Official Report: Minutes of Evidence

The Chairperson (Mr Mathison): Joining us are Ruth Sedgewick, head of the Royal College of Speech and Language Therapists (RCSLT) Northern Ireland office; and Sue McBride, policy adviser for the royal college. You are very welcome. The last time that we were in your company, we were cracking jokes with May McFettridge in the slightly different context of the VoiceBox awards. We should probably have recognised that event as a Committee. It was a brilliant event, and the children and young people clearly had an absolute ball. I do not quite know why they did, given some of the jokes from the MLAs around the table here that they were subjected to, but it was a really great event.

Mr Brooks: It was something very different.

The Chairperson (Mr Mathison): It really was.

Mr Burrows: I had no confidence whatsoever in the voting.

Ms Sue McBride (Royal College of Speech and Language Therapists): Because you did not win.

The Chairperson (Mr Mathison): Did you think it was rigged?

Mr Burrows: There should be some sort of appeal.

Ms Ruth Sedgewick (Royal College of Speech and Language Therapists): You can try again next year.

Mr Brooks: I am disappointed that Jon did not wear his hat to the Committee.

The Chairperson (Mr Mathison): Yes, some interesting headwear was worn at one point in the proceedings.

I thank you both for offering your time to the Committee to speak to the regulations. I do not know if you heard any of our previous conversation. The Committee is working its way through the regulations, and that is proving to be a lengthier process than might have been anticipated. It will be great to hear today from an organisation that brings a health and allied health professional perspective and how that interacts with the education system. It is timely to hear from you. I will hand over to you for any initial presentation. We want to bring the briefing in at 30 minutes in total, if possible. I ask that we all try to work to that timescale.

Ms Sedgewick: Thank you so much, Chair. Our presentation will last for only a few minutes so that we have plenty of time for your questions. Chair and members, thank you so much for the opportunity to speak on behalf of the Royal College of Speech and Language Therapists in Northern Ireland regarding the proposed SEN regulations, the revised code, the graduated response framework and the enhanced support model, which really do come as a package.

As the professional body for speech and language therapists, our focus is on what the proposals will mean for children and young people with speech, language and communication needs (SLCN) and for those who support them in schools and services every day. We really welcome the ambition behind the reforms. We recognise that the system is under pressure and that change is needed. We have concerns, however, that the proposals as drafted do not provide sufficient clarity on how children with SLCN will be identified, supported and reviewed. Our concern begins in respect of early identification and ensuring that children are recognised before they reach the crisis point. SLCN can be hidden. Children may appear to cope well, or they can present with anxiety or emotional dysregulation behaviour challenges or learning difficulties without anyone recognising that SLCN could be the underlying issue. The Early Language Support for Every Child (ELSEC), in its interim report that was published in England earlier this year, found that 60% of children screened had previously unidentified needs, which was higher than even it anticipated. Whilst that is not Northern Ireland data, it highlights the potential scale of hidden need and reinforces the importance of early identification and communication-focused supports in educational settings.

We have some concerns about the response framework, as we do not feel that it adequately reflects SLCN. It does not clearly reference speech and language therapists, provide pathways for liaison or referral or demonstrate clearly how SLCN should be identified and escalated.

It is important that I say that our members continue to face significant workforce pressures. We previously highlighted the fact that, between 2021 and 2023, there was an 85% increase in the number of children waiting for speech and language therapy. While we wait for updated figures, the DE SEN data continues to show that the numbers continue to increase year on year, and that is without taking into account the potential hidden needs.

Waiting lists are long. There is no sustainable way around the challenge without increasing workforce capacity and securing additional commissioned speech and language therapy posts. We support universal targeted and specialist support, such as the Balanced System framework that is operating in the trusts. We feel that there would be real value to DE linking into that approach, so that Health and Education can identify and support children through shared models and pathways.

Many children can be helped by such universal, communication-rich environments. Some children need the more targeted interventions, and others will always require specialist speech and language therapist input. However, there remains limited direct speech and language therapy representation to inform policy and strategic decision-making in Education. Based on the Welsh approach of embedding SLT expertise in education, leadership and government structures, we advocate the secondment of an SLT into the Departments.

Speech, language and communication is fundamental to learning, participation and inclusion; therefore, specialist expertise must inform the reforms. I have mentioned examples from elsewhere that demonstrate what joint working could look like. Think about the ELSEC programme, which used joint Health and Education funding, and the Department of Education and Youth in Ireland. Those two examples recognise that SLCN spans the Departments of Health and Education, and that reflects something that we have said consistently: speech and language therapy needs to be embedded in Education. We need protected, commissioned posts, as outlined in the SEN reform agenda last year, to allow for appropriate governance, supervision and multidisciplinary working.

