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March 2018
www.bercow10yearson.com
Bercow:
Ten Years On
An independent review of provision for children and young people
with speech, language and communication needs in England.
2 BERCOW: TEN YEARS ON FOREWORD
Contents
Foreword
3 Foreword
4 Introduction
6 The children and young people Chairing the Review of Services for Children reforms in a generation for children
and young people with special
and Young People (0–19) with Speech, Language educational needs in 2014.
8 Background and Communication Needs (SLCN) 10 years ago
It is in the context of these
was the most stimulating project of my changes that I was delighted
10 Communication is crucial parliamentary career up to that point. to learn of the intention of I CAN,
the children’s communication
charity, in partnership with the
15 A strategy for system change Given the vital importance of In the years following the
Royal College of Speech and
communication to a child’s life report’s publication, a number
chances, the chance to make a of our recommendations were Language Therapists (RCSLT),
19 An accessible and equitable service for all families difference was a privilege I was implemented, including: to undertake an independent
honoured to accept. review of provision for children
the creation of the and young people with SLCN
24 Support that makes an impact During the review we identified Communication Council; in 2018.
five key themes – issues that the post of Communication
30 Early identification and intervention are essential needed to be addressed for Champion, which was filled The 10th anniversary of the
real change and improvement by Jean Gross CBE; original report provides an ideal
to happen: opportunity to look again at
a National Year of Speech,
38 Conclusion Language and Communication
provision for children and young
Communication is crucial people with communication
in 2011; and
Early identification and difficulties, and ensure their needs
40 Recommendations in full intervention are essential the Better Communication are placed at the heart of local and
Research Programme,
A continuum of services national policy, where they belong.
46 References a programme of research to
designed around the family
enhance the evidence base It is my hope that this report will
H O W TO R E A D T H I S R E P O RT is needed
and inform delivery of better act as a call to action to all those
Joint working is critical outcomes for children and
A summary of recommendations are
involved in supporting children
included at the end of each chapter. The current system is young people with SLCN. and young people, to come
characterised by high together and do what is needed
Recommendations in full can be
variability and a lack of equity There have also been many
to make a difference to the lives
found at the end of the report. important developments since
The final report which we of those for whom communication
the publication of the report that
The Bercow: Ten Years On website
published in 2008, focused on is more difficult.
have significantly impacted on
contains further calls to action practical proposals to improve services for children and young RT HON. JOHN BERCOW MP
and practical steps that everyone services, together with measures people with SLCN, such as changes
can take. which sought to embed speech, within the commissioning and
The full report can be downloaded
language and communication provider landscape, and the
from www.bercow10yearson.com in wider policy frameworks for Children and Families Act, which
the future. ushered in the biggest education
4 BERCOW: TEN YEARS ON INTRODUCTION
Time for change What this report shows prioritised. This is the case in decisions
Introduction
about planning, commissioning and
A lot has changed in the 10 years Speech, language and communication funding services, and there is often no
since The Bercow Review of are critical to children and young joined-up approach across education
Services for Children and Young people’s development, but a lack and health. So, service models are
People with Speech, Language of awareness and priority has led to far less effective and the workforce
and Communication Needs in 2008. national and local strategies that do is not sufficiently equipped to have
Some of this change has been for not have the speech and language of the necessary positive impact on
the better, but sadly far from all of it. children and young people at their children and young people. Their
heart. Nor do they recognise the needs are too frequently unidentified
The most fundamental life skill for children is Without a shift in approach, children
numbers of children and young people and unsupported.
the ability to communicate. It directly impacts and young people will continue to
with SLCN. There is a lack of clear
leave school without basic language But it can be different, and we will show
on their ability to learn, to develop friendships and literacy skills. We will continue
leadership and limited understanding
of the need to work across and between outstanding examples of what can be
and on their life chances. As a nation, we have having disproportionate numbers achieved, as well as recommendations
the health and education systems.
yet to grasp the significance of this and as of young people with SLCN who are which seek to secure this good practice
a result, hundreds of thousands of children not in education, employment or As a result, the SLCN of children for all.
training, who need mental health and young people are not sufficiently
and their families are suffering needlessly. support or who are in contact within
This report aims to help change this situation. the youth justice system. Children
and young people with lifelong
More than 1.4 million children and young communication needs will not get
the support and adjustments they
Key changes since 2008
people in the UK have speech, language
and communication needs (SLCN). Language
require. As a result, children and POSITIVE
young people with the potential
disorder alone is one of the most common More evidence about
to do well will struggle to make
SLCN through the
disorders of childhood,1 affecting nearly 10%2 an active contribution to society Better Communication
of children and young people everywhere as adults. Research Programme.
throughout their lives. In areas of social We cannot afford, socially or THE CHANGING
Consistent government
economically, to continue with LANDSCAPE
disadvantage this number can rise to 50%3,4 funding for workforce
the status quo. development in SLCN. Reforms and
of all children and young people, including reorganisation NEGATIVE
those with delayed language as well as national service
A
of the NHS. Austerity and resulting
specification for
children with identified SLCN. Alternative and Academies and free cuts to services.
Augmentative schools – increased Loss of senior and
Poor understanding of and insufficient Communication (AAC). autonomy for schools. specialist speech and
resourcing for SLCN mean too many children I ncreased recognition eforms to support for
R language therapy posts.
and young people receive inadequate, of SLCN in the children with special Removal of speaking
justice system. education needs and and listening from the
ineffective and inequitable support, impacting MORE THAN
1.4M
disabilities (SEND). National Curriculum.
Language and
on their educational outcomes, their communication as one Significant changes in Removal of a judgement
employability and their mental health. of the three prime areas the use of technology.
