Speech Therapy in an Ageing Society

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Speech and language therapy (SLT) is not an area which often attracts a lot of attention in older people’s policy yet it is an area of potentially significant concern. Around 2.5 million people in the UK have a speech or language difficulty and whilst the most likely users of speech therapy services are younger people, the figures below show that the over 75s are also major users of SLT services.


 
55 NHS cases per 1000 children aged 3-4
 18 per 1000 children aged 0-2
 17 per 1000 those aged 5 to 9
 1 per 1000 16-54 year olds
 18 per 1000 75 to 84 year olds and
 42 per 1000 over 85s
 
Every year, an estimated 150,000 people have a stroke and a third of them are left with a communication disability as a result. But it’s not just victims of stroke who could benefit from speech and language therapy. Older people with a variety of other impairments (including neurological impairments such as dementia and conditions such as cancer of the head, neck and throat), also benefit from speech therapy. Many older people will also have life-long persisting conditions which need on-going support such as learning disabilities.
 
We’ve seen growth in the numbers of speech therapists over recent years and it has been estimated that there are in total, around 10,000 practicing SLTs in the UK (7000 within the NHS in England). But there has also been a significant growth in the number of episodes of care (over the fifteen years between 1988 to 2005).  And evidence suggests there are a large number of ongoing issues facing SLT services.
 
In October 2008, the Unite union described the services as ‘heading towards crisis’. They claimed that they were seeing longer waiting and referral times for patients, while the workforce was becoming more stressed and demoralised. In addition, I CAN have argued that there is a mismatch between the number of speech and language therapists employed by the NHS (approx 7000) and the needs of children with SLCN (over 1 million).
 
Over the last ten years, SLT has attracted a degree of policy interest from politicians and Government. We’ve seen debates in Parliament, Government commissioned research reports and good advocacy from the sector.  We’ve also seen championing of the cause by a number of MPs including the now speaker of the House of Commons, John Bercow MP.
 
In September 2007, the Secretaries of State for Children, Schools and Families and Health asked John Bercow MP to lead an independent review of services for children and young people with Speech, Language and Communication Needs. On publication of the final report, the Government announced that it accepted the key recommendations and would invest up to £12 million to lead action to take them forward. (They published ‘Better Communication: An Action Plan’) 
 
So progress seems to be being made in terms of the issues faced by children. But with an ageing population with increasing levels of disabilities, it can be hypothesised that major growth in demand in the future for speech and language therapy is likely to come from the older population. There are some indications that current NHS SLT services are struggling meet the needs of an ageing society.
 
In March 2008, for example, the Royal College of Speech and Language Therapists noted that people who survive stroke are not receiving the speech and language therapy they need to help them cope with their severe communication problems. Their survey of 500 recent stroke victims found that:
  *Two-thirds said speech and language therapy had allowed them to remain independent  
 * Three-quarters said that it helped them to understand and be understood by their family and friends  
 * But less than one in five of respondents said they received therapy in the first month following their stroke.  
 * Half said they had to wait over two months for their speech and language therapy to begin.  
 * Three-quarters of the stroke survivors said they only received speech and language therapy for six months or less
 * More than half felt they did not receive enough speech and language therapy.
 
And whilst not ignoring the importance of the Stroke Strategy in this area, it seems that adults and older people have not had the same attention as younger people from policymakers in terms of SLT. With this context surely it’s time for another Bercow style Review to consider the issues facing SLT in terms of adults and older people.
 
Earlier this year an Adult Communication Coalition England, was created to pull together a group of over 25 charities (including Royal College of Speech and Language Therapists, Mencap, Scope, the Stroke Association, the National Autistic Society and UK Connect. The coalition is calling for calling for a review into services for adults with speech, language and communication needs).  
 
Certainly on the surface, it appears that unless health authorities consider some of the challenges facing SLT, the service is likely to struggle and not meet future needs.
 
David Sinclair
 
 
This blog post was extracted from a larger piece of work commissioned by ATcare with a view to providing tools to assist with the problem.

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