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Agenda item

Adult Dysfluency and Cleft Lip and Palate Service Update

Report of Sandie Buchanan, Director of Commissioning Development, NHS Clinical Commissioning Group.



The Committee received an update on the Sheffield Children’s NHS Foundation Trust’s current position regarding the Dysfluency (Stammer) and Cleft, Lip and Palate Services for Adults within Sheffield.  The report set out the current position, detailed the engagement activities being undertaken and identified the next steps to be taken.




Present for this item were Kate Gleave (Deputy Director, Commissioning, NHS Sheffield Clinical Commissioning Group (CCG) and Dr. Jeff Perring (Sheffield Children’s NHS Foundation Trust) (SCNHSFT).




The Chair stated that two public questions on this matter had been received and it was decided to hear these before the report was presented to Members.




Kirsten Howels, representing STAMMA (the British Stammering Association)




“We are grateful to the Children’s Trust in Sheffield for overturning their earlier decision to close the stammering service to new adult referrals from January 2022 and for committing to continue to take referrals until there is suitable adult provision in place in Sheffield. We are also grateful to the CCG for inviting STAMMA to join the Task and Finish Group – an invitation which we’ve accepted with enthusiasm.




Although STAMMA is taking an active role in this consultation, the inner workings of the CCG are not easy to understand and the longer-term processes and procedures feels opaque to those not familiar with them. For the purposes of clarity, we have two questions relating to the next steps outlined in the documents pack…




We note that on page 26 of the documents pack for this meeting it states, “Key wider stakeholders also need to be heard to ensure that possible future options can be considered for service delivery”. Who are the “key wider stakeholders” referred to here?

And on page 27, it states “The outcome of the further involvement will enable us to consider appropriate next steps in line with our statutory obligations and moral duties which will lead to the development of possible future options for consideration.” What might such “appropriate next steps” involve?




Kate Gleave responding to the first question and stated that the CCG and its providers had a legal duty to those who use the Service.  She said that the key wider stakeholders were teenagers, people who had been recommended to the Service, people with long covid, those working in Primary Care, the wider South Yorkshire area including Rotherham and Doncaster, staff working within the Service, health professionals and Local Area Committees.  In response to the second question re “Next Steps”, Ms. Gleave stated that the process that had been followed was robust and the CCG was confident that the data used was comprehensive.  To establish appropriate next steps, it was important to find out what the wider cohort needed.




Isabel O’Leary retired Speech and Language Therapist, Clinical Lead in Disorders of Fluency 1993 to 2021




I am appreciative of the fact that the Children’s Hospital Trust’s Executive Team have decided to re-open the service to adults who stammer and will continue to take referrals as is stated on page 25 “until there is suitable adult provision in place in Sheffield”.

I will be happy to be involved in a Task and Finish Group organised by the CCG in conjunction with the Children’s Trust as I hope we all want to ensure that adults who stammer can receive the best possible NHS Service.




My offer was accepted by the SLT service to return part time from retirement for 3 months in order to see the patients whose referrals had been rejected when the service was closed from April to August 2021. I offered appointments to 15 adult patients according to their expressed wishes. All of these were through telehealth (ie video appointments) as I have been operating throughout the pandemic.  I asked for and gained valuable feedback from these patients on various aspects of their experiences both of stammering and the services offered and several of them are happy to speak directly to the CCG.




Previous to the pandemic all people who stammer, whether children, teenagers or over 16s were seen at a community clinic separate from the main Children’s Hospital site. This has a waiting area for teens and older people slightly separate from the main waiting area and the clinic rooms are suitable for all ages.




My questions are:




(1)      To the CCG and Children’s Trust

          In the process of looking for the best NHS service to Sheffield over 16s  who stammer, can you clarify whether all options will be considered, including the status quo?  As the Children’s Hospital Trust are quoted on page 26 as being of the view that it is “not in the best interest of adults to be seen in a paediatric setting and care should be transitioned to adult services as per other services”  it appears that the status quo is being discounted from the start of this review. Is this the case?




(2)      To the Scrutiny Committee

          I have found it helpful to have the independent oversight of this Scrutiny Committee throughout this review of the Speech and Language Therapy Service to over 16s who stammer or have cleft lip and palate. May I seek reassurance that this kind of oversight and scrutiny will continue after the transition to the Modern Committee System?




Kate Gleave stated that whilst a review was ongoing to identify gaps in the CCG’s and the Trust’s knowledge relating to patient experience that would enable the development of a robust involvement plan, all options would be considered, but it was not known whether “status quo” could be an option and the CCG and Trust would only proceed with viable sustainable options.  Dr. Jeff Perring stated that the Trust would look at all available options and work closely with the CCG.




The Chair stated that, with regard to the question around Scrutiny, it was difficult to answer as the Council was in the process of reviewing its Governance system and it was not yet known whether or where Scrutiny would sit within that system.  He said that a copy of these questions would be put before the Governance Committee. He said that a Working Group had been set up to look at how scrutiny would fit into the new system. The Policy and Improvement Officer stated that the City Council had a statutory health scrutiny function and as such would continue.




Kate Gleave extended an invitation to Isobel O’Leary to sit on the Task and Finish Group and said that she would inform her of the date and time of the next meeting of the Group in due course.




Kate Gleave presented the report to Members and highlighted a couple of points.  She said that the dysfluency (stammer) and cleft, lip and palate services for adults had not ceased and would continue to take referrals until there was suitable adult provision in place in Sheffield.  She said that all available information had been reviewed although it was still unclear what people wanted from the Service, but it was clear that there still needed to be a service in the city.  Kate Gleave referred to the developing Involvement Plan, which would enable the CCG and the Trust to capture the experience and preferences of people who have used the service in the past, those who are current patients and those who are potential patients.




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




·                The Sheffield Children’s Hospital was a paediatric trust for children and young people and has been for many years.  Work between the Children’s Hospital Trust and Sheffield Teaching Hospitals Trust had been carried out to remove children from the adult services and vice versa, so that each Service could concentrate on its core business.  It was felt that adults should receive treatment in an adult environment.




·                There was a lack of information on all options available, however if the preferred option was “no action” the Sheffield Children’s Hospital Trust would look further into this.




·                The use of services such as Pathways, Head Injuries Unit and the Neurological Service was a potential option and there was a need to evaluate this as an option.




RESOLVED: That the Committee:-




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




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




(c)      hopes that this matter will continue to be monitored in the Governance system post May.




Supporting documents: