Co-design and co-production in Adult Speech and Language Therapy

Photos from project

NELFT Quality Improvement Services have been working closely together with the Adult Speech and Language Therapy Team on an innovative co-produced piece of work to explore where areas of improvement might be needed within the service, with the aim of creating a service that truly is patient lead, where patients voices are heard and change is made as a result.

This project was born as a result of a quality improvement project led by Rhiannon Haag (Clinical Lead Speech and Language Therapist) which came about due to the onset of the Covid-19 pandemic. Find out more about the orginal quality improvement project, and how this has developed into the co-production piece of work below.

Co-Design and Co-Production Project: One Voice

Introduction to project:

The result of the above quality improvement project was so successful that the users of service didn't in fact want to return to hospital for appointments after the threat of Covid-19 had reduced as they saw the many benefits the at home service offered. This showed the Adult Speech and Language Therapy team that a service they previously had been running (in hospital appointments) although seemingly had not problems or particular improvements required, in fact could be improved further and indeed was. As such, the Adult Speech and Language Therapy team were understandably keen to ensure that the users of service continued to receive the care they were asking for, but also wanted to ensure that the quality of this care was as high as it could be, not making the assumption that no immediate red flags or complaints meant that the service was performing at as high a quality as possible.

As such, the team wanted to explore what other improvements might be needed and where else problems in care might be occurring. The team knew that involving the users of services not just as stakeholders, but as equal parts in the project where they could truly co-design the project was essential.

This started the journey of the project, which used the Point of Care Foundation Experience Based Co-Design Framework. Find out more about this framework and the foundation here: 1. What is Experience-based co-design? - Point of Care Foundation

Project posters and presentations:

Below you can find out more about the project below:


Staff and user of services interviews around experience of the project

Freya Sparks - Speech and Language Therapist from Barts

Leo Morgan - Speech and Langauge Therapist from NELFT

Michelle Coleman - Speech and Langauge Therapist from NELFT

User of service and wife

User of service, wife and daughter

Original QI Project: Bringing the hospital home post laryngectomy

Introduction to project:

The Speech and Language Therapy (SLT) department at North East London NHS Foundation Trust (NELFT) offers specialist laryngectomy rehabilitation in North East London. A laryngectomy is when an individuals voice box is surgically removed as a treatment for cancer of the larynx, which leave the individual without a voice, and therefore needs a replacement means of communicating. Part of the care post surgery is the care of the permanent neck stoma & management of surgically placed voice prostheses. Historically, clinics were offered at a local acute hospital.

However, as a result of the Covid-19 pandemic in March 2020, outpatient clinics were closed. Initially, another hospital provided emergency support, however this was unsustainable and some patients, concerned about travelling and covid exposure, declined appointments. Waiting times rose to 83 days, increasing the risk of avoidable medical complications. As suc, an alternative, innovative model of community-based provision was introduced to reduce waiting times, limit covid exposure, and re-establish local care, whilst maintaining patient safety. This was the first comprehensive domiciliary laryngectomy service to be introduced across the NHS.

This background triggered the start of a quality improvement project that has gone on to be presented at the international Institute for Healthcare Improvement conference 2022, won a NELFT Make a Difference Award, and a NELFT Quality Improvement Award due to it's innovative nature and the true difference it has made to the users of service.

Learn more about this project:

The links below will help you understand this project further:

Bespoke Facilitator Training

QI facilitated a bespoke training programme for Havering Adult Speech & Language Therapy and Havering Adult Nutrition & Dietetics. This is the first time we have conducted a tailored facilitator programme (6 teaching and learning sessions over a period of 9 months) with positive feedback from all involved that the bespoke offer really helped in testing change ideas and contributing to improvements.  

At the graduation ceremony ,  project leaders (now QI facilitators) were provided with a platform to present their projects before their peers. Across a span of nine months, six projects were developed, each focusing on specific elements of the service they want to improve.

Find out more about all of these projects below:  

  • Chiara Vivaldi Specialist Speech and Language Therapist, Adult Speech and Language Therapy service, Havering - Improving Oral Healthcare in the community inpatient rehab setting 

  • Kerynne Thompson Adult Speech and Language Therapist, Havering - Increasing Patient Access to Communication Post-Laryngectomy  

  • Christine Hulthom Prescribing Support Dietitian – Redbridge , Claudiu Brici, Community Adult Dietitian – Havering & Nicole Poidevin , Adult Learning Disability Dietitian- Havering, Redbridge, Waltham Forest, Barking & Dagenham - Reducing the number of inappropriate referrals received into the Adult Redbridge Nutrition and Dietetic Service  

  • Michelle Coleman Head and Neck Cancer Speech and Language Therapist, Havering - Supporting transition from hospital to home post laryngectomy  

  • Jessica Harvey and Natalia Antunes Brandao,  Adult Speech & Language Therapy, Redbridge, Havering, Barking & Dagenham - Reducing the length of referral-to-therapy time for patients with Dysarthria in Redbridge  

  • Luiza Deaconescu Speech and Language Therapist, Adult Speech and Language Therapy, Havering - Increasing the number of hours of aphasia therapy provided to patients in the community  

Although the projects are in early stages of testing, there has already been improvement across these services and we look forward to communicating outcomes in due course .  

If you think your team/service could benefit from a similar programme, get in touch at qi@nelft  

Experience Based Co-Design Framework

The framework utilised to compelte this project was the Point of Care Foundation Experience Based Co-Design Framework.

Find out more about this framework and the foundation here: 1. What is Experience-based co-design? - Point of Care Foundation

Sharing the learnings from the project

The great success of this project so far as been shared across a variety of platforms. Find out more about this here: One Voice: Bringing the hospital home post laryngectomy – best practice example | NELFT Quality Improvement News | NELFT NHS Foundation Trust