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The challenges posed by COVID-19 to the population at large will be significant and wide-ranging.  To help you keep abreast of the developing situation, we have put links here so members can access the latest advice given by the government, the NHS and public health agencies. 

Members are urged to discuss clinical queries with their employer: while the RCSLT is unable to offer specific clinical advice for COVID-19, we have developed the responses below to questions we’ve received. 

We will continue to add to these in the days and weeks ahead in order to offer advice not covered elsewhere. Please check back regularly for further information. You can also contact the RCSLT’s enquiries team during office hours by emailing info@rcslt org

Clinical questions

Q: To ensure continuity of support, therapy and advice for service users through the COVID-19 outbreak, what guidance does the RCSLT have for members

A: To ensure continuity of support for service users, the RCSLT has made lots of its guidance open access, including: the remote provision of healthcare services using technology (telehealth), dysphagia and respiratory care.

In response to the changing work environment brought about by the pandemic, the RCSLT has also produced the following: guidance on using personal protective equipment (PPE); advice for independent therapists in conjunction with ASLTIP; and routes back to/into the NHS for SLTs and student SLTS.

 

Q: Does the RCSLT have any advice or guidance around fit testing of masks?

A: As a result of a significant increase in requests for information about fit testing, the RCSLT has asked one of its specialist advisers trained in fit testing for advice and links to helpful resources in line with the Health and Safety Executive (HSE) Operation Circular (OC) 282/28.

Before using any FFP masks you must be trained on the proper use and limitations of FFP masks and fit tested to determine the appropriate size of the mask needed. This is under the HSE OC282/28 protocol.

The fit testing procedure is the same regardless of mask which is being fitted. Once you have been fitted to a particular mask, you are only fit tested for that brand and serial number.

 

Q: Does the RCSLT have a position on the use of clear face masks?

A: The Royal College of Speech & Language Therapists is supportive of investigating the procurement and use of clear face masks where appropriate as part of PPE provision. This mask will need to have the required levels of protection as part of the manufacture.

There is a communication challenge for all regarding reduced clarity and audibility while wearing PPE, and all of us who are sighted make use of lip reading and facial expressions to communicate. Facial expressions are particularly important when we are stressed or unwell or in a noisy or unfamiliar environment, so clear face masks would potentially have a general benefit.

There is though, an issue of equality in respect of the deaf community and those with hearing impairment, who may rely on lip reading to communicate on an equal basis.

It is also the case that the appearance of opaque PPE may be distressing or confusing for others with communication challenge, including potentially people with aphasia, autism, with dementia or with learning disability. This again would have a general applicability to for example children, and those with delirium related to illness.

Furthermore, facial expressions are important for building rapport and demonstrating empathy - a smile can help make a connection and a ‘friendly face’ can be particularly helpful when in an unfamiliar environment and for individuals who are stressed or confused (Hatfield, Cacioppo & Rapson, 1999; Chartrand & Bargh, 1999; Dimberg, Thunberg & Grunedal, 2002)

We also support the undertaking of research to test these benefits.

 

RCSLT guidance on clear face masks

Employment questions

Q: What job roles could an employer reasonably ask me to do in response to the outbreak?

A: We are aware that the Health and Care Professions Council, alongside other regulators, has put out a joint statement recognising that in the period ahead regulated health professionals may be asked to do things that are not in their normal scope of practice.

As part of local planning it may be reasonable for staff to move between clinical areas to support their setting’s Covid-19 response. However, work should still be within an individual’s grade and professional scope of practice, and/or competencies (ie SLTs may be asked to move to work on busier wards in order to help expedite the discharge planning of patients, for example).

The RCSLT would expect employers to discuss suggestions that may be brought up at a local level with staff and union representatives.

The NHS Staff Council statement provides further advice on the importance of agreeing any changes with individual staff, taking into account their own health and well-being. If changes are agreed and put in place, it is essential that staff receive adequate training on the use of equipment, for example, and are paid appropriately for any shift work.

Although the statement has been produced for the NHS, the good practice principles it outlines would be relevant in any similar environment.

Q: Should I be concerned that I’m not able to gather evidence towards my NQP goals due to the COVID-19 pandemic?

A: The RCSLT understand that due to the current circumstances some NQPs may be unable to gather evidence towards their NQP goals i.e if they are redeployed or furloughed and this may delay the sign off and transfer to Certified membership. NQPs will usually complete the NQP goals within 2 years of graduation however this timeframe can be flexible and you should not be concerned if the sign off of your NQP goals has been delayed by COVID-19.

