Item 10 - Speech and Language Therapy Update
North Lanarkshire Council · 19 April 2023
Back to IJB Performance, Finance and Audit Committee — 19 April 2023 and its agenda
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1 REPORT Item No: 10 SUBJECT: Speech and Language Therapy Update TO: Integration Joint Board Performance, Finance and Audit Lead Officer for Report: Maggs Thomson, Head of Health NHSCP Author(s) of Report Pauline Downie, Professional Lead for Speech and Language Therapy DATE: 19 April 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Pauline Downie, Professional Lead Speech and Language Therapist
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2 3. RECOMMENDATIONS 1. The IJB approves that mobilisation funding is extended to 2023-24 financial year to enable appointment of SLTs over-establishment of up to 6 WTE band 6 posts 2. The IJB endorses the formation of a SLT Service Improvement Group with wider stakeholder engagement and support from Project Management and Service Improvement manager within the SCHSU. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Purpose Update to Integrated Joint Board Performance, Finance and Audit Committee on Speech and Language Therapy (SLT) Children and Young Peoples Service including performance against waiting times, service improvement plans to date and future plans Background Pre-Covid performance against the waiting times target of 90% of children seen within 12 weeks for specialist intervention was 67% In March 2020 all routine SLT CYP services were paused and schools and nurseries closed. In June 2020 all routine clients/families were contacted, further risk assessment was carried out and families offered support. Waiting times performance in July 2020 was 4%. The service in clinics schools and nurseries recommenced from June to October 2020. Waiting times performance in February 2023 is 24%. The SLT CYP service have had temporary funding to March 2023 to recruit a further 12 posts in community SLT teams. Staff have been recruited to these posts, however due to staff turnover the SLT CYP service has at no time been over- establishment for the past 2 years. A recent Public Health report highlighted the impact of the pandemic on children’s speech development and the role of SLTs and the wider workforce in supporting children with speech, language and communication needs. The SLT CYP service works within a Balanced System of Universal, Targeted and Specialist support for children with communication and eating, drinking, swallowing problems. This has been described in a recent paper Equity for All. Universal and targeted support Yes ☐ No ☐ N/A ☐
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3 includes working with the wider early years workforce and therefore this is a core element of SLT CYP service. The current waiting times reflect specialist intervention only. Performance SLT CYP Staffing capacity The funded establishment for SLT CYP is 92.64 WTE (this includes leadership and admin posts and staff working in the neurodevelopmental service) Current WTE in post is 77.36 WTE + 9.55 WTE on SLT mobilisation funding = 86.91 WTE The actual number of staff working in community clinics with children on the waiting list for specialist intervention is less than above as some of the SLT CYP staffing is funded by Education departments in North and South Lanarkshire. Actual SLT staff working in community clinics 86.91 WTE – 13.74 WTE (NLC) – 18.37 WTE (NLC) – 4.5 WTE (NDS) = 50.3 WTE Turnover in CYP service for 2021-22 8 staff left and 8 staff were appointed Turnover in CYP service for 2021-22 16 staff left (5 to other integrated teams within NHSL) and 9 were appointed. This is due to supply of SLTs. Staff turnover has a significant impact on caseload management and therefore waiting times as children on the caseload have to be re-allocated to other SLTs and also there is a period of vacancy while recruitment is ongoing. Mobilisation funding While this has been welcomed and utilised, as can be seen from the underspend in the SLT budget, it has not been possible to appoint over-establishment.
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4 Please note figures from finance below reflect the whole SLT budget: 2021-22 £264,056 - average wte 6.06wte 2022-23 – to M11 - £639,880 – average wte 12.87wte The current underspend within SLT at M11 is £794,487 Split Pays £723,045 / Non Pays £71,762 The underspend in pays is £723,045 and the spend on mobilisation is £639,880 so effectively the underspend without mobilisation funding would have been £83,165 Current Clinical Service Improvement Plan SLT CYP The SLT CYP service has focused on the following areas Aim Desired Outcome Aim 1 The SLT CYP vision and service model has been developed based on national guidance for universal, targeted and specialist service delivery, including the balanced systems approach. The vision and service model will be documented in accessible formats and communicated with staff and stakeholders. Outcome: The SLT CYP Service will have a communication plan to share the service delivery vision and model with staff and stakeholders. This will ensure staff and stakeholders have a clear and shared understanding of the SLT role with children and young people across Lanarkshire. Aim 2: The CYP service will use the principles of Realistic Medicine, Effective Decision Making and Who’s Concerned/Bothered/Worried (Kate Malcomess, Care Aims) to provide evidence- based support for CYP at Universal, Targeted and Specialist levels. Outcome: The CYP data will evidence a decrease in the variation of support for CYP across the service at Universal, Targeted and Specialist levels. The SLT performance data will show reduced: Waiting times Variation in waiting times Variation in new to return ratio numbers Variation in vetting outcomes Aim 3: The vetting process following receipt of a RfA will be evaluated to determine if the current method allows consistent and effective management across the CYP service in line with the service model. Outcomes: Discussions will take place with staff and parents/guardians to identify what works well in our current vetting practice and any improvements that can be made. Any identified improvements will inform recommendations for future management of *Request for Assistance) RfAs when they are received in our service. Aim 4: To develop and pilot a vetting pathway which gives CYP access to Universal/Targeted advice, Outcome: Two localities will be identified to trial the vetting pilot with CYP once an RfA has been received. The data for these localities will demonstrate:
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5 strategies and resources within 6-12 weeks of an RfA being received. The person who is worried/bothered/concerned will be able to access resources/advice and will be supported to implement this with the CYP, through telephone calls, Near Me and/or face to face appointments. Contact being made following an RfA within 6-12 weeks with families and professionals to undertake vetting. An increase in the number of cases managed at Universal/Targeted. A decrease in the number of cases progressing for Specialist Assessment. Families will be consulted following participation in the waiting well project and feedback will highlight an increase in: Families reporting access to resources and implementation of advice/strategies with CYP. Stakeholders, including families and professionals understanding the value of their role as the people closest to CYP providing input with Universal/Targeted support from SLT. Aim 5: The admin team supporting the enquiry service will increase their confidence levels and efficiency in this area of the service. Outcome: Helpline admin staff confidence levels will increase for managing calls and we will establish standardised processes in the team Aim 6: To improve outcomes for CYP who are not brought to appointments Outcome: CYP who are not brought to appointments, or are not consistently brought to appointments will be supported to achieve the best possible outcome. Some of the above aims are underpinned by the need to have access to mainstream systems such as Trakcare. The implementation of Trakcare and improvement of activity data gathering systems are included in our SLT service work plan. We are making progress with the above aims however there have been many stumbling blocks such as access to Trakcare, waiting for targeted information to be added to website, lack of clarity about Data protection impact assessments. Assessment Despite a continued focus on service improvement and recruitment, the waiting times for specialist assessment have not improved. This can partially be attributed to workforce capacity but also as seen above, there is still variation in vetting outcomes and also access to systems which could improve consistency of data collection. Many children and families have already had speech, language and communication support at universal and targeted levels before being placed on a waiting list for specialist assessment. Current data collection does not reflect the service model as it focuses on only one tier of the service model.