CHILDREN of the Early Years
of communication from
the Ofsted framework.
with speech, language and Foundation Stage
We must improve the outcomes No assessment in
curriculum.
for these children and young people. communication needs (SLCN) spoken language
after age five within
the curriculum.
6 BERCOW: TEN YEARS ON THE CHILDREN AND YOUNG PEOPLE
The children
and young people
More than 10% of children and young
people have long-term speech, language
The impact
and communication needs (SLCN) which We have more evidence than ever before
create barriers to communication or learning demonstrating the direct impact of SLCN
in everyday life: on children’s life chances.
∙ 7.6% have developmental E D U C AT I O N A L AT TA I N M E N T
language disorder.5 Just 26% of young children with SLCN made
∙ 2 .3% have language disorders associated expected academic progress in the Early
with another condition such as autism Years Foundation Stage9 compared with
or hearing impairment.6 69% of all children.
∙ SLCN also include conditions such as speech
Just 15% of pupils with identified SLCN
difficulties, stammering and many others.
achieved the expected standard in reading,
Children living in areas of social disadvantage writing and mathematics at the end of their
are at much higher risk, with around primary school years10 compared with 61%
50% of children starting school with delayed of all pupils.
language and other identified SLCN.7,8
Only 20.3% of pupils with SLCN gained grade
4/C or above in English and maths at GCSE,
compared with 63.9% of all pupils.11
SOCIAL, EMOTIONAL
A N D M E N TA L H E A LT H
81% of children with emotional and
behavioural disorders have unidentified
language difficulties.12
Young people referred to mental health
Developmental services are three times more likely to
language disorder: have SLCN than those who have not
A condition been referred.13
where children
have problems LIFE CHANCES
understanding Children with poor vocabulary skills are
and/or using spoken twice as likely to be unemployed when
language. There is they reach adulthood.14
no obvious reason
for these difficulties 60% of young offenders have low
– no hearing problem language skills.15
or physical disability
explains them.
8 BERCOW: TEN YEARS ON BACKGROUND
Background
Bercow: Ten Years On We consulted with more than 2,500 people
follows in the footsteps of between January and November 2017
its predecessor The Bercow
Report16, investigating the Surveys and Submissions Oral evidence sessions
services and experiences of Main survey of The impact of SLCN: what
practitioners and others happens if needs are not
children and young people identified or supported
Parents and carers of
with speech, language and children with SLCN Support for children
communication needs Children and young people aged 0-2
(SLCN) and their families. Commissioners – health, Commissioning of support
local authority and schools for children and young
This extensive review has heard people with SLCN
Employers
from more than 2,500 people Low-incidence, high-need
75 written evidence The resulting report presents a Our analysis of the evidence
across England; more than conditions: deafness,
submissions picture of the current landscape collected identified five key themes
contributed to the original Bercow selective mutism, cleft lip for children and young people with which provide the structure for
review. We collected views from and palate, brain injury SLCN with a focus on solutions, this report:
parents and carers, children and and stammering and presents examples of effective
practitioners. We also spoke to The links between Communication is crucial,
practice. Further information
employers, commissioners and language and social yet awareness of children
is available on the Bercow:
other local leaders. Whilst informed disadvantage and young people’s speech,
Ten Years On website:
by a rich body of recent academic language and communication
www.bercow10yearson.com
studies and reports, the focus of is not sufficient.
the review is on the new evidence Digging deeper The report and website include: Systemic change is needed
from the front line; from local – speech, language and
practice and from the experiences recommendations to
communication must form
of children and their families. Focus groups with children and young people government and local leaders
a core part of national and
In-depth review in three local authority areas to ensure change is sustainable
local plans.
and embedded;
Review of relevant research and policy reports Services must be equitable.
bold calls to action for those
Currently there is far too much
involved in supporting children
variation in the support children
and young people; and
and young people receive for
signposts to helpful information their SLCN.
The review benefited from a for practitioners, children and
decision-making panel of key Support must make a difference
young people, and parents and
influencers, chaired by Jean Gross and be based on the evidence
carers to respond to the calls
CBE, guiding and supporting the of what works.
to action.
process. It was further supported Children and young people’s
by an advisory group of experts: needs must be identified
practitioners, researchers and early and then supported
decision-makers. appropriately.
10 BERCOW: TEN YEARS ON COMMUNICATION IS CRUCIAL
them when they need it, and parents and carers and mental health problems, and involvement
regularly encounter professionals whom they in the justice system.
Communication
felt did not know enough to effectively support
them and their children. T H E S O C I A L I M PA C T
Readily available information is essential but Lack of awareness is an issue not just for
is crucial
parents and carers reported low priority given individual families, but for society as a whole.
to speech, language and communication in Half of children and young people living in
children’s services. There is no clear message deprived areas may have SLCN.17,18 Children and
for parents and carers about speech, language young people are at high risk, with a stark social
and communication in the way that there is for gradient in the quality of language they hear,19
a good diet or exercise. Yet spoken language is impacting on educational outcomes20 and
vital for our children’s cognitive development health inequalities. In 2010 The Marmot Review
Speech, language and communication What needs to happen and mental health, just as diet and exercise are reported that children from disadvantaged
skills are crucial to every person: for brain We need everyone to understand speech, crucial for physical health. backgrounds were more likely to begin primary
language and communication needs (SLCN) school with lower language and literacy skills
development in the early years and our Where information sharing is working well than their peers.21
better. Think of the difference that wider public
attachment to others, for expressing ourselves understanding of autism, mental health and
services are using innovative methods such as
social media, video clips and other technology More recently, reports have found
and understanding others, for thinking and dementia have made in those areas. Only
presenting information to parents and carers a link between:
learning, for social interaction and emotional through having greater awareness of SLCN, and
in accessible ways. social disadvantage and school
their impact on children and young people’s life
wellbeing, in school, as part of society and chances, will we raise the profile of SLCN and T H E I N D I V I D U A L I M PA C T
readiness22; and
in the workplace. Yet despite their centrality, speech, language and communication
ensure these needs are prioritised. Our consultation with children and young development and health.23
the importance of these skills continues
The evidence
people highlighted the crucial nature of spoken
to be widely underestimated. language, with children commenting that their
Our evidence shows a lack of awareness difficulties made everything more challenging,
and information about speech, language both inside and outside of school.
