Health inequalities and their impact on speech and language therapy

In this episode we explore the complex topic of health inequalities which are being exacerbated by the pandemic and cost of living crisis. We discuss the social and economic impacts as well as some ideas about how these inequalities can be addressed. 

Interviewees:

• Michelle Morris, Consultant Speech & Language Therapist 
  SRO, Greater Manchester Early Years Pathway for Speech, Language & Communication.
• Sahar Nashir, specialist speech and language therapist - CCPNR (Cambridge Centre for Paediatric Neuropsychological Rehabilitation)
• Berenice Napier, Policy Adviser, The Royal College of Speech and Language Therapists

Useful links from RCSLT:

• RCSLT Online Outcomes Tool - 'ROOT' 
• Health inequalities resource
• Health inequalities audit tool

The interview was produced by Jacques Strauss, freelance digital producer.

Please be aware that the views expressed are those of the guests and not the RCSLT.

Transcript

Speaker Key (delete/anonymise if not required): 

HOST:                         JACQUES STRAUSS

MICHELLE:                 MICHELLE MORRIS 

SAHAR                        SAHAR NASHIR

BERENICE:                 BERENICE NAPIER 

MUSIC PLAYS: 0:00:00-0:00:08 

HOST:                         0:00:08 Welcome to another RCSLT podcast. My name is Jacques Strauss. For today’s episode, we’ve assembled a panel to talk about health inequalities, which is a pressing topic. As one of the panellists pointed out, even though in the UK we’re very lucky to have a publicly funded world class health system that is free at the point of use, that does not mean we do not have significant health inequalities. 

The NHS may treat us when we are sick, but that doesn’t equate to health. There are a number of complex factors at play, including income and education. This is exacerbated by the cost of living crisis and, of course, the ongoing impact of the pandemic. 

We now have a large cohort of children who have missed out on education, not at the same language exposure they would have had, or for some SLT interventions and so forth, and many of these children may well need additional care in the future. We have something of a perfect storm on our hands. So, in this podcast, we’ll be looking at the issue and what we can do to mitigate some of the impacts, including a new tool that RCSLT has made available. 

I started by asking the panel to introduce themselves. 

MICHELLE:                 0:01:18 I’m Michelle Morris, and I’m a Consultant Speech and Language Therapist and my consultant role is in population health. 

SAHAR:                      0:01:25 Hi, I’m [inaudible 0:01:26], I’m a Speech and Language Therapist in Acquired Brain Injury, and I work with children and teenagers. 

BERENICE:                0:01:32 Hello, I’m Berenice Napier. I’m a Policy Advisor here at RCSLT, and I’ve worked on the health inequalities resource that we’re going to be talking about today.

HOST:                         0:01:32 Michelle, do you think we can start by defining what we mean by health inequality? 

MICHELLE:                 0:01:48 That’s a really good question, and the answer is it’s very complex. But to summarise it, I guess one would say that they are the unjust and avoidable differences that people experience in their health across the country and between specific population groups. 

We know that in the in the UK, for example, that there are wide variations in population health. For me, one of the most scary statistics is that if you were born in London in 2020 you have a life expectancy which is, on average, eight years longer than if you’re born in Manchester or Liverpool. 

HOST:                         0:02:32 Okay, so that’s horrifying, and as a non-expert I guess my response would be, but we’ve all got the NHS. We’re all using a publicly funded healthcare system. Why are there these disparities?

MICHELLE:                 0:02:50 Because health doesn’t derive from the NHS. The amount of benefit the NHS provides in terms of people’s overall health and wellbeing is relatively small. The things that are big factors are things like income, about where people live, clean water, housing, whether they have access to transportation, and all these other factors, that are called the wider determinants of health, are much bigger hitters, if you like, than actual access to health services. 

HOST:                         0:03:20 Right. It’s so interesting when you say that – when you say, things like access to clean water. That’s not something that we tend to think about [inaudible 0:03:26] first world, we don’t think about clean water.

