Agenda Item: 2(i)

A Report of: Children & Young People Scrutiny Committee

Speech & Language Therapy – The provision of facilities for Children with Language Difficulties including Speech.

MAY 2005

County Council of The City and County of Cardiff

Report of the Children & Young People Scrutiny Committee Speech & Language Therapy Services- DRAFT

CONTENTS  CONTENTS……………………………………………………………………………………………... 2 FOREWORD……………………………………………………………………………………………... 3 TERMS OF REFERENCE……………………………………………………………………………… 4 STRUCTURE OF THE REPORT……………………………………………………………………… 4 KEY FINDINGS …………………………………………………………………………………………. 5 RECOMMENDATIONS…………………………………………………………………………………. 8 WHAT IS SPEECH THERAPY?................................................................................................... 10 HOW SPEECH AND LANGUAGE THERAPY IS STRUCTURED & DELIVERED………………. 11 RESEARCH……………………………………………………………………………………………… 18 SPEECH & LANGUAGE THERAPY SERVICE ISSUES IN CARDIFF……………………………. 21 WAITING TIMES AND APPOINTMENT SYSTEM………………………….. 21 RESOURCING………………………………………………………………….. 22 TRAINING……………………………………………………………………….. 25 EARLY INTERVENTION……………………………………………………….. 27 COUNCIL/NHS CO-ORDINATION……………………………………………. 27 LEGAL IMPLICATIONS………………………………………………………………………………… 29 FINANCIAL IMPLICATIONS…………………………………………………………………………… 29 APPROACH USED……………………………………………………………………………………… 30 TERMS OF REFERENCE OF THE CHILDREN & YOUNG PEOPLE SCRUTINY COMMITTEE……………………………………………………………………………………………

Page 2 of 31

31

Report of the Children & Young People Scrutiny Committee Speech & Language Therapy Services- DRAFT

FOREWORD 

I was pleased, but not surprised, to find that the quality of support for children with speech language and communication difficulties provided throughout Cardiff is considered by all to be of a very high standard, with the Meadowbank Special School facilities to be considered a national centre of excellence. However, its was not the quality of the service but the amount of service provision that concerned the Committee, particularly after hearing that over 800 children are presently waiting for speech therapy assessment.

The Committee and I consider that to be fully effective the report’s recommendations must be directed at the three main service providers, that is, this Council, the Cardiff and Vale NHS Trust and the University of Wales Institute Cardiff.

I feel that should the Council and its partner organisations fully implement the recommendations contained in this report, the shortfall in service provision will be addressed, enabling all Children and young people that require support and assessment to receive it as early as possible.

I would like to thank all those who gave evidence to this inquiry, expert witnesses, Executive Members and Officers, who attended Task Group meetings, gave presentations and answered detailed questions. It is only with the help and assistance of all these people that the Committee could complete its work effectively. Finally I would like to take this opportunity to thank the members of the Task Group for their hard work, commitment and assistance during the past few months.

Councillor Freda Salway Chair, Children & Young People Scrutiny Committee April 2005

Page 3 of 31

TERMS OF REFERENCE 

i. The Children & Young People Scrutiny Committee agreed the following terms of reference for the Task & Finish Group at the Committee meeting in October 2004:

To review the provision of services for Children with speech language and communication difficulties, in particular: a) To investigate the waiting times and number of children waiting for the service; b) To assess the process for provision of the service to identify reasons for delays; c) To review the issues considered by the Tribunal Hearings to identify issues to improve service provision and reduce referrals;(see footnote) d) To utilise the information to inform a review of service provision in Cardiff; and e) To make recommendations to the Executive.

ii. The Committee also agreed that the Membership of the Task & Finish Group would be: Councillor Freda Salway – Chair Councillor Susan Goddard Councillor Ann Rowland-James.

STRUCTURE OF THIS REPORT 

The Task and Finish Group that undertook the inquiry into Speech and Language Therapy in Cardiff heard from a wide range of witnesses and commissioned research to establish the views and experiences of Headteachers on this subject. This report draws out the main evidence and findings. A full record of all evidence received is available for inspection upon request to the Chief Scrutiny Officer.

Footnote During the inquiry it became apparent that there were no significant issues arising from Tribunal decisions.

Page 4 of 31

KEY FINDINGS 

The Task & Finish Group gathered evidence from a wide range of sources, and commissioned a survey of 137 schools to inform its deliberations. It has used the evidence gathered throughout the Inquiry, and the research data, to inform its recommendations. The recommendations follow from the Key Findings listed below and are designed to help improve the provision of services and facilities for children and young people in Cardiff who have speech, language and communication difficulties. Key Findings General

1) The National Health Service Trusts are the primary providers of Speech and Language Therapy Services. However, it is the Council that has the ultimate responsibility for ensuring that provision of such services is made for Children whose Statements of Special Education Needs specify that the provision is an educational requirement. The lack of a service level agreement between the Council and The Cardiff & Vale NHS Trust for the provision of speech therapy service allows shortfall in provision, which at times requires the Council to procure services direct, using its own resources. This was exemplified by a Headteacher who had undertaken an audit of statements and identified a significant shortfall in the provision of therapy to pupils.

2) All stakeholders expressed their satisfaction with the quality of the service provided by the Health Trust and Council, when it was available. Currently, in Cardiff, there are 205 children presenting with speech, language and communication difficulties, who have statements of special educational need. The Cardiff & Vale Health Trust confirmed that there were a further 856 Children are waiting for an assessment as a result of having speech language and communication difficulties identified. The present waiting time can be as long as 18 months, which may have a detrimental effect on a child’s social and educational development. This was highlighted by over 50 Headteachers, who stated that they had pupils waiting for an assessment and many were experiencing problems due to the delays.

