Analysis

Cause for optimism on a learning disability nursing ‘reset’ in 2020

Learning disability nursing celebrated its centenary in 2019, but was rocked by scandals and negative headlines throughout. Can the profession expect better in 2020?

Learning disability nursing celebrated its centenary in 2019, but was rocked by scandals and negative headlines throughout. Can the profession expect better in 2020?

  • 100 years of learning disability nursing showcased positive work but the year was marred by scandals such as Whorlton Hall 
  • Tranforming Care programme fell short of its target to reduce the hospital population to below 1,700 by March 2019 
  • Health and social care secretary Matt Hancock is determined to tackle problems in the inpatient sector


Supporting more service users in 
independent living is one aim of
of the learning disability sector
Picture: John Houlihan 
​​ 

The year 2019 was one of celebration for the centenary of learning disability nursing, but in other ways it was more of an annus horribilis.

From the BBC Panorama undercover exposé of abuse at Whorlton Hall to tales of young people being kept in seclusion and the failure to meet the Transforming Care targets set for moving people out of hospital, 2019 provided a catalogue of bad headlines.

But are there reasons to be optimistic about 2020? Could it in fact be a turning point for the sector? Learning Disability Practice looks at the reasons to have hope.

NHS England and NHS Improvement joint plan of action

£8,000-a-year

Amount new learning disability nursing students in England could be eligible for as a maintenance grant 

RCN learning disability nursing forum member Simon Jones says: ‘The history of learning disability services shows it’s often the scandals that prove the catalyst for change more than anything else.’

He points to some of the steps being taken by NHS England and NHS Improvement – which held a learning disability symposium in London and is in the process of drawing up a joint action plan with Health Education England (HEE) for the sector – as a sign that there is a ‘recognition things have to change’.

Another important project is the work the RCN is doing with the Nursing and Midwifery Council to identify learning disability nurses employed in the independent sector.


Simon Jones
Picture: David Gee

‘We know from the register that only 20% are in the NHS – that means there are many more that may be isolated and unsupported in the independent sector. If we can identify them, we can start working with them and supporting them,’ says Mr Jones.

Indeed, at an RCN conference in early January, NHS England and NHS Improvement head of learning disability nursing David Harling said the coming year could be a chance to ‘reset’.

Mr Jones hopes so: ‘I am an optimist.’

Discharge of inpatients in mental health hospitals

Progress on getting people out of hospital may have been slower than anticipated, but there still appears to be momentum.

The Transforming Care programme fell short of its target to reduce the hospital population to below 1,700 by March 2019 although numbers have dropped by nearly one quarter since 2015. Figures for December however show the target of a 35% reduction by March this year may not be met due to delayed discharges and a lack of housing and social care.

‘The history of learning disability services shows it’s often the scandals that prove the catalyst for change more than anything else’

Simon Jones, RCN learning disability forum member

Health and social care secretary Matt Hancock says he is determined to tackle the problem, promising by the end of 2020 that inpatients in mental health hospitals will have their care reviewed and get a date of discharge or agreed plan to get them ready for discharge.

Meanwhile, the Queen’s Nursing Institute is developing a set of standards for community learning disability nursing, which, Mr Jones believes, will help by providing a ‘clear vision’ for the first time of what the roles involve.

The continued drive to reduce bed numbers has also been accompanied by a crackdown on the use of seclusion and restraint, and cases such as Bethany's (see below) have persuaded ministers to act.

How Bethany’s care was transformed by learning disability nurses


Bethany* (centre) with her father Jeremy and mother Julie 

Bethany’s* case was one of the scandals that shamed the learning disability sector. The 19-year-old, who has autism and a mild learning disability, spent more than two years in seclusion with food being passed to her through a hatch at one point.

But, after a high-profile campaign by her family, she was finally moved and is now being cared for at a step-down unit in Clitheroe, Lancashire run by Mersey Care NHS Foundation Trust.

The unit is still classed as an inpatient facility, but the wards have been converted into self-contained flats. She can go into the gardens, has her own lounge and has started music and drama-based therapy.

Staff are all trained in autism and know how to de-escalate situations

Her father, Jeremy, says her life has been transformed – and it is thanks to the expert care of learning disability nurses.