MICHELLE:                 0:03:29 Yeah, you’re right. But in America, it’s the first world, and actually, many millions of people don’t have secure access to clean water. There’s lots of different areas, but access to education, good quality education, access to resources, like shops and libraries. All these things have an impact, particularly on children’s health and wellbeing. 

HOST:                         0:03:54 I wonder if you could tell us a little bit more about why this is a topic that we need to care about. 

MICHELLE:                 0:04:00 From my perspective, I will be focusing largely on the economic aspects of how that impacts on children’s development. And what we know is that there are intergenerational issues that transfer. So, depending on how people were parented themselves, that then transfers through to their children. We are talking specifically today about language and communication, and that is a really intergenerational thing, if you like, unless there is intervention. 

That kind of brings me nicely on to talk about two concepts that are really important. One of those is equality. We talk about health inequalities, but actually equality in the true sense of the word means equalness, so everybody gets the same. For example, everybody who is of school age in the UK is offered a school placement. That’s equality of access. 

But what I’m talking about and actually what makes the difference is equity, and equity is actually getting everybody to the same place. For example, if you start off and you are two or three years old and you have a really restricted vocabulary, what interventions need to happen to get you to the same place as other children who are starting school at statutory school age? 

So, it’s about the difference you have to make, and that’s really the kind of key concepts that stand behind that inequalities issue. 

HOST:                         0:05:30 Okay, that’s really interesting. Let me make sure I’ve understood this. Equality, we would say, everyone technically has access to speech and language therapy services, for instance. But if we’re not sure that the speech and language therapy service is being used at the appropriate time by the target population, then equality is hollow, really. 

MICHELLE:                 0:05:53 Correct. That’s exactly right. And actually, so many things impact on that. For example, if we think about Maslow’s hierarchy of needs, where we talk about the physiological needs or the bottom level, and then the next level up is safety. If you haven’t got secure access to food, if you have issues with heating, if you have issues with income, then all those issues are going to impact on how you can focus your time as an adult on the child’s development. Because actually, you’ve got to these really fundamental things, these fundamental needs that need to be met before you can think about the actualisation of child development. 

HOST:                         0:06:36 What are the main drivers of these inequities? 

MICHELLE:                 0:06:37 What we’re talking about here is actually keeping people healthy and well. And actually education – the level of education that people experience is a very significant driver in how healthy they remain. Part of that is to do with how they can access the information that’s provided, how they will seek out health services. 

But things like people’s aspirations make a big, big difference to how people will see themselves in relation to the world and health services that they can access. 

One of the things that I was always struck by – this was actually before I started doing my Masters in public health, but we, in Salford, were launching a clinic in an area that, historically, many health services in that area were closed because people just didn’t attend. We ended up launching a new clinic, new setting, and had this massive, massive event. And it was to encourage children through the schools. We had local celebrities. We had the fire service. We had all sorts of people who use talking and language and communication as part of their job. And that was a big draw for people. 

An older lady came up to me at the end of it and said that she’d lived in that area for 20 years and she’d never set foot into the previous clinic. Now, in the previous clinic were all the different health provisions, but that wasn’t for the likes of her. That’s what she said: these services were not for the likes of her. And if it hadn’t been for her child being the driver of getting her into the building, she probably wouldn’t have come again. 

But it’s kind of understanding people’s view of life and circumstances that, when you really have a good understanding of that, then you can start to build on those inequities and actually start to support to get people to the same place. 

HOST:                         0:08:36 If I’m hearing [recording scrambled 0:08:38] that one of these drivers is that people are not accessing the services because they think it’s not for them. 

MICHELLE:                 0:08:45 Yeah. Or they’re intimidated. We will take for granted going to an appointment, but actually speaking to the receptionist, remembering when your appointment is, if there’s a problem sorting out that problem, if there’s an issue talking to the professional that you’re meeting, all those things are potential barriers to people accessing services. And so, what we need to do is understand our communities in a lot of depth to really drill down on what the barriers are, because they will be different to every community.

HOST:                         0:09:21 On the one hand, obviously, there’s moral imperative, that we want to give everyone the best life we possibly can, the healthiest life we possibly can, and the longest life we possibly can. So, there’s that. But then there’s this interesting issue that you said, there’s an economic issue around why health equality matters.

