Child health has always been a minority interest in the NHS. And few managers have moved up the career ladder on the strength of their achievements in the niche field of children's speech and language.

But July's publication of the Bercow review of services for children and young people with speech, language and communication needs has raised the bar. Schools secretary Ed Balls and health secretary Alan Johnson have publicly committed to acting on all 40 of the review's recommendations with a£52m funding package, which includes£40m to promote language development in very young children.

Why the sudden high-level political interest? It reflects increasing recognition that speech, language and communication are the foundation life skills for the 21st century. Good communication skills are essential for learning, literacy, social and emotional well-being, and mental health. They underpin every one of the five Every Child Matters outcomes.

It also reflects how widespread speech, language and communication needs are. In some parts of the UK - particularly areas of social disadvantage - upwards of 50 per cent of children are starting school with such needs. Many have language skills that are inadequate for the start of formal learning. But with the right support, they may catch up with their peers.

However, an estimated 10 per cent of these children have more complex or persistent needs. Within this group, 7 per cent of children and young people have speech, language and communication needs as their main difficulty. Other children have these needs as a result of another condition, such as autism, hearing impairment or general learning difficulties.

Urgent issue

Speech, language and communication needs can - if unaddressed - have a devastating impact on a child's whole life. Poor language skills undermine confidence and hinder the ability to relate well to other people. They create a major barrier to learning. There are strong links, well documented in research, with poor prospects and social exclusion in later life. People with speech, language and communication needs are over-represented among offenders and among people with mental health problems.

Speech and language problems are the most common form of developmental delay in children. They affect 10 times as many children as autism and three times as many children as dyslexia. Viewed in the round, it is hard not to view this as an issue of epidemic proportions. Indeed, in the US, "diseases of communication" are defined as a public health issue.

Getting it right for children's communication development requires the NHS to integrate its provision with local authority children's services in exactly the way envisioned in Every Child Matters. In practice, this has proved easier to advocate through central government policy than to deliver on the ground. The Bercow review team's extensive visits programme identified disappointingly few areas with local excellence or innovation.

Accordingly, the review's recommendations challenge primary care trusts to raise their game. This means integrating their services with those of local authorities to improve children's life chances. Key areas for action are:

Joint working

Local leadership and joint working are identified as playing a vital role in improving outcomes for children with communication needs. Collaborative working between education and health is advocated as best practice for children with speech and language needs. This is particularly true in the early years, since early identification and intervention is key. However, a 2006 report from the National Audit Office on children's centres found that only five of 27 surveyed worked closely with their PCT.


Bercow's final report recommends developing a commissioning framework through a series of five pathfinders allied to the DH world class commissioning programme. The framework would help commissioners model a continuum of universal, targeted and specialist services for children at every age and stage, including auditing need, configuring services and developing the workforce required for delivery.


The forthcoming child health strategy and child health promotion programme are key vehicles to disseminate information about the importance of good communication skills for children to parents and child-facing professionals. The report recommends ensuring families and professionals have a clear record of a child's language development, so that any problems can be addressed early.

New vision

At the review's launch, Alan Johnson and Ed Balls made it clear that they saw children's communication skills as a fundamental issue for children's services in the UK. This autumn, the government will outline how it intends to implement the review's recommendations. Let's hope the government, PCTs and local authority children's services can look beyond their traditional entrenched disputes and pull off a new approach that will deliver for children and families.

With such a high proportion of the children's population affected, speech, language and communication needs are emerging as a new public health issue. That unwelcome fact, together with Bercow's legacy, might just help end the perennial pass-the-parcel funding rows about speech and language therapy support that create such anguish for families.

What we are talking about here is repositioning children's speech and language from a Cinderella issue into one central to children's policy. That would mean PCT managers taking a fresh look at these services.

The DH and strategic health authorities are now looking at which PCTs should be Bercow pathfinder sites. Let's hope they are flooded with ideas on how speech and language services could be reinvented around children's and families' needs.

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Bercow review