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Any downside to getting the NHS S&LT off your statement altogther

(36 Posts)
appropriatelytrained Fri 15-Jul-11 20:11:57

Would rather have our own S&LT carrying out direct work with DS and setting up a proper programme and measuring progress and training staff than throw money at crap provision from the NHS S&LT who we can never trust again.

Any downside to this? Can you have a statement with time set aside for S&LT delivered by an independent S&LT employed by parents???

appropriatelytrained Fri 15-Jul-11 22:56:09

Any ideas? Trying to redraft working statement to achieve something positive for DS

mariamagdalena Fri 15-Jul-11 23:01:41

You need to find a form of words that your private therapist can fit, but which excludes the SLT you don't want. 'good working relationship with parents, ability to train and motivate parents and carers to to continue the programme at home' or something on those lines might do it.

utah Fri 15-Jul-11 23:04:17

I would say it depends on do you want the educational setting to deliver the recommendations of your private salt as this would cause problems with would they except this. If you remove salt all together this reduces the complex issues of your statement and if at a time later you wish to have a certain setting where salt would be an advantage then you will need to push(fight) to have it brought back. Sorry not much help but didnt want not to reply.

appropriatelytrained Fri 15-Jul-11 23:06:31

Thanks. I want S&LT to stay on and for the specified time for the S&LT programmes and S&LT targets to be worked on.

I just don't want anything to do with the lying bunch of shits in this S&LT dept so would rather employ our own to carry out the work

appropriatelytrained Sat 16-Jul-11 11:44:40

Sorry to bump but need to sort this out Monday at the latest!

cansu Sat 16-Jul-11 12:17:26

If you can get a lot of direct SALt therapy specified in the statement then you will probably find the NHS will be unwilling and unable to provide this. As soon as I had fortnightly direct SALT specified they withdrew and as education din't have their own they had to find an independent.

appropriatelytrained Sat 16-Jul-11 12:28:33

It's not going to work like that though. The LA are only prepared to specify what the NHS will provide because they basically fund the NHS contract through tender and leave the decision making to the NHS - illegal but they would deny it.

So the only way to get increased S&LT is either:
(a) pay thousands to get it at Tribunal in which case you would end up with crap NHS S&LT team
(b) pay for it myself which means DS will get it at a standard I can control

But I want to know whether this can be incorporated into a statement - ideally, I would like to explicitly exclude this particular S&LT team from it.

So, although we have agreed X visits, can I have it stipulated that those visits are not provided by the NHS S&LT team

Starchart Sat 16-Jul-11 12:41:16

No. All statement provision has to be funded by la

appropriatelytrained Sat 16-Jul-11 12:56:48

OK, so could you keep agree the NHS stuff at the miserly low level but stick in provisions about collaborative working with parent's S&LT re: targets, recording work, measurement of progress???

appropriatelytrained Sat 16-Jul-11 13:02:54

Or can you refuse to have this team deal with your child and ask that the LA fund someone else?

Lougle Sat 16-Jul-11 13:22:39

I think if the provision is in Part 6, non educational provision, it could say something like 'SALT provision as provided by parents'.

appropriatelytrained Sat 16-Jul-11 13:54:55

The provision is part 3 but I want to limit the S&LT intervention from the NHS which is actually pointless and positively detrimental but keep the legal obligation to provide daily time to work on targets and integrate throughout school day and to provide group work.

utah Sat 16-Jul-11 16:46:18

The lea I worked for would flatly refuse even though it saves them money they have been stung too many times before with independent therapy provided by parents then requested for the lea to fund at next annual review or an emergency review then tribunal. You are also reliant on the school to follow advice from an independent source which they would have to as written in statement only in part 3,if in part 6 the school will not have to allow independent therapist in. If the line of communication is broken then you have good cause to request a different salt team as the progress and measurement would be inefficient due to this lack of communication but again this will be difficult because of caseloads and lack of provision

appropriatelytrained Sat 16-Jul-11 17:03:03

So I could keep the half-termly visits as they are (we have wasted almost all of the year on trying to set them up - it's a disgrace) and try and put in provisions about working with an independent S&LT?