MICHELLE:                 0:09:42 Just going back to it… let’s take it antenatally. If you are in a family where there is fuel insecurity, there’s food insecurity, you are less likely to eat well, you are more likely to be exposed to stress, and these things have impact on the developing foetus. And you’re also less likely to engage with services. For example, we know there is a direct correlation between low birth weight infants and poverty. 

Right from the start, even before you’re born, you are experiencing inequalities. And that’s very, very different. And that will then continue. I’m going to jump from antenatally. But then perinatally, there’ll be issues about whether you access services to support you and your child. If you’re experiencing postnatal depression, do you seek out support? And this is about how services have to shape around families because, actually, Health Visiting services with COVID have moved online. But then we’re talking about people who potentially have IT poverty. 

For example, we know that in Greater Manchester, one in three people either doesn’t have the hardware, the software, the connection, or the skills to access online learning of any sort. That’s really frightening. We’re talking about children’s development. Services from schools moved online with COVID, but one in three families in Greater Manchester would have had difficulty accessing that. 

SAHAR:                      0:11:24 It’s really interesting listening in and hearing it from a different perspective as a different part of the UK as well. I think for me as well, it’s really important to consider how health inequalities sort of impact on the access to our services. For me, I always remember, how do different communities even understand how healthcare works? And do they understand how to attend appointments? For example, families might receive a letter in the post that says, your appointment is this day and this time, and not understanding exactly what I’m being asked to come for and where I’m being asked to go, there’s immediately a huge language barrier there for a lot of families. 

For me, that’s a huge part of this topic as well. But I think that during the pandemic it’s also just been exacerbated, because you’ve got… we’ve really understood as a community and as a profession how the racial disparities have just evolved hugely, and we’re really now only understanding how it’s impacting on our services now, because I think we’re talking about it more and we’re looking at what are our biases with different communities and how do we understand our data, and how do we understand our service users? 

I think that’s such a huge part of this topic as well. And I think that’s why I feel really passionate about thinking about how do we support our service users. If you don’t understand the system, you’re not going to access it at the same level as everyone else. If there’s a migrant community or a migrant family, they’re probably not going to have the same understanding of speech and language therapy or different healthcare services as a family living in the UK. 

HOST:                         0:13:07 I consider myself a reasonably informed person. I have a number of family members that work in healthcare. But the truth is, until I started working with RCSLT, I don’t think I really had any genuine understanding of what speech and language therapy was. 

BERENICE:                0:13:22 You wouldn’t be alone amongst the general population in not having that wider awareness of speech and language therapy. We tend to find that people have an awareness if they have a family member perhaps who’s experienced it. 

But in terms of the why now, I think following the horrific events around the killing of George Floyd and the Black Lives Matter, movement afterwards, we had been looking at our existing guidance for speech and language therapists and thinking, actually, we need to do something to pull this together into one place to make it easier to support SLTs in finding that easily on the website. 

And then I think with the pandemic as well, as [inaudible 0:14:14] said, it’s really highlighted those health inequalities in a much more stark way than has ever been done before. We’ve seen continued research as we’ve gone through the pandemic. RCSLT has looked at the impact of the pandemic on speech and language therapy and on service users. And then you’ve seen other reports, so from the NHS Race and Health Observatory report very recently too. All of those things have come together and really made us think hard about how do we support SLTs in the context of their practice.

HOST:                         0:14:55 Talking specifically around the issue of race, what are the disparities, and do we do we have any understanding as to why it may be? 

MICHELLE:                 0:15:07 I think there are there is understanding about it. I think a lot of the work is done at a local level, so it’s really important to have that data and that information that’s held by public health and to work with public health to really understand the needs of communities. 

And what we’ve done is really drill down in Greater Manchester, and I’m giving you a live example, if you like, but this is just one of many, many, many, is that we have looked at things like, for example, that two-year take-up of the early years offer. And what we know is that, in certain communities, that’s not taken up very highly, so we’ve actually put behavioural analysts, behavioural insight people into that area, and to really identify what are the barriers for people. And then once we’ve identified what those barriers were, they’ve worked with communities to address some of those barriers. 

