The (rural) communication divide

How can we bridge the (rural) speech, language and communication divide?   
On 4 July 2018 a Westminster Hall debate was held on Speech, Language and Communication Support for Children. In leading the debate, Rebecca Pow MP for Taunton Deane, described how “the most fundamental life skill for children is the ability to communicate, which has a direct impact on their ability to learn and develop friendships, and on their life chances. There are huge benefits to getting communication…right from birth, not just to the individual but to society and the economy as a whole. However, despite the best efforts of many involved in supporting children and young people, and some tremendous individual projects and programmes… awareness of the importance of children and young people’s speech, language and communication among the public and decision makers still seems sadly lacking.” If speech, language and communication skills are fundamental in helping children and young people flourish and achieve, why does support vary widely throughout England and what can be done to improve provision, particularly in rural areas? Jessica Sellick investigates.

Speech, language and communication needs (SLCN) is a term used to describe a situation(s) where children and young people find it difficult to listen, understand and communicate with others and/or may need support to develop the skills needed to do so. Children and young people with SLCN may have difficulty with one skill or several. In the Special Educational Needs and Disability Code of Practice ‘children and young people with SLCN have difficulty in communicating with others. This may be because they have difficulty saying what they want to, understanding what is being said to them, or they do not understand or use social rules of communication. The profile for every child with SLCN is different and their needs may change over time. They may have difficulty with one, some or all of the different aspects of speech, language or social communication at different times of their lives.’  Here ‘needs’ refers both to the needs of the individual (learning, communication, socialisation) and what society needs to do to support their inclusion (within the school environment and the transition to and from home).  

There is no conclusive evidence about what causes SLCN – for each child it can result from a range of factors: as a result of hearing loss, general developmental needs, from a disability or medical condition. Risk factors are thought to include children with delayed speech (who do not go on to ‘catch up’ with other children), being summer born and therefore the youngest in a year group and/or having a family history of delayed speech and language development. While children and young people from all areas and backgrounds can have delayed speech, language or communication; there is data to suggest that the prevalence of SLCN is higher in socially disadvantaged areas – with some studies suggesting around half of the children in these areas may have significant language delays. Similarly, pupils entitled to free school meals are 1.8 times more likely to be diagnosed with a SLCN; and 2-3 times as many boys as girls have SLCNs.

SLCN is thought to be one of the most common disabilities amongst children. Estimates vary from 7-10% of children, some 2-3 children in every class or 1.2 million children. 1% of all children will have the most severe and complex SLCN requiring long-term specialist support. For pupils requiring Special Educational Needs (SEN) support or with a Statement of Special Educational Need or an Education Health and Care (EHC) Plan, SLCN is identified as their primary need in 29% of cases in state funded primary schools and in 10.8% of cases in state funded secondary schools. 

There is a growing body of work around the effects of having a SLCN now and into the future. For example, evidence suggests that children with SLCN do not perform as well as their peers in school: only 15% of pupils with SLCN achieve the expected standard in reading, writing and arithmetic by the end of primary school compared to 61% of pupils without a SLCN. In later life research shows between 66% and 90% of young offenders have low language skills, with 46-47% of these being in the poor or very poor range.  Among young offenders, studies have shown a mismatch between the literacy demands of programmes available in young offender institutes (which may require up to GCSE level English A-C) and the skills level of offenders (one-third have speaking and listening skills below Level 1, equating to age 11 years).  In October 2015 the Youth Justice Board (YJB) and Royal College of Speech and Language Therapists (RCSLT) issued joint guidance for practitioners and managers in youth offending teams to help them work with young people with SLCN.

How many children and young people in rural areas have a SLCN and what can be done to support them, now and into adulthood?

A chance to talk’ was an initiative led by ICAN between 2010 and 2012 that worked with thirty schools in four Local Authority areas, representing some 8,303 children aged 4-7 years. It involved schools, speech and language service managers, funding partners and advisors working together, in clusters, to support children’s language. Four of the seven schools that participated in North Yorkshire were in rural areas. In a rural context the initiative found limited nursery provision led some children to arrive with limited school readiness skills and higher than average numbers of children having language difficulties. Some families described the difficulties they faced in accessing speech and language therapy services in rural areas because of the limited public transport available. 