I'll speak to my lawyer on Monday but it's so frustrating as everyone I instruct seems to disappear promptly off the face of the earth for weeks to do Tribunals and I seem to get no advice about progressing these matters.

Starchart Sat 16-Jul-11 17:25:56

Okay. Private and NHS SALTs HAVE to work together. It is written in their code. So you can perhaps aim for the private SALT to write and devise a programme for the NHS one to 'approve'.

Use our LA's wording and get a high number, with no meaning like this:

DS will receive up to 30 sessions of approximately 60 minute duration of direct or indirect therapy as appropriate.

Then follow it with TA time specified like this:

DS will receive 3 times weekly, 30 minutes of a SALT programme devised by a qualified SALT. This will be updated fortnightly.

Then in part 6 say ds will receive additional private SALT who will input into the TA's programme.

appropriatelytrained Sat 16-Jul-11 18:15:47

Thanks.

You see that is the problem. These things are, as you say, written into their code, but they doesn't mean anything at all: baseline assessments, recording work undertaken, seeing a child before advising on his needs, measuring progress through your own judgment etc etc shoudl all happen according to RCSLT guidelines but they don't. You raise it and you get accused of being 'varied and complex' and told to go to the Ombudsman!

So, I would like these people out of our lives. They can have their little sessions but I want to confirm that they will work collaboratively in relation to target setting and progress measuring and keep records!!

Once bitten, I tell you, I'm cementing it to the floor with law as they say!

Starchart Sat 16-Jul-11 18:29:13

I DO understand. Me of all people. I want no-one involved with ds except the school, and I want the school to LISTEN to me and just try ONE of my suggestions, JUST ONCE.

I asked them to hire my ds' tutor with an MSc for less than they were going to recruit an untrained LSA, or even nothing as I was prepared to pay her salary in full. They refused. Why did they refuse? What possible reason could they give? Well I don't know, because they didn't give a reason except 'we are the school so it is up to us'.

I want them to begin ds' communication targets from day 1 when he starts as the children he will start with are currently unaware of his difficulties so will treat him normally. In half a term it will be too late and they will have learned to either ignore him, compensate for him or mother him. The school say 'we don't set IEP targets in July for Sept children because we are busy with July children, and in any case we need to see him for a while to assess him.

Why? DS has assessment data galore. And I couldn't care less about their time management issues that prevent them from starting working with ds in September. That shouldn't be to his detriment and wouldn't be if they simply hired ds' tutor instead.

Last year, ds spent the first half term 'settling in' (ds doesn't need to 'settle in' btw. He has ASD. He lives in the present). The second half term arguing about the crap targets and practising for the school play. The last half term of the year they didn't work on any targets because he was 'preparing for tranistion and working up to the summer'. So for a whole half a year there are excuses to not have to work with ds.

The sad thing about this though, is that if the other children are getting the same treatment then it is an optimal time to work with ds intensively, because he has a chance of catching up when the other children are all over the shop.

Agnesdipesto Sat 16-Jul-11 23:05:17

AT we got our tribunal to fund ABA using their own tutors rather than training a TA for the school based hours, so I see absolutely no problem in principle with you requesting SALT that is specified and quantified etc but asking it to be delivered by a private SALT. It will come down to costs.

We argued that the cost of using staff trained in house was not much more than using a TA once all the training had been factored in - but the advantages eg much better qualified and experienced staff outweighed the minimal extra cost

I would argue as separate issues:
1. This is the type of SALT input we need school to deliver (how much, how often)
2. The supervision needed to set and monitor the programmes / how much direct SALT
3. The qualifications / expertise the SALT will need
4. That cannot be expected to work with NHS SALT as relationship broken down (there is a case on this I will try and dig it out)

And ask the tribunal to make a finding on each point separately.

I would think saying you want someone specifically trained in ASD and able to deliver social skills coaching to a HF child eg the nuances of social skills, higher level conversation skills etc would rule out most NHS SALTS anyway. I think if you argue for a particular level of expertise and win on that point, then LA would struggle to find NHS SALT who can deliver it. The NHS SALT may be forced to say if the Tribunal order that we deliver ASD specific social skills training etc then we would not be able to provide it.

