Speech, Language and Communication Needs Joint ...

JOINT COMMISSIONING STRATEGY
SPEECH, LANGUAGE AND
COMMUNICATION NEEDS
2011-14

DOCUMENT HISTORY
Version
Approving
Committees
Final
NHS HMR Locality Board - May 2011
Children , School and Families Joint Strategic Commissioning Group
Author:
Karen Kenton - Associate Director Commissioning Children & Maternity
Support by Speech, Language and Communication Needs Project Group
Dr Sean Pert - HMR Community Healthcare
Alison Drake - HMR Community Healthcare
Jan Stothard - RMBC
Maria Boyle - RMBC
Kate Charlton - Schools
2

CONTENTS
Preface 4
Vision 5
Principles 6
Introduction 7
Needs Assessment 10
Current Service Provision 16
Finance and Funding 20
Current Performance and Outcomes 22
Best Practice 23
Service Delivery Model 26
Priorities 28
Action Plan 29
Governance 30
References 31

PREFACE
“The ability to communicate is an essential life skill for all children and young people in the 21st century.
It is at the core of all social interaction. With effective communication skills, children can engage and
thrive. Without them, children will struggle to learn, achieve, make friends and interact with the world
around them. The centrality of communication is not simply a personal statement of value. It is a formal,
public and multi-lateral declaration by UNICEF, UNESCO and the World Health Organisation, which list
communication as one of ten core life skills. Communication is a fundamental human right.” (Bercow
2008).
In 2008 the government published ‘The Bercow Report: A Review of Services for Children and Young
People (0-19 years) with Speech, Language and Communication Needs’. This was quickly followed by
‘Better Communication: An Action Plan’ which proposed the establishment of 20 commissioning pathfinders
to explore the joint commissioning of provision for SLCN across the range of universal, targeted
and specialist services.
One of the greatest challenges for meeting SLCN is the range of need across the client group and the
great variability in models of intervention. Children with SLCN are a significant concern for families and
educators, with a prevalence of 7% of 5 years olds and as much as 50% in socio-economic deprived
populations such as Rochdale. Research undertaken within the borough showed that at one nursery
only 5 out of 52 (9.6%) had age appropriate SLC skills.
SLCN do not represent a single disability that can be easily recognised and treated but are present across
the range of disabilities, as well as existing as a discreet developmental difficulty in the context of
adequate skills in other developmental areas. SLCN therefore presents a considerable challenge for
service commissioners and providers.
Rochdale Borough Children’s Trust has recognised the importance of speech, language and communication
in enhancing the outcomes and future life chances of children and young people living in the
Borough, and has reflected this in the Borough’s Children and Young People’s Plan.
2011 is the National Year of Speech, Language and Communication, and this strategy reinforces the
commitment of all partners to work together to improve speech, language and communication (SLC)
and to reduce the inequalities in outcomes that children and young people experience as a result of poor
SLC skills.
4

VISION
We want to see:
● Children entering school with sufficiently developed speech, language and
communication skills to enable them to learn.
● Children and young people with additional SLCN receiving the support they need,
when and where they need it.
● Children and young people growing up and learning in ‘communication rich’
environments.
● A diverse range and mix of service providers with a capable and confident workforce,
equipped with the skills and experience necessary to support the SLCN of children and
young people.
● A whole systems approach to strategic planning and service delivery.
● The participation of children, young people, families and all relevant stakeholders in
service development
5

PRINCIPLES
This strategy has been developed taking account of the following principles:
● Speech, language and communication are ‘everybody’s business’
● Children and young people should have equal access to a range of high quality services
● All children within the borough of Rochdale achieve the best possible outcomes, during
childhood and adolescence to provide a solid foundation for adulthood.
● High quality, evidence based and timely interventions are provided
● Children and their families are recognised as equal partners and supported to identify their
needs and access appropriate services
● There is close collaboration between all services, settings and agencies to ensure close
working relationships, working across organisational boundaries and the development of best
practice
● Commissioners and providers across all sectors, work in partnership to deliver integrated
services for children and young people
● All children and families have a right to receive appropriate services, irrespective of ethnicity,
religion, disability, sexuality, gender or socio-economic status.
● Services will safeguard and promote the well being of children and young people
● Services will be delivered within available resource and deliver best value, and within the
QIPP framework
6

INTRODUCTION
PURPOSE
This strategy sets out how Rochdale Metropolitan Borough Council and NHS Heywood, Middleton
and Rochdale intend to jointly commission a range of provision to support speech, language and
communication needs within the context of an integrated, whole systems approach to service delivery.
The aims of the strategy are:
● To describe SLCN needs within the Rochdale Borough, and review existing provision
● To identify best practice at national and local levels
● To describe a joint service delivery model that will ensure high quality and best value
● To identify how partners intend to jointly commission services
● To identify key priorities for action and implementation
It seeks to:
● Develop provision across the full range of SLCN needs for children and young people
● Encourage a range of providers from across the public, private and voluntary sectors to support the
development of SLCN services
● Develop the workforce to be able to support SLCN
● Maximise the use of existing available resources supporting SLCN through partnership working
● Consult with children, young people and their families, and the range of stakeholders.
THE VALUE OF SPEECH LANGUAGE AND COMMUNICATION SKILLS
Speech, language and communication skills are key to a child’s social and educational success. Making
friends, learning and enjoying family life are all activities where communication skills are central.
Educational attainment and future employment prospects are all built upon good communication skills.
There is a wealth of evidence showing that children and young people who have SLCN are placed at
significant risk of failing to achieve their potential (Bercow 2008, Marmot 2010). This is not only a
concern for the child and their immediate family. Poor outcomes for children lead to a risk of higher
unemployment, mental health issues and even risk of antisocial and criminal behaviour. This is why SLCN
is everybody’s concern.
Early intervention and sustained support for children and young people with SLCN are therefore cost
effective for local services and society as a whole, as problems addressed earlier on not only improves
outcomes for the child, but also prevents future costs to services.
7

DEFINITION OF SPEECH, LANGUAGE AND COMMUNICATION SKILLS
The term speech, language and communication need encompasses a wide range of difficulties related to
all aspects of communication in children and young people. These can include difficulties with fluency,
forming sounds and words, formulating sentences, understanding what others say, and using language
socially.
SLCN may be a child’s primary educational need. Primary SLCN include specific difficulties of which there
is often no obvious cause. A significant proportion of children and young people in both primary and
secondary school with special educational needs have SLCN as their primary need.
In contrast secondary SLCN are associated with other difficulties that the child may be experiencing such
as autism, cerebral palsy, hearing loss or more general learning disabilities.
FINDINGS OF THE BERCOW REVIEW
In the light of the ‘Every Child Matters’ agenda and concerns about provision to meet language and
communication needs in general, the previous government commissioned John Bercow M.P. to
investigate current practice and make recommendations about how services could be improved. The
subsequent Bercow Report (DCSF, 2008) made five key recommendations:
● Communication is crucial – communication is a fundamental human right and is a key life skill.
Communication is at the core of all social interaction. For some children and young people, acquiring
the ability to communicate is a difficult and ongoing challenge. Just as the nature and severity of
their needs will vary, so will the type and extent of the help required to address them.
● Early Identification and intervention are essential – if the right help is received early on the child has a
better chance of tackling problems, communicating adequately and making progress. If a child does
not benefit from early intervention there are multiple risks including lower educational attainment,
behavioural problems, emotional and psychological difficulties, poorer employment prospects,
challenges to mental health and in some cases criminality.
● Continuum of services designed around the family – universal, targeted and specialist services are
required to meet the range of needs, and children, young people and their families must be at their
heart. Support for SLCN is essential in the early years of a child’s life. Whilst this is often the crucial
stage at which to intervene, older children and young people can also require support.
● Joint working is critical – in planning, commissioning and delivering SLCN provision. It is critical that
health services and children’s services, including schools, work together in support of children and
young people with SLCN.
● The current system is characterised by high variability and lack of equity – it is routinely described by
families as a ‘postcode lottery’, particulary in the context of their access to speech and language
therapy (SLT).
8

BETTER COMMUNICATION ACTION PLAN
In response to the Bercow report, the government set out it’s response, detailing a range of initiatives to
improve services for children with SLCN. These included:
● Appointing of a national communication champion to raise awareness and work with delivery
partners.
● The formation of a communications council to monitor service improvements and provide advice
and support to government.
● Development of the workforce to give a wider understanding of the importance of SLC, and the
knowledge and skill required to support those with SLCN.
● Ensuring that mainstream early years, education and health services provide the prevention, early
identification and intervention services needed to support children and through parents/carers to
develop speech, language and communication skills.
● Meeting communication needs through targeted and specialist services, helping commissioners
to make joined up responsive and effective provision for children with SLCN. Support for
commissioners included the identification of a number of SLCN commissioning pathfinders,
investing in the Augmentative and Alternative Communication (AAC) sector, commissioning a
research programme including the cost effectiveness of provision for children with SLCN
● Commissioning of a National Year of Speech, Language and Communication. This is 2011.
NORTH WEST REVIEW OF SPEECH, LANGUAGE AND COMMUNICATION
NEEDS 2010
The North West Strategic Health Authority commissioned this review report in response to Bercow and in
recognition of the importance of SLCN services in enhancing the future life chances of children and
young people. The review covered twenty four children’s trust areas and found that in common with the
national picture, the planning and delivery of SLCN services across the North West is patchy and not
always informed by robust commissioning. The report provides a useful baseline of services across the
North West, and also identifies the key elements needed to improve services. It findings will be threaded
throughout this strategy.
9

Needs Assessment
Rochdale’s Joint Strategic Needs Assessment in relation to children and young people provides a high
level outline of children’s needs in the borough. Speech, language and communication needs are identified
as a local priority. The following information provides a detailed analysis of need relevant to SLCN.
DEMOGRAPHICS
Population and Gender
In Rochdale Borough there are approximately 54,800 people aged 0-19 years, making up 26.7% of the
total population (Office for National Statistics mid-year population estimates 2009).
In 2009 there were 3,000 children under 1 year of age, 14,120 children age 1-5 years and 37,680 children
and young people aged 6-19 years. The gender balance is slightly higher for males at 51.3% (26,700)
compared to females at 48.7% (26,700).
Birth Rates
The birth rates in the borough have remained consistently higher than the North West and England and
Wales averages. The birth rate per 1,000 female population aged 15-44 was 73.5 in 2008. This is a
decrease of 1.2 per 1,000 population on the previous year and 9.7 higher than the North West average
and 9.7 higher than the national average.
The current trend (as shown in the graph below) suggests that the birth rate is going to continue to rise
at a higher rate than the regional and national averages. This would suggest that the borough has
greater need in terms of speech, language and communication services compared to other areas.
Crude Birth Rate per 1000 Female Population Aged 15 to 44
10

