11 May 2022
Jo Marks, Zoe Gordon, Katy Parnell and Annie Aloysius introduce the new strategic allied health professional (AHP) roles and explain the benefits of neonatal SLTs as an embedded AHP service.
Over the past two decades there has been increasing acknowledgement that infant outcomes following neonatal care need to focus on more than survival and discharge. They must also consider the neurodevelopmental consequences, ensuring care is focused on optimising these outcomes too (Moore, Hennessy, Myles et al, 2012).
While we know that expertise from SLTs in supporting early communication and feeding is beneficial to the neonatal setting, understanding of the role of the SLT and other AHPs in neonatal settings remains limited and the AHP workforce is currently under-represented in neonatal care (Murphy, Harding, Aloysius, Sweeting and Crossley, 2021).
The SLT role in neonatal care
SLTs have various roles in the areas of early communication, feeding, and swallowing, including:
- Working with families, medical, nursing and AHP teams to support and improve communication and feeding outcomes within a developmental care framework.
- Direct assessment and management of feeding and swallowing difficulties.
- Using outcome measures to demonstrate effective patient care and improve quality of care.
- Supporting implementation of models of neonatal care that enable parental bonding and relationships for communication and feeding interactions.
- Supporting parents and infant/s with the transition to home, collaboratively with the neonatal multidisciplinary team (MDT) and community providers.
You can learn more about the role of SLTs in the RCSLT’s neonatal care clinical guidance.
National drivers for neonatal change
The Toolkit for High Quality Neonatal Services (2009) and the British Association of Perinatal Medicine’s Service Standards for Hospitals Providing Neonatal Care (2010) recognised the need for access to AHPs within the neonatal team.
However, there was not one clear model for provision of neonatal SLT, and consequently there are currently a myriad of different sources of funding, range of SLT competency and skill mix, and various models of care and staffing provided, eg in-reach services from community providers vs funded embedded service.
Comparison of neonatal speech and language therapy funded embedded service and in-reach provision:
|Funded provision embedded in neonatal care||In-reach provision|
|Dedicated and ring-fenced neonatal time to establish service.||Ad hoc service delivery based on goodwill which impacts on other clinical areas of speech and language therapy provision.|
|Preventative, proactive, timely interventions.||‘Last resort’ referral culture leading to a reactive service and missed opportunities to prevent feeding issues developing.|
|Recognition of the neonate as a complex and neurodevelopmentally at risk infant- considering all elements of communication, feeding and brain development.||Focus on dysphagia assessment referral therefore missing the SLT role and expertise in supporting early communication and development.|
|Deeper understanding of neonatal unit structure and ethos which can impact on implementation of SLT recommendations.||Full scope of the AHP and SLT role may not be so well understood or valued.|
|SLT becomes part of the neonatal MDT with more opportunities to integrate and build effective working relationships with staff.||Opportunities for more SLTs to gain some experience within neonatal units if sharing a caseload however lack of opportunity to develop expertise without neonatal SLT supervision and support.|
|Enhanced learning environment to develop expertise when able to access training opportunities on the unit, at ward rounds and MDT meetings.||Less exposure to the neonatal environment and team, therefore less awareness of neonatal care and may have difficulty accessing neonatal specific supervision and competency development.|
|Opportunity to provide education and training for MDT and parents.||Limited opportunity to be part of integrated training programme within unit.|
A decade later, the Neonatal Critical Care Review (2019) set out to review the evidence for providing high quality neonatal care and outcomes resulting in a specific action plan for regional commissioning teams with the Neonatal ODN’s to affect a service change.
“AHPs have been central to the implementation and embedding of developmentally sensitive care into neonatal practice in many neonatal units and champion the need to view neonatal care that looks forward to improving longer term outcomes for babies and their families.” (NCCR, 2019)
Neonatal ODNs in England
As a consequence of the NCCR recommendations, each of the 10 Neonatal ODNs in England have been commissioned to establish an AHP team working at a strategic level to contribute to neonatal service development. The aim is to ensure a holistic, equitable and cohesive approach to the delivery of neonatal care through consideration of the neonatal workforce.
There are now 11 SLTs in post within the ODNs across England. These SLTs are working alongside their Neonatal ODN strategic leads, other Neonatal ODN AHPs and local neonatal AHPs to scope and support neonatal workforce, quality and education workstreams, as well as to highlight the value of SLT involvement in neonatal services.
Much has changed for neonatal speech and language therapy provision over the past 10 years. It is important that SLTs, together with our neonatal AHP colleagues continue to raise the profile of neonatal SLT at a national and local strategic level to influence change and demonstrate the skills and expertise SLTs can bring to the neonatal AHP workforce, improving infants and their family’s outcomes through their neonatal care journey.
Neonatal networks and SLT contacts
If you are an SLT working within a neonatal unit we would encourage you to reach out and contact your ODN SLT to access support, education and share best practice within your network.
Get in touch with your local network’s SLT contact:
- Northern Neonatal Network – Caroline Gilg Watson, firstname.lastname@example.org
- Yorkshire and Humber Neonatal Network – Samera Mian, email@example.com
- Northwest Neonatal Network – Jo Marks, NWNODN@alderhey.nhs.uk
- West Midlands Neonatal Network – Katy Parnell, and Julie-Ann Watford, firstname.lastname@example.org
- East Midlands Neonatal Network – vacancy
- Thames and Wessex Neonatal Network – Zoe Gordon, email@example.com
- East of England Neonatal Network – Laura Baird, firstname.lastname@example.org
- Kent, Surrey, and Sussex Neonatal Network – Kate Jones, medwayft.kssneonatalodn.nhs.net
- London Neonatal Network – Alexandra Connolly and Brenda Carty, email@example.com
- Southwest Neonatal Network – Marina Sloan, firstname.lastname@example.org
The authors’ thanks are extended to members of the RCSLT Neonatal CEN committee, in particular the Neonatal ODN SLTs.