More investment and focus needed to ease pressures on learning disability nursing workforce

In January, the House of Commons' health committee published its inquiry into the NHS workforce. Although a ten-year workforce strategy is being actioned, figures show 16.3% of learning disability posts in England are now unfilled. So how can workforce pressures be eased?

In January, the House of Commons' health committee published its inquiry into the NHS workforce. Although a ten-year workforce strategy is being actioned, figures show 16.3% of learning disability posts in England are now unfilled. So how can workforce pressures be eased?

The RCN believes that there is still not enough being done
to help learning disability nurses whose roles can be different to those found in other fields of practice

MPs have added their voice to the chorus of concerns about the future of the learning disability nurse workforce.

The House of Commons’ health committee said it was ‘particularly’ worried about what was happening as it unveiled the findings of its inquiry into the entire nursing workforce.


The vacancy rate for learning disability nurses

The cross-party group of MPs said too little attention had been given to retaining nurses across the board, pointing out more were now leaving the profession than joining it.

Ann Norman

The committee blamed workload pressures, poor access to continuing professional development (CPD), pay and a general sense of not feeling valued. It said there was now serious vacancy problems that were placing ‘unacceptable’ pressures on those left in the system – and learning disability nursing had been the worst hit.

The MPs highlighted figures – supplied by Health Education England (HEE) – which showed across the sector there was a vacancy rate of 16.3%, the highest of all the specialities.

That should come as no surprise. Learning disability nursing has seen one of the biggest falls in numbers working among all the nursing groups – down by 38%, the equivalent of more than 2,000 nurses, since 2010.

RCN professional lead for learning disability nursing Ann Norman says: ‘The nurses left are under so much pressure and that has a terrible impact on people with learning disabilities. Their physical health is affected and they end up in acute care. Nurses are good at focusing on prevention, stopping them getting to that crisis point. The whole situation is crazy.’

The committee also raised concerns about the future of learning disability nursing. It said the evidence suggested mature students had been ‘disproportionately dissuaded or diverted’ from nurse training following the scrapping of the bursary scheme.

How England is tackling the workforce problem

The government in England maintains plans are in place to tackle the workforce problems in nursing. So, what is happening?

  • The 1% pay cap in the NHS is being lifted sometime this year, although details of the rise have yet to be revealed
  • Training places are increasing – rising by 25% this year to over 25,000 places in England, the biggest ever expansion, according to health and social care secretary Jeremy Hunt
  • New routes into nursing through apprenticeships and nursing associate scheme are being introduced
  • A Homes for Nurses scheme, giving 3,000 NHS workers first refusal on affordable housing generated through the sale of surplus NHS land, is being considered
  • NHS Improvement is running a three-year retention programme, but this is only aimed at mental health and hospital trusts not learning disability providers
  • Health Education England is supporting transforming care partnerships to ensure plans for learning disability services create a ‘sustainable workforce’


Close monitoring


fewer nurses in learning disability settings in 2017 than 2010

Figures from Universities and Colleges Admissions Service (UCAS) show there was a fall in acceptances for older age groups in 2017 – down 6% for the over 26s. The report said this was of ‘great concern’ as mature students make up most mental health and learning disability nursing students. And it suggested the trend may already be having an impact, noting some universities were struggling to recruit learning disability students, putting the viability of courses at risk.

The report said the government needed to monitor closely the continued impact of the reforms to student funding.

But what else can be done? The committee made several recommendations, including reversing cuts to CPD budgets, close monitoring of the English language testing requirements to make sure they are not placing ‘unnecessary barriers’ on working in the UK and a realistic approach to pay.

In its response the government defended its record. It highlighted a range of measures, including the new routes into nursing, such as nursing associates, and its Homes for Nurses scheme.

Debra Moore
Picture: Jim Varney

What is more, HEE is consulting on a ten-year workforce strategy to ensure better long-term workforce planning. HEE says there are plans in place to help the learning disability sector. It says, together with Skills for Health and Skills for Care, it is working with the local transforming care partnerships to ensure their plans create a sustainable workforce that is properly equipped with the ‘education, skills, values, knowledge and behaviours’ it needs as care is moved away from hospital and into the community.

This includes the publication and dissemination of a core skills education and training framework.

‘Too little too late’

But Ms Norman says this is all ‘too little too late’. ‘A lot of the focus is on hospitals. There is simply not enough being done to help those working in the community – and learning disability nursing is coming out the worst of the lot.

‘We need more investment and a special focus on areas like learning disability nursing. We need to make sure universities keep providing the courses. We also need to make learning disability nursing more attractive by having better terms and conditions and ensuring nurses get the support they need to progress their careers.’

Independent learning disability nurse consultant Debra Moore agrees. She is concerned that, if the trends continue, England could end up trying to ‘poach’ nurses from elsewhere in the UK where the bursary has been retained.

As in England, the number of learning disability nurses in post has been falling in Scotland, Wales and Northern Ireland although many universities in those nations are now trying to increase the number of students on their courses.


Percentage of learning disability students that are 25 or over

 ‘If we are going to get this right we have to think about it UK-wide. I would like to see universities compelled to retain the learning disability courses.

'It could be run as a loss leader to ensure we have the workforce we need. Learning disability nursing is unique. We can’t lump it in with everyone else.’

How a Welsh university has trebled its student numbers

Ruth Northway
Picture: Andy Forman

The University of South Wales is the biggest trainer of learning disability nurses in the nation. This September there will be 55 places on its course – more than triple the number there was five years ago. The university is no doubt helped by the bursary, which has been retained in Wales.

But head of learning disability nursing Ruth Northway says there has also been a concerted effort to attract students. Careers in learning disability are promoted heavily through graduates' profiles who have completed the course, stressing the variation in jobs from working in prisons and to being part of children’s teams.

These feature in literature produced by the university and health boards, and are pushed out on social media, while graduates are recruited to become student ambassadors and come back on open days to talk to prospective students.

Healthcare assistants are also actively encouraged to become learning disability nurses by taking up the opportunity of doing a two-year part-time course while they work and then moving straight into year two of the degree course.

‘There isn’t a magic bullet,’ says Professor Northway.

‘You have to try a variety of things to create a positive atmosphere. When you see pictures of nurses it’s always of someone in a hospital. We’ve tried to counter that by celebrating the opportunities available.’


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