POPULATION BY LSOA
The map below shows the distribution of 0-15 year olds in the borough by LSOA. Data is only available
at LSOA level by broad age group which is why 0-15 age category is being used and not 0-19. Red
indicates the LSOAs with the highest proportion of this age group: between 31% and 35.4% of the total
population. The highest proportions predominantly involve neighbourhoods in and around central
Rochdale whilst Heywood and Middleton are more mixed.
It is important to note that the areas with higher numbers of children and young people correlate with
some of our most deprived communities. It is recognised that children and young people living in
poverty are much more likely to require support from speech, language and communication needs
(SLCN) services therefore we could assume that there will be greater levels of need within these
communities
11

ETHNICITY
The following pie chart and graph show the proportions of ethnic groups, firstly by White British and Non
white and White Other. By far the largest minority group are children and young people from a Pakistani
background.
Proportion of 0-19 year old population Rochdale
Borough by White British, Non-White and White Other.
Proportion of 0-19 year old population in Rochdale
Borough by Minority Ethnic Group
Work conducted by the Centre for Census and Survey Research at the University of Manchester suggests
that there will be a significant increase in the percentage of the population who are from “non-white”
ethnic backgrounds, rising from just over 18% in 2001 to a projected 31% in 2021, with the biggest
increase being amongst the Pakistani population.
In 2008 the local authority reported that 86 languages were spoken by children attending local schools.
Whilst bilingualism does not cause or contribute to SLCN, services provided in the mother tongue are
more effective and have a higher success rate in terms of user engagement and clinical outcome. This
have significant implications for the local workforce who support children’s SLC development.
12

Population Estimates
Population Estimates 2009
Under 1
1 to 5
6 to 19
11 to 19
0 to 19
Percentage
Age 5
7% of Age 5
1% of Age 5
Total Male
3000 1500
14120 7300
37680 19300
24920 12740
54800 28100
2520 51.3%
176.4 1300
25.2 91
13.0
Female
1500
6820
18380
12180
26700
48.7%
1220
85.4
12.2
2008 Based Population Projections 2013
Under 1
1 to 5
6 to 19
11 to 19
0 to 19
Percentage
Age 5
7% of Age 5
1% of Age 5
Total
2960
14660
36380
22600
54000
2760
193.2
27.6
Male
1520
7540
18740
11600
27800
51.5%
1400
98
14.0
Female
1440
7121
17640
11000
26200
48.5%
1360
95.2
13.6
Source of Data: ONS Mid Year Population
Estimates 2009
Source: Subnational Statistics Unit, ONS:
Crown Copyright
PREVALENCE OF SLCN IN ROCHDALE
As part of a review of the Early Years Speech and Language Therapy Service, Gascoigne and Burns (2009)
calculated the prevalence of SLCN for the Rochdale borough, based on the prevalence data detailed in
the Bercow review. The Bercow Review (2008) of SLCN concluded that the following prevalence data can
be taken to broadly represent the prevalence of SLCN in England.
1% of children at school entry will have severe and pervasive speech, language or communication
needs which will require long term specialist support, often of an intensive nature. These children have
communication needs which are likely to go on into adulthood. This data has been extrapolated to
Rochdale borough level and equates to 25 children across the Borough per school year or potentially
approximately 548 children and young people across the age range 0-19 at any one time.
Using 2009 based population projections for 2013, this would equate to 28 children
Based on 15 years of schooling, potentially there could be, in 2013 as many as 420 children
and young people with severe and pervasive speech, language and communication needs.
13

7% of children at school entry will have significant speech, language or communication needs which will
not improve without specialist intervention as part of the team working with the child, including the
parents. Children in this category can be expected to have long term needs but their access to learning
can be improved with appropriate support. These children have SLCN which are associated with an
underlying speech, language and communication impairment or as a secondary issue associated with
other learning disability or complex needs. The prevalence in this group is not correlated with
socio-economic factors or disadvantage.
In Rochdale this equates to 176 children across the Borough per school year.
Using population estimates 2009 figures, this would equate to 176 five year old children across Rochdale
borough with significant difficulties with speech and/or language. This figure would increase to 193 five
year old children based on 2013 population projections.
Based on 15 years of schooling, potentially there could be, in 2013 as many as 2,895 children and
young people with significant difficulties with speech and/or language.
According to Bercow, in the most disadvantaged areas of England, approximately 50% of children and
young people have speech and language skills that are significantly below those expected for their age.
At school entry, low income children lag behind their middle income counterparts by nearly one year in
vocabulary. 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 aged five, and those who had poor oral language skills. By the time they
are 14, this gap has widened to five years’ difference (Office of the Communication Champion, 2010).
Given the level of deprivation in Rochdale, it is not unreasonable to take the 50% estimate as a guide to
the potential levels of SLCN in the pre-school population which are not necessarily linked into long term
underlying impairment and may be expected to respond to the appropriate universal and targeted
support.
Using population estimates 2009, it is estimated that there were 8,560 children in the 0-5 age group
who would have benefited from universal and targeted support in order to minimise the risks of
long term SLCN; this number could increase to approximately 8,810 by 2013.
14

