Fed up with local SALT provision (or lack thereof...)

[mm22bys]

DS2 sees the local SALT provision once in a blue moon, and now I have received an email saying that his next appointment has been put off again.

His regular SALT told us in November that she would be leaving in December to work closer to home. Fair enough...they said though that provision would be for emergencies only till they found a replacement.

HE was supposed to be seen by the other one (who we've met before) on Feb 18 but she's cancelled because she's on school holidays.

So they rescheduled for Feb 25. Now that one's been cancelled because that's when they are doing interviews for the SALT who they knew at least as late as November would be leaving. Why does it take 3 months to organise interviews?

So he will be seen on March 2nd

AIBU to think this is really not acceptable, and that patient / client time should not be taken up with interviewing...

I would lodge a complaint but we are leaving this god-forsaken borough in about six weeks. The way I'm feeling now, I can't get out of here soon enough...

phoenix That is shocking! Surely the more severe cases need looking at first. Whilst I totally accept that it is a more complex system than I can know about I think that that is a terrible system.

As you can probably tell I feel very passionately about this! Just wish there was more that could be done to make our voices heard.

there is a split here between those who can see what the problem is and those who can't.

The problem is not how one (or several) SLTs spend their time between 9-5 but a lack of SLT services in the first place.

If we each had a caseload of 20 kids there would be no problem but our caseloads can stretch upwards of 100.

Patient contact generates other (lengthier) work. Reports take time (and you are frequently interrupted). Programmes have to be compiled. Therapy sessions must be planned, social workers telephoned, health visitors contacted.

Home and school visits take much longer but then clinic is not a naturalistic environment. If you search these threads you will find complaints that an SALT has made an error in judgement or hasn't gained a true picture of a child's skills. Seeing children in nursery or at home isn't something we do randomly - it's a clinical decision taken by us because we feel we will get a clearer or more accurate picture.

I'm sorry to say mm that although I understand your frustration, you have an overly simpistic view of the job of an SLT which places no value on anything but seeing a child for an appointment in clinic. I would be interested to hear your opinion of this change if you were waiting for a report to be written (and chasing it up) or for a programme of therapy to be given and explained to your child's teacher.

And many parents are glad of home visits - not just those whose children have mobility problems.

We do have lives, yes. We have children who have needs, just like yours. In many cases these are basic needs like the need for a parent to collect them from nursery at the end of the day. The idea of us working beyond 5pm is interesting but bear in mind that NHS trusts are so strapped for cash that they simply will not make overtime payments.

Do we then do it out of the goodness of our hearts?

How long do you think an SLT would stay in a post where she saw children like sausages on a production line in a community clinic? Seven kids a day with no variation in routine?

yeah i was shocked mind i have bit of name there i had to fire letters of right left and center to even get seen , i got the polite piSSed of down tro fine art now , i dont moan at the salts i tend to go for the big bosess

here's a thing.......

The government pledges to cut waiting times.

The SLT department is in big trouble because their assessment waiting time is 18 months.

"We want it down to 16 weeks this time next month" says the chief executive.

"You going to give me more staff then?" comes the reply.

"Don't be silly" replies the trust board.

SO what does the SLT service manager do?

Right then, she thinks, we'll see new referrals and nothing else. This is the only way we can keep the assessment waiting list down to sixteen weeks.

So she instructs her staff to cancel all appointments except those of children on the waiting list for initial assessment.

All therapy and review appointemnts are cancelled without the parents being given the real reason.

The staff aren't happy. They have a duty of care to the children on their caseloads. Professionally, they object to what they've been asked to do. However, their contracts say they must do "whatever the manager asks".

SO they start to look for other jobs - perhaps in another department like the adult department or the special needs team or whatever. Perhaps in a differnet trust.

The remaining staff can't cope - they go off sick. The manager rings them at home when they're off sick because the manager is stressed about waiting times. "We've got a child here been waiting 15 weeks" she says. "One more week and he'll breach the government target" she says.

"I'm sick" says the therapist. "But what are we going to do?" shrieks the manager.

Eventually someone else sees the child and - phew! - nobody has breached the waiting times that month. The head of therapy services sends a congratulatory e-mail because all of the assessment kids were seen within the 16 week target. None of the other kids got an appointment but the managers don't care about that.

The chief executive will keep his job! The government have delivered their promise! "We want a better health service" scream the public.

"Right" says the government - "let's get the wait down to six weeks".

The membership for private SLT goes up dramatically in a three month period. You can have a better heath service. It costs £65 per hour, thanks.