In 2015 Family Action carried out a short piece of research to identify: (i) common challenges in early year settings in rural areas in developing special educational needs and disabilities provision and (ii) to identify examples of inclusive practices in rural school settings. The research found that while many of the barriers settings faced were also common to urban settings, other barriers were specific to rural (e.g. limited public transport, lack of professional/specialist support available locally and greater distances to travel to access provision). While rural settings noted an increase in the number of children with SLCN difficulties, accessing speech and language therapists and not being able to get short term quality extra support for specific children were seen as particularly challenging.

Research by the University of Sydney highlights the communication delays, inequity of access to essential speech-language pathology services and poorer later life outcomes for children in rural and remote areas of Australia. Similarly a national survey of speech-language and audiology services in the United States found  children in underserved rural counties were not being served due to distance from the nearest provider. 

These studies point towards the lack of availability and accessibility of SLCN services in some rural settings – and a lack of clarity about how many children and young people in rural communities have unmet service needs.

What has Government done to support children and young people with SLCN? Back in 2008 – and following 10 months of evidence gathering and analysis - John Bercow MP published his report making recommendations to Government about the steps it should take to transform provision for and the experiences of children and young people with SLCN and their families. These recommendations covered five themes: (i) communication is crucial, (ii) early identification and intervention is essential, (iii) design a continuum of services around families, (iv) joint working is critical, and (v) the current system is characterised by high variability and a lack of equity.  The purpose of Bercow’s review was two-fold: to do better in providing help for every child or young person with SLCN; and to improve educational outcomes, promote public health, tackle anti-social behaviour, reduce the number of people who go through the criminal justice system, bolster the skills of the workforce, and increase the competitiveness of the country where SLCN services play their part in helping to deliver these outcomes.  Following the report, the Government published an action plan, ‘Better Communication’, which accepted many of the recommendations: from appointing a Communication Champion to raising awareness of SLCN and working with delivery partners to coordinate and improve services through to forming a Communication Council to monitor service improvements and provide advice to Government.

‘Bercow: ten years on’ was published in March 2018. An independent review of provision for children and young people with SLCN in England, the report reveals the findings of a consultation with 2,500 people, focus groups, research review and in-depth analysis of three Local Authority areas. The report highlights some of the key positive and negative changes since 2008. It cites the increasing evidence about SLCN through the Better Communication Research Programme, Government funding for workforce development in SLCN, a national service specification for Alternative and Augmentative Communication (AAC), increased recognition of SLCN in the justice system and language and communication gaining recognition in the early years school curriculum. Less positive changes that have taken place since 2008 include reductions to SLCN services, loss of specialist speech and language therapy posts, the removal of speaking and listening from the National Curriculum, the removal of communication from the Ofsted framework and no assessment of spoken language after age five. These changes are set against a backdrop of reforms and reorganisation with the NHS/health system, education system (e.g. academies and free schools, reforms to support children with special needs) and the (increasing) use of technology.

Overall the report reveals how public awareness of the importance of speech and communication is still not high enough on the agenda, how SLCN rarely features in national policies, and how services are not integrated enough (e.g. only 3 out of the 44 Sustainability and Transformation Plans reference SLCN). In practice, data tends to be collected on waiting times rather than outcomes, specialist services are being reduced (limiting services to only the highest needs children) and screening tools to spot the signs of SLCN need to be more sensitive. For children diagnosed as requiring support the report found over half of parents waited six months for an appointment and 34% had to wait more than a year for an appointment.

At the end of April 2018 the Department for Education (DfE) announced two funding initiatives: (1) a £5 million scheme run by the Education Endowment Foundation  to trial projects to provide practical tools and advice to parents so they can help their child learn new words through simple steps like reading and singing nursery rhymes; and (2) an £8.5 million programme for Local Authorities to fund projects to improve early language and literacy development for disadvantaged children. In July 2018 the DfE announced a £6.5 million scheme for voluntary and community groups to run projects that help disadvantaged families teach their child to read, write and gain language skills. ‘Opportunity areas’ are part of the Government’s national plan for addressing social mobility through education. Of the 12 Opportunity Areas, 5 are in rural and coastal locations: Fenland and East Cambridgeshire, Hastings, Ipswich, North Yorkshire coast and West Somerset. 