I would set out the costs of your private SALT going into school - have the NHS costed their support?? if they don't then they won't be able to argue your option is more expensive. Do you have CVs for the NHS SALT?

If your option is no more expensive I see absolutely no reason why Tribunal could not order SALT provision up to a set financial limit pa. This is what we have for ABA we have an order for a set number of hours per week, a set amount of supervision and consultation and a financial limit.

appropriatelytrained Sat 16-Jul-11 23:38:05

The LA say, and I have asked them, that they have already 'funded' S&LT and they don't care what is quantified and specified as they are paying no more towards it. They will be led by their S&LT team and of course there is no incentive on this team to add to their offered provision because they will be not be paid anything more for it.

Basically, by that I mean, the LA put the work out to tender and the local Community NHS team 'won' the contract to do all the LA work - so everything is done by this team and has been, in principle, paid for upfront.

That is why the LA are prepared to let their S&LT people decide what they are prepared to do and to fight it out at Tribunal if the S&LT refuse to offer additional therapy.

This is not a 'normal' NHS S&LT and LA relationship - the S&LT basically work for the LA so if we end up with these people involved they will always be looking to undermine provision.

However, we have S&LT and school lying together from the same hymn sheet about the 'success' and sufficiency of their intervention.

Against this, the LA have an inexperienced S&LT and were refused their 4th witness TWICE to talk about service delivery issues.

But, our problem is that to fight this out will cost us a couple of grand and at the end of the day that will be for S&LT - not ABA or any 'game changer' for DS, just more S&LT. Money that could be applied with certainty for the benefit of our child. Our own S&LT things we should bide our time and let it all fail and that now is not the time to fight.

I just want to know, if we decide to retreat, how we can retrieve something concrete and helpful from this

Agnesdipesto Sun 17-Jul-11 08:40:22

Well I would say don't pay the £1000s but do it yourself. You can do this AT. You know your case inside out.
Its one day and if you don't win ok you don't win, but you might win, or at least improve whats there.
We did use an advocate and it was valuable to do that but I could have done it myself.
Also remember a Tribunal cannot issue a statement that is not quantified and specified. And the Tribunal can write extra stuff into the statement using their own expertise. The Tribunal have to be satisfied it will meet need.
Don't retreat. But don't spend money you may need if you lose. Do it yourself. Its worth a go.

Have you seen the Govt White Paper on open public services? Its all about opening up public services to competition eg using private SALT.

What is the cost difference between what you want and they want?

Have you ever looked at your council's spending - they now have to publish all spending over £500 - you will see lots of children getting funded eg out of area placements etc, what you are asking for is not expensive and if successful could save the public purse alot of money later on

You almost certainly will win some concessions on the day. Perhaps not everything but something.

appropriatelytrained Sun 17-Jul-11 10:11:38

Thanks. I know you are right. I suppose it is kind of like a traumatic shock - you just want to run away and hide and not have anything more to do with these people.

I wanted to instruct a representative because I am so angry at the lies that I will come across as a complete loon!

I do think the argument has become diverted between experts arguing what 'model' should be implemented - direct or indirect - without thinking of the actual work which will be done (or not done) with the child and how whether it will actually make a difference.

So I have an expert who will be arguing for increased levels on S&LT intervention on a direct model but even if this happened and we got weekly S&LT, DS's life would absolutely not be improved because the S&LT team are beyond useless. Part of the reason they are fighting hard against this is because they haven't got a clue what they would do were they to be told to work with him.

So I feel like I am fighting for a rather pointless principle.

Do you know the name of the case about a breakdown of trust?

What also annoys me is that I have instructed a mediator and than a law firm, and I still end up trying to work the bloody details of this myself. Lawyers were quite happy to take 2.5k off me for counsel's fees without advising on the chances of success.

The whole system is a bloody joke.

