I work in the NHS and I feel I am wasting my time

You are doing a really important job. I'm an adult physician and we have so many patients that really need your input (I appreciate that you may specialise in paediatric patients, but this is equally true) - patients post stroke, or with neuromuscular disorders - doing assessments to determine if they are safe to swallow (or need NG feeding - really important) and also with post stroke and traumatic brain injury patients who need help to get them speaking again - it's just so important. If you specialise in paeds patients then you are equally as important - yes, everyone wants to do the best for their kids, so there'll always be a few who go private, but there will be many many children whose parents can't afford to go private.

Please don't be disillusioned - you are doing a really important job

A quick look at this return to the Bercow report by the ICAN charity paints a pretty worrying picture:

”In our evidence, we heard from services that were having to scale back, rationing support in ways that are not based on evidence of what works. We heard of specialist services that have been:

• cut by approach, supporting only children with the highest need or reducing training;
• cut due to children not making progress in predetermined episodes of care, taking no account of the complex nature of some children and young people's SLCN;
• cut by age, with fewer services as children get older: in one example, only very basic drop-in services were offered to children over the age of five.

www.bercow10yearson.com/wp-content/uploads/2018/03/337644-ICAN-Bercow-Report-WEB.pdf

Yes I clearly don’t believe in free healthcare and am not loyal to the NHS (despite over 15 years’ service) because I think medics/AHPs deserve better than this. Great point!

What the parents are saying is true isn’t it? NHS speech therapy has been cut to a tiny fraction of what children need and hardly anyone gets seen. They are just doing their best for their children at huge financial cost to themselves.

It might be a good opportunity to reflect on how to find a way to respond and prepare in advance for this type of conversation.

I agree with above PP, why see patients who are also accessing private care? In my service it's one or the other...use us or go private.

As a physiotherapist with the HSE (Irish NHS) we would not treat at same time as private. We would regard it as a professional conflict - like receiving treatment from 2 doctors at the same time. Occasionally patients are seen in the hospital during follow up, maybe post op, if there was a specialist service, but we wouold get a letter from the hospital therapist. Therapy would not be regular from 2 providers.

When patients have the wherewithal to attend private, I absolutely encourage it! Some of my colleagues like yourself are uncomfortable with it - they see it as a shortcoming of our service. I look on the public service as like a bus service - you might have to wait, and it is not fully in your control ( it's not door to door), or you can get a taxi, (ie, go private) and pay. Taxi use does not mean the bus is not a good service.

Even if it not policy I would discharge your 'double dippers' ASAP. 'I'm soo pleased that little Johnny is recieving such a good service from my colleague in X Clinic, and his needs are being addressed. As all therapists are trained to the same standard, I'm sure that I have nothing to add to her programme for you. I assume you're happy enough for me to DC you today'

I do not look at a referral as a voucher for therapy - and the patient is entitled to a certain number of treatments. Provision is on the basis of clinical need. If that child is being cared for, privately, their need is being addressed. Your next patient might need 1 session, or 10.

I'm in practice 35 years just laugh at rude people. 'I'm getting better, but not thanks to you' would be met with - I'm so pleased to hear that you are getting better, and have found a treatment that works for you. I'm going to discharge you today, and you are welcome to get a new referral if you need us in the future. Byeee

Many many people are not in a position to go private, and need the public service - I have worked public and private, in Ireland and Canada. Public patients are vulnerable, They have no choice but to wait. We all hate that aspect, but I do not dwell on it

Some of us working in the NHS believe in free healthcare and would not want to work in a private service where many families would struggle to afford it. Some of us are very loyal to the NHS.

I'm a nurse in the NHS and sometimes I get frustrated with patients getting annoyed at the constraints but then sometimes I like to remind myself that the service we offer isn't good enough at times. For example in my previous role we bedded patients in corridors. It was the only option to get them treatment and somewhere to lie down. Families complain and of course I explain that we are doing the best we can and the hospital is above capacity etc. Etc. But actually it's really not safe or acceptable. In the case of elderly patients with significant personal care needs its downright undignified.

We were told that my DS wasn't speech delayed for years, I called the S+LT helpline monthly, I went to the drop ins at nursery and was pacified every time. It wasn't until one of the nursery teachers actually listened to him speak (as he had been all but silent to non family) I was taken seriously and referred. That then took 1.5 years, we got one assessment with a therapist then onto an assistant and had six weeks then lessons were cancelled for a few months. Sadly we then had to move house (same country but different trust) and we are back on the waiting list as they don't accept transfers. 6 months and waiting. My best friend is a S+LT that works 5 miles from my house (same trust buy different county) with no waiting list. Are there any jobs out for S&LT given the significant wait times? No infact they are cutting funding and losing 3 B7 therapists. My DS should be in school but I have kept him in nursery another year already because he is painfully shy due to the lack of clarity in his speech and sadly I do think he has been failed by the NHS. Of course I do not blame individual therapists, i understand the politics at play but I think it's important to say that waits of 1 year plus for children over 4 is simply not good enough.

