An Accidental Therapist by Ciara Robertson at @online_his

An accidental therapist

To mark Allied Health Professions (AHP) Day 2021, Ciara Robertson, an Improvement Advisor in the ihub’s Mental Health Improvement portfolio at Healthcare Improvement Scotland reflects on her ‘accidental’ career choice as a Speech and Language Therapist and explains how the training and experience she gained in her role has helped her to step into the shoes of an Improvement Advisor. 

I became a Speech and Language Therapist (SLT) by accident.  At the age of 17 my careers advisor (Mr B) suggested speech and language therapy because his sister was an SLT.  I’m very glad he did.  I have been an SLT since 1996 and love it.   It’s an exciting and varied profession with many different areas of work.  SLT’s are often associated with speech and articulation but my clinical role supported people living with learning disabilities and mental ill-health.  

The power of interchangeable skills

I am proud of my clinical background as an SLT and have found the training and experience I gained in that role allows me to bring a different perspective to the Improvement Advisor role I now have at Healthcare Improvement Scotland.  My clinical role had a focus on supporting people who have communication support needs, and dysphagia (eating and drinking difficulties).  Communication skills help people build relationships, learn and interact with others and are central to improving people’s quality of life and maintaining wellbeing.  Dysphagia is one of the most common long-term conditions experienced by people who have learning disabilities and can contribute to premature death.  SLT input can be life-changing for those people as we have specialist skills to support people to be fully involved in all aspects of their care, which can lead to positive personal outcomes.  

During my role as an SLT, I worked closely with service users, families and colleagues in health and social care.  Person-centred partnerships helped us to develop a shared understanding of issues that lead to difficulties, and to identify ways to overcome challenges, and build a system that supports good health and wellbeing for a person with complex needs.  There were many complex issues that required holistic understanding therefore, working in a systemic way was crucial.  Supporting and educating those closest to the person was key to building capable environments for communication, and eating and drinking.  This often required a sensitive approach to changing practices so that those working closest to the person living with learning disabilities developed a good awareness of communication and dysphagia needs.  A supportive approach helped carers use their assets to support effective communication and reduce risks associated with dysphagia.  This is no mean feat as communication and dysphagia needs are often embedded within complex multi-disciplinary team care plans. 

After working in this field for many years, I became increasingly frustrated at the challenges of sustained change and limited ability for me and my colleagues to influence the systemic issues that frequently led to crisis for people with learning disabilities.  I decided it was time to think about a different direction.  Thankfully, I put more thought into this career-changing decision although I wish Mr B. had been around to offer his support and advice!   

A change of direction

I began my transition from a clinical post to an improvement role when I joined Healthcare Improvement Scotland in March 2020 as Associate Improvement Advisor.  My time at Healthcare Improvement Scotland has been a huge learning curve, however, I have grown to appreciate how many aspects of the clinical and improvement roles complement each other.  The skills needed to work as part of a team to understand systems and identify areas for improvement are closely aligned to the skills I developed as an Allied Health Professional.  Both roles have a focus on building capacity and developing the skills of others to improve health and wellbeing outcomes for people. 

The use of an improvement framework has developed my understanding and appreciation of how to implement changes in practice.  It offers a more structured and detailed look at aspects of change that I often overlooked as a clinician – particularly the need for data and the human factors associated with change.  I am particularly enjoying exploring and understanding the need to redesign systems that support practice for services and I regularly reflect on how my new skills and understanding could be used in my previous clinical role.  Quality Improvement is a powerful tool to understand and identify problems and solutions in services.  The application of these tools could support the implementation of SLT interventions – ensuring these programmes are designed well, with data to evidence how and why approaches make a difference.  

The journey, not the destination

Reflecting on where I am now, I can see there are  other skills from my time as an SLT that complement my current improvement role,  in particular the understanding of language and communication skills needed for people to engage meaningfully within their work.  The benefits of working in partnership with people who have lived experience are widely recognised and there are many tools and systems available to support this in practice.  With my SLT skillset, I’m curious to further explore how we best support people who have communication support needs to engage with our work.  

Thank you Mr B for starting me on this journey!      

Ciara Robertson is an Improvement Advisor in the Mental Health Improvement portfolio in the ihub at Healthcare Improvement Scotland.

 Find out more about roles with Healthcare Improvement Scotland at 


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