Our joint statement on NHS autism assessment guidance

The RCSLT and our two expert Clinical Excellence Networks were very concerned to see that the latest NHS England guidance for autism assessment services excludes speech and language therapists from carrying out “clinical interviews” during the autism assessment process, despite this being a role that they undertake on a daily basis. As autism services are using this national framework and guidance for their workforce planning, there is a risk that SLTs will be devalued, their skills not recognised, and worse still, their jobs placed at risk in favour of clinicians who can carry out all the assessment roles in the guidance.

As a result, we jointly approached NHS England calling for a meeting to better understand why the scope of the speech and language therapist role was being restricted. We met with the national autism team and the national clinical adviser to share our concerns that this was devaluing the role of speech and language therapists and to better understand the reasons behind this.

We highlighted that:

1. it reduces the number of professionals able to conduct interviews at a time when there is a significant waiting list for diagnosis and increasing referrals.
2. differential assessment is a central part of any diagnostic process. Not having access to speech and language therapy assessment will mean less focus on supporting autistic people with language and communication needs as well as removing the ability to differentially diagnose language disorder, whether co-occurring with autism or not.
3. clinical interviews being the remit of psychiatrists, psychologists, mental health nurses and paediatricians creates a bias towards mental health diagnosis, starting from a mental health assessment rather than considering this as a co-occurring diagnosis.
4. it ignores the impact communication and language problems have on someone’s social and relational experiences.

It appears that NHS England have conflated a clinical interview with completing a single professional assessment, which we do not believe is best clinical practice. There is also ambiguity in what counts as a ‘clinical interview’, for example using a standardised interview tool such as the ADI-R versus completing a broader interview or developmental history. Speech and language therapists are appropriately qualified and skilled to complete both.

Our members have told us that a number of autism services are already making changes in response to the guidance and are removing speech and language therapists from the clinical interview part of the assessment and from taking case histories/developmental histories. This is placing autistic people with communication needs at risk of receiving no speech and language therapy. Restricting the role in this way is not helpful to the thousands of people waiting for diagnosis who often have language problems and whose assessment would benefit from the expert advice of a speech and language therapist.

The RCSLT is calling on NHS England to take urgent action to provide clarity on this guidance and safeguard the expert role that speech and language therapists have during an autism assessment. We will continue to pursue the issue with relevant officials including government, until the issue is resolved.

Update: 28 November 2023

NHS England have revised the autism assessment pathways guidance and removed the tables and information outlining the workforce roles across the five stages of the assessment pathway, which says SLTs cannot conduct clinical interviews.

Urgent Update: 13 November 2023

Following the publication of this story, the RCSLT, the Diagnostics in Autism and Neurodevelopmental Conditions Clinical Excellence Network, and Clinical Excellence Network for Autistic Adults are delighted to announce that NHS England have agreed to change their all-age national framework and operational guidance for autism assessment services.

NHS England have told us that:

• They will remove the tables and information outlining the workforce roles across the five stages of the assessment pathway, which says SLTs cannot conduct clinical interviews.
• Revisit what a clinical interview is and ask us to help them write a shared definition.
• Include us at future meetings.

This is good news for autistic people and speech and language therapy therapists. People undergoing an autism assessment need to have access to the expertise and specialist input from speech and language therapists. This change will enable this to happen.