Adult speech and language therapy

  • The Adult Speech and Language Therapy (SLT) service is provided in east and north Hertfordshire. For residents in west Hertfordshire, a service is provided by Central London Community Healthcare NHS Trust.

    All the speech and language therapists are registered with the national regulatory body, the Health and Care Professions Council, which maintains an online register of Speech and Language Therapists meeting the required standards.

    The service works as a team to provide integrated, seamless care to adult patients with speech, language, communication, voice or swallowing difficulties. The care is patient-centred with individualised packages based on clinical evidence, good practice and clinical experience. The service works in partnership with patients and their families and with other professions, multidisciplinary teams and partner agencies to reduce the impact of these often life threatening and isolating difficulties on people’s lives.

    The service has a culture of service review and development to meet identified needs.

    The service is delivered from acute hospitals, community hospitals, rehabilitation units, intermediate care locations, residential and nursing homes and patients’ own homes. The patients are seen in the most appropriate setting to their needs.

    The SLT service operates open access for referral for all disorders with the exception of:

    • Dysphagia (swallowing) referrals should be made by a Doctor
    • Dysphonia (voice) referrals require ENT examination prior to SLT assessment in line with national recommendations

    Adult speech and language therapy information or view this in an accessible format

    Contact the service

     

    East and North Hertfordshire
    Email: hcnt.sltenhct@nhs.net

How the Service is provided

  • The service accepts referrals for adult patients with stroke, progressive neurological conditions, head injury, cancer, voice disorders, dementia, COPD, stammering and other conditions that affect communication and swallowing.
  • SLTs aim to minimise the long-term impact of speech, language, communication and/or eating and drinking disorders on patients’ daily living, prevent admission to hospital, and provide rehabilitation.
  • Adults who are referred or who refer themselves will be seen for assessment and, depending on their needs, will be offered a package of care which could include further assessment, treatment, advice, family/carer support, rehabilitation and review.
  • The needs of each person are individually assessed including their family if appropriate. The type of care provided is based on their goals to maximise motivation and participation.
  • SLTs assess for suitability of communication aids (both high and low tech) to enable patients to have more autonomy and confidence in communicating with others and expressing their decisions.
  • SLTs consider not only the impairment but also the impact on the patient’s life.
  • health promotion packages are offered to prevent problems recurring e.g. voice care.
  • All packages promote self-management strategies and triggers are negotiated with patients ensuring timely re-referral into the service, preventing possible admission to hospital.
  • SLTs can offer adapted ‘aphasia-friendly’ written information.
  • SLTs will facilitate communication with other services where specialist knowledge and skills are required.
  • SLTs can support mental capacity assessments by facilitating communication.
  • Patients with swallowing difficulties may be referred for video-fluroscopy assessment in the x-ray departments of Lister Hospital or QE2 Hospital.

Who is eligible for the service

The service provides specialist assessment and management of adult patients who present with speech, language, communication, voice and swallowing disorders resulting from:

• Stroke
• Progressive neurological disorders e.g. Parkinson’s Disease, Multiple Sclerosis, Motor Neurone Disease
• Head Injury
• Brain tumour
• Head and Neck Cancer
• other cancers
• voice disorders
• Dementia
• Tracheostomy
• gender dysphoria
• Mental Health (East and North Hertfordshire)

The disorders assessed and treated by SLT are:

• Dysphagia (swallowing disorders)
• Aphasia (acquired language disorder)
• Dysarthria (speech disorder)
• Dyspraxia (speech disorder)
• Dysphonia (voice disorder)
• Dysfluency (stammer/stutter)

What will happen at your appointment

Appointments may take place in the SLT Clinic or in your own home. During your first appointment, your SLT will take a case history from you, including any relevant medical information, and also give you (and your relative or carer if you wish) an opportunity to describe the nature of your problem and how this is affecting you.

The SLT will then assess you and discuss the results of the assessment. Following this you will discuss your goals from treatment together and will make a plan as to what to do next.  Timescales will also be agreed.

This might involve:

• advice
• lifestyle modifications/exercises to do at home
• health promotion package to prevent problems
• a review appointment to chart your progress 
• further appointments at the clinic for therapy

Your progress will be reviewed again at the end of a period of treatment, and a decision will be made as to what happens next. You may be discharged, or offered further appointments.

For enquiries or to change the time and/or date of your appointment if necessary, you can phone the Speech & Language Therapy Service administrators on 01438 285287.

Useful information

Augmentative and alternative communication

Augmentative and alternative communication (AAC) has been defined by the International Society for Augmentative and Alternative Communication (ISAAC):

"to describe extra ways of helping people who find it hard to communicate by speech or writing. AAC helps them to communicate more easily."

Key points

AAC should be considered as a viable option for improving the quality of life of anyone of any age with a severe communication impairment resulting from developmental, acquired, progressive, long-term or acute conditions.

“AAC covers a huge range of techniques which support or replace spoken communication."

These include:

  • gestures
  • signing
  • symbols
  • word boards
  • communication boards
  • books
  • Voice Output Communication Aids (VOCAs) Communication Matters".

If you are a person who uses AAC, family member, carer or professional, it is important to consult a speech and language therapist (SLT) or an AAC specialist to request a multi-disciplinary assessment to make an informed decision about any equipment you may need.

There is no ‘best’ type of AAC system. Each has pros and cons - the most suitable one for an individual will depend on their personal preference, situation and on their abilities and needs. Specialist assessment will help to identify the most appropriate AAC system(s).

The Speech & Language Therapy Service can assess AAC needs and provide AAC devices and systems on a long term loan basis. Where AAC needs are complex, the SLT service will refer patients to our regional AAC centre CASEE for assessment and AAC system provision.

Trans and Gender-Diverse voice and communication therapy

An individual’s voice is central to their identity - it is how they communicate with their family, friends, work colleagues and wider society.

As part of a multidisciplinary team (MDT), speech and language therapists (SLTs), with the appropriate skills have a key role to play in ensuring the best possible outcomes for trans and gender diverse people.

SLTs provide voice and communication assessment and therapy for trans and gender diverse individuals to explore, discover and sustain their authentic voice and communication which fits with their sense of self.

Voice and Communication Therapy (also known as voice modification, including voice masculinisation, voice feminisation, voice neutralisation) facilitate vocal and communication pattern changes which forms part of the psychosocial intervention within the care pathway for treating gender dysphoria.

Voice and Communication Therapy can help to reduce distress related to gender dysphoria, which can cause a significant lack of confidence and social participation. It can also help reduce the occurrence of transphobia and being misgendered. Examples include: people being vocally misgendered on the telephone; being ridiculed and discounted in or excluded from social or workplace contexts due to listener expectation, bias, or prejudice.

Supporting people with Dementia 

The term dementia is used to describe a collection of symptoms, including a decline in memory, reasoning and communication skills. It may result in communication problems for the person with dementia and with their carers as well as eating, drinking and swallowing difficulties.

Key points:

  • Individuals with dementia need access to speech and language therapy services. Commissioners, decision makers and service providers, who are aware of the needs of their local population, can ensure there is access to speech and language therapy services to meet those needs.
  • Speech and language therapy services provide equal access to intervention for communication and for swallowing disorders.
  • It is important that speech and language therapy services are adequately resourced to provide quality care for people with dementia.
  • Speech and language therapy services for people with dementia are provided within an integrated multidisciplinary context to ensure the philosophy and goals of intervention are shared and consistent.
  • "Cost per case" arrangements or service level agreements with minimal levels of provision for SLT are unlikely to provide a service of the quality and expertise that people with dementia require.
  • Communication and swallowing are the responsibility of the whole team – the role of the speech and language therapist is to empower and educate others as well as providing direct specialist input as appropriate.
  • Early speech and language therapy intervention is crucial so that people with dementia and their carers have their needs met in a timely way.

For more information read our Dementia factsheet.