and communication in general and more
specifically about SLCN. There is both a social In school, the sheer amount of language can be Our research has shown
and economic impact of not providing support overwhelming, especially if teaching staff are very little change in
to children with these needs. unclear on how best to support language parents and carers’
in the classroom. views in the last 10 years,
L A C K O F A W A R E N E SS The children and young people we talked to
with 78% reporting
A N D I N F O R M AT I O N information was either
also recognise the impact of SLCN on their own
Since the Bercow review in 2008 there has been not easily available or
wellbeing and how a lack of understanding in
some progress in awareness of the crucial role not available at all; in
the adults around them can make the situation
of speech, language and communication. But 2008 the figure was 77%.
much worse.
the momentum created by the initial review has
not been maintained. There is still insufficient Children with SLCN told us:
public awareness and understanding among “It makes everything hard”
i decision-makers and professionals about
Language is crucial: the importance of speech, language and “Talk too many words and my head can’t
The most important communication, particularly beyond the do it really like BOOM!”
factor in reaching the early years of life.
“It isn’t good when they shout if we don’t
expected levels in English understand, 'cause people might get
“With greater public awareness comes
and maths at age 11
greater pressure on funders to provide a little bit sad”
was children’s language
skills at age five; more an appropriate level of service for this Information from our oral evidence sessions
important than poverty population” Professional Association described a situation of compounding risks:
or parental education.
Save the Children (2016)
Although there is more high‑quality information children who enter school with SLCN are at
higher risk of literacy difficulties, which in
“It makes everything hard”
available for practitioners and parents and
The Lost Boys carers, our surveys told us it is still not reaching turn increases the likelihood of behavioural
12 BERCOW: TEN YEARS ON COMMUNICATION IS CRUCIAL
“Poor communication and ineffective Now is the time to ensure plans such
acquisition of early language are as apprenticeships and vocational skills
associated with behavioural problems, programmes take account of the need to
in turn linked to worse outcomes, support young people’s speech, language
including worse health, throughout life” and communication.
UCL Institute of Health Equity24 T H E D I F F E R E N C E T H AT C A N
“Children’s language development should BE MADE
be viewed as a public health wellbeing We heard examples of excellent local initiatives
indicator, rather than just as an individual recognising the crucial role of communication
or ‘clinical’ concern. Child language is and prioritising language to tackle social
similar to obesity and other risk factors disadvantage in the early years.
(such as mental health and diet) in terms of
its impact on children’s overall wellbeing”
Early Intervention Foundation25
The Department for Education’s social mobility
action plan26 recognises a gap between the early
language skills of children from disadvantaged
backgrounds and those from more advantaged
areas. Given the Government’s vision for a
country in which it is your talent and hard
work that matter, rather than where you were
born or who your family are,27 we need greater
recognition of the importance of speech,
language and communication to the social
mobility agenda across Government.
T H E E CO N O M I C I M PA C T
The lack of awareness of the importance of
spoken language also has an economic impact.
Communication skills are highly regarded in GOOD PRACTICE EXAMPLE
“It isn’t good when
the workplace, but employers experience Warwickshire Time to Talk
challenges in recruiting staff with adequate prioritises speech, language and
skills across all levels, from entry level communication. They have expanded
they shout if we
through to graduate entrants.28 and contracted as funding changed,
Communication difficulties at all levels in the developing traded services and
thinking creatively. They collect data
don’t understand,
workplace can impact on problem solving,
effective practice and decision-making.29 each year, evidencing impact. They
Loss of production through the lack of soft train champions, some with level
3 qualifications – 98% of settings
'cause people might
skills, including communication, has been
estimated at £8.4 billion a year by 2020.30 now have a champion. They spread
Raising awareness of and improving the speech, the word locally with leaflets, multi
media campaigns, films and growing
get a little bit sad”
language and communication skills of children
and young people needs to be recognised social media networks. Their
as a solution to increasing employability promotional week is in its fifth year.
and productivity across Government.
14 BERCOW: TEN YEARS ON COMMUNICATION IS CRUCIAL A STRATEGY FOR SYSTEM CHANGE
A strategy for
system change
Speech, language and communication are Our evidence clearly demonstrates
the lack of a strategic approach
foundation life skills. Children’s communication to supporting children with SLCN:
“Quality interaction In this chapter we have highlighted the is everyone’s business. However, speech, language 95% of respondents to our survey
impact that lack of awareness of children and communication needs (SLCN) rarely feature in felt that central Government’s
at every point makes and young people’s communication can have. national policies. The result is an absence of integrated contribution to raising standards
the difference.” Our recommendations will raise awareness system‑wide approaches to supporting children and
and improving outcomes for
children and young people with
SPEECH AND LANGUAGE THERAPIST and put speech, language and communication young people with SLCN, both locally and nationally. SLCN is either not clear or in need
of strengthening.
centre stage in public policy.
Without a clear and unified
The evidence It doesn't have to be this way.
