Untitled

[Minnette]

I'm a speech and language therapist and a regular lurker on this board.

I've noticed over the time I've been reading this board that there's a general feeling that NHS speech therapists are useless. Some of you are paying privately and think the service you receive is much better. Those of you who are happy with this service encourage other parents to do the same.

I've been working in the NHS for 12 years and it's been a very stressful experience. The vast majority of my colleagues enjoy their clinical work but feel worn down by the system they have to work in. There's a general feeling that we are too far stretched to be effective.

Last month a good friend of mine resigned from the NHS to practice privately. Her charges will be £60 per hour for a regular therapy session. This week two more former colleagues have done the same. In the 12 years I've been working I've never known such an exodus of skilled staff and the reasons they cite are that they do not feel valued by their employers of the people they are employed to help. It seems possible that the NHS service will eventually become staffed by recently-qualified therapists biding their time and gaining the experience to set up independently.

Personally I haven't worked for almost two years but was considering going back to the NHS after easter. However, since my colleagues started to resign (and from reading your comments about NHS therapists on this board) I am considering withdrawing two job applications and setting up an independent practice myself.

I am interested to know what parents think of these developments, developments I'm convinced are just the beginnings of a wider brain drain from the NHS. What proportion of you can afford to pay privately and do you think this will improve the NHS for other patients?

Do you have healthcare insurance that can cover this? What if physio/OT staff go the same way?

It seems the moral argument isn't just about those who can afford to pay being seen more quickly, it looks as though they may end up being seen by more experienced staff too. As far as I'm concerned, the NHS has let me down, why shouldn't I take my skills elsewhere?

Just a discussion point really??

[2shoes]

can I suggest you repost with a title
you can copy and paste.
can't answer my self as dd has it all done at school.

[mymatemax]

Minnette,
Whilst I have always had a very poor service from our NHS Salt I have always understood that it is the system & not the therapists at fault.
That said SALT is failing our children & it appears (reading the posts on mn) & it appears to be nationwide.

Can I afford private SALT, no, but we have struggled & found the money & there was an improvement even with the very short block sessions that he had.
Other than that we have muddled through with exercises at home & when at pre school.
TBH the money it costs for ds2 to have NHS salt assessments is entirely wasted if they aren't going to invest in any follow up treatment.

Surely its a false economy to review a child every 3 or 6 months for years rather than give them proper therapy & set them up with a programme & see real benefits over a shorter period.

DS2 has had fantastic NHS provision in all other services (physio, ot, paed,s, psych's)i'm sorry to say SALT has been the biggest disappointment

[sphil]

I agree with mymatemax. We are lucky enough to have been able to pay for private SALT for DS2 (pre-school) but it was hugely expensive. The woman that did it was in a very similar position to you and with the same dilemmas. DS2 was her only private patient (she was recommended by a friend) and she was highly committed to the NHS- but increasingly disillusioned by workload and other SALTs going private.

Having said all that, DS2 has made much more progress with a Verbal Behaviour programme (ABA) delivered by a team trained by us than he ever did with a SALT. Both the NHS and the private one were very keen on PECS and to be fair this was hugely beneficial to DS2 in kickstarting the desire to communicate - but once he'd got the basic 'I want X' the input seemed to stall. I know Moondog(SALT on here)is doing an ABA MA - my wish would be for more SALTs to be knowledgable about behavioural methods and willing to use them when appropriate for the child.

[yurt1]

NHS SALT was useless - partly because of a real lack of hands on practice. My son's needs are very complex (he's 8 and non-verbal). The last NHS therapist we saw said he wasn't teachable. I told our private one who said 'rubbish' and sat down and did 40 minutes work with him. The private one had lots of hands on experience, the NHS one left standard communication programs and when ds1 didn't fit one of those she had nothing else to offer.

Since moving to special school and coming under the school SALT service things have improved- they do have hands on experience.

The prices of private SALT does make it unaffordable for many. I encourage people faced with a years wait to go for one session plus report and advice - as that can be helpful for people to start getting on with stuff whilst waiting for referrals.

I've had a few private SALTs. the SE ones charged 50/60 quid /hour . The best one with loads of experience charged £35 /40 mins (not SE though). We used to get her to join us for croissants as well.

I don't think it will improve the NHS for others. We still needed an NHS SALT to do the school liaison when ds1 was in ms and reports etc. We saw her as often as we would have (i/e not that much!) had we not had private SALT.

