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The history corner: from patients to service users

Jois Stansfield looks at the changing faces of speech and language therapy service users

When the College of Speech Therapists was established in 1945, service users were known as ‘patients’. For many that was an accurate description, as they needed to wait patiently for the limited speech therapy service that was available, and many areas of the country had no service at all.

The register of 1945-6 listed 46 SLTs practising in London, 12 in Lancashire (which included all of Manchester, Liverpool and the rest of the county) and one in Norfolk. Scotland was relatively well served with 39 therapists, but Wales listed only one, and Northern Ireland none. This was pre-NHS of course, but even when free speech therapy became available in principle, the service grew very slowly during the 1950s and 60s.

The Quirk Report of 1972 made sweeping changes to the level of service provision, recommending six therapists per 100,000 in the population—a quadrupling of full-time equivalent SLTs at the time. Later, Enderby and Phillip increased this recommendation further to 23 therapists for the same population, and today there are almost 17,000 therapists for a population of nearly 68 million. You can work out the ratio!

Over the years, our ability to recognise the needs of service users has also changed. Many older SLTs speak of being trained mainly to work with ‘articulation’ difficulties, and it was not until the late 1960s that linguistics raised its head in the speech therapy world, with pragmatics coming later still.

On my own course, we had only one hour a week of linguistics for three terms. My ‘finals’ case book from 1972 described 13 ‘patients’ in detail (present-day students take note, 13!). There is little evidence anywhere in the case book that this linguistic theory was put into practice, although language tests were reported (the Watts vocabulary test, the recently published Reynell scales and, for adults, the Minnesota Test), as was working with people to increase language, and articulation, voice and fluency skills.

What that case book also shows is how the age range of patients (they were still patients in 1972) has changed. Most of the children were at school and the oldest adult was only 63. Today I would expect ‘birth to 100-plus’ to be a more accurate reflection of our service users’ ages. I smiled when I realised that I had included a thank you note from the parents of one child, whose family included 11 children, five of whom had some ‘speech’ difficulty. I am astonished and impressed in retrospect that this child was brought to clinic every week without fail and the parents followed advice on what to practise as homework.

Jois Stansfield, emeritus professor,
Manchester Metropolitan University