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Changes to speech and language therapy provision in Richmond.

On 6 October, a letter was sent to school SENCOs informing them of changes to speech and language support in schools in Richmond. The letter outlined a situation which had been prompted by a national shortage of speech and language therapists.

In summary the changes are as follows:

  • A temporary pause in the delivery of speech and language therapy to children at SEN Support, so HRCH can deliver statutory assessments and provision set out in EHCPs.
  • From 1 January 2022, HRCH will no longer be commissioned to deliver a speech and language therapy service to children and young people whose EHCPs are the statutory responsibility of another local authority area.

Following schools sharing this information with relevant families a number of questions have been raised. We have therefore created a list of frequently asked questions below:

Risks

We would like to understand the scale of the following risks and how they will be managed:

How many children may face delayed diagnosis as a result of this change and how will this be managed?

There are approximately 100 referrals per term across Richmond. The temporary change in service would not necessarily delay diagnosis. Many students have on-going communication difficulties that would not result in a diagnosis. Schools receive advice on recommended strategies to support learning and this will continue to meet and support the needs of a large percentage of students.

How many additional ECHPs are expected as a result of this change and how will this increased need/demand be met/managed?

We do not expect this to lead an increase in requests for assessments for EHCPs or plans. It is rare that Speech and Language needs alone would lead to an assessment for an EHCP or a plan as they tend to be part of wider presenting needs. AfC monitor the number of new plans robustly and we will work with them to monitor if any change occurs. Schools can still get advice from the service to support pupils without a referral.

There are out of borough children in Richmond schools who will have unmet needs. How many children does this relate to and what will be done to ensure that the responsible Local Authority meets this need?

There are approximately 40 children with out of borough plans in our schools. This does not include children with plans issued by Wandsworth. We are talking to neighbouring boroughs to identify their approaches and to communicate this appropriately as soon as possible.

Children with communication needs in mainstream schools who do not quite meet the threshold for an EHCP, or for whom the pandemic has led to a delay to having an EHCP, will be less able to express their needs and risks as a result of this. At the same time their risks and needs may have increased during the pandemic. How will these young people be identified and supported to ensure that their wider risks and needs are addressed?

The service has continued to write into similar numbers of plans throughout the pandemic as they did pre pandemic. Children in reception continue to be managed via our early years’ service. Most of these children will be known to us having been referred when they are pre-school. Schools are offered a link meeting in the Autumn term to highlight these children and to offer advice. Further training is offered in subsequent terms.

Communication with parents

How will this change be communicated to parents?

Schools have been asked to update the parents of children registered for SEN Support. This change has already been communicated widely within Richmond and at various multi agency meetings with parent/carer and school representation. We are planning to communicate with parents of children with out of borough plans. We are waiting for updates regarding arrangements from the responsible boroughs.

What alternative support (statutory and otherwise) is available to them and how will this be communicated to them?

Schools are offered two hours of bespoke training per year and a termly consultation clinic where they can access advice. Further advice is also available on our website. Schools can also access our telephone advice line. Further work is being done to see where we may be able to increase this type of support.

How can parents escalate concerns about their children arising from a lack of SALT and what support can they expect?

Parents can go to Achieving for Children SEND Advisory Support helpline to escalate concerns. They can contact the Richmond Parent Carer Forum and HRCH has a website and telephone advice line.

We are aware that there are routes both for communications and for support through partners and it would be sensible to consider how these are used.

We are working with our multi agency/stakeholder Therapies Oversight Group to support HRCH to build an action plan, to have robust communications and support across the system, during this time.

Communication to Schools

How will schools be informed and what is available to help them support the children affected by this?

A letter has now gone out to schools from the CCG, AfC and HRCH. Contact details have been shared with them. Staff allocated to individual schools have also discussed the situation with them in person. As previously mentioned, further advice and support clinics for schools is being worked through.

Schools may identify children who are at risk in terms of mental health/social skills/behaviour/academic performance as a result of not being able to access SALT. How can they escalate this and what response can they expect?

There are a number of routes other than the SALT where such concerns can be raised. These include mental health in schools support teams, Educational Psychology and SENCOs themselves. Provision for MH in schools is increasing across the borough as part of a wider programme of work.

Is there any opportunity to involve schools in co-designing the recovery and reinstatement of the service?

School representatives are members of the SEND Partnership Board, the Emotional Health & Wellbeing Group and of the Therapies Oversight Group. They are working with us to get back on track as quickly as possible.

We work closely in collaboration with all our schools as part of the model of service delivery. As part of these discussion, we will explore school training needs and offer advice. Some interventions recommended and modelled for children with EHCP’s can also be used for children at school support. This would also be discussed with schools SENCo’s/class teachers

Impact of the change

How will the impact of the change be measured on parent's children and schools?

We will work closely with our Designated Clinical Officer and Designated Social Care Officer to look at the possibility of sending a questionnaire to school to get their feedback. We will also include our school improvement lead in these discussions.

How will this be used to inform the recovery of the service?

Initial recovery plans have been written and sent to Directors for approval. These have already included the suggestions from a variety of stakeholders from the forums mentioned above. Recovery plans will be reviewed regularly with stakeholders.

Can funding, that is presumably not being spent due to voids in staff, be used to mitigate the impacts - for example by giving schools access to training and support?

The immediate aim is that the available funding will be used to pay for locums as direct therapists. This has been problematic, mainly due to the national, London and local shortage of such therapists currently. As previously mentioned, we will try to expand the current offer for staff to deliver additional training, support and clinic sessions if possible.

Recovery from the reduced service

Stakeholders have told us that they are concerned that these changes do not become permanent. We support their position that the reduced service should not become permanent. What assurance can you give them that this is short term?

We estimate that this situation will be resolved and is temporary. We will monitor and adjust our action plans to ensure recovery.

What is the plan for recruitment and recovery of the service?

This is currently with senior managers for sign off before sharing more widely. Many of the issues above and comments will be within the action plan.

What are the timelines for planning, reviewing and taking decisions on this service?

We expect this situation to last for one full term. The multi agency Therapies Oversight Group will monitor the situation closely and report to the partnership board.

What options are there for co-designing changes that might enhance the service when it recovers?

The Therapies Oversight Group has parent and carer representation and the Partnership Board has children and young people’s representation. Through the investment plan, a model of delivery with an outcomes framework was approved and these are being implemented with partners and stakeholders through co-design. We engaged the Council for Disabled Children  (CDC) at the beginning of the process who have supported our approach and helped to develop our outcomes framework.