I think race is a huge issue in terms of inequalities. I think physical and mental and disabilities are also… we mustn’t forget about our other populations as well. There are other groups who are significantly disadvantaged in terms of their healthcare. 

HOST:                         0:16:17 We’ve seen very, very significant cost of living increases that are happening incredibly fast. I can’t remember things getting that much more expensive that quickly and an awfully long time. Is the concern that this is going to continue to drive up inequities if we’re not very, very careful and proactive about it?

MICHELLE:                 0:16:36 It’s inevitable. It’s inevitable that it will. If you think about the amount of money, and just for example – and this was a pre COVID example – the difference in the percentage of spend on food and drink between the people who are more advantaged and people who are less advantaged. There was an 8.4% difference. So, it costs more to be poor. That was pre COVID. We’re talking now that gap is going to just widen. 

In many societies, if you look at the gap rather than actually what the top income earners earn and what the low income earners earn, it’s that gap between the two that actually makes a less equitable society. People who have got sufficient money are going to feel the pinch a little bit with the cost of living rises. People who are already in economic disadvantage are going to be blindsided by it. 

HOST:                         0:17:47 What are some of the things that we can do to begin to turn the situation around? And I’ll go around and ask each of you. I don’t know – do you want to start, Michelle?

MICHELLE:                 0:17:55 Yeah, I think you’re… it is a bad news story. However, I do think there are some really positive things that we can do. And that is, as health professionals, it’s about understanding our data, understanding our communities, and working with communities to facilitate their access to help them, so that we don’t access for them but so that people feel empowered to access what is available. 

It’s understanding the communities from the community’s point of view. It’s not about us designing something and then say, what do you think about this? It’s about starting right at the very beginning and saying, this seems to be a problem: tell us about it, and how do you think we might manage that problem? 

If services were developed in that way, they would look very different to how they look now. They would look very different indeed. And actually, that would mean that people were able to access [inaudible 0:18:55] we can’t do anything about fuel and about food, but what we can do is make access easier. 

SAHAR:                      0:19:02 And I think in paediatric brain injury, because brain injury does not just impact on one area, it’s the whole thing, and it’s the community, it’s the family, it’s education, and all the services around that person. I think that’s why I’ve even seen it more since being in this field. I think that’s spurred on my interest and my passion for this. But I think aside from that, I really agree with what Michelle’s saying about how do we support and use the community services to help us understand more as clinicians. But we really do need more data, and we really need clear data to show us, we need this at a huge level of what are the issues in even accessing a service user group, for example? Are there going to be families that have a really tight work schedule or they have a lot of childcare responsibilities? How are they going to be able to access the same things as other families? 

That’s something we’ve been thinking about in our team. And because I’m the speech and language therapist as part of an interdisciplinary team, I’ve been thinking about how do we then involve other professions and thinking about this? How do I involve occupational therapists in thinking about physical access, and how do we then think about language and making it accessible? 

The brilliant thing that we really have access to is community advocates, so we can look through interpreters, for example. We can look at different professions to help us explain what is going on for a different community, so learning more about culture and a religion. It’s even at that base level, isn’t it, of thinking about how do we create a safe service, and how do we develop that within a team? 

I think as speech and language therapists we always have that hat on of thinking about language, obviously! But I think pulling out bits of information from other professionals really does help in developing our understanding. 

MICHELLE:                 0:21:16 I think when we deliver health services, we work implicitly. We don’t we don’t even think about it, but we work on a deficit model. What’s wrong with this person? What do we need to do to make it right? Instead of looking at an assets-based approach. And when you start thinking about what assets are in the family, what assets are in the community, it’s a completely different mindset. 

HOST:                         0:21:40 Could you give me a practical example of that?