Page 5 of 31

3) Comments by Headteachers and Parents representatives identified a lack of a coordinated approach across the City in the provision of a service for Children with Speech, Language and Communication difficulties, which is resulting in a failure to adhere to the statemented needs of the pupils. In addition, the funding levels for Special Educational Needs services has caused a reduction in places and support available for pupils with severe speech, language and communication difficulties. The limited use of Early Learning and Sure Start initiatives, although effective, only benefits a few selected areas. Key Findings on waiting times

4) All speech and language therapists interviewed agreed that Speech & Language Therapy intervention is most effective for a child the earlier it is provided, often reducing the need for formal statementing when they start school. Parents representatives stated that the special Early Years Team scheme is very effective, however it was confirmed by Meadowbank School that the team only visits three nurseries in Cardiff, which is considered unsatisfactory and resulted in more children requiring speech therapy. Headteachers commented that the outreach service provided by Meadowbank School is excellent

5) Parent representatives and Headteachers appreciated that attendance at Children’s clinic appointments are vital, however they consider that the present appointment system at the Community Clinics to be unsympathetic, causing children to miss appointments and thereby further extending their waiting times. Very few pupils were seen at school, which was considered to be less disruptive for the pupils. In response to the research questionnaire many Headteachers expressed concerns that there were significant educational and social problems associated with pupils who were waiting for assessments, as the appropriate support, facilities and therapy was not being provided.

6) Meadowbank School was considered by all to be a centre of excellence for children with speech language and communication difficulties, and that the specialist provision is essential to enable children to overcome any speech, language or communication difficulties. An integral part of the school is the day class, which provides special education for eight children. The demand for this facility exceeds the present places, resulting in many children having to wait this provision, however the Headteacher informed the Group that the facility could easily be expanded to two classes with limited additional resources, allowing more pupils to receive this provision. Headteachers also highlighted that Page 6 of 31

reductions in resources available for special educational needs units had resulted in a decrease in the number of pupil’s places available, resulting in more pupils being left in inappropriate mainstream classes.

7)

Parents, teachers, and the research undertaken across all Cardiff’s schools, highlighted the need for improved communication and information for parents and teachers. Raising awareness and enabling speech, language and communication difficulties to be identified and addressed as early as possible, would reduce the numbers waiting for assessment. Almost 85% of Headteachers who responded to the scrutiny inquiry had at least one pupil receiving therapy, with many commenting that there was a lack of communication between themselves the Trust and pupil support, resulting in extended waiting times for support.

Key Findings on service provision

8)

The Welsh Assembly Government published details of each Welsh Authority’s budgeted expenditure on Special Educational Needs for 2004/05. Cardiff was listed as budgeting £24,732,000, or £492 per pupil. When assessed against all other Welsh Authorities, the level of resources provided by Cardiff Council was below the all Wales average, of £509 per pupil, and would require an additional £850,000 to match the average. The recently approved increase for 2005/2006 of £125,000, only partly addresses this shortfall.

9)

Parents and Headteachers commented that support for Pupils with speech, language and communication difficulties is primarily directed to pupils during their primary education, and is not extended to cover their needs during secondary education even when the pupil’s needs require it.

10) Research undertaken across all Council schools in Cardiff, as well as comments received during visits to schools, identified that service provision was limited by insufficient training opportunities available for Teachers and Teacher Assistants throughout the Council, especially those dealing with mainstream SEN pupils. The INSET training was limited and oversubscribed. The specialist training provided by Meadowbank School is considered excellent and was available for all schools, however only 4 schools had taken up the training due to resource implications.

Page 7 of 31

11) The University of Wales Institute Cardiff currently receives around 400 applicants for its Speech & Language Therapy course, but only has places for 38 students. The Committee considers this to be inadequate considering that there is a shortfall of over 3,000 therapists nationally. The University of Wales Institute Cardiff also confirmed that the teacher training degree only contains one work-shop to raise awareness of speech, language and communication difficulties in pupils, again this is deemed to be totally inadequate when it is considered that most teachers teach statemented pupils at some time.

RECOMMENDATIONS  Recommendations for the Executive

R1. The Committee recommend the following to the Executive for implementation:

R1.1. That the present SEN funding gap, as compared with the all Wales average, is reduced as soon as possible, so that Cardiff Council at least matches the all Wales average;

R1.2. That a proportion of the additional resources already allocated in the 2005-2006 budget be targeted at Speech & Language Service to help provide:

R1.2.1. An additional day class for eight Children at Meadowbank School; R1.2.2. Additional places within special units in mainstream schools; R1.2.3. An expansion, in partnership with the Health Trust, of the out-reach service and Early Years Team.

R1.3. The implementation of a Service Level Agreement between Cardiff Council and Cardiff & Vale NHS Trust to ensure the continued provision of Speech & Language Therapy Services for all Statemented Children in Cardiff;

R1.4. A County wide training programme be implemented to raise awareness of all Teachers and Assistants, particularly those in direct contact with statemented children.

Page 8 of 31

Recommendations for the Cardiff and Vale Trust

R2. The Committee recommend that the Cardiff & Vale Trust Board:

R2.1. Target additional resources to provide more effective pre-school support for all children in state and private nurseries, and that the waiting times for assessment within the children’s clinics are reduced to a few weeks;

R2.2. Provide additional Speech and Language Therapists to ensure that the service is sufficient to meet the needs of statemented SEN children in Cardiff;

R2.3. Extend Speech and Language Therapy support for pupils to Secondary Schools, where there is a clear need;

R2.4. Develop and implement a detailed communication and awareness strategy to ensure children, parents, and teachers are aware of the service and therapies provided;

R2.5. Undertake a review of the community clinic appointment system to ensure that it is a more sympathetic service for pupils and parents and that more school based clinics are held at schools with significant numbers of SEN pupils.

R2.6 Develop and implement an intervention strategy for Midwives and Health Visitors to ensure the early identification of difficulties such as feeding. Recommendations for the University of Wales Institute Cardiff

R3. The Committee recommend that the University of Wales Institute Cardiff:

R3.1. Expands the Speech & Language Therapy course to enable more Students to study;

R3.2. Includes additional modules in the present teacher-training course to raise the awareness of speech, language and communication difficulties for all student teachers.

Page 9 of 31

WHAT IS SPEECH AND LANGUAGE THERAPY? 

1)

Speech & Language Therapy is the term used for the provision of specialist assessment, diagnosis and intervention for Children & Young People who are experiencing difficulties in the development of speech, language and communication skills. They may experience difficulties with any or all aspects of speech & language, from moving the muscles that control speech, to the ability to understand or use language at all.

2) There are different forms of language impairments and difficulties. Speech and Language Therapy is involved in many different areas of language and communication impairments. These can include: •

Speech apparatus – the mouth, tongue, nose, breathing and how they are coordinated and operated by muscles;

•

Phonology – the sounds that make up language;

•

Syntax or Grammar – the way that words and parts of words combine in phrases and sentences;

•

Semantics – the meaning of sentences, words and bits of words;

•

Pragmatics – how language is used in different situations and how feelings are conveyed;

•

Intonation and stress – the rhythm and music of the way we speak

3) The Special Educational Needs (SEN) Code of Practice for Wales (2002) provides guidance and procedures aimed to enable children and young people to reach their full potential. The Code advises a graduated response covering a four-part approach reflecting a child’s needs and progress over the years. These are: i.

Early Years / School Action – A concern is recognised and progress is monitored.

ii.

Early Years / School Action Plus – Specialists are invited to advise and support providers and schools

iii.

Statutory Assessment – A multi-agency statutory assessment of the child’s identifiable special educational needs is made; Page 10 of 31

iv.

Statement of Special Educational Needs – This legal document describes in detail the child’s needs and the range of provision that should be made to meet those needs.

4)

The National Assembly Government’s (NAG) Lifelong Learning Committee undertook a detailed review of speech and language services in Wales. In response to its recommendations the Minister for Education and Lifelong Learning stated that the key issues for the service were: •

Effective early identification and intervention;

•

Flexible approach to service provision from all agencies;

•

The communication and agreement of policies and protocols to ensure a seamless service; and

•

The joint commissioning and pooled budgeting across services to ensure that needs are met in a coherent way.

To this end the National Assembly Government allocated £3 million over the next three years to develop pilot projects to establish joint commissioning and pooled budget arrangements to deliver the speech and language services across health and education.

HOW SPEECH & LANGUAGE THERAPY IS  STRUCTURED & DELIVERED 

5)

The Speech & Language Therapy Service is available for all children & young people who have been identified as having speech, language and communication difficulties. The service provides an open access system, enabling parents, teachers, doctors or health visitors to refer children for assessment at health centres and clinics.

6)

Speech and language therapists, based in clinics, assess, diagnose and develop therapy programmes for children presenting with speech, language and communication difficulties. Therapists work in partnership with parents, carers and teachers to ensure the implementation of the specified programme of therapy. The Pupil Support Service is Page 11 of 31

responsible for the allocation of statemented children. Depending on the level and type of therapy required, a child can be placed in either:

7)

•

a special school;

•

special unit in a mainstream school; or

•

an ordinary class in a mainstream school.

The primary responsibility for the provision of Speech and Language Therapy rests with the National Health Service. In Cardiff the service is organised and managed by the Cardiff and Vale NHS Trust using a multidisciplinary / multi-agency approach. The NHS Trust service is organised in clinical teams consisting of; qualified Speech & Language Therapists who are registered with the Royal College of Speech & Language Therapist and HPC, Technical Instructors and support staff, working in partnership with educational staff within Cardiff Council’s Schools wherever possible.

8)

The aim of the service is to assess, diagnose and provide intervention for individuals presenting with feeding, speech, language & communication difficulties. Intervention is focused on achieving functional communication within the child’s environment according to the severity and prognosis of the presenting disorder and within the overall ability level of the child.

Assessments 

9)

The Council’s Pupil Support Service is responsible for providing the Early Intervention service. A school-based assessment is made of each child and key priorities are included in the pupils Individual Education Plan (IEP). Progress is monitored, usually at 2 monthly intervals. Each child’s IEP is then updated and developed with specialist advice. This may be followed in some cases by a formal assessment and a statement of SEN for the child.

10) The Cardiff and Vale NHS Trust’s Community Clinic Service provides assessment, diagnosis and intervention for pre-school and school aged children in the community. The service is delivered mainly from Clinics and Health Centres although informal school Page 12 of 31

and home visits are undertaken, when necessary. Where statemented children are not provided for, by allocated school based input or individual pupil support provision, they may be supported by the community based service.

11) The Children’s Centre at St David’s Hospital offers a multidisciplinary approach to the assessment and management of children with complex special needs. The core service is directed at pre-school children with complex communication and feeding disorders. The service includes home visits where appropriate and designated sessions providing a Nursery Assessment Service.

Special Schools 

12) The specialist school provision in Cardiff for children with primary speech and language impairment is provided at Meadowbank Special School and Whitchurch High School and is directed at children with severe specific speech, language and communication difficulties. Therapy is provided by dedicated Health Authority funded Speech Therapists, each session lasting half a day.

13) The Special Schools provide education for the children who are unable to access teaching and learning in a mainstream setting. This specialist-learning environment provides a needs lead curriculum, jointly planned and delivered at an appropriate and differentiated pace, together with adult guided social intervention and support.

14) Meadowbank Special School has 30 full time places for Cardiff’s children and provides 30 sessions a week. There is also one day-class of eight Children funded by the Council. There are three fulltime Speech & Language Therapists, funded by Health. In addition there are three sessions of speech and language therapy time to work with the day class, and one full time speech therapist working with the Early Years project (to be appointed), funded by the Council. Allensbank Primary School has three classes of ten children each, receiving 11 half-day sessions in total. The aim of this provision is to provide an intervention period of 2/3 years followed by re-integration into mainstream. There are further follow up meetings for pupils during their first term in Secondary School. Page 13 of 31

15) The Cardiff & Vale NHS Trust team for school-aged children with complex special needs is special school based. The therapists work with children who have a statement of special educational need that includes a need for speech and language therapy as a consequence of speech, language, communication and / or feeding disorders. This team also provides a service for school-aged children with complex needs who are new to the Trust or Local Education Authority.

