Report of the Integrated Speech Language and Communication Service Project, Flintshire and Wrexham, May 2008

‘Communication and language skills are essential to survival. At every twist and turn of the way, therefore, children try to make sense of what they have heard and to respond in a way that they hope will be at least vaguely appropriate and useful.’ Bridges (1997).

‘Language is the key enabler to learning. Provide that key and you unlock the learning.’ Bishop (1998).


1. Introduction / Page 3
o  Purpose of Report
o  Project Origins
o  Project Focus
o  Policy Context
o  Speech and Language and the all-Wales Projects
o  ISLACS Target Group
2. Assessment of Need / Page 9
o  Research and Evidence
o  Integrated Services
o  Models of Joint Working
o  Demographic Data
o  Service Model
3. Current Provision / Page 17
o  Overview and Finances
o  Availability of Services
o  Service Pathways and Processes
o  Planning and Commissioning
o  Local Good Practice
4. Local Good Practice / Page 30
5. Stakeholder Views / Page 34
o  Pupil Views
o  Parent Views
o  School Views
o  Views of Professionals
6. Conclusion: Themes and Issues / Page 45
o  Information
o  Early Intervention
o  Involvement
o  Integration
o  Communication
o  Service Gaps
7. Recommendations / Page 51
8. Appendices / Page 56
o  References
o  List of Available Appendices
o  Glossary

1.  Introduction

Purpose of the Report

1.1  This report is the result of a project funded by the Welsh Assembly Government (WAG) to explore the development of integrated speech, language and communication services across Flintshire and Wrexham. The project became known as ISLACS.

1.2  The project involved the North East Wales NHS Trust (NEWT), Flintshire and Wrexham Local Health Boards (LHBs) Flintshire and Wrexham Local Education Authorities (LAs) and the voluntary organisation Afasic.

1.3  The report sets out to describe current planning, practice and provision and to assess the potential for more integrated services for children with speech, language and communication needs.

Project Origins

1.4  The ISLACS Project was developed following an invitation for bids as part of a WAG initiative on speech and language. The project was approved in the second phase of funding, awarded in March 2006 and commenced in Autumn 2006 with a completion date of March 2008.

1.5  A Project Board was formed at that time, with representatives from the LHBs and LAs together with Parent and Voluntary Association representation.

1.6  The initial aims of the project, as stated in the project bid, were to move towards a future service which would look like the following:

o  “It will be delivered to children and young people at transition stages within the 2-19 age range who have speech, language and communication needs.

o  The action plan will specify the children and young people to be targeted by the Service.

o  On completion of the pilot project the Service will be jointly commissioned.

o  It will be delivered by collaborative services that are jointly commissioned by the Local Health Boards and Local Education Authorities of Flintshire and Wrexham.

o  Service delivery will be seamless with a single point of access for all service users.

o  There will be explicit referral, prioritisation according to need and discharge/exit criteria, and care pathways.

o  The budget will be managed according to Value for Money and Best Value principles.

o  The Service will actively promote seamless and collaborative working.

o  A core value of the Service will be to concentrate on early intervention and preventative methods and will refrain from discrimination on the basis of age, cultural background, gender, language, race, religion or any other consideration. Intervention will be based on relevant individual information and accepted standards of best practice and professional guidelines.

o  To establish an integrated joint team which will provide a single, effective and coherent pathway for services for children and young people who have speech and language needs.

o  To develop equitable services across the county boundaries.”

1.7  The emphasis on transition within the project bid and initial specification was included because it was felt that the transition stages can be a vulnerable time for children and young people. If the service had capacity and was comprehensive at these stages then it was seen as reflecting a general robustness.

1.8  The project was co-ordinated through WAG by a Pilot Project Co-ordinator and, as part of the process across all Wales, three central meetings were held during the life of all the Welsh projects which enabled the sharing of information.

1.9  Towards the final stages of all the Welsh projects, WAG commissioned an independent evaluation which was undertaken by CRG Associates in November 2007, with a final report due to be delivered in the summer of 2008. The initial findings have been made available through WAG.

Project Focus

1.10  Prior to December 2005, there was an established and successful commitment to joint working practice between NEWT Speech and Language Therapy Services, Wrexham and Flintshire LAs and schools. Despite this commitment there was also a mutual recognition of the rising demand and of the considerable challenges in relation to identifying the best way of mutually meeting these needs.

1.11  In common with other projects across Wales, the specific aim of ISLACS was to use the 1999 Health Act in order to develop an integrated service for children and young adults with speech and language and communication difficulties.

1.12  The Act amended the law regarding arrangements between local government and the NHS, allowing joint commissioning, joint funding and joint provision of services. The ISLACS project set out to take advantage of the Act by:

o  Identifying current and future (next 10 years) need/ demand for speech, language and communication support across the two Local Authorities

o  Identifying current resources devoted to speech, language and communication services, assess their capacity to deliver (for example current provision, workforce availability) and identify any unmet need

o  Identifying good practice locally and nationally using both research evidence and consultation with local professionals, parents and young people.

1.13  Furthermore it was intended to use the information from the above and in consultation, advise on the structure, management and resourcing of a single equitable service for the delivery of support to children and young people (2- 19) in North East Wales who have speech, language or communication needs (SLCN).

1.14  It was anticipated that the data produced would have a high level of impact and potentially involve radical changes to service delivery. Such changes were likely to be founded on existing good practice both locally and nationally. It was also anticipated that changes would be made within existing resources.

1.15  The ISLACS project spanned a period of eighteen months and this placed some time limitations on the nature of the audit and the development of proposals. This was recognised to be the case for all second wave pilots and resulted in the suggestion that projects narrow their focus somewhat. This report therefore may be seen as a platform to further develop the initial remit of the project submitted with the original bid.

