What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Co-production and user-engagement are essential tools in boosting the culture, capabilities and structures needed for learning and improvement. However, some of our most vulnerable populations require the highest level of skilled facilitation if they are to engage in meaningful coproduction. (Mander 2016). People with cognitive communication disabilities (e.g. learning disabilities, autism & dementia) are often unable to engage in ‘traditional’ written and verbal feedback methods and require a more specialist supported approach (Davis et al 2022).

The challenge is exacerbated by limited access to inclusive communication training provision, due to lack of staff availability, resources and the limitations of specialist speech and language therapy services. In addition, evidence suggests that short-term standalone training is ineffective in achieving long-term cultural and capability change (Chadwick 2024, Lewer & Harding 2013).

What does your project aim to achieve?

The project aims to ensure that the voices of people with cognitive communication needs are heard within quality improvement work; inclusive communication skills are the bedrock of coproduction and investing in staff capability means that no-one is left behind.

Through an appreciative enquiry & observational model, it aims to reduce the ‘time burden’ of training, identified as a barrier to achieving change (Lewer & Harding 2013) and to personalise the approach to individual and organisational needs to maximise long-term impact & sustainability.

As well as building capacity for genuine coproduction within services, increased inclusive communication skills reduce the risks of delayed intervention, diagnostic overshadowing, (LeDeR 2022) safeguarding issues (RCSLT 2018) and escalating behaviours of concern, all of which have devastating effect on vulnerable individuals and the costs of their care.

A review cycle will enable care organisations to evidence ongoing learning, embedding improvement into management systems and processes.

How will the project be delivered?

After an initial pilot, specialist speech and language therapist will carry out 3 x 90-minute observational visits and assess the existing inclusive communication environment using a review tool which was developed using clinical research and reviewed and adapted by our expert by experience group.

Where possible, these visits will include a short focus group which enables users of the service to have their say directly too.

The results will consist of a 1-page summary, to be discussed with the service-manager. Positive reinforcement of good communication and co-production practice will be highlighted and areas of need discussed.

Training needs will be identified (e.g. using visual resources (Bradshaw 98) or engaging with non-verbal service-users (Chadwick 2024) and agreed with the Manager.

The training will take the form of ‘bitesize’ training modules which model and embed good practice in context.

Accessible resources and review visits will follow the training.

How is your project going to share learning?

We will gather insights and share learning through the Q community, seeking out other contributors in related fields.

Findings will be evaluated and shared through existing networks (Kent Surrey & Sussex Community of Practice, Royal College of Speech and Language Therapists, Surrey Care Association and others.

With support from our university networks, we aim to publish the research in a peer-reviewed journal.

In the long term, we hope this project will add to evidence base for training delivery and early intervention which can help NHS services develop a cost-effective and enduring model of service delivery; initial discussions with speech and language therapy services within local NHS Trusts, as well as with local care providers indicate there is the potential for this work to have significant impact across health and social care systems as well as to the lives of individuals with care needs.