Useful links

The Stroke Association - 020 7566 0300
www.stroke.org.uk
Helpline: 0303 303 3100
Info@stroke.org.uk

Different Strokes - 0845 130 7172 or 01908 317618
www.differentstrokes.co.uk

Speakability - helpline: 080 8808 9572
A charity dedicated to helping aphasic individuals rebuild communication through information services, self-help groups and training.
www.speakability.org.uk

Motor Neurone Disease Association - 01604 250505
www.mndaassociation.org
03457 626262
enquiries@mndassociation.org

Parkinson’s UK - 0807 800 0303
https://www.parkinsons.org.uk/   

Multiple Sclerosis Society - 0808 800 8000
www.mssociety.org.uk
helpline@mssociety.org.uk

PSP Association for people with Progressive Supranuclear Palsy & Cortico-Basal Degeneration - 01327 322410
www.pspassociation.org.uk
Helpline: 0300 0110 122
helpline@pspassociation.org.uk

Multiple System Atrophy Trust - 020 7940 4666
www.msatrust.org.uk
support@msatrust.org.uk

British Stammering Association - 020 8983 1003
For information and support on stammering, also known as stuttering.
www.stammering.org
Helpline: 0845 603 2011

The Speech & Language Therapy Service has a number of groups attached to the service. Entry in to the groups is through the service, so if you are interested and want to know more, contact us on 01438 285287.

These are:

Dysphasia Support Groups run by The Stroke Association.

Aphasia Network Groups in East and North Herts: For people who have aphasia (a language disorder) after a stroke, run in local areas by trained volunteers to provide an opportunity for social interaction and supported communication.

Speakability: A self-help group in Hertford for people with Aphasia.

Making a referral

East and North GPs

Use EMIS and SystmOne

Non-GP referrers

Use the referral form or view an accesible version

Referrals for swallowing disorders (dysphagia)

Care homes and care providers should follow the feeding safely routines  when someone is having difficulty with swallowing.

The  dysphagia referral algorithm will also help with establishing whether a referral should be made.

Patient experience

If you would like to share your story, please contact the Patient Experience team on 01707 388036 or email pals.hchs@nhs.net.

We would also love to hear about your experience on our service, please complete a survey by clicking here.

This is part of the Carer Stories initiative by NHS Hertfordshire where the carer of a client is asked about their journey through the Hertfordshire Speech and Language Therapy Service (SLT) as a means of feedback for the service. The informal interview was carried out by Student SLT under the supervision of a qualified SLT. The following are the most prominent themes that were discussed and seen as crucial areas which the service should keep central in their approach.

Maintaining contact with client/family

The carer thoroughly praised how, for the majority of the journey, the family had been given constant updates mostly through telephone calls but also, where possible, face to face discussions. The updates and contact that had been maintained throughout the service had allowed him to feel as though he was also part of the process and stressed how happy this made him feel as he felt he could then actively contribute to the care required for his child.

However, the carer did cite a time in which he felt this area was neglected. When previous SLT and staff had decided to begin to teach Makaton to his child as a means of functional communication; however the family were not informed, which led to the client attempting to gesture for objects and the family were unable to support this learning which inevitably dissipated without the support of the family.

Client Centred Approach

The carer was very appreciative of how the service for his child seemed to be individualised to her particular needs. According to the carer this stems mostly from how he felt his opinion mattered as many small strategies that were devised were always to benefit the client in the short term and had functional implications for their implementation. Such as introducing photos for objects that the client desired. Not only did this benefit the client but also the family as the carer expressed a joy in being able to successfully interact with the client in a meaningful and helpful way.

Flexibility

The carer mentioned how surprised he was at how smooth the transition of data and notes seemed to be between professionals. Additionally, the carer spoke of how staff  were willing to listen to his opinions over certain matters such as the transfer of the client into a new school. The flexibility of the service made him feel more relaxed in a highly tense situation such as moving schools which he praised.

Overall Thoughts

When asked if there was anything the carer would change about his journey through the service his response was a resounding "no". The carer seemed happy with the service as a whole. In terms of his child he stated that she was getting "the best help" and was convinced of this fact. His reasoning behind this was repeating some of the key factors as mentioned above but also that he was witnessing the client's language develop and despite how small the progress may appear, every part seemed to mean a great deal to him.

Advice for the Service

When asked if the carer could give advice for the service for future clients and their families the carer firstly stressed the importance of patience; not only for the client themselves but the family around them. Secondly, he stated that acknowledging the feedback they receive is important, to which he yet again praised the service for carrying out this process as it made him as a carer feel valued to the service and that he was contributing to those SLT's who are just starting in the profession. Finally, a point that the carer emphasised the most was the desire to feel as if he was actively helping the client. The carer stated that the feeling of the inability to help was one of the worst feelings and that he was so glad that the service was able to empower him with advice, instruction and strategies so that he could continue to support the client in their journey.

Adult speech and language therapy

  • The Adult Speech and Language Therapy (SLT) service is provided in east and north Hertfordshire. For residents in west Hertfordshire, a service is provided by Central London Community Healthcare NHS Trust.

    All the speech and language therapists are registered with the national regulatory body, the Health and Care Professions Council, which maintains an online register of Speech and Language Therapists meeting the required standards.

    The service works as a team to provide integrated, seamless care to adult patients with speech, language, communication, voice or swallowing difficulties. The care is patient-centred with individualised packages based on clinical evidence, good practice and clinical experience. The service works in partnership with patients and their families and with other professions, multidisciplinary teams and partner agencies to reduce the impact of these often life threatening and isolating difficulties on people’s lives.

    The service has a culture of service review and development to meet identified needs.

    The service is delivered from acute hospitals, community hospitals, rehabilitation units, intermediate care locations, residential and nursing homes and patients’ own homes. The patients are seen in the most appropriate setting to their needs.

    The SLT service operates open access for referral for all disorders with the exception of:

    • Dysphagia (swallowing) referrals should be made by a Doctor
    • Dysphonia (voice) referrals require ENT examination prior to SLT assessment in line with national recommendations

    Adult speech and language therapy information or view this in an accessible format

    Contact the service

     

    East and North Hertfordshire
    Email: hcnt.sltenhct@nhs.net

How the Service is provided

  • The service accepts referrals for adult patients with stroke, progressive neurological conditions, head injury, cancer, voice disorders, dementia, COPD, stammering and other conditions that affect communication and swallowing.
  • SLTs aim to minimise the long-term impact of speech, language, communication and/or eating and drinking disorders on patients’ daily living, prevent admission to hospital, and provide rehabilitation.
  • Adults who are referred or who refer themselves will be seen for assessment and, depending on their needs, will be offered a package of care which could include further assessment, treatment, advice, family/carer support, rehabilitation and review.
  • The needs of each person are individually assessed including their family if appropriate. The type of care provided is based on their goals to maximise motivation and participation.
  • SLTs assess for suitability of communication aids (both high and low tech) to enable patients to have more autonomy and confidence in communicating with others and expressing their decisions.
  • SLTs consider not only the impairment but also the impact on the patient’s life.
  • health promotion packages are offered to prevent problems recurring e.g. voice care.
  • All packages promote self-management strategies and triggers are negotiated with patients ensuring timely re-referral into the service, preventing possible admission to hospital.
  • SLTs can offer adapted ‘aphasia-friendly’ written information.
  • SLTs will facilitate communication with other services where specialist knowledge and skills are required.
  • SLTs can support mental capacity assessments by facilitating communication.
  • Patients with swallowing difficulties may be referred for video-fluroscopy assessment in the x-ray departments of Lister Hospital or QE2 Hospital.

Who is eligible for the service

The service provides specialist assessment and management of adult patients who present with speech, language, communication, voice and swallowing disorders resulting from:

• Stroke
• Progressive neurological disorders e.g. Parkinson’s Disease, Multiple Sclerosis, Motor Neurone Disease
• Head Injury
• Brain tumour
• Head and Neck Cancer
• other cancers
• voice disorders
• Dementia
• Tracheostomy
• gender dysphoria
• Mental Health (East and North Hertfordshire)

The disorders assessed and treated by SLT are:

• Dysphagia (swallowing disorders)
• Aphasia (acquired language disorder)
• Dysarthria (speech disorder)
• Dyspraxia (speech disorder)
• Dysphonia (voice disorder)
• Dysfluency (stammer/stutter)

What will happen at your appointment

Appointments may take place in the SLT Clinic or in your own home. During your first appointment, your SLT will take a case history from you, including any relevant medical information, and also give you (and your relative or carer if you wish) an opportunity to describe the nature of your problem and how this is affecting you.

The SLT will then assess you and discuss the results of the assessment. Following this you will discuss your goals from treatment together and will make a plan as to what to do next.  Timescales will also be agreed.

This might involve:

• advice
• lifestyle modifications/exercises to do at home
• health promotion package to prevent problems
• a review appointment to chart your progress 
• further appointments at the clinic for therapy

Your progress will be reviewed again at the end of a period of treatment, and a decision will be made as to what happens next. You may be discharged, or offered further appointments.

For enquiries or to change the time and/or date of your appointment if necessary, you can phone the Speech & Language Therapy Service administrators on 01438 285287.

Useful information

Augmentative and alternative communication

Augmentative and alternative communication (AAC) has been defined by the International Society for Augmentative and Alternative Communication (ISAAC):

"to describe extra ways of helping people who find it hard to communicate by speech or writing. AAC helps them to communicate more easily."

Key points

AAC should be considered as a viable option for improving the quality of life of anyone of any age with a severe communication impairment resulting from developmental, acquired, progressive, long-term or acute conditions.

“AAC covers a huge range of techniques which support or replace spoken communication."

These include:

  • gestures
  • signing
  • symbols
  • word boards
  • communication boards
  • books
  • Voice Output Communication Aids (VOCAs) Communication Matters".

If you are a person who uses AAC, family member, carer or professional, it is important to consult a speech and language therapist (SLT) or an AAC specialist to request a multi-disciplinary assessment to make an informed decision about any equipment you may need.

There is no ‘best’ type of AAC system. Each has pros and cons - the most suitable one for an individual will depend on their personal preference, situation and on their abilities and needs. Specialist assessment will help to identify the most appropriate AAC system(s).

The Speech & Language Therapy Service can assess AAC needs and provide AAC devices and systems on a long term loan basis. Where AAC needs are complex, the SLT service will refer patients to our regional AAC centre CASEE for assessment and AAC system provision.

Trans and Gender-Diverse voice and communication therapy

An individual’s voice is central to their identity - it is how they communicate with their family, friends, work colleagues and wider society.

As part of a multidisciplinary team (MDT), speech and language therapists (SLTs), with the appropriate skills have a key role to play in ensuring the best possible outcomes for trans and gender diverse people.

SLTs provide voice and communication assessment and therapy for trans and gender diverse individuals to explore, discover and sustain their authentic voice and communication which fits with their sense of self.

Voice and Communication Therapy (also known as voice modification, including voice masculinisation, voice feminisation, voice neutralisation) facilitate vocal and communication pattern changes which forms part of the psychosocial intervention within the care pathway for treating gender dysphoria.

Voice and Communication Therapy can help to reduce distress related to gender dysphoria, which can cause a significant lack of confidence and social participation. It can also help reduce the occurrence of transphobia and being misgendered. Examples include: people being vocally misgendered on the telephone; being ridiculed and discounted in or excluded from social or workplace contexts due to listener expectation, bias, or prejudice.

Supporting people with Dementia 

The term dementia is used to describe a collection of symptoms, including a decline in memory, reasoning and communication skills. It may result in communication problems for the person with dementia and with their carers as well as eating, drinking and swallowing difficulties.

Key points:

  • Individuals with dementia need access to speech and language therapy services. Commissioners, decision makers and service providers, who are aware of the needs of their local population, can ensure there is access to speech and language therapy services to meet those needs.
  • Speech and language therapy services provide equal access to intervention for communication and for swallowing disorders.
  • It is important that speech and language therapy services are adequately resourced to provide quality care for people with dementia.
  • Speech and language therapy services for people with dementia are provided within an integrated multidisciplinary context to ensure the philosophy and goals of intervention are shared and consistent.
  • "Cost per case" arrangements or service level agreements with minimal levels of provision for SLT are unlikely to provide a service of the quality and expertise that people with dementia require.
  • Communication and swallowing are the responsibility of the whole team – the role of the speech and language therapist is to empower and educate others as well as providing direct specialist input as appropriate.
  • Early speech and language therapy intervention is crucial so that people with dementia and their carers have their needs met in a timely way.

For more information read our Dementia factsheet.

