England policy

Children and young people

Find out more about our policy work relating to children and young people in England.

• Follow @rcsltpolicy on Twitter for more news and updates.

Bercow: Ten Years On

In response to concerns about the support for children with speech, language and communication needs (SLCN) and major changes in the education and health systems, I CAN, the children’s communication charity, and the Royal College of Speech and Language Therapists (RCSLT) have undertaken an independent review of provision for children with SLCN in England.

Since the first call for evidence in January 2017, we have heard from more than 2,500 people including children and young people; their parents and carers; practitioners, and other key stakeholders.

The report, published on 20 March 2018, brings together the outputs of the review and includes strong recommendations to government and local leaders.

Find out more and read the report at: www.bercow10yearson.com

Background

Bercow: Ten Years On marks a decade since the publication of The Bercow Report: A Review of Services for Children and Young People (0-19) with Speech, Language and Communication Needs.

Read the original Bercow report (PDF)

If you have any questions about Bercow: Ten Years On, please contact us.

Read the Six month progress report (PDF)

Learn more about Parliamentary mentions of speech, language and communication needs between March 2018 and June 2019 (PDF)

The Bercow Report, 2008

The Bercow review was published in July 2008 as the result of an independent cross-government review chaired by John Bercow, MP and RCSLT vice-president.

The report, entitled the Bercow review of services for children and young people (ages 0-19) with speech, language and communication needs, was the culmination of a major consultation process. It included a questionnaire which received over 2,000 responses, meetings with groups of parents and visits to children’s centres, nurseries, primary and secondary schools across England.

The final report followed the submission of an interim report in March 2008. The RCSLT worked closely with the Department for Children, Schools and Families (DCSF) and Mr Bercow to support and contribute to the review.

The report set out 40 recommendations to improve services, and the Government launched its response to the review on 17 December 2008.

The response, Better Communication: An action plan to improve services for children and young people with speech, language and communication needs (SLCN), accepted many of the review’s recommendations.

The action plan contained a range of initiatives to improve services for children and young people with SLCN, and understanding across the whole children’s workforce of the importance of speech, language and communication.

Many initiatives are integrated within mainstream programmes and projects, to ensure all services understand the importance of supporting children with SLCN.

A decade later, the RCSLT has published Bercow: Ten Years On.

Special educational needs and disability (SEND) reforms

The SEND reforms were the theme of the All-Party Parliamentary Group (APPG) on Speech and Language Difficulties meeting on 21 February 2017.

Derek Munn, RCSLT’s Director of Policy and Public Affairs, gave a presentation on RCSLT’s SEND reforms report (PDF).

RCSLT presentation

RCSLT’s presentation (PDF) highlighted the findings of the report, its policy calls and what it is going to do to help address some of the issues. Nick Smith MP has asked a written question on the report. During the meeting:

• The Communication Trust highlighted its Workforce Development Report (PDF).
• The Driver Youth Trust highlighted its Joining The Dots Report (PDF) and Joining The Dots Recommendations Card (PDF).

For more information, please contact us.

Children and young people’s mental health

• RCSLT statement on Government’s response to the children and Young People’s Mental Health Green Paper, July 2018 (Word)
• RCSLT submission to NHS England consultation on CAMHS, November 2017 (PDF)

Adult

 

Community rehabilitation

RCSLT is part of the Community Rehabilitation Alliance which includes national charities and professional bodies who are all committed to improving commissioning, planning and delivery of rehabilitation.

In May 2020, the RCSLT submitted evidence to the Health and Social Care Select Committee inquiry ‘Delivering core NHS and care services during the pandemic and beyond’ – Read the RCSLT’s evidence (PDF).

 

Mental health

The RCSLT is prioritising mental health work across children and adults for 2020. This directly links to our mission of enabling better lives for people with communication and swallowing needs.

 

The RCSLT’s stroke policy

Influencing stroke policy

On 10 May 2016, the RCSLT invited speech and language therapy stroke leads from 50 services across England to the RCSLT stroke study day to discuss how their service records data in SSNAP and to discuss the draft fifth edition of the stroke clinical guidelines. The stroke study day was supported by Sue Pownall and Rosemary Cunningham, the RCSLT representatives for the Royal College of Physicians.

