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Bercow: Ten Years On - www.bercow10yearson.com
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.
Bercow: Ten Years On - www.bercow10yearson.com
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
Bercow: Ten Years On - www.bercow10yearson.com
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.
Bercow: Ten Years On - www.bercow10yearson.com
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.
Bercow: Ten Years On - www.bercow10yearson.com
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.
Bercow: Ten Years On - www.bercow10yearson.com
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
Bercow: Ten Years On - www.bercow10yearson.com
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.
Bercow: Ten Years On - www.bercow10yearson.com
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.
Bercow: Ten Years On - www.bercow10yearson.com
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
Bercow: Ten Years On - www.bercow10yearson.com
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.com
20                    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.com
24                   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 SLCN
28                      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.com
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