MICHELLE:                 0:21:43 An example of an assets-based approach, I’ll give you a real-life example from where I work. As part of the early language and communication process that we have in Greater Manchester, in my particular locality, we were looking at putting on a [inaudible 0:21:58]. This was to encourage families to come in and to work with a member of the speech and language team, and to just have a fun time with their children and build on those early social interaction skills. 

So, we put on the [stay and play 0:22:14], advertised it really widely, no one pitched up. And then we did the same the next week and nobody pitched up. What we tried to do then do is think, actually, let’s go right back to the beginning here. And what we worked out were, there were a number of people in that community who were influencers. And they weren’t people in positions of authority, but actually, they were very influential people in their community. 

What we actually did, we went and talked to them and we said, this is this is what we want to do. We know in other areas this works. But actually, we’re really struggling to get people in. Help us. You tell us how we might go about doing this. And we worked with them. They came up with some great ideas, including employing somebody from the community to help run it. They became a champion, and so when they were out shopping, or they were picking their kids up from school, they could say to the mums, I’ve been to this, it’s absolutely great, you need to go, try it out for yourself. 

And it was increasingly, week on week, after that… It took time. I’m not saying it was an overnight success. But it took time. Actually now, we’ve had to put a second group on in that local area there’s such demand for it. 

HOST:                         0:23:34 The College is thinking about a lot of stuff. Obviously, there’s the issue around race, and there’s the issue around how the RCSLT is becoming more representative. But in terms of health inequalities, what is the College doing to try and address some of these issues?

BERENICE:                0:23:49 Thank you. [I think of a response 0:23:52] in two different ways, really. Firstly, our role is to support SLTs in this. It’s one of those areas where everybody could look at it individually. But actually, if we can support SLTs, bring together all the information into one place and provide helpful means through which they can think about it, talk about it within their teams, then that’s something that we want to do. 

And I think that’s why we’ve developed our health inequalities resource [which I can come along to talk about more 0:24:25]. But before I do, the other way that we are responding is to influence the wider systems, so in terms of trying to influence governments about the impact of health inequalities on speech and language therapy, how to influence NHS systems. We’re trying to influence those different wider public systems about the impact of health inequalities too. 

HOST:                         0:24:57 You mentioned there’s this inequalities toolkit. I wonder if you could tell us what it is and how we hope people are going to use it?

BERENICE:                0:25:06 Yeah, of course. Our health inequalities resource is broken down into a few sections. Firstly, we’re looking widely at what health inequalities are, what are the links to the social determinants of health and to the equality, diversity, and inclusion agenda. And then we’re also looking at what it means for SLTs in their practice, so in a more practical way, and what resources that they can use to help identify what those health inequalities are in their services. 

As part of that, we developed a self-audit tool, and that offers a practical way to think about health inequalities in your team, and you might discuss and record what you might want to do in practice. 

We know that not all parts of the tool will be relevant for everyone. From some feedback we’ve had already, we know that you could consider it differently if you were an individual or whether you were a part of a team or in a wider multidisciplinary team. We know of also two universities that are looking at it with their students, an SLT who’s used it to influence the work of a wider local authority youth offending team. 

My message is that you can use it flexibly. You can download the audit tool as a Word document and then just change it. 

MICHELLE:                 0:26:31 Okay, so there’s a couple of things. Firstly, I think it’s really important to make friends with public health, because they have lots of local data. But there are lots of other things available widely anyway, so things like the Public Health Observatory gives you a really good… the fingertip tools on there give you really good broad data on your local area, but public health can certainly provide much more detailed information that’s available. 

And then I think it’s a case of looking at what that data tells you, looking at things like the joint strategic needs assessment, the JSNA in your local area, and gathering all that information. 

I don’t think we, as SLTs, are necessarily in a position to be able to collect it ourselves. What we need to do is tap into what’s already being collected, and there is lots of it out there. But then, once you’ve got all that data it’s kind of understanding it and interpreting the data, and then developing action plans on the basis of what the data tells you. 

HOST:                         0:27:41 I then asked Michelle to tell us a bit more about the Greater Manchester Language and Communication Pathway. 

