Losing Faith

As a speech and language therapist, I am regulated by the Health Care Professions Council (HCPC) and the Royal College of Speech Language Therapists (RCSLT). Both of these organisations are involved with developing professional standards and regulating our scope of practice. I am starting to lose complete faith in both of those organisations, mainly the RCSLT, because I don’t think the healthcare professions council is responsible for looking so closely at sort of advocating for our profession and how our profession is run. That is much more the role of the RCSLT. But at this point, I am staggered by the amount of poor practice going on in the face of everybody where everybody can see. The Royal College appear to have nothing to say about it. They have been asked several times by many different professionals to intervene in the situation regarding education, health and care plans (EHCPs), but their response has been minimal.  In fact, they only jointly issued a statement with the Association of Speech and Language Therapists in Independent Practice (ASLTIP) when they were urged to do so by ASLTIP to advocate for private speech therapy reports being accepted for EHCP purposes.

So the state of affairs is that speech and language therapists are required to write reports detailing the needs of a child for their speech language and the provision which should be set out in that child’s education healthcare plan. No matter where that therapist works whoever employs them, they are governed by HCPC and RCSLT. However, in practice what is happening is that when therapists are employed or commissioned by the local authority their reports are being accepted for inclusion within a child’s EHCP.  So, this means that therapists who are employed directly by the local authority, or by the NHS trust that is commissioned by the local authority to deliver that speech and language therapy provision for that local authority are being given priority.  We need to ask why.  The reason is always- money.   When these therapists write reports of EHCP provision, they will write that a child needs anywhere between 6 and 12 hours of speech and language therapy across the academic year. It used to be 12 was the magic number. Currently, I’m not seeing anything more than 6-9. They will also “specify and quantify” as we are required to do for EHCP provision, but they will do this very loosely and specify that a very high proportion of those hours are spent indirectly with the staff and not with the child providing direct one-to-one intervention = actual therapy. So, what they’re doing is quantifying the need of the child and then saying, “We’re only going to provide this many hours and it’s just to train everybody else around the child. We’re not actually going to work with the child very much.”

But that’s not evidence based. Therapists like me are wondering why the Royal College does not care that this is happening. So, we’ve reached out to the Royal College about this issue, highlighted by the fact that private therapists, such as me, have been asked to write reports to detail the child’s need and provision in their EHCP alongside our NHS colleagues but our recommendations are being excluded. Now, sometimes there is an absence of an NHS report and despite being given our private report, the local authority will often ignore the report we have provided.  Local Authorities have often attempted to push through an EHCP to final draft (where a child’s main presenting need of speech and language) with ZERO hours of provision of speech and language, because they say that child is on a waiting list for an assessment with the NHS.  This is unethical. So the issue here is even considering our report, they will exclude speech and language provision from the EHCP, push parents to finalise and await an NHS EHCP report which will no doubt recommend far less hours than we have done.  Why? Money.  Why does speech and language provision in EHCPs only total 6- 12 hours? Is it because it is evidence based? NO.  It’s blatantly obvious that is not evidence-based because it’s highly improbable based on the cohort of children that we deal with that they all mysteriously need between 6 and 12 hours across the year.  These children have complex communication needs including DLD, speech disorders, autism, AAC users, disfluency, we are talking our auditory processing difficulties, multiple and complex needs. They do not fit into 6 to 12 hours of provision. That just isn’t possible.

Despite therapists, their managers, therapy leads, local authority staff all knowing this information, they willingly allow these reports to go through. No one is saying anything.
No one is calling it out. When we called this out to the RCLST, they did not respond with any meaningful action to stop this unethical practice.  If the HCPC were to strike off every therapist who wrote 6 to 12 hours when a child clearly needed more, they would be striking off half of the profession. Now, the reason I say this is because 90%, I think it’s actually higher, I think it’s 98% of all tribunal cases where speech and language provision is under debate, are won by the parents of the child and the higher recommended provision is upheld. So when they get all the way to tribunal, they finally must admit the provision stated by the private therapist or the tribunal therapist is actually what is needed and should be legally written into the child’s plan.  By that point both the local authority and the parents will have had to pay thousands of pounds in legal fees. This tells me absolutely 100% that NHS trusts, local authorities, and all under the noses of the RCSLT and know that that’s what’s required, and the law upholds that. It is clear that it is cheaper for the local authority to pay legal fees at extortionate amounts to allow some of the cases to go all the way through to tribunal, than to provide adequate provision as only some make it to tribunal, and in the end, they only have to provide for a fraction of the for the need that’s out there. It is financially cheaper. If you were to add up costs including the number of therapists that would have to be employed to deliver all this provision that we’re recommending, it is much more than is available now.  

So, my question is, why doesn’t the Royal College of Speech and Language Therapists insist that when therapists, regardless of who they work for, write EHCP advice reports that they are required to detail need and provision based on the need, not based on the resource and the capacity of their service. Now, I don’t know why they’re not looking closely at this. It doesn’t take a genius to realize that this is what’s happening. I cannot be the only one who notices this. Well, obviously, I’m not because we’re having these debates on other social media. RCSLT don’t seem to be fighting that fight for us as a profession.
And even more worrying, there aren’t enough therapists out there working for local authorities or NHS trust commissioned by local authorities, who are willing to write unethical, inadequate provision, in in an EHCP report, and sign their name at the bottom. They will say that they’ve been told to put that provision in their manager has signed off on that provision. Yep, but when it comes right down to it, they get to tribunal, and the law will look at them and go no, that’s your signature, you’re the one who is saying that that’s what that child needs. And it’s their HCPC registration that is on the line. So, it’s a massive issue and the unethical practices are just rife, and it’s like it’s like the elephant in the room.