Bethany spent more than two years in seclusion with food being passed through a hatch

‘The change has been wonderful to see. She’s so much better. She is happy now, like any 19-year-old, she listens to music and enjoys putting make up on.

‘The staff are all trained in autism and know how to de-escalate situations. That’s completely different to what it was like before.’

He says her experiences have left her ‘traumatised’, but for the first time they can now envisage the day she will be able to be cared for in the community.

And he believes her case should act as a lesson. ‘There is money in the system, it’s just that it is being spent in the wrong areas. Bethany’s care cost £750,000 a year when she was in seclusion – imagine what that could have done in the community?

‘We have had report after report over the years, but nothing really changed. I hope it will now. It needs to.’

*Bethany’s surname has been withheld to protect her anonymity

 

An independent panel chaired by Baroness Sheila Hollins is starting to review the cases of all patients in long-term segregation.

The final report of the Care Quality Commission into the issue is also due in March, while in November parliament’s joint select committee report on human rights made clear there needs to be a ‘narrowing’ of the Mental Health Act 1983 (amended 2007) criteria. Expect the government to respond in the spring or summer.

Workforce expected to grow

The high vacancy rate in learning disability nursing is well documented, but there is plenty of reason to hope 2020 will provide a turning point.

150

dedicated learning disability nursing associate roles being funded by Health Education England

Maintenance grants return in England in September and students studying to become a learning disability nurse will be eligible for up to £3,000 on top of the £5,000 annual grant – although students will still be liable for fees.

This move has coincided with more learning disability courses being launched, including a degree course at the University of Winchester, although that is offset by the fact the number of places in Wales will remain static.

Other initiatives should help too. HEE is in the process of funding 150 dedicated trainee nursing associate posts – to date the roles have not been targeted at a specific area with trainees working across all four fields of practice  – adult; children’s; learning disability and mental health nursing. 

‘Learning disability nursing attracts a higher number of mature students and the financial consequences can be a barrier’

Trish Griffin, Learning/Intellectual Disability Nursing Academic Network vice-chair

And with the first nursing associates graduating last year, apprenticeship routes to becoming a learning disability nurse are being prioritised by HEE.

Learning/Intellectual Disability Nursing Academic Network vice-chair Trish Griffin says: 'I'm very hopeful the numbers studying will start going up. The return of the grant should make a difference. 

‘Learning disability nursing attracts a higher number of mature students and the financial consequences can be a barrier,’ she says.

'The new routes in through nursing associates are also beginning to make a difference. What we need now is the recruitment campaign that has been talked about. We need to highlight the impact learning disability nursing has and showcase what an attractive career option it is.’

Learning disability care is becoming mainstream


Rebecca Chester

UK Learning Disability Consultant Nurse Network chair Rebecca Chester says the investment in new nurses combined with steps such as the NHS Improvement learning disability standards plus efforts in the other nations are raising the profile and value of learning disability nursing across the UK.

She points to the recruitment of learning disability nurses in areas such as prisons, child mental health and on general wards as evidence of this.

‘We know they’re being recruited into many different roles because of the positive recognition of their skills and value base.’

1 in 10

people with learning disabilities get social care support from local councils in England

The forthcoming mandatory training requirement, which will see all nurses receive training in caring for people with learning disabilities and autism from this year, also presents an opportunity to further ‘engage the wider profession’, says Ms Chester. ‘I’m very excited.’

Social care reform on the cards

The prospect of social care reform is nothing new – successive governments have been promising to act for the past two decades.

But there is genuine hope that it will finally happen given nearly everyone agrees further delay is not an option and changing the system was part of the manifesto primie minister Boris Johnson was voted in on.

‘We need to ensure that whatever plan is agreed, it takes into account people with a learning disability’

Dan Scorer, Mencap head of policy


Dan Scorer

The government wants reform on a cross-party basis. While much of the debate about social care has focused on the system for the over-65s, the remit includes the system for working-age adults.

According to Mencap, in England during 2017-18 only 150,000 of 1.5 million people with a learning disability received support from their local authority for daily tasks such as cooking, washing and dressing.

Mencap head of policy Dan Scorer says it is time to ‘get on with it’ as the years of austerity have left people with a learning disability ‘experiencing loneliness, poverty and homelessness’.

‘We need to ensure that whatever plan is agreed, it takes into account people with a learning disability.’


Nick Evans is a health journalist


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