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

[Yorkie66]

I work as a speech therapist. Our waiting lists are long and I can only do so many sessions with the children. This is out of my control.

I put so so so much time and effort into my sessions, but nowadays every other parent will come in and tell me how amazing their private therapist is instead. (They’re not any better or higher trained, they can just see them more often).

Basically so many parents are just using my sessions as ‘a few free ones’.

Yesterday I was told ‘my child has improved, but not because of you’. When actually I set the exact same targets as the private therapist, the parents just didn’t practice at home.

I can understand the frustration with the waiting list, of course, but I trained so hard and I try so hard every day, and it’s not enough for most people anymore.
I spent 2 hours planning a nursery visit earlier, to be told later that I didn’t need to go in because their private therapist was going in.

I feel so deflated and wasting my time…

Surely there are lots of people you see that couldn't dream of affording a private SALT? There are always going to be a few assholes who want to use you to make a point about the NHS but I bet there are loads of people who are desperate to see you and appreciate the help you are able to give.

It sounds like you are really dedicated and doing a fantastic job so please don't feel deflated. You are definitely not wasting your time. It's a shame that you are told how many sessions you can do rather than it being based on need but that is beyond your control.

Don't stop trying hard OP, it's people like you that make the NHS amazing even if it's on it's knees. No one could blame you for doing the bare minimum so be proud of the effort you put in even if others don't always appreciate it. I think you need a little treat to give yourself a boost if that's a possibility.

im clinical in nhs…..I go in, do my job and come home, I couldn’t give a monkeys what a parent says to me

Work as private salt, as pp said??

DS saw an NHS SLT when he was 3, and I really appreciated it!

I agree with the previous poster OP, please don't give up because people are so frustrated by the system, and think that by paying for a service, which they'd have to wait for on the NHS, means that they are somehow getting a better treated. I'm sure there are loads of people who can't afford to pay for therapy, who really DO appreciate all the effort and work you put in. It's just a shame that they don't always think to tell you, how much they appreciate you, which is much the same as so many people who deal with the public, are treated these days. So many people are so entitled, thinking that you're only there to serve them, and are paid for doing a job, but they forget that a little appreciation goes such a long way, and helps keep all of us motivated to carry on.

I work in the NHS as a manager in admin and if I was clinical I would 100% go private. I pay to use private healthcare. You lot need to vote with your feet.

This makes me sad. DS had a severe speech disorder. We had an amazing NHS speech therapist who worked with him for three years, first weekly in a Children's Centre then twice weekly in a specialist speech and language base in school.

You are right, the difference wasn't the quality of the therapist, it was that, by some good luck, we got intense support on the NHS. His NHS speech therapist changed my son's life. I always made sure she (and her boss) knew we thought she was great.

I recently met a 4 year old with a serious speech problem..you would be a gift from heaven for her..and her parents would not be using a private therapist. If a parent has a private therapist can you take them off your list and help another child with the time now available. You are sooo important t the lives of children.

you sound lovely and dedicated. it's not our experience with NHS SALTs though. usually rushed sessions. nothing individual, copies that have been made from copies of copies and are barely readable so grainy and wonky. just really general advice... and then seen once in a blue moon. No progress tracked. mass. No wonder parents who can afford it go private. appointments are more frequent, truly individuals plans...

I understand your frustration@Yorkie66. I'm on the other side: I have a grandchild who needs more NHS SLT input than is provided. DGC has good vocab, reads easily and had lots to say, but faulty physical oral apparatus makes clarity of speech very difficult. I watch DGC try so hard to say it again more clearly, and eventually a fuse blows. DGC has regular but spaced-out NHS speech therapy, outside school. (Anyone who has had eg music lessons knows that frequent lessons bring more progress than infrequent ones.) In a ideal world, an SLT practitioner would be there, in school for DGC, every week and helping prevent explosions. Please don't give up your profession; there are too few of you, and your expertise is so very much needed. (

My child speaks because of an NHS speech and language therapist. We couldn't afford private. He was non-verbal and we very much worked hard at home, my DH and I would also go into nursery to do the PECS exercises with him because nursery didn't have the staffing to do it daily with him. People like my family still need you OP and appreciate all that you do for children like ours.

We was offered 5 sessions of speech therapy through the nhs. There was nothing wrong with the therapist but so much was crammed into those few sessions my daughter did not even engage it honestly felt pointless. Like tick boxing. Again it’s no reflection on the therapists it’s that the service isn’t for for purpose.

The private speech therapists however have built great relationships with her and have seen her weekly for over two years now.

Please don't give up or be discouraged; you are changing lives and building lifelong confidence. I speak from personal experience. Most parents can't afford private sessions and rely on what you do as a lifeline.

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

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

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.

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 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.

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.

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.

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

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.

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?

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.