Shaken Not Stirred

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Shaken Not Stirred

• Royal College of Speech and Language Therapists
• Realising the Vision

P. Enderby May 06
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Essential Ingredients

• Knowledge of size and needs of population
• Therapy
• What (type/aim)
• Evidence
• May be shaken,
• but never stirred.

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Optional Extras?

• Therapy
• (what)
• where
• who
• when
• how much
• Workforce
• skillmix

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Size of Population

• Children Prevalence
• Fluency 4.5
• Dysphonic 6 - 18
• Language lt7yrs 6
• Phonology 8.5

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Size of Population

• Adults per 100,000
• Stroke -Dysphasia Prevalence 170
• -Dysphagia Incidence 120
• Parkinsons -Dysarthria Prevalence 69
• - Dysphagia Prevalence 30
• Head Injury -Communication Prevalence
  150 Disorder

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More Obscure

• Guillan Barre -communication/ Incidence 2.5
• swallowing
• Motor Neurone Incidence 4
• Disease Prevalence 7
• Myasthenia Gravis Incidence 3

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Types of Service/ Clients Needs

• Assessment, information, advice
• Prevention and maintenance
• Guided/supported stimulation
• Routine regular therapy time limited
• Routine regular therapy not time limited
• Intensive therapy
• Specialist input

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What For?

• Impairment/disorder reduction
• Improved Function (communication/swallowing)
• Psycho social gain
• Wellbeing

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Therapy

• What type?
• Clarity of Goals
• When to provide?
• Who Should Provide?
• Where to Provide?

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Workforce optionssimplified

• Get more new workers
• Get more out of existing workers
• Change the way we work
• skills, roles-of
  individuals
• structurally-of
  system
• 
  Boyce

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Fastest Growing Sector
(Audio) Reference Boyce
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Evidence

• From disorder specific studies
• From related studies (communication)
• From other studies (not SLT)
• Examples

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Evidence Base

• Where there is evidence use it
• Where there is evidence of no benefit dont do
  it
• Where there is no evidence
• Do nothing
• Do what you think is best
• Do what majority think is best
• Gather evidence do research!

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Consequences of Delaying Appropriate Care to
Stroke

• Death
• Dependency
• Spasticity
• Depression
• Sick carers
• Financial burden

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Consequences of Delaying Appropriate Care to
Children with Language Impairments

• Poor educational attainments
• Reduced social development
• Reduced employment opportunities
• Increased Financial Burden

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Evolution of Working Practice in NHS

• 1950s reverential and directed
• 1960s sequential
• 1970s team working
• 1980s collaboration/multidisciplinary
• 1990s partnership
• 2000s interprofessional

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• the world is so fast that there are days when
  the person who says it cant be done is
  interrupted by the person who is doing it
• Anon

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Political Context of Health

• Mixed economy
• Increased skill mix
• Increased pt choice and expectation
• Increased regulation/bureaucracy
• Shaken not Stirred

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• It is not necessary to change. Survival is not
  mandatory
• W.Edwards Demming

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• to pull together is to avoid being pulled apart
• Bob Allistat

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Where is James Bond?

• RCSLT (i.e. ourselves)
• Hold to the principles
• Be confident in our profession
• Be unafraid to change/evolve

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ConclusionKeep the essential ingredients

• Always going to be people who need our skills
• Knowledge base specific general is substantial
  and growing
• Have a clear identity reflected by our
  Professional body

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• a positive attitude may not solve all your
  problems, but it will annoy enough people to make
  it worth the effort.
• Herm Albright 1876

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Politics Will Shake But Should Never Stir