I’ve been a speech and language therapist a long time – since 1986! I can’t think of anything I would rather do. It’s complex and challenging, frustrating and rewarding and for better or worse it’s part of my DNA.

In my first job, the expectation when I went on school visits was that I would arrive, be given a list of children, sprinkle my speech therapy magic dust and “cure” the children. This magic would often take place in a small windowless room, or maybe a nearby corridor. Not great!

There was also a point in my early career when I was actively discouraged from working in schools, sitting instead in empty clinics waiting for children who would never arrive!

Things weren’t all bad, but there was a definite need for change.

Cut to the 1990’s where we saw speech and language therapists and schools working more collaboratively, with each other and with parents. I was a specialist speech and language therapist at this time for children with Specific Language Impairment (now Developmental Language Disorder).[1] [2] Following the closure of our then “Language Unit,” our children with DLD went into mainstream provision. We worked with the children in schools, two or three times a week, providing direct speech and language therapy. We worked with teachers and support staff, modelling approaches, working in and out of the classroom, sharing expertise. We learned from each other. Parents would come together with us and share ideas, worries and tips. It was far from perfect; we were all learning how to do things differently; there was a huge variety of knowledge and engagement from school to school, but on the whole, it was inclusive, and the children made good progress.

Speech and language therapy makes a difference.

Cut to 2018 – I still do a little therapy, amongst other things, working with children with DLD, so complex they make my head hurt. My therapy is more evidence based than ever and I’m working out how to shift massive deficits in aspects of language to build the children’s communication, confidence, wellbeing and academic performance. The work is in partnership with schools and parents, providing regular direct, collaborative speech and language therapy. I feel I am better at taking account of educational demands, I’m more confident about providing therapy that is inclusive. I work harder at demonstrating that the work we do is impactful - captured by standardised test scores, accelerated academic progress; parents and kids telling me things are better now…

However, I now provide this speech and language therapy not as part of the NHS, but commissioned directly by schools.  The schools we work with are commissioning their own speech and language therapy, often due to depleted local provision.  Not the fault of the therapists who are wonderful, knowledgeable practitioners. The fault of a system bursting at the seams.

Speech and language therapy services have been slashed, speech and language therapy clinical leaders are bleeding from the system, specialists in specific areas lost. Some services are thriving despite the system – usually due to strong local leadership, some hanging on for dear life, others are massively depleted. The impact – children receiving inequitable access to services. In many areas it means less collaborative practice. Less direct speech and language therapy.[3]

Whether due to circumstance or system, the pendulum from speech therapy magic dust in the 1980’s to current practice has swung too far.  I visited a school recently where children on School Support with DLD got an annual visit from speech and language therapy. Once a year! No surprise then that their speech and language assessment scores had stagnated, some even gone backwards.

It’s not everywhere, but I see it more often than not as I travel around the country visiting schools and settings; an insidious shift of less direct speech and language therapy, less collaboration, less personalised, bespoke approaches, more generalised practice.

Don’t get me wrong, general good practice is wonderful – it is inclusive and very important. Targeted (as opposed to personalised) approaches can be hugely impactful. Professional development for educators is essential and done well, can impact positively on practice, BUT… and this is a big but… some children need speech and language therapy as well - direct, personalised, specific to their very particular needs – speech and language therapy.

Diluted services often result in less input for children who have specific needs, such as Developmental Language Disorder (DLD), Phonological Disorders, Social Communication Disorders. Less therapy means less impact on their speech, language and communication. Less long term impact on their progress and attainment. More negative impact on wellbeing and mental health.[4]

Often the given reason for cuts is the cost… but this is the epitome of short term thinking. Ten years ago, I CAN wrote an update of their “Cost to the Nation” paper;[5] the long term cost of poor communication. It’s a costly business when children don’t get the support they need – financially, emotionally and morally. One we really can’t afford.

The need for therapy is in no way to denigrate the huge importance of great teaching, high quality early years provision and of targeted intervention – all elements are important for inclusive, impactful provision. But, for some children, this provision will include direct therapy.

For more information and great organisations supporting parents and practitioners of children with DLD:

NAPLIC: https://www.naplic.org.uk/

I CAN: https://www.ican.org.uk/

AFASIC: https://www.afasic.org.uk/

RADLD: https://radld.org/

The Communication Trust: https://www.thecommunicationtrust.org.uk/

[1] Great article here written by Professor Courtney Norbury on DLD: https://www.theguardian.com/science/head-quarters/2017/sep/22/developmental-language-disorder-the-most-common-childhood-condition-youve-never-heard-of

[2] Naplic has lots of information on children with DLD – conference this year on DLD: https://www.naplic.org.uk/

[3] See Bercow 10 for evidence: https://www.bercow10yearson.com/wp-content/uploads/2018/03/337644-ICAN-Bercow-Report-WEB.pdf

[4] See Bercow 10 for evidence: https://www.bercow10yearson.com/wp-content/uploads/2018/03/337644-ICAN-Bercow-Report-WEB.pdf


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