Research carried out in Rochdale (Stothard 2005) indicated that 75% of KS1 pupils had statistically
significant levels of language delay. More recent data collected in a local project by Drake and Stothard
suggested that in one Rochdale nursery only 9.6% of children had age-appropriate speech, language and
communication skills on entry to nursery. If figures are extrapolated form the data, the indications are
that there are thousands of pupils with language delay, who would benefit from universal and targeted
support in order to minimise the risks of long term SLCN.
SLCN BY AGE GROUP
Early Years (0-4 years)
Population of Rochdale 0-4 Years
Rochdale had a population of 14,600 children (7,700 males and 7,100 females) aged 0-4 based on
population estimates mid 2009 (OfNS June 2010).
Considerations for SLCN for this age group (0-4)
● 1% of children or 146 children will have severe and pervasive speech, language or communication
needs.
● 7%-10% or 1022 – 1460 of children will have significant speech, language or communication needs.
● 50-70% or 7300 – 10,220 children would benefit from universal or targeted work to support the
development of their speech, language and communication.
● A nursery of 52 children in Rochdale was assessed at the start of the nursery year. Only 5 children
(9.6%) of these children had age appropriate speech, language and communication skills.
Children and Young People Years (5-19 years)
Population of Rochdale 5-19 Years
● Rochdale had a population of 40,200 children and young people aged 5-19 based on population
estimates mid 2009 (OfNS June 2010).
Considerations for SLCN for this age group (5-19)
● 1% of children or 402 children will have severe and pervasive speech, language or communication
needs.
● 7%-10% or 2814 – 4,020 of children will have significant speech, language or communication needs.
● 50-70% or 20,100 – 28,140 children would benefit from universal or targeted work to support the
development of their speech, language and communication.
● There is very strong evidence from Canada and the USA that speech language and communication
difficulties tend to be labelled as “behaviour problems” (RCSLT 2009).
● A third of children with speech and language difficulties later developed mental health problems,
with resulting criminal involvement in some cases (ibid).
15

CURRENT SERVICE PROVISION
SERVICES/PROVISION SUPPORTING THE SLCN PATHWAY
There are many services and initiatives across the borough that support SLCN either as their core
function or as an element of the service that they provide. We have identified the key services and
initiatives across the borough as 1 April 2011.
No of educational settings within the borough.
All settings will contribute to SLCN provision. There are currently
● 4 state maintained nursery schools
● 69 state maintained nursery and primary schools
● 12 secondary schools
● 2 further education colleges
● 4 special schools
● 1 pupil referral service
*Source: RMBC 2010
CHILDREN’S PROVISIONS
Private Early Years Provision:
● Day nurseries
● Child Minders
Overview of SLCN Provision and Initiatives as of 1 April 2011
Core Provision – i.e. whole service/initiative is focused on SLCN
Provision
Level
(universal,
targeted,
specialist) Settings Description
Communication,
Language and Literacy
Development
Consultants
U & T
Y1, reception and
nursery classes
National Strategy initiative, 2 consultants employed
by School Improvement service.
Early Talk
U & T
EY settings,
maintained &
non-maintained
ICAN national initiative- training, accreditation
packages and networking.
Primary Talk
U & T
Primary Schools by
invitation of School
Improvement
Service.
ICAN initiative - Run by School Improvement
Service.
Training and accreditation packages. Currently 15
schools involved. Training is delivered by SIS
consultant and part-time SLT
16

Provision
Level
(universal,
targeted,
specialist) Settings Description
ICAN team,
(within Rochdale
Additional Needs
Service)
T & S
Any EY setting
attended by pupil on
ICAN caseload
Peripatetic service -SLT, specialist teacher and
specialist support assistant. The target group is
children with SLI (and the staff that support them).
Accredited I CAN specialist level
A Chance to Talk
(ACTT)
U, T & S
8 Primary schools
2 year ICAN pilot, started 1/4/10, involving 8 schools,
who as a cluster employ a SLT between them. Idea is
to develop a sustainable model of practice, in which a
group of schools commission SLT services and share
cost.
SALTAC resourced
language provision
(RANS)
T & S
Castleton Primary
School
Specialist unit for pupils with SLI in reception, KS1 &
KS2 if appropriate. The team consists of SLT, specialist
teacher and support assistants. Service under review
as part of the larger review of RANS
Speech and Language
Therapy/ist (SLT)
T & S
St Peter’s CE Primary
School
School employs own SLT
RCAT (Rochdale
Communication Aids
Team)
S
Any
Provision of communication aids eg software and
hardware for individual pupils. Some training is also
delivered.
Children’s Speech and
Language Therapy
Service (SLT)
U,T,S
Any
Core SLT service
Support Provision – where the service/practitioners support SLCN as part of a wider role
Provision
Level
(universal,
targeted,
specialist) Settings Description
Children’s Centres
U,T
Support identification of need
Health Visitor
U & T
Domicillary
Support identification of need
Portage
S
Home visiting service
Supports SLCN as part of wider package of care for
young children with significant needs
Learning Together
S
Supports SLCN as part of wider package of care for
young children with significant needs
Educational Psychology
S
Schools
Identification of need
Children’s Occupational
Therapy and
Physiotherapy
S
Any
Support specialist needs
Community Paediatric
Service
S
Child Development
Unit, schools and
clinics
Support specialist needs
Child and Adolescent
Mental Health
Service-tier 3 (CAMHS)
S
Clinics and
community
Support specialist needs – mainly autistic spectrum
disorder
Acute Hospital Services
S
Hospital and clincs
Supports identification and specialist intervention
17

