Balanced System Information for Commissioners

Gascoigne M.T. (2006) 'Supporting children and young people with SLCN within integrated children's services' Position Paper Royal College of Speech and Language Therapists


This document sets out ambitions for speech and language therapists working within children's services.  The position paper introduces the concept of universal, targeted and specialist levels of provision to the speech and language therapy profession and wider children and young people services.  This terminology or way of considering service provision or commissioning was not previously considered in the UK

Commissioning Support Programme (2011) Speech Language and Communication Needs: Tools for commissioning better outcomes

This suite of tools was produced as part of the Better Communication Action Plan in response to the Bercow Review.  Marie Gascoigne was commissiond to author four of the six papers and the Balanced System is referenced throughout in it's early iteration.  In many ways these documents remain as relevant today as when they were published over 10 years ago.  These pdf documents are best viewed using Google Chrome and do not always open using Safari as a browser.

Introduction.                                    Needs analysis                                  Whole system mapping                                         


 Workforce                                      User involvement                                 Outcomes                          


Gascoigne MT (ed). (2012) Better communication – shaping speech, language and communication services for children and young people. London: RCSLT.

This publication provided a synthesis of the activities of the National Year of Communication in 2011 and a series of conferences as part of this programme.

The section on Commissioning for Speech, Language and Communication Needs will be of particular interest.

Gascoigne MT (2014) Implementing the SEND reforms: Joint commissioning for children and young people with speech, language and communication needs London The Communication Trust

This publication was written following a series of stakeholder events following the consultation for the 2014 - 2015 Code of Practice for Special Educational Needs (0-25)

This is the summary document for a web based commissioning guide that can be accessed here 

The resource uses the evidence base from the Better Communication Research Programme, the large scale programme of 19 studies that were commissioned by DfE in response to the Bercow Review (2008), to inform and support a commissioning model for joint and integrated commissioning for children and young people with SLCN

Gascoigne, MT and Gross J (2017) Talking About a Generation The Communication Trust, London

This document provides an overview of the policy, evidence and practice base for provision for children and young people with SLCN in the UK and makes recommendations for future policy and practice initiatives

Public Health England (2021) Best start in speech, language and communication: Guidance to support local commissioners and service leads

This guidance published just as the COVID pandemic was diminishing provides advice for commissioners focused on Early Years,  The Balanced System High Level Outcomes are given as a recommended framework for consideration by commissioners in commissioning early years provision

Gascoigne, Marie (2021) Equity for All: Children's Speech and Language Therapy Services in Scotland

This report, commissioned by Scottish Government and includind a foreword from Carolyn McDonald, Chief Allied Health Professions Officer, summarises a two year analysis of the needs and provision for children and young people with speech, language and communication needs in Scotland.  The analysis provides a full national dataset of needs, workforce, caseloads and service delivery models across all fourteen Health Board areas and associated Local Authorities. 

Gascoigne Marie (2022) A Tale of Three Services: exploring the needs, capacity and demand in Salford, Hackney and Worcestershire using the Balanced System®


This case study was produced to support NHS England and Improvement (NHSEI) in a deep dive into factors impacting on waiting lists for speech and language therapy services for children and young people.  This case study outlines key datasets from three NHS provider services in different parts of England.  The three services were selected by the Royal College of Speech and Language Therapists (RCSLT) as they are known to be exemplars of good practice in the profession.  All three services have also been involved in service transformation towards a whole systems approach aligned with the core principles of the Balanced System®.

Hear Emma Jordan, service lead for Worcestershire describe the Worcestershire journey from Bercow Review Better Communication Action Plan Pathfinder to the present day

Download the presentation showing the impact of the service transformation in Worcestershire delivered at the Royal College of Speech and Language Therapists' conference in 2019