Private or NHS speech therapy: which is right for my child?

What does the NHS offer, and how do I get a referral?

NHS speech and language therapy is free to families, and you get to it through a referral. The Royal College of Speech and Language Therapists (RCSLT) says you can ask your GP, a health visitor, or your child's nursery staff or teacher to refer you, and that you can also refer yourself by contacting your local NHS speech and language therapy service.¹ The NHS website says much the same: talk to your GP or health visitor, or refer your child yourself.²

What happens next depends on where you live. RCSLT says services are organised in different ways across the UK, and that in some places demand is very high.¹ Some areas sort first referrals before offering appointments, and you may get a phone call first. So what an NHS service can offer your child, how soon, how often and in which setting, is something to ask the local service directly. I don't know how any particular service is run, and I'm not going to guess.

What does private therapy change?

Mostly the timing, the choice and the pattern of sessions. RCSLT says independent therapists can usually offer an assessment straight away, followed by therapy.¹ You also choose who you see. RCSLT points families to the website of the Association of Speech and Language Therapists in Independent Practice (ASLTIP), where you can search for a local therapist by postcode, age range, languages spoken and conditions treated.¹ ASLTIP says its therapists work in a range of settings, and that how often sessions take place is one of the things that affects the cost, so these are worth asking about.³

It doesn't change who is qualified. Every practising speech and language therapist in the UK, NHS or private, has to be registered with the same regulator, the Health and Care Professions Council (HCPC).⁴ A private therapist isn't more skilled than an NHS one by virtue of being private. What you're buying is the extra choice and the earlier start, and in my view those matter most when waiting would be hard on your child or your family.

What does private therapy cost, in money and in effort?

Money first. ASLTIP says independent therapists set their own fees, and that cost depends on things like how often sessions take place and whether extra work such as reports or liaison with other professionals is needed.³ My own are fixed and on the fees page: a free 15-minute call, then an assessment at £270 (a written report is £95 on top) and therapy at £85 an hour. My guide to choosing a therapist covers what to ask before you book.

Then effort, which people don't always think about. You'll be arranging and getting to appointments, usually practising a few things with your child between sessions, and passing on what you learn to the nursery or school. With the NHS, a good deal of this can be handled through the service and the setting, though parents often carry some of it there too.

Can we use both?

Yes. Seeing a private therapist doesn't take your child off an NHS waiting list, and you don't need a GP referral to see me. Lots of families use the NHS and a private therapist together, either because the wait is long or because they want something extra, such as time at the setting or a report.

The one request I'd make is that you tell both therapists. An RCSLT article by a therapist who has worked in both settings describes NHS and independent therapists working jointly and sharing reports with the person's consent.⁵ Its example is about adults, but the principle carries over, and it means your child isn't given conflicting advice. If you tell me you're on an NHS list, I'll ask whether you're happy for me to talk to your NHS therapist.

How do I check a private therapist?

Check the HCPC register. "Speech and language therapist" and "speech therapist" are both titles protected by law, which means anyone using them must be registered with the HCPC.⁶ The register is public, and you can search by surname or registration number.⁷ Other labels, such as communication therapist or speech practitioner, aren't regulated, and RCSLT says people using them might not have appropriate training.⁴

You can also look for membership of ASLTIP. Its FAQs say all its members are HCPC-registered and members of RCSLT, and that its directory lets you contact independent therapists directly.³ None of this tells you whether a therapist will suit your child, only that the basics are in place. The questions to ask beyond that are in the choosing guide, so I won't repeat them here.

So how do I decide?

Start with what you need and when. For many families, staying with the NHS route is a sound choice, especially with help from the nursery and plenty of talking and playing at home. If you'd also like an earlier start, a say in who works with your child, or something your NHS service doesn't offer, a private therapist is worth a call. If it isn't affordable, the NHS route is still open to you, and you can ask the service or the nursery what to try in the meantime.

The points to ask sooner apply whichever route you choose: a child who loses words or skills they had, doesn't seem to understand you, or isn't trying to communicate should be seen by a GP or health visitor promptly. You can also start one route and add the other later. My parents page describes how I work with families. The questions page answers some common worries.

Who can I ask for help straight away?

Your GP, your health visitor and your child's nursery or school can all help at no cost. At a nursery or school, ask for the SENCO, the special educational needs coordinator. Whichever you pick, you can raise your worry about your child's speech and language without needing to decide between NHS and private first.

What happens if I get in touch?

I offer a free 15-minute call, where you can describe what you've noticed and ask anything about how I work. You don't need a GP referral, and seeing me doesn't take your child off an NHS list. If you go ahead, the first step is usually an assessment (£270), which is mostly play, and the fees page has the full list.