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Children lose out in recruitment crisis

Martin Whittaker on the changing role of speech and language therapists

One in 10 children have some form of communication problem. Yet we are so short of speech and language therapists that some children face long waiting lists and in some areas have no access to a speech therapy service.

The profession is in crisis, according to the Royal College of Speech and Language Therapists. There are currently 6,300 therapists looking after children, but the Royal College estimates that there should be nearly 2,000 more.

Speech and language therapy is beset by recruitment problems, with a third of posts receiving no applications. Entry routes into the profession are restricted - there simply aren't enough courses.

Meanwhile, there has been an increase in the number of children with communication difficulties as more premature babies survive with learning and developmental disabilities.

The picture varies regionally. In some areas, such as the South-west, there are few jobs for those qualifying, while in inner-city areas posts go unfilled.

The policy of inclusion in schools has also stretched the profession, said Steven Harulow, spokesman for the Royal College of Speech and Language Therapists. "It used to be that a therapist would go and see perhaps 25 children all in one special school," he said. "Now they're going round to mainstream schools, they're travelling all day and they're a lot thinner on the ground."

Speech and language therapists (SLTs) specialise in communication disorders, from which 2.5 million people suffer in the UK. Of those, nearly a third have a difficulty so severe that it's hard for anyone outside their immediate family to understand them. The result is that thousands of people miss out on education, career and other opportunities. Around 5 per cent of children enter school with a speech or language difficulty.

SLTs work mostly for health trusts, though some work privately. They work with people with a broad range of problems, including learning difficulties or hearing impairment, dyslexia sufferers, those with stammering or social interaction difficulties and stroke sufferers.

The nature of the job has changed over the past 15 years, says Elaine Hirst, a Royal College clinical adviser for language impairment. "In the past, we followed a very medical model where we would focus the majority of our work in a health centre clinic, and we worked on the philosophy that a child had things wrong with them and we put them right.

"Time has shown that that's not really the best way to help children.

School is a fundamental part of their life, and so much of school life depends on language ability and communications skills, ranging from the ability to interact with your peers, to relating appropriately to your teachers and accessing school-based learning.

"We very much need to be in there helping to facilitate that process. And we need to do that collaboratively with people in the school environment who know the children well and who know about education."

Speech and language therapists work to assess, diagnose and develop a programme of care to support those with communication difficulties, working directly with them but also with their carers and families.

Qualities needed to do the job include creativity, good interpersonal and negotiation skills, empathy and the ability to solve problems. You also have to be self-motivated - you're required to be an autonomous professional, able to manage your own time, caseloads and stress levels.

Qualifications and training How do you get to be a speech and language therapist? The minimum academic requirements are five GCSE passes or equivalent, and two A-levels - though some universities require three, and some require the passes to be in specific subjects.

You have to take a three or four-year degree course accredited by the Royal College, before you can gain a certificate to practise in the NHS. Those with an appropriate first degree can take a two-year post-graduate qualification. A number of degree level courses have their fees subsidised by the NHS, and there are also low-rate loans and bursaries.

Newly qualified speech and language therapists usually work with a general caseload of children and adults for a year, before moving on to specialise in a particular type of clinical work, or moving into research or management. You can also work as a speech and language therapy assistant, which people enter from a wide variety of backgrounds.

SLT assistants earn between pound;11,556 and pound;13,229. Those starting as a qualified therapist in band 1 earn from pound;17,371 to pound;20,319. An expert practitioner at band 3 earns between pound;35,185 and Pounds 42,807.

At the top of the pay scales are consultant heads of service, whose earnings range between pound;42,807 and pound;68,537. There are also allowances of pound;2,851 a year for inner-London.

The profession is currently subject to Agenda for Change, a new pay and conditions system across the NHS, which threatens large pay cuts for some speech and language therapists.

* Elaine Hirst works for Broxtowe and Hucknall Primary Care Trust in Nottingham.

"I arrive at work at 8.30am. I do admin, check phone messages and emails. I finish off work, photocopy and send data to schools. Then I prepare for my first school visit.

At 9.30am I visit a junior school to work with a child with established long-term language difficulties. I liaise with a teaching assistant to review targets, activities and strategies agreed at a previous visit. I work with the TA and child to try new strategies and activities. I write a summary for the school and the parents.

And then on to another primary school to work with a newly-referred child.

I talk to the teacher about their concerns and observations about the child's communication strengths and difficulties. I work alongside the child and teaching assistant.

I go back to base for lunch and write official case notes.

At 2pm I visit a teaching assistant working with a child with learning difficulties and quite severe communication problems. We look at ways of modifying the next science topic so the child can access it.

At 3.30pm I visit another school to attend a small multi-agency group who were reviewing a child's IEP and setting some new targets. I finish at 4.30pm because I have childcare to sort out. Though this is a typical day, I'm also involved in other areas, such as working groups across the service to develop a range of initiatives."

For further information see the Royal College of Speech and Language Therapists website:

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