Starchart Sun 17-Jul-11 12:17:53

Yes, it's a joke.

i'm afraid Agnes, that I was 'awarded' by tribunal an unspecified and unquantified statement. In actual fact, the school chose to deliver the spirit of the wording rather than the letter so it wasn't a disaster (except for the fact, as AT points out, the 'spirit' was blardy useless anyway).

I didn't know about the Gov white paper, but will be onto that shortly. Thanks.

AT You're doing all the right thinking, and you're spot on, under no illusion. You'll get the best you can out of this situation I've no doubt. The problem though is with all the resources and will in the world you can only 'win' adequate, and 'adequate' is a movable ranking which is currently sinking.

You say you will display your anger and emotion on the day, but I don't think you will. You know how to stick to the points. Write them out on a top page and ignore any attempts to derail the focus of the day. If you stay cool whilst they wobble all over the shop with allegations and attempts to put you on the defense you will come across as the sane one.

moondog Sun 17-Jul-11 13:51:32

This might help.
It is RCSLT guidelines on private and NHS s/lt.

Working in Harmony
This document sets out the general principles to facilitate cooperation between
therapists, wherever employed, to ensure a consistently high standard of informed
care for all clients.
Speech and language therapists (SLTs) may be employed within the NHS, by
education authorities, charities or the voluntary sector or as independent practitioners
working alone, or in group practices.
For clarity, all SLTs working outside the NHS will be referred to as independent
practitioners.
General principles
SLTs, whether independent practitioners or from the NHS must communicate with
other SLTs with whom they share clients. In these situations, SLTs must, with client
or parental permission, make assessment results available to each other.
Under the NHS Act, a client receiving NHS speech and language therapy who also
seeks speech and language therapy outside the NHS cannot be discharged from the
NHS provider.
All clients are entitled to seek speech and language therapy from one or more services
if they so choose. They are not entitled to seek a service from more than one NHS
provider.
If a client chooses to use more than one service, it is in that client's best interests that
SLTs from both or all the services involved collaborate freely. It may be appropriate
for one SLT to take the lead role in managing the client's case. All the SLTs involved
should be told about all case conferences involving a shared client and ask to be
invited if appropriate. The aim is to offer complementary input in the best interest of
the client.
An individual SLT seeing a client in the NHS should not see the same client privately
at the same time.
NHS SLTs cannot recommend independent SLTs. They should instead suggest the
client contact the Association of Speech and Language Therapists in Independent
Practice (ASLTIP) at http://www.asltip.co.uk/main.asp. Alternatively, local telephone
books may have contact numbers.
The RCSLT publication Communicating Quality 2 (CQ2) recommends that SLTs
notify other SLT services involved with the client, with the client's or
parent/guardian's permission.
If the client wishes a confidential second opinion and does not wish a previous
therapist be informed, this should be respected and recorded in the client's notes.
All SLTs involved have a responsibility to liaise with one another, providing such
permission has been given. The draft standard letter below may be useful.
SLTs should not express negative views about other sources or models of speech and
language therapy being used. Therapists must seek agreement on a similar or
complementary approach to the shared client. Good working practices between SLTs
will allow complementary treatment plans to be developed.
If, when therapists are discussing a case, it becomes apparent that they are using
different and possibly conflicting approaches, it should be agreed that this be
discussed with the client and the client then invited to decide which approach he/she
wishes to pursue.
The client should be told that the second practitioner would still be happy to see them
if and when the client wished following completion of their therapy with the chosen
practitioner.
Communication
The role of the ongoing communication between all SLTs should be to
• Allay anxiety
• Facilitate the therapeutic process
• Develop mutual trust
• Resolve potential conflicting professional issues
• Provide appropriate knowledge of local and national speech and language
therapy service provision.
See CQ2 on Good Practice and Client Management for further information.
Good Practice
Therapists should ensure that their competencies are sufficient to meet the client's
needs and access professional support if necessary.
All therapists working with a mutual client must acknowledge that intervention may
be subject to constraints. Examples include the client's ability to pay, availability of
