Niche role brings speech and language therapy to the frontline

PICTURED: Alys Haswell's new role has benefited patients in Morriston Hospital's Older Person’s Assessment Unit.

A new niche role within a Swansea Bay unit is improving frailty care one swallow at a time.

Elderly and frail patients are benefiting from a specialist Speech and Language Therapy post within the Older Person’s Assessment Unit (OPAU) in Morriston Hospital.

This is the first and only dedicated Speech and Language Therapist (SLT) role within frailty services in Wales.

As well as increasing patient care and experience, the new post has led to earlier discharges and decreased demands on hospital and community services.

A SLT supports people with communication and swallowing difficulties, with the latter particularly prevalent in older people - affecting up to 70 per cent of care home residents and up to 30 per cent of elderly patients admitted to hospital.

Alys Haswell started in the new position in September 2024. She conducts communication, swallowing and mental capacity assessments, and provides intervention and education to staff, patients, families and carers on how to best support needs.

Working closely with the multi-disciplinary team (MDT) in both the assessment and short stay areas to support safe and timely discharge, Alys’ role has benefited over 260 patients so far.

Alys said: “I’m really enjoying the new role.

“I’m passionate about improving the care of patients within our elderly population and I’m keen to show what value SLT can offer to this area.

PICTURED: Alys with colleagues from the Older Person’s Assessment Unit.

“The types of swallowing and communication difficulties we see in older people vary. Difficulties can arise from age-related changes, the loss of muscle mass and strength, and cognitive decline, but also from conditions which are more likely in older age such as certain types of cancer, respiratory or neurological conditions.

“I have a strong focus on personalised care, quality of life, and longer-term planning which supports patients beyond their stay on our unit. This can mean providing patients and their families with preventative advice and knowledge about how their communication or swallowing may change, signs to look out for and how to access more support. I also contribute to advance and future care planning, for example when considering non-oral feeding, or eating and drinking with known risks of aspiration and choking.

“I frequently communicate with community teams including GPs, virtual wards and nursing, and care homes to ensure patients’ needs are communicated clearly between settings and ensure consistency of swallowing management plans.

“Providing patients with timely SLT assessments on admission to hospital, almost always on the same working day, is very important as it can minimise or avoid a number of potential adverse consequences.

“Unidentified or unmanaged swallowing difficulties can lead to dehydration, malnutrition, aspiration pneumonia and delirium. These often require medical treatments which prolong a patient’s length of stay in hospital, increase their risk of deconditioning and could result in them losing their package of care.

“Supporting communication difficulties is also vitally important to support mental capacity decisions, support patient’s understanding of their healthcare needs and choices, and ensure they are able to express themselves effectively.”

Dr David Burberry, Consultant Geriatrician said: “I regularly see patients that I feel would benefit from Alys’ opinion. Early SLT input has helped with diagnostic planning, investigations and onward referrals. It has increased the number of patients we have diagnosed and proven aspiration pneumonias due to poor swallows at the point of admission, which speeds up care.”

Dr Liz Davies, Clinical Director for Care of the Elderly, said: “Alys has been an excellent addition to the team in OPAU.

“Her expertise has been instrumental in championing mouth care and safeguarding communication, hydration and nutrition. Her compassionate, person-centred approach has enhanced dignity, safety and recovery for some of our most vulnerable patients, while also strengthening multidisciplinary collaboration.”

The new role has also had an impact on the wider SLT service.

Jade Farrell, Clinical Lead Speech and Language Therapist, said: “Having Alys as a dedicated Speech and Language Therapist on OPAU has been a really valuable addition to the service and has already demonstrated a positive impact.

“Alys has fully embedded SLT into the MDT on the unit which has improved communication, care and referral response times.

“This holistic management has also led to the majority of patients leaving the unit without any ongoing SLT needs.

“Feedback from MDT colleagues and patients about the impact of Alys’ work has been fantastic and it is lovely to see greater recognition of the value SLT can provide to our elderly population and acute services.”