Mainstream Schools 

16) Children with Special Educational Needs, who have been assessed as not requiring attendance at a special school, either receive their support within a mainstream school or based in a special unit within a school.

17) School based special needs units are funded by the Council and supported by regular visits from peripatetic speech and language therapists, who advise, instruct and support the work of the Special Educational Needs Teachers and teaching assistants to ensure that Individual Education Plan’s are followed and that each pupil obtains continuous care whilst at the school. The Community Clinic Service also provides dedicated sessional input to Special Needs Units attached to mainstream schools.

18) The Council’s Speech and Language Pupil Support team provides input for statemented children in mainstream schools. Cardiff and Vale Trust employees are members of the multidisciplinary / agency team based at the LEA Pupil Support Service at the Mynachdy Centre. At present there is a caseload of approximately 100 cases with a waiting list of about 10 cases. The service provides casework administration for all statements of special educational need, as well as the specialist assessment and teaching of Children. The service manages the assessment, issues the statements and arranges provision and placements, programmes and advice as necessary. It provides input to some special needs units, and training for schools and LSA's , and supports children in mainstream schools.

Page 14 of 31

19) The team for Autistic Spectrum Disorders is for both pre-school and school-aged children. Those attending school are seen within the school setting and the focus is on a collaborative consultative model of intervention in partnership with school staff.

20) The Specific Speech & Language Impairment Team caters for children with severe specific and complex speech and language disorders. It is school based and staff work collaboratively with teachers in modifying the curriculum and providing intervention and classroom strategies for children with specific language impairments. Staff are based at Meadowbank School and the Language Unit attached to Allensbank Primary School. In addition there is input to Whitchurch High School for secondary-aged children with specific language disorder who transfer out of Meadowbank and Allensbank.

21) Children with hearing loss are seen by staff in the hearing impaired team. In Cardiff there is pre-school provision and input to the hearing impaired units at Coed Glas and Cefn Onn. There is also limited input for secondary aged children attending the special unit at Llanishen High School.

Outreach 

22) The Meadowbank School also funds an Outreach Officer who supports and advises School Staff when children leave Meadowbank to return to their mainstream Primary School. When children are deemed ready to begin integrating into their mainstream school, Meadowbank staff advise and monitor this process and the child’s progress. Therapists only visit for the first term after a child has moved to mainstream provision. This is a joint process between all staff at Meadowbank, parents and mainstream schools. At present there are six children involved in this process.

Early Years 

23) The Early Years project based at Meadowbank School is a newly established facility in Cardiff. It is staffed by a fulltime Nursery Nurse, a Speech & Language Therapist (to be appointed) and .4 of a Meadowbank Specialist Teacher. The project is entirely funded by Page 15 of 31

the Local Education Authority. Early years settings across Cardiff, are targeted where there is the greatest need. The Team offers a six week block of group listening/language work with particular emphasis on involving the Nursery/Playgroup staff so that they acquire skills for running the groups when the Early Years Team have moved on. At present the team visits three nurseries in Cardiff, but will expand over time.

24) The Cardiff and Vale NHS Trust’s Sure Start Team is a government funded multiagency initiative, established in recognition of the importance of early years development for children. Cardiff has one part time Speech & Language Therapist covering two of the Cardiff Sure Start areas, and focuses on prevention, parent-child interaction, and early identification and transfer to generic services

Service Provision 

25) The Cardiff & Vale Trust service allocated to Cardiff provides for a total of 191 sessions per week. Five sessions (3 % of overall resources) are for Sure Start, 39 sessions (20% of the resource) are allocated for community services, 46 sessions (24% of the total resource) are for the children’s centre and 101 sessions (53% of the total resource) are for school-based services.

26) The primary responsibility for the provision of Speech and Language Therapy rests with the National Health Service. This applies generally and also to any specification in a “Statement of Special Educational Needs”. The Local Health Boards are responsible for commissioning therapy services through contracts with providers of health care (NHS Trusts). The Speech & Language Therapists assess, diagnose and develop programmes for children; they work with parents, carers and other professionals in the delivery of these services, however, it is the Local Education Authorities (LEA) that have the ultimate responsibility for ensuring provision of such services is made for Children whose Statements of Special Education Needs (SEN) as it is an educational requirement.

27) The service in Cardiff is accessed either through the Children's Centre or Community Clinics, both have waiting lists with the longest wait and highest demand being for the Community Clinic based team. This team has insufficient staffing establishment Page 16 of 31

to meet the present level of demand and at the end of November 2004, the community waiting list for initial appointment was standing at 856, a reduction of 93 from the previous year.

28) Currently, there are 205 children in Cardiff with a statement of SEN where SLCD is identified as the primary need on their Statement. However many other children also have speech and language provision identified on their statements. Speech Therapists advised that speech & language therapy intervention is most effective when it is provided early in the child’s life, ideally before the child attends primary school. Typically, mainstream pupils will have programmes devised jointly by a Speech and Language Therapist / Specialist Teacher and delivered by a trained Teaching Assistant.

29) The Special Educational Needs procedure for assessments and the issuing of statements are undertaken using the SEN Code of Practice 2002 agreed by a panel that includes a Headteacher representative. All assessments are undertaken through a transparent decision-making process aimed at equity of provision.

30) Should parents be unhappy with the statemented provision for their child, they have the legal right for the statement to be reviewed by an Appeals Tribunal. The Tribunal decisions have to be implemented by the Local Education Authority from its own resources. A review of the issues arising from Tribunal Decisions made over the past two years indicated that, these were not having a significant impact on service provision, and therefore did not warrant further inquiry.

31) A Statement of Special Educational Need is a legal document that is binding on the Local Education Authority. Part 1 identifies the child and parent details; Part 2 described the child’s special educational needs, difficulties or other problems; Part 3 describes the provision identified to meet those needs. This is the section that contains the reference to the child’s specific needs for speech therapy; Part 4 names the schools where the child will be placed; Part 5 identifies the non-educational needs and provision.