• Read an article about the stroke study day in Bulletin, July 2016 (PDF)

RCSLT stroke study day 2018

The RCSLT held a stroke study day ‘Continuing Improvement in Stroke Care – The way forward’ on Friday 27 April 2018 at RCSLT London.

Aims and objectives

It was our aim that delegates would:

• Find out how SLTs should record data for the Sentinel Stroke National Audit Programme (SSNAP)
• Learn how to interpret SSNAP data
• Understand how to improve SSNAP scores
• Be able to apply SSNAP data work for Speech and Language Therapy (SLT) and use it to grow services
• Have the chance to discuss the latest guidance in stroke and the impact on SLT services

Top five therapy questions on SSNAP.

NICE Stroke rehabilitation in adults

Supporting guidelines and resources

• Therapy report (PDF): The purpose of the therapy report is to provide a summary of the therapy aspects of SSNAP. This includes an overview of how therapy data is collected and reported on by SSNAP and provides guidance for data entry and submission
• RCSLT factsheet: supporting people after a stroke (PDF)
• The fifth edition of the National clinical guideline for stroke
• The profession specific and concise guides
• The Sentinel Stroke National Audit Programme
• NICE Stroke rehabilitation in adults

RCSLT’s stroke campaign calls

During the RCSLT stroke campaign we called for:

• One in 10: in an acute ward there must be one speech and language therapist for every 10 people who have had a stroke
• A communication lifeline: every stroke survivor must have prompt referral to speech and language therapy to allow rapid development of methods of communication in the immediate days following their stroke
• Community service: every community stroke team must have at least one speech and language therapist

Please contact us for more information.

Key messages

• Speech, language and communication difficulties can cause a significant barrier to accessing work support services.
• Services which aim to provide access to welfare, support people into work and / or retain people in work must mainstream inclusive communication approaches throughout their procedures.
• All information on services must be communication accessible.
• Front line staff should be trained and provided with resources to be able to identify and adapt their own communication to the needs of people with speech, language and communication needs.

Improving lives: The Work, health and disability green paper

The joint Department of Health and Department for Work and Pensions green paper was published in October 2016. The Government’s aim was to improve the links between health services and employment support and to close the disability employment gap.

The RCSLT response to the “Improving Lives: The Work, Health and Disability Green Paper”

In our response (PDF) we highlighted the lack of acknowledgement of communication disability and the challenge this presents to people with communication impairments in both entering work and remaining in work.

The RCSLT successfully lobbying the Government to include two case studies within the Green Paper to demonstrate the effectiveness of speech and language therapy in rehabilitation: ‘Anita’ is featured on page 20; while ‘Robert’s’ case study appears on page 71.

Read the Bulletin, April 2017 article (PDF) discussing our response

The Council for Work and Health

The Council for Work and Health was established in 2008 as part of the Government’s response to Dame Carol Black’s 2008 report “Working for a healthier tomorrow.” The Council comprises the professional bodies which represent those engaged in the delivery of health and wellbeing, and occupational health services, as well as others supporting work and health. The RCSLT is delighted to be a member. The Council provides an authoritative and representative “single voice” on health and wellbeing issues.

AHP Advisory Fitness for Work Report

The Allied Health Professions (AHP) Advisory Fitness for Work Report is an A4 form which provides an employee, their employer and GP with information on the employee’s reported problem and to help keep that employee in or return to work following illness, injury or recovery from treatment.

Support for speech and language therapy services

• RCSLT factsheets
• How to influence your local sustainable and transformation plans

What are the workforce priorities for AHPs in England’s mental health services

Health Education England (HEE) have commissioned a rapid research project to explore and understand what AHPs believe are our top workforce issues and priorities for mental health. HEE want to use this information help inform the development of future policy both in the short and longer term. The RCOT has been invited to lead this important project, which will be delivered in collaboration with BAAT and Clever Together and all the AHP Royal Colleges /AHP professional bodies have been invited to get involved.