1.16  The project was overseen by the Project Board and the work undertaken by three half-time coordinators, selected and appointed on the basis of their experience and local knowledge. They were:

o  Specialist Educational Psychologist, Flintshire

o  Senior Educational Psychologist, Wrexham

o  Speech and Language Therapy Service Manager, (Sept 2006-Summer 2007)

o  During the autumn term 2007 a Project Administrator was appointed on a term-time basis and in February 2008 an external advisor, was appointed by the LHB to facilitate completion of the report.

1.17  An initial project action plan was drawn up and this was developed and amended throughout the project. Regular meetings were held throughout the project to agree tasks and share perspectives.

1.18  During the first term of the project there was a focus on agreeing the remit, finding accommodation and appointing administrative support. During the Spring and Summer of 2007 wide-ranging consultation was undertaken with service users, parents, school-based referral agents and co-providers. This consultation covered most of those directly involved in speech, language and communication work but due to time constraints did not include some wider stakeholders, such as health visitors or GPs.

1.19  Throughout the project the coordinators sought to gather information via their own professional knowledge, literature research and discussions with selected professionals working in the field.

1.20  The final stage of the project involved writing up the data collected into a report and the development of proposals for further action locally. The report will also be submitted to WAG with a view to developing good practice guidance on the basis of the project outcomes across Wales.

Policy Context

1.21  There are a number of policy drivers influencing change. Some of these are shared by all agencies; others are more specific (and it is sometimes these differences which make the alignment of priorities across agencies difficult).

1.22  In many ways the recent policy context makes work on integration both more necessary and more possible. Educational policy and practice have long stressed the importance of social, economic and health factors upon educational attainment. Similarly Health policy increasingly stresses the importance of close working with universal services to improve health outcomes.

1.23  Recent legislative initiatives such as the Children Act (2004) and the Health Act (2006) also provide the tools with which to promote this culture and practice of integration.

1.24  At a national level all agencies have a key role in all aspects of development to achieve the seven core aims for children and young people set out by WAG:

1.  Have a flying start in life

2.  Have a comprehensive range of education and learning opportunities

3.  Enjoy the best possible health and are free from abuse victimisation and exploitation

4.  Have access to play, leisure and cultural activities

5.  Are listened to, treated with respect and have their race and cultural identity recognised

6.  Have a safe home and a community which supports physical and emotional wellbeing

7.  Are not disadvantaged by poverty.

Policy Drivers: Children and Young People
Health / Shared / Local Authority
Global / WHO / UN Convention on Rights of the Child / UNESCO
National / NHS Act / Children Act 2004 / Code of Practice
Access Targets / Working Together / Early Years Foundation Curriculum
National Service Framework
NHS policy / Welsh Language / Estyn
Professional / Communicating Quality 3 / Teacher Status Standards
Local / Local Needs / C&YP Frameworks / Single Education Plan

1.25  These policy drivers and national strategic aims have been translated into local priorities for children and young people. Overseeing this process are the Framework Partnerships in each Authority.

Wrexham / Flintshire
C & YPS The Promise:
Learn and achieve
Be safe from harm
Be healthy and active
Enjoy and participate / CYPP Priorities:
Support parenting
Reduce behaviour and conditions that put children and young people at risk
Support vulnerable individuals and groups
Safeguard children and young people
Raise children and young people’s attainment in learning settings
Inclusion of all children and young people
Reduce impact of poverty & deprivation
Workforce: a skilled, competent and knowledgeable workforce
Information: available and accessible to all
Single Education Plan:
Raising educational achievement
Increasing inclusion and participation
Improving the educational environment
Improving the coordination of services

Speech and language and the all Wales projects

1.26  Within the context of these multiple policy drivers, numerous reports have highlighted the importance of speech, language and communication, both to child development generally and to educational attainment specifically

1.27  In Wales WAG attempted to progress the recommendations of a UK Joint Working Party, published in 2000.

1.28  The Speech and Language Therapy Action Group (SALTAG) was established in 2002 in response to concerns over the escalating demand for speech and language therapy and the lack of a coherent approach by the statutory agencies to meet this demand.

1.29  The outcomes of the SALTAG deliberations were presented in the consultation document ‘Working Together’ (WAG, 2003) which contains a wide range of recommendations. A key recommendation was that Local Health Boards and Local Authorities should work together within partnership arrangements for the delivery of speech, language and communication services to children and young people.

1.30  ‘Working Together’ stated that: ‘Mechanisms and structures need to be established that support true collaborative working, with joint planning, joint training, joint prioritisation and shared sense of responsibility to meeting needs’

1.31  Consequently, as part of progressing some of the recommendations of the ‘Working Together’ document, pilot projects were established across Wales to establish joint commissioning services for children with speech, language and communication needs. The remit stated:

“For effective integrated working, the providers need to have resolved that there are clear management structures, professional accountability, clear performance management of the service and a joint location of the service and proper administrative support.”

ISLACS Target Group

1.32  It was envisaged that integrated services would focus much of their involvement and intervention on home and educational environments. However, in order to ensure that there was a shared understanding of the target group for integrated services, the following list was compiled. This represents the groups most likely to need speech, language or communication support. It was acknowledged that some of these would lend themselves to integration locally, while others (such as cleft palate services) might be part of more specialist regional networks (N.B. Children may fall into more than one category):

o  Pupils experiencing a developmental SLC delay

o  Pupils having a specific speech and language impairment

o  Pupils with speech, language and communication needs, including:

§  Autistic spectrum disorder

§  Sensory impairment, in particular hearing disorder

§  Learning difficulties (severe and moderate)

§  Selective/elective mutes


o  Pupils with cleft pallet and velopharyngeal abnormalities (many regional acute services provided by Alder Hey)