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Background Info

The petitioner asserts that ensuring local authorities and health boards protect quality speech and language therapy services for all ages of people with communication support needs and / or swallowing difficulties when planning local services and setting budgets will save lives, save the public money in the short, medium and long term; ensure the most effective multi-disciplinary working and prevent hardship and secure equality of opportunity for all of Scotland’s children and young people; people with long term conditions such as stroke, mental illness, learning disabilities, and cancer or people who are involved, as victims or perpetrators, in Scotland’s justice system.

Why ensure local authorities and NHS boards protect quality speech and language therapy services when planning local services and setting budgets?

A 2009 RCSLT survey and 2010 FOI data from 11 of Scotland’s NHS boards (including data on education authorities funding) shows that budget cuts are already having a negative impact on service access – even where speech and language therapists are proactively trying to maintain quality services through innovation and service redesign

• Waiting times and lists have grown and are growing
• SLTs are being cut or are missing from multidisciplinary teams across care groups
• There is evidence of the use of less experienced and less qualified staff supervised by a shrinking number of senior staff. 

How do SLTs save lives?
SLT for babies with suckling and / or swallowing problems or adults with swallowing difficulties after stroke or other head injury helps to reduce malnutrition, recurring chest infections, aspiration pneumonia and potentially death.

How does SLT save the public money in the short, medium and long term?
Recently published independent research on the economic evaluation of SLT revealed;

For people with swallowing problems following stroke
• Every £1 invested in low intensity SLT is estimated to generate £2.30 in health care cost savings through avoided cases of chest infections.
• In comparison to usual care by a non-specialised nurse, speech and language therapy is estimated to prevent 4,300 cases of chest infections requiring hospital care, and 9,200 cases of chest infections requiring community care (across the UK).
• The estimated annual net benefit is £1.1m in Scotland.

For adults with Aphasia (speech and language problems after stroke)
• Every £1 invested in enhanced SLT is estimated to generate £1.30 due to the monetary benefit associated with a quality of life gain.
• In comparison to routine SLT, enhanced SLT results in an estimated 0.057 Quality Adjusted Life Years (QALY) gain per patient.
• Estimated annual net benefit £1.3m in Scotland.

For children with specific language impairment (and no other difficulty)
• Every £1 invested in enhanced SLT generates £6.43 through increased lifetime earnings.
• The benefits of SLT are derived from improved communication leading to improved educational achievement and in turn increased adult earnings.
• Further breakdown of the net benefits shows that estimated annual net benefit is £58m in Scotland.

For people with Autistic Spectrum Disorder
• Every £1 invested in enhanced SLT generates £1.46 through lifetime cost savings and productivity gains.
• Estimated annual net benefit is £0.8m in Scotland.

How does SLT ensure the most effective multi-disciplinary working?
SLTs are identified, in government policy and Quality Improvement Scotland Clinical Guidelines and Standards as key members of multi-disciplinary care teams for children with additional support needs, people with learning disability (of all ages), mental health services (for all ages), stroke care, cancer care (e.g. laryngeal cancer) and dementia care. Working within the social model of disability, SLTs have responsibility for establishing (through communication skills training and adaptation of written information) communication accessible services where ever people with communication disabilities wish or need to function. As such they have a key role in ensuring effective communication between the service users with communication disability and any public service provider.

How can services for people with communication support needs prevent hardship and secure equality of opportunity for all children and young people; people with long term conditions such as stroke, mental health difficulties, learning disabilities, and cancer or who are involved, as victims or perpetrators, in Scotland’s justice system?

Scottish Governments own research showed people with unmet communication support needs compared to the general public are more likely to be unemployed or employed at an inappropriately low level; experience negative social interactions/communication within education, healthcare, criminal justice system, etc.; be misjudged in terms of cognitive and educational level and in terms of mental health status; be involved in the criminal justice system as both victims and perpetrators of crime; have difficulty accessing the information required in order to utilise services and live in socially deprived areas (Law et al. 2007).

Evidence based SLT services act to eradicate or minimise the impact of communication support needs on outcomes for individual and by extension their carers, community, service providers and Scottish economy generally.

RCSLT is calling on the Scottish Government to specifically:

A: Act to encourage NHS boards and local authorities to protect access to SLT services for people with communication support needs and/or swallowing difficulties to at least current (Dec. 2010) levels.
B: Develop and implement a communication action plan for Scotland’s children and young people. The plan would require Scottish Government, local authorities and NHS boards to identify and address needs at the earliest opportunity by:
1. re-establishing universal quality early years, pre-school speech, language and communication screening
2. establishing screening of young people as they enter secondary school
3. jointly planning services in line with identified needs and with established evidence and guidance on what works best

RCSLT and partners, AFASIC Scotland and ICAN have made initial proposals to Scottish Government on a model plan.

C: Ensure Speech and language therapists are employed as core members of the multi-disciplinary teams providing for people who need stroke, mental health, learning disability, cancer and other services. NHS boards and local authorities must—
• maintain better data on the speech, language and communication needs of their populations
• plan services in line with these needs and with established evidence and guidance on what works best
• work more closely together to provide access to speech and language therapy, regardless of when and where people seek support

D: Establish Speech and language therapy services throughout Scotland’s justice system. 
Responsible agencies such as health boards, local authorities, community justice authorities, Scottish Prison Service and the COPFS must:
• identify demand for and review provision of speech, language and communication needs services throughout the justice “pathway”
• pilot evidence-based speech, language and communication needs services throughout the criminal justice services – including identification of speech, language and communication needs in the national screening tool and communication skills training for key professionals working with young offenders
• develop speech, language and communication needs services throughout the criminal justice pathway – based on evidence from the pilot.