Personally I think NHS SALT is a shambles (the fault of the system/funding rather than therapists) and it gets worse each year (I've been dealing with it for 7 years now).

[Minnette]

Thanks for all your replies, it's interesting to hear your persepctives.

I agree it's a complete shambles. Unfortunately it's usually the therapist who bears the brunt of the failings in the system though; parents make it clear they're not happy, not always through something they say or do, just by their attitude to the therapist. Then the therapist feels crap and demoralised - squeezed by what the parent wants and squeezed the other way by what the system wants.

My colleagues who have resigned from the NHS have done so after "coming home and crying for an hour every night" about their inability to offer what the children need. The biggest single difficulty has been the mainstreaming of SEN kids. Therapists used to get through 7/8 kids a day in clinic, now they can only get through 3/4 because of the travelling times involved between schools, yet there's been no funding for more staff.

SLTs who work in special schools are often reluctant to move out into mainstream so cling onto the smaller and smaller caseloads in their schools while the children in mainstream get divided up between clinic therapists.

We used to do the therapy, now we give programmes out for others to do and they often don't do them, so we see no progress and the parents blame us.

I really can't see anything changing in the near future and it's so sad because none of us entered the profession to make money (it was never well paid in comparison with other graduate jobs). Unfortunately we've been treated so shabbily that the idea of taking skills elsewhere and yes, being paid properly, seems to to be attracting all the best staff away from the NHS.

[TotalChaos]

I feel that NHS SALT these days only seems to work for kids with minor problems that are easily fixable. Just doesn't seem to be the resources for effective ongoing involvement. I agree 100% about the problems with mainstreaming/inclusion. M/s schools are picking up the pieces both of inclusion and of SALT shortages. I suspect that quite a few schools are not willing, never mind able to give kids with serious lang problems the support they need.

Part of the reason for going private is that it's so difficult to get a referral till your child is 3, and then you could end up waiting a further year, as your child painfully and evidently falls further and further behind his peers. I was first concerned when DS was 2.3 - NHS appointment wasn't till 3.8. I wish I had gone private when I was first concerned, but unfortunately I was only too pleased to have GP/HV reassure me that DS was normal for his age.

The private SALT I use still works in the NHS, in Special schools. I prefer a professional to be working within a framework of colleagues and supervision/management for some of the time, rather than completely out on their own.

Part of the other advantage to having private SALT is being able to get unbiased advice about schooling/what sort of placement might be most appropriate etc. I feel that NHS cannot really do this due to budget constraints.

[coppertop]

My experience of NHS SALT so far has been good. My one complaint would be the length of the waiting lists to see anyone, although I realise that ours is still shorter than many places. It was also frustrating to see so many appointments being wasted by people who didn't turn up and didn't cancel either.

Our SALT was great and quickly found the best way to get through to each ds. She also gave us lots of materials to work on between appointments. Having one appointment per month suited our needs but I suspect it wouldn't have been anywhere near enough for some children. Ds2 now has SALT via the school. The SALT visits every couple of months to assess progress and to talk to the staff about how best to help him.

There is no way that we could have afforded to see a private SALT back when we were first going through it all with ds1. We had a very low income at the time and £60 would have been an absolute fortune to us. I don't think that parents using private SALTs would improve the situation for those needing the NHS. Less children needing NHS SALT would just mean that funding would be cut for that service.

[yurt1]

Special schools don't have enough therapists for their needs either though. The children in ds1's SLD/PMLD school have to take it in turns to have SALT - and the school have said that although it's better than some they do not have the SALT resources that the children need.

I agree with TC that for any complex problem you can forget NHS SALT.

[yurt1]

Although tbh I'm not sure that a SALT is the best person to deliver therapy to say a pre-schooler with autism as their training is too general and usually their experience is not hands on enough for them to be able to offer anything with the more complex cases. Someone (such as an ABA, even play) therapist with hands on experience would be better. Useful if there's a SALT on board but there are other sorts of experiences I'd buy in before SALT now.

[Shannaratiger]

My DD had SALT for a few weeks in a normal clinic before being refered to a special nursery where she has SALT, i assume NHS pays. The SALT was excellent in both cases, her first session was only a few weeks after teh referal. I agree with coppertop about being annoyed with selfish people not turning up/ canceling appointments.

