Finding my voice in ICU

Sarah Wallace is leading the way for speech and language therapists (SLTs) working at very senior levels. She recently became the first SLT to be awarded a Manchester Academic Health Sciences honorary clinical chair, recognising her major contribution to healthcare. Her specialism is working in intensive care units (ICU) which has taken her to many different places at home and abroad.

When I first started out as an SLT, over 30 years ago, ICU wasn’t even on the map for us. We simply weren’t part of that world. Breaking into critical care felt like trying to walk through a wall, with eyes watching and doors shut. But something in me knew we had a place there; we just had to prove it. 

I focussed on acquiring the clinical experience I needed, stepping into complex, high-pressure spaces that didn’t always welcome SLTs at first. Our role was built from scratch, with no roadmap, just passion, perseverance, and a deep belief in what we could offer. Along the way, I dug into the research, working to fill the evidence gaps to help justify our role and demonstrate the value SLTs bring to critical care. 

Championing communication and swallowing in ICU became more than a mission, it became my calling.

Collaborating with medics, devising patient-centred research (particularly in tracheostomy care), developing the RCSLT fibreoptic endoscopic evaluation of swallowing (FEES) policy, and co-developing the National Tracheostomy Safety Project’s resources and videos; tools that now amazingly help to guide practice all over the world. I’ve worked closely with the Intensive Care Society, pushing for the inclusion of speech and language therapy and helping to shape national intensive care guidelines that now recognise our role as essential. 

All of this has taken years of research, advocacy, clinical expertise, and countless conversations to open doors that were once shut. Achievements only made possible by networking and the support of incredible RCSLT tracheostomy clinical excellent network (CEN) colleagues. During the pandemic, I was called upon to be a clinical expert advisor to the RCSLT CEO and the Intensive Care Society, which gave me the privileged opportunity to influence policy and progress at the highest levels. Multiple guidelines, journal publications, and international work supporting SLT developments in countries such as Chile, Italy, Mexico, Portugal, Sweden, and India, have helped take this vision wider than I ever imagined. 

I’ve continued my commitment to global health which began at the age of 23 years volunteering as an SLT in Grenada, West Indies to more recently working with an NGO in Cambodia. Wherever I am, I try to support equity of care. Helping SLTs serve patients in low- and middle-income countries has always been at the heart of what I do. 

SLTs in the UK are at the forefront of critical care and working in this space brings an unparalleled opportunity to learn, to innovate, and genuinely change lives for the better. 

Working in ICU brings huge rewards. Seeing a critically ill patient regain their voice, safely swallow again, or simply say “I love you” to their family is incredibly powerful. What I never expected were the awards and recognition that I’ve been fortunate to receive; an OBE, an RCSLT Fellowship, an honorary master’s in public health and becoming a professor with an honorary clinical Chair. Personally, these are huge rewards and deeply humbling and doubly gratifying for their capacity to champion our profession. 

Working in ICU is not easy. Patients are complex, things change fast, and the emotional toll can be high. But advancing treatment techniques like above cuff vocalisation and demonstrating the benefits of early rehabilitation for swallowing and communication are achieving better patient outcomes and pushing the boundaries.

Critical care

To every SLT reading this: you belong in ICU, your skills and your voice matter. The more of us there are in this space, the louder and clearer our impact becomes. Step into the challenge, because it’s worth it, for you, for our profession, and most of all, for the patients.   

Find out more 

Listen to Sarah discuss dysphagia in critical care. 

Look out for an article about the new guidance for allied health professionals (AHPs) in acute care in the summer issue of Bulletin, RCSLT’s member magazine.