What is the data telling us?

When looking at the trends we can see that where Speech, Language and Communication services are well established there is a positive impact for children and young people:
 

• In the Every Child a Talker settings there has been an increase in practitioner confidence and in work done with parents and carers around developing speech and language.
• Key speech and language measures indicate that there has been a significant decrease in the number of children at risk of delayed speech, language and communication development.
• There is evidence of effectiveness of Speech and Language Therapy provision in Sure Start Children's Centres including a significant decrease in the number of children discharged for non-attendance at Speech and Language Therapy appointments; increase in preschool referral rate to Speech and Language Therapy; case studies of children and families with favourable Speech and Language Therapy (and broader) outcomes.
• Overall, trends in the Early Years Foundation Stage show that there has been a gradual improvement in the last two years. The data shows that Newcastle is slightly above the average for England in terms of percentage improvement. The average for England was +3.0% whereas for Newcastle it was +4.3%.
• The progress of children in Communication, Language and Literacy is generally improving, with all children achieving 42.5% in 2007 and increasing to 46.5% in 2009.
• This could be related to an increased focus on the importance of developing communication skills in the early years within Sure Start Centres. Latest available data shows the improving trend has not yet reached up to Key Stage 2, which has remained fairly static. We would hope to see the trend improving in the future as the current early years children reach key stage two, with ongoing specialist input as needed.

However, despite this progress:

• There has been an increase in children and young people who have English as an Additional Language. In 2009 this figure stood at 15.7% compared to 12.2% in 2005.
• Whilst interpreting services could be accessed, as shown above, interpreters are not available for all languages and interpreters trained in Speech, Language and Communication are not available at all. Provision of parent programmes and assessment of children in their home language is a significant issue. Referral rates for Black, Minority, Ethnic groups and English as an Additional Language are below those expected.

- Significant increase in referral rates for Speech and Language Therapy and the Speech and Language teachers at SENTASS, (Special Educational Needs Teaching and Support Services). Figures below include referrals for regional specialist Speech and Language Therapy services;

Preschool referrals have increased over the past two years across the whole city, indicating that children are being referred at a younger age, (early intervention).  However, there is also a trend towards increased referrals of older children, (upper primary and secondary age).

• Whilst the table above shows the number of referrals made to each service, when looking at levels of service provision it is important to look at both the number of referrals but also how many children and young people are active to the service at any one point.
• The services all offer different levels of involvement depending on a child or young person's need, e.g. Community Team Learning Disability will offer a longer term service due to the enduring nature of the SLCN presented while the Paediatric Speech and Language Therapy will offer a mix of long and short term involvement which reflects the mixture of SLCN that they deal with.

The number of children active on each services caseload of under 18's as of 19th July 2010 was:

• The children and young people on the Paediatric SLT caseload, which also includes referrals to regional services, has risen from 1233 in September 2009 to 1361 in July 2010. One of the reasons is the general increase in number of referrals; however, another is the increasing complexity of the children, who now remain on the caseload for longer.
• There has been a rise in referrals from the Child and Adolescent Mental Health Service, particularly for Attention Deficit Hyper Activity Disorder, as it is now recognised as good practice to include a Speech and Language Therapy assessment in all assessments for suspected Attention Deficit Hyper Activity Disorder. It is also due to increased awareness of the higher prevalence of SLCN in young people with behavioural difficulties. Past experience has shown that referrals rise when there is a service in place, i.e. many referrals that could be made are not currently being made as referrers are aware of the lack of provision.
• There has also been a rise in the referral rate for Autism Spectrum Disorder with a 30% increase in the referral rate for pre-school children between March 2006 and May 2010.
• There have been significant medical advances and the survival rates of preterm babies and/or babies with complex medical needs are higher and increasing. As a result many children go on to have increasingly complex and long term needs, including SLCN including dysphagia; feeding and swallowing difficulties. Interventions such as tracheostomy are also now more common. This situation has led to a clear trend for increased referrals to Speech and Language Therapy over the past 5 years (See referral rates above).

There have been positive changes in recognition of SLCN and an increased focus on language and communication, particularly in the early years. However, there is also a clear trend towards greater identified need and more referrals across the city, thereby increasing pressure on current Speech, Language and Communication provision.  Current capacity is not in line with observed trends.

What is the story behind the data?

Currently there is no formal system for collecting views and opinions about children with Speech, Language and Communication Needs and the provision of Speech, Language and Communication services. Therefore, we have chosen to use the views that were collected as part of the Bercow review of Speech, Language and Communication services and provision, bearing in mind that some evidence was gathered from Newcastle.

Bercow (2008) conducted a national review of SLCN and provision visiting many cities within the country, including Newcastle. He found that -

Children and Young People

• Reported feeling isolated and excluded because of their communication difficulties.

Parent and Carers reported:

• Concern that their children's ability to communicate, to speak and to understand was taken for granted. They discussed the lack of understanding of their children's SLCN: their children often looked like any "normal" child and yet behaved differently.
• That they did not know enough about typical speech and language development.
• They wanted to see information and guidance about speech, language and communication development given to all parents and the issue raised to the top of the agenda.
• Once a child's SLCN had been identified, parents need clear signposting to where they might find help and consistent advice from the professionals working with their child.
• The absence of a formal or coordinated system to provide parents with information and the difficulty of locating the right person or department to contact.
• That health and education services' staff were apprehensive in providing information because to do so would add to the demand on their time and resource.
• That staff lacked sufficient knowledge to be able to help them. Several parents said that other parents, support groups and independent organisations had been most helpful in giving them the information that they needed.
• 77% of families said that the information they needed to support their child was either not easily available or not available at all.
• Where Speech, Language and Communication was a priority, parents and professionals often reported that this was as the result of an individual with a special interest, rather than a product of the system.
• Only 15% of respondents said speech, language and communication issues were a high priority in their area.
• that specific language impairment, is not always distinguished from the far more prevalent speech and language delays, with the result either that no early intervention took place or that the wrong help was provided particular among children and young people from socially disadvantaged backgrounds or among children whose first language is not English as this increases the challenge in identification.
• Some parents said that they were able to access quality support for their children relatively smoothly. Others talked about how they struggled or were still struggling to access adequate support, leading in some cases to deterioration in their child's condition.
• Services tended to 'disappear' over time, especially at entry to primary school or on transfer to secondary school.
• Continuity is an issue during consultation groups: both in terms of having contact with the same speech and language therapist and of having that contact on a regular basis.
• Need for more specialist expertise in order to support children and young people with more complex SLCN. They identified the need for tailored packages giving the right care for every child, training for schools about the development of children and young people's speech, language and communication skills, and more speech and language therapists developing specialisms.
• Professionals who worked directly with them had been invaluable in supporting them and their child and helping them navigate the system. However, almost a third of respondents to the consultation felt that there was a shortage of speech and language therapists, which meant there was limited access to these staff. Many parents also reported that they encountered professionals who didn't understand SLCN or have the time, training or resource to meet their child's needs.
• Parents expressed concern about the lack of clarity over the respective responsibilities of health and education services. Parents often felt that they and their child were 'caught in the crossfire' between the two. Families wanted to see effective joint working both between services and between professionals and families.