Hi OP.
You sound like you are very dedicated and I am sure are amazing at what you do.
I work in the mental health sector (non clinical) and I get complainers too (I've waited so long for this, is this all I get? Private therapy is better, what can talking do?) i just think about the people who are grateful that I turn up for work every shift. It's not easy, but I'm sure you so have clients/ patients who do appreciate you.

My child required a lot of speech therapy when little. I am so so appreciative for the work they did, the outcomes for him because of this and would say the exact same to you if you'd been ours.

So many people can't pay. You're doing something so great. I hope you get a thanks one day.

I'm sorry those parents are so rude to you. My DS got referred at age 2 for speech therapy. He reached the top of the list for 1-1 therapy two years later (last May). He made little progress then, but he's just started his second round of 1-1 sessions (3.5 years after referral), and just in four weeks alone, he's made such excellent progress. The therapist has taught him some fantastic techniques and shared really handy worksheets for us. I think the work that you, and your colleagues, do is exceptional and I am incredibly grateful. We don't have the funds for private sessions, so we welcome the NHS sessions with open arms and feel very lucky to be accessing the support.

You are doing a great job 💕

It’s not personal OP. The NHS cannot afford to provide the level of service everybody needs.

Most people I know use a mix of public and private services. Essentially using private care as their primary provider and drawing on free services from the NHS to keep costs down.

A couple of years ago I needed weekly physio for 18 months. Only six of those sessions were NHS funded.

No. It wouldn't.

Plenty of responses are talking about the value NHS clinicians offer

I see the benefit they bring.in my role. I also had SLT input when I was a child from NHS. Didn't speak at all until I was three.

Not everyone has the luxury of going private.

Fellow SLT here, have worked in schools now in adult. I honestly don’t feel we can do the job properly in most NHS settings with current time constraints. Or not without doing a huge amount of unpaid overtime (and then burning out). I want to be part of the NHS as don’t think only rich people should be able to access therapy, but also don’t see the point of doing a job in conditions where you’re inevitably set up to fail. I don’t know what the answer is. Private SLT is expensive for the client because it does need prep time as well, so it is out of reach of many people. Private work with negotiable fees? Private work including an affordable/pay as you can drop in group?

This is heartbreaking, many people can't pay togo private and those that are then throwing it back in your face is awful, there should be something in place that if they are paying private then they don't use nhs and someone who can't afford private can take their space.

I had an email the other day saying that my dd was being discharged from the boroughs speech and Language Therapist as she gets therapy at her special needs school

They said the speech therapy is done by a private company, I was so surprised!

Sorry op - if you were our speech therapist we would've done the homework

I'd say that maybe it's so few sessions (I think they were offering 6 in our area) that parents don't have faith x

Same where I work in podiatry, same in nursing. The nhs is fucked at the moment. Im sick of the struggle. Thank god Im retiring in a few years.

OP - I understand how you feel. It can be very difficult to manage expectations of patients within the NHS when they are also accessing private therapy that can provide much more especially in terms of time and frequency.

It can be very challenging to find the time to do this but if your patients consent to it, it could be really useful to contact their private therapist and have a discussion about their treatment plan and goals and decide how best to jointly work with your patient, complimenting each other and sharing expertise. The good ones will be happy to work with you as you can approach as a team however I fully appreciate it a) is not always possible and b) not always welcomed or facilitated by private therapists.

I can't speak for everywhere but in my trust this is not allowed. I'm an NHS physiotherapist and we are not allowed to discriminate on the basis of someone also accessing private services - therefore if the patient wants to access NHS therapy alongside private then we have to honour that.

My previous trust not so much - as soon as we found out someone had private physio we were told to discharge and tell them to come back once they weren't being seen privately anymore! Apparently due to risk of conflicting advice being given by private and NHS therapists however, my current trust feels that communication is a key skill of any therapist therefore if you have a patient who is accessing private therapy, it's actually part of your job to get in touch with their private therapist (with consent of patient) and ensure you are essentially working together or at least complimenting each other's treatment.

I still have my NHS job (OT) but have branched out in to private work and will be out the door as soon as feasible. I'm sad for families that can't afford private therapy but it's such a nice way to work and I can make a difference to the children and their parents.

It's not about your skills/abilities most children's services aren't fit for purpose. Often what families need is a more timely and detailed report/assessment than the NHS can provide, extra time and support in understanding needs and implementing strategies, going over the same strategies and problem solving in the moment and not in 4 weeks at their next review.

Ultimately somebody they pay privately is going to be more 'help' even if they're not more skilled. It's not a reflection of your abilities just the constraints/limitations of NHS service provision. Also parents frustrations are usually about the service and not the therapist - I tend to encourage parents to raise their concerns with the trust (as I rarely ever disagree that their child needs more input than I can provide as an NHS OT!)

I wondered this too.
Would you be "allowed" to discharge those patients whose needs are being met by their private therapists?
This would then free up more time for you to get new patients assessed earlier/or provide some extra sessions for those who need a bit more than you can currently provide.

Honestly I’d leave - I left the NHS for the charity sector and it’s the best thing I ever did.

From the responses it seems like being a private SALT would be more gratifying.