Recommendations
message from the highest levels In our oral evidence session we
in both education and health, Our evidence shows a lack
heard about a national strategic
1.1 Public Health England should develop clear messages support will continue to be of leadership and a lack of a
approach to addressing speech,
and information for parents and carers regarding speech, inconsistent and insufficient. cohesive approach for children
language and communication
language and communication and promote these Many children and young people and young people at a national
development in Scotland.
directly to public services. will miss out on the support they level, impacting on the priority
need, and the impact will be costly, given to SLCN at a local level. In In response to an amendment
1.2 The Department for Education should strengthen the places with strong and committed debate in the Scottish Parliament
both to the economy and society.
place of communication and language in its strategy local leaders, who drive shared in February 2016, Scottish
to improve social mobility.
What needs responsibility and buy in, children
and young people with SLCN
Government committed to a
to happen
1.3 Local authorities should ensure that evidence from this Communication Summit held
GOOD PRACTICE EXAMPLE are better supported. We need jointly with the RCSLT. At the event,
report is included in their contribution to tackling health
We need a national strategy to ensure this good practice is cross sector leaders gathered to
Language is used to tackle social inequalities: in their published Joint Health & Wellbeing
for children and young people replicated nationwide. discuss the importance of children
disadvantage in children’s centres Strategy and in their contribution to Integrated Care
in the Kirkby area of Knowsley, an Systems. In their inspections, regulators should check to ensure their needs are and young people's speech,
prioritised across government; N AT I O N A L S T R AT E G Y language and communication
area of high need. They focus on to see that this evidence is reflected. A N D P O L I CY
their community through the local within that strategy, we need the development and agree how to
children’s centre, with prevention, 1.4 The Department for Education should ensure that importance of communication to Providing early support to children work together to improve this. As
communication skills, specifically those identified as be recognised and consequently and young people can reduce a result of the summit, Scotland’s
early identification and appropriate
needed for the workplace, are appropriately recognised integrated into all plans for the likelihood of severe problems Deputy First Minister and Cabinet
support to get children ready for
in the criteria for the Functional Skills qualifications. children and young people. later in life, which could cost Secretary for Education and
school. Workforce development
an estimated £16.6bn a year.31 Skills requested an Action Plan
and production along with parents 1.5 The Education and Skills Funding Agency should revise At a local level, we need strong Yet children are not sufficiently for systemic change and growth
and carers are key, alongside their apprenticeship funding rules for training providers leadership to ensure that speech, prioritised by government, as of Scotland’s speech, language
working with charities such as I CAN. and employers, to include training for communication language and communication is shown by the lack of a cross- and communication assets.
Following the introduction of the skills development in the list of items that can be funded. integral to local plans and that governmental strategy for
new pathway, 72% of children now integrated systems are put in place
See page 40 for the recommendations in full. Further calls children and young people.
meet expectations. to support children and young
to action and practical steps that everyone can take can
be found at www.bercow10yearson.com people with SLCN.
16 BERCOW: TEN YEARS ON A STRATEGY FOR SYSTEM CHANGE
The absence of children and young people is notable
in health policy: the Royal College of Paediatrics and
Child Health (RCPCH) have reported that child health
is suffering due to a disjointed approach from central
Government in England.32 53% of survey respondents did not feel that
the way children learn in schools supports
Where children are included in health policies, they their spoken language development.
rarely mention SLCN, more frequently focusing on
issues such as obesity33 and tooth decay.34 While the
government’s commitment to prioritising children Children and young people with SLCN who took part
and young people’s mental health is welcomed, in our focus groups commented on the particular
we are concerned that speech, language and challenges of their educational experiences, including
communication is not recognised as a risk factor.35,36 working in silence and the focus on writing.
Beyond the early years, education policy puts very “Working in silence, that is bad. Because the
little emphasis on spoken language. Since the teacher is telling us to be quick when we are
publication of the original Bercow Review in 2008, trying to ask questions. It doesn’t help at all” GOOD PRACTICE EXAMPLE
there is no longer a distinct ‘speaking and listening’ Child with SLCN Stoke Speaks Out is a multi-agency
strand to the National Curriculum in schools, and initiative to tackle the high incidence
spoken language has been removed from the grading “[What I find difficult is]... lots of writing, because
of delayed language in Stoke-on-Trent.
of GCSEs in English and English language, sending a it’s really boring and really, really tricky” With strong local leadership, this city‑wide
signal to schools that spoken language is not a priority. Child with SLCN strategy offered training and support for all
practitioners working with children under
seven and their families. The initiative
resulted in huge improvements
T H E N E E D F O R A N I N T E G R AT E D A P P R O A C H T H E I M P O R TA N C E O F L E A D E R S H I P in children’s early language, with an
18% reduction in the number of children
Unclear lines of responsibility and variation in the Of the 44 sustainability and transformation plans In our review we heard repeatedly that restructuring of with delayed language at school entry.
extent to which speech, language and communication (STPs) published in 2016, only three mention children’s NHS speech and language therapy services over recent A return‑on-investment analysis of Stoke
is included in local plans are concerning. Our survey speech, language and communication. years has resulted in the downgrading or removal of Speaks Out, conducted by the New
found that 42% of respondents feel it is not clear who senior posts, meaning there are fewer speech and Economics Foundation, has demonstrated
has overall responsibility for speech, language and Parents, carers and practitioners alike are too often language therapists working at a strategic level with
frustrated by the inefficiencies caused by the lack the contribution that the programme
communication in their area. the ability to influence decision-makers. The same is makes to improved school readiness
of an integrated system. true for educational leadership for children’s SLCN. We for children at age five, and improved
Strongly heard in our evidence of many local authority advisory educational attainment and prevention
Strongly “I was leading on any health issue and was
Agree Disagree services being reduced or disbanded.
