Analysis

Has the planned ‘reset’ of learning disability nursing been a success?

2020 saw a sea change for learning disability nursing as it sought to improve its reputation and bolster its workforce

2020 saw a sea change for learning disability nursing as it sought to improve its reputation and bolster its workforce

  • After some difficult years for learning disability nursing in England, 2020 was a year of rejuvenation
  • The All-England Plan for Learning Disability Nursing consolidated a move to attract more recruits to the specialty with new training opportunities
  • The focus on retaining staff involved improving career pathways, offering clear skills development and advanced training programmes

The past few years have, to say the least, been a difficult period for the learning disability sector.

2020 was set to be a year of change for learning disability nursing

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2020 saw a sea change for learning disability nursing as it sought to improve its reputation and bolster its workforce

  • After some difficult years for learning disability nursing in England, 2020 was a year of rejuvenation
  • The All-England Plan for Learning Disability Nursing consolidated a move to attract more recruits to the specialty with new training opportunities
  • The focus on retaining staff involved improving career pathways, offering clear skills development and advanced training programmes
Picture: iStock

The past few years have, to say the least, been a difficult period for the learning disability sector.

2020 was set to be a year of change for learning disability nursing

From the struggle to meet the targets to move people out of hospital set by the Transforming Care agenda to the stories about young people with learning disabilities being kept in segregation and the Panorama exposé that uncovered abuse of vulnerable adults in Whorlton Hall, the sector has found itself in the headlines for all the wrong reasons.

In 2019 NHS England and NHS Improvement head of learning disability nursing David Harling first made a call for a ‘reset’ of the sector.

445

acceptances for a learning disability nursing degree course starting in September 2020

Source: UCAS

Now in 2021 there is a growing sense that not only has this been done – but the sector’s fortunes are on the up.

From an increase in the numbers studying to become learning disability nurses to an ever-widening range of postgraduate opportunities for those who have qualified, there seems to be cause for optimism.

The cover of the All-England Plan for Learning Disability Nursing
Easy read version of the All-England plan

One of key steps taken in 2020 was the publication of the All-England Plan for Learning Disability Nursing, which set out a clear roadmap to attract and retain nurses.

Roadmap laid out ways to attract people to the sector

It highlighted the need for more opportunities for nurses to develop their skills as well as emphasising the need to look at innovative ways to entice people to work as a learning disability nurse.

Much of the groundwork for this was under way by the time Mr Harling made his reset call as Health Education England (HEE), NHS England and senior nurse leaders were already working together to re-energise the sector.

The origins of the All-England Plan can be traced back to work by the Learning and Intellectual Disability Nursing Academic Network and UK Learning Disability Consultant Nurse Network in 2019 which drew up its own workforce plan calling for action to be taken on recruitment and retention.

This meant by the time the All-England Plan was published, there was already a coordinated attempt to boost the numbers coming in.

NHS plan to attract and retain nurses

The All-England Plan for Learning Disability Nursing highlights ways to attract and retain learning disability nurses.

Encourage more people into learning disability nursing by:

Retaining learning disability nurses with:

Peer support iconPeer support networks for students

Better, more interesting placement opportunities for students, including working in prisons

Investment in post qualification training and skills development

Creation of a national award for community learning disability nurses

Maintenance grants returned in England in September 2020 for all nursing students, with learning disability nursing students entitled to a £1,000 supplement on top of the £5,000 annual grant, plus childcare allowances.

This has undoubtedly been a key factor in the increase in successful applications to learning disability nursing university courses. According to Universities and Colleges Admissions Service for the September 2020 intake, there were 445 acceptances – a rise of one fifth on the year before.

Health Education England chief nurse Mark Radford
Mark Radford

A new emphasis on opportunities within the specialty

HEE chief nurse Mark Radford says he was ‘delighted’ to see the growing interest in learning disability nursing.

And he says he wants it to be just the start – with other routes into the specialty also emerging.

This includes the creation of 150 dedicated learning disability nursing associate posts and extra financial incentives for employers to take on learning disability nurse apprenticeships as part of the government drive to double the number of nurse apprentices being taken on over the next four years.

Professor Radford says: ‘It’s important we continue to attract people into this great career.’

There are other signs it is working too. The NHS Health Careers website saw nearly 47,000 unique visits for information about learning disability nursing in 2020, a 45% rise on the year before.

But Professor Radford wants to do more to reach out to those already working in the sector. ‘We recognise more needs to be done to support learning disability nurses working in private, independent and voluntary settings as well as the NHS.’

To help HEE has launched a new website – www.learningdisabilitynurse.co.uk – to bring together the different sections of the profession and help promote the opportunities that exist.

Website celebrates the work of learning disability nurses

It includes first-hand accounts from those working as learning disability nurses about the roles they do and the difference they make to people’s lives.

The sector is also being championed at conferences and events – in December HEE and NHS England held its second learning disability nurse symposium.

Florence Nightingale Foundation Academy director Gemma Stacey says it is great to see how the sector is celebrating its work and how nurses are ‘making their voices heard’.

20%

rise in acceptances for a learning disability nursing degree course in 2020 compared with 2019

Source: UCAS

She has run two learning disability leadership programmes in recent years, one funded by HEE and one by the Burdett Trust for Nursing.

