Re: Speech and language therapy services in Norfolk
We are writing to express our deepest possible concern to hear of unsubstantiated rumours that adult speech and language therapy (SALT) services in the county are to be significantly reduced or reorganised. We are surprised that any such changes to the service are being considered without prior engagement of key stakeholders at this Trust, including the neurologists, MFE consultants, gastroenterologists or ENT surgeons, none of whom, to our knowledge, were made formally aware of any proposals.
There is good evidence to support the utility of SALT and other therapy services. For example, we would draw your attention to the pivotal role that SALT plays in the management of swallowing problems in motor neurone disease. There is growing evidence that in this condition, life expectancy and quality of life is related to nutritional intake, Body Mass Index and appropriate early PEG insertion for which SALT is crucial in assessment, monitoring and managing. We also question whether North Norfolk PCT is aware of a number of seminal national guidelines, published in the last few years, which have evaluated the evidence for therapy services, and which emphasise the importance of SALT in the management of chronic neurological conditions. We request that the Trust urgently review these guidelines accordingly. These are summarised for your convenience on the accompanying pages. We believe that the overwhelming body of opinion places at the very least an ethical obligation upon local healthcare facilities to provide better SALT services, which even at present are less than comprehensive.
We note that the vision of North Norfolk PCT as detailed on its website is to "provide services as near as possible to local residents" and "to maintain and develop... our community hospitals to make them centres for local care" which is in line with DoH policy. However, we understand that a decision to close Lascelles ward at Kelling Hospital at Christmas has been taken, again without involvement of us as clinicians. Many of our neurological patients receive convalescent and regular respite care at Kelling. This decision significantly undermines our confidence in North Norfolk PCT to provide adequate out-patient neurological services, which, together with any decision to withdraw or reduce community SALT, is entirely inconsistent with the PCT's own vision, and therefore with Government policy. In our view, these developments would represent a significant retrograde step in the modernization of local health services, that will be very concerning for patients, and would be predicted to have a detrimental effect on their care.
We are mindful of North Norfolk PCT's financial problems, and its wish to 'balance the books' prior to amalgamation with the other local PCTs on 1 October 2006. However, we are disappointed that our PCTs often seem to fail to engage with secondary care in the management of these matters. Commissioners tend to view community rehabilitation services as a soft target for cost savings. In many cases, these are the only services that can make a significant and positive difference to the lives of people with progressive neurological conditions, for which there is no cure, as anyone who has personal experience in this area will corroborate. It seems to us that PCTs continue to commission or decommission services in an uncoordinated and piecemeal manner, with cost as the a priori consideration. If PCTs were to engage with secondary care and commission integrated healthcare pathways, not simply individual services, there is substantial evidence that cost savings would be readily forthcoming.
Despite our attempts to clarify the situation via SALT managers, considerable confusion remains, and we are hoping that you will be able to provide some clarity in this matter. We respectfully ask for the provision of the detail of whatever options are under consideration, and for our involvement in any further discussion that are scheduled. We feel that this information should also be extended to clinicians in the other specialities mentioned above whose patients may be affected. SALT is already one of the least well-staffed therapy services in the county, and any loss of services for patients is unacceptable, and will be vigorously opposed.
We would be grateful for your prompt reply.
Yours sincerely
Dr Jeff Cochius
Clinical Director and Consultant Neurologist
Dr David Dick
Consultant Neurologist
Dr Simon Shields
Consultant Neurologist
Dr Martin Lee
Consultant Neurologist
Dr Tom Staunton
Consultant Neurologist
Dr Paul Worth
Consultant Neurologist
Dr Warren Woodward
Staff Grade in Neurology