7%
spending half my day trying to sort things out of offending amongst young people in
10% with people saying, this isn’t mine, we’re not “ ...[we] have seen a reduction in senior posts and the long-term.
responsible for that... that made us think, so specialist knowledge of speech, language
we’ve just got to do this in a more joined-up way. and communication/SLCN has gone, both in
And it saves time” Head of Commissioning education and speech and language therapy In their first year of local area SEND inspections,
It is clear who services” Professional Association Ofsted and CQC also found that, “in the most effective
Agree has overall Disagree Many people told us that the joint Ofsted and CQC
48 35
% responsibility % local area special educational needs and disabilities local areas, strong strategic leadership had led
Yet a strong theme emerging from the review has been
for speech, (SEND) inspections have the potential to be a positive to established joint working between education,
language and the importance of local leadership. In our evidence
driver towards a more integrated approach. Of the first health and care services... [In areas of significant
communication the areas with more strategic, well-developed and
16 areas where inspectors had significant concerns concern] leaders were unable to secure much needed
impactful support were led by strong local leaders
about the local area, 11 of the inspection reports joint working, leading to poor collaboration and
who recognise the importance of speech, language
identify strategic planning, joint commissioning commissioning between professionals from education,
and communication.
or leadership as areas of significant weakness. health and care.”37
18 BERCOW: TEN YEARS ON A STRATEGY FOR SYSTEM CHANGE AN ACCESSIBLE AND EQUITABLE SERVICE
An accessible and
equitable service
for all families
In this chapter we have shown that
children and young people with SLCN
rarely feature in either national or local
plans. Our recommendations call for a Our evidence shows a system of fractured
national strategy for children and young THE COMMISSIONING LANDSCAPE services and high levels of inequity for
people, with a recognition of speech, Since 2008 the commissioning landscape children and young people. The postcode
language and communication at its has changed rapidly, becoming more and
lottery described by families 10 years ago
heart. The strategy must be underpinned more complex. The Health and Social
Care Act (2012) established clinical remains: the support you get depends on
by strong leadership in order to deliver commissioning groups (CCGs) as the where you live or where you go to school.
the change that is needed. primary commissioners of the majority of
health services, able to commission from a The variation in availability of services to support
multiplicity of providers. The responsibility
Recommendations
children and young people with speech, language and
for commissioning specialist services sits communication needs (SLCN) is unacceptable. With
N AT I O N A L ST R AT E G Y A N D P O L I CY T H E I M P O RTA N C E O F L E A D E R S H I P with NHS England, while public health decisions about children made in local areas, and no
moved to the remit of local authorities. clear steer from government, there is wide variability
2.1 The Department for Education and the 2.5 Government should establish a system leadership
Meanwhile, education funding has across England.
Department of Health should use the findings group to drive forward the recommendations of
increasingly been devolved to schools, who
and recommendations of this review as the driver the report, and the tangible actions arising. Where there has been a push from government is
have also now entered the playing field
to develop a new cross-governmental strategy towards outcomes-based joint commissioning.
2.6 Government should ensure that existing and future as commissioners of support for children
for children, including a joint statement about However this is still the exception rather than the rule.
leadership boards include parents and carers and with SLCN.
the importance of children’s speech, language
and communication. an expert in speech, language and communication Health and Wellbeing Boards were intended We have found examples of excellent joint
and SLCN to inform strategic decisions. to bring all partners together to improve commissioning, but more commonly we have heard
2.2 Ofsted should review the extent to which the the health and wellbeing of their local about services that are commissioned in a way that
teaching and monitoring of spoken language is 2.7 School leaders should ensure that the
importance of spoken language is reflected in population, with the potential to play a key cannot meet local needs, driven by unhelpful targets.
taken into account in its framework for inspection role in joint commissioning. The Children Commissioners themselves are too often forced to
when next revised in 2019. their schools’ special educational needs (SEN)
information report. and Families Act (2014) also required local focus on the short term, rather than planning based
2.3 Government should commission Ofsted and authorities and partners to make “joint on longer term impacts and costs.
the CQC to continue their inspections of local 2.8 NHS England, NHS Improvement, Public Health commissioning arrangements” to provide
areas and SEND beyond the current initial five England and Health Education England should for children with special education needs
year cycle. make use of the evidence from this review and disabilities (SEND).
regarding the impact of effective leadership on
2.4 The Department for Education and the improving service commissioning and provision,
Department of Health should strengthen the to demonstrably inform their work developing
place of speech, language and communication leadership in the allied health professions.
in its proposals to transform children and young
See page 40 for the recommendations in full. Further calls
people’s mental health provision. to action and practical steps that everyone can take can
be found at www.bercow10yearson.com20 BERCOW: TEN YEARS ON AN ACCESSIBLE AND EQUITABLE SERVICE
What needs to happen A number of factors compound this situation. Reduced
levels of public funding mean that commissioners and
Within a local area, we need systems in place to leaders of children’s services have limited resources,
ensure support is planned and funded so that it reduced capacity, and competition for limited funds.
