Beware lovely readers this post is going to get ranty. I apologise in advance because I pride myself on being a blogger with a positive outlook and can usually find something that I’m proud of/ happy about/ amused by that I can share, even when things get challenging. However, even if I dredge the silty bottom of today’s subject matter I cannot think of even one half positive to balance things out. So for one day only I’m just going to vent.
The thing is that our local Speech and Language Therapy (SaLT) Service is turning out to be completely and utterly useless and for the first time in my career I am embarrassed by association.
Little Bear was referred last February. As most of you will know he was experiencing developmental delay caused by neglect with more specific and significant speech and language difficulties on top. His communication difficulties impacted on every area of his life, from his learning to making friends to his behaviour. I felt he had a high requirement for therapy, not least because he had had such poor stimulation for the first 3 years of his life.
We were offered an initial assessment appointment on 4 separate occasions and each time the appointment was cancelled by the SaLT Service. Apparently the therapist had experienced a string of personal problems. I was empathetic, things happen, it can’t always be helped. It wouldn’t have happened where I used to work though: somebody else would have covered for the therapist after the first or second cancellation.
Eventually Little Bear was seen on our 5th attempt, after 8 months of waiting, back in October.
I don’t think I was ever going to particularly enjoy taking him to his appointment: I’ve been doing Speech Therapy my way for a long time and obviously you do things a certain way because you think that is the best way. I knew a different therapist would do things differently and I would need to sit on my hands and try to distance myself as best I could. I have worked with lots of other therapists though and I know that my way is pretty similar to most other people’s way and I would have been very happy for any of my colleagues to see Little Bear.
I wasn’t totally convinced that the differences I saw in how the therapist ran Little Bear’s initial assessment could be passed off as style differences but I gave her the benefit of the doubt. I noticed that she didn’t take any time to get to know Little Bear or build up any rapport with him. There wasn’t any chat about what he likes or how old he is or where he goes to school, she just spoke with me to do a case history then assessed him very clinically. His behaviour during the session was off the scale compared with what was typical for him at the time.
During the assessment she didn’t transcribe his speech, just making some basic notes. I concluded her memory must be a lot more detailed than mine. She didn’t ask me anything about his social communication or memory skills.
At the end of the initial assessment, the therapist concluded that Little Bear’s expressive language skills were pretty much in line with his age (??!) and that his needs were not that severe. She agreed to put him on the waiting list for therapy though and said an appointment might come through before Christmas if we were lucky. I somehow came away feeling like a neurotic parent who had completely exaggerated my child’s needs.
Little Bear had a huge meltdown on our arrival home and flatly refused to go to school afterwards. He has never done that before or since and I had to carry him there with his dummy and blanket.
Then we waited. And waited some more.
We recently received a letter inviting us for a “follow up” appointment. It was at 8:45 am on the Friday of half term. I certainly wouldn’t have chosen to get both boys out of the house earlier than on a typical school day during their holiday but beggars can’t be choosers. We’d waited a year by now, I was damned if I was going to try to change it.
We arrived 5 minutes early and checked in at Reception. “Do you know which therapist it is?” the receptionist enquired. I didn’t. “It’s just that there are 2 and one is currently stuck in traffic” she explained. I really hoped it wasn’t our one.
It was our one. We duly took a seat and waited. This could have gone either way and we were just lucky that Little Bear was able to tolerate a wait today. I think it helped him that Big Bear was there too.
Little Bear did try to tell me that he was nervous this morning though. Previously you could just spring things on him and he would either go with it or not, depending on what sort of day we were having. He is getting a lot more aware of what’s going on now though and he knew that the ‘talking lady’ would expect something from him. Although he wasn’t able to say “I’m nervous” or “I’m worried”, he tried his best to get the idea across to me without a meltdown. He said “I think I take Phoebe to see the talking lady and he sit on my knee”. Phoebe is his cuddly dog who barks and wags her tail. Ok, I said. “Why? Does Phoebe want to come?”. “Yes, cos it might be scary”. “Might it? I don’t think the talking lady is scary” I tried to reassure. “Yes” he said “speaking might be scary for Phoebe”. Aha. I think perhaps he knows his speech isn’t quite how it should be and he knew that it would be under the spotlight today. We decided that noisy Phoebe might be best left at home but he brought 3 cuddly puppies to sit on his knee because they are “more sensible”!