SPEECH AND LANGUAGE THERAPY SERVICES
Bench marking data undertaken as part of the NW SLCN review provides a high level comparison of
capacity and demand across the region, allowing some comparison of Rochdale’s SLT service to others.
Whilst there may be some variance (eg in how SLCN is identified as primary need for SEN) across areas,
figure 1 provides the most reliable information currently available regarding Greater Manchester
children’s trust areas.
Of the ten areas, Rochdale is the 3rd most deprived with Greater Manchester, and is therefore likely to
have high levels of SLCN. Although the figures need to be treated with caution Rochdale has the 2nd
highest percentage of children whose SLCN needs are identified as their primary need in relation to
special educational need. The number of speech and language therapists per 10,000 school population
in Rochdale is broadly average in comparison to all 10 areas. However when comparing the four most
deprived areas who are likely to have the greatest need, Rochdale has the lowest numbers of SLTs.
Figure 1 Comparison GM Children’s Trust Areas
Children’s
Trust Area
Population
School aged
children
IMD Rank
2007
% with SLCN
as primary
need for SEN
% pupils with
statements
SLT wte SLT per 10,000
of school
population
Ashton, Wigan
and Leigh
45611
80th
12.4
3.0
15.9
3.5
Bolton
48062
65th
13.3
2.4
22.3
4.6
Bury
30033
136th
17.4
3.1
12
4
Manchester
71624
4th
15.5
2.8
42.3
5.9
Oldham
41387
42nd
20.9
2.1
19.7
4.8
Rochdale
33527
35th
22.1
3.3
15.4
4.6
Salford
33604
24th
27.6
2.8
20
5.9
Stockport
43149
190th
17.3
3.6
16
3.7
Tameside
34981
47th
14.9
2.1
15.2
4.3
Trafford
38390
178th
19.3
2.4
19.6
5.1
18

POTENTIAL GAPS IN SLT PROVISION
• The NW Review of SLCN 2010 highlighted the limited provision for children of secondary school age
in most areas. Within Rochdale, in 2009 there were 24,920 secondary school age children, reducing
to 22,600 in 2013. Although we are unable to conclusively determine the proportion of these
children who have a SCLN, for their longer term outcomes, it is important to introduce interventions
when a child’s SCLN is identified regardless of the child’s age.
• The review also highlighted gaps in provision for young offenders. In Rochdale (January –December
2010) there were 323 children and young people aged 10-18 years who were engaged by the Youth
Offending Service. In addition, in the same period, 400 children and young people age 5-16 years
who were vulnerable and at risk of offending or anti-social behaviour were known to the service.
Although there may be some double counting of these individuals, there is a significant group of
children and young people who potentially have SLCN.
• There is currently no specific service for young offenders. Young offenders often present with
previously undiagnosed SLCN (RCSLT Criminal Justice briefing).
• Hard to reach populations. Children who do not regularly attend school, or who are transient often
miss out on services.
• A service focusing on the needs of the traveller population to work along side current support
services with the LA
• Young people who are experiencing SLCN in their teenage years may experience shame,
embarrassment and bullying. A service designed to meet the needs of these children could reduce
school absenteeism, and avoid mental health issues.
• Children who fail to attend/access services. Families may need support to prioritise the SLCN of their
child. The use of contracts/agreements, Common Assessment Framework (CAFs) by referrers could
support specialist services. ‘Failure to attend’ rates are similar in Rochdale to other areas of the
country.
• Children presenting with behavioural difficulties and suspected SLCN would benefit from assessment
and where appropriate intervention by a specialist speech and language therapist. Such identification
and intervention could reduce future costs to services by avoiding exclusion from school, antisocial
behaviour and even criminal activity.
19

