FEATURE
MATRIX REPORT
ILLUSTRATION Alberto Antoniazzi
W
ith the RCSLT’s
Giving Voice
campaign now
in full flow
members are
taking every
opportunity to increase understanding of
the role of speech and language therapy,
and demonstrate how it makes a difference
to individuals and the wider society.
A key aim of Giving Voice is to help
services demonstrate the value of SLTs
to national and local decision makers,
while at the same time showing evidence
of efficiency and value for money. This is
an important aspect of the campaign at
a time when all public services, and the
professionals who deliver them, are under
increased financial scrutiny. As you no
doubt know by now, there is more pressure
than ever before to show how taxpayerfunded services are cost-effective and how
they meet local and national priorities.
In anticipation of this, the RCSLT
12
Bulletin
012_015_Cover.indd 12
Saving money,
transforming lives
Steven Harulow examines the RCSLT’s Matrix
report outlining the economic case for speech
and language therapy
April 2011 | www.rcslt.org
21/3/11 12:26:16
FEATURE
MATRIX REPORT
Matrix report
findings
Every £1 spent on speech and
language therapy for:
−
Adults with dysphagia
after stroke delivers £2.30
in healthcare savings –
generating
£13.3m
annual savings
Adults with aphasia after
stroke delivers £1.30 in
savings – annual benefits of
£15.4m
Children with autism
produces £1.46 in lifetime
cost savings and productivity
gains –
£9.8m
Children with SLI creates
£6.43 savings through
increased lifetime earnings –
£741.8m
commissioned analysts Matrix Evidence to
review the existing evidence and undertake
an economic evaluation of the provision
of speech and language therapy to specific
client groups. The aim of this was to
pinpoint the benefits generated by speech
and language therapy in relation to the costs
of provision. The result was the UK-wide
study, ‘The economic case for speech and
language therapy’.
The Matrix research aimed to determine
the costs and benefits for four common
speech and language therapy client groups:
■ Adults with dysphagia post-stroke.
■ Adults with aphasia post-stroke.
■ Children with speech and language
impairment (SLI).
■ Children with autism.
Matrix Evidence undertook an evaluation
of the costs and benefits of speech and
language therapy intervention for each
condition. They compared either the effects
of speech and language therapy with the
effects of alternative forms of treatment or
the effects of intensive against less intensive
April 2011 | www.rcslt.org
012_015_Cover.indd 13
therapy. Specifically, the analysis evaluated:
■ Speech and language therapy for stroke
survivors with dysphagia compared with
‘usual’ care.
■ Enhanced NHS speech and language
therapy for stroke survivors with aphasia
compared with usual NHS therapy.
■ Enhanced speech and language therapy
for children with SLI compared with
existing therapy provision.
■ Enhanced speech and language therapy
for children with autism compared with
usual SLT treatment.
Outweighing the costs
The results of the Matrix report show that
speech and language therapy for all four
cohorts and conditions represents an
efficient use of public resources. The net
benefits of the interventions – including
health and social care cost savings, quality
of life, and productivity gains – are positive
and exceed their costs.
The report shows the total annual net
benefit across aphasia, SLI and autism is
£765 million – it excludes dysphagia from
the calculation since the two post-stroke
conditions are not mutually exclusive. The
next few paragraphs look at the results for
each group.
Dysphagia following stroke
Every £1 invested in low intensity speech
and language therapy for adults with
dysphagia after stroke generates an
estimated £2.30 in healthcare cost savings
through avoided cases of chest infections.
This reduction in respiratory problems
results in health cost savings that exceed
the cost of the speech and language therapy
by £13.3 million. The economic analysis
also underestimates the benefits of speech
and language therapy, which go beyond
reduction in chest infections – for example,
improved quality of life, avoidance of
malnutrition and death.
Further breakdown shows the estimated
annual net benefit is £11.2m in England,
£1.1m in Scotland, £0.7m in Wales and
£0.4m in Northern Ireland.
Bulletin
13
21/3/11 12:26:22
mil.
mil.
Annual cost
Annual
cost
of speech
and language
oftherapy
speech
and language
therapy
mil.
mil.
Annual Cost
mil.Adults with
dysphagia after stroke
mil.Adults
with
Annual
Cost
aphasia after stroke
Adults with
Children
dysphagia after stroke
with autism
Adults with
Children
aphasia after stroke
with SLI
Children
with autism
Children
with SLI
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
mil.
SCOTLAND
WALES
N. IRELAND
ENGLAND
◉ Available online: www.rcslt.org/giving_voice/news/matrix_report
14
Bulletin
012_015_Cover.indd 14
INFOGRAPHICS Luke Shuman
mil.
