Analysis

Concerns for the future of learning disability nursing as mortality report reveals people dying from poor care

With the number of people with learning disabilities rising, cases of poor care and figures showing that people are dying even earlier than previously thought, protecting this vulnerable field of practice has never been more important

With the number of people with learning disabilities rising, cases of poor care and figures showing that people are dying even earlier than previously thought, protecting this vulnerable field of practice has never been more important

Almost one in ten learning disability nurses has left the register over the past four years,  figures from the Nursing and Midwifery Council have revealed.


Learning disability nurses have a unique role but the branch is under threat. Picture: Alamy

Between March 2014 and 2018, the number of learning disability nurses on the NMC register declined by 9%, dropping from almost 19,000 to 17,100.

It was by far the sharpest drop among the four branches, when adult nursing saw a drop of 0.2%, mental health a reduction of 3% and children’s nursing an increase of 7.5%.

46%

of universities said they had held internal discussions about not being able to run their learning disability nursing course in 2018-2019

(Source: CODH)

The figures from the regulator are the latest in a string of negative reports about the state of the learning disability nursing workforce and failures of care for people with learning disabilities.

Nurses speak out

Senior learning disability nurses have spoken out about their concerns for the future of the smallest branch of practice and the people they care for.

Major concerns have been raised about the next generation of nurses with a survey finding that almost half of universities have discussed closing pre-registration learning disability nursing programmes next year due to a shortage of applicants.

The Council of Deans of Health survey of 15 course providers – based mainly in England – found that three quarters had been unable to fill their spaces for courses starting in September.

Renewed fears about standards of care for people with learning disabilities were raised again in May, with the publication of the Learning Disabilities Mortality Review (LeDeR) annual report.

It found that 13 people with learning disabilities died in England because of substandard care, neglect or abuse over a 16-month period between July 2016 and November 2017.

However, the true scale of deaths of people with learning disabilities because of substandard care may be much higher, with the 103 reviewed deaths a fraction of the total 1,311 cases submitted to programme.

‘I have never known learning disability nursing to be as vulnerable before’

Debra Moore

Independent nurse consultant Debra Moore described the state of learning disability nursing as the worst she has known it during her 35-year career.

‘I have never known learning disability nursing to be as vulnerable before,’ she says. ‘We don’t seem to have a plan to address this. We have lots of workshops, reviews and reports, but I cannot really say that we have any discernible action on the part of NHS England or Health Education England. It is almost a perfect storm.’

The findings of the LeDeR report were met with ‘concern and dismay’ by the 750 members of Learning Disability England. The report said that more than one quarter (28%) of deaths were of people under 50.

13

the number of people who died because of substandard care, neglect or abuse

(Source: LeDeR)

The difference in age at death between people with learning disabilities and the general population is almost 23 years for men and 29 years for women.

The most common recommendations from reviews into deaths included improving collaboration between different health and social care organisations and improving understanding of the needs of people with learning disabilities.

This report is only the latest to raise concerns about standards of care and health inequalities for people who have learning disabilities, stretching back to the influential Mencap report, Death by Indifference in 2007, and including the poor care uncovered at Winterbourne View.

Ms Moore says that workforce shortages need to be addressed urgently by national action. Places at universities are commissioned based on NHS needs, when a good proportion of learning disability care is provided by the third sector, private companies and charities, she says. This means too few nurses are trained.

Could a funded fast-track course be the answer?

Ms Moore would like to see healthcare assistants who have a degree be offered a funded fast track two-year graduate course to rapidly boost the numbers of nurses. This would recognise the contribution of valued staff and boost the morale of current nurses, she says.

‘We only know about vacancies in the NHS, but I know that the independent sector is carrying vacancies for learning disability nurses that they are filling with mental health nurses,’ Ms Moore says. ‘What that does for outcomes, we have no idea.’

There also needs to be a concerted campaign to raise the profile of learning disability nurses and their particular role. ‘Like the people we serve, we are hidden,’ Ms Moore says.

Professor of mental health and learning disability at London Southbank University Ben Thomas says it is disappointing that little action has been taken when the problems facing the workforce have been known about for years.

9%

The drop in registered learning disability nurses over past four years

(Source: NMC)

‘We have an increase in the number of people with learning disabilities and we are seeing a declining number of nurses,’ Professor Thomas says.

‘There are major health inequalities for people with learning disabilities and the people who can do something about it are learning disability nurses. But we seem to be letting the profession go to the wall, it doesn’t make any sense.’

Chief nurse, Health Education England Lisa Bayliss Pratt, said: 'Health Education England values Learning Disability (LD) nurse courses and is committed to securing their future and to making sure we have a future workforce that has the right skills mix to meet the changing needs of people, families and carers.

'LD nurses play a vital role in supporting people’s needs and that is why working with partners including NHS England and education providers we are looking at the issues affecting this key workforce, including recruitment to training courses. 

'We are also hosting a series of regional  events to give the nursing community and education providers a chance to tell us their views and experiences to help us build up a picture of what is happening across the country.

'We will use the feedback provided to help shape plans for a workforce capable of delivering the new models of care designed to meet the needs of children and adults with learning disabilities and or autism.'

Universities

Nursing education leaders have called for urgent action to protect vital university courses and the future of learning disability nursing.

A Council of Deans of Health (CODH) survey of 15 institutions – 14 in England – found that almost half had discussed not running their course next year due to difficulty recruiting. More than 90% had had some difficulty recruiting to their September courses.

This follows news earlier this month that London South Bank University has launched a consultation about whether to permanently close its undergraduate and postgraduate learning disability programmes. The University of Hertfordshire has suspended student recruitment at two of its three sites offering undergraduate learning disability nursing training from September 2018.

The CODH survey briefing paper said: ‘A drop in mature student applications along with a lack of awareness of the profession in younger people are highlighted as compounding issues that may be contributing to a recruitment problem.’

Bursary removal blame

Senior learning disability nurses say courses in Scotland and Wales are not facing the same difficulties, and blame the removal of the bursary for causing the difficulties.

Associate director of student education for quality and enhancement at University of Leeds and chair of Learning and Intellectual Disability Nursing Academic Network (LIDNAN) Jo Lay says it is bad news for nurses and their patients.

She says: ‘The number of higher education institutions in England who offer the learning disability nursing field of practice has been diminishing for a number of years due to a variety of reasons, including cost effectiveness of smaller programmes and difficulty with recruitment, exacerbated by the additional pressures from the lack of bursary and fee paying.’

LIDNAN is planning a summit later in the year to develop a consensus clarifying the importance of learning disability nursing. ‘Members are concerned that the profession is being eroded due to a lack of clear commitment to its value and future. We are calling for a top down approach of commitment in a government mandate which clearly establishes the role of the learning disability nurse as necessary in meeting health outcomes for individuals with a learning disability.’

 

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