MICHELLE:                 0:27:51 The Greater Manchester Early Language and Communication Pathway is a pathway that runs across the ten local authorities that make up Greater Manchester. It sets out how we, as a conurbation, are going to explore language and communication and support language and communication in different communities. So, we have an enhanced system of identification, and then we have different types of intervention that are offered. 

Even though it’s obviously delivered into individual localities, it’s reported up to Greater Manchester at a strategic level, which means it’s got the oversight, it’s got that governance, and that really has driven the change in practice. Because we don’t specify how individual localities will deliver things, but we do specify the outcomes we want them to deliver. We know that if you are within Oldham, or you live in Trafford, you will have a very different means of delivering something, but you’ll be achieving the same outcomes. 

The whole point of it is to make sure that children who are disadvantaged in any way are able to start school as close to their more advantaged peers as possible with the same level of skill. And what we know pre COVID was that… again, this is where data is so absolutely essential is that across Greater Manchester, we tracked the data and we know that it was closing that gap between more affluent families and less affluent families. It was actually starting to come down, that gap was starting to close and, of course, COVID has blown that out the water. 

SAHAR:                      0:29:42 I do really think that if a team prioritises this work and now that we have things like this tool from the Royal College, I really do think that it just takes one person as part of a team to champion this and just to say, look, if we if we have time as part of a team meeting or a clinical day that we lead on that we spend half an hour looking at the tool and we look at, okay, what’s our population, what’s the data looking like at the moment, what kind of issues are we having in terms of appointments and all that kind of stuff. And thinking about readdressing our own kind of viewpoints on this as well, because it really varies from clinician to clinician. 

And I do think, as well, that we’re really lucky to have many, many trusts and universities that will fund for this work. It’s just about that same person saying, I’m going to make an application, I’m going to speak to someone and say, we’ve got this pot of money, how do we use it for this, and how can we further the research? 

HOST:                         0:30:46 The panel made the point that we need to look at all the data, but also the policies and the nomenclature when thinking about health inequalities. For instance, Michelle made an interesting point about DNA or ‘did not attend’, how that is now referred to as ‘was not brought’, which is really more appropriate coding when talking about children. How we use language really frames how we think about things. So, even seemingly trivial things can be very important. 

Finally, the panel turned to the question of how COVID has impacted health inequalities, and given that the first five years of the child’s life are most important for language acquisition and development, two and a half to three years have been severely disrupted. 

MICHELLE:                 0:31:32 I think we’ve always known that there is an issue between language and communication skills and educational access. That’s not a new thing, and there’s loads and loads of research which that backs that up. But I think, and I am going back to the COVID issue again, because I think that there were two things that happened. One is that RCSLT produced some really, really helpful data during COVID identifying the inequalities. But I think also, now, we are potentially in a so-called post COVID world. Although, I’m not sure about you, but everybody I know seems to have COVID! 

SAHAR:                      0:32:09 There’s a lot of COVID going around, yeah. 

MICHELLE:                 0:32:14 And there’s kind of very recent information coming out, which is confirming what we know anecdotally. The education select committee that met last week talked about the devastating impact of the pandemic and how that widened inequalities for children. Again, there are massive regional variations in that. 

A recent study showed that… this is, again, post COVID. They asked teachers across primary and secondary, and over half of the children on free school meals were identified that school had a significantly negative impact on their language and communication skills. 

Now, free school meals is a proxy indicator of poverty. And so, when we talk about children being on free school meals, what we’re talking about is social disadvantage. Up to 50% of those children had an impact on their communication skills and their education, as opposed to 20% of those children who were from more affluent families. 

So, the gap has widened again significantly, and we need to do things to help catch up. And I think actually what we’re going to have, we’re going to potentially have a whole generation of children growing into adults that are scarred developmentally by COVID. And I think we need to think, as speech and language providers, how we are supporting that systemic language and communication development to try and accelerate children’s development because of those gaps that exist. 

And if you think about that on a neurodevelopmental trajectory, actually, the first five years of the most important years in the child’s life in terms of the speed and rate of learning. So actually, if three of those five years have been disrupted, then we are talking about significant deficits.