The current situation is not satisfactory for parents. They sensed a lack of leadership from local authorities and the NHS.

Professionals and Managers reported:

• The gap left by the changed role of health visitors and school health advisers in many areas which has resulted in a trend of children with significant SLCN not being identified and referred to specialist services until later because universal surveillance is no longer present. This is less of an issue in Newcastle due to the existence of a city wide Speech and Language Therapy Team working within Sure Start Children's Centre areas.
• Three key barriers to increasing the Speech, Language and Communication skills of the workforce: resources to pay for training; difficulty in releasing staff from work to attend courses; and limited availability of high-quality, accessible training of this kind.
• The desire to improve training and continuous professional development across the workforce but they also highlighted problems and challenges.
• Although in many areas there is good integrated working in direct service provision for children and young people with SLCN, joint working across children's services breaks down at the strategic level. Where strategic inter-agency governance arrangements are not in place, and with some local authorities and Primary Care Trusts still commissioning services independently, poor integration of frontline delivery is usually evident.
• That strengthening and formalising local joint strategic leadership through Children's Trusts would result in more effective integrated working across health, social care and education services at the level of the individual child.

Overall 65% of respondents to the Review's consultation agreed that resources should be directed towards early intervention and preventative work to ensure better outcomes for children and young people.
Although no formal consultation was completed in Newcastle the Paediatric Speech and Language Therapy Service have received the following informal feedback;

Views of Children, Young People, Parents and Carers -

• Satisfaction with intervention is high, (feedback from therapy groups and feedback to individual therapists seeking views of young people they work with).
• Complaints are low. Any complaints received are about quantity of service or length of wait, not about the quality of service.
• Evaluation of Sure Start Speech and Language Therapy, (qualitative research project), indicated that parents placed a very high value on the service received.
• The Community Team Learning Disability had an annual, now bi-annual, parent carer survey which seeks the views of families, and there has also been a survey with the paid workers (professional support staff for children and young people with Speech, Language and Communication Needs) using the service. There has been particularly good feedback to specific approaches e.g. the use of 'About Me' books to support children and young people with complex needs with their comprehension.
• The views of parents and carers about Speech and Language Therapies was captured at the Annual Parents and Carers conference on June 30th 2010. At this conference 56% of parents who attended voted for Access to Therapies to be one of the 3 key priorities to work on between now and June 2011.
• Other Service User Views
• Evaluation of training delivered by the service is consistently very high, with particular focus on the relevance to the specific role of participants.
• Feedback by schools on the joint referral system indicated a high level of satisfaction with the process. It was felt to be less confusing and more responsive than the previous system - a separate service referral process.
• Evaluation questionnaires from the Newcastle Specific Language Impairment Team indicate a high level of satisfaction from both parents and schools.

Current Activities and Services/Current Provision for SLCN in Newcastle
There is a range of support available for children and young people in SLCN, provided at universal, targeted and specialist levels -

• Universal level - all children,
• Targeted level - children in need of some additional support,
• Specialist level - children with more severe or complex needs.

The key providers for Speech, Language and Communication in Newcastle are:
Speech and Language Therapy services, currently provided from two NHS Trusts:

• Newcastle Upon Tyne Hospitals NHS Trust,
• Northumberland Tyne and Wear NHS Trust,

Specialist teaching support, provided by the Local Authority as part of SENTASS (Special Educational Needs Teaching and Support Service).Families may also access support from independent therapists or voluntary agencies.These key providers work with a wide range of other services and agencies to implement strategies for the development of speech, language and communication skills at universal, targeted and specialist levels.
The provision is described under the following headings:

Newcastle Upon Tyne Hospitals NHS Trust (NUTHT)

        Paediatric Speech and Language Therapy Service

• The service provided by Newcastle Upon Tyne Hospitals NHS Trust is described below under separate sections. The different elements are well integrated and therapists and therapy assistants will all work into several different aspects of the service. Children resident in Newcastle and/or attending a Newcastle state nursery or school can access the local services where possible. Where it is in the interest of the child, individual arrangements may be made for children living outside of Newcastle but attending an independent nursery or school provision.
• The service is provided via a citywide system of core pathways and groups. However there is also a 'locality focused' approach with Speech and Language Therapists allocated to a geographical area for work with individual children and families. This allocation is flexible to accommodate natural variation e.g. referral patterns, staff changes and experience levels.
• There is a very strong model of joint working with other agencies, including joint assessments, groups and provision of training. The joint working with SENTASS (Young Children's Team and speech and language teachers) is very well established, with a number of shared processes and provisions. These are described under the section on joint working.
• The service operates an open referral system, in line with professional guidelines.

Preschool and school age provision - mainstream PCT funded service

• Initial assessment offered within 8 weeks of receipt of referral (home visit, nursery visit or booked clinic appointment). School age referrals are managed via a joint system with SENTASS speech and language teachers, (description under joint working section).
• System of core pathways to manage children requiring intervention or review:

Preschool Provision - Sure Start Children's Centre Local Authority Funded Service

• The citywide Sure Start Children's Centre Speech and Language Therapy team provides a prevention and early intervention service into each of the Sure Start Children's Centres, as an integral part of the overall paediatric Speech and Language Therapy service. Speech and Language Therapists and Speech and Language Therapists assistants work closely with other Sure Start Children's Centre staff, mainstream Speech and Language Therapists and local authority staff to:

- Develop knowledge and skill in developing young children's language,
- Enable children and families to access speech and language activities and support,
- Ensure early intervention for children with difficulties as locally as possible.

School Age Provision for Specific Settings - Local Authority Funded Service

 Allocated Speech and Language Therapy sessions for the following settings during term time: 

• Thomas Bewick School and nursery
• Atkinson Road, Welbeck and Kenton Speech and Language/Communication ARCs, Cheviot Early Years ARC, Bridgewater Early Years ARC, Atkinson Road, Communication ARC, Kenton Bar Communication ARC, Tyneview Communication
• Newcastle Specific Language Impairment Team.

