RCSLT calls for UK COVID-19 Inquiry terms of reference to be strengthened

In welcoming the public inquiry and the opportunity to comment on its terms of reference, the RCSLT’s Chief Executive, Kamini Gadhok MBE, said:

“To ensure that we truly learn the lessons of the pandemic, we’re calling for the inquiry to address three extra areas. First, the impact of the pandemic on people with communication and swallowing needs and their families and carers.

“Second, the impact of the pandemic on the workforce including the effects of redeployment and their overall mental health and wellbeing.

“Third, why there was a consistent failure to provide healthcare workers with better personal protective equipment, especially when it became apparent that COVID-19 is airborne. We look forward to exploring these issues further in our formal evidence to the inquiry.”

What did the RCSLT say?

Our consultation response said the inquiry’s terms of reference must be amended or strengthened to ensure the inquiry can examine and understand:

• The impact of the pandemic on people with communication and swallowing needs and their families and carers, and on the professionals working with them.
• The impact of the pandemic, including redeployment, on healthcare workers, including on their mental health and wellbeing.
• The consistent failure to provide healthcare workers with appropriate personal protective equipment, especially when it became apparent that COVID-19 is airborne.

Understanding the impact on people with communication and swallowing needs

Communication and safe eating and drinking are basic human rights. We all take them for granted. But during the pandemic too many people who rely on speech and language therapy were not able to get the support they needed. Neither were their families. Nor the professionals working with and caring for them.

People’s mental health. Their home lives. Their friendships. Their education. Their jobs. People have told us that all these things got worse because they did not have speech and language therapy.

Existing inequalities

We know other things got worse too. Existing health inequalities, including for those from certain ethnic backgrounds or from poorer areas and for those living in poverty. Existing inequalities in access to speech and language therapy were also made worse.

Some of these issues continue. Demand on already overstretched services has increased, is increasing, and will continue to do so. At the same time a brand new clinical condition has emerged: Long COVID.

Avoidable barriers

During the acute phases of the pandemic people who communicate differently or with difficulty faced other unnecessary and entirely avoidable barriers too.

Government communications and public health messaging were not always delivered in an accessible or inclusive way. For too long UK Government press conferences – especially those broadcast from Downing Street – did not include British Sign Language (BSL) interpreters, for instance. This compares unfavourably, for example, with the situation in Scotland where communications were delivered in a more accessible and inclusive way.

It is not clear if a failure to provide communication and information in accessible and inclusive ways resulted in people who communicate differently or with difficulty not following health advice because they did not understand what was being said or what they were meant to do.

The inquiry must examine these impacts and identify potential communication failings.

In addition, we have called for the inquiry to examine the accessibility of health interventions. For example, the wearing of non-clear face masks by healthcare staff posed particular challenges for some people with communication needs, such as deaf people requiring sign language.

At the same time as examining these negative aspects of the pandemic, we urge the inquiry to learn the lessons of good and best practice. We once again salute those speech and language therapy services that were able to continue supporting people with communication and swallowing needs and their families during the pandemic and continue to do so.

Understanding the impact on healthcare workers

The sudden, drastic changes necessitated by the pandemic led the profession to innovate and practise in entirely new ways. However, this relentless increase in demand has had, and continues to have, a huge impact on speech and language therapists (SLTs).

In an RCSLT survey on members’ wellbeing, the majority of respondents told us that – since the beginning of the pandemic – they have felt overwhelmed at work, their anxiety and exhaustion has increased, they have felt an increase in low mood, and they had concerns about their safety.

Redeployment

Alongside this, redeployment has had a significant impact on healthcare workers, on the clients they were no longer able to support, and on the new clients they supported. For example, the redirection of SLTs to adult and acute services had a significant impact on children and young people who rely on health services.

The inquiry must examine these impacts and identify lessons to be learnt both good and bad.

Understanding the failure to better protect healthcare workers

For much of the pandemic, too many SLTs were sent in to do their jobs without being given the level of personal protective equipment (PPE) they needed to keep their patients safe, to keep their families safe, to keep themselves safe.

This failure to provide SLTs with the appropriate level of PPE continued for far too long. ​Even in the light of evidence presented to the UK government from almost the start of the pandemic by the RCSLT that some of our members required higher grade PPE due to the some of the procedures they undertake. This failure persisted even when it became apparent that all healthcare workers were at risk of contracting the virus, no matter which procedures they undertake, due to COVID-19 being airborne.

The inquiry must examine these consistent and persistent failures and identify lessons to be learnt both good and bad.

Again, we also urge the public inquiry to learn the lessons of good and best practice. We once again salute those healthcare employers across the UK who took a safety-first approach.

Next steps

The RCSLT will continue to engage with the inquiry in relation to these areas, both as the RCSLT and as a leading member of the COVID-19 Airborne Transmission Alliance.