Useful links

The Stroke Association - 020 7566 0300
www.stroke.org.uk
Helpline: 0303 303 3100
Info@stroke.org.uk

Different Strokes - 0845 130 7172 or 01908 317618
www.differentstrokes.co.uk

Speakability - helpline: 080 8808 9572
A charity dedicated to helping aphasic individuals rebuild communication through information services, self-help groups and training.
www.speakability.org.uk

Motor Neurone Disease Association - 01604 250505
www.mndaassociation.org
03457 626262
enquiries@mndassociation.org

Parkinson’s UK - 0807 800 0303
https://www.parkinsons.org.uk/   

Multiple Sclerosis Society - 0808 800 8000
www.mssociety.org.uk
helpline@mssociety.org.uk

PSP Association for people with Progressive Supranuclear Palsy & Cortico-Basal Degeneration - 01327 322410
www.pspassociation.org.uk
Helpline: 0300 0110 122
helpline@pspassociation.org.uk

Multiple System Atrophy Trust - 020 7940 4666
www.msatrust.org.uk
support@msatrust.org.uk

British Stammering Association - 020 8983 1003
For information and support on stammering, also known as stuttering.
www.stammering.org
Helpline: 0845 603 2011

The Speech & Language Therapy Service has a number of groups attached to the service. Entry in to the groups is through the service, so if you are interested and want to know more, contact us on 01438 285287.

These are:

Dysphasia Support Groups run by The Stroke Association.

Aphasia Network Groups in East and North Herts: For people who have aphasia (a language disorder) after a stroke, run in local areas by trained volunteers to provide an opportunity for social interaction and supported communication.

Speakability: A self-help group in Hertford for people with Aphasia.

Making a referral

East and North GPs

Use EMIS and SystmOne

Non-GP referrers

Use the referral form or view an accesible version

Referrals for swallowing disorders (dysphagia)

Care homes and care providers should follow the feeding safely routines  when someone is having difficulty with swallowing.

The  dysphagia referral algorithm will also help with establishing whether a referral should be made.

Patient experience

If you would like to share your story, please contact the Patient Experience team on 01707 388036 or email pals.hchs@nhs.net.

We would also love to hear about your experience on our service, please complete a survey by clicking here.

This is part of the Carer Stories initiative by NHS Hertfordshire where the carer of a client is asked about their journey through the Hertfordshire Speech and Language Therapy Service (SLT) as a means of feedback for the service. The informal interview was carried out by Student SLT under the supervision of a qualified SLT. The following are the most prominent themes that were discussed and seen as crucial areas which the service should keep central in their approach.

Maintaining contact with client/family

The carer thoroughly praised how, for the majority of the journey, the family had been given constant updates mostly through telephone calls but also, where possible, face to face discussions. The updates and contact that had been maintained throughout the service had allowed him to feel as though he was also part of the process and stressed how happy this made him feel as he felt he could then actively contribute to the care required for his child.

However, the carer did cite a time in which he felt this area was neglected. When previous SLT and staff had decided to begin to teach Makaton to his child as a means of functional communication; however the family were not informed, which led to the client attempting to gesture for objects and the family were unable to support this learning which inevitably dissipated without the support of the family.

Client Centred Approach

The carer was very appreciative of how the service for his child seemed to be individualised to her particular needs. According to the carer this stems mostly from how he felt his opinion mattered as many small strategies that were devised were always to benefit the client in the short term and had functional implications for their implementation. Such as introducing photos for objects that the client desired. Not only did this benefit the client but also the family as the carer expressed a joy in being able to successfully interact with the client in a meaningful and helpful way.

Flexibility

The carer mentioned how surprised he was at how smooth the transition of data and notes seemed to be between professionals. Additionally, the carer spoke of how staff  were willing to listen to his opinions over certain matters such as the transfer of the client into a new school. The flexibility of the service made him feel more relaxed in a highly tense situation such as moving schools which he praised.

Overall Thoughts

When asked if there was anything the carer would change about his journey through the service his response was a resounding "no". The carer seemed happy with the service as a whole. In terms of his child he stated that she was getting "the best help" and was convinced of this fact. His reasoning behind this was repeating some of the key factors as mentioned above but also that he was witnessing the client's language develop and despite how small the progress may appear, every part seemed to mean a great deal to him.

Advice for the Service

When asked if the carer could give advice for the service for future clients and their families the carer firstly stressed the importance of patience; not only for the client themselves but the family around them. Secondly, he stated that acknowledging the feedback they receive is important, to which he yet again praised the service for carrying out this process as it made him as a carer feel valued to the service and that he was contributing to those SLT's who are just starting in the profession. Finally, a point that the carer emphasised the most was the desire to feel as if he was actively helping the client. The carer stated that the feeling of the inability to help was one of the worst feelings and that he was so glad that the service was able to empower him with advice, instruction and strategies so that he could continue to support the client in their journey.