Agenda item

Adult Dysfluency and Cleft Lip and Palate Service

Report of NHS Sheffield Clinical Commissioning Group.



The Committee received a report which provided background context and outlined the current situation of the potential changes to the provision of Dysfluency and Cleft Lip and Palate Service for adults within Sheffield.




Present for this item were Lucy Ettridge (Deputy Director, Communications, Engagement and Equality, NHS Sheffield Clinical Commissioning Group (CCG), Kate Gleave, Deputy Director of Commissioning, NHS Sheffield (CCG) and Dr. Jeff Perring (Medical Director, Sheffield Children’s NHS Foundation Trust).




Kate Gleave introduced the report and stated that she was aware that this Committee was usually concerned with adults and that matters dealing with children were under the remit of a different Committee but due to the increased demand for speech and language therapy assessments and treatment of around 8% year on year over the last six years, the Sheffield Children’s NHS Foundation Trust, the CCG, the City Council agreed to undertake a review of the Paediatric Speech and Language Service in May 2019, which had stalled due to the pandemic, but the outcome of the review was now being finalised.  The Trust, along with the CCG and the City Council, worked with colleagues in the education and voluntary sector and it became apparent that adults were being assessed and treated as well as children by the Service.  Kate Gleave said that the CCG and the Trust had been in discussions to ensure that all needs and legal obligations were being met.  The Service was not universally commissioned with some areas in the country having no adult service. However, the CCG was planning on commissioning a service for both assessment and treatment since the 1st April on a temporary basis whilst engagement work is  undertaken so that we can fully understand patient needs.  Patients will not have to undertake an assessment process whereby they were requested to go through of a panel process to determine whether they could be funded under exceptional circumstances.  Kate Gleave stated that work was ongoing to identify another provider firstly we need to understand the service on offer as there were different service models and secondly to identify waiting times as throughout the NHS waiting times for all services have significantly increased.  She said work had begun on equality and quality impact assessments  with the intention to produce a combined Trust and CCG assessment to understand the impact of the decision which would help to tease out any potential issues that may arise.  The Children’s Hospital Service was well funded, this decision wasn’t about funding cuts.  Kate Gleave asked whether Members considered the closure to new adults would constitute a substantial change which would require formal consultation with the Committee.




Members of the Committee made various comments and asked a number of questions, to which responses were given as follows:-




·                In terms of closing the Service to adults before alternatives had been found, both the Trust and the CCG have focused over the past couple of months on recovering from Covid and had chosen to prioritise work to special educational needs and disability services and supporting services with long waiting lists.  This service had unfortunately dropped down the list of priorities.




  • The risks and rationale were considered when carrying out the review as the Therapy Service treats patient cohorts significantly outside of the Trust’s normal age range.  The Service treats children up to the age of 16, and rarely up to the age of 18, but never to those in their 20s as there was limited capacity within the service and as a result, the Service was unable to meet all the demands placed on it.  This review would create additional capacity to identify earlier specific needs and be able to see children sooner.  There was also a lack of alignment with other adult therapy services which prevented integration and provision of care for adult patients.  It was acknowledged that transition was vitally important but having a service that managed all ages was no longer appropriate and a pathway to transition people from paediatric to adult services was necessary.




·                In an ideal world it would have been better to have a system in place before the service ceased accepting new referrals, however information received suggested that it was unlikely that there would be any referrals during transition, but it came to light that there were referrals, so the priority now was to find an alternative service for adults.




·                It was not known whether the Head Injury and Neurological Department had been contacted, but it was confirmed that the Speech and Language Therapy Service at the Northern General Hospital have been contacted and that Service has confirmed that it was not able to offer any service at the present time.




·                The CCG was looking into how long patients would have to wait to be seen both locally and nationally and would want to commission a service with shorter waiting times.  This is being prioritised and it was hoped that answers were available towards the end of next week.




·                The shortage of Speech and Language Therapists was not known.  The expectation was that the service would be able to offer the opportunity to spend more time working with children and that capacity would be created.




