Experienced West Midlands based speech & language therapy

Monday, July 23, 2018

Why commissioning a speech and language therapy service was definitely the right thing to do

NHS Speech and language therapists (SLTs) are able to provide little or no support in schools, and increasingly adopt a consultative model – a term which covers a wide range of working practices but essentially means that SLTs delegate their work to others – primarily school staff.  This is usually in the form of a programme of work sent to school with little or no explanation or opportunity to collaborate.


Our own personal experience working in schools receiving this kind of service is that it is deeply unsatisfactory on all sides.  Even more worryingly, the study found that newly qualified therapists reported delegating programmes which they had no experience of delivering themselves.


We know that children receiving support from TAs with experience and additional skills made gains.  The need for the TA to receive the training and support in the first place therefore, is of paramount importance.


About the research

The study was conducted in one geographical area where there was a ‘2-tier’ NHS service: a core offer is available to everyone and schools then have the option of topping this up  by purchasing more from a ‘traded or enhanced’ NHS service.  This model is now widely replicated in many parts of the country.  Increasingly however, the ‘top-up’ is available from a variety of different suppliers – not just an NHS traded service.


The researchers asked schools why they wanted additional input.  Staff in Soundswell schools will recognise common themes.


  • meet the needs of high numbers of children with delayed language, particularly in nursery and reception years
  • because educational and social outcomes for children with SLCN are worse than for other children
  • develop capacity within school to meet the needs of children with

SLCN ourselves

  • deploy strategies with more of a focus on prevention
  • provide more direct input (i.e. therapy) for children who need it


Positive results from commissioning a service

  • We know the SLT, s/he knows us
  • We feel supported
  • We can access the SLT at any time
  • The SLT now has a more holistic view of the children
  • Early intervention means fewer children need help in year 1
  • Children with poor language because of a lack of stimulation made noticeable gains academically
  • We are much better at identifying SLCN
  • We now have a specialist TA
  • The SLT works round us now rather than just telling us what is on offer
  • The SLT has backed up what I had wanted to implement in classrooms for a long time (quote from Senco)


Things which schools identified as being important

  • Continuity of SLT
  • Shared expectations and goal setting
  • Finding out what other schools who buy in SLT are doing
  • Being able to evidence positive outcomes – attainment gains etc
  • Reducing the numbers with difficulties as early as possible


Overall summary of findings

SENCos reported many positive aspects of the commissioned model, including better communication with SLTs and improved outcomes for children.  They also felt that the numbers of children with SLCN had reduced following commissioned input.  Very few disadvantages of the model were identified.


SLTs delivered a range of activities, including training staff and providing direct input for children.   This was deemed to be particularly important for ‘speech’ children.


SENCos would recommend the service, and perceived the cost to be ‘moderate’  (no figures were identified as part of the study). 


All of these things suggest that SLT in schools is of value and welcome the opportunity to purchase additional input.


If you would like to read about this research in detail (including the methodology and statistics) it was published in:


Child Language Teaching and Therapy


© The Author(s) 2018

Reprints and permissions:


DOI: 10.1177/0265659018780961


A school-commissioned model of speech and language therapy

Sarah White:  Leeds Beckett University, UK; Leeds Community Healthcare NHS Trust, UK

Sarah Spencer:  University of Sheffield, UK