meets children and young people’s SLCN regardless
of where they live. Local areas and schools should be “Money and resources will always be an issue and
aware of how many children and young people have never more so perhaps than now. Inevitably this
SLCN in their community, and use this knowledge to puts a strain on relationship between service
commission support accordingly. To do this we need providers, schools and families” Assistant
commissioners to understand SLCN. Director of Children’s Services
Commissioning should be based on what makes a “...I was given the devastating news just before
difference for children and young people, both in the Easter that speech and language therapy
short and long-term. We need more collaboration in our area has been outsourced and that they
and for agencies across local areas to jointly take are no longer funding children in junior school
responsibility for ensuring support is available for
and above!” Parent
children and young people with SLCN, whatever
their age or level of need. The formation of integrated care systems, while
controversial, may enable closer collaboration
The evidence between NHS organisations, local authorities and
Our evidence shows an unacceptable level of variation others, who have the potential to address these issues. We heard from commissioners that one of the biggest “True needs-led joint commissioning across
in the support available to children and young people barriers is that there is no widely accepted definition disciplines would allow the holistic needs
The increase in the number of schools commissioning
with SLCN, as a result of commissioning which is not of what joint commissioning means, and for schools in of children and families to be addressed
speech and language support presents both
based on an analysis of local need. particular commissioning is a relatively new concept. in the most efficient and effective way”
opportunities and challenges. Some schools are
forming networks to share resources; for example Our evidence also found that many commissioners do Speech and language therapy service
CO M M I SS I O N I N G
a partnership made up of 10 schools in Brighton, not have sufficient understanding of speech, language
Repeatedly joint commissioning was highlighted as most of whom have a speech and language and communication, particularly for low-incidence,
one of the most promising solutions to providing champion. The network provides a safe place for high-need conditions where they are unlikely to Excellent Good
equitable and accessible support. Where it is
happening, leadership and knowledge are key.
schools to discuss how they can use their funds have detailed knowledge: conditions like selective 4 % 25%
effectively, also providing a vehicle for sharing mutism, hearing impairment and stammering. Given
The commissioning landscape is complex, and disseminating ideas. their competing priorities, increasing commissioners’
characterised by a huge variety of commissioners understanding is crucial, with strong leaders in local
However, it can also lead to variation in the support
and providers, with a lack of clarity about who is services who can work with and help to inform their
that is available so that this depends not just on Nearly 40% of
responsible for providing what. Our evidence provided commissioning decisions. participants felt
where you live, but where you go to school.
confirmation that on-the-ground joint commissioning commissioners'
Commissioning should be based on a robust analysis understanding of
is not easy. “Commissioning by schools varies very much from
of the needs of the local population in order to ensure speech, language
head to head and their priorities – some heads the right support is available. Yet our evidence shows and communication
Very often joint commissioning arrangements are required significant
see very little value of speech, language and that in many areas this is just not happening. Local
patchy; in an RCSLT survey, speech and language improvement
therapists reported varied and inconsistent levels communication and feel other curricular areas data systems are not joined up across education,
of joint commissioning.38 This issue is not limited far more important. Thus, very big discrepancies health and local authorities making it very difficult
between similar schools...” Professional In need of
to speech and language therapy.39 to collate an accurate picture of the populations’ significant
Association needs.40 For example, information collected on improvement Satisfactory
“Current commissioning and funding
arrangements are not conducive to joint
children at the two-and-a-half-year health visitor
check is not shared, and is in a different format and
38 %
33%
working and collaboration. This needs system to the data early years practitioners collect in
to be commissioner-led” Practitioner nurseries and schools.22 BERCOW: TEN YEARS ON AN ACCESSIBLE AND EQUITABLE SERVICE
A CC E SS I B I L I T Y O F S P E C I A L I ST There are particular challenges in accessing support
SPEECH AND LANGUAGE SUPPORT for older children and young people – just 3% of G O O D P RA CT I C E G O O D P RA C T I C E
The result of this fragmented commissioning is people who responded to our survey felt resources EXAMPLE EXAMPLE
that many parents and carers find services such as for children and young people’s speech, language
Worcestershire promotes One Service, One Solution. Based on Greater Manchester
speech and language therapy are difficult to access.41 and communication are used to provide support
a thorough needs analysis, the Local Authority and NHS jointly Heath and Social
Too many children are not getting the support they for young people aged 16-25.
commission core speech and language therapy services using Care Partnership is
need. Parents and carers shared stories of being Overall, our review paints a picture of specialist The Balanced SystemTM framework with a clearly defined role part of the first wave
let down by the system – experiencing insufficient services that are unable to meet the needs of children for speech and language therapists at each level. Schools and of integrated care
support, irregular appointments and support being and young people with SLCN and their families. Many settings, each with a named speech and language therapist, can systems. As part of
indiscriminately withdrawn. For many, the support professionals are equally frustrated about being put then commission additional activities as top ups. Evidence-based their five year plan
they needed was not available. in the untenable position of being asked to practice programmes are well embedded into an SLCN pathway, meaning to improve health
in a way that is not in the best interests of children there are clear routes for early identification, information and social care, they
The Local Area SEND inspections: one year on report
and young people. and resources. have committed to
from Ofsted and the Care Quality Commission found
delivering integrated
that access to therapy services was weak in half of the National datasets exist; we know enough about As a result:
commissioning and
local areas inspected, making it worse than access to prevalence to calculate local need. We now have
Children at risk of SLCN in targeted early years provision across
mental health services, which was poor in more than high-quality guidance, tools and resources to support
settings have decreased on average by 20%. all early years
a third of local areas. commissioners to use the available data so they can services, including
The evidence we heard through our review described commission in an informed way. We need to ensure Children are identified earlier: 84% of health visitor a focus on speech,
a situation that is unacceptable. this reaches the people responsible for planning referrals are now made under the age of three, communication
and funding support, and to spread the good compared to 35% in 2010. and language.
Many parents and carers shared negative experiences practice that already exists.
for themselves and their child, describing services
as poor, appalling or awful, dreadful and frustrating.
Children and young people also told us that the G O O D P RA CT I C E E XA M P L E In this chapter we have outlined the and the Care Quality Commission should train
support they needed was not available. all inspectors to challenge local areas.