A report will be produced for HEE’s internal use and will provide them with guidance to write public responses or position papers about its intentions and plans.

The RCSLT wants to influence the future SLT workforce, so please get in touch to get involved with this exciting mental health project.

Other work we are involved with

• #PrescribingNow campaign, calling on the UK government to extend prescribing abilities
• Engaging with HEE to inform the Five Year Forward View for Mental Health.
• Engaging with NHS Improvement on their mental health work contributing to the Five Year Forward View.
• Discussions with NHS Benchmarking on data collection and input/outputs.
• Engaging and responding to relevant NICE guidelines and quality standards.
• Influencing government-led initiatives: planning for mental capacity legislation this Summer and mental health legislation later in 2018/19 and the Independent Review of Mental Health Act.
• Representation at groups and committees including Senior Mental Health Leaders Seminar.

Resources

• The RCSLT has developed a key messages briefing (PDF)
• RCSLT response to the APPG on Parkinson’s mental health inquiry (PDF)
• RCSLT response to the Public Accounts Committee inquiry into mental health in prisons (PDF)
• RCSLT Bulletin article on SLTs and mental health (PDF)
• RCSLT Bulletin article on R&D: Evidence-informed practice in areas with limited research (PDF)
• Supporting adults with mental health conditions: Speech and language therapists play an important role supporting adults with mental health conditions (PDF)

Please contact us to get involved.

Integrated Care Systems

Integrated care systems (ICSs) are partnerships of organisations that work collectively to plan and deliver joined up health and care services which meet the needs of people who live and work in their area. ICSs aim to improve healthcare outcomes, tackle inequalities, enhance productivity and value for money, and help the NHS to support broader social and economic development. Integrated care boards (ICBs) are NHS organisations responsible for planning health services for their local population. There is one ICB in each ICS area. They manage the NHS budget and work with local providers of NHS services, such as hospitals and GP practices, to agree a joint five-year plan which says how the NHS will contribute to the areas integrated care strategy.

The development of Integrated Care Systems (ICSs) provides an opportunity for speech and language therapists to influence the development and direction of new structures, plans and priorities.

By making connections with the right leaders in your local system, sharing the evidence base and convincing them that speech and language therapy can help them to deliver on their priorities, you could make a real difference to the services that are available for the people in your local area.

More information about ICSs, along with resources you can use to support your local influencing, can be found in the resources section of this page.

Model ICB blueprint

In May 2025 NHS England issued the Model Integrated Care Board – Blueprint v1 document following the announcement that ICB functions would be reviewed and the resource available to them significantly reduced.

The document sets out the proposed core functions of ICBs going forward, offers some guidance on matters such as the expected mergers between ICBs, and suggests areas which might move from being ICB functions to national, regional or service provider level. The following information should be read alongside the document to support you to understand the changes being proposed. The RCSLT have also led discussions at the Allied Health Professions Federation Board and contributed to letters produced by the Community Rehabilitation Alliance.

Positive areas in the blueprint

We recognise that Lord Darzi in his review said that ICBs should become strategic commissioners. This proposition being accepted, there are proposals for ICBs’ new focus which we welcome:

• the focus on population health and prevention – shifting focus from institutions to population outcomes
• the focus on reducing health inequalities and on inclusion
• the focus on user involvement and co-design
• developing and agreeing best practice pathways
• future investment decisions ‘guided not just by precedent’
• co-design with local government.

