Allied health professionals (AHPs) make up the third largest clinical workforce in the NHS. They represent a diverse group of registered professions who play a vital role in the health service, working across various settings and with all age groups. They have clear clinical expertise distinct from medical professionals – the result of which is development of a strategic plan by NHS England, entitled ‘AHPs Deliver’. This plan, running from 2022–2027, aims to maximise the contribution of AHPs to improving health outcomes, providing better quality care and ensuring the sustainability of health and care services. ENT services work closely with a significant number of AHPs. Their expertise now means that conditions traditionally referred to ENT can be directed straight to AHP services and managed quicker and with a higher level of expertise than seeing a doctor. This month’s Editors’ Choice journal review looks at referral of patients with chronic swallowing disorders directly to speech and language therapists. The likelihood when these referrals are received is that the patient will ultimately need to be seen by speech and language services. This pathway results in patients being seen significantly quicker, reducing delays in initiation of treatment strategies and the need for radiological investigations and increasing patient satisfaction. This enhanced speech therapy role (after appropriate training) also reduces costs and time. Current AHP services across the board are under immense pressure to deliver in cash-strapped trusts, but this paper adds credence to supporting the indispensable role played by AHPs in the modern NHS and ENT practice. Thank you as always to our wonderful reviewers for their contributions.
Hannah and Nazia
Referral to an ENT consultant is the conventional way to manage patients with chronic swallowing disorders. With non-complex cases, this results in longer waiting times and often entails a barium swallow which then needs to be done, reported and actioned. Many patients are then referred to speech and language therapists, resulting in further delays before any treatment can begin. In this article, the authors have shown how this wait can be reduced if the speech and language therapists led clinics for non-complex swallowing disorders. That is by seeing these patients first, directly visualising their act of swallowing and also performing fibreoptic endoscopy. Of the 335 patients referred to SLT-led swallowing disorder clinics, only 25 were then referred to an ENT consultant clinic. A barium swallow, which the authors contend gives radiation equivalent to 75 chest x-rays, was required in only seven patients. Patient satisfaction, in terms of experience with endoscopy, level of information provided and confidence to manage their own swallowing conditions, rated very high in the feedback received. The authors feel this is a useful, time-saving multidisciplinary approach. In providing an enhanced clinical practitioner’s role after appropriate training, this would give encouragement and incentive to the speech and language therapists, thus reducing costs and time.