[r3dh3d]

tbh, I've found similar problems with SALT in SN schools. Although our SALT has a fair amount of time, it's not enough to actually work with the kids who all have a huge amount of need. Instead she focusses on training the teachers and classroom assistants. But of course the kids' problems are so diverse that this "one size fits all" training program leaves the kids with a single SALT program between them and only lip service paid to differentiation in the IEP. So limited individual progress and much less than they could make with individual therapy.

[pagwatch]

Minnette
I have a very poor history of NHS SALT and my son gets very little SALT at his school even though he needs a great deal of support. However I do not blame the individual therapists but rather the pressure on resources and the administration behind provision.

I have to say though ... Parents of children with profound speech delay, especially in the pre-school age group, are often terrified, exhausted and massively unsupported. They will have had to persuade someone that their child is struggling and then waited some considerable time for any constructive referrals.
Of course it is not right that the therapist should take any flack because of this but fear is an odd creature.

I would wish many many more trainned therapists but I think anyone who is going to personalise the anxiety of the parents in front ofthem may well be better served in a different career.
The ladythat owned and rans my sons first SN nursery received a severe ear bashing from all of us including my ( then six year old ) DS1. We were all just so tired and worried about DS2. Later I apologised and she laughed. She said it was something she got from 90% of parents and she understood why - so she didn't let it bother her.
Perhaps the SALT trainning courses could incorporate some imput from parents onthe diagnostic process and the pressures and anxiety it causes. That may help SALTs cope a little better when they feel under attack.
Of course it is not acceptable but like others i was for about 2 years almost mad with grief and worry. Hurtingthe feelings of the SALT at that time would have been terrible but i am not sure I could have guarenteed not to do it.

[TotalChaos]

"Parents of children with profound speech delay, especially in the pre-school age group, are often terrified, exhausted and massively unsupported. They will have had to persuade someone that their child is struggling and then waited some considerable time for any constructive referrals."

Absolutely 100% agree with that part of Pagwatch's post. Also pre-diagnosis, SALT may be the child's firsrt entry point into the system.

[Minnette]

Thanks for even more interesting replies.

The thing about parental exhaustion and being terrified is something that you work out as you gain experience as an SLT, not something I ever remember being covered properly on my degree course (though things might have changed I suppose). I also think haivng your own children gives you a different perspective on how the parents MIGHT be feeling though you can never fully empathise unless you've been through it. For this reason, older and more experienced therapists tend to have a better handle on it.

Doesn't stop the therapists feeling demoralised though. One of the collecgues that resigned was working for an NHS trust that made her fill in a form to account for every single minute of her day, every day of the year. Filling in the form alone took 30 minutes every afternoon.

Not content with this, the employers are now talking about using a mobile tracking sort of device so they know exactly where every member of staff is at any time. You could say it's like being tagged, an absolute insult. The final straw was when the management told her to cut her waiting list from 18 weeks to 6 weeks and didn't offer any extra help for her to do this.

The solution was to see children for screening sessions to tick the box to say they had been seen. The result was even longer waiting lists in real terms but at least the government could tell the public the waiting lists had been reduced.

All sorts of things like this go on in the NHS, that's just the tip of the iceberg.

[yurt1]

I've been (attempting) to use SALT for the last 6, almost 7 year. The service has noticeably declined in that time.

Do you have to work to a Malcomess Care Aims model Minnette (or rather your colleague) and is it used as a way of not treating more complex cases? I

[Minnette]

Not sure what the system was she was working under. At the moment I don't work for the NHS at all.

More complex cases used to be seen by therapists who specialised in a particular area or by more experienced therapists. When I started as an SLT I had two mentors and lots of on-the-job training and support. My first paediatric caseload was a very general community clinic where anything I suspected to be more complex would be handed to a more senior colleague (or at the very least I would ask her advice).

As the years went on the new graduates got less and less support and were expected to see complex cases much sooner. The more experienced staff were too stretched to offer the same level of support.

The thing that really tipped the boat was the mainstreaming of SEN children. Suddenly these children were scattered all over the district and it took much longer to get to them all. Also, when you did get to see them, the schools weren't designed for lots of visiting professionals so there might not be a quiet room available or you might have to move rooms halfway through an appointment.

Add to that the need to see the class teacher, LSA and possibly the SENCO and school visits took up so much time. When the children were in unit provision you could spend all day there and there would only be one SENCO and you'd see them all at lunchtime anyway.

The first of my friends to resign told me that the department she worked for was trying to dilute the specialist posts. The SLTs jobs were banded according to how specialised their caseload was. So, for example, an ASD specialist would see all the ASD children in the district. She would also be the only person who was able to get funding to go on courses relating to ASD. From this her job would be better paid than a more "generalist" colleague.

