Closing the word gap

05 July 2019

Wendy Nicholson MBE explains how Public Health England and the Department for Education are working to equip socially disadvantaged children with the speech, language and communication needs they require to fulfil their true potential.

By 2028, the government aims to halve the number of children who do not achieve the minimum communication, language and literacy goals by the end of reception year (National Literacy Trust, 2018). This supports the ambition outlined in Unlocking talent, fulfilling potential: a plan for improving social mobility through education (Department for Education, 2017).  

The early years are a critical period for laying the foundations of good health and wellbeing, which will ensure a child reaches their potential. Socially disadvantaged children are more likely to have speech and language difficulties than their peers, which has implications for their educational attainment and future life chances (Department for Education, 2017). Evidence suggests early language impacts significantly on child development, including the ability to manage emotions and communicate feelings, establishing and maintaining relationships, to think symbolically and also, importantly, to learn to read and write (Law et al, 2017).

Bercow: 10 years on suggests 1.4 million children and young people in the UK have speech, language and communication needs (SLCN). In addition, children with poor vocabulary skills at age five are twice as likely to be unemployed when they reach adulthood, and 60% of young offenders have low language skills (ICAN and Royal College of Speech and Language Therapists, 2018). SLCN is the most common special educational need in England; however, it is one need that is often not identified early enough.

Figure 1 (below) shows the extent and complexity of SLCN in children, together with the support required.

Appropriate support

There is wide variability in children’s language ability and rate of language development, particularly within the pre-school years (Department for Education, 2017). Healthcare professionals (HCPs) working with children and families need to recognise signs of language delay, understand differing levels of need and have clarity of the support systems available locally to ensure early, appropriate support.  

HCPs also need to support parents and carers to have the capability, motivation and opportunity to support their children with language development. Figure 2 (below) outlines the approach being advocated by the Department for Education, which was initially developed by the National Literacy Trust. This focuses on behaviour change to support language development in the home. There are three core components parents can use to support their children in their home learning environment (HLE) – chat, play and read.

Health visitors as leaders of the Healthy Child Programme (Department of Health, 2009) work across four levels of service to meet needs by delivering a universal service to all families, and have specialist public health knowledge and skills in assessing need. Health visitors have trusted and enduring relationships with families and communities, therefore there are opportunities to promote language development, allowing them to offer timely interventions.

Health visiting teams are well placed to promote SLCN, and to enable parents to use their home as a learning environment. The revised high-impact areas for early years were refreshed in 2016 to include SLCN (Department of Health and Social Care and Public Health England, 2018).

Training the Workforce

Public Health England (PHE) is currently leading on a programme of work providing training to health visitors across England. PHE has the professional leadership role for health visitors and has commissioned the Institute of Health Visiting to develop and deliver a new training programme focusing on early identification of language delay and promotion of early language development. The initial training is underway nationally and will be cascaded locally to ensure reach across the health visiting workforce. The training has two key aims, which are to increase:

1. Knowledge of:
  • Typical/non-typical speech, language and communication development in all children  
  • The impact of SLCN on long-term health and wellbeing outcomes for children
  • The application of evidence-based strategies to promote speech, language and communication development with all children and families.

2. Confidence, and ensure health visitors:

  • Identify the risk factors for SLCN by conducting assessments
  • Use evidence-based strategies to support families when a SLCN is identified, and consider methods to demonstrate impact of the interventions
  • Identify SLCN appropriate for referral to speech and language therapy, and/or evidence-based support through local pathways.

The training will encourage health visitors to work in partnership with parents and other service providers to ensure there are a variety of approaches to support children and families, including:

  • Delivering the key messages of chat, play and read
  • Using daily routines and everyday interactions as the context for modelling language
  • Small group targeted interventions.  

The training is only one strand of work PHE is leading on. Other elements include:

  • A speech, language and communication pathway for children under five years, and guidance to support local commissioners and service leads. This guidance will support local areas to develop integrated SLCN pathways for use by professionals and parents/carers, as well as support to develop a confident and skilled workforce. The guidance will be available from autumn 2019.  
  • An early language assessment tool, which is currently being developed and evaluated. The tool is being piloted in five local authorities across the country and its evaluation is expected to be completed by spring 2020.

SLCN is everyone’s business and effective approaches require strong partnership working locally. Parents are crucial as the experts in their child’s development; they should be supported to ensure their child has the best start in life and that any SLCN is identified early. Health visitors and their teams are in an ideal position to support parents to improve child development, while assessing the needs of the child at the earliest opportunity to ensure children are ready to learn at two, and ready for school at five.    

Wendy Nicholson MBE is deputy chief nurse, children, young people and families, at Public Health England.


Obi Amadi, lead professional officer, says:

‘Any additional supported training or refreshing of knowledge is of value to professionals. As there are not always the right professionals in the right place available to offer support, having refreshed skills is a positive.

‘The early identification of language delay and promotion of early language development has been identified as an important need, as children are not getting timely access to the services required. The obvious consequence is that they are less able to communicate or have problems in school or later life. This is placing children at a disadvantage, yet it’s avoidable.

‘The concern is that while we have staffing shortages, increasing the requirements on professional practice relies on professional cooperation, as health visitors will have to reprioritise what they do to add this activity to their service.

‘Clearly there is still a need for further recruitment. To use the saying “We can do anything but cannot do everything” is very apt in this situation and it should be remembered.’


Department for Education. (2017) Unlocking Talent, Fulfilling Potential: A plan for improving social mobility through education. See: https://www.gov.uk/government/publications/improving-social-mobility-through-education (accessed 11 June 2019).

Department of Health and Social Care, Public Health England. (2018) Early years high impact area 6: health, wellbeing and development of the child aged 2: Ready to learn, narrowing the ‘word gap’. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/756700/early_years_high_impact_area_6.pdf (accessed 25 June 2019).

Department of Health. (2009) Healthy Child Programme Pregnancy and the first five years of life. See https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167998/Health_Child_Programme.pdf (accessed 11 June 2019).

ICAN and Royal College of Speech and Language Therapists. (2018) Bercow: Ten Years On. See www.bercow10yearson.com (accessed 11 June 2019).

Law J, Charlton K, Asmussen K. (2017) Language as a child wellbeing indicator. Early Intervention Foundation. See https://www.eif.org.uk/report/language-as-a-child-wellbeing-indicator (accessed 11 June 2019).

National Literacy Trust. (2018) Improving the home learning environment: A behaviour change approach. See https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/756020/Improving_the_home_learning_environment.pdf (accessed 11 June 2019).

Public Health England. (2018) Overview of the 6 early years and school aged years high impact areas. Health visitors and school nurses leading the Healthy Child Programme. See https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/754796/overview_of_the_6_early_years_and_school_aged_years_high_impact_areas.pdf (accessed 11 June 2019).


Image credit | iStock

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