SAHAR:                      0:34:24 Hearing you talk, Michelle, makes me think about just the sheer amount of trauma that so many people have gone through, not only in the last two years, just thinking about racial trauma, but also the pandemic. There’s just been so many events, and from a social perspective but also for many people personally. People have been grieving and people have had to deal with war and poverty. There’s so much trauma interlinked in all of this, but we know that trauma has a huge impact on development and communication. 

I think it’s great that we have more research into this area and we understand it a bit more. I think a lot of the research from America in particular has really shown us that many black and ethnic minority groups and children are not accessing the same level of care, and then maybe being missed for speech and language therapy support compared to white children. 

So, it’s knowing that and thinking about how does that impact on child development and how does that impact on Michelle was saying, you know, on the trajectory. 

MICHELLE:                 0:35:38 In many homes where language and communication, as you said, was okay, it was fine, if you put bereavement into that or as [inaudible 0:35:49] said, trauma, then actually that alters that language and communication model in the family and children are not exposed to the same amount of and quality of language. And I think that’s really important is those two things. 

So, it’s not just how much but it’s also the quality of the language that’s used. 

HOST:                         0:36:04 Would it be fair to say that we probably still haven’t actually got our head around potentially the fallout from COVID? 

MICHELLE:                 0:36:04 [Inaudible 0:36:15] I absolutely don’t. Money has been made available, but it’s – like all these things, I guess – it’s not enough and it’s probably targeted in the wrong place. 

HOST:                         0:36:27 So, what we need to come to terms with, it’s not just a question of, okay, we have massive backlog in the NHS because of COVID, which is going to cost the vast amount of money to fix, we have a whole new set of problems, totally separate from Long COVID, or any of those things with childhood development and stuff, which yeah, now that you mention it, we can’t imagine people having been locked inside for two years having far less social contact than they ordinarily have, and we’re going to be dealing with this fallout for potentially a very, very long time. 

MICHELLE:                 0:37:03 I think so, and I think the children are going back into settings, but actually the impact is still incredibly visible, just in terms of interaction skills, I’m not talking here about language at all [inaudible 0:37:16] interaction, little ones are not interacting with each other in a typical way, because they actually… many children had never seen other people outside their family. So, it’s very, very different typography out there at the moment. 

I think speech and language therapists have got the skill, so rather than see things through that medical lens of health services, we operate across a number of different modalities, if you like. In terms of education, we have the skills to support schools and settings to think about those developmental models and how we they can really enhance children’s learning in a restricted amount of time. 

HOST:                         0:37:57 Berenice gave us a useful summary of some planned activity that addresses the question of health inequality, and a reminder to check the show notes for links to all the resources. 

BERENICE:                0:38:09 Okay, so we’re also planning some further development work on the tool this year, both to respond to the feedback we’ve had and to try and help speech and language therapists with that local analysis of [recording scrambled 0:38:22] and matching that with what we know about outcomes, prevalence, and incidence of clinical conditions.

In addition, we’ve got the RCSLT ROOT tool, and that tool has been developed to enable SLTs to collect diversity data. So, they’re all helpful things that will be added to over the course of the year. 

Also, if you would like to look out for our tweet chat that we’ll be having on health inequalities on 27 April from one o’clock to two o’clock in the afternoon, and that will be on the @RCSLTpolicy Twitter feed. And that’ll be for speech and language therapists just to chat together about how they’re using the resource or to ask questions about how others are doing. 

We’re also planning a webinar for the autumn about health inequalities. If anyone would like to share their work on health inequalities for that webinar, then please do get in touch. 

And we’d also love to hear from anyone about how you can use the resource. We’re looking for more case studies to put onto the website. I think this is one of those things where sharing of experience is going to be really valuable for others. 

HOST:                         0:39:36 A very big thank you to all of our panellists for their time. We do ask that if you found the podcast interesting you rate it on Apple Podcasts or whatever your preferred podcast provider is. Why not send your favourite episode to three of your colleagues? Personal recommendations really do matter. It helps us grow the audience and advocate for speech and language therapists and their patients. 

Until next time, keep well. 

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