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 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: ........................................................