Speech Therapy Waiting Lists: How Did We Get Here and What Are the Solutions?

According to the Royal College of Speech and Language Therapists, as of June 2024 there were more than 75,000 children on the waiting list for speech and language therapy (RCSLT SEND Briefing: Breaking down the barriers to opportunity faced by children and young people with SEND and their families, September 2024). This staggering figure is more than the entire population of Barnsley. But what are the issues that have led to this situation, and how might they be resolved?

Covid: The Straw that broke the camel’s back

Whilst lengthy speech and language waiting lists are not necessarily a new phenomenon, the backlogs caused as a result of the Covid-19 pandemic served to exacerbate the problem. During the Covid period, the majority of face to face appointments were put on hold for safety reasons, so many children were simply unable to be seen at all for lengthy periods of time. Whilst some NHS trusts were able to provide online therapy or assessments, the complex nature of many of the patients on SLT waiting lists meant that in a sizable number of cases, this was just not a feasible option.

In addition, the impact of Covid on the lives of children was widespread. Significant effects have been felt in areas such as social development, education and mental health, all of which have led to an increase in children being referred to speech and language therapy services.

On top of this, it is well known that there is a recruitment and retention crisis within the NHS when it comes to qualified speech and language therapists. Many therapists left the NHS in the aftermath of Covid for a variety of reasons, but one of the most commonly cited to us has been the desire for a greater work-life balance which simply cannot be supported whilst working in the NHS.

All the above have come together to create a ‘perfect storm’ of long waiting lists, without the necessary skilled therapists in place to be able to reduce them.

The ‘perfect storm’ and its impact

When looking at the number of children on waiting lists, it is easy to lose sight of the fact that each number represents a child and a family, each of whom will be impacted in their own individual way as a result of the delays in being able to access SLT services. Children struggling with communication for example are much more likely to struggle in school and may fall behind in areas such as reading and writing, as well as being more likely to suffer from mental health issues (for example, anxiety and depression).

The longer the delays in accessing the necessary SLT support persist, the more severe the issues become and the more difficult it is to be able to provide appropriate support and interventions to allow the child to ultimately reach their full potential.

In addition to this, the impact on families as a whole should not be underestimated. The stress of their child being on such a long waiting list can take its toll on parents and caregivers, and some even investigate what support may be available within the private sector. This then becomes a significant financial commitment, which many families are unable to take on.

Looking to the future: How might these issues be addressed

It is important to note that many of the issues that have contributed to the current situation have not occurred overnight, and therefore we should not expect them to be able to be resolved overnight. However, as the famous quote says ‘the true measure of any society can be found in how it treats its most vulnerable members’, and so it is vitally important that solutions are found so that those who most need SLT support can access it within a reasonable timeframe.

One innovative solution may be to make use of the private sector, where it is estimated approximately one third of SLTs are employed (Written evidence to Parliament, submitted by the RCSLT, January 2022). This represents a substantial amount of capacity that may be able to be utilised to help reduce waiting lists, and we have already seen in many clinical areas that when needed the NHS and private sector can work together to achieve shared outcomes.

Secondly, improving working conditions for SLTs within the NHS will also serve to improve retention rates. As mentioned, a key issue cited by many SLTs leaving the NHS is the lack of work-life balance making it unsustainable for them to continue in their roles. Approximately 96% of SLTs in the UK are female (HCPC Diversity Data Report 2021), and we know that childcare and other caring responsibilities still fall predominantly on females, so it perhaps should not be surprising that SLT is a profession disproportionately affected by this. Whilst the societal changes needed to fully resolve this will take much longer to implement, a more flexible approach taken by the NHS as a whole would certainly encourage SLTs to remain within the organisation and increase the pool of staff that the NHS has available to work on reducing these waiting times.

Finally, another key issue must be attracting new entrants into the profession. The Royal College of Speech and Language Therapists have suggested that to manage the backlog, the profession needs to be growing by a minimum of 15%. However, the actual current growth rates are only at around 1.7% per year (Witten evidence to Parliament, submitted by the RCSLT, January 2022). Working to address the issues with working conditions discussed above would certainly go some way to making the profession more attractive to new entrants as a starting point. It would also be easy to simply suggest creating more student places on speech and language therapy courses, but this will only work if the courses on offer will provide suitably qualified therapists who have the right skills upon entering the workforce. Without sufficient experienced staff available (as well as of course the necessary funding) to provide high quality placements for every student, it becomes difficult to see how just increasing the number of student places will achieve the goal of reducing waiting lists.

However, the introduction of the new SLT apprenticeships may prove to be a useful way to increase access to the profession. These offer the opportunity to both study and work at the same time, allowing the apprentices to start earning an income whilst the employer benefits from having them available to start working and helping to reduce the backlogs. In addition, apprenticeship schemes are well known to promote equality, diversity and inclusion within the profession which can only be of benefit both in the short term and the longer term.

Final Thoughts

Lengthy waiting lists for access to speech and language therapy have existed for many years. The effects of Covid-19 worsened the situation, and the impact on children and their families has been felt in a variety of ways. By adopting various solutions such as utilising the private sector, improving working conditions within the NHS and the introduction of the new SLT apprenticeships, the speech and language therapy profession can demonstrate its resilience and ability to adapt to change, and work together to achieve the ultimate goal of reducing these waiting lists and allowing patients to be seen as quickly as possible

This article was written by Emma Spencer, Recruitment Consultant at Globe Locums. Emma specialises in speech and language therapy roles and supports SLTs across the UK to find positions that fit their skills, preferences, and career goals. To learn more or discuss your situation, reach out to Emma at Globe Locums.