Q: How can I support my supervisee to work through their NQP goals whilst we are not delivering face to face services?

A: The RCSLT understand that due to the COVID-19 pandemic members are having to adapt to new ways of working. Although the sign off of NQP goals may be delayed by the current situation the RCSLT encourage members to consider how NQPs can continue to gather evidence towards their NQP goals during this time, for example incorporating evidence from online therapy sessions; online profession-related learning; and learning from the multidisciplinary team.

Q: Does my RCSLT insurance cover me for loss of income due to COVID-19?

A: The RCSLT insurance policy has been developed to protect members against claims raised from alleged clinical negligence, or whose fitness to practice has been brought into question for any reason. Unfortunately the policy does not include provision to cover members own personal loss of earnings. Those with other forms of business or personal insurance should check with their provider on the levels of cover their policies provide.

Q: What do I need to know as a returning practitioner, about going to work in the NHS at this time?

We have guidance that answers a number of FAQs on this topic, click here for more information.

Higher education questions

Q: What provision is there for students who are unable to meet the required number of placement hours due to Covid-19?


A: The Health and Care Professions Council has produced a statement for pre-registration education course providers.

We are aware it could mean that the number of hours/sessions stipulated for student placements may not be able to be met.

With this in mind the RCSLT is in discussion with higher education institutions (HEIs) to encourage a pragmatic approach to enable students to graduate. This may include HEIs supporting students to achieve the necessary standards and competencies with fewer directly supervised hours, where appropriate or necessary.

The RCSLT would urge any students who are concerned about this to discuss it with their university tutors directly.

 In addition, it would be helpful if HEIs could:

  • update the RCSLT on their contingency plans as they develop
  • record approaches that they use along with their outcomes.

 

Schools, children and young people questions

Q: What does the Coronavirus Act (2020)  mean for the statutory requirements to meet the needs of children and young people?
 
A: In England,
the Coronavirus Act (2020) has given the Secretary of State for Education the power to relax the requirements for local authorities to secure the special educational and health care provision as set out in an EHCP. If the Secretary of State were to use those powers, local authorities would instead need to use ‘reasonable endeavours’ to ensure that provision continues to be available to meet education, health and care needs. Guidance from the Department for Education states that educational settings, local authorities, health bodies, parents and young people with special educational needs and disabilities should work together to respond pragmatically and flexibly to each individual’s needs. You can read the full guidance here.
 
In Scotland, the Act says that failure by education authorities to make adequate provision for children and young people with additional support needs can be disregarded if the failure is due to a direction from Scottish ministers to close schools or other educational establishments. Deputy First Minister John Swinney has stated that “local authorities are creatively considering different ways of supporting young people with different needs during this period, for example using outreach models and joining up available staff to provide care, support and continuity” and that Scottish Government will “will encourage local authorities to maintain as much continuity as possible.”
 
The Welsh Government has stated that “Local authorities have a duty to meet the needs of learners for whom it maintains a statement of SEN” and  that where learners are no longer attending school, alternative arrangements including online therapy, should be considered. You can read the full guidance here.
 
For Northern Ireland, the Act gives the Department of Education (DoE) powers to dis-apply or modify existing duties in relation to special educational needs, assessments and statements, including the duties on health and social service authorities. You can read the guidance here.

Q: I work with children and young people in schools. What should I do now that schools have closed?

A: It has been announced that schools across the UK will all be closed from Monday 23 March 2020. It is not known when they will re-open.

Schools are being asked to continue to provide care for a limited number of children – children who are vulnerable and children whose parents are critical to the COVID-19 response. Information on which children are included in these categories will be provided in separate guidance for England, Scotland, Wales and Northern Ireland.

The RCSLT is aware of members’ concerns regarding provision of services to children who have an Education, Health and Care plan (in England), Co-ordinated Support Plan (in Scotland) or Statement of SEN (Wales and Northern Ireland). We are raising those concerns with the relevant government agencies with a view to developing guidance.

The RCSLT would encourage speech and language therapy services and, where appropriate, individual members to make contact with the local authorities and schools they work in, and the families of the children they support, to discuss how information, advice and support can continue to be provided to staff, children and families. This may include considering the use of telephone, video conferencing and home visits where necessary. Risk assessments should be undertaken to protect the safety of children, families, school staff and speech and language therapists as far as possible.

