Adult Community SLT referral form

Details/ examples where we are not able to accept referrals as our service is not commissioned to see patients with these conditions/circumstances.

Where possible, we have included links or information to signpost you to the most appropriate services.

Outside of our service contracts

• Out of area – for example, a community patient who does not have a GP within east or west Kent
• Under 18 years of age. Contact the Children’s Speech and language Therapy team.

Comes under another service

• Anyone with a confirmed learning disability should be referred to the Community Learning Disability Team
• Anyone who has a swallowing/communication impairment caused by a recent stroke – for example, within the previous six months should be referred to their local Community Neurological Rehabilitation Team by a health professional via the Local Referral Unit. This team also accept referrals for patients with other neurological diagnoses including traumatic brain injury and some progressive neurological conditions. If unsure, please contact their team or ours to see which service would be most appropriate to refer to.

Limited potential for impact of SLT

• If the person has previously not responded to SLT treatment for the same presenting condition we cannot accept a re referral unless there are good indications that further treatment will provide improved outcomes.
• Where the speech, language or communication disorder has no impact on functional daily living or their health and psychosocial wellbeing, except in cases where the condition is progressive.
• Patients previously known to SLT who are managing on their previous recommendations and with no new symptoms
• Patients who are considered to be at the very end of life (in their, last days/hours) where SLT assessment is unlikely to change management. Please find an information sheet here which can be shared with family/carers: Eating, drinking and swallowing at the end of life. If there is still significant concern after following the advice please proceed with referring to us. 

Condition-specific exclusions

• Patients referred for intervention for diagnosed Bell’s palsy: Facial Palsy UK - Supporting people affected by facial paralysis
• Patients with a communication problem due to deafness
• Patients who need advice regarding developmental dyslexia: British Dyslexia Association
• Adults with developmental/lifelong conditions impacting on communication, for example, lisps/articulation disorders. 
• Adults with communication difficulties due to autism. The KCHFT neurodevelopmental service may be able to help: Adult Neurodevelopmental Service. You could also try the Kent Autistic Trust for support.
• Adults with selective mutism.

Head and neck 

• Laryngectomy patients – these services are provided by EKHUFT or MTW hospital trusts in east and west Kent.
• Other head and neck patients who are currently under the care of an acute hospital trust for active treatment and being seen by the head and neck Macmillan specialist SLT at EKHUFT or MTW.

Inappropriate swallowing referrals

• Difficulties with eating and drinking that are not due to oropharyngeal dysphagia, for example, dental problems
• Problems swallowing tablets but able to eat and drink without difficulty. 
• Patients who have been placed on an eating and drinking at risk pathway where there have been no changes to their circumstances or wishes.
• Patients who refuse to eat, have a poor appetite or take a long time to eat and there are no other specific signs of an oropharyngeal dysphagia. Food refusal and poor appetite are rarely due to physical swallowing problems. If there is concern about inadequate nutrition please consider referral to the Clinical Nutrition and Dietetics Service
• People with symptoms which are indicative of oesophageal dysphagia and not oropharyngeal dysphagia, such as vomiting, regurgitation, excessive burping, sensation of food sticking at/below the larynx, or where there is a known oesophageal condition and associated symptoms. SLTs are specialists in assessment and management of oropharyngeal dysphagia and oesophageal issues are outside of our remit.
• If the problem is pain when swallowing and/or oral thrush or other painful conditions of the mouth or throat. Medical review advised.
• Anyone who has a one-off unexplained event of swallowing difficulty, for example a single coughing or choking event, but there are no other signs of dysphagia and the problem has not occurred again on their usual food/drink. This may have occurred on a barium swallow examination. 
• Referrals made ‘just to check’ if a person has any swallowing problems, though no actual signs of difficulty have been observed.