Speech and Language Therapy Provision for Specific Disorders - mainstream PCT Funded Service and/or Regional Health Service Specialist Commissioning
The Paediatric Speech and Language Therapy service employs a number of highly qualified Speech and Language Therapists who provide assessment, advice and intervention at a specialist level for specific disorders. This may be in community or acute (hospital) settings depending on the disorder. Specialist Speech and Language Therapy is provided for a wide range of disorders including:

• Cleft Lip and Palate
• Dysphagia (Feeding and Swallowing Difficulties)
• Preschool Complex Special Needs
• Severe Specific Speech and Language Disorders
• Autism Spectrum Disorders
• Moderate Learning Difficulties in Mainstream Schools
• Fluency (Stammering)
• Hearing Impairment
• Emotional and Behavioural Difficulties
• Voice Disorders
• Physical Disability
• Acquired Disorders

Northumberland Tyne and Wear NHS Trust

Community Team Learning Disability

Community Team Learning Disabilities Speech and Language Therapy currently provides a community Speech and Language Therapy service to children with a learning disability and communication difficulties, who have a Newcastle GP. This is provided as part of a wider multidisciplinary team and operates an open referral system. The Community Team Learning Disabilities service offers a range of intervention from focussed individual work to more generic teaching and training alongside joint curriculum development within school.

 Child and Adolescent Mental Health (CAMHS)

The Child and Adolescent Mental Health Services are provided by Northumberland Tyne and Wear (NTW) NHS Trust. However at present there is no specific Speech and Language Therapy input to CAMHS. NTW NHS Trust Paediatric Speech and Language Therapy provide a limited assessment, advice and intervention service for referred children and young people. Some joint work has been undertaken with individual Child and Adolescent Mental Health Services staff.

Regional Communication Aids Service

NTW NHS Trust is also commissioned to provide the Regional Communication Aids Service. This service provides assessment and advice in relation to all aspects of communication aids. The service is accessed by referral from Speech and Language Therapists across the region.

 Newcastle Local Authority

The Local Authority provides specialist teaching and support for children and young people with Speech, Language and Communication Needs through SENTASS (Special Educational Needs Teaching and Support Service).

Joint Working and Service Provision across Speech and Language Therapy and SENTASS

 SENTASS Young Children Team

• Speech, Language and Communication development underpins most of the work of the Young Children Team and is a vital part of all home teaching and support to nurseries.

The Team consists of 6 specialist teachers and 6 Nursery Nurses and offers a range of multi disciplinary groups to pre school children and their families with an emphasis on speech and language development. These jointly run groups include Speech and Language Therapy, Educational Psychology Services and Social Care.

•  Busy Bees - for children on the Autism Spectrum at an early stage of communication
•  Multi Sensory - for children with multiple difficulties including speech and language
•  Early Communication Group - for children with complex needs at a single word level
•  Pre School Communication Group - for children with suspected social communication difficulties

The Young Children's Team also provides the Rhythm and Rhyme group, which focuses particularly on developing attention and listening skills, (underpinning any speech, language and communication learning).

SENTASS Specialist Speech, Language and Communication Teachers

Two teachers are employed to provide assessment of individual children and advice andsupport to schools across the city. Close working has developed with Paediatric Speech and Language Therapy to ensure efficient use of this resource. The Specialist Teachers also provide training to schools and have taken the lead in running speech and language focused conferences and courses in Newcastle.

Joint Referral System

Referrals for school age children with SLCN are managed via a joint system involving SENTASS speech and language teachers and staff from the Paediatric Speech and Language Therapy service. Referrals are directed to the Paediatric Speech and Language Therapy base and then allocated to the most appropriate service according to agreed criteria. The service includes assessment, advice, consultation and access to all paediatric Speech and Language Therapy pathways and specialist Speech and Language Therapy as required.

The Newcastle Specific Language Impairment Team

The multi disciplinary Newcastle Specific Language Impairment Team is for primary age children with severe speech and language difficulties. The Newcastle Specific Language Team is part of the pathway for consideration for a place in a speech and language ARC. The aim of the Newcastle Specific Language Impairment Team is to maintain children in their mainstream school where possible, improving outcomes for children and reducing the waiting list for a place in a speech and language ARC.

• The Newcastle Speech and Language Team was established in April 2000 and is recognised nationally as an example of good practice, with articles published in a number of professional publications.

Independent/other Provision accessed by Newcastle Children

Some Newcastle children with very complex needs are placed in out of area provision such as Percy Hedley School and Thornhill School. Speech and Language Therapists are employed directly by some independent schools. Where placement is in a local authority school in another area the local Speech and Language Therapy service may provide some input as part of the local arrangements for that school.

• There is some Speech and Language Therapy input to Northern Counties School, funded through specialist health commissioning arrangements.
• Some parents pay for the services of an independent speech and language therapist. They may be able to access funding for independent therapy from the charity Cerebra, and they may access Speech and Language Therapy guidance from the Toby Henderson Trust. Where there is an independent therapist working with a child the NHS therapist would work within the principles outlined within the Royal College of Speech and Language Therapists 'Working in Harmony' document.

Current Commissioning Arrangements

Currently there is no coordinated and coherent commissioning plan for Speech, Language and Communication Needs in Newcastle.

Limitations of Provision

Joint work across services and agencies and flexible use of resources enables the key providers to make the most efficient and effective use of the resource available. Clear systems and pathways, avoidance of duplication, and provision of workforce training all help to maximise resources. However there are limitations and gaps, both explicit and hidden, including:

• Limited provision for young people in secondary education,
• Limited provision for Autism Spectrum Disorder at school age,
• Lack of service linked to Child and Adolescent Mental Health Services,
• Difficulty providing equitable service for Black, Minority, Ethnic groups and English as an Additional Language population,
• Delays in meeting Speech, Language and Communication Needs due to resource limitations in other services (e.g. occupational therapy, educational psychology, learning support assistant time),
• Delays due to want of understanding of systems and processes by other agencies e.g. referral systems, Special Educational Needs systems,
• Delayed or missed review dates,
• Long waits for individual intervention from Speech, Language and Communication specialists (either Speech and Language Therapist or specialist teacher),
• Fixed term blocks of intervention, when child may need longer period of intervention,
• An additional concern is the number of Speech and Language Therapist posts that are funded on a fixed term basis. All Sure Start Children's Centre posts are currently only funded until 31.3.2011. The Newcastle Specific Language Impairment Team post is funded on a year on year basis, rather than substantively. This makes long term planning difficult, particularly towards the end of the contract period. There is also a significant recruitment and retention risk (loss of trained staff and difficulty recruiting at the appropriate grade).

The Youth Offending Team

There is currently no provision for Speech, Language and Communication Needs within the Youth Offending Team.

Workforce Development

• There are a number of workforce development initiatives at both preschool and school age. Many involve joint work across SENTASS and Paediatric Speech and Language Therapy, particularly in early years, and this is seen as the best approach. Some training packages require involvement of Speech and Language Therapists in order to run the course e.g. ELKLAN.
• Creating and sustaining a robust and joined-up workforce development programme is essential to achieve improvement in outcomes for children with Speech, Language and Communication Needs.

