Publish date: 10 August 2023
Overhaul of specialist service reduces waiting times and delivers for patients
Respiratory patients at Northumbria Healthcare are benefiting from an improved speech and language therapy service which is helping to deliver better outcomes.
Respiratory speech and language therapy (SLT) is a specialised part of respiratory medicine and Northumbria’s service is one of just a small number in the UK, and globally.
It provides valuable support to patients with upper airway disorders and the trust’s service has undergone a series of changes. Key changes include the introduction of online records, telephone triages, new patient information leaflets, a website, and more regular nasendoscopy clinics.
Nasendoscopy assessments are now offered earlier in the care pathway, and have been offered in more rural hospitals, such as Hexham General Hospital. This has resulted in SLTs being able to deliver more appointments, closer to patients’ homes, and has reduced the average number of appointments patients need. These changes have resulted in a significant reduction in waiting times.
The changes have been driven by Jen Butler, the clinical lead speech and language therapist for Northumbria Healthcare’s respiratory service, who is passionate about the difference that SLT can make to a patient. But she explains the overhaul would not have been possible without the commitment and dedication of the whole respiratory SLT team across Northumbria, and through having such supportive colleagues, notably Dr Sean Parker, a respiratory consultant who specialises in chronic cough.
“This is a multidisciplinary service where speech and language therapists work with respiratory doctors and physios to really understand what patients are experiencing, and get an accurate diagnosis and treatment plan,” she said. “Respiratory nurses, pharmacists, lung physiologists and clinical psychologists also provide invaluable support.
“This is so important because our patients have often got a really negative experience of the symptoms in their daily lives and have excessive healthcare use, whether that be medication or excessive GP and hospital appointments.
“When patients come in to the service, they can expect to be listened to and taken seriously, and for us to really work with the patients to understand what is driving their symptoms.”
What does a respiratory speech and language therapist do?
They work with people who have upper airway disorders, which are throat disorders that can make it difficult to breathe or cause a persistent cough. They also support people who experience changes to their voice or swallowing.
The most common types of upper airway disorders are chronic refractory cough, which is a dry cough that lasts for eight weeks or more, without responding to medication, and inducible laryngeal obstruction (ILO), which is a breathing disorder where the throat muscles squeeze together tightly, making it difficult to breathe. Sometimes it can feel like people are choking.
This is still a relatively new area of medicine, and the evidence base is growing for what causes these conditions, but for most patients, these symptoms are caused by hyper-sensitive nerve endings in the throat.
This means that, instead of the throat muscles only coughing or closing in response to something like water going down the wrong way, they react by coughing or closing off in response to harmless material such as a smell or cold air, or as a response to feeling a tickle in the throat.
What can SLT do to support these patients?
A speech and language therapist will first support people to get an accurate diagnosis, by listening to a patient’s personal experience. They find out when symptoms started, what makes symptoms better or worse, and whether any medical or social factors may be making symptoms worse.
Therapists then work with the patients to support them to make sure their throat is as healthy as possible, teach breathing techniques to retrain the throat muscles to open up and release tension, and support people’s wellbeing through a combination of counselling and looking at practical approaches to reduce symptoms in a range of different scenarios.
Supporting these patients can make a huge difference
Jen explained: “Upper airway disorders can cause a lot of unpleasant physical symptoms and have a huge impact on people’s wellbeing.
“For anyone, the feeling of being unable to breathe is going to be distressing, and living life with a persistent cough isn’t going to be nice, especially following the Covid-19 pandemic.
“Some of our patients report that their cough is so severe they become incontinent, some avoid going out in public and socialising due to feeling embarrassed
“There’s also the healthcare side of things. Many people with these symptoms have been misdiagnosed as having asthma or have been labelled as having ‘unexplained’ symptoms, leading to many GP and hospital appointments, and trials of medications which haven’t been useful.”
A patient’s view
Chris Driver, a 48-year-old patient from North Shields, is one of those who has benefited from SLT with Jen and the Northumbria Healthcare team.
He explained that he was a little unsure about why he was seeing a therapist when he was first referred but would now tell anyone in his position to ‘go with it’.
“Some of the techniques are a little bit funny and a little bit strange, but I can say they do work, because they work for me,” he said. “Ever since I started seeing Jen, ever since I started doing the techniques, my coughing has subsided an awful lot.
“I wish I’d done it a lot sooner. Dr (Sean) Parker (consultant respiratory physician), and Jen, the help and support they’ve given is absolutely brilliant. They were always available if I had any questions or needed any support, so overall, absolutely perfect.”
Plans for future development
It is hoped that the respiratory SLT service will be developed further in the future, helping to deliver further improvements for patients, while offering more advanced clinics and new clinics in other locations across the trust’s patch in Northumberland and North Tyneside.
Jen and the team are also supporting regional colleagues to set up similar services.
Additional guidance, advice and resources
The respiratory SLT service has recently overhauled its website to provide an extensive range of information and resources for patients. For more information, visit www.