setting has a named
professional to communicate directly with.
This new model of service delivery commenced in September 2012 following a detailed
caseload analysis of the speech and language therapy service across Wiltshire. The whole
caseload was then reviewed again in February 2013 to ensure robustness in setting
This model enables a further layer of flexibility in the service to ensure it is responsive to the
needs of children and young people with speech language and communication needs in
Wiltshire. The SLT Department has a confident flexible workforce able to respond to different
pressures and demands
Additionally commissioned activity
In addition to the core commissioned services other agencies have commissioned further
training and support. This includes training in
Visual strategies for transitioning children
Play and communication
Pilot project on BLAST in to reception classes
Speech and Language Targets explained
Implementation of Makaton signing throughout the day
The Speech and Language Therapy Services budget for 2012/2013 was made up of
£1,535,076 pay and £117,090 non-pay. The final outturn on pay was under spend of
£28,181, there was an overspend on non-pay or £44,008.
The more significant non-pay overspends related to training expenses and materials
£17,887 overspent; purchase of new computers/laptops £10,455 overspend; room hire
£7410 overspend; travel and subsistence £5810 overspend; stationery £4326 overspend.
Income was overachieved by £9720. Cost improvement plans were not taken into account in
the budgets this year but were held centrally by the women and children's directorate.
Business plan 2013-14
A business plan for the Speech and Language Therapy Service has been agreed for 201314 based on strategic priorities and local health and communication needs.
The priority areas identified include:
Ongoing evaluation of service user experience,
Audit programme aimed at monitoring quality and performance.
Continued programmes to support partnership working.
Effective management of resources including staffing.
A comprehensive multiagency training programme
Continuing to develop easily accessible resources.
Embedding the Link model of service delivery.
The complete business plan can be found on
The paediatric speech and language therapy service across Wiltshire has completed two full
years. There continues to be an increase in referrals into the service of increasing
complexity and the team has been very busy throughout the year managing an active
caseload of 3,200 and supporting services into over 340 early years’ settings and 240
schools as well as district specialist centres, clinics and children's homes.
Training provided by the service continues to be acknowledged to be of a high standard and
enables those trained to actively support children with speech language and communication
needs in Wiltshire. Audits carried out by the service ensure that current practice is based on
current research and evidence-based practice.
Matrix evidence, an economic evaluation of speech and language therapy. Marsh
Bertranou, Suominen, Venkatachalam December 2010.
Speech and Language Referrals – Tom Frost Public Health Scientist Nov. 2012