They focus on everything from building confidence to writing and presentation skills.

More than 100 nurses have completed the programmes and a group of alumni were part of a working group that advised on the formation of the All-England Plan.

‘A few years ago the numbers coming into the profession were falling. I worked at a university and we had a good course, but we got to the point where we were struggling to attract students to it. It was all at risk of fading away.

‘Now it is so different – it is great to see what is happening. Nurses are finding their voice and helping celebrate what the profession is all about.’

Apprenticeships and new career paths

RCN learning disability nursing forum chair Jonathan Beebee agrees it is ‘an exciting time’.

‘There is a lot happening. At my organisation, PBS4, we have just started our first learning disability nurse apprenticeship post.’

The COVID-19 pandemic does create challenges supporting people in their training, he says. ‘We are still going into people’s homes when it is essential. However, this is reduced and we are doing what we can by video call so the experience for students will be different. But we are doing what we can.’

‘It is great to see the positive developments around learning disability nursing. The scandals of recent years do have an effect on learning disability nurses – they have left a lasting legacy that we struggle with. Slowly, perceptions are beginning to change’

Rebecca Chester, co-chair, UK Learning Disability Consultant Nurse Network

More widely, he agrees with Professor Radford that there are ‘real challenges’ reaching out to those already working as learning disability nurses.

‘We are a diverse family of nurses working in the NHS, social care and independent sectors. I’ve heard it said that there is something like 120 different learning disability nursing roles, and only about 3,000 learning disability nurses (15%) are in the NHS.

‘We need to make sure we engage them and support them in their careers. The appointment of a chief nursing officer for social care will help and the Nursing and Midwifery Council is looking to survey learning disability nurses on their register to identify where they are working. This is a vital part of the process to help build on what has been achieved so far.’

Retention of nurses should not be overlooked

UK Learning Disability Consultant Nurse Network co-chair Rebecca Chester
Rebecca Chester

UK Learning Disability Consultant Nurse Network co-chair Rebecca Chester says there needs to be a big push on retention, saying nurses need career development opportunities to help keep them in the sector, particularly those outside of the NHS.

She says this is beginning to happen, citing the launch of advanced practice credentials at Edge Hill and Cumbria universities in the spring and a post-nursing qualification being developed by Tavistock and Portland NHS Trust for HEE, NHS England and NHS Improvement as examples.

‘It is great we are attracting more people in to the learning disability nurse profession, but we also need to ensure we have career pathways so we can retain them. That’s why courses like these and the other opportunities that are emerging as part of the All-England Plan are vital.

‘We also need to do more to reach out to younger students – we have always had a larger proportion of mature students opting for learning disability nursing, which is great, but we also want to see the younger age groups increase too.

‘But it is great to see the positive developments around learning disability nursing. The scandals of recent years do have an effect on learning disability nurses – they have left a lasting legacy that we struggle with. Slowly, perceptions are beginning to change. It’s great to see.’

How opportunities are widening for learning disability nurses

Alongside the investment in nursing associate and nurse apprenticeship roles, an increasing number of post-qualification opportunities are being created.

Two new courses will launch in the spring. Health Education England (HEE) is launching an advanced practice credential at Edgehill and Cumbria universities in March. It will be for nurses and other health and care professionals supporting people with learning disabilities and/or autism. Interest has been shown from all areas of learning disability practice from acute liaison and mental health services to prison and social care.

The course will be the first of their kind in the UK. There are 20 places available on each course, which will run to September 2022 and be delivered predominantly online.

Meanwhile, pilots of a learning disability nursing post-qualification course are due to start in April. The course is being developed by the specialist workforce development team at The Tavistock and Portland NHS Foundation Trust for HEE, NHS England and NHS Improvement. It is likely to be piloted in a small number of universities and NHS trust training units at first.

Course that can be a precursor to advanced practice

The course is aimed at those nurses who have qualified and are looking to develop their skills further. While not a formal academic qualification, completing the course will enable nurses to develop a portfolio that can be drawn on if they want to pursue further qualifications such as a master’s or advanced practice qualification.

Everyone will complete a core module followed by one of three specialist modules – specialist inpatient, primary and acute care liaison or community, forensic and intensive support. Each will take about 100 hours with the aim that they will be completed over the course of two to three years.

Programme lead Sue Beacock says ‘We have designed it to try to stretch participants. The aim is to give nurses some structure and definition to their career pathway. It is designed to be a precursor to advanced practices. Lots of learning disability nurses have not had the chance to develop their roles. There had been a disinvestment in learning disability education for nurses.

‘It has not been down to any specific policy decision, but learning disability nurses are just so spread out in diverse situations.’

Reset plan has begun to invoke change and dispel myths

So what does the man who originally called for a reset think? Mr Harling says the progress that has been made is ‘heartening’, saying the increase in student numbers in particular signals a ‘sea change’ in fortunes.

46,990

unique visits to NHS Health Careers website for information about learning disability nursing in 2020

He says the idea of the reset was to create something akin to a ‘social movement’ which involves invoking change and dispelling myths.

And that involves championing what is being done as well as engaging with those who have had a poor experience to create a continuous cycle of improvement.

‘By embracing this, we can communicate an even stronger message that there has never been a better time to be or to become a learning disability nurse.’

Further information

All-England Plan for Learning Disability Nursing


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