Vulnerable children with speech and language problems face a postcode lottery of care, the Children’s Commissioner for England has warned.
Anne Longfield said a lack of joined-up services and overall responsibility meant children could fall through the gaps, wait months to be seen or may not be seen at all.
She pointed to an “enormous variation” in how much is spent per child according to where they live.
In 2018/19, the top 25% of areas spent £16.35 or more per child on speech and language therapy, compared to 58p or less per child in the bottom 25% of areas.
In her report, she said: “Additionally, while overall spending has increased (albeit by only 2% per child), it has fallen in many areas.
“More than half of areas experienced a real terms decline in spending per child.”
Figures show that 11% of two-year-olds are below the expected level of communication, while 18% of five-year olds – equating to 114,822 children – are also not reaching their expected level.
Overall, 193,971 primary school children – about 4% of the total – are on the special educational needs register for speech, language and communication needs, although the true level of need is thought to be higher.
The problem is also worse among youngsters from deprived backgrounds, with 23% of five-year-olds eligible for free school meals not meeting expected levels, compared to 13% of those not having free meals.
Research shows that children with poor vocabulary skills are twice as likely to be unemployed when they grow up, while more than 60% of children in Young Offender Institutions have communication difficulties.
In her new report, Ms Longfield found that no single body exists that can be held to account for spending on children’s speech and language services.
Research by her office found that councils and clinical commissioning groups reported spending about £166 million in 2018/19, or £10.12 per child, but with huge regional variations.
Among children with an identified speech and language need, the top 25% of local authorities spent at least £291.65 per child, with the bottom 25% of local authorities spending £30.94 or less.
Ms Longfield said: “Communication skills are vital for children starting school and for improving social mobility throughout a child’s education.
“We should be very concerned that almost one in five children aged five is behind in speech and language development – and yet more than half of areas in England have seen a real-terms fall in spending on speech and language therapy in recent years.
“The next prime minister must make school readiness a priority if we are to give all children the chance to thrive.
“A well-resourced strategy for addressing speech, language and communication needs must be part of that.”
Ms Longfield made a number of recommendations in her report, including ensuring local areas are held to account and expenditure data is collected on an ongoing basis.
She said all areas should have a plan looking at need in their region and how it should be met, with particular regard to disadvantaged children.
Kamini Gadhok, chief executive of the Royal College of Speech and Language Therapists, said the current situation was “unacceptable”, adding that its own survey had shown that 59% of parents already have to fight to get the support their child needs.