Every Child a Talker

• A Speech and Language Therapist has been seconded into the Every Child a Talker consultant role, job-sharing with a teacher from the SENTASS Young Children's Team. This has proved to be an extremely effective model of delivery of the Every Child a Talker requirements and has been assessed by National Strategies as 'outstanding'. Benefits include:
• Greater understanding of the different and complementary skills of teachers and Speech and Language Therapists
• New opportunities for joint working and sharing of practice e.g. Speech and Language Therapists with early years consultants
• Opportunity to link the work of Speech and Language Therapists with that of the local authority to make a direct impact on the working practices of early years settings in relation to speech and language

Paediatric Speech and Language Therapy Training Initiatives (Sure Start Children's

  Centre and Mainstream Speech and Language Therapists)

• A modular training package has been developed for all Sure Start Children's Centre workers,
• Paediatric Speech and Language Therapy provides a basic training course for Private, Voluntary and Independent settings,
• Training on recognition and referral of SLCN where English is not the first language,
• Speech and Language Therapists involvement in roll out of the early years Inclusion Development Programme, for speech, language and communication,
• Joint work with YCT, Sure Start Children's Centre teachers and Every Child a Talker particularly around embedding use of Makaton in early years settings,
• Regular visits to early years settings to provide ongoing support and advice to staff.

Makaton Training (SENTASS and Paediatric Speech and Language Therapy and Community Team Learning Disability Speech and Language Therapy)

There has been a drive to provide Makaton training to all early years and school age staff. Benefits include:

• Facilitating inclusion in any setting of children with special needs who use Makaton to communicate,
• Supporting any child who enters the setting with limited language and communication skills, and those where English is not the home language,
• Creating a communication environment where all forms of communication (verbal and non-verbal) are recognised and valued,

 ELKLAN (Paediatric Speech and Language Therapy and SENTASS)

Accredited training course for Learning Support Assistants that enables them to carry out specific speech and language programmes with Speech and Language Therapist or specialist teacher support.

Inclusion Development Programme (SENTASS with some Speech and Language Therapist Involvement)

The Inclusion Development Programme for speech, language and communication has been distributed and the materials are seen as a useful resource for schools and early years settings. However there is recognition that ongoing support is needed to ensure that the resource is used.

The same applies to the more recent Autism Spectrum Disorder Inclusion Development Programme.

SENTASS Specific Training

• Accredited training in Speech and Language Difficulties for teaching assistants,
• Phonics - Putting the Tools in the Toolbox,
• Foundation course in Speech and Language Difficulties,
• Phonology meets Phonics,
• Jolly Phonics.

CTLD Speech and Language Therapy Training

The Speech and Language Therapy team offers a range of training to parents and carers of children and young people with learning disabilities and communication difficulties, and professionals working with these children. These include:

• Makaton training, as detailed earlier,
• General communication workshops for parents of children within the special school environment,
• Use of alternative and augmentative communication e.g. the use of symbols or communication aids,
• Working with school to help parents to understand the link between behaviour and communication. Training is provided in conjunction with the wider team,
• Autism and communication training.

Northern Open College Network Autism Course

A course accredited by the Northern Open College Network,  'An Introduction to Autism', has been developed and delivered in association with SENTASS and Thomas Bewick School to a range of staff working with children and young people with autism.

When looking at the workforce we need to recognise that there are other professionals with specialist skills relevant to SLCN, especially when looking at the following specific areas:

Alternative and Augmentative Communication

Access to additional therapy services is key to the appropriate level of service delivery when looking at children who need alternative and augmentative communication aids, from low-tech switches through to more complex high tech communication aids. Access to skilled physiotherapy and occupational therapy services is required when assessing the child's seating and positioning, or how they will be able to use a piece of equipment e.g. with a head pointer or switch. There is also a requirement for staff to keep up to date with the most recent technological developments.

Sensory Difficulties

Recent developments within the field of sensory perception has led to an increase in joint working between Speech and Language Therapists and occupational therapists, looking at the sensory needs of individuals prior to looking at their communication needs. Often children are overwhelmed by sensory processing difficulties and it is only by working to change their sensory environment and 'sensory diet' that their communication and interaction needs can then be met.

There is currently limited provision for occupational therapy to support the above.

What are the gaps in data?

• This is currently no co-ordinated approach to data collection across the Speech, Language and Communication services in Newcastle. Currently service providers are not collecting data about this specific group that can easily be aggregated to give us a clear picture of the SLCN in Newcastle. As the data below will show we are relying on information that was collected for an alternative use and interpreting it for the purpose of assessing the likely needs of children and young people in Newcastle.
• The data that is collected about SLCN and outcomes are often inferred from other measures, for example, Early Years Foundation Stage measures and SATS measures. This makes it difficult to have clarity about the needs and outcomes of children and young people with SLCN.
• This is a lack of co-ordinated information about the effectiveness of workforce training for SLCN.

What are the national and local drivers?

The Government wishes to address the root causes of child poverty, impoverished communication, poor learning skills and social exclusion. These factors can result in low aspirations in young people, restricted life chances through poor educational attainment and a descent into criminality.

National and Local Drivers

The Bercow Report (2008) increased the focus on the importance of addressing SLCN.  It made it clear that Speech, Language and Communication provisions needed to be transformed to improve the experiences and outcomes of children and young people with SLCN and their families. During the review five key themes were identified as issues that need to be addressed for real change and improvement to happen. The five themes are:

• Communication,
• Early identification and intervention,
• A continuum of services designed around the family,
• Joint working,
• The current system is characterised by high variability and a lack of equity;

There are also other national policies and documents that give added impetus to the work of Bercow.  The following represent the key policy drivers: -

'Every Child Matters' and  Children's Act 2004 set out the government approach to the well being of all children and young people from birth to 19 years.  A very important aspect of the Act that followed is the expectation of much closer co-operation between agencies responsible for the well being of children, such as schools, social services, the police and health professionals.

Every Child a Talker: Guidance for Early Language Lead Practitioners November 2008 - Every Child a Talker is designed to strengthen children's early language development by improving the quality of language provision in early years settings. Every Child a Talker aims to create a developmentally appropriate, supportive and stimulating environment in which children can enjoy experimenting with and learning language. It can be implemented whether children are in Early Years settings, with a child minder, or at home with their parents. Through everyday fun and activities which reflect children's interests, Every Child a Talker will encourage early language development right from the outset, extending children's vocabulary and helping them build sentences so that before they start school children are confident and skilled communicators.