What a shame to make an anxious child with attention difficulties (who finds sitting still difficult at the best of times) wait in this manner. Why arrange an early appointment if you couldn’t be sure of being there? I was getting cross but again tried to be reasonable. It wasn’t her fault the traffic was bad.
Eventually, the other therapist who was there came out to us. She was starting her own clinic at 9:30am but could squeeze us in. Apparently her colleague lived a fair distance away and was never going to make it.
We walked into the clinic room to find another person in there. She was later introduced as a student though I was not asked to consent to her being there which I know is the standard procedure.
The lady who had stepped in was obviously trying to do us a favour but was clearly flustered and had not read the notes. She started reading them while I was there and began firing questions at me: “how are his vowels?” “Have they improved?” “What about his word retrieval difficulties? Are you still concerned about those?”. As she was using technical language I assumed she knew I was a SaLT. “What is he working on at the moment?” she asked. “Well, we have started doing some work on ‘pl’ and ‘bl’ sounds” I explained. “Why?” she demanded. “Err well, because he was reducing those clusters and it was affecting his intelligibility” I replied. “Oh” she said “seems odd, those sounds are very complicated”. “And because I’m a Speech and Language Therapist” I retorted before I’d really considered whether that was a wise thing to say. I did well and kept the swearing inside my head though.
She proceeded to attempt an assessment with Little Bear. She was clearly in a rush and didn’t bother with any rapport building either. I could have told her, had she asked me anything about his behaviour and how best to manage him, that sitting him next to a big stack of toys would impact negatively on his ability to concentrate.
Once the assessment was over, she said “yes, he does have some speech difficulties I’ll put him on the waiting list for a block of therapy. Is that ok?”. Well no, after a year of waiting and thinking that therapy was starting today, no, that isn’t really ok. On querying whether today was meant to be the start of input, she explained that they have a lot of children waiting and some for quite lengthy periods so they are just seeing everyone to “check in” so “everybody has had something”. I can only think that that terrible piece of clinical decision making is due to having to meet some sort of waiting time target. It makes literally no sense because we still haven’t had anything. We haven’t had one piece of advice or even a strategy to use. Time is being wasted reviewing everyone who is waiting and doing NOTHING with them when they could have used that time more productively to start several children’s therapy. Although assessment is essential from a clinician’s point of view, on its own it does nothing to improve outcomes for children.
The whole experience was painful. We were very quickly dismissed, with minimal attention paid to Little Bear. I think it is just common courtesy to praise a child and let them know that they co-operated well at the end of a session.
I have been quite unsure about writing this post as it feels so wrong criticising fellow professionals. However, the whole experience to date has made me feel like an old person who says “it wasn’t like this in my day” as if things have changed beyond recognition over the past 50 years or so. Yet I am not elderly and I only left the NHS last year. Nevertheless I do not recognise this as the Speech and Language Therapy that I know. Where is the quality? The bit where you care about the children and families you are trying to help? The bit where you are thorough and try to consider all aspects of a child? The bit where you look beyond the snapshot provided by one rushed assessment? The bit where you think about a child’s background and the impact that their communication difficulties are having on their life? The bit where you don’t keep patients waiting, where you manage your diary in a realistic way and you prioritise the children who need you most?
If this is what people’s experience of SaLT is, I’m not surprised that nobody really knows the breadth of what we do and that as a profession we have a bit of an image crisis. I am ashamed to be associated with the type of service that has been provided to us. I know that each individual failure in our case has had a fairly reasonable personal excuse behind it but overall the quality of the service Little Bear has experienced is not excusable.
We have experienced the Audiology Service, Educational Psychology, School, Health Visiting and other medical professionals and I have felt well supported by them all. It does upset me that it is SaLT in particular that is letting us down.
And so we wait again.
*Rant over. I promise some positive sentiments next week.