Page 17 of 31

RESEARCH 

32) The Task and Finish Group considered that the provision of facilities and services for Children and Young People with Speech Language and Communication difficulties in schools and its impact on the teaching of Children was a critical factor to take into consideration. The Task Group therefore commissioned research through a questionnaire to all Cardiff’s Headteachers.

33) A total of 137 questionnaires were sent out to schools by both post and e-mail. A total of 72 questionnaires were returned, representing 52.5% of the total. Schools were asked to identify their type, and 78% of responses were from primary-age schools, including nursery, infants, juniors, primary and Welsh medium primary.

33) Many Headteachers and special educational needs co-ordinators gave very full answers, making clear that this issue is highly relevant to the rate of educational progress of children affected. Quite a number felt very strongly about the problems they, their staff and their pupils, have experienced and noted both their frustrations and their suggestions for improvements.

34) In summary the returned questionnaires commented as follows: •

Children receiving services - Almost 85% of respondents currently had at least one child receiving speech and language therapy services, with most schools having between one and six children receiving services. The range did however extend to 55 children, with four schools having between 16 and 40 children in receipt of some provision. Some schools were unsure of the number, due to what was explained as ‘lack of communication’ between the Health Trust, Therapists and Schools;

•

Satisfaction with the service - Dissatisfaction was expressed mainly at the very long wait for speech and language therapy input (waits of 18 months and more than two years were cited); other comments repeated several times included: ‘too little liaison with school’; ‘no speech therapist in the area’; ‘the need outstrips provision’. Page 18 of 31

One comment, repeated several times, noted that if an appointment is missed, the child must go to the end of the waiting list, when this may be because the parent(s) either don’t see the need or are otherwise not co-operative. Satisfaction with the service, when available, was high, but it was stressed many times that there are simply insufficient numbers of qualified therapists, specialist teachers and training for class teachers and teaching assistants to meet the demand; •

Monitoring of outcomes from Speech and Language Therapy services - A large majority of respondents (72%) stated they monitored outcomes from the speech and language support service and the impact on educational outcomes. Most (29%) undertook this through reviews of the Individual Education Plan (IEP), given when a child has special educational needs. Other methods used by significant numbers of schools included using the annual review process and speech and language therapists’ reports to plan work for the children;

•

Waiting Lists -- 55 respondents noted that they had children on the waiting list for services: 12 had one child on the list, six had two and six had three. Three schools had 12 children waiting; one school had as many as 15. One stated ‘numerous’ and another 11 schools specifically stated that they did not know how many children were on the list, again partly due to a lack of communication with/response from speech and language therapy services;

•

Problems arising from the length of waiting times - A broad range of problems were noted, such as reading, writing and social development. The damaging effects on a child’s self-esteem, and the increase in self-consciousness during the months whilst waiting for input were also frequently mentioned. Other significant problems included the deterioration of behaviour; the delay in, or lack of, progress in all areas and concomitant falling behind peers; and that the level of frustration amongst the children, parents and staff would be significantly increased;

•

Expenditure on SEN and SLT support – additional funding - 58 of the 72 respondents stated they had spent the additional LEA funds made available in 2004 fully on Special Educational Needs related support. A wide range of responses was received regarding the proportion of this funding spent on supporting Speech and Language issues, ranging from ‘none’ to ‘100%’. Most of the funding was spent on an LSA or other teacher support time; one school had a speech and Page 19 of 31

language therapist on site; and one mentioned extra support via School Action Plus (SA+). A small number of schools believed they could not directly fund any speech and language support, as it was provided by the NHS or LEA; •

Support for implementing Individual Education Plans - 20 respondents stated that they had no or very little support. A significant number noted that support was only available when a Statement was in place. Headteachers commented that it was ‘excellent’, ‘very good’ – one school noted that it was ‘thrilled’ with the current level of support, having had none for many years;

•

Effectiveness of In-Service Training (INSET) - Those who had received training considered it to be ‘sufficient’, ‘good’ or ‘effective’. 14 schools responded that no training had been offered; while others stated they had only received minimal training, or that the courses were oversubscribed and they were expecting more to be available in the next session of INSET. Four schools had arranged training with Meadowbank School (Outreach), which they reported as excellent and very effective Other training was noted, for example: more general training on identifying speech and language needs, literacy, completing Individual Education Plans;

•

Provision of services by the Health Trust and LEA and possible improvements-The

most

frequent

comment

noted

the

lack

of

communication/collaboration between the Health Trust and schools, leading in many cases to an unsatisfactory situation where schools were not aware of appointments offered or any possible support they could give to child or parent during the waiting and intervening periods. A number of schools commented that the appointments should be at school, rather than in the community, as it wasted a lot of time taking the child out of school, and it would be easier to have a co-ordinated approach to the services provided – increasing the chances of the child attending the appointment.

Page 20 of 31

SPEECH & LANGUAGE THERAPY SERVICE ISSUES IN  CARDIFF 

34) Drawing on evidence from a wide range of witnesses and from direct research to establish the views and experiences of Headteachers and staff, the Task Group identified a number of key issues of concern relating to the provision of the service. These are set out below under the headings: •

Waiting times and appointment system

•

Resourcing

•

Training

•

Early Intervention

•

Council / NHS Co-ordination

Waiting Times and Appointment System 

35) The Cardiff and Vale Trust confirmed that a total of 856 Children are presently waiting for an appointment at Community Clinic or Children Centre, due to an insufficient number of speech therapists being available to undertake assessments. The resulting waiting time can be as long as 18 months, which inevitably has a detrimental effect on a child’s social and educational development.

36) All stakeholders considered that children’s attendance at clinic appointment is essential, however Headteachers and parents representatives considered the present appointment system to be unsympathetic, further exacerbating the already long waiting times. They suggested that school-based clinics could be introduced, particularly at schools that have a number of SEN pupils.

Page 21 of 31

37) Headteachers, school staff and parents, all stated that delays in the present assessment process and long waiting lists have a significant impact on children’s pre-school development, resulting in many problems when they reach school age. It was noted that the parent groups actively support and reassure parents before and during the assessment process.