We support reform, but it must be implemented carefully and realistically. We are concerned that the proposed SEN regulations, the revised code, the graduated response and the enhanced support model (ESM) are progressing simultaneously without sufficient clarity on implementation, accountability, workforce planning or governance. That makes it difficult to fully assess how the reforms can operate together in practice and whether the Health and Education systems can align effectively.

Our message on what is needed is clear: dedicated SLT leadership across the Departments of Health and Education, the joint commissioning of SLT posts, sustained workforce planning and investment to support earlier identification and intervention. Above all, the reforms must be properly resourced and the requisite time must be allowed for them to be implemented effectively, consistently and sustainably. Thank you

The Chairperson (Mr Mathison): Thank you. You successfully brought your presentation in at under four minutes, which is great.

I think that we have found, with almost every aspect of the graduated response, the enhanced support model and the draft regs, that the question is where to begin. It is very big and it is all connected, so it is hard to separate it out and say that we will look at just one thing or another.

First, I will raise some issues relating to the draft regulations, if that is OK. I will try to be brief and clear in my questioning. In your consultation response, you highlighted the fact that you are concerned that the regulations may not be specific enough to ensure that health advice is sought from the right health professional for a child or young person with speech and language needs. The wording in the regulations is that medical advice should be sought:

Do you have concerns that a child or young person may not get advice from the right person to inform their statement and the assessment process?

Ms McBride: As Ruth said in her opening speech, many children with speech, language and communication needs will be unidentified and hidden. The other problem is that children and young people who are on a waiting list to be seen by speech and language therapists may not receive the correct advice and support because they will not yet have been assessed by the statementing process. By the time that is done, the statement could already be in place, so it is about when the advice goes through and whether the statement is reopened for that advice to be entered into it.

The Chairperson (Mr Mathison): It is about making sure that the process is responsive so that, when an assessment is carried out that there is a process around data-sharing, which is something that we hear about a lot, there is some sort of process by which it is fed into the education system and it does not just sit isolated in a silo because a speech and language assessment has been done somewhere else.

Ms McBride: Yes, because it could be, unless it is an annual review. With this, the time frames for the reviews will be at key transition points. Will it be longer before the information is given to the relevant people to enable them to make an informed decision on that statement?

The Chairperson (Mr Mathison): That is really helpful. There has been quite a bit of discussion about where health advice should sit on the statement. There have been concerns that, if it goes into part 6, it will not carry appeal rights at a special educational needs and disability tribunal (SENDIST). Comparing how things operate now with what is in the draft regulations, do you have a sense of where speech and language provision in a statement should sit? Should it be in part 3 or part 6 of the statement?

Ms Sedgewick: You have seen our statement. We have been reflecting on that and listening to the people who gave you evidence previously. We want to clarify our position regarding speech and language therapy provision. Our concern is not with recognising that speech, language and communication needs are educational needs, because they clearly are, as they directly impact on access to learning and participation in the curriculum. Rather, in our statement, we were trying to say that our members have experienced difficulties where provision has been framed in an overly rigid or formulaic way, which is worrying and can really limit a clinician's ability to respond reflexively to children and young people's changing communication profiles and evolving needs.

Our position, therefore, is that provision should be clearly identified as an educational need where appropriate but that we still need to make sure that intervention can be determined by professional and clinical judgement and that there is space for ongoing review of evidence-based practice.

Is there anything else that you want to ask on that?

The Chairperson (Mr Mathison): No, I am content. That is fine. I may come back to things, but I want to make sure that all members have a chance to come in.

Mr Sheehan: Thanks for that. You will be familiar with the education and health oversight group. Have you had any engagement with it?

Ms Sedgewick: We have not had engagement with the group. We know from you and from watching previous evidence sessions that work is going on. We know that our chief allied health professions officer (CAHPO) sits on such groups. We understand that good work is commencing between the EA and SLTs. I am not sure whether you are aware, but, hopefully, there will be work to support a programme that looks at reviewing language and communication across preschool, primary and post-primary, with support from the EA and SLTs. That is a really good opportunity that, we hope, is coming. However, it would be great to see even more joined-up collaboration at a higher level so that things are done together at development stage, from the start of operational realities, with both education and health in mind.

Mr Sheehan: Thanks for that. You said that you have listened to previous witnesses giving evidence to the Committee. The foremost of that group was probably the Children's Law Centre (CLC). They are asking that this process be paused so that there can be greater scrutiny and clarification. Is your organisation of the same mind?