FINANCE AND FUNDING
As has been clearly described, Speech, Language and Communication is everybody’s business. Many
services and practitioners across agencies support the SLCN pathway. Financial arrangements and
funding are therefore complex, and in many cases difficult to differentiate. We have taken a pragmatic
approach in our attempt to quantify current spend. Where possible we have identified ‘dedicated’
budgets (ie those where the purpose of funding is to specifically address SLCN). Where this is not possible
(those services/area that support pathway but who are not dedicated just to SLCN) we have indicated
the level/type of support provided.
Funding sources are primarily via NHSHMR, RMBC and Schools.
Primary Care Trust *
£1,182,000- speech and language therapy service for children in Heywood, Middleton and Rochdale
(HMR) as part of a block contract with HMR Community Healthcare (to be part of Pennine Care NHS
Foundation Trust from 1 April 2011)
£15,500 - RCAT
Other support:
The PCT funds community services such as health visiting, school health practitioners, other therapy
services such as occupational therapy and physiotherapy, audiology, posture and mobility service who
all contribute to the SLCN pathway. Some services such as health visiting support universal and targeted
provision and others such as therapies support specialist intervention particularly for those children and
young people with more complex needs and/or disabilities. Acute hospital services and some CAMHS
also support the SLCN pathway. It is impossible to disaggregate the percentage of spend for SLCN for
these services.
£98,508 is allocated to the learning together service. SLT support is a key element of provision along with
other the other children’s therapy services.
*Source: Finance Dept., NHS Heywood, Middleton and Rochdale, 2010
Local authority
Circa £160,000 direct funding for SLT services
Circa £350,000 relating to specialist services for SLCN
Other support:
The local authority funds a number of services that support the SLCN pathway for example school
improvement officers, educational psychology, LA Officer time, RANS teachers and TAs around ASD. It is
not possible to disaggregate the percentage of spend for SLCN for these services.
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Combined Spend
PCT and RMBC dedicated spend is in region of £1.7m per annum, plus unquantified support from other
services
Schools
The identification of school’s financial contribution to SLCN is an area for further exploration. Within the
borough there is an example of a school directly funding a speech and language therapist
The Economic Context
The current economic climate and public sector efficiencies mean that it is even more imperative that all
interventions are evidenced to be effective and efficient. It remains the case that there needs to a focus
on preventative and early interventions delivered by the wider workforce, and that specialist services are
enabled to respond to those children and young people with the most significant need. This will have
greater prominence as the financial landscape becomes evermore challenging and competing pressures
for resources will require reassurance that interventions are effective and demonstrate best value. It is
imperative that all available funding streams for SLCN are aligned to enable a whole systems approach to
service development.
Financial Risk
Both the Local Authority and Primary Care Trust are identifying unprecedented levels of efficiencies. This
has already seen a reduction in the overall spend on SLCN for 2011-12, compared to the previous year as
existing funding streams have drawn to a close and efficiencies have been identified. It is essential that
the crucial contribution that SLC makes to long term outcomes is not forgotten, and that the focus upon
early intervention is maintained. This will require all agencies to take a long term view in relation to
outcomes and cost efficiencies realised.
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CURRENT PERFORMANCE AND OUTCOMES
In the absence of agreed performance indicators relating specifically to SLC it is difficult to benchmark
service performance or outcomes for children in a meaningful way.
Rochdale’s Early Years Foundation Stage Profile can be used as a proxy measure in relation to outcomes
in the early years. The profile assesses children across 10 developmental domains, generally during the
year before school entry (reception), against expected age appropriate skill level. The inclusion of
outcomes which focus on speech, language and communication provide a good indication of children’s
development in this area within the borough.
Since 2008 there has been a year on year increase in the percentage of children achieving 72-78 points
across the foundation stage profile, rising from 46% in 2008 to 53% in 2010. This compares to a national
average of 56% and a statistical neighbour average of 52.9%. However the gap between the lowest
achieving 20% and the rest has only reduced by 4% during the same period, and the 34.8% gap is higher
than both national (32.7%) and statistical neighbour (32.8%) averages. Closing the gap remains a key
priority.
The table below details foundation stage profile data that is specifically relevant to supporting speech,
language and communication.
2008 2009 2010
% achieving age appropriate skill in
personal, social & emotional development
(PSED)
65.7
66.2
66.8
% achieving age appropriate skill in
communication, language and literacy
development (CLLD)
49.2
51.3
55.8
% achieving age appropriate skill across all
10 profile domains
67.7
67.2
67.9
Despite the improvement noted above, it is of significant concern that only just over half of children
across the borough (and significantly less in areas of high deprivation) have developed age appropriate
CLLD. This means that very significant numbers of children are entering school without the pre-requiste
skills to enable them to learn. There appears to be a significant gap in achievement in CLLD when
required to the level of attainment across all ten profile domains.
22