38) Research undertaken across all Cardiff’s schools identified that many Headteachers consider that while pupils are waiting for assessment and subsequent statementing, schools are encountering considerable social and educational problems with these pupils.

39) The parent’s representatives expressed their concern with the services provided by the Centres and Clinics. In particular they are not organised sympathetically for Parents and Children, only operating 1 day a week with was no encouragement, advice or support for the other 6 days of the week. The long waiting list was considered totally unacceptable, and Special Educational Needs assessment reports written by the therapists were considered to be unclear, long and unspecific.

Resourcing 

40) The National Assembly for Wales undertakes an annual analysis for each Council’s budgeted expenditure on Special Educational Needs. A copy of the 2004-2005 data is set out in the table below. This table indicates that Cardiff Council’s budget is seventh lowest in Wales at £492 per pupils, with the all Wales average expenditure being calculated at £509. As Cardiff has over 50,000 pupils, this results in significantly lower funding of SEN, and would require an increase of about £850,000 just to match the all Wales average. The Council at its meeting on 24th February 2005 approved the budget for 2005-2006, which included an increase in the SEN budget of £125,000 to help reduce the funding gap.

Page 22 of 31

B u d g e te d g ro s s e x p e n d itu re o n s p e c ia l e d u c a tio n a l n e e d s (S E N ) p ro vis io n in W e ls h lo c a l e d u c a tio n a u th o ritie s , 2 0 0 4 -0 5 (a ) £ th o u s a n d D e le g a ted S E N e x p en d itu re (b )

Au th o rity

N o tio n a l a llo c a tio n to p rim ary sc h o o ls

N o tio n a l a llo c a tio n to s e c o n d a ry s c h o o ls

S p e c ia l s c h o o ls

N o n -d e le g a te d S E N p ro v is io n (c )

All d e le g a te d e x p e n d itu re

School budget

L E A b u d g et

(d )

C onwy Isle o f A n g le s e y B ridg e n d

T o ta l o f c en tra lly re tain e d S E N p ro v is io n

R e la tiv e in d e x

T o tal S E N e x p e n d itu re fo r w h ic h e a c h L E A is re s p o n s ib le

(e )

All p u p ils (n u m b e r)

of SEN e x p e n d itu re p e r T o ta l S E N p u p il e x p e n d itu re (W a le s= 1 0 0) (£ p e r p u p il) (f)