In 2001, the government published the Special Educational Needs Code of Practice and the Disability Act, which delivered a strengthened right to a mainstream education for children with Special Educational Needs. The 2001 Act amended the Disability Discrimination Act, 1995 to make unjustified discrimination by education providers against disabled pupils and students and unlawful. The Disability Discrimination Act 2005 took things further, giving most public authorities a positive duty to promote disability equality. In practice this has led to many educational and child care workers identifying the need for additional training and support.

National Service Framework, for Children and Young People; Standard 8  - Children and young people who are disabled or who have complex health needs receive co-ordinated, high-quality child and family-centred services which are based on assessed needs, which promote social inclusion and, where possible, which enable them and their families to live ordinary lives.

National Service Framework for Children and Young People; Standard 9 - All children and young people, from birth to their eighteenth birthday, who have mental health problems and disorders have access to timely, integrated, high quality, multi-disciplinary mental health services to ensure effective assessment, treatment and support, for them and their families. The section on improving service equity notes that children with a learning disability and mental health problems have not received sufficient input from Child and Adolescent Mental Health Service. An increase in capacity may be required to ensure that all children and young people attending education settings and mainstream or special schools have equal access to therapy.

National Service Framework Autism Exemplar - The exemplar follows one child's journey with autism, from early childhood to adulthood. It includes best practice and standards at each phase of the child's journey, demonstrating optimal care pathways.

Lord Bradley's Review of people with mental health problems or learning disabilities in the Criminal Justice System April 2009. This clearly illustrates the link with learning disabilities, mental health and offending behaviour.

Royal College of Speech and Language Therapists - is the professional body for speech and language therapists in the UK. It is responsible for setting, promoting and maintaining high standards in education, clinical practice and ethical conduct. The Royal College of Speech and Language Therapists has developed a position paper that explains the essential role of speech and language therapy within integrated children's services.

Newcastle Children and Young People's Plan for 2011-2014 (currently in consultation) - This focuses on:

• the vision for children and young people living and growing up in the city,
• the principles which will underpin the work,
• the priorities that would be at the heart of the plan.

The plan will set out how partners will work together to make a difference to the life chances and outcomes of children and young people in Newcastle.  It covers all children and young people in Newcastle aged 0 to 19 years old and some groups of young people up to the age of 25 who have learning difficulties and/or disabilities. It includes children and young people from other areas who are attending Newcastle schools or college, and those in the care of the local authority who live outside the area.

Aiming High for Disabled Children - Launched in May 2007, this government plan was designed to help disabled children and their families get the support and chances they need to live ordinary family lives. All local areas in England have received extra money to increase support and services for disabled children and young people.

Promoting the Health of Looked After Children Department of Health November 2009 -. Improving the health of looked after children is a multi-agency responsibility involving Councils and health agencies. This guidance sets out the responsibilities on all agencies to work together to provide services which meet the needs of these children and young people. It also sets out the values and principles which should underpin the delivery of services.

Valuing People Now: a three year strategy for people with learning disabilities Jan, 2009 - Following consultation, Valuing People Now sets out the Government's strategy for people with learning disabilities for the next three years. It also responds to the main recommendations in Healthcare for All, the independent inquiry into access to healthcare for people with learning disabilities.

Lamb Enquiry 2009 - The Lamb Inquiry has investigated a range of ways in which parental confidence in the Special Educational Needs assessment process might be improved. It produced a Plan focusing on the following five key areas:

• Improving skills and practice within the workforce and focusing on children's outcomes;
• Strengthening engagement with parents;
• Ensuring a strategic local approach;
• Making the system more accountable;
• Improving the national framework.

Achievement for All - Achievement for All was announced by the Department for Children Schools and Families in the Children's Plan Progress Report in December 2008. It stated:

Pupils with Special Educational Needs and disabled children make the best progress in schools where there is a strong ethos that all pupils should make good progress academically as well as in their personal and social development. Too many are leaving education without the skills and qualifications needed to become independent adults.

The evidence shows that there are still too many children and young people with special educational needs and disabilities who:

• are not achieving as well as their peers,
• are more likely to suffer from bullying,
• have fewer friendships.

The Achievement for All pilot project will showcase how schools can work together with children with Special Educational Needs and disabled children and their parents to ensure they achieve their full potential.

What is working here or elsewhere?

This section brings together the information in the previous section to identify what we know is working and what we need to do next.

Joint Service Planning and Delivery

1) Within Newcastle a joint referral system exists between Education Services (SENTASS) and the Paediatric Speech and Language Team to ensure that children/young people who are referred to these services are directed toward the appropriate support pathway as efficiently as possible. This may be SENTASS only, Paediatric Speech and Language Therapy only or a joint intervention.

The joint referral system allows for initial assessments to be carried out by the appropriate service and a programme of intervention to be implemented by the appropriate service, team or individuals.

The system prevents unnecessary duplication of assessments and interventions thus meeting the needs of individuals in a more timely fashion.

This integrated working relies on the capacity of each of the services being maintained.

• Because of the nature of the services and the integrated working that is in place any change in the capacity and resources of either SENTASS and Paediatric Speech and Language Therapy will have an impact on how the other service is provided. If funding was reduced or removed in one service it would affect the other services' ability to meet the needs of the children and young people in the city.
• For example the recent reduction of the teaching capacity of SENTASS has meant that children/young people who require SENTASS assessment or intervention have a longer wait to be seen following initial referral. This has the effect of putting increased pressure on the Paediatric SLT service to allocate more resources to the joint referral system, to ensure that the services continue to meet the needs of the children/young people. Any change in allocation of resources in one area of the system will inevitably have an impact on another part of the service.

2) There has been very successful integrated working in the form of the multi-disciplinary Newcastle Specific Language Impairment Team.  This Team comprises staff from Paediatric SLT, SENTASS and Educational Psychology, including Learning Support Assistants, Speech and Language Therapists, a specialist teacher and Educational Psychologists. The Team is responsible for providing assessment and intervention for children and young people who have severe Speech, Language and Communication Needs. It ensures that the majority of these children/young people can have their needs met within their local mainstream setting in a timely and effective way. The Team also contributes to the appropriate placement of children and young people whose needs are severe enough to require intervention in a specialist school or setting.

The Team was created using funding from the Area Based Grant (previously the Standards Fund). This has continued to be awarded thereafter on a year on year basis; however, funding has not been mainstreamed and secured.

This care pathway has worked well and the effectiveness of the Newcastle Specific Language Impairment Team has been recognised nationally, appearing in national publications, as good practice.

• The budget to achieve this system was provided through the area based grant system (previously standards fund) and was therefore neither secure nor mainstreamed. Funding remains non-substantive.
• A reduction in the grant or its removal would severely impact on the ability of the Newcastle Speech Language Team to operate effectively. It would reduce capacity within the services to provide therapeutic interventions for children and young people with severe Speech, Language and Communication Needs and would have significantly detrimental effects on outcomes for this group.
• There would also be a significant impact on the overall delivery of services for all children/young people with speech and language needs, as resources would need to be reallocated from other aspects of the services. This would increase waiting times and would also result in a less efficient and effective interventions as the coordination of multi-professional input would be far more difficult to achieve.

3) Paediatric SLT and SENTASS Young Children's Team jointly run a number of preschool groups. Some groups also have input from Educational Psychology and Paediatric Physiotherapy, depending on the needs of the children.

These groups provide both assessment and intervention function. The multi-agency approach reduces the number of appointments that parents are required to attend and prevents duplication of assessments and reporting. It also ensures a holistic view of a child's needs, develops skills and understanding of other professionals roles and informs decisions such as future educational placement or need for longer term support.

Joint individual assessments with professionals from different services are also carried out, for some children for example children with suspected Autism Spectrum Disorder.

• The groups have developed as need has been identified and this approach is not clearly included in each service's commissioned remit. Provision of joint groups is very dependent on each service having sufficient staffing resources to allocate to the groups. A change in funding or priorities for one service may make it impossible to continue running these groups, as it is unlikely that the other services would be willing or able to increase their input to compensate.
• Frequent changes in staff allocated to the joint groups, due to ongoing change in the local organisation or service, can negatively impact on the effectiveness of joint groups.
• Provision relies on access to appropriate accommodation to run joint groups.

4) The Sure Start Children's Centre Citywide Speech and Language Therapy team provides very effective locality based early intervention for preschool children and families. A key focus is on developing skills in the workforce to support speech and language development and to identify delays and difficulties. The Sure Start team also works very closely with other Children's Centre staff to engage with vulnerable families

The Sure Start Children's Centre Speech and Language Therapy team works with children and families individually and in groups to develop language skills and support access to mainstream Speech and Language Therapy services. It is part of the overall citywide Speech and Language Therapy service, integrating closely with other therapists to ensure cohesive preschool intervention across the total population (universal, targeted and specialist services).

The team can demonstrate successful outcomes, e.g. raising the confidence of practitioners in recognising speech and language delay and improving early referral rates for children with recognised difficulties.

• Funding for the Sure Start Children's Centre Speech and Language Therapy team is not secure. The history has been of funding being agreed for a fixed period only (dependent on central government allocation for Sure Start and early years).  Current funding is only until end of March 2011. Staff therefore do not have permanent contracts. This has a significant effect on recruitment and retention and staff are already starting to look for other posts in anticipation of the end of the current funding period. This means a loss of skilled and trained staff, as well as difficulty with longer term planning, innovation and development until the funding is agreed.
• Loss of the Sure Start Children's Centre team will impact hugely on all early years provision for speech and language difficulties. It will also severely limit the capacity for training the early years workforce around speech language and communication needs.

5) There is good integrated working between the Newcastle Hospitals Trust Speech and Language Therapy Service and the Northumberland, Tyne and Wear Trust CTLD Team at the following transition points: -

entry into special school or nursery,

when children transfer from mainstream to special school,

when a child leaves school but still requires access to Speech and Language Therapy.

There is a transition protocol in place to support the transfer between services and this is aided by a specific post that works to support children with speech, language and communication needs with learning disabilities in mainstream school. This Speech and Language Therapist post works jointly with the CTLD multidisciplinary team.

• The current arrangements work well for transition to support continuity of care across speech and language therapy services.

• Current practices need to be reflected in services plans and specifications.

6) The CTLD Speech and Language Therapy team are fully integrated within the multi-disciplinary learning disabilities team so there is good joint working with community nursing, psychiatry, physiotherapy and clinical psychology. This work is also often around the management of behaviour and or around complex health needs.

CTLD works closely with education and families within the special school context and alongside agencies supporting children and families.  For example all Speech and Language Therapy recommendations are incorporated within IEP targets and reviewed at least annually, these are also adapted to support children accessing respite care.

Child-adult transition within the CTLD Speech and Language Therapy service is supported by the fact that the team is a lifespan team.

• The Speech and Language Therapy children's service is part of a lifespan multi disciplinary team and as such is commissioned as a whole package which makes identifying the Speech and Language Therapy component difficult. Currently the Speech and Language Therapy service supplement the service to children from the adult service. The CTLD may be split over coming months into adult and child.

7) Service level agreements have been in place between Newcastle Local Authority and Newcastle Upon Tyne Hospital Trust for a number of years. Good relationships are in place between key individuals to review the agreements and monitor outcomes.

New service level agreements have been agreed when there has been an identified need for additional speech and language input to a specific area e.g. into a Special School, the Sure Start Children's Centres and the Every Child a Talker programme.

• There are several different contract arrangements between Newcastle Local Authority and Newcastle Upon Tyne Hospital Trust. This can be complex to monitor. Any new agreements tend to be established without reference to other arrangements already in place, largely due to the varied funding streams which underpin the agreements.
• Some Service Level Agreements are agreed on a year on year basis (Newcastle Specific Language Impairment Team and Sure Start Children's Centres). This means that staff do not have permanent contracts, which has a significant effect on recruitment and retention, particularly at more senior grades.
• Agreements are with the Local Authority, but therapists are generally working within specific school or Children's Centre contexts. This can cause some tension due to variable understanding of accountability, management and expectations of the different parties.
• Information sharing can be difficult when staff from different organisations are working into the same setting or with the same children. This is due to current lack of flexibility within organisational requirements e.g. regarding record keeping and data collection. This can actively work against joined up working.

Joint working between Strategic and Middle Management

8) At the service delivery level provision of Speech and Language Services are continuing to become more integrated and joined up.

This includes some joint working with other speech and language therapy services across the region e.g. provision of groups for young people who stammer.

The Children's Trust Arrangements around the Children's Be Healthy work stream are fairly well developed and Speech, Language and Communication falls within the scope of several of the planning groups, for example, Children With Disabilities, SEND etc.

Each of the Speech, Language and Communication services individually collects data and measures outcomes for children and young people with speech, language and communication needs.

The Newcastle Speech and Language Therapy Service managers meet within the Regional Speech and Language Therapy Managers Group, where issues relating to Paediatric SLT service delivery are discussed. Individual meetings are arranged around specific local issues or projects relating to Newcastle services as required.

Meetings between the Speech and Language Therapy service managers and relevant Local Authority managers are arranged as needed, around specific topics.

There has been some multi-agency involvement in recruitment, particularly around Sure Start Children's Centre Speech and Language Therapy appointments, the appointment to the Every Child a Talker consultant and the appointment of a SENTASS specialist teacher.

Managers of services for speech, language  and communication needs are making the best use of their resources by joining up where possible and integrating. For example, the Speech and Language Therapist post working with children with learning disability in mainstream schools, based in the Paediatric Speech and Language Therapy service. This post also works very closely with colleagues in CTLD to ensure that children and families have full access to appropriate support.

