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Therapies Review

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March 2021

Richmond Progress Report - Therapies Review March 2021 (pdf)

Kingston Progress Report - Therapies Review March 2021 (pdf)


June 2020

Therapies Review Implementation: update for 2020/21

Following the detailed therapies review completed in December 2019 and subsequent investment agreement from the Council and NHS CCG, we are now looking to implement the recommendations within the review. This has, unfortunately, been delayed due to the unprecedented situation that we have all found ourselves in during the past few months with Covid-19.

The investment, whilst very welcome, will not easily resolve all of the issues identified within the review immediately, however, we do need to work collectively to ensure that we are prioritising and targeting the investment in the most urgent areas and in the most effective way possible.

Implementing the recommendations from the review will be jointly led by Achieving for Children (AfC) and the NHS CCG. The commitment to coproduction of the model with children and young people, and parent and carer representative forums is a central feature of implementation.

To co-ordinate this change in the best and most transparent way, we will be forming an oversight group that will oversee the co-production and the implementation of a project plan. This group will have senior representation from all our stakeholder groups and the group will be responsible for ensuring that the investment is targeted at local need as identified in the review. The group will ensure absolute co-production is at the heart of the project. This will include delivery of local community development sessions to ensure as much participation as possible and that we maximise the investment opportunity that we have.

The oversight group will be supported a short-term project lead, for six months, to help us to help co-ordinate the ideas that we have as a system to drive the process within our agree timescales. The project lead will also ensure that we have a plan for the further investment in 2021/22 and 2022/23.

There have already been some key agreements across stakeholders which include:

  • a need to co-ordinate current and future investment by improving commissioning arrangements to standardise and maximise investment
  • an agreement to deliver the ‘balanced system’ which provides support at universal, targeted and specialist levels
  • increasing support, advice, and direct interventions for those at SEN support as well as those with education, health and care plans
  • increasing the skill mix and capability within therapy teams
  • increasing the skill mix of those supporting therapy interventions in schools through training
  • we aim for a model of care for all providers to follow, with a clearer philosophy on how we deliver services and monitor their success. This includes better defined outcomes for our children and families
  • co-production of the implementation plan, detailed guidance, and information for stakeholders
  • co-production of key performance indicators, outcomes, and effective contract monitoring
  • co-production around changes in the way in which therapy is delivered with schools and families as well as lead therapists and their teams

We anticipate that we will be looking to start co-producing the implementation plan early in July.

Download this update as a pdf

In response to queries raised by parents and carers there is also more information about what the Balanced System model means.

The Balanced System®, what will this mean for therapies in the Kingston and Richmond boroughs?

The Balanced System® was developed by Marie Gascoigne and Better Communication CIC. It was developed as a framework for commissioning and providing services for children and young people with a range of speech, language and communication needs.

For more detailed information see here (opens a link to a pdf)

The approach has also been taken on by occupational therapy services with the support of the Royal College of Occupational Therapists. The principles of the ‘Balanced System’ will form the core of the new model for therapies (speech and language, occupational and physiotherapy). Many of these principles are evident in previous practice. We are looking to respond to feedback from parents, carers, young people and settings about what does and does not work and to develop what has been working well, address gaps in provision through this work and ensure consistency of what is offered across the Kingston and Richmond boroughs.

The core model reflects the need for a clear strategic overview, jointly commissioned outcomes for services and core involvement of parents and carers. It also highlights the need to ensure the most effective use of all elements of the children and young people’s workforce to support children and young people in achieving their outcomes.

There are five key areas of the model which will be considered in terms of the way the services are commissioned and consequently the way in which contracts are monitored.

These are:

  • family support
  • environmental support
  • workforce development
  • identification of need
  • intervention

These principles will be supported through the work of services at universal, targeted and specialist levels. The underlying premise is that all children will begin at the universal level and that targeted and/or specialist interventions may become appropriate over time for some children and young people. The principles mean that a child will access the right support at the right time regardless of whether they have an education, health and care plan.

Universal interventions are, by definition, available to all and may include:

  • generic advice sessions through children’s centres, schools, clinics
  • general information leaflets and signposting
  • provision of training for different groups around topics such as understanding of speech, language and communication needs, opportunities to promote physical and mental health
  • Targeted interventions are designed for children and young people where there are concerns about aspects of their development and where a therapist may work with a setting to support
  • families and settings to delivering interventions which are embedded within their everyday experiences.
  • Specialist interventions include those which are directly managed by a therapist working in collaboration with the family and the setting the child or young person attends.
When will we see the difference?

This is a three year development programme. We are establishing an oversight group to manage the work and have already gone out to advert for additional occupational therapy posts. A project plan is in development and will be shared on the Local Offer and through the Parent Carer Forums.


RCOT; Occupational Therapy Unlocking the potential of Children and Young People

Download this information as pdf

Alison Stewart, Designated Clinical Officer for Special Educational Needs and Disabilities

June 2020


 December 2019

This paper provides an executive summary of the joint therapy review which has been conducted by the Clinical Commissioning Group (CCG) and Achieving for Children (AfC) on behalf of Richmond and Kingston councils. Extensive consultation has been undertaken with families which has informed this review. Due to the prohibitive factor of Purdah, key decisions are yet to be made. This will take place in early January 2020. A full public report will be published by the end of February 2020, however, this document sets out the key findings of the review.

Therapies Review Paper - December 2019 (opens pdf)