1 ,2 9 4

909

2,6 0 1

4 ,80 3

5,4 9 0

1 ,0 7 4

6,5 6 4

1 1 ,3 67

1 7 ,0 90

665

515

168

1,0 4 0

1 ,72 3

4,1 9 7

358

4,5 5 5

6 ,2 7 9

1 0 ,2 63

612

131 120

2 ,2 8 3

1 ,4 2 4

4,9 8 3

8 ,69 0

3,6 5 5

1 ,1 0 7

4,7 6 2

1 3 ,4 52

2 2 ,4 88

598

118

W re x ha m

2 ,5 9 4

1 ,8 1 2

2,1 1 3

6 ,51 9

4,0 8 0

427

4,5 0 6

1 1 ,0 25

1 8 ,5 73

594

117

C e re d ig ion

2 ,6 1 5

1 ,9 7 9

0

4 ,59 5

1,4 3 9

120

1,5 5 9

6 ,1 5 3

1 0 ,4 89

587

115

B lae n a u G w e n t

2 ,5 9 3

875

976

4 ,44 4

1,5 7 2

446

2,0 1 8

6 ,4 6 2

1 1 ,3 39

570

112

M e rth yr T yd fil

1 ,6 3 8

1 ,0 4 8

1,4 4 4

4 ,13 0

1,1 6 6

363

1,5 2 9

5 ,6 5 9

9 ,99 2

566

111

927

722

1,8 7 5

3 ,52 5

5,8 8 5

395

6,2 8 0

9 ,8 0 5

1 8 ,0 03

545

107

N e w p o rt

3 ,7 4 5

1 ,8 4 6

1,3 5 3

6 ,94 4

3,9 5 4

2 ,1 1 4

6,0 6 8

1 3 ,0 12

2 4 ,4 01

533

105

C a rm a rth e n s h ire

3 ,9 2 1

2 ,7 6 9

2,4 0 7

9 ,09 8

4,2 0 8

1 ,3 6 8

5,5 7 6

1 4 ,6 73

2 7 ,7 63

529

104

C a e rp h illy

1 ,7 6 7

2 ,2 5 9

2,0 9 7

6 ,12 3

8,2 2 3

1 ,4 0 2

9,6 2 5

1 5 ,7 48

3 0 ,0 01

525

103

G w yn e d d

Swansea

4 ,5 3 4

2 ,9 2 4

2,5 2 6

9 ,98 3

7,5 0 6

849

8,3 5 5

1 8 ,3 38

3 5 ,0 04

524

103

F lintsh ire

2 ,0 1 9

2 ,6 9 4

2,5 4 4

7 ,25 7

4,9 8 0

510

5,4 9 0

1 2 ,7 47

2 4 ,7 40

515

101

N e a th P o rt T a lb o t

3 ,0 2 7

2 ,3 3 4

2,0 3 2

7 ,39 3

3,3 4 1

342

3,6 8 3

1 1 ,0 76

2 1 ,5 76

513

101

P e m b ro k e s h ire

3 ,1 4 3

2 ,3 7 7

980

6 ,50 0

2,4 3 6

562

2,9 9 8

9 ,4 9 8

1 9 ,2 51

493

97

C a rd iff

5 ,1 8 3

3 ,8 7 2

6,4 7 1

1 5 ,5 26

7,6 5 8

1 ,5 4 7

9,2 0 6

2 4 ,7 32

5 0 ,2 88

492

97

T orfae n

1 ,9 7 5

1 ,1 5 3

1,2 4 2

4 ,37 0

2,2 0 3

978

3,1 8 1

7 ,5 5 1

1 5 ,5 88

484

95

927

502

2,7 6 1

4 ,19 0

4,8 6 7

643

5,5 1 0

9 ,7 0 0

2 1 ,0 00

462

91

1 ,6 7 5

1 ,0 9 7

1,3 9 7

4 ,16 9

1,4 2 5

347

1,7 7 2

5 ,9 4 1

1 2 ,9 13

460

90

P o w ys M o nm o u th s h ire T he V a le o f G la m org

1 ,5 6 2

797

3,5 9 4

5 ,95 3

2,1 8 6

727

2,9 1 4

8 ,8 6 6

2 1 ,4 13

414

81

R h o n d d a C yn o n T a ff

1 ,9 0 6

2 ,5 5 6

4,2 5 1

8 ,71 3

4,9 0 0

2 ,8 9 6

7,7 9 6

1 6 ,5 09

4 2 ,5 65

388

76

D e n b ig h s hire W a le s

296

106

3,0 8 6

3 ,48 8

2,1 2 8

672

2,8 0 0

6 ,2 8 8

1 6 ,3 29

385

76

5 0 ,1 3 9

3 6 ,2 2 3

51 ,7 7 4

13 8 ,1 36

8 7,4 9 9

1 9 ,2 4 8

1 0 6,7 4 7

24 4 ,8 83

48 1 ,0 68

509

100

Page 23 of 31

41) Cardiff Council’s dedicated resource provision for Children with primary speech language impairments, is as follows:

Meadowbank Special School Outreach for Early Years children Allensbank Primary School

Whitchurch High School

Pupil Support Service Speech & Language Team Additional support for mainstream pupils with SLCD

For primary aged children with severe speech and Language disorders

30 places Cost £610,093 Cost £22,950

3 special classes for primary aged children with moderate/severe speech and language disorders Special class provision for secondary aged pupils with speech and language disorder (transferring from Meadowbank). Provides support to approx. 80 mainstream primary school pupils

30 places Cost £170,000 12 places Cost £75,000 £78,506 £155,000

42) Parent’s representatives confirmed that the service and facilities provided by the Council’s special schools and the special educational needs units in mainstream schools are excellent. However they considered that there were insufficient places at the schools to provide for all the children with severe speech & language difficulties.

43) In April 2003 the Council agreed to delegate a proportion of the centrally held SEN funding direct to schools. Research conducted with Headteachers, identified that 80% were able to spend this delegated budget on Specialised Educational Needs. However many Headteachers indicated that they are not aware of the funding implications of Special Educational Needs pupils, particularly what was provided within their budget, or what remained centrally funded. This inconsistency indicated lack of awareness of Headteachers ability to respond and support pupils with Special Educational Needs.

44) The special education provided at Meadowbank School is well regarded by all stakeholders, but is limited in terms of the number of children it serves. At present there are only 30 places available for Cardiff pupils, however demand is considerable. In addition the school has a day class for eight children, the Headteacher stated that this facility could be expanded to two classes with limited additional resources, enabling considerably more children to receive therapy and remain in mainstream schools.

45) Reductions in specific resources available for special educational needs units within mainstream schools, has resulted in the decrease in the number of pupils places, which results in more pupils being left in mainstream classes which are inappropriate. Page 24 of 31

46) All stakeholders were concerned that the support for Pupils did not continue during their secondary education. They requested that pupils with special educational needs that require further therapy during secondary school should continue to receive their therapy.

47) Current resources available to the Community Clinics and Children’s centre has resulted in insufficient speech and language therapists being available to meet with the demand for the service. In addition a recent audit of statemented provision undertaken by a Headteacher highlighted that the statemented provision for children, is not consistently provided, often resulting in the Council having to fund the provision.

48) In February 2005 the Welsh Assembly Government announced that following a report, on speech and language service, from the Education and Lifelong Learning Committee of the Assembly, it had allocated an additional £3 million over the next three years to develop pilot projects to establish joint commissioning and pooled budget arrangements to support children with speech, language and communication difficulties. Unfortunately Cardiff Council and Cardiff & Vale NHS were unsuccessful in their bid to be included as a pilot project area.

Training 

49) The Royal College of Speech and Language Therapists estimates that there is currently a shortage of around 3,000 Speech and Language Therapists (SLT) in the UK. At present there are 259 SLT working in Wales, with a current caseload in excess of the recommended 40 children per speech and language therapist.

50) The Head of the University of Wales Institute Cardiff’s Speech Therapy Centre informed the Group that its course is the only one in Wales. The course is limited to a maximum of 38 places and lasts four years, with each student undertaking eight work placements. Each year over 400 students apply for the course, and a strict assessment process is followed to ensure that those taking the course are fully aware of the pressures, demands and commitment required in the profession.

Page 25 of 31

51) Presently the University of Wales Institute Cardiff is in discussions with the Welsh Assembly Government to increase the number of students. In addition there are discussions to review the format of the course to enable students to study in North Wales.

52) Although every teacher in any school may have a child with speech, language and communication difficulties, the present teacher-training course contains only one workshop to enable student teachers to understand communication disorders.

53) To aid in the training of speech therapists and to enable the present lecturing staff to maintain their expertise in the theory and practice of speech & language therapy the Centre for Speech & Language Therapy also acts as an honorary clinic providing a full range of therapy to children who attend.

54) Meadowbank School provides training for Teaching Assistants who work in mainstream schools with children with language difficulties. Each Teaching Assistant is provided with five training sessions per year. The staff at Meadowbank School are also working with Speech and Language Therapists, Pupil Support Service and mainstream Headteachers to produce and deliver a training package for Early Years Teachers in Cardiff schools.

55) Research identified that almost 85% of Schools had at least one child receiving speech and language therapy services. However Headteachers indicated that they were not fully aware of the training opportunities in Speech & language issues, with many responding that their staff had received no training at all.

56) Headteachers commented that there were insufficient training opportunities available for Teachers, Teacher Assistants and Governors, although demand for additional training was high. They suggested that the Council’s Pupil Support Services should implement an all County training programme to raise awareness of speech language and communication difficulties amongst mainstream teachers and provide training for those directly involved with SEN children, or consider utilising the training facilities provided by the charity ICAN, which offers help for children with speech and language difficulties, as well as reminding Governors of their responsibility towards SEN pupils.

