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…

I used to work for a private company, and it’s the reason I went to the NHS. it was the worst job I ever had.
My manager was a cash cow, she treated me disgustingly and burnt me out. She only cared about the income, not the children.

That made me swear I’d never become a private SLT and start to think the way she did. Plus, I don’t have a businessy bone in my body - I have no idea how I’d set up my own caseload, it’s really not easy!

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.

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 💕

Thank you everybody!
My area has fairly short waiting lists also (about 6 weeks for therapy block and then 10 weeks for a review) so it’s frustrating to get so many people tell us we’re not doing enough

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.

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.

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.

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.

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

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.

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.

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!

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.

The situation is exacerbated by the loss of clinical specialism and professional leadership from the speech and language therapy profession. In an RCSLT survey of NHS children's speech and language therapy services, more than two thirds said they had seen a reduction in the number of specialist speech and language therapy roles within their service in the last 10 years. People told us there needed to be a more consistent approach to the way that children with SLCN are supported. Through our evidence we have identified the key features of impactful practice, but more is needed. We need to draw these together into recognised guidance and ensure they are used by commissioners. "...Now children who would have been seen in the past are rejected as not high needs enough. They're given strategies and discharged." PRIMARY SPECIAL EDUCATIONAL NEEDS CO-ORDINATOR”

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

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