All true. All actually happened.

Home visits are probably much more likely to give a truer picture of a child's SALT difficulties - there is nothing like an alien environment to shut a child up/make them scream the place down.

BTW, Nurses get no overtime pay and work after 5pm....mind you, I doubt whether SALT appointments would really work during a busy breakfast or supper time in our household!

nurses work after 5pm because patients are sick 24 hours a day. You know that when you become a nurse though.

They actually get a choice about overtime and don't have to work unpaid. Any nurse working unpaid overtime is within her rights to go to her union (and rightly so).

They get a different rate for nights, saturdays, sundays and bank holidays.

How many mothers of young children here would willingly work overtime without pay when they have a family who need them to come home at a regular time?

Seriously!

Mogwai, totally respect what you're saying and it must be shitty to be part of it and know that 'the system' is letting people down. I feel the same as a teacher.

I think, as parents, we give so much time to our children that we get annoyed at the idea that people won't give up their own time e.g. 5pm for an interview or to write reports, but a job is a job and therapists' kids have got to come first just like anyone's!

Paperwork must be a bugger. I know that J's CAMHS consultant has had to write pages and pages of reports for LEA, DLA, Social Services, School...very few of which were standard and presumably all of which were done in her own time.

From Mugwai:

Patient contact generates other (lengthier) work

Solution, stop seeing patients...

I've received what reports?

I've received what programs?

Also from Mugwai

you have an overly simpistic view of the job of an SLT

Please don't patronise.

I think I am perfectly reasonable to want my child seen by a SALT, you may only see them as patients to fit around YOUR children, this is my child you are talking about here, and you can justify it and complain as much as you want but (AFAIK) you are not seeing it from the point of view of parent who only want some direction and guidance for her child...

yeah it's hard.

And actually, you feel there's nothign you can do, so in a way you are more likely to see at as "just a job" and refuse to take it home with you.

I'm sure teaching is the same.

Service users and parents of kids always have a perception of "the system" which is usually a million miles from the truth of the situation, as you'll appreciate.

I don't usually get involved in threads like this because I think, god, where do you start (and anyway, the parents tends to turn their aggression on you when you are trying to help them see things differnetly or more realistically).

I've seen replies from other SLTs that just urge more aggression and make statements suggesting most SLTs are crap for one reason or another, suggest writing to the head of SLT services when you know it's far more politcal than that and that's there are different, cleverer ways of goign about these things.

Professionally I think those sorts of comments are distasteful but more importantly, it's easy to come on this board and by sycophantic and agree with everything and everyone but actually sometimes you should stand up and be truthful. To do anything else is a disservice to the parent involved (IMO) and I answer threads on here as I would answer them in real life (thoguh perhaps a more sanitised version!)

DH works in the NHS at a senior management level so we tend to discuss the politics of things and have an idea of how things might change for the better. Unfortunately, while the public still equate "better services" with waiting less, the government of the day will continue to prioritise quantity over quality to get re-elected. The government have no problem with a privatised system (and I agree to an extent otherwise I wouldn't work privately) but untimately we run a huge risk of driving experienced therapists into the private sector with comments about us working unpaid overtime.

My children, like everyone's, will always come first. I know few experienced SLTs who would put up woth this (or be able to do it) as it's actually not the solution.

We all put our kids first. That's how it has to be and how it should be.

I would never put a pupil before J. Never. That doesn't make me a bad teacher. I do what I can for them in the time that I have. As it happens, of course I stay out of official school hours to see pupils or mark work but that's expected in teaching. That's part of the deal. But there are limits. Everyone needs them.

I guess your comments about working unpaid overtime are directed at me.

Where did I mention the "unpaid" bit?

FWIW, I have worked since having children, and yes I did have to work long hours (passed 5pm shock horror), yes, in the private sector. It was necessary so I could pull my weight in my team.

Yes, it was paid, but where did I mention I want you SALTs to work unpaid (your graduates seem quite happy to...)

You did say that you didn't think it was acceptable that she wouldn't work past 5pm (which would be her unpaid time). To be fair.

To be fair right back at ya, I was not aware that the NHS did not pay overtime in these circumstances...

sigh

Why the comment about graduates?

A situation that was sad for those involved - you appear to be using this sarcastically.

You think this was right they should work unpaid? That as our graduates were happy to do so, we ought to follow suit?

I don't think they were strictly happy to do so, but you know that, it's obvious.