Other examples include the joint referral system and joint groups across Speech and Language Therapy and SENTASS.

Services are also working towards a joint approach to training the early years workforce.

• The difficulty is that there is no single planning group to consider the needs of children and young people with Speech, Language and Communication Needs. The current structures do not allow the managers of Speech, Language and Communication services to link effectively with the strategic management of the Children's Trust.
• This has resulted in there being no official management structure to allow regular communication and shared decision making between Speech, Language and Communication service managers.
• The Local Authority have been transforming their targeted services into integrated teams. These structures are currently not yet in place and so it is difficult to engage with health teams in an effective way.
• Nor is it clear what information strategic managers and commissioners use to make commissioning decisions. There is currently no shared data collection across all Speech, Language and Communications services.
• Commissioners have not identified clear outcomes for the services.

9) Managers of services for Speech Language and Communication endeavour to maximise available resources within their separately funded services and organisations, to provide as comprehensive a service as possible. This includes development of joint working practices to provide a more efficient and streamlined service for children and families.

• Services for speech, language and communication are not commissioned in a planned and structured way. Each service is funded separately within a different organisation. This creates uncertainties and barriers to flexible use of the available resources.
• A significant proportion of the service for speech, language and communication is funded non-substantively.  Although funding has been generally been renewed on a rolling basis the funding has not been mainstreamed and secured. This results in a lack of stability and difficulties for long term planning
• There is no clear commissioning plan and process for speech, language and communication services across the city.

Workforce Development

10) Speech, Language and Communication training is available for the children's workforce in a variety of ways. This includes nationally developed training packages such as the online Inclusion and Development Programme. There are also accredited programmes, for example ELKLAN as well as locally developed training tailored for specific groups.

These training programmes support the whole Children's Workforce to develop their knowledge, understanding and skills relating to Speech, Language and Communication. This raises awareness of the need for early identification of children/young people who have Speech, Language and Communication Needs and how to support them.

There are also training packages available for more specific communication related disorders e.g. Autism which are delivered in partnership with education, as well as training on specific approaches to speech, language and communication needs.

• It is essential that the whole of the children's workforce are aware of their responsibilities to support children with speech, language and communication needs.
• Within Newcastle it is difficult for therapists and specialist teachers to provide a sustained approach to training of the wider Children's workforce. This is in part due to capacity issues, as training is often provided in the context of heavy caseloads. It is also due to training commitments not being clearly recognised by commissioners as a criteria that services are measured by. Face to face contacts are more widely used as a service measure.
• National initiatives such as the Inclusion and Development Programme have not yet been consistently used by practitioners to increase knowledge and understanding and embed good practice. They have therefore not had the desired impact. Again this is due to capacity of specialist services to be the 'drivers' behind the programme and to roll-out and support this training.
• There is currently no mechanism for jointly planning and delivering a training strategy for children and young people beyond the early years. There is therefore potential for both duplication of effort and fragmentation of delivery, resulting in an ineffective and inefficient training framework across the city. This will affect outcomes for children and young people with SLCN.

11) The Every Child a Talker had evaluated very positively. A therapist and specialist teacher were seconded as Every Child a Talker consultants to work together with 30 preschool settings across the city, to improve the communicative environment and raise the skills of the staff in recognising and supporting speech and language difficulties.

The Every Child a Talker project was closely linked to the work of the SURE Start Children's Centre SLT team, with therapists supporting the Every Child a Talker input in their locality area.

Every Child a Talker and SURE Start Children's Centre have worked together with other professionals including early years consultants and Sure Start teachers to begin developing a more integrated speech and language training framework for early years staff. SURE Start therapists have also developed a Speech and Language training package which has evaluated very well.

Funding for Every Child a Talker was from central government for a fixed term period, which has now ended. However the therapist and teacher have been seconded for a further period as Inclusion Consultants, with the intention of embedding the Every Child a Talker work in other settings.

• Every Child a Talker was a very intensive approach and it is unclear to what extent the outcomes can be achieved within a less intensive model. This will need to be carefully monitored and reviewed.
• The lack of security of the Sure Start Children's Centre Speech and Language Therapy team will impact on the effectiveness of the Inclusion consultants.
• The Inclusion Consultants are much less likely to achieve successful speech and language outcomes if the Sure Start Children's Centre resource is not available to support and embed good practice in settings.
• Development of an integrated approach to speech and language training is essential, to avoid duplication and inconsistent messages from different professionals supporting early years staff. This is at an early stage of development in the city and depends on the continued joint working across LA and Speech and Language Therapy staff
• The therapist currently working as Inclusion Consultant is seconded for a further year. However, this is having some impact on the Speech and Language Therapy service as it has not been possible to fill her substantive post at the appropriate grade. It will be difficult to continue the secondment arrangement longer term. A long term solution is required.

12) There is a wide range of specialist Speech and Language Therapy and other expertise available in the city. Theses specialists and experts play a key part in workforce development at all levels (specialist, targeted and universal).

• As a regional centre of expertise, the local population benefits from the range of specialists available for more complex or long term disorders.
• To maintain the level of specialist expertise within the city, services need to have succession planning in place. This is currently difficult to achieve due to capacity issues and uncertainly over continued funding for many posts. Without succession planning services are at risk of being unable to replace the skills and expertise of their experienced staff as they move on to new posts or retirement. Currently specialist staff find it difficult to find time for training others in a systematic way. There also needs to be sufficient capacity amongst the junior staff to allow time for specialist level training.
• It needs to be more widely understood that it is not only the Speech Therapist or specialist teacher who can provide therapeutic programmes to children and young people with Speech, Language and Communication Needs. Very often it is parents and professionals who have more contact with the children day to day who are better placed to provide ongoing programmes of intervention, under the guidance of a therapist or specialist teacher.

13) Trained Speech and Language Therapy assistants and learning support assistants are an essential and highly valued part of the service for children and young people with a speech, language or communication need. There is evidence of positive outcomes for children and young people where a trained assistant practitioner has carried out intensive work under the guidance of a Speech and Language Therapist or specialist teacher.

• Trained Speech and Language Therapy assistants and support assistants are employed within specialist services. However there are a limited number and they have specific remits within their services. A wider city-wide pool of trained support workers is required, to support schools and settings to deliver therapeutic interventions.

14) The Paediatric SLT service works very closely with the Speech and Language Sciences Department at Newcastle University, where speech and language therapists are trained. The service offers a wide variety of student placements, including a clinic held at the University site, supported by clinical staff at the University.  This joint approach supports the provision of a range of therapy options, whilst ensuring that students acquire therapeutic skills within a variety of contexts.