BEST PRACTICE
The information in the following section is drawn from the Bercow Report (2008), Better Communication
(2008), Lamb Inquiry (2010) and relevant guidance issued by professional organisations.
Best Practice at Strategic Level
The appointment of a Communication Champion to lead on SLCN in the LA at a strategic level. This
person should sit as a member of the Children’s Trust’s governing body.
• The identification of the appropriate skills and capacity ‘mix’ required in the children’s workforce to
deliver services at universal, targeted and specialist levels
• The development of a robust evaluation process by which progress towards targets set in the plan for
the delivery of provision can be monitored and performance against those targets published and
open to scrutiny
• Joint commissioning of services
Best Practice at Universal Level
• Early intervention
• the early years, often described as ‘a window of opportunity’ or ‘sensitive window’ is a period of
rapid neurological development. Positively supporting children’s language development during
this critical time is essential (ICAN 2009)
• early identification and intervention is supported both in terms of having the greatest impact but
also being the most cost-effective
• the Centre for Social Justice has focused on early intervention as the essential solution to breaking
the cycle of disadvantage in the early years of a child’s life
• All maintained and non-maintained settings should appoint a Communication Champion at
practitioner level to lead on SLCN in their setting.
• The development of Speech, Language and Communication skills should be prioritised by all
Children’s Centres
• There should be awareness-raising amongst all professionals within the Children’s Workforce about
the importance of speech, language and communication skills. This should link into the government’s
Year of Language planned for 2011
• Appropriate training should be provided for all professionals within the Children’s Workforce to
improve their skills in raising standards of language and communication skills in children, in assessing
and identifying SLCN and in providing appropriate interventions. This training ideally should be
multi-agency in nature both in terms of delivery and receipt.
• Parental input and interaction is crucial. Positive communication behaviors such as encouraging the
child, positive reinforcement and a range of different types of language are important. Consideration
should be given to ways in which access to increased information and support around the
development of speech, language and communication can be offered to parents.
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Best Practice At Targeted And Specialist Levels
There should be core specialist services available to influence and shape advice to practitioners about a
range of targeted interventions to meet the needs of children with SLCN
There should be core clinical services available to provide rapid assessment, intervention and advice for
children referred with SLCN
• There should be sufficient skills and capacity within the Children’s Workforce to enable the delivery of
appropriate targeted and specialist support for children and young people with SLCN. This support
should provide a continuum of service across all age-ranges and equitably across all groups, not only
to include children and young people within the education system but also population groups such
as traveller children and young offenders
• Staff with specialist skills, who are able to develop and/or implement care pathways to address the
needs of specific populations of children with SLCN, such as:
• Speech and Language Disorder
• Bilingualism
• Dysfluency
• Autistic Spectrum Disorders
• Hearing Impairment
• Dysphagia
• These staff should possess the skills to enable them to:
• Identify, assess & treat
• Train other professionals within their own and other clinical services, multi-disciplinary teams and
the wider workforce
• Have a strategic overview of their particular specialist area, in order to monitor/evaluate current
practice and be pro-active in planning future services
• There should be flexibility of approach and provision of services to meet the needs of a wide range of
families
• ways of engaging those families considered ‘hard to reach’ or ‘at risk’ need to be developed, for
example the provision of SLT services in clinics, in local schools or Children’s Centres etc.
• since the needs of children change over time, there should be a range of provision to enable
families to exercise choice about where and how their child’s speech, language and
communication needs can be met.
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1. Partnership:
a. Involving parents in understanding SLCN, decision making and agreeing expectations;
b. Whole system improvements – commissioners and providers working to the same priorities;
c. The formal assessment of special educational need process being conducted in true partnership
with families.
2. Learning:
a. Use of evidence based approaches;
b. Building capacity in workforce and using the skills of parents and carers;
c. Workforce development, facilitating learning in the workforce;
d. Use of a structured training programme which promotes work-based learning;
e. Training of the wider workforce by Speech and Language therapists.
3. Leadership:
a. Strategic representation of professional speech and language therapy;
b. Communication champions at senior and practice level.
4. Cycle of review and planning:
a. A whole systems improvement strategy for children with SLCN;
b. Joined up and mutually agreed processes and systems for decision making;
c. Robust commissioning based on analysis of intelligence and data;
d. Meaningful measures of quality and outcomes;
e. Regular review to inform development.
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SERVICE DELIVERY MODEL
A key driver for Rochdale’s service delivery model is the desire to ‘get in’ early and support all children’s
communication development, and not wait until the there are problems. For many children, prevention
or a reduction of difficulties is possible.
We are adopting a whole system approach, from prevention through to specialist intervention. The
model recognises the contribution that needs to be made from across the wider workforce and
communities to support speech, language and communication. We expect that everybody who works
with children will have basic competencies in speech, language and communication and the confidence
to apply strategies to improve SLCN.
The model on the following page aims to ensure that all children have language experiences which will
support the development of language skill, by bringing together practitioners across universal, targeted
and specialist services. It will also ensure early identification and effective intervention for children with
speech, language and communication difficulties.
The model recognises that children, young people and their families will move up and down the three
levels, or may be receiving supporting at more than one level depending on their need at the time.
Figure 2 illustrates a pathway across the various levels.
Figure 2 Intervention Pathway
