Wednesday, 18 January 2012

Could the Minister please read the report now? - Anita Kerwin-Nye, Director

Jean Gross last report as the Communication Champion was released this week, please click here to view.

Full of excellent intelligence on the state of services on the ground and bursting with sensible recommendations for improving outcomes for over a million children, you would have thought that this would be on the must read list for relevant Ministers – or at least their special advisors – or I’d settle for their junior civil servant.

However, the Minister for Public Health - Anne Milton – press response to the report is very telling, Repeating the now ubiquitous quote that GP commissioning will solve all shows a total lack of understanding of how children’s community health services operate in practice and frankly leaves me in doubt as to whether anyone in her department has even read the report.

Jean Gross’ report is clear on the risks of leaving services for children with SLCN to GPs and clinical commissioning groups. In London, for example, only 9% of referrals to speech and language therapists go through GPs.

And Milton’s reference to GPs working with paediatricians and nurses on this issue shows a significant gap in knowledge about the realities of supporting children with speech, language and communication needs (SLCN). While community paediatricians have a valuable role in supporting children whose communication needs are part of more complex impairments most children with SLCN do not see (or need to see) a paediatrician or nurse. Their needs are met through speech and language therapists and appropriate targeted support from teachers and staff within early years and schools.

It could just be of course that this is the response from an uninterested Department of Health press officer. But sadly I suspect it is part of a wider malaise affecting the Department when it comes to children. I received an email yesterday inviting me to the launch of an ‘exciting’ new initiative in children’s health and well being to be unveiled by the Secretary of State (at least he hopes to be there) in Liverpool next week. I think most of us would settle less for exciting and more on functional. And the Trust are no nay sayers – we work hard to inform and to respond to government policy trying to ensure that it works in practice. But even we are stretched in understanding where Health places the needs of children who struggle to communicate.

This is at odds with the efforts of their government colleagues within Department for Education who have made such strides in work to identify and support children with SLCN. Maybe it is time for the entire responsibility (and budget) for this work to move across? It is this significant disparity in both understanding and in approach between these health and education nationally and locally that is of such grave ongoing concern with so much of Jean’s report highlighting the risks of these children falling between the gaps at a local level between the NHS and local authorities/schools.

The government’s communication champion has written a report with so many of the answers – just about time somebody read it!

From the report

38. I have met no one outside government who believe that commissioning by Clinical Commissioning Groups led by GPs will change this fundamental problem. All say it will make it
worse. I have found that in London, for example, only 9% of referrals for speech and language
therapy go though GPs. Most come from schools and health visitors. Most disabled children are dealt with by community paediatricians not GPs. Most referrals to CAMHs services do not go through GPs. Children requiring community health services are largely invisible to GPs, so it seems unlikely they will be a commissioning priority.

39. I would like to see the Health and Social Care Bill recognise this, and explicitly require Clinical Commissioning Groups to delegate the commissioning of these services to an expert joint local authority and NHS children’s commissioning team, managing pooled budgets.

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