28 April 2022

Today the Health and Care Bill has received Royal Assent.

In welcoming the act, the RCSLT Chief Executive, Kamini Gadhok MBE, said:

“The Health and Care Act has the potential to improve the lives of people of all ages who depend on speech and language therapy, particularly babies, children and young people. However, the UK government must do more to improve workforce planning as a matter of urgency.

“Without a well supported, sustainable workforce, the ambitions of the act will not be achieved. We stand ready to work with the government and other partners to deliver the workforce we need now and in the future.”

Why the act matters

The act has significant implications for:

  • People of all ages with communication and swallowing needs and their families
  • Speech and language therapists

We thank those parliamentarians who advocated for the act to be stronger on:

  • Babies, children and young people
  • Rehabilitation for adults
  • Membership of Integrated Care Boards (ICBs)
  • Workforce planning

Stronger but not strong enough

The act emerges from parliament stronger than the bill that entered it. People with communication and swallowing needs should get better support.

But the act could be stronger. The government must do more for people who rely on speech and language therapy. This is particularly the case with workforce planning – it is not fit for purpose. Without change, it will remain not fit for purpose. This poses risks to speech and language therapists’ ability to meet demand. It also risks the people they work with and support not getting the help they and their families need.

Babies, children and young people – a big win

Including babies, children and young people in the wording of the act is significant. It is also very welcome. We thank members of the House of Lords for advocating for that to happen and we thank the government for listening to those arguments.

We are particularly pleased that the government have put on the record that they: ‘recognise the importance of communications needs, and the important part that they play in children’s development. We will work with stakeholders on the development of guidance, and ensure that we engage with the Royal College of Speech and Language Therapists.’

We look forward to working with the government and other partners on the guidance so it delivers:

  • A population level, public health, approach to speech, language and communication development
  • The speech and language therapy that some children and young people need

We wait to see the government’s proposals for a single identifier for children and young people. We hope this makes their journey through the system simpler and more effective.

Rehabilitation for adults – useful assurances

Everyone has the right to rehab. The act’s provisions could be stronger on this.

But we welcome the government’s on the record comments that: ‘Under the existing bill provisions, every ICB will be required to provide and improve rehabilitation services as part of its duty to provide a comprehensive health service. As an added layer of scrutiny, ICBs must publish an annual review detailing how they have discharged this function.’

Speech and language therapists should highlight these comments to their Integrated Care Boards. They should use them as the basis of conversations about their rehabilitation role. That is central to adults with communication and swallowing needs having better lives.

Membership of Integrated Care Boards – ICBs must take action

We welcome the act stating that Integrated Care Boards must:

a) Keep under review the skills, knowledge and experience that it considers necessary for members of the board to possess (when taken together) in order for the board effectively to carry out its functions, and

b) If it considers that the board as constituted lacks the necessary skills, knowledge and experience, take such steps as it considers necessary to address or mitigate that shortcoming.

We call on Integrated Care Boards to ensure the inclusion of allied health professionals wherever appropriate and certainly where other groups of health workers such as doctors and nurses are included. Allied health professionals, including speech and language therapists, have a key role:

  • In delivering local priorities
  • In delivering the act’s ambitions

Workforce planning – fundamental changes needed

For too long workforce planning has not been fit for purpose.

  • There has been no national assessment of the demand for speech and language therapy. There has been no assessment of the extent of unmet need.
  • Workforce planning does not take account of speech and language therapists who are:
    • Employed by non-health employers. This includes those working in independent practice. It also includes those employed by schools; and
    • Employed by the NHS but working in non-health settings. This includes those working in schools and criminal justice settings.

This has resulted in speech and language therapy becoming a shortage profession. The UK government recognises that this is the case.

  • The NHS Long Term Plan states that speech and language therapy is a profession in short supply.
  • Speech and language therapists are on the Shortage Occupation List. The Department of Health and Social Care called for this. It argued that the profession is facing a range of pressures (PDF), including:
    • Increasing demand in mental health in particular; and
    • Limited education and training course output.

These challenges have been long standing. The pandemic has exacerbated them. The pre-pandemic demands on the workforce have worsened. This is impacting on patient care and on the health and wellbeing of the people our members support. It is also impacting on the health and wellbeing of speech and language therapists.

We will have more to say on workforce in the weeks to come. But we renew our call for the UK government to improve workforce planning. We also call on Integrated Care Boards to plan for the health workforce they need. That is the only way they can deliver better outcomes for people whichever setting they are in.

More information

Letter calls for more allied health professional involvement in clinical leadership

Our news story on the Allied Health Professions’ Federation letter to government

Joint letter sets out need for measures to prioritise rehabilitation services

Our news story on the Community Rehabilitation Alliance letter to government