While many RSN readers will welcome these announcements, there remains a sense that not enough progress is being made. At the Westminster Hall debate Rebecca Pow MP highlighted how SLCN remains a Cinderella sector: “I surmise that that may be linked to the fact that the whole area seems to fall between two stools: health and education. Somehow, it fails to be allotted the place it deserves in this country’s national policy.” While children with SLCN may be identified by nurseries and schools (education), the commissioning of speech, language and communication support services comes from the health system.  

While the Government will formally respond to ‘Bercow: ten years on’, it is already taking further steps around SLCN, including training for practitioners such as health visitors (working with Public Health England), and through a desire to work with the APPG on speech and language difficulties.

In Scotland, health visitors and family nurses play a key role in prevention, early identification and intervention for children in relation to SLCN – and NHS Education for Scotland has developed an online resource to extend their skills and support their continued professional development.

In England, the Westminster Hall debate highlighted organisations that seek to raise the profile of SLCN – from ICAN and the Royal College of Speech and Language Therapists (RCSLT) through to the work of Gillian Rudd at Birmingham City University;  as well as a plethora of projects seen as national exemplars including Stoke Speaks OutTime to Talk - Warwickshire, No Wrong Door (North Yorkshire), A Better Start Southend and Bookbug in Scotland. In Wiltshire, the Speech and Language Therapy Service is jointly commissioned by NHS Wiltshire Clinical Commissioning Group (CCG) and Wiltshire Council to provide training and a collaborative model of support to children with SLCN needs in Wiltshire. 

In a rural context, the ‘a chance to talk’ initiative highlighted the importance of accessibility to therapy within schools. In North Yorkshire, for example, ‘talk boost’ was implemented with groups of 4 children and they all made progress. Having regular specialist staff training opportunities and providing local in-school support were all found to be important.

I am currently evaluating the Linkage Community Trust’s sensory library project. This provides a fully-accessible converted bus for individuals and groups across Lincolnshire to access a mobile sensory room (and multi-sensory equipment hire), on their doorstep, at no cost. I have heard first-hand from children with learning disabilities, learning difficulties and other health conditions (and from their parents/carers and professionals) about the difference the project makes: from the fun and joy it brings (e.g. sensory balls, flying round the solar system, vibrating snakes, flashing balls and a waterfall with glittery bits) to the way in which it helps children engage with their environment and the people around them. While the sensory library has developed a unique proposition around being mobile, being affordable, being beneficiary led and being a catalyst for others; I am all too aware of the difficulties that many parents/carers now face over the summer holidays where the support they receive from other agencies “closes down for 6 weeks.”  I have also heard from brothers and sisters about the everyday things and activities they forgo to help support their sibling and family.  

Will the publication of ‘Bercow: ten years on’ provide renewed impetus to support the continuation of projects and programmes that we know are successful; to provide clear messages for parents/carers so they know when and how to access support; reduced waiting times; support for children and families during school holidays; and/or an overarching strategy for SLCN? 

What do successful SLCN rural pathways look like? How and where does technology fit into this pathway?  And how does this pathway join up with other public services – public health, health, transport, education, leisure?

What is clear is that if Government, Local Authorities, health bodies, nurseries, schools, charities, community groups, practitioners and the public all work together we will ensure provision for children with speech, language and communication is no longer a Cinderella sector.

Following a briefing on nature I am indebted to Louise Beaton (Community Halls Consultant) for drawing my attention to provisions within the Lawton Report (‘Making Space for Nature’) and the National Policy Planning Framework (NPPF) for designating ecological networks or biodiversity corridors. Neighbourhood plans offer one means of doing this and Louise highlights the work of Aldingbourne Parish Council (over several years) as being one of the few in the country so far to designate biodiversity corridors. However, getting the Planning Inspectorate to understand biodiversity, whether the Local Authority Planning Committee will uphold the area designated in the face of development proposals, and more broadly ensuring the protection of these areas in legislation in ways similar to AONBs or National Parks, all remains unresolved.

Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at the National Centre for Rural Health and Care. Her current work includes helping public sector bodies to measure social value; evaluating a mental health project supporting young people; and undertaking a piece of work on migration. In her spare time Jessica sits on the board of a housing association. She can be contacted by email or telephone 01522 521211. Website: @RoseRegen


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