HNY Policy and Pathway Repository - Humber

Hull and East Riding Speech and Language Therapy

The CHCP Speech and Language Service provides assessment and management for adults with a  Hull and East Riding GP, who have acquired communication  difficulties or an oral or pharyngeal swallowing disorder. We also see adult patients who stammer. Please see exclusion criteria for patients who require referrals to other services.

Our patients may have a range of conditions including neurological disorders, respiratory conditions, frailty and cancer.

Any patient with an acquired communication difficulty who will benefit from assessment or therapy can be referred. This can include speech difficulties e.g. due to a progressive neurological condition, a voice disorder, stammer or language disorders due to head injury, stroke or tumour. Patients can also self refer for communication assessment.

Patients with a suspected oral or pharyngeal swallowing problem affecting their eating and drinking can be referred by a registered health or social care professional.  Care home managers and their deputies can also refer. Patients cannot self refer for a swallowing assessment

Patients are seen in clinic locations across Hull and East Riding and home visits are provided for those who are house bound or have significant difficulties in attending clinic appointments.

The service also runs an outpatient community videofluoroscopy clinic on a fortnightly basis at Castle Hill Hospital for patients who require instrumental assessment following an initial speech and language therapy assessment. This is not appropriate. 

GP practices should follow red flag advice for ENT, Gastroenterology and neurology referrals that may be appropriate for patients presenting with a new and unexplained speech, language, voice or swallowing difficulty. 

DO NOT REFER

• Oesophageal Dysphagia. These are to be managed by Gastroenterology, GP with support from dietetics if nutritional advice is needed.
• Voice referrals need to have been recently assessed by ENT prior to referral 

All Patients with a voice disorder need to have been seen by ENT before they can be referred to speech and language therapy.

For patients with a swallowing disorder, GP practices should consider if an ENT or Gastroenterology referral is required. Speech and Language Therapists do not have easy access to instrumental assessment so if the underlying cause or nature of the swallowing disorder is not known then referral for endoscopy or barium swallow needs to be considered.

We do not manage patients with oesophageal level swallowing problems. Therefore if reflux , oesophageal dysmotility, oesophageal cancer, strictures etc.. are suspected to be the cause then these should be managed by Gastroenterology, GP and/ or dietetics as appropriate. We may reject referrals if there has been insufficient investigation prior to SLT referral where this is suspected.

We do not provide an upper airways service therefore referrals for inducible laryngeal obstruction or chronic cough without a voice or swallowing disorder will not be accepted.

Where weight loss is a concern GP practices should consider a dietetic referral at the point of referral to speech and language therapy, to avoid delay in assessment.

Where patients are end of life and swallowing deterioration/  reduced oral intake is expected , GP practices should consider whether standard end of life feeding advice is more appropriate than SLT referral.  (See End of life Swallowing guidance leaflet) 

If GPs are prescribing thickener for patients, they should follow local prescribing guidance and ensure that a referral to speech and language therapy is made to ensure this is appropriate.

GP Practices should be aware that the service is not currently commissioned for an urgent response to referrals and that is reflected in our current response times and KPIs.

We do not accept referrals who only have a problem swallowing tablet medication. They should be managed by their GP practice/ pharmacy and alternatives considered.  

• Registered with a Hull and East Riding GP
• Adult, over 18 years of age
• Acquired communication or oral/ pharyngeal swallowing difficulty.
• Stammering

Exclusion criteria

• Difficulties related to confirmed learning disability (refer to Community Team for Learning Disabilities)
• Voice difficulties or ENT dysphagia  and live in Hull (refer to SLT Team at Hull Royal Infirmary)
• Speech or swallowing disorders due to head and neck cancer (refer to SLT Team at Hull Royal Infirmary)
• Patients with upper airway conditions e.g. inducible laryngeal obstruction or chronic cough and no oral/ pharyngeal swallowing/ voice issues.
• Hull GP and diagnosis of stroke (refer to Hull Integrated Stroke Service)
• Patient with oesophageal level swallowing difficulties only (may require gastroenterology referral)
• Difficulties only with swallowing medication (refer to GP / pharmacist as indicated)
• Patients with psychogenic related dysphagia. SLT may have supported assessment and diagnosis to confirm this but ongoing management will need to be with local mental health services.
• Swallowing referrals for patients with a tracheostomy
• Care home dysphagia referrals which can be managed by first line web based advice
• Referrals for voice disorders need to have been seen by ENT prior to referral to speech and language therapy.
• People with a developmental communication disorder other than stammering e.g. developmental language disorder, autism, developmental language disorder, ADHD, no local service.
• People with communication difficulties primarily due to a hearing impairment, no local service
• People with communication difficulties relating to a mental health condition, no local service.
• People requiring voice and communication therapy in relation to gender dysphoria, need to be referred to Leeds.

Referrals should be made on the departmental referral form and emailed to chcp.247111@nhs.net or via RAS. The information on these forms is used to prioritise the referral, therefore it is important that accurate information regarding chest infections, choking episodes, weight loss, dehydration and deterioration is given. 

Referrals

All referrals are triaged within 2-3 working days of receipt of the referral. Priority referrals aim to have a telephone assessment completed within 10 working days. All other routine referrals aim to be assessed within 8 weeks of referral either in clinic for certain communication disorders or via telephone assessment. Acknowledgement letters will be sent to all patients and their referrers where waiting times for assessment are expected to be longer than 2 to 3 weeks. Following telephone assessment the patient will be either given an appointment or sent a telephone assessment report detailing the advice given and plan which may involve a further wait for direct assessment depending on clinical need.

Service website: https://www.chcpcic.org.uk/chcp-services/speech-and-language-therapy

Service Referral Form - available on Ardens

Primary Care Prescribing Guidance for Thickener

Care Home Advice on Thickener

End of Life Swallowing Guidance

Elearning dysphagia training package for those advanced practitioners working in care homes https://www.e-lfh.org.uk/programmes/dysphagiaguide/

Please ensure diagnosis, medical history, description of the swallowing problem and information regarding chest infections, weight loss, choking , dehydration and prognosis/ dehydration are included. We will check systmone electronic record for any missing information but where key information e.g. medical history or diagnosis cannot be found, the referral will be returned.