Best Start in Speech, Language and Communication

The term speech, language and communication needs (SLCN) encompasses a wide range of difficulties related to all aspects of communication in children and young people. These can include difficulties with fluency, forming sounds and words, formulating sentences, understanding what others say, and using language socially.” [1].

“The first years of life are vital in giving every child the best start, with speech, language and communication skills an important indicator of child wellbeing. These skills shape a child’s ability to learn, develop friendships and their future life chances. Every child, regardless of circumstance should be able to develop and thrive. There is increasing concern about the numbers of children starting school with poor speech, language and communication skills, with unacceptable differences in outcomes in different areas of the country. Inequalities in early language development are recognisable in the second year of life and have an impact by the time children enter school.” [2]. Because of the impact of the Covid-19 pandemic on children, young people, families, schools, services and wider society, speech, language and communication needs (SLCN) are likely to increase in the UK. Two-thirds of primary school teachers and half of secondary school teachers report they have at least one pupil who now has SLCNs because of the impact of Covid-19. [3]

In Nottinghamshire, our aim is to develop a system wide approach to identify and meet the needs of children with speech, language and communication needs and reduce inequalities.

[1] The Bercow Report. A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Needs. Department for Children, Schools and Families.: DCSF-00632-2008. 2008. available at: basw_102721-9_0.pdf.

[2]. Public Health England. Best start in speech, language and communication: Guidance to support local commissioners and service leads. 2020. available at: Best start in speech, language and communication (SLC) - GOV.UK (www.gov.uk).

[3]. I CAN Charity. Speaking up for the Covid generation. (ICAN, 2021). Available at:

speaking-up-for-the-covid-generation-i-can-report.pdf (ican.org.uk)

Joint commissioning

In 2020, the commissioning of Early Intervention and Specialist SLCN services was brought into a joint commissioning arrangement. Previously, both services were provided as separate contracts by Nottinghamshire Healthcare NHS Trust; Home Talk commissioned by the Local Authority as part of Children’s Centre Services and specialist Speech and Language Therapy by the Nottingham and Nottinghamshire Clinical Commissioning Group (NNCCG). The two services were combined to establish one single pathway for children aged 2-19 years, with the Early Intervention Service being incorporated into the overall NNCCG contract. This agreement was finalised contractually with an aligned budget in April 2021. A joint triage process has been established ensuring that children receive the right support at the right time, thereby streamlining processes and ensuring the effective use of resources, as illustrated in the pathway.

The joint commissioning arrangement does not incorporate Bassetlaw, where specialist speech and language therapy services are provided by Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust.

Best Start SLCN group

A Best Start SLCN group has been established, attended by commissioners and providers, to support the continued development and embedding of clear and aligned pathways across the County.

The group is a sub group of the Best Start Partnership delivering the Nottinghamshire Best Start Strategy 2021-2025

Key areas of focus will be:

Encouraging and empowering parents and carers in their children’s speech, language and communication development and providing language rich environments.
Further developing and embedding a system wide pathway for children with SLCN in Nottinghamshire, at universal, targeted and specialist levels.
Enabling children and families to access the right support at the right time in the right place.
Supporting a system wide approach to workforce development at universal, targeted and specialist levels, for all practitioners involved with children under five and their families.

Current provision

There is a range of SLCN support and provision for children and families in Nottinghamshire including:

Children’s Centre Service

The Children’s Centre Service at Nottinghamshire County Council works to ensure young children get the best start in life and that their families are supported to help them achieve this. Children Centre Service provides a range of services for parents-to-be and families with children under five years old who live in Nottinghamshire.

The staff have expertise in family support, developing parenting skills, promoting health and wellbeing, early years development, communication and language, working with volunteers, and supporting parents to get back to work. This service works with partner agencies to ensure families are supported in whatever area they need.

Early Intervention and Specialist Speech and Language Therapy

This service- provided by Nottinghamshire Healthcare NHS Foundation Trust- provides a wide range of activities to support children with their communication potential. Home Talk Workers work in partnership with parents/ carers to deliver a fun, home-based programme for children aged 22 months- two and a half years with spoken language difficulties. Language Lead Networks provide support and Continuing Professional Development to local childcare settings and schools. This service also offers a ‘traded service’ to schools and early years settings.

The Children and Young People’s specialist Speech and Language Therapy element of the service provides specialist support for children/young people with speech, language and communication needs (SLCN) and/ or swallowing and feeding difficulties (Dysphagia). Interventions are based on assessment of an individual’s need in conjunction with environmental factors and requirements associated with the most appropriate agent of change e.g. parent, support worker, school staff, to improve or maintain speech, language and communication skills and facilitate safe swallowing.

Children’s Speech and Language Therapy Service

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust provides life-improving treatment, support and care for children and adults who have difficulties with communication, eating, drinking or swallowing.

The Early Childhood Services

Nottinghamshire County Council provides and commissions a range of services for all families and targeted services for families with children aged 0-4 years who are in need of extra support. Early education is a key factor in preparing young children to be ready to start school.

Healthy Family Teams

This service, provided by Nottinghamshire Healthcare NHS Foundation Trust, is part of the Healthy Child Programme and has a critical role in identifying children that require support with SLCN. What happens in the home, in children’s earliest years before they start school, has an important influence on later outcomes. All interventions are founded on the principle of involving and supporting parents and carers in their children’s learning and development.