Need
Identified/possible
SLCN
Targeted
Intervention
Specialist
Specialist
Treatment
Need resolved
Ongoing
Universal
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CONSIDER COMMON
ASSESSMENT
FRAMEWORK FROM THIS
POINT
Children and young people with no identified need
No concerns about SLCN development
Examples:
UNIVERSAL
(Level 1)
• Awareness raising/information for
families and carers re SLCN
promotion and risk factors
• Awareness raising/information for
settings/service providers re: SLCN
promotion and risk factors
• Skilled workforce to provide
communication rich
environments/effective teaching &
learning strategies and support
families/carers
• Awareness of speech and language milestones
• Highlighting the importance of play, and other opportunities
to interact with other children and adults
• Encouraging the use of mother tongue
• Appropriate weaning and dummy use
• Delivery of I CAN training package to parents (or similar)
• Encouraging effective adult-child interactions (where
culturally appropriate)
Windscreen Model for SLCN
TARGETED
(Level 2/3)
Trained children’s workforce delivering:
• Time limited interventions
• Evidence-based packages
• Delivering specialist-led programmes
• Rapid onward referral when needed
SPEECH, LANGUAGE AND COMMUNICATION WORKFORCE
Children and young people with additional multiple
needs identified, including vulnerable groups
Examples:
• Structured approaches to developing understanding
and expression, e.g. Derbyshire Language Scheme
and BLAST
• Structured approaches to specific SLCN, e.g. ELKLAN
• Delivering specialist-led individualised programmes
• Referral onwards with information of outcomes of
above
• Involving parents in delivering specialist-led
programmes (in mother tongue where appropriate)
Examples:
SPECIALIST
(Level 4)
Specialist workforce delivering:
• Evidence-based therapeutic
approaches
• Providing direct intervention
and/or individual therapy
• Advice/programmes/support to
wider workforce
• Includes communication
aids/signing systems etc.
Children and young people with severe and/or
complex, specialist needs identified
• Specialist language intervention, e.g. BELP
• Specialist speech interventions, e.g. Bigmouth, Cued
Articulation
• Signing and symbol systems, e.g. MAKATON, PGSS
• Group and individual packages for disordered speech
and language (in mother tongue where appropriate)
• Treatments and management plans for long-term
conditions such as ASD, SLI, stammering, HI and Cleft
palate etc.
• Hanen courses for parents or similar
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PRIORITIES
The underpinning outcome driving this strategy is the improvement of speech, language and communication
for children and young people, so that this not a barrier to achievement impacting throughout life
Based on our analysis of needs, reviews of current provision, national guidance and best practice we
have identified the following local priorities to help us achieve this:
Local Service Delivery:
1. Development and implementation of a whole system service delivery model, encompassing all
provision from universal to specialist services.
2. Development of a trained and skilled workforce in all settings to promote SLCN, identify need and
provide targeted interventions.
3. Delivery of identified and agreed evidence based training packages and intervention packages across
the borough.
4. Ensuring equality of access and provision for secondary age children, children not in school, hearing
impaired children and bi-lingual children with SLCN.
Commissioning:
1. Development of a range of outcomes based service specifications
2. Development of datasets, data collection systems, monitoring and review systems
3. Development of performance metrics
4. Engagement with schools and GP consortia as commissioners, and their role in joint commissioning
5. Evaluate existing interventions/initiatives to identify those that are not effective, or where there is
duplication with a view to disinvest and reinvest to support the new service delivery model
6. Align all existing funding streams across the whole system to maximise efficient use of resources.
Consultation and Engagement:
1. Identification of a strategic SLCN champion, and network of champions across settings and services to
support engagement across all agencies
2. Engagement with children, young people and their families to inform service development
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ACTION PLAN
The following high level actions for 2011-2012 have been identified to support the delivery of commissioning
priorities and implementation of the SLCN strategy.
Service Delivery:
Action
Priority By Whom By When
Workforce Development
Development of a core skills and
competencies framework for SLCN
SLCN project
team
Sept 11
Embed SLCN core skills and competencies
framework into borough-wide
workforce development plans
RBCT Workforce
Lead Group
Dec 11
Evidenced based training
and intervention packages
Develop a resource pack/menu of
agreed packages
SLCN project
team
Sept 11
Service Specifications
Develop new commissioning
specifications for:
RMBC & PCT
commissioning
Speech & Language Therapy Service
July 11
SALTAC
Dec 11
I CAN services
Dec 11
Financial Alignment
Identify financial arrangements and
agreement across agencies to enable
joint funding
Led by RMBC and
PCT
commissioning
Jan 12
Consultation and
Engagement
Launch strategy at local ‘Hello’
campaign event
Event steering
group
June 11
Share strategy with relevant services
SLCN project
team
May 11
Development consultation and
engagement plans to ensure children
and families contribute to service
development/delivery plans
SLCN project
team
Dec 11
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GOVERNANCE
This strategy will be monitored through Rochdale Borough Children’s Trust Board
Service Delivery:
Rochdale Borough
Children’s Trust
Board
Rochdale Borough
Safeguarding
Children Board
CSF Joint Strategic
Commissioning
Group
Lead Group –
Skills
Strategy
Lead Group –
Readiness for
School
Lead Group –
Young People’s
Lifestyle Choices
Lead Group –
Narrowing
the Gap
Lead Group –
Children’s
Workforce
SLCN Joint
Commissioning
Project Team
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REFERENCES
Bercow J - The Bercow Report: A Review of Services for Children and Young People (0-19) with Speech,
Language and Communication Needs. DCSF 2008
Better Communication: An Action Plan to Improve Services for Children and Young People with Speech,
Language and Communication Needs. DCSF 2008
Gascoigne M - Review of Speech and Language Therapy Sure Start Funding for Heywood, Middleton and
Rochdale PCT 2009
ICAN
Lamb B - The Lamb Inquiry Special Educational Needs and Parental Confidence DCSF 2009
Marmot M - Fair Society, Healthy Lives. The Marmot Review 2010
North West Review of Speech, Language and Communication Needs 2010 Cheshire and Merseyside
Child Health Development Programme
Office of the Communication Champion 2010
Office for National Statistics
Rochdale Borough Children’s Needs and Response Framework 2010
Rochdale Borough JSNA for Children and Young People 2010
RCSLT Criminal Justice Briefing
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