Page 26 of 31

Early Intervention 

57) Parent’s representatives were concerned that the Early Years support for 2 to 5 year olds is perceived to be very poor, with some schools refusing to take children with speech, language and communication difficulties unless they are provided with additional support. There are instances where children have been excluded because the Headteacher considers that the school has inadequate support for the child. This has a considerable impact on a child’s educational progress, as they do not attend nursery prior to school. Parent’s representatives considered that Nursery schools attached to infant schools were the most likely to exclude children on this basis. At present Early Years Team only visits three nurseries, and is therefore limited in the number of children it can serve.

58) All stakeholders stated that Speech & Language Therapy intervention is most effective for a child the earlier it is provided, ideally before the child is attending Primary School. The present outreach service and Early Years support provided by Meadowbank School are regarded as excellent but limited and could be expanded to enable more children to be included.

Council / NHS Co‐ordination 

59) The Headteachers and Special Educational Needs Co-ordinators indicated that the Speech & Language Therapy support provided for pupils was inconsistent throughout the time a pupil was at a school, and between individual pupils.

60) Headteachers and Special Educational Needs Co-ordinators commented that there was a lack of communication / collaboration between the Heath Trust and the individual schools, resulting in schools not being able to support pupils when they were undertaking therapy. Teachers also identified reluctance by pupils to leave school for appointments as they lost considerable learning time and were identified as different by other pupils. Page 27 of 31

61) Parent’s

Representatives

considered

that

the

outreach

services

provided

by

Meadowbank School is very good, but there is a long waiting list of children needing the service. Parents had also complained that there is lack of communication between parents and the outreach service, which results in a lack of understanding of the processes involved in the provision of therapy through the outreach service. The service is also only provided for children at primary level.

62) All stakeholders considered that the most important aspect of co-ordination relates to the responsibility for meeting the needs of children and young people whose statements of educational needs specifies that speech and language therapy is required. Once a statement is in place, it is the Council’s responsibility to ensure the provision of the therapy, although it is the National Health Services that provides the service.

Page 28 of 31

LEGAL IMPLICATIONS 

63) The Scrutiny Committee is empowered to enquire, consider, review and recommend but not to make policy decisions. As the recommendations in this report are to consider and review matters there are no direct legal implications. However, legal implications may arise if and when the matters under review are implemented with or without modification.

64) All decisions taken by or on behalf of the Council must (a) be within the legal power of the Council; (b) comply with any procedural requirement imposed by law; (c) be within the powers of the body or person exercising powers on behalf of the Council; (d) be undertaken in accordance with the procedural requirements imposed by the Council e.g. standing orders and financial regulations; (e) be fully and properly informed; (f) be properly motivated; (g) be taken having regard to the Council's fiduciary duty to its taxpayers; and (h) be reasonable and proper in all the circumstances.

FINANCIAL IMPLICATIONS 

65) The Scrutiny Committee is empowered to enquire, consider, review and recommend but not to make policy decisions. As the recommendations in this report are to consider and review matters there are no direct financial implications at this stage in relation to any of the work programme. However, financial implications will arise if and when the matters under review are implemented with or without any modifications.

APPROACH USED 

66) Scrutiny Services use a project management approach; including mechanisms to consistently prioritise topics suggested for scrutiny (PICK process), scoping reports and project plans. The aim of these is to ensure there is dialogue with the service areas and

Page 29 of 31

partner organisations involved in the scrutiny process with the ultimate aim of improving overall service delivery and enabling effective scrutiny.

67) The initial PICK process and scoping reports were completed with assistance and advice from Schools Service – the service area responsible for working with the Health Authority to ensure the speech and language needs of children are met as fully as possible.

68) The involvement of the Schools Service from the start of the process enabled the terms of reference and timescales for the inquiry to be appropriately framed and ensured that the scrutiny process was undertaken with the full support of the service area.

69) The scoping report clarified the need to look at overall provision of the service and links with partner organisations in order to fully understand all the factors impacting on service provision. It also helped in the identification of appropriate witnesses and stakeholders from whom the Task & Finish Group wished to invite comments.

70) The Task & Finish Group received background, briefing reports outlining the Speech & Language Therapy service in Cardiff and providing an overview of the issues impacting on its provision.

71) They received evidence from Cardiff County Council Pupil Support Service, Local Health Trust, and the University of Wales Institute Cardiff’s Centre for Speech & Language Therapy, visited Meadowbank Special School, and two mainstream schools with special units, as well as hearing from key local stakeholders such as Parents Federation, SNAP Cymru and AFASIC Cymru.

72) The Chair of the Task & Finish Group met with the relevant Executive Member and Officers in order to outline the interim findings and discuss the implications of these.

Page 30 of 31

TERMS OF REFERENCE OF THE CHILDREN & YOUNG  PEOPLE SCRUTINY COMMITTEE 

73) To scrutinise, measure and actively promote improvement in the Authority’s performance in the provision of services and compliance with Authority’s policies, aims and objectives in the area of children and young people, including the following: •

Early years provision of all types

•

Schools and related services

•

Child Protection

•

Vulnerable children, including children in need, children looked after

•

Child Health

•

Youth offending and challenging behaviour

•

Youth service

•

Careers and training

•

Leisure for Under 18s

•

Other issues and services relating to children and young people.

To assess the impact of partnerships with and resources and services provided by external organisations including the National Assembly for Wales, Assembly Sponsored Public Bodies and quasi-departmental non-governmental bodies on the effectiveness of the Authority’s service delivery.

To report to an appropriate Cabinet or Council meeting on its findings and to make recommendations on measures which may enhance the Authority’s performance in this area.

Scrutiny Services, Cardiff County Council Room 6 The Courtyard, County Hall, Atlantic Wharf, Cardiff CF10 4UW Tel: 029 2087 2296 Fax: 029 2087 2579 Email: [email protected] © 2005 Cardiff County Council

Page 31 of 31