personnel or availability therapy skills. Any constraints must be acknowledged and
respected by all therapists and communicated with the client and every effort made to
lessen their effects.
Any therapeutic intervention should be underpinned by a robust assessment, clear
goal setting and evaluation, agreed in advance with the client and/or carers. See CQ2
for more information.
With the client's consent, all therapists involved in treatment and care should be
informed of any meetings to discuss their case and be invited to contribute.
Each SLT has a responsibility to liaise with colleagues working with mutual clients.
This is different from, and separate to, professional accountability.
All therapists are accountable, professionally and legally, for their own actions with a
client.
Where there is an agreement to implement joint case management, each therapist will
have defined areas of responsibility and, thereby, accountability, which will be agreed
and documented with the client.
All SLTs have a duty to contribute to the training of SLT students. Joint working
within a locality should be explored and pursued.
Statementing and second opinions
SLTs undertaking this work must:
• Give their professional opinion in the client's best interest
• Identify accurately the client's needs, uninfluenced by pressures such as the
client's desires, or parent, carer or resource availability
• Build flexibility into identified provision
• Acknowledge constraints in respect of statementing or providing a second
opinion, such as lack of knowledge of context, or inability to access other
SLTs' reports
• Justify a recommended prescriptive approach by providing substantive clinical
evidence or reference
• Be aware of further information outlined in the RCSLT publications: Role of
SLT in Statementing Guidelines; Education Code of Practice and Clinical
Guidelines by Consensus for SLTs.
Ethical and legal issues
• All SLTs should know about, and have access to, all policies, procedures and
protocols to be followed wherever they work.
These may include:
• Health and safety issues
• Child protection
• Positive police vetting
• Vulnerable Adults: No Secrets - Guidance on Developing and Implementing
Multiagency Policies available from Department of Health series number HSC
2000/007 - Category Continuing Health/Services
• Access to patient health records
• Data Protection Act : Caldicott
• Transparent complaint procedures: NHS complaints policy
Other useful references
The RCSLT Communicating Quality 2 has useful information for SLTs on many of
these areas. See also ASLTIP guidelines and RCSLT Legal Resources Pack.
Further reading: Health Care Law by Jonathan Montgomery, published by Open
University Press.
Issues arising from patient/therapist interaction, or raised by a patient/parent/guardian
or carer involving a third party, must be factually documented in the case notes
contemporaneously, dated and signed.
If the patient or another person is potentially at risk, the therapist cannot agree to take
no action. The patient should be made aware that departmental procedures will have
to be followed and this may involve sharing sensitive issues with another person,
provided that doing so will not put the therapist at risk. Any subsequent action must
also be documented.
There follows now a draft letter, for permission for liaison with other professionals
who are involved in the care of clients.
DRAFT LETTER
PERMISSION FOR LIAISON WITH OTHER PROFESSIONALS INVOLVED IN
CLIENT'S CARE
Child's Name:
Date of Birth:
Address:
Telephone Number:
E-mail:
Please circle the answers to the following questions:
Is your child having, or has he/she ever had NHS speech and language therapy?
YES NO
Are you happy for me to discuss your child with the NHS therapist and obtain written
and/or verbal information about his/her therapy?
YES NO
Are you happy for reports to be sent to various professionals involved with your child
(including NHS Speech and language Therapy)?
YES NO
Are you happy for me to discuss your child's therapy with other professionals such as
a doctor, health visitor, nursery (nurse/teacher?) or schoolteacher?
YES NO
Signed: ........................................................
Date: ........................................................
Name of
parent/guardian: ........................................................

appropriatelytrained Sun 17-Jul-11 14:35:22

Thanks Moondog - that is really helpful and these are the sorts of issues I have been raising with this NHS team.

However, the manager's repsonse has been to brand the queries 'varied and complex' and refuse to respond to them any further saying I can discuss them with the S&LT when I see her next.

Of course, this inexperienced S&LT passes me back to her head of dept.

Now, no one will answer me or discuss these types of issues.

I don't trust them. I don't think they know what they are doing (their interventions are based on 'qualitiative and quantitative data' they say but they ignore my requests for sight of it) and I don't want them in my child's life.

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