Risks and concerns

The RCSLT identifies a number of risks and concerns:

• Workforce reduction and leadership impact: This may affect AHPs in positions of leadership, or opportunities for AHP leadership. We question how realistic the resource reductions and the pace of them are. Upheaval from ICB mergers will destabilize existing leadership structures.
• Transfer of activities away from ICBs: Many of the areas and activities proposed for streamlining and for transferring out of ICBs are areas of interest to SLT. In particular the potential transfer of SEND (with associated legislative change) and safeguarding functions – it is important that statutory roles and responsibilities are not lost. Other transfers include sustainability, digital, infection control – we need to be assured of the readiness of partner organisations in these transfers.
• Decentralisation of workforce planning: Moving education and training responsibilities away from ICBs risks fragmenting professional development. AHPs and SLTs could be affected undermining service quality and workforce retention
• Transition disruption: The impact on staff morale and continuity of care, and the availability of adequate resource for transition planning.
• The sustainability of merged ICBs with respect to the amount of resource per head, and overall population size.

Areas for clarification and reassurance

The RCSLT seeks clarification and reassurance in a range of areas:

• All remaining NHSE direct specialised commissioning is to be reviewed. We will need clarity on which areas remain centrally commissioned and on the implications for local services. Members working in cleft and in AAC have raised particular concerns.
• The blueprint proposes ‘directing resources where they will have the greatest impact’. This is welcome but needs to have the greatest impact to individuals as well as collectively. It cannot just a numbers game of which conditions are most common.
• The blueprint calls for ‘forecasting and modelling demand and pressures’. This should include unmet need as well as demand for services already commissioned.
• Outcome-based contracts: we strongly support these, but this should actually mean outcomes, not outputs or activity in disguise. We point to Therapy Outcome Measures (TOMs) as one evidenced model.
• Building the strategic commissioning capabilities of Integrated Care Boards, including understanding of rehabilitation, is essential.
• Clinical leadership and AHP involvement: there will be a need to embed clinical leadership, with AHPs represented in strategic planning. A dedicated rehab lead in each ICB would drive integrated and preventative models of care.
• Alignment with the 10-year plan: clear alignment and interdependencies, especially around the workforce, digital, and prevention priorities.

Areas for discussion with the speech and language therapy profession

We would welcome engagement and views from the SLT profession on a number of proposals.

• Encouraging new providers, for example in frailty. We welcome any expansion of frailty services but urge a broader scope, addressing cognitive, psychological and communication barriers. New providers should be encouraged to deliver integrated, multidisciplinary care that includes SLTs and wider AHPs with a focus on presentation and rehabilitation to support independence and wellbeing.
• Transferring high level strategic workforce planning to regions or to national level. There are potential risks around disjointed efforts and local disparities must be addressed.
• Transferring local workforce development including recruitment and retention to individual providers.
• Transferring responsibility for data to national level.

Further reflections on the shift of strategic workforce planning to regional teams

• Potential loss of insight and context-  Regional NHS teams may lack understanding of local demographics, service models or community-specific needs and workforce demand-supply issues. In addition, ICBs are more able to respond to emerging local needs.
• Disconnection from integrated area objectives – Workforce planning is central to delivering place-based, integrated care. Removal of strategic workforce planning from ICBs could fragment efforts to build cross-sector workforce models between health and social care.
• Weakened data intelligence –  ICBs collect local workforce information from providers, whereas regional NHS teams may not have such good and timely access to the data. There would also need to be effective data-sharing agreements in place, such that ICBs can still access and benchmark their data.

Both NHS regional teams and ICBs could retain some workforce planning responsibilities.  However, this could cause confusion with respect to governance and accountability, so responsibilities would need to be clearly defined.

Resources

To support the speech and language therapy role in ICSs, the RCSLT has developed information for SLTs, outlining what ICSs are, how AHPs are represented, and how you can get involved in your local ICS.

• Download Integrated Care Systems: What SLTs Need to Know (PDF)

During the passage of the Health and Care Act we were part of a coalition that helped to secure a higher priority for children and young people in ICSs. Find out what these new duties mean in practice, and how you can get involved.

• Download What does the Health and Care Act 2022 mean for children and young people? (PDF)

For more information about the changes to ICBs:

• Watch a webinar Integrated Care Boards: what now and where next? Hosted by RCSLT CEO Steve Jamieson and Director of Policy & Public Affairs Derek Munn. View the presentation slides from the webinar

Campaigns

For information about campaigns we’re running to promote change across England, visit our Campaigns page for England.