Birmingham Children’s Community SLT Service: Delivering effective outcomes through whole service redesign Gill Williams 11 October 2011

Birmingham Community Children’s SLT service Large citywide service 76 staff members

Caseloads Number of referrals has remained fairly constant But significant increase in: a) complexity and diversity of children’s needs, b) expectation

Bercow Review 2008 How could we work most effectively with our partners in the children’s workforce, to cater for the needs of all children with SLCN at universal, targeted and specialist level?

In Birmingham History of effective collaborative working providing training and support for the wider workforce (Sure Start, ECAT, Action for Inclusion) ….But without an overall strategic plan

And, in April 2010… Withdrawal of funding from the Local Authority

The Challenge Continue to provide a quality service Effective, efficient and value for money In a climate of: Increased choice and control for users and commissioners of the service

We needed to: Be able to describe the unique role of the SLT Develop evidence-based, effective, costed packages of care for a range of conditions Prioritise those children with whom we could be most effective Work collaboratively with other services and parents to ensure that other children receive a quality service Produce robust data so that success could be measured

What did the data show us? Excessive caseloads Insufficient flow in the system Variation between different caseloads and variable clinical decision making Limited understanding of ‘core business’

Working parties Set up to look at the evidence regarding effective models of working in specific areas of the service

Vision

Clinics team Clinic clusters More efficient booking system Working with referrers to ensure that all referrals are appropriate

Mainstream schools Improved partnership working with support services Clearer expectations of roles and responsibilities Joint training model to support the wider workforce

Special schools Consultation with parents, SLTstaff, teachers, headteachers leading to: A Co-Working Agreement

Resource base team Clarified SLT role, focussing resources in the newly designated language resource bases

Early years settings Education funded projects to provide a universal and targeted service aimed at: –The environment –The child –Parents –The workforce

Collecting quality data Everyone to be involved in improving the quality of data The better the quality of data, the better the service can be described and improvements can be measured

But…. Still unable to meet demand; unable to provide an effective amount of SLT input

So…. We needed to start to use the prioritisation system that we were developing

All children on our caseloads to be prioritised by September 2011

Principles of Prioritisation Clinical decision-making is complicated and involves weighing up many factors Can all these factors be combined in one tool?

Principles of the tool Severity of communication impairment Risk of contributing to lasting harm if SLT input not provided, and impact of primary presenting problem right now Benefit of SLT involvement Support available

Implementation Training ++ Consultation ++

We asked staff to think about Every contact I have with a child should be a quality contact What is my unique role as part of the patient’s journey? What package of care can I offer to the child right now? How else can I help the child/parent to achieve health outcomes?

Benefits of Prioritisation Brings together all the work to date: Consistency and transparency Clarity of unique SLT role, Partnership working, Sharing of responsibility, Relates to packages of care, Evidence based effective outcomes

Critical success factors InformationSignposting Shared understanding Consultation

A vision for the future Manageable caseloads Reduced waiting times The right children seen at the right time, and given a quality package of care Episodes of care rather than long term responsibility The wider workforce supported to work effectively with children with SLCN

Planning at a strategic level A vision of an integrated approach across the city through joint training packages for the workforce at universal and targeted level from early years and throughout school life

Mainstream flowchart

National campaigns