The problem with mainstreaming children meant that one therapist could no longer see all the ASD children (and the same applies to other sub-specialties) because of travelling times. The ASD children would therefore be seen by just about anybody, though nobody else had been on any ASD courses so the children weren't really getting specialist help anymore. You could end up with someone advising on PECS who knew nothing about PECS.

And the result for the specialist ASD therapist was that her role was no longer considered any different from anyone else and she would have to prove why she still justified that salary.

So I'm not sure it's about not treating complex cases, it's actually about complex children being in mainstream schools (which is an educational policy) and the NHS not having the resources to cope with this change because, presumably, nobody with any authority saw the problem coming.

[moondog]

Minnette, realy interesting to read this thread.
I'm a regular poster and a salt.I also have a child who is language disordered so speak fro a unique perspective.

You are right about people leaving in droves. The insane bureaucracy would reduce a grown man to tears wouldn't it? I have long realsd that it would be very easy to be a salt and do next to no clinical work at all. I fight this every step of the way as the clinical work is the one thing that i really love.

I think TC is right when she says the nHS salt system is geared to kids with easily fixable minor problems.The emphasis is on coping with a huge number of (often uterly inappropriate) referrals and then proving they have been 'theraped'-easy when it's a bit of dodgy phonol. or similar.

I disagree with your obvious fondness for clinics.I see no place for clinic visits (or only on very rare occasions).What is the pint of seeing a child out of context when we are looking at communication? I never even take children out of the classroom unless I am assessing.

I work on a (very good) LD team.

[yurt1]

"You could end up with someone advising on PECS who knew nothing about PECS."

ha ha yes- been there. DS1's first SALT. Straight out of college- handed one of the most complex children (then) in mainstream. Non verbal, no imitation skills at all. All she could do was try and teach him Makaton (when he couldn't imitate).

Poor woman. She was very nice, but utterly stuffed.

[moondog]

Every day I am expected to

-fill in a time sheet
-fill in an online diary
-fill in an even more complex online diary
-write up my files (one for every service user)
-input details on everyone I've seen-(times,dates,recommendations-in short everything that I have already put in the file) into an online database,whicxh is so slow that it can take 15 mins to input details for one person
-register details of visits,distances and times with central tracking system

That's quite apart from any hands on stuff.

[Minnette]

ah yes, but have they got you tagged with one of these funny machines that tracks your whereabouts yet? That seems like the final straw to me.

You are wrong about my fondness for clinics though. Clinics are excellent for certain children but useless as assessment contexts for many others. The problem is the mainstreaming of SEN children without adequate funding on the health side.

As an aside, I wonder about the parents' perspective on mainstreaming. There seems to be a split, with some parents thinking it's right and some fighting to get their child into units.

I realise (obviously) this depends on the individual child, but in general, do parents feel that mainstreaming is the right thing for SEN children? On the one hand it has destroyed many services the children needed (see SLT as an example) but on the other hand the children are living in the mainstream world.

What do you all reckon, on balance?

[TotalChaos]

Minette - as I don't work, I would be happy to take my child to a clinic if that meant that SALT could see more patients in a day - as prsumably that would mean he would either get longer sessions or be treated more quickly. But other parents might be completely unable to do that for work or childcare reasons.

In terms of mainstream - I would be happy for DS to go to a language unit, rather than run the risk of him being overlooked and marking time in m/s.

[yurt1]

clinics never worked for ds1 as he just wanted to look at the sink.

I far prefer special school. DS1 went from a mainstream disaster (where he had full time 1:1) to thriving in an SLD special school (where he doesn't have full time 1:1)

[moondog]

Not yet Minnette.
I'm sure it's coming though.

I think very few parents relaize that althoguh attendance of an m/s school looks great on paper,in reality a child with SN is quite often far more dependent and passive in this situation.

On the other hand althoguh the thought special school upsets some parents,I generally find that within them chidren are expected to take much more responsibility for themselves and their lives.

It goes without saying that i work in a couple of fantastic special schools.

TC fair point but clinics also favour M/C people with cars and diaries and childcare for the other kids. It's often too much to expect for example, a single parent on benefits with three kids and no childcare to turn up on a rainy January afternoon.

Clinics are about making the salt feel at home, not the child or his family.

[moondog]

Excuse mad spelling.Tis late and am tired and ill.