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6 Recommendations The SCHSU will support SLT with further service improvement ideas with dedicated time from project management and service improvement manager. This will include wider stakeholders from eHealth, communications and information services as well as representation from SLT CYP staff across a range of bands and specialisms. The initial focus will be on process mapping. This is planned for April 25th. Going forward the service improvement plan will be supported and underpinned by a focussed review of current position, current improvement plan and wider organisational support that can enhance delivery of aspiration. Work Stream Challenge Action E Health The service recognises that the need for robust data to report and manage performance is being hampered by lack of implementation of a service wide electronic system (Trakcare). The service recognises the lack of an electronic documentation recording system. This is complicating communication and robust supervision within the service and externally with other children’s services. Service improvement and project management colleagues will work collaboratively with professional leadership, wider team and ehealth colleagues to expand scope and span of Trakcare across SLT system. This will provide assurance of capacity and demand. Service improvement and project management colleagues will work collaboratively with professional leadership, wider team and ehealth colleagues to progress delivery of MORSE. Service improvement and project management colleagues will work with team and ehealth colleagues to develop systems that accurately represent universal and targeted aspects of SLT service as well as waiting times for specialist intervention Workforce Recruitment and retention of staff to CYP service has been a long term challenge. Service improvement and project management colleagues will work collaboratively with professional leadership, wider team and HR colleagues to progress delivery of
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7 focussed recruitment plans for the service. Opportunities will be explored that will encourage positive relationships to develop between service and further education. Opportunities will be explored that will support development of non- registered colleagues to expand competence and if wanted to support progression to professional learning. Environment Service is provided over multiple sites and in multiple ways. Service improvement and project management leads will use opportunity of Process Mapping day to engage with staff to consider environment and challenges that it presents in provision of care planning. This will inform: - Capacity and demand of buildings across whole system Economies of scale that can enhance flexibility of team over all. Flexibility of service delivery times.
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8 Communication Significant work has already been undertaken to address unmet needs of CYP who are waiting to be seen. Team recognise that there is limited awareness of this beyond specialist service Support required from Service Improvement and Project Management colleagues in collaboration with Communication colleagues to ensure:- CYP and families are appropriately informed of what they can do to help themselves or support their child whilst waiting. Professional colleagues inclusive of Education and other health professionals need to know how to support families whilst waiting. Increase awareness of the range of tools that can be directed to that will encourage self-directed support. 6. CONCLUSIONS In conclusion we ask that the committee: 1. Note the difficulties in recruitment, retention and national supply of SLTs 2. Approve the extension of mobilisation funding to appoint over- establishment in SLT CYP service up to 6 WTE band 6 staff at an annual cost £313,914 3. Endorse the formation of a Speech and Language Service Improvement group with wider representation from support services and including support from Project Management within the SCHSU
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9 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The Speech and Language Therapy (SLT) Service are a hosted service within the SCHSU within the Health and Social Care North and subject to their operational governance arrangements. The SLT service also have professional governance arrangements through the AHP Director/ NMAHP Director 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. Yes ☐ No ☐ N/A ☐
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10 7.5 PEOPLE This affects children and young people with speech, language and communication support needs and their parents/carers. Also staff working within the Speech and Language Therapy service. We have received feedback from parents and families on certain elements of the work plan such as their experience of the vetting process. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS Relevant documents Gascoigne, M (2021) Equity for All: Children’s Speech and Language Therapy Services in Scotland, Better Communication CIC URL https://www.bettercommunication.org.uk/downloads/2022%20Equity%20for%2 0All%20Final%20for%20Publication.pdf (Accessed 15/03/2023) Public Health Scotland (2023) Speech and communication development among children in Scotland during the COVID-19 pandemic. URL https://publichealthscotland.scot/our-areas-of-work/conditions-and- diseases/covid-19/covid-19-data-and-intelligence/speech-and-communication- development-among-children-in-scotland-during-the-covid-19-pandemic/ (Accessed 15/3/2023) 9. APPENDICES None. Please include a glossary of terms if not already included. Yes ☐ No ☐ N/A ☒ Yes ☐ No ☐ N/A ☒
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11 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Pauline.Downie@lanarkshire.scot.nhs.uk Professional Lead SLT