East Cheshire NHS Trust

4. Mr C complains about the care and treatment from the Trust between July 2022 and July 2025. Mr C says the SaLT has not been sufficient for Master C’s care and needs. He specifically raises his concerns on the assessment and referral process and the services provided.

5. As a result, Mr C says the delay in treatment has had a negative impact on Master C’s behavioural and speech abilities and involvement with social services. Mr C says the distress this caused led to him losing his job and seeking financial help from his mother to fund private additional speech and language therapy treatment for Master C.

6. As an outcome, Mr C is seeking service improvements so that NHS services should take ownership in managing care and treatment better. He is also seeking a financial remedy of £9600.74 for reimbursement of private treatment fees.

7. Mr C questions if Master C’s Autism assessment was done correctly. He says Master C was initially referred to SaLT by his GP practice in July 2022. Master C was assessed by paediatrics in November 2022 and was not diagnosed with Autism until 20 September 2023. Autism is a neurological condition which includes impairments in social, developmental and communicative skills.

8. Following Master C’s diagnosis, Mr C approached SaLT to request more therapy sessions on 29 November 2023. He says he was told he could seek more sessions privately.

9. Mr C feels the sessions provided by the Trust, four sessions per term, were not sufficient and therefore did not meet Master C’s needs.

Issue 1 – Insufficient speech and language therapy sessions

13. We understand Mr C’s concerns about whether his son received the right level of speech and language therapy and support. We also recognise the impact this situation has had on him and the family.

14. We have seen evidence that the SaLT team carried out a comprehensive assessment of Master C. We consider this was in line with guidance from NICE and RCSLT. This is because the therapist assessed all key areas expected in a paediatric communication assessment.

15. This included Master C’s understanding and use of language, his non-verbal communication, his social interaction, and how he plays and learns. The therapist also considered his sensory needs, emotional wellbeing, and how he communicates in everyday situations.

16. We can see the therapist looked at how different environments, such as home and school, affected his communication, and whether he might benefit from additional communication tools such as visual supports. The records show the assessment also considered the support Mr C could provide and involved other professionals where appropriate.

17. This approach is consistent with NICE CG128 which says assessments should consider communication, social interaction, behaviour, development and the child’s wider environments. Therefore, we have not identified any concerns with how the assessment was carried out.

18. We appreciate why Mr C feels the number of therapy sessions was not enough, particularly given Master C’s diagnosis and the challenges he has described.

19. The records show Master C had around twenty-five contacts with the SaLT service. These included home visits, school visits, clinic appointments and telephone support. At times, he was seen approximately monthly by specialist therapists.

20. In addition to direct sessions, the SaLT team provided wider support. This included working with school staff, attending meetings, contributing to his education, health and care plan (EHCP), and providing advice and reports.

21. Our clinical adviser explained that this type of indirect support is an important part of SaLT. NICE CG128 and CG170 recognises that supporting a child’s communication across different settings is key part of effective intervention. The guidance also says services should provide a range of interventions, including advice, training and support across settings, not just direct therapy sessions.

22. We recognise that Mr C expected Master C’s autism diagnosis to lead to increased therapy. The evidence shows that SaLT consistently took Master C’s autism into account when planning and delivering his care. The therapist adapted sessions to meet his sensory and emotional needs, for example by adjusting the environment and the pace sessions. It used a child-led, play-based approach, which is recommended for children with autism.

23. The evidence also shows that, at times, Master C received more than the standard four contacts per term because of the changes in his circumstances and needs.

24. The records show the therapist used communication strategies tailored to autism, such as visual supports and alternative communication methods. We can see they considered behaviours such as echolalia (repeating words or phrases), as part of his communication development and adapted their approach accordingly.

25. We can see the therapist worked with Mr C and other professionals to support Master C across different environments. It also made appropriate referrals, for example for sensory support where needed.

26. We consider this approach is consistent with NICE CG170, which recommends play-based, developmentally appropriate interventions that involve parents and carers, and with RCSLT guidance on person-centred, autism-informed practice.

27. We understand why Mr C wanted more frequent sessions, especially given the difficulties his son was experiencing.

28. However, NICE CG170 does not set a specific number or frequency of speech and language therapy sessions. Instead, it says support should be tailored to the child’s individual needs and delivered through a multidisciplinary approach. The RCSLT guidance explains that therapists should provide care based on clinical need within the limits of the commissioned service, while supporting the child across different settings.

29. We understand that NHS SaLT services are commissioned to provide a certain level of support. This means therapists must balance individual need with the resources available and ensure services are provided fairly.

30. Our adviser confirmed the evidence shows that Master C was receiving a comprehensive package of care. This included regular assessment, direct therapy and advice, which were consistent with his needs and accepted clinical practice.

31. The records show the SaLT explained the limits of the NHS service and continued to provide appropriate care within those limits. We have not seen any indications that the decision to maintain the existing level of provision was clinically inappropriate or that it meant Master C’s needs were not met.

32. We recognise that being advised about private therapy may have been frustrating and added to Mr C’s distress.

33. The evidence shows that the discussion arose because Mr C asked about additional sessions. The SaLT team explained that the NHS service could not increase input beyond what was commissioned. It then advised that private therapy was an option if the family wished to access more frequent support.

34. Our clinical adviser says there are no indications the SaLT team required or pressured Mr C to seek private treatment. It also maintained professional boundaries by not offering private services themselves and instead signposted to an independent provider.

35. We consider this approach is consistent with HCPC guidance on conduct. This guidance informs us it appropriate for services to be clear and transparent about what they can offer and to inform families of other available options.

36. In conclusion, after considering all of the evidence available, we have not found any indications that the Trust failed to meet the relevant standards and guidance in the care it provided. The assessments and level of therapy provided was in line with NICE and RCSLT guidance and was appropriate to meet Master C’s needs within the limits of the NHS commissioned service.

37. For these reasons, we will not be taking any further action on this complaint. Despite this decision, we acknowledge the significant impact this situation has had on Mr C and his family. It is clear he was trying to do the best for his son in difficult circumstances. We would like to thank him for sharing his concerns with us, and we hope he is reassured by the information in this statement.

1. We are sorry to learn of Mr C’s dissatisfaction following his experience with East Cheshire NHS Trust. We acknowledge the difficult circumstances around this complaint, and the impact this has had on Mr C and his son, Master C.

2. We have carefully considered Mr C’s complaint about East Cheshire NHS Trust. Having done so, we have decided we will not investigate this complaint further. This is because we have not seen indications of failings in the way the autism spectrum disorder (ASD) assessment was carried out, nor in the amount of speech and language therapy (SaLT) and support allocated to Master C.

3. We understand this was and continues to be an upsetting time for Mr C and his family. Our decision is not made without recognition of the upsetting experiences he had with his assessment and its outcome. We have explained the reasons for our decision below and we hope this provide Mr C with some reassurance about the care package his son received.