WIH Policy Notification

Working in Harmony: Interface between Speech & Language Therapists

Speech and Language Therapists (SLTs) may be employed and work in a variety of settings such as privately, for the NHS, schools, hospitals and charities, etc.

The Royal College of Speech and Language Therapists (RCSLT) produced a document called Working in Harmony. The document provides guidance to make sure clients received a consistently high standard of shared care when independent and NHS SLTs are involved in the care of the child.  The main points in this document are:

  • Parents/clients are entitled to seek speech and language therapy from one or more services of their choice; however, they are not entitled to seek a service from more than one NHS provider.
  • If you choose to receive therapy both from the NHS and from an Independent service such as E.W.Options, it can be preferable for the Speech and Language Therapists to collaborate and with your permission, make assessment results available to each other but this is not essential. The aim is for the therapists to agree on a complementary approach.
  • Where it is considered in the child’s best interests to receive professional help from two practitioners, it may be appropriate for one therapist to take the lead role in managing this client’s case after discussion and joint planning. In order to provide continuity of care all SLTs should have the opportunity to contribute to planning meetings or case conferences concerning a client.
  • Should SLTs wish to follow different or perhaps conflicting approaches, this should be discussed with the child’s parents. The parents should be invited to decide which approach they wish to pursue. Parents should be made aware that they are free to return to the second SLT following the completion of the chosen therapy.
  • Parents may seek a second opinion at any time. In certain instances, for example, where a parent seeks a confidential second opinion, the SLT should make discretionary decisions in order to act in the child’s best interests.


Service users’ rights and best interests

The following guidance has been provided by the Royal College of Speech and Language Therapists (RCSLT) and the Association of Speech and Language Therapists in Independent Practice (ASLTIP).

  • Children cannot be discharged from the NHS simply because they are having private speech and language therapy. A discharge decision would need to be made in accordance with NHS discharge criteria. A client may be discharged from the NHS if there are no further clinical needs and continue to see another provider if they wish.
  • After an assessment, every child should receive their allocated SLT which could be a block of therapy sessions or periodic review. This must happen regardless of whether they are receiving private SLT.
  • All parents are entitled to seek speech and language therapy from one or more services if they choose.
  • If a parent chooses to use more than one service (Private and NHS), it is in that client’s best interests that SLTs from both or all the services involved collaborate freely. It may be appropriate for one SLT to take the lead role in managing the client’s case. Guidance on who takes the lead e.g. the SLT who sees the service user most frequently. All the SLTs involved should be told about all case conferences involving a shared client and ask to be invited if appropriate. The aim is to offer complementary input in the best interest of the client. For example, therapy could be offered out of phase i.e. if NHS is offering a more intensive block then the SLT in independent practice may take a back seat and vice versa. However, if the parent wishes a confidential second opinion/therapy and does not wish a previous therapist to be informed, this should be respected and recorded in the client’s notes.
  • Parents should be made aware that assessment results may be inaccurate and/or invalid if repeated within a certain timeframe.


Next steps…

If your child has already been referred to/ or is receiving input from an NHS Speech and Language Therapist, you will need to choose if you would prefer to opt in or opt out of ‘Working in Harmony’ and record your preference on the N.E.W.Options referral and consent form that will be provided to you by our team or your child’s school/teacher on our behalf.  It is therefore important that you have read and understood the information given above.


If you prefer to ‘opt-in’ to Working in Harmony;

  • If you are happy for N.E.W.Options to ‘Work in Harmony’ with your child’s NHS Speech and Language Therapist (SLT), you will need to complete the relevant sections on the referral and consent form
  • Following your consent, we will contact the NHS SLT, await their response, liaise with them regarding input, and mutually agree to therapy aims and intervention and then action the agreed plan within your child’s school.

If you prefer to ‘opt out’ of Working in Harmony;

  • You may not wish for us to work in harmony with your child’s NHS Speech and Language Therapist.
  • In this instance, N.E.W.Options will assess your child and directly provide a therapy programme. Your child’s therapy input will be actioned in school by the N.E.W.Options team and school staff with immediate effect.


If you have any queries, concerns or would like to discuss Working In Harmony in more detail, please contact N.E.W.Options for a chat.


The N.E.W.Options Team