By Laura Lennox
The 6th March is European Day of Speech and Language Therapy (SLT). It’s a time to raise awareness of the SLT profession and its role in promoting the rights of people with speech, language and communication needs. This year the focus is on Telepractice and Digital Technologies which has provided an opportunity to reflect on the changes in the provision of our adult SLT service in Dumfries and Galloway and also on how the SLT profession as a whole has had to respond to a global pandemic. This is a health and care context that we still find ourselves in but I believe that we can look forward to this year with optimism: The learning from which will undoubtedly better equip SLT service provision for person centred care in an emerging digital world.
Dr Mike Ryan, Executive Director, WHO Health Emergencies Programme, discussing the need for prompt international action to the COVID-19 Crisis on 13 March 2020:
“Perfection is the enemy of the good when it comes to emergency management. Speed trumps perfection. And the problem in society we have at the moment is everyone is afraid of making a mistake. Everyone is afraid of the consequence of error, but the greatest error is not to move, the greatest error is to be paralyzed by the fear of failure”.
In March 2020, our SLT team did not want to be paralysed with the fear of failure. We wanted to continue to provide a high quality SLT service and to do this during a period of social distancing would require a ‘digital first’ approach. For us this meant using telephone, email and the Attend Anywhere platform as a video appointment system, otherwise known as NHS Near Me. In all honesty, there were mixed feelings given that the majority of people accessing our SLT service have communication support needs (CSN).
The Scottish Government’s (2011) Principles of Inclusive Communication broadly defines communication support needs (CSN) as those individuals who require support with understanding, expressing themselves and/or interacting with others.
The Big Question: How could we continue to deliver the same quality of person centred care and achieve jointly agreed care outcomes over remote platforms that we always endeavour to maintain within our face to face consultations?
This emerging digital world threw us straight into the chaos zone of innovation. Not an area that health and care organisations particularly thrive in given that high quality services require a much more linear approach as described in this model by Stacey (1999):
In order to make sense of our thoughts, feelings and experiences and towards sharing our learning we decided to use Quality Improvement (QI). This allowed us to rapidly implement remote consultations whilst simultaneously measuring and recording impact and progress. The plan-do-study-act (PDSA) cycle was undertaken for every remote consultation during the months of April and May 2020. The data collected was placed into themes to inform our service delivery as part of continuous improvement. The results provide information regarding the enablers and barriers to remote consultations for our particular service and suggest that many people with communication support needs both could and could not access remote consultations for different reasons. A shared decision making process at the referral and triage phase as the outcome is now implemented to identify which types of consultation would best suit each individual person and their needs.
It would seem our adult SLT service is not the only SLT service in Scotland using NHS Near Me as part of remote consultations. These figures are shared from NHS Near Me for Jan 2021 and identify Speech and Language Therapy as the 6th highest user group and second highest AHP group. This is most definitely a cause for celebration on this European day of SLT Telepractice and Digital Technologies:
It is hoped that in sharing this then it may dispel any assumptions that people with communication support needs are not suitable candidates for remote consultations. Or, that speech and language therapy support cannot be successfully delivered remotely to adults, children and young people with a wide range of needs and to professionals, carers and families. In reflecting back on the big question, this process has also made our team consider whether face to face and remote consultations are easily comparable given that they are in completely different innovation zones. We may have been thrown into the chaos zone with little choice but It is worth considering whether we should sit in this emerging digital world for just a little bit longer, however imperfect it may feel right now. We can’t move forward into the complex and linear innovation zones unless we do. If we all did this then I am optimistic that eventually we will be able to provide informed choice as well as a blended approach to consultations via the effective conversations with those people accessing our services and their significant others. A true reflection of high quality person centred care.
Gilbert, A. W. Billany, J, T. Adam, R. Martin, L. Tobin, R. Bagdai, S. Galvin, N. Farr, I. Allain, A. Davies, L. Bateson, J. (2020). Rapid Implementation of Virtual Clinics due to COVID-19: A Report and Early Evaluation of a Quality Improvement Initiative. British Medical Journal. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247397/ [Accessed on 3rd March 2021].
Holdsworth, L. Provan, D. Nash, G. Beswick, M. Curran, C. Colhart, I. Hunter, A. (2021). Can Webinars Support the Implementation of Video Consultations at Pace and Scale within the Allied Health Professions? British Journal of Healthcare Management. Available at: https://doi.org/10.12968/bjhc.2020.0127. [Accessed on 3rd March 2021].