Towards the Balanced System®: Summary of Impact Evidence
This paper brings together a range of examples from a number of different sources. To date there is no systematic evaluation. I should welcome support for both internal capacity to interrogate outcomes and impact data we have available and external support for an evaluation of system change.
The Core Delivery Principles are the ‘how’ to achieving the Balanced System Outcomes across the Five Strands and Three Levels. The delivery is driven by the Measuring Impact principle. The Easy Access, Place Based and Continuum of offer principles form the ‘engine’ for change and the Information principle ensures that practitioners and families have a way of finding the information they need that is relevant to them through the structure of the Outcomes Framework. Easy access, place based delivery and a continuum of offer principles work together to shift the local system.
The ‘Easy Access’ Core Delivery Principle challenges local areas to find the simplest way of providing access to therapy advice and consultation as possible. There is scope for variation in how this is achieved but the strong suggestion that bringing therapists to places that families access routinely and removing unnecessary barriers to access is critical. The Balanced System is based around population need and not diagnostic categories, therefore the Easy Access principle requires service delivery to be planned in response to population need and open access regardless of the nature of the concern.
There is clear evidence emerging from the implementation of easy access delivery on waiting times for access to therapeutic advice and intervention. It is important to note that this is not about a first contact in isolation but then having a range of options available to the family that are appropriate to the presenting situation and need.
Evidence of the impact of the Balanced System Easy Access approaches, in particular the concept of the open access community-based session to meet a therapist and the school-based access to a link therapist is available from several case examples.
A presentation at the RCSLT 2023 conference outlines the impact of two cases – one showing the immediate impact of introducing an easy access ‘drop-in’ at Family Hub in Lancashire and the other showing the long term sustainability of the impact in Worcestershire who moved to a Balanced System delivery model for SLT in 2010-2011 as part of their trial as a ‘Bercow Pathfinder’ which then led to the service being jointly commissioned and full implementation which they have maintained throughout the intervening 15 years. The slide deck and recording can be accessed here: https://www.thebalancedsystem.org/downloads/rcslt-conference-presentation-2023/
Similar patterns have been noted in Kent and Birmingham and this evidence was included in my supplementary evidence to the Education Select Committee https://committees.parliament.uk/writtenevidence/141895/pdf/
The SLT lead for East Kent summarises the impact the transformation has had for children and young people in this presentation https://www.youtube.com/watch?v=io94CdNCoAk
This service was also a pilot site for the Balanced System Prove It! platform. The following extracts from the family responses to attending the Talking Walk In Easy Access sessions provide an indication of the type of data we hope to capture over time as the system automatically provides opportunity for follow up with families that opt into receiving alerts.
The data below is taken from the initial attendance and some follow up data (Part 2) from a small number of families.
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The RCSLT has recently published a report on waiting times and included a number of case studies of examples of service initiatives that have had a positive impact on access for children and young people. Ten of the fourteen case studies were from services which have been supported using the Balanced System or are in the course of moving towards the delivery model https://www.rcslt.org/wp-content/uploads/2025/08/Appendix-2-How-services-are-tackling-waiting-times-in-CYP-services.pdf
More recently, impact reports have been shared internally for the Essex transformation across SLT, Occupational Therapy and Physiotherapy provision. The following slides illustrate the significant impact of providing access at place and developing a continuum of offer so that those children and young people who do not require individualised support can be offered the appropriate support immediately whilst ‘freeing up’ access to more specialist and individualised support for those that need it.
This is an important point to note – the Balanced System is about enabling access to the most effective support to achieve functional outcomes but absolutely includes more specialist support. Furthermore, specialist practitioners within the workforce should actively deliver targeted support alongside the training and support of wider workforce colleagues – specialists ‘do’ targeted and not all specialist intervention requires a ‘specialist’ to deliver it – this is a key tenet of the cultural shift that is required in embedding the delivery model.
Some quotes:
Essex July 25: LK (HCRG) shared document that demonstrated reductions waiting list breaches this year compared to 2024. ‘the backlog is gone. All of those children that waited over 2 years have gone, they've all been seen. And I think that just shows you how amazing therapy's balanced system is. The colleagues in North Essex have absolutely worked, worked and worked and worked, and I can't tell you describe to you how amazing they've been.’
Essex July 25: Sarah (OT): Sensory Intervention & Impact A number of identified schools have received focused universal and targeted work around sensory input. One Occupational Therapist has shared strong positive feedback from a school where staff were upskilled. This resulted in a significant drop in caseloads (from 14 to just 2–3) and a reduction in sensory referrals, aided by the creation of a Sensory Circuit Club and other self-sustaining strategies.
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Balanced System® Scheme for Schools and Settings
The Scheme for Schools and Settings Accreditation has been available since 2015. The Scheme was initially made available on a school by school basis but early learning was that it is more impactful when there is a cohort within a geographical area, both in terms of economies of scale but also the opportunity to facilitate a local community of practice.
In Scotland, one Local Authority used Pupil Equity Funding to facilitate 42% of primary schools to complete the accreditation over a three-year period. The SLT service working with these schools that was also part of a Scottish Government funded pilot of the Balanced System and this service is referred to in a recent RCSLT Scotland report (https://www.rcslt.org/wp-content/uploads/2025/08/Transforming-support-for-CYP-in-Scotland-Report-August-2025.pdf) as well as a case example in Equity for All, the report of the Balanced System Understand Phase across Scotland https://www.bettercommunication.org.uk/downloads/2022%20Equity%20for%20All%20Final%20for%20Publication.pdf
In England, Kent County Council has taken a strategic approach to the Scheme for Schools and Settings, initially commissioning support or 60 schools to undertake the scheme followed by a further 40 including early years settings. Local evaluations of the impact of the Scheme have been carried out and are attached as an appendix. Recently a celebration and networking event was held in Kent for both accredited schools and settings and those still undertaking the process to enable sharing and begin a local community of practice. Reports of the event can be found on the following links:
https://news.kent.gov.uk/articles/early-years-settings-named-centres-of-excellence-for-communication
Summary
We have an emerging evidence picture but need to evaluate more systematically at both the strategic systems change level, the school and settings level and for individual children and families. The Prove It! platform is being used in two sites within the Greater Manchester transformation and also in Birmingham as well as the pilot results referred to from Kent. Essex and Devon are going to be introducing Prove It! over the coming academic year.
Marie Gascoigne
The Balanced System®
Director, Better Communication CIC
This document provides a summary of emerging evidence of the impact of Balanced System Implementation prepared for DfE following Marie Gascoigne's written and verbal evidence to the Education Select Committee Inquiry into SEND and the publication of the What works in SEND review including the Balanced System
https://www.thebalancedsystem.org/2025.08.31%20Summary%20of%20Impact%20evidence%20%20for%20DfE.pdf
