SPEECH AND LANGUAGE THERAPY SERVICE FOR CHILDREN WITH MILD / MODERATE SPEECH LANGUAGE AND COMMUNICATION NEEDS IN MIDDLESBROUGH PERFORMANCE REPORT QUARTER 4 13/14 Nikki Joyce Paediatric SLT Service Manager The information contained within this report was pulled from SystmOne on 25th April 2014 following the Easter holiday. All contacts for 1st January to 31st March 2014 were inputted and reportable by this date. All information contained within this report (with the exception of the new referrals as the initial assessment is a health funded contact and, until seen and assessed, the children do not have a diagnosis) relates to children with a diagnosed mild / moderate speech, language or communication need. All children with health needs are excluded from this report. All children with Redcar and Cleveland postcodes are excluded from this report. All Middlesbrough postcodes are included – where children with a Middlesbrough postcode attend a Redcar and Cleveland School (Nunthorpe especially) – data for that school is included. All children included in this report have a diagnosis of either a speech or language DELAY or a mild / moderate general communication DELAY. All disorder diagnoses are excluded from this report as disorder diagnoses would be part of the Specialist Health Funded SLT provision. NB staff funded by health also see children in homes, schools, daycare and clinic settings. Most of the data relates to the number of individual children seen. A child may be seen more than once in a quarter (for example a 6 week block of once weekly speech sound therapy) and this is the number of CONTACTS. Children are allocated the number of sessions as agreed in Part 6 of the contract according to age and diagnosis / aim of therapy. For the purpose of equity for children within the same class as per part 6 of the contract – aged 3-5 = foundation stage and aged 5-8 = Y1 to Y3. From 1st April 2013, additional funding was agreed by SMF as follows: Contract value for 1/4/12 to 31/3/13 is £179181 and additional funding of £31537 will provide a total funding for 1/4/13 to 31/4/14 of £210718 for a revised caseload of 1082 +/- 5% = 1028 - 1136, increased from 920 +/- 5% = 874 - 966. Appendix 1 is the locality team list for Middlesbrough showing which locality team covers which locations and schools and with which staff. As of January 2014, SystmOne was updated and there are new reporting fields available which are giving more accurate data than previously, particularly around non-attendance and “care plans” which give us our diagnostic data – please note therefore that there may be some disparity with previous reports as a result. Performance data as per schedule 2 of the Contract: 1ai) Number of children receiving the service including the number of contacts: Number of children on the mild / moderate caseload currently (with diagnosis – post initial assessment): 1050 Number of children seen in the quarter: 560 Number of contacts for these 560 children (excluding initial assessments) 1449 Of 1449 contacts offered 62 were DNAs (4.3 %) and 1 was cancelled by patient (0.7%) 13 were Child Protection contacts (0.9%). 1aii) New referrals together with the waiting times from referral to service delivery: Waiting times relates to children referred in qtr 3 as children referred in qtr 4 will not have been seen yet and therefore we don’t know what their completed wait is. In qtr 4 there were 142 referrals which were given a diagnosis of mild / moderate delay (out of 155 triaged to Middlesbrough locality teams in qtr 3). The waiting time to initial assessment appointment (health funded) was between 0 and 188 days. Average wait was 77 days (11 weeks). The NHS Referral To Treatment (RTT) target is 18 weeks. 3 referrals waited beyond 18 weeks – all of these had been offered at least 1 appointment before 18 weeks but had DNA-ed or cancelled. 47 referrals waited beyond 12 weeks but all referrals were offered appointments within 18 weeks. School nurseries are reporting increasing numbers of children with speech, language and communication needs and some are reporting to us that they feel this is because we don’t see them under 3. Source of 167 new referrals in quarter 4 which were triaged to Middlesbrough locality teams & are predominantly therefore education contract children: NB: Continued shift this quarter between referrals from Health Visitors and referrals from education (which Includes school nurseries). East locality are going to undertake the audit that North did in quarter 3 in quarter 1 of the next financial year to see if there is a pattern developing. 1aiii) Source of referrals for each child that has been seen this quarter: This relates to all children seen under this contract during quarter 4 – some of these may have been referred some years previously. 1aiv) DNAs – see 1ai 1av) Age range of children seen: We are seeing a steady trend towards increasing numbers of children aged over 8 being re-referred to our service. Many of these are young people in year 5 / year 6 who have a residual mild speech problem for example a lisp. They often were too young or not motivated to have therapy as younger children but are more aware and more motivated to resolve the problem before they start secondary school. These children do not meet health criteria for therapy as their problem is mild however, under the terms of the contract, they should not receive therapy. We have been offering them a block of therapy however as the impact on their self esteem, confidence and in terms of the social emotional aspects of learning may be detrimental if we don’t. We are able to accommodate them within the numbers agreed within the contract and we hope that this is acceptable in terms of a modification of the contract based on clinical good practice and client need. 1aVi) Break down by individual school and locality - East locality – number of children with mild moderate delay seen each quarter by school North locality – number of children with mild moderate delay seen each quarter by school South locality – number of children with mild moderate delay seen this quarter by school Secondary School – number of children with mild moderate delay seen each quarter by school 1avii) Health information for schools is not included as not commissioned by Middlesbrough Council. However, all schools receive copies of appointments or schedules of visits for children seen by health funded or specialist staff. Individual schools are therefore able to identify the total number of visits to their setting. This information is sent to the SenCo unless the school makes an alternative request. 1aviii) Language not reportable on SystmOne – our Admin and Clerical Team have developed a record from 12/13 qtr2 and that data is available below. During quarter 4 – the following new referrals came in that were triaged to Middlesbrough teams (so out of 167 referrals) where English was not the first language Of 167 new referrals, 11 were EAL = 6.6% With some of the new reporting functions available, we have been able to log which children have an “additional language background” and report on SystmOne. We have allocated children to this group during quarter 4. Of 1050 children on the education contract caseload currently, 130 (12.4%) have a first language background other than English. Many of these have parents whose English is sufficient to support them and they do not require interpreters but nonetheless their first language background may be a factor in their speech and language needs and we will now be able to monitor this group. There is no field to report which language background they come from only that they have English as an Additional Language. During quarter 4 – outside interpreters had to be employed for the following 8 appointments for children on the education contract caseload (nb: some children had more than one appointment in the quarter): Our Punjabi / Urdu bilingual SLTA offered 57 appointments to children on the education contract caseload for either therapy or to support the therapist with a review. Of 1449 contacts then 3.9% were Punjabi / Urdu first language and 0.5% were other languages requiring purchasing interpreters. 4.4% of contacts required translators in total. 1aix) Gender Ethnicity WHERE RECORDED / GIVEN Disability is not recorded and is confidential to the patient. We record disability as a medical diagnosis (e.g. Autism, Down’s Syndrome etc). Children with those types of medical diagnoses will be seen under the Health Contract NOT under the Education contract. In terms of the Education contract – if the child had a disability that was not the underlying cause of their mild and moderate speech, language and communication needs but additional to it, we are not required to record this – and patients / carers are under no obligation to tell us. The type of disability that we may find among this group would be dyslexia, dyspraxia (not verbal / oral dyspraxia), ADHD etc which the SenCos would have details of. Diagnosis of mild / moderate speech and language difficulty is recorded and breaks down as follows: 1ax) Locality information included as breakdown of children seen into schools above on the assumption that the majority of children attend their nearest school in Middlesbrough. 1axi) No flag or reportable function for LAC, Child Protection or CAF. All of this data is held by the local authority. Families are under no obligation to give us this information and we do not record in on SystmOne other than where we have direct input to Child Protection reports / conferences etc and those are listed under 1ai) above.