Commissioning for children needing factors which contribute to the high
“…after this experience I do not wish any parent Augmentative and Alternative variability of support across areas in 3.4 Ofsted should consider children and young people’s
to go through this EVER. No child deserves such Communication (AAC) – Liverpool SLCN in its future research on SEND, through
England. We need to ensure that planning looking at provision and joint commissioning
treatment” Parent Liverpool City Council and the NHS and funding services for children’s SLCN of specialist therapies, and support.
“I should have speech therapy, but it never Liverpool Clinical Commissioning Group
collaborate on commissioning for children
is based on knowledge of what is needed 3.5 NHS England and the Department for Education
happens” Child with SLCN
with AAC needs (for example children in an area, and that accountability should provide a clear definition of joint
“I am in special college in my special school I got requiring communication aids). They measures are in place to make sure commissioning and fund a programme of training
no help at all only when went to independent work together at the interface between for local joint commissioners on commissioning
specialised commissioning, through
this happens everywhere. for SLCN.
special college I got help it cost lot of money to
go tribunal to get it” Young person with SLCN regional centres and local NHS England
Recommendations
3.6 Sustainability and Transformation Partnerships
support, alongside a special resource and Integrated Care Systems will provide joined-
in a primary school. 3.1 Public Health England should use its Fingertips up commissioning between local government
The joint commissioning approach helps tool to provide local areas with data on estimated and the NHS.
clarify services for children with AAC needs incidence of SLCN in their local population and the
known prevalence of SLCN (based on data from The provision of integrated commissioning
and takes the higher cost challenges away
two-year review). for SLCN should be:
from the local authority. Working together
on commissioning has meant more clarity included in these arrangements as one
3.2 Public Health England should work with the
for commissioners and service providers of the tests in any accreditation regime;
Department for Education to investigate the
as well as for children and their families. supported through any national development
Just 15% Outcomes for children are positive and
are shared with a steering group, who
addition of data from the Early Years Foundation
Stage Profile at age five. work; and
of survey respondents felt speech prioritised as a means for reducing
are responsible for the governance, 3.3 Local area SEND reviews should take account of health inequalities.
and language therapy was available and funding is administered through the the evidence from this review for effective joint
See page 40 for the recommendations in full. Further calls
as required. primary school, which eases the process. commissioning of support for SLCN, and Ofsted to action and practical steps that everyone can take
can be found at www.bercow10yearson.com24 BERCOW: TEN YEARS ON S U P P O RT T H AT M A K E S A N I M PACT
Support that
makes an impact
Investing in support that does not work is a waste database for interventions to
support SLCN, endorsed by the
of public resources and a risk to children’s life chances. Royal College of Speech and
We need to make sure that services are designed around Language Therapists (RCSLT).
what is going to have the greatest impact for children There is an expansion of evidence
both in terms of academic
and young people. research and in organisations
producing evidenced papers to
Currently, this does not happen. progress. We need effective and support the issue. We also have
When resources are stretched, impactful models of support; increasing evidence on the cost
service design is often driven these should be shared as a effectiveness of interventions.44
by factors other than evidence strong business case with local However, the focus is largely
about what works. Until we take commissioners, so they know what on single interventions or
a more evidence-based approach ‘good’ looks like. programmes. One area where
with longer term thinking, this
The evidence
evidence is still required is around
avoidable situation will persist. effective service models, including
Until we plan support using Although we know much more within schools.
available evidence based on about what works to make the
the outcomes we want for our A raft of local and national data
biggest impact for children and
children; until we use data to across health and education has
young people’s speech, language
capture those outcomes, we are the potential to show the impact
and communication, people told
making decisions about what of intervention, but in our review
us that this evidence is not being
services are needed completely people questioned whether
used to plan services.
in the dark. the right data was collected.
THE EVIDENCE BASE Particularly in health contexts,
What needs Since the original Bercow review performance metrics often focus
to happen in 2008, our evidence base has on processes and activities such as
grown. The Better Communication reduced waiting times or number In a survey of NHS
Systems need to be in place Research Programme42 provided of children seen. While possibly children’s speech and
to ensure that decisions about rich data and strong evidence on desirable in themselves, these do language therapy
support for speech, language and children and young people with not say anything about the impact services, the vast
communication needs (SLCN) are SLCN in terms of prevalence,43 on children. In fact, beyond the majority said their
made on the basis of what we impact and interventions. It also age of five, there is no statutory commissioner measured
know will achieve the greatest worked with The Communication requirement to report on progress the performance of their
impact. This means having the Trust to develop the What Works in children’s speech, language service on outputs – for
right indicators for benchmarking and communication. example, the number of
children seen – compared
to around a third who
were measured on the
impact of their service.26 BERCOW: TEN YEARS ON S U P P O RT T H AT M A K E S A N I M PACT
A SS E SS I N G A N D R E P O RT I N G O N S P E E C H , L A N G U A G E A N D CO M M U N I C AT I O N EVIDENCE FROM OUR CHILDREN
A N D YO U N G P E O P L E F O CU S G R O U P
Age 0-2 2½ 4-5 4-5 5-6 6-7 10-11 15-16 Children and young people themselves are
a critical evidence source. In our review, they
Measure Health Integrated two From 2019: Early Years Phonics Key Key GCSE described the help that worked best for them,
visitor year check Reception Foundation screening Stage 1 Stage 2 reinforcing the need for a knowledgeable
checks baseline Stage Profile check tests tests
as part of Ages and (EYFSP) and skilled workforce. We heard that children
Stages
Healthy
Questionnaire
and young people prefer support in school
Child by people who know how to help.
Programme (ASQ)
Is speech, Not always Yes Yes Yes No No No No
language and
communication
included?
From age five
Continual monitoring of progress in the curriculum
No requirement to measure or report on spoken language
There are now many practical tools People told us of examples where
available to monitor progress in data and local evaluations were GOOD PRACTICE
children’s spoken language, but used to make a case for services.