• Provision of student training can be time consuming for staff. However, there are many benefits to the service, including ongoing professional development for therapists and a targeted and intensive service for those children seen by students in training. Students from Newcastle very often opt to stay in the area, and therefore recruitment to new qualified posts is never difficult.

15) As CTLD Speech and Language Therapy currently offers a lifespan service this supports recruitment and development of staff with the required level of experience to work with people with learning disabilities. The experience of working with adults is also key when supporting parents in being able to explain about longer term speech, language and communication needs.

• The CTLD service may no longer be offered as a lifespan service and there may be fewer opportunities to offer a broad range of experience at graduate entry level.

Communication with Parents and Carers and Children and Young People

16) The indications are that communication between Speech, Language and Communication services and the children/young people and their families who access these services is well received.  Parents and carers seem to be generally satisfied with the way information is communicated to them.

Informal feedback and small scale surveys and questionnaires indicate satisfaction with the service received and the involvement of families in their child's therapy.

The CTLD Speech and Language Therapy team have also been heavily involved in supporting social care in the development of their user feedback and the team have Investing in Children status.

• There is no systematic collection of parent's views and feedback either within services or across agencies. It is therefore difficult to apply the feedback received about individual services to strategic decision making.

17) When the parents and carers of children and young people with Speech, Language and Communication Needs gain access to Speech, Language and Communication Service they get appropriate information regarding the service they are involved with.

• Although Speech, Language and Communication services strive to provide parents and carers with appropriate information when they become involved with services, there are concerns about the knowledge and understanding of the wider population. The indications are that there is limited understanding of Speech, Language and Communication Needs, the services that exist, where they are and how to access them. There is also a lack of awareness of the importance of providing intervention for children/ young people with Speech, Language and Communication Needs in order to reduce the impact on their own lives and to reduce the potential impact that it can have on society.
• There is limited opportunity for professionals to signpost parents and carers to information and the various types of support available from voluntary organisations in relation to specific difficulties or disorders.

Equity for a Changing Population

18) There is evidence that integrated working across speech and language therapy and the local Authority is improving outcomes and equity for children and young people who need to access the services.

Early intervention is recognised as being key to improved outcomes for the children/young people. Services for speech, language and communication are working towards improving access and waiting times, with evidence of improvement particularly in the early years.

• It is important to ensure that early intervention is not viewed in terms of age but instead that it is recognised as timely intervention once a Speech, Language or Communication Need is identified.

• This would assume that Speech, Language and Communication services have input into upper primary and secondary school. However, currently there is very little input of these services into these areas which does impact on the level of support that children/young people who need interventions receive. Waiting times are often long for children and young people beyond the early years.
• There is no input from Speech, Language and Communication Services into the Youth Offending Team.  There is limited input into Child and Adolescent Mental Health Services and provisions for children and young people with Emotional Behavioural disorders and other vulnerable groups, (narrowing the gap as described in the Children and Young People's Plan) and nor have they been considered. This is despite a higher prevalence of Speech, Language and Communication Need within these groups of children/young people. This is due to lack of commissioned service for these populations and to limited awareness of the need within other services.
• There has been no coordinated and clearly commissioned approach to assess which of the vulnerable groups (narrowing the gap as described in the Children and Young People's Plan) in the city would benefit from targeted intervention for speech, language and communication.

19) Newcastle has a very diverse population who speak a wide variety of languages. Interpreter services are available to Speech and Language Therapy for many, but not all, languages.

Training has been given to staff in early years settings on recognising and referring children with language delay where English is not the first language.

The number of languages and cultures represented in Newcastle is increasing. This is a significant challenge for service provision, as assessment and intervention with these families is generally more complex and time consuming, due to the need to assess more than one language.

• The service for children and families where English is a second language is not as comprehensive as for English speakers. There is a lack of trained interpreters and bilingual co-workers who can support assessment of language delay and intervention with non-English speaking families. Interpreters are not available to all services working with BME children and families.
• It is difficult for families who do not speak English to access therapy groups aimed at training parents to support their children's language development.
• Referral of children with English as an additional language is often delayed, due to the complexity of recognition. This can lead to longer term and more complex difficulties as the language delay impacts on access to education.
• Training the workforce to recognise and support language delay is at an early stage and needs to be more coordinated with other training initiatives and with other agencies working with BME children and families.

20) Significant medical advances have meant that the survival rates of preterm babies and/or babies with complex medical needs are improving. Children with acquired injuries also have a greater chance of survival.

• Medical advances have meant increased pressure on services that are all ready operating over their capacity. They have also increased the scope of services delivered by the Speech, Language and Communication services even though funding for these services hasn't necessarily increased.

21) Where possible services for speech, language and communication work closely with other therapy services, particularly with children with complex needs for example running joint groups.

• Occupational Therapy and Physiotherapy play a vital role in supporting the speech language and communication assessment of children and young people with complex needs. These services also are essential in successful delivery of interventions for these children. However, Occupational Therapy and Physiotherapy have limited capacity to support speech, language and communication needs.

22) The Regional Communication Aids service offers access to specialist Speech and Language Therapist and clinical engineering advice about high-tech devices which support communication and has also offered advice and training to staff in relation to low-tech communication support.

The service works in tandem with the local therapists and has a remit to provide specialist equipment for children who live in Newcastle.

The Regional Communication Aids service ensure the safe maintenance of the electrical equipment and also provide a loan service which enables the trial of the specialist equipment - long term and short term.

• A new service delivery model has recently been introduced; currently it is not clear how this will impact on local service delivery.
• It is unclear whether offering advice and training in relation to low tech communication support is still in the remit of the Regional Communication Aids service.

What should we be doing next?

In order to ensure that the areas of good practice identified in the previous section continue to work well and that the areas of difficulty and inequity are eradicated Newcastle has developed a Speech, Language and Communication Action Plan. The action plan is focusing on reviewing current Speech, Language and Communications services, the way they are commissioned, performance measured and funded in order to make the best use of available resources.

The action plan focuses on five themes;

1) Ensuring that Joint Working between services is promoted and maintained to maximise resources,

2) Ensuring that strategic and middle management communicate and work together to provide good leadership for individual services,

3) Ensuring that the Children's Workforce develops and retains skilled staff for children and young people with speech, language and communication needs,

4) Ensuing that communication with parents and carers and children and young people is appropriate and accessible,

5) Ensuring that services develop and maintain equity for the changing population so that services are available for all children and young people who require them.

Through these five themes, and the actions identified against them, Newcastle aims to ensure that services within the city are able to meet the needs of children and young people with Speech, Language and Communication Needs, now and in the future.

The information provided in this Joint Strategic Needs Assessment has been used to inform the Newcastle Speech, Language and Communication Needs Action Plan (October 2010).