Speech and language therapy: Help children, dementia sufferers and many others to communicate their needs better

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By the end of today, John Bercow, the former Speaker of the House of Commons and MP for Buckingham, may find himself unemployed. Traditionally, the Speaker's seat is uncontested but Bercow, a controversial figure for many MPs, is facing a range of opponents in today's general election. Before he became Speaker in June 2009, few outside Westminster knew of Bercow; few, that is, other than the UK's 11,500 practising speech and language therapists (SLTs). Indeed, should Bercow find himself on the wrong side of the count tonight, he can take comfort from the fact that, in this small and female-dominated segment of the health service, the Bercow Review lives on.

The Bercow Review of services for children and young people with speech, language and communication needs, to give it its full title, was generally welcomed by a profession that maintains a low profile despite undertaking very important work that can transform a child's chance to lead a happy and fulfilled life.

In his report of 2008, Bercow found that up to 50 per cent of children in some areas of Britain grow up with significant speech, language and communication needs. If unaddressed, these difficulties can lead to problems at school, poor employment prospects and delinquency (about 60 per cent of the 7,000 young people who pass through young offender institutions have communication difficulties), not to mention significant emotional and psychological challenges.

Bercow argued for better monitoring of children's communication skills and improved access to SLT services to end what he called a "postcode lottery" in provision. For many SLTs, the review raised the standing of the profession to one of national import.

There are a wide range of reasons why someone may struggle with communication, from specific language impairments, autism spectrum disorder or physical difficulties through to head injuries, strokes and dementia. Among young children, it can be difficult to diagnose the problem, yet early intervention can make a massive, transformative difference.

"A child who cannot attain core communication skills is really disadvantaged and destined to struggle all the way through life," says Professor Jane Marshall, the joint head of department for language and communication scienc at City University in London, one of 18 universities and colleges offering recognised SLT courses in the UK. "To give those children a leg up when they need it can make a real difference to their prospects. To then see them go on and succeed can be really rewarding."

The City course is a four-year BSc that mixes academic study with clinical practice and attracts a mix of school leavers and career changers. The diverse student body seems to be typical as many students don't know SLT exists until they have personal experience of it, perhaps because a family member requires the assistance of a therapist. This can open the door to a life-changing career, both for practitioner and client.

It is the variety of the job that makes it so attractive, says Claire Hartley, head of SLT at Birmingham City University, which condenses the BSc into three years. "We work with people right across the spectrum, from babies with feeding problems to the elderly who have had strokes or people with progressive conditions," says Hartley. "You can end up working in all sorts of settings, from homes for people with learning difficulties, to Early Years Centres to hospitals, prisons and the justice system."

Therapists can work on the frontline as a clinical specialist, take on a managerial role with responsibility for service delivery, undertake specialist research or teach future practitioners. Or do a mix of everything. Most will work in the NHS, and places on recognised degree programmes are NHS funded with home students eligible for a means-tested bursary.

Excellent communication and problem-solving skills are a must and therapists have to be able to work with a wide range of people, from pre-schoolers to anxious parents to other health professionals. Salaries are reasonable, starting at around £21,000 and advancing to more than £50,000 for principal therapists with significant managerial responsibilities.

"You can progress quite rapidly and assume quite a lot of responsibility reasonably early on in your career," says Marshall, who puts this down to the calibre of the practitioners coming through and the openness of the profession. "In a female-dominated profession, there's also a certain amount of attrition for family reasons, which creates opportunities for those coming up," she adds.

Sophie Scott, principal SLT for pre-school and acute paediatrics at Northwick Park Hospital and the Royal National Orthopaedic Hospital, says she counts herself to be "hugely lucky" in her chosen career. "Working directly with the children and parents, and seeing change and development in their communication skills is hugely rewarding – not just from seeing a child develop, but also seeing parents better able to understand their child's difficulties and able to communicate with them," says Scott.

There are downsides too. "As with all public services, there are huge and increasing demands within a service that does not have an increasing budget, so we are always being challenged to find more effective ways to see more patients," says Scott diplomatically of the pressures facing her team of therapists. For now, SLT is still a profession that's employing people, with universities citing some impressive destination statistics for their graduates. How today's election result will change that has yet to be seen.

'You have to get them to their maximum potential'

Emma Kardani-Zadeh is a newly qualified practitioner working in community clinics and mainstream schools for the North West London Hospitals NHS Trust

"I hadn't heard of SLT until my friend's mum had a laryngectomy. Her therapist was happy to chat to me about the job – that's how I got into it. I was doing office work, having left college at 18. I was 23 when I started looking at SLT and I got a place to study at UCL.

I'm now doing two and a half days in clinic working with pre-school children, and two and half days in mainstream schools. It's exciting when you've been working with a child for six months and suddenly they get it.

You're looking to get them to the point of discharge, but some are never going to be within normal limits, so you have to get them to their maximum potential and give recommendations to their teachers so they can be supported and have all their needs met."

'I see up to eight children a day'

Jessica Rose is a speech and language therapist who works within mainstream schools in Harrow, north-west London

"This is my second career. My first degree was in politics and I worked for an MP, but I hated the cut-throat way politics works. I'd always had an interest in speech and language therapy. I did some work experience, loved it and decided to do the postgraduate course at City.

A typical day starts around 8.15am when I catch up with the teachers. I take the children out of class for group or individual therapy. I see a maximum of eight children a day.

Around 2.30pm, I might meet the special educational needs coordinator to go over the caseload or do annual reviews for children with statements. Then I prepare for the next day.

Sometimes in a session, nothing goes to plan. Other days, the child suddenly understands the instructions and there's progress. That's very satisfying."