April 2011 | www.rcslt.org
21/3/11 12:26:27
FEATURE
MATRIX REPORT
Aphasia following stroke
Every £1 invested in enhanced speech
and language therapy for adults
with aphasia after stroke generates
an estimated £1.30 as a result of the
monetary benefit associated with quality
of life gain. The associated annual
benefits exceed the costs of the enhanced
speech and language therapy by an
estimated £15.4 million. Speech and
language therapy reduces symptoms of
aphasia leading to improved ability to
perform daily living activity and healthrelated quality of life gains.
Further breakdown of the results
shows that the estimated annual net
benefit is £13m in England, £1.3m in
Scotland, £0.7m in Wales and £0.4m in
Northern Ireland.
Speech and language
impairment
Every £1 invested in enhanced speech
and language therapy for children with
SLI generates £6.43 through increased
lifetime earnings. In comparison to
routine speech and language therapy,
enhanced therapy results in an additional
5,500 students achieving five or more
GCSEs A* - C (or equivalent). The
resulting benefit of providing enhanced
therapy for all children aged six to 10
who currently have SLI exceeds the cost
of the speech and language therapy by
£741.8 million.
Further analysis shows the estimated
annual net benefit is £623.4m in England,
£58m in Scotland, £36.1m in Wales and
£24.2m in Northern Ireland.
“The total annual net
benefit of speech and
language therapy across
aphasia, SLI and autism is
£765 million”
A powerful report
Speaking after the launch of the Matrix
report, RCSLT CEO Kamini Gadhok
said the study clearly demonstrates the
transformation impact of speech and
language therapy, both on patients’ lives
and the overall UK economy.
“This is incredibly powerful as we
continue our campaign to demonstrate to
commissioners the importance of investing
in services, such as speech and language
therapy, where the immediate cost savings
are not apparent,” she said.
Kamini reiterated the report author’s
comments that it is important to remember
that the Matrix analysis is necessarily
based on a subset of the populations that
benefit from speech and language therapy
and the value generated by SLTs.
“As a result, it is possible that the
analysis underestimates the benefit
generated by speech and language
therapy,” she added.
“Through our Giving Voice campaign
we are now meeting directly with
commissioners, including central
government, devolved administrations
in Scotland, Wales and Northern Ireland,
and local authorities to help them make
the right decisions for individuals and the
taxpayer. This report is proving to be a very
useful tool in our discussions.” ■
Case studies
Here are two examples that illustrate the human face of the financial savings
demonstrated in the Matrix Report
Children with autism
Alan’s dysphagia
Charlie’s autism
Every £1 invested in enhanced speech
and language therapy generates £1.46
through lifetime cost savings and
productivity gains. Enhanced therapy
targeting parent-child interaction
results in improved communication that
increases future independence. This leads
to a greater number of individuals living
in private and supported accommodation
in adulthood, relative to residential and
hospital settings. The benefit of providing
enhanced speech and language therapy
for children aged two- to four-years of
age who have autism exceeds the cost of
standard speech and language therapy by
£9.8 million.
Further breakdown by region shows
that the estimated annual net benefit is
£8.3m in England, £0.8m in Scotland,
£0.4m in Wales and £0.3m in Northern
Ireland.
When Alan, 72, became dizzy, unable to
walk in a straight line and lost the ability
to swallow, he went to hospital where he
was diagnosed as having suffered a mild
stroke. A few days later, and still unable
to swallow, Alan required a percutaneous
endoscopic gastrostomy tube for
nutrition, hydration and medication. He
describes his experience as ‘dreadful
and frustrating’. Shortly after, Alan met
Andrew, his SLT, with whom he worked
on a variety of exercises to regain his
ability to swallow. Practising these
exercises daily, Alan began to make swift
progress and now back on solid food, he
hopes to have his feeding tube removed
soon. He attributes his progress not
only to the exercises but to Andrew’s
enthusiasm and support. He says, “Until
it happens to you, you don’t realise how
many people benefit from speech and
language therapy.”
Four-year-old Charlie was diagnosed
with autism in February 2010. He had still
not started speaking at age three; one
or two words at best. He was referred to
SLT Debbie, by a health visitor and was
diagnosed with an auditory and speech
disorder. His parents became increasingly
concerned when he also started showing
the key signs of autism. Charlie was then
referred to a paediatrician and assessment
began. The process was long and hard,
particularly because of his age, but from
the outset Debbie was Charlie’s most
passionate supporter. She was a key
influence when planning his transition
from nursery school to reception. She also
introduced Charlie and his family to the
visual timetable, enabling him to familiarise
himself with his daily routine. As Charlie
has difficulty learning things audibly, his
parents were thrilled when he responded
to this new method instantly.
April 2011 | www.rcslt.org
012_015_Cover.indd 15
Bulletin
15
21/3/11 12:26:34