Ms Sedgewick: Yes.

Ms McBride: Yes. We support what the CLC is saying.

Mr Sheehan: OK. That is all I have. Thank you.

Mr Burrows: I have a slightly broader question, Sue and Ruth, and thank you for all the work that you do for young people. You mentioned a pilot that identified young people far earlier. That is vital. If we identify children at the very earliest stage and provide early language support for every child, that will make the outcomes much better.

Ms McBride: Yes. That was a joint initiative that the UK Government had under the Change programme in 2023. They brought together expert teams that they called "pathfinders", made up of speech and language therapists and speech and language therapy assistants to develop innovative ways of working.

There were nine areas altogether. They went into early years and primary schools to deliver universal, targeted intervention. However, as we said earlier, the findings were that, in some areas, the majority of children — 60% — had not been identified as having any speech, language or communication needs —

Ms Sedgewick: Before that.

Ms McBride: — before that. They were completely hidden. Screening, and the power of Health and Education working together to identify those children and young people, being able to implement the appropriate universal and targeted approaches, closed the gap for some of those children. Those who did require the specialist support were identified and went on to receive help.

Mr Burrows: I have one final, slightly broader question. Any of those measures relies on resource. I am picking up that you have people who are getting qualified in your area. They come out with their degree, but there are no posts for them, so they have to go to England. Is that a problem?

Ms Sedgewick: That is very new, Jon. We have just heard it from somebody who qualified as a SLT. Our 2019 speech and language therapy workforce review said that we needed 40 graduates a year by 2024. We sat at the baseline of 28 for a few years, and we really welcomed the Health Minister's decision last year to increase that to 56. We had that 100% increase last year.

However, last year, we saw for the first time that our 2025 cohort did not all secure band-5 posts, and will now be entering competition with the 2026 cohort for a limited number of band-5 positions. As you were saying, that raises questions about workforce planning. We know that demand for our services continues to rise across the board — adults as well as children — as we have been talking about. However, the expansion in those training places has not been accompanied by a corresponding increase in commissioned, permanent posts. We really need a more coordinated approach to workforce planning and service investment. As you said, there is a real risk that we will be training them — our members work really hard to support placements for that increased number of students — only to lose them.

Last week, I was in the South at a conference. They talked about their wonderful Department of Education and Youth in Ireland directly funding 350 SLT posts in the next few years. Fifty started this week in schools. They were saying, "We do not have enough SLTs in Ireland, so send your SLTs down here. We want to keep them". We are worried. In all seriousness, we really need the two Departments to work together at all levels and to commission together. That is where we have to be at.

Ms McBride: We have had emails from newly qualified members, who have said that they had no option, so they have gone to England [Inaudible.]

Ms Sedgewick: Some have gone further abroad, to work in Dubai, Australia and New Zealand, because we do not have the posts for them. We do not want that to happen, obviously.

Mr Burrows: Thanks. That directly relates to SEN, and that early intervention is really important. Thank you.

Ms Hunter: Thank you so much, ladies, for your time and for the important work that you do. I had a question earlier to an Irish-medium panel. You might not have the answer to hand, but one of the challenges is ensuring that Irish-medium education has the right support, particularly for the children who have developmental language disorder (DLD). Is there anything more that the Committee could be doing on that? Do you have any feedback for us on how support can be improved?

Ms Sedgewick: That is a very good question. [Laughter.]

Ms Hunter: You might not have the answer. I am mindful that there might be a bit of a gap within Irish-medium education, but I am keen to hear whether there is anything more that we can do.

Ms Sedgewick: That is certainly something that I do not think we have ever been asked or have thought about, specifically with DLD. However, it is coming up more and more for us. We have great links with Comhairle na Gaelscolaíochta and Altram, the Irish-medium organisations. We were training them in communication last week. We have lovely connections with them, and we know that they would absolutely love —. We are sometimes asked how many SLTs can speak Irish and how many can deliver the therapy in Irish, and we do not have an answer to a lot of those questions.

We could follow Wales, where there is a requirement for a certain number of training places to be taken up by Welsh-speaking speech and language therapy students, but no one is sure where those students will end up, so the number of places needed is hard to work out. We have members who speak fluent Irish, but we do not know whether they will end up working in an Irish-medium setting. It is tricky to plan for, but we are open to conversations about where we need to try to open doors and move things. I am definitely happy to have another conversation about that.

