Background: The UK government set up a review of provision for children and young people with the full range of speech, language and communication needs led by a Member of Parliament, John Bercow. A research study was commissioned to provide empirical evidence to inform the Bercow Review. Aims: To examine the efficiency and effectiveness of different arrangements for organizing and providing services for children and young people with needs associated with primary speech, language and communication difficulties. Methods & Procedures: Six Local Authorities in England and associated Primary Care Trusts were selected to represent a range of locations reflecting geographic spread, urban/rural and prevalence of children with speech, language and communication difficulties. In each case study, interviews were held with the senior Local Authority manager for special educational needs and a Primary Care Trust senior manager for speech and language therapy. A further 23 head teachers or heads of specialist provision for speech, language and communication difficulties were also interviewed and policy documents were examined. Outcomes & Results: A thematic analysis of the interviews produced four main themes: identification of children and young people with speech, language and communication difficulties; meeting their needs; monitoring and evaluation; and research and evaluation. There were important differences between Local Authorities and Primary Care Trusts in the collection, analysis and use of data, in particular. There were also differences between Local Authority/Primary Care Trust pairs, especially in the degree to which they collaborated in developing policy and implementing practice. Conclusions & Implications: This study has demonstrated a lack of consistency across Local Authorities and Primary Care Trusts. Optimizing provision to meet the needs of children and young people with speech, language and communication difficulties will require concerted action, with leadership from central government. The study was used by the Bercow Review whose recommendations have been addressed by central government and a funded action plan has been implemented as a result. (Contains 3 tables and 4 notes.)