Ms Muireann McCleary:

Communication is a fundamental feature of humanity. The ability to communicate, to receive, process, store and produce messages is central to human interaction and participation. It is also a fundamental human right. Everyone has the right to freedom of opinion and expression, and we as a society have a responsibility to ensure every person has this opportunity. The IASLT, the recognised professional association of speech and language therapists in Ireland, is committed to playing its part in ensuring the voices of people who have communication disorders are heard in our society. We are thankful for this opportunity to discuss communication accessibility and assistive technology.

People with severe speech or language impairments may experience communication difficulties across their lifespans. Their natural abilities may not be sufficient to meet their communication needs, and they may rely on AAC to communicate. Communication impairments may arise from a developmental disability, such as cerebral palsy or an intellectual disability, or from an acquired disability such as Parkinson’s disease, motor neuron disease or stroke. Based on UK data which estimate that 0.5% of the population has a communication impairment resulting in a need to use AAC, we estimate that approximately 25,000 Irish people who have a significant communication disability may benefit from AAC.

AAC refers to various communication modes used to supplement or replace speech. These modes include communication boards, manual signs such as Lámh and electronic devices with voice output. The currently accepted evidence suggests there are no specific prerequisites for getting started with AAC and it serves different purposes for different people. For those who have a good understanding but with a motor difficulty producing speech, AAC provides a mode of expression. For example, an adult with motor neuron disease might use voice output software on a laptop. Others need AAC to support their understanding and expression. For example, an adult with dementia may require picture symbols to support their understanding of health and care needs and their decision-making. Some people also need AAC to support communication in specific circumstances or at particular times. A child with Down's syndrome, for example, may use his or her speech and Lámh signs at home but then use a communication book with people who are less familiar. AAC may be used at any stage of life and may be a permanent or a temporary support. With this range of functions, it is clear that no one size fits all. People using AAC are diverse and may need multiple technical and non-technical solutions to access communication across contexts and communication partners.

AAC can have many positive benefits. It can allow people to control their world and to engage actively in society, with significant long-term benefits for well-being, participation and employment. These extend beyond the individual. A UK report calculated that an appropriately prescribed and implemented AAC system that resulted in a young person taking up employment could lead to a benefit of £500,000 accruing to the economy over a lifetime. Considering the potential benefits of AAC to individuals and to the economy, we must ensure everyone who needs them has access to high-quality AAC services. Significant challenges, however, are encountered in facilitating access to services and equipment for some of those who may benefit from AAC. Irish people do not have equitable access to speech and language therapy supports and funding pathways to help them access the most appropriate AAC systems. Waiting lists for speech and language therapy and other team supports are critical issues. Addressing the long waiting times is a crucial resourcing issue requiring urgent action.

Speech and language therapists have a unique role in supporting people and their families to navigate the options and to implement the most appropriate AAC systems. In a recent statement, the IASLT highlighted that specialist support pathways for AAC were to be established as part of the roll-out of the progressing disability services, PDS, programme. These services had previously been provided by specific, client cohort-focused services, or the agencies themselves had staff skilled in these areas who could provide the relevant supervision, support and training. Reconfiguration dismantled this structure. The promised specialist supports have not been consistently developed and, in some cases, there is no local access to specialist supports for children and families. New pathways for clients to access specialist AAC supports are required. The introduction of clinical specialist speech and language therapy roles is also required.

There is no national framework for the prescribing and funding of communication devices. We need a system that allows rapid access, including a loan model so people can access and try out different devices, to ensure they get the best system for their needs.

Providing an augmentative and alternative communication, AAC, system is only the start of the journey. Speech and language therapy, SLT, intervention is required for the individual and for communication partners across all contexts, including home, school, community and employment. Without this support, AAC systems may be abandoned and may be costly in terms of assessment time, device cost and, ultimately, quality of life, with opportunities lost through decreased communication and participation.

October is AAC awareness month and IASLT welcomes this opportunity to raise awareness of AAC and to offer our support in the implementation of the following steps towards a communication-accessible society for all Irish people who use AAC. One is the recognition and implementation of communication accessibility for all in line with Article 21 of the UN Convention on the Rights of Persons with Disabilities. Article 21 protects the right of all people to communicate by whatever means, modes or formats of communication are most appropriate to them, but lack of access to AAC and SLT means that this right is not currently being upheld. In order to make progress on this, both social and practical steps need to be taken. IASLT recommends the following: first, changes in the provision of services, with equitable access to speech and language therapy supports, including specialist supports and pathways for AAC; a national framework for funding prescribing and funding of communication devices; urgent action on staffing to address the long waiting times; and provision of public services which are fully accessible to people with communication disabilities; and, second, social and attitudinal change, with training required for those in service industries and community organisations to ensure communication accessible communities; and a mass media campaign to raise awareness and advocate for communication accessibility.