EXAMPLE
without an imperative to report on It can be done. A common
progress, the risk is that these will thread running through many Nottinghamshire
not be used. Our survey evidence of the best practice examples Children’s Services
found just this. The drive in Ofsted was a determination to design employ an evaluation
to look at impact is encouraging; approaches based on evidence; lead, skilled in research,
however, it is critical that to capture impact and use it to who supports the whole
inspectors ask questions about inform practice and maintain team to be involved
progress in speech, language and improve services. in evaluation. They Many parents and carers also expressed strong
and communication. have communicated views about what makes the greatest impact
“We must collect consistent their evaluation of core for their children:
data and be able to analyse programmes in one
single ‘Year of Evaluation’ Speech and language therapists training and
it in a way that makes that
document. Evidence working closely with nursery and school staff
moral business and evaluation
case for the work that we’re is used to inform Communication supportive schools,
In a sample of 42 Ofsted improvements to services
“I wish I could
doing.” Service Manager knowledgeable staff
reports from primary and to communicate
and secondary schools
have more help
These service evaluations can a strong case for Schools and early years settings giving advice
across inner city, rural be a powerful influencing tool. continued investment. and information to parents
areas and London
boroughs, no school Classroom approaches to involve children: at school, so
reported assessing or visual support, recasting adult language,
giving demonstrations
I can be like
everyone else.”
tracking progress in
spoken language. Supporting communication at break time
or between lessons CHILD WITH SLCN28 BERCOW: TEN YEARS ON S U P P O RT T H AT M A K E S A N I M PACT
T H E E V I D E N C E I S N OT U S E D In our evidence, we heard from services that were
having to scale back, rationing support in ways that
In this chapter, we have highlighted the Recommendations
On the ground, many practitioners responding to our
are not based on evidence of what works. We heard
fact that, although we now have a rich MAKING SURE WE HAVE
surveys saw data collected but not used. Likewise,
knowledge of what works is not effectively made of specialist services that have been: bank of evidence, this is not used to THE RIGHT EVIDENCE
use of. More than 17,000 people are registered on cut by approach, supporting only children with make the best, most impactful use of 4.1 The Education Endowment Foundation should
the What Works database; more than half of school the highest need or reducing training; diminishing resources. We need to ensure make a 5-10 year commitment to work closely
leaders make use of the Educational Endowment with language experts to design and fund a
Foundation toolkit; many more speech and
cut due to children not making progress in pre- that we mobilise the evidence we have so school-based SLCN evaluation programme, in
determined episodes of care, taking no account
language therapists have access to resources to of the complex nature of some children and young
that it reaches commissioners and drives order to develop and evaluate innovative models,
support evidence-based practice through the RCSLT. models of support. We need to ensure our and to mobilise the evidence already available.
people’s SLCN;
However, this is not enough, we are only scratching
the surface. There are still many more professionals
cut by age, with fewer services as children get older: children and young people benefit from MAKING SURE WE HAVE THE
in one example, only very basic drop-in services what we know works. RIGHT INDICATORS AND METRICS
who do not make use of these resources. Critically,
were offered to children over the age of five.
the evidence is not reaching people it needs to reach: 4.2 In their next review and update of inspector
those responsible for commissioning. The research The situation is exacerbated by the loss of clinical training, Ofsted should ensure a focus on
is absolutely clear,45 for specific interventions and specialism and professional leadership from the children’s SLCN.
programmes, we know what works; yet this is not speech and language therapy profession. In an RCSLT
4.3 NHS England and commissioners should work
being implemented. survey of NHS children’s speech and language therapy “Can we have something closely with providers and service users to identify
services, more than two thirds said they had seen like NICE guidance for
Greater awareness of effective and cost-effective what needs to be measured as an indicator of
a reduction in the number of specialist speech commissioners and providers
interventions needs to be provided for those success and to support providers in being able
and language therapy roles within their service to follow around speech,
responsible for commissioning and delivery to collect and benchmark this information.
in the last 10 years. language and communication
of services.” Voluntary organisation services, so it is absolutely ENSURING WE USE THE EVIDENCE TO
People told us there needed to be a more consistent
Parents and carers, as well, would like their view approach to the way that children with SLCN are clear how they should be PLAN SERVICES AND INFORM PRACTICE
of what makes a difference to be taken into account. supported. Through our evidence we have identified delivered based on the 4.4 C
QC and Ofsted, in their Local Area SEND
the key features of impactful practice, but more evidence base and informed inspections, should judge whether support for
professional opinion?” children and young people’s SLCN is commissioned
77
is needed. We need to draw these together into
29 % %
of practitioners
recognised guidance and ensure they are used S PE E C H AN D LAN G UAG E on the basis of outcomes not outputs.
of parents said by commissioners. T H E RAPY S E RV IC E M A N AG E R
satisfactory said satisfactory 4.5 NHS England should continue to support
or better or better providers to collect data on the quality
and the outcomes of intervention.
“…Now children who 4.6 The Department of Health and the Department
Although 77% of
practitioners felt
would have been seen in for Education should work together on guidance
to support a consistent approach to the
parental involvement
in planning was the past are rejected as development of evidence-based integrated
not high needs enough.
satisfactory or better, care pathways for children and young people
only 29% of parents with SLCN.
felt the same
They’re given strategies 4.7 The Department for Education should continue
and discharged.” to fund the sharing of evidence through tools
such as What Works.
P R I M A RY S P E C I A L E D U C AT I O N A L See page 40 for the recommendations in full. Further calls
N E E D S CO - O R D I N ATO R to action and practical steps that everyone can take
can be found at www.bercow10yearson.comYou can also read