Workplace questions

Q: What if I have concerns about treating a patient with COVID-19?

A: You should discuss your concerns with your manager and make every attempt to follow local protocols, including any isolation or infection control protocols. Where this does not apply you or these protocols are not in place, members should use public health advice relevant to their setting or region.

 

Q: ‘Aerosol generating procedures’ (AGPs) are flagged as high priority for personal protective equipment (PPE) by the NHS, but dysphagia assessments are not included in this list. What is the RCSLT doing about this?

A: Along with other AHP professional associations, the RCSLT has submitted a list of procedures and elements of care, along with evidence, detailing why these should be included in the government’s PPE guidance.

We remain extremely concerned that the procedures listed in the government’s guidance, particularly dysphagia assessments, are not currently listed as AGPs. We also acknowledge that the guidance states, ‘AGPs are undergoing a further review at present’ (see point 2 in Table 2: Recommended PPE for primary, outpatient and community care by setting, NHS and independent sector).

RCSLT CEO Kamini Gadhok has written a letter to the Secretary of State for Health about this urgent matter.

As the RCSLT considers that dysphagia assessments, as well as several procedures are AGPs, we recommend members should refer to RCSLT guidance alongside government guidance, particularly as section 7 of the new government guidance on PPE (2 April 2020) states:

“Ultimately, where staff consider there is a risk to themselves or the individuals they are caring for they should wear a fluid repellent surgical mask with or without eye protection, as determined by the individual staff member for the episode of care or single session.”

 

Q: Are there any communication accessible resources which I can use to help support my patients around COVID-19?

A: Members have been getting in contact with us and sharing some great stories and resources in how they are continuing to support their patients at this time. You can see some of these resources here.

The RCSLT encourages members to look at new and adapted ways of supporting their patients with their communication. Some accessible resources which have been shared can be downloaded via the links below:

 

Workplace questions continued

Q: Is there any guidance for employers who need to risk assess staff deemed to be at high-risk due to long-term health issues such as asthma and diabetes? Is there advice on what factors to consider and where we can deploy staff to, if necessary?

A: The issue about staff deemed to be in a high risk category due to long-term health conditions is a local HR/health and safety policy issue. As such, the RCSLT would suggest members raise this with their local HR department in the first instance. At present we do not know what the options will be for where staff could be redeployed in terms of local work places and the risk of exposure to COVID-19. However, some potential roles  in which these staff could work remotely (either at home or in a safe environment within the trust) may include:

  • updating polices
  • using telehealth to help assess/ manage patients
  • remote working to support non-patient related activities to help build capacity in the system :
    • supervision for junior staff
    • training for final year students
    • training for others who are on the ward

 

Remote service delivery

Q. What are the things to consider when completing a risk assessment for a remote dysphagia procedure?

A. To help reduce risk we suggest that:

  • You ensure that the technology you are using is secure and that there is no exchanging of personal identifiable data (PID) over the video call. We suggest that all the PID is dealt with via secure email or phone before the video is commenced.

  • There is a skilled and knowledgeable health and care practitioner present on the video call with the service user. This professional should be someone who has received dysphagia training and understands their role in the assessment process, while also being a competent telehealth practitioner. 

  • If it is a family member or carer who is assisting, you make sure they are aware of the process of the assessment and the expectations of their role. Consider a phone or video call with them to go through the assessment process, their role in this and the emergency procedures. Ensure that the right equipment is sent out prior to the assessment e.g. thickener sachets and ensure that they have the appropriate utensils.

  • You use your clinical expertise to consider the level of competency of those present, and the case history of the patient, while assessing the risk throughout the video call, and; 

  • You also use the information you have gathered, including the results of the oro-motor assessment, and the consent of the individual, (as it is in a face-to-face assessment) to inform the food textures that are used.

We also suggest that you fully explain your reasoning during the assessment to the service user, family and carer. This can help the patient accept the recommendations that you are making.

 

Q. Can speech and language therapy assistants use telehealth as a means of delivering therapy?

A. Provided that the speech and language therapy assistant is delivering therapy under the direction of the speech and language therapist (SLT), and that the SLT deems that the assistant has the relevant experience and skills to do so, there should be no difference between this and delivering the intervention face to face.