You are terribly angry aren't you? I'm sorry you're angry but I bring my experience to this board in good faith and if my opinion doesn't match yours then thats because yours is subjective (as a parent) and I'm looking at it objectively (with professional head on). I canmot help but bring a professional head to threads about SALT. I cannot simply agree with you and say "you're right, ain't it awful".

I'm not in the slightest shocked that you worked past 5pm to be part of a team. My husband works frequent unpaid overtime in his NHS role because that's what he signed up for. I also wasn't always an SLT and worked in the private sector as you describe. Unfortunately the NHS does little to foster team spirit as I've experienced in the private sector. It fosters a clock on clock off mentality (even if I were able to stay late in a practical sense).

At the end of the day, my opinion and the views I have expressed stand.

I am disappointed that you felt the need to turn aggressive and sarcastic towards a profesional trying to help out on a SN board. This isn't the sort of spirit we have here - it's a spirit of pulling together as mums (or dads) and helping each other. IF that means offering professional advice, then I'm happy to help. If you expect every professional to agree with your point of view then you will always be disppointed. If you just want to have a rant then say so and make it clear that you are not interested in any professional contributions to your thread.

(and yes, you were not aware the NHS will not always pay overtime. There are clearly many things of which you are not aware but I don't think you want to take them on board because they're not convenient to your point of view),

Of course not Mogwai. Of course it is very sad that they spent years studying for a degree so they could help people, only to find there were no positions and so had to leave the field before they even got to first base.

Hey, it happened to me, in a very different field when I graduated during the last major recession (1991).

I use the board differently Mogwai, I do come here to rant and rave, and normally that is what happens. It makes the whole awful situation just that little bit easier to bear when you do get sympathy and empathy from other parents in the same situation.

I have to say...I have not felt this patronised in a long long time.....

Mogwai, next time I want professional advice I will ask for it. Don't presume I do. I could have posted this on AIBU, or any other area which I felt was suitable, where I would have got blasted as I did here (and accepted it).

Normally SN is actually supportive....which is exactly why I posted here.

I do not come here to be demeaned...

all I see was Mogwai trying to explain why things happened that way. She did sympathise with your predicament. And then getting (understandably, imo) pissed off that she was being expected to justify the failings of her entire profession.

She's not demeaned or patronised you at all.

I get this on some forums, as a teacher: it pisses me off that my entire profession is dismissed as shite when it's some, not all, and we work in difficult circumstances.

It's hard to separate out personal from objective from subjective from professional from parent from supportive forum member. That's the problem.

mm22bys, I think it's crap that you have this situation with SALT. I really do. But I think you've overreacted to mogwai.

My perception of nhs salt services is that they are extremely underfunded/understaffed. I realise that although DS gets seen so sporadically, this is not because SALTs are in anyway not doing their duty. But - doesn't make it any less frustrating for a parent, who may well be worried sick, which never helps anyone's temper.

She-said/I-said:

I didn't "expect her to justify the failings of her entire profession".

She asked me if my priority was getting a new SALT (which I responded to), I asked her how much time a SALT actually sees a patient.

I asked why it's patient time the first to be sacrified rhetorically, it was not directed at Mogwai.

I have had little dealings with SALTs but surely from a point of view of a parent of a child with SN continuity is important to improve the condition being treated.
Not good that the service is understaffed or underfunded. Surely the Trust could have put some sort of temporary provision there until filling the post permanently.
Incredibly frustrating for you though.

Spooky, I would have thought that they would have had experience of appointing temporary staff in situations such as this, even if it didn't mean continuity (any help is better than no help).

They did have trouble a while back appointing a physio for him, and he saw about 3 in 3 months, but at least he did see therapists, and at least we did get some guidance.

Yes it is frustrating! You have fight for every little thing...

Oh to be a parent of a child with SN....

sorry your having a crap time, I remember going through this when dd was little, I found there never seemed to be any continuity with the appointments. but was lucky to keep the same SALT.
I think imo that is important, the child needs to build up a relationship with the SALT as every time they change you go back to square one.

When he was assessed, he saw two SALTs, and did see the same one for the next 14 months (not often mind...). Occassionally we would see the other one, and it is actually this one that keeps on having to postpone for various reasons...she did say to me that she would try to keep DS2 on her list, so I guess that is positive and encouraging.

I wouldn't mind not seeing them very often if they gave us a good home program to do (I am well aware that the good work is done on a regular basis, whether at home or at school), but that is sadly lacking.

so they don't give you work that you could do?