Ms Hunter: Thank you so much. It is fascinating that the earlier panel also said that a lot of talent is going to Australia. The brain drain has a real impact on teaching across our sectors. If I get answers to any of my targeted questions, I will forward them to you. Thank you so much.

Ms Sedgewick: Please do. Thank you so much.

The Chairperson (Mr Mathison): There are no other indications, so that probably brings the session to a close. I will finish with an observation that might be a question. We have asked questions about the regs because we want to make sure that, when the statements come out at the end of the process, the right supports are in place for children with speech and language needs.

However, your evidence highlights your view that it is vital for speech and language expertise and supports to be embedded in the education system and that that be done in partnership with Health. Will you briefly set out what changes would be needed to how we deliver health and education services to ensure that, rather than being an extra for a child who gets a statement, the speech and language services that we need are embedded in the system so that the services can be accessed when the need is identified?

Ms Sedgewick: That is a wee easy question: we are just going to change the whole system. First, we truly believe that the basis of what we need is a speech and language therapist post that sits across the Department of Health and the Department of Education: somebody at the top strategic level who would inform service creation before it comes to delivery. The other thing that we need to do is embed early intervention and screening

Ms McBride: ELSEC is amazing, but the problem is that we do not have the boots on the ground to implement it, whether —.

Ms Sedgewick: It comes back to workforce.

Ms McBride: Yes.

The Chairperson (Mr Mathison): Is there anything to say about the training of speech and language assistants, if that is the right term for them? Where are we with that in Northern Ireland, and can we do more in that space?

Ms Sedgewick: We do not have figures for you, Chair. Provision differs across the trusts, but, across all the clinical areas — adults and children — we have a number of speech and language therapy assistants (SLTAs) or technical instructors — TIs — as they are sometimes called. They are absolutely fantastic. They work so hard and really support our workforce. We would love to widen access to our workforce, because we have SLTAs who want to do an apprenticeship to become a speech and language therapist while they are working. That is something that we always talk about and lobby for. However, there are a lot of barriers to it at the moment.

In an arrangement with the University of Derby, we have one allied health professional (AHP) apprenticeship in radiography, which is a pilot to see whether it provides proof of concept. However, we are so behind here, which can be frustrating. Apprenticeships have been run in areas of England for several years, and pre-registration master's programmes have been run in other parts of the UK for over 20 years, yet we still have just the undergraduate degree: we would be asking somebody who is a key member of our workforce to give up their job and have no money while they do a three-year degree course. I do not even think that I have necessarily answered your question.

Ms McBride: I still think that it is a commissioning issue, Chair, whether we do have more SLTAs, and they have been really beneficial in ELSEC. In some pathfinder areas, they would have had a lead SLT and then trained up. The SLTAs would have gone in and done capacity building in schools. We do not have that infrastructure here or the commission places to deliver that. I can certainly send you over the ELSEC interim report, which might be helpful for you to review.

The Chairperson (Mr Mathison): That would be really helpful. If you can do that through the Clerk, it can be circulated to all members.

It was probably an unfair question, but you are highlighting a whole range of issues where we could be doing better: the joint commissioning of SLT posts and services, some sort of early intervention screening programme, and the role of SLTAs in the system. There is plenty there. There is that senior SLT cross-departmental role; an SLT champion — is that sort of what we are getting to — at senior level? It is not a tokenistic role: someone is there, at the table, at strategic planning level.

Ms Sedgewick: Absolutely.

Ms McBride: At the minute, there is something similar —

Ms Sedgewick: In Wales.

Ms McBride: — in the Department of Health with the occupational therapist.

Ms Sedgewick: Yes. There is an occupational therapist who sits across the Department of Health and the Department for Communities on housing, so there is already a precedent. Our example is the Royal College of Speech and Language Therapists in Wales. Two SLTs were seconded there and are now permanent in education in the Welsh Government. They are doing great things. Having somebody there before issues develop has been transformational.

The Chairperson (Mr Mathison): That is really helpful. There is a lot of the higher-level, strategic stuff in there. We are still finalising recommendations on our SEN inquiry, so it goes beyond the regs consideration. There is lots to take away. I am sure that all members will agree that, when you visit schools, and you get on to the subject of SEN, the two areas where schools generally identify gaps are behavioural support and speech and language. Those are the two areas that are raised, almost without exception. If they could get more support, that is where they would ask for it. Therefore, it is really important that we give that the attention that it needs.

As always, thank you for your time. There is no doubt that we will be hearing from you again in the not-too-distant future. Thank you.

Ms Sedgewick: Thank you so much for having us.

Ms McBride: Thank you.