Feature - Without words

"Too many children in Britain are literally speechless," says John Bercow MP. His interim report on speech and language provision for children and young people will be published tomorrow (Thursday 20 March).

According to children's communication charity I Can, one in 10 children in the UK has a communication disability. Speech and language needs are closely associated with poor educational attainment and can affect employability and mental health in adulthood.

Despite this, Bercow says children and young people still don't seem "to be getting anything like the help they need to address their difficulties".

Bercow has been collecting evidence since last October when ministers asked him to carry out the first review for seven years. Pressing issues such as gaps in early intervention services, a lack of speech and language therapists, plus a desperate need for therapists in young offender institutions have come up time and time again.

However, "there seems to be very little going on at secondary school," says Bercow. "I didn't get a sense of this before, but I have been hearing it consistently this time. If a young person has a statement of special educational needs, and if speech and language therapy is specified, then they may be getting some help. But the vast majority of those with difficulties don't have statements and it is these children who are not getting help."

Kamini Gadhok, chief executive of the Royal College of Speech and Language Therapists, claims the lack of therapists is due to the fact that many local NHS decision makers do not value their service. Consequently they are freezing posts and not recruiting enough therapists. She would like to see "more training for commissioners so they better understand the vital role played by therapists".

The last review into speech and language provision seven years ago found significant problems with joined-up working. Bercow says these still exist and believes the status of children's trusts might need to be reconsidered.

"In some areas we visited it seemed as if people working in the local authority had not met with people from the PCT at all. They sat on different sides of the table and there was indifference and at worst hostility."

Bercow will also use his interim report to call for a speech and language therapist in every young offender institution. More than 60 per cent of the 11,000 young people in these institutions lack the communication skills to take part in education or behaviour and anger management programmes, according to Karen Bryan, professor of clinical practice at the University of Surrey.

In 2001, she carried out research for the prison inspectorate on young offenders' speech and language abilities. This found 73 per cent of inmates were grammatically incompetent and more than a fifth had the comprehension skills of an 11-year-old.

Despite these worrying findings, there are only five therapists currently working with young offenders in the UK. One of these is Judy Debenham. She is a specialist speech and language therapist and manager of the community homes health team in the 5 Boroughs Partnership NHS Trust in Merseyside.

"We believe 70 per cent of our young offenders have communication problems. A lot of young people with difficulties use violence as a way to communicate. We had five male young offenders in one unit where the use of restraint was extremely high. After they started speech and language therapy there was a reduction in the amount of restraint used," she reveals.

However, the Home Office is against placing speech and language therapists in all institutions. It argues that young offenders are only held in secure units for a short time - not really long enough for a course of speech and language therapy.

Debenham agrees this can be a problem. "The average stay for our young offenders is 84 days, not long enough for effective intervention. A lot of our work involves managing communication effectively while they are here and referring them onto their PCT for therapy when they leave," she says.

However, she insists even a small amount of therapy makes a difference and at least referrals get them on the right path.

Of course, early intervention might have prevented these problems developing in the first place. At the Mulgrave Early Years Centre in Woolwich, south London, 16 children with speech and language difficulties follow a 10-week intensive programme. Speech and language therapy is done through play.

The children have specific language targets, but they are also fully integrated into the mainstream nursery that takes 45 children full-time and 70 children part-time. "The children are totally included in a large community nursery," explains Barbara Murphy, the centre's head.

Early intervention

The service at Mulgrave is accredited by I Can. It has a network of 18 centres across the UK, set up in partnership with local authorities to support children who have speech and language problems.

Demand for places has increased over the years. "Sure Start has targeted speech and language needs so early years practitioners are very well educated in identifying the needs of children," says Murphy.

The centre's speech and language therapist is funded by the PCT and its four specialist early years practitioners are funded by the local authority.

But, says Murphy: "We haven't got enough therapists. We used to have three, but we had to reorganise the service due to a lack of funding. We still need more professional development and it would be good to do more training alongside therapists."

Helen Waymouth, speech and language manager of the ABC centre in Ashford, Kent, is another advocate of early intervention. The centre is also accredited by I Can and has 24 children with speech and language difficulties.

"If we talk about action words we will do the actions alongside the Makaton sign language. Or we will use toy figures to explain words," says Waymouth.

At such an early age, development can be rapid with proper support. "We have just had six children who came to us with needs bordering on severe. Within six months they were above average in their communication skills," she reveals.

However, as the Bercow Review will highlight, not enough children get this support. "There is a lot to do," says Bercow. "But if, as a result of the review, we can do something to change things, I will die a happy man."

CASE STUDY - Emma Rose and her son Lee, six, Plymouth

At the age of three, Lee Rose could only say five words. "He could say yes, no, mummy, daddy and juice," says his mum Emma. "But I was concerned as he didn't seem to be making progress."

Lee suffered from a number of ear infections during infancy and was also premature, which Emma believes may have contributed to his speech and language difficulties.

The private nursery that Lee attended advised Emma to seek professional help for him. "There was an incident at the nursery where he became aggressive and pushed a little girl because he was frustrated and couldn't express himself," she says.

Lee was assessed at the Scott Hospital in Plymouth and sent for tests. His hearing was fine and he was referred to the I Can early years centre at Southway Primary School in Plymouth. A total of 25 children attend the centre and nearly half of these have speech and language difficulties.

The centre started teaching Lee Makaton sign language. He learnt more words and was then taught to say simple sentences. "It all happened so quickly. In October he had just turned three and could say five words. By the time he left in May, he was talking away just like any other child," says Emma. "It was all through play. He would also have little packs to do at home, learning positional words such as beside and on top of," she says.

Emma took a year off work to support Lee. "They have turned his life around. I dread to think what things would be like now if he hadn't started attending the centre. Lack of speech can cause all sorts of behavioural problems. If you met him now, you wouldn't realise he ever had a speech and language problem. He is top of the class at school," she says.