·                Over a number of years, there has been a lot of work around transition from child to adult across multiple services and it was acknowledged that in days gone by, sometimes young people did “fall of the cliff” when they reached a certain age.  There are many services throughout the NHS that do successfully transition from one age group to another, so the Service was working to make the transition as seamless as possible.  There was no certain set age as when young people reach the age of 16, they have different ways of thinking and have other stresses in their lives and perhaps may not be ready for more change, and also a recognition that at the age of 18, not everyone was ready to make the change, so there is a Transitions Register in place to enable patients to be seen for a while longer so that they could be transferred when ready.




·                The  CCG has been looking at service alternatives relatively locally in Rotherham and Hull and also the position in Barnsley and Doncaster. There was a need to understand how best to meet the needs of patients whether through an online or virtual service versus how many would prefer face to face appointments and how that would impact on travel outside of the city.




·                The process of looking for an alternative service started in January this year but was paused when it came to light the number of users that were likely to need the Service and due to the further lockdown, as previously stated, dropped down the list of priorities, but over the past three to four weeks alternative services have been identified and contacted to see if they meet our needs.




·                The CCG has a legal duty to bring any substantial change to this Committee.  There is no legally defined variation, so it was for the Committee to decide whether there was a substantial change which would trigger NHS consultation. The CCG was committed to a 12 week consultation period.




·                As previously stated, there are many services within the NHS that require transition to adult services, but the speech and language therapy service is primarily a children’s organisation and to provide the Service it did was in part an anomaly and therefore not appropriate to continue with that Service in the medium to long term.




·                The decision was made around the type of service that it was, and the service was outside of the normal age range of the organisation, so to start implementing and developing it further would be inappropriate.  




·                The Trust have stopped all referrals temporarily, on the grounds of clinical risk which legally a provider is allowed to do, so what the CCG are now going to do, is to engage and consult with the users on future options.  One option might be a status quo, so currently this would mean adults being seen at the Children’s Hospital, but this is not viable.  Its far from ideal, its not the perfect process and the Service will look at the impact of the change i.e. people might not be able to travel or take a zoom call or telephone call.




·                The CCG approached a number of services including Hull. In terms of picking up the costs, if it means patients have to travel outside of Sheffield, the usual NHS rules concerning travel apply, whereby, if someone was able to travel through the patient transport service then travel costs outside the city would be free, and if someone doesn’t meet the eligibility criteria, costs would have been met individually.




·                The decision that was taken was based on a risk-based approach and it was taken by Sheffield Children’s Hospital.  Due to the pandemic, mental health across the board has been affected over the last 18 months and the health service as a whole were seeing increasing numbers of mental health issues.  However, the question remains as to what Sheffield Children’s Hospital is there for, and its reason to exist is to care for children, young people and their families, and the risks associated to this review was the risk to the Service and the significant concerns about its the capacity to treat young children, and the consequences of continuing to manage the service.  In taking the decision, the CCG does appreciate that a small number of adults would be affected by the proposed change.




·                It was acknowledged that there might be some adults affected who would also be parents to  children with multiple illnesses, mental health and disabilities and it was appreciated completely that that does have an effect on children and their life chances.  The Service does not directly manage those issues but what it would do, would be to contact parents where appropriate and ask what they have in place. 




RESOLVED: That the Committee:-




(a)      thanks Lucy Ettridge Kate Gleave, and Dr. Jeff Perring for attending the meeting;




(b)      notes the contents of the report and responses to the questions raised;




(c)      unanimously agrees that this is a substantial change which requires formal consultation with the Scrutiny Committee;




(d)      strongly recommends that Sheffield Children’s NHS Foundation Trust reinstates the service to ensure that a proper, legal consultation and EIA can be undertaken;




(e)      recommends that any future service that is commissioned is accessible to service users and isn’t outside of South Yorkshire; and




(f)       requests that an update be brought to the next meeting on what has happened to the service/update and actions taken from the recommendations made.




Supporting documents: