Analysis

Nurses crucial to success of Transforming Care programme

A national plan to move people with learning disabilities from hospital settings into the community was announced last month as part of NHS England’s Transforming Care programme to improve services for people with learning disabilities and/or autism

A national plan to move people with learning disabilities from hospital settings into the community was announced last month as part of NHS Englands Transforming Care programme to improve services for people with learning disabilities and/or autism

The government pledged to transfer people with learning disabilities out of unsuitable inpatient units following the Winterbourne View scandal, in which the BBCs Panorama programme exposed abuse of patients at the Bristol residential hospital in 2011, eventually leading to its closure.

A report by Sir Stephen Bubb published last year showed that, despite the Conservative and Liberal Democrat coalition governments plans to close such institutions, admissions to inpatient care in 2013/14 were outnumbering discharges by about 40%.

The national plan, called Building the Right Support, was published in October. Englands chief nursing officer Jane Cummings, who is chair of the delivery board, says that society has failed people with

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A national plan to move people with learning disabilities from hospital settings into the community was announced last month as part of NHS England’s Transforming Care programme to improve services for people with learning disabilities and/or autism

The government pledged to transfer people with learning disabilities out of unsuitable inpatient units following the Winterbourne View scandal, in which the BBC’s Panorama programme exposed abuse of patients at the Bristol residential hospital in 2011, eventually leading to its closure.

A report by Sir Stephen Bubb published last year showed that, despite the Conservative and Liberal Democrat coalition government’s plans to close such institutions, admissions to inpatient care in 2013/14 were outnumbering discharges by about 40%.

The national plan, called Building the Right Support, was published in October. England’s chief nursing officer Jane Cummings, who is chair of the delivery board, says that society has failed people with learning disabilities in long-term institutions ‘for decades’.

Put things right

Referring to the Transforming Care Programme, Ms Cummings adds: ‘Now is the time to put things right, and with this far-reaching plan I am confident that we can finally make quick, significant and lasting improvements to their lives.’

The plan is based on estimates that, as new services are put in place, the number of inpatient beds will be reduced by a half and that some units will close.

Co-ordination

Co-ordination of services is an important part of the plan, with clinical commissioning groups and local authorities in England joining forces to create 49 local Transforming Care Partnerships. The aim of these is to deliver better services that are informed by people with learning disabilities, their carers and families.

To this end, NHS and local authority budgets will be amalgamated, and there will be a £45 million boost in funding from NHS England over the next three years.

Discharges for people who have been in inpatient care the longest are to be speeded up, while the NHS will make specific payments to local authorities to ensure that the needs of those who have been in hospital for five years or more can be met in the community.

Closure

The last remaining NHS hospital for people with learning disabilities in England – Calderstones in Lancashire – is to close as part of the plan. The organisation is a forensic service supporting offenders who also have a learning disability or extremes of challenging behaviour.

NHS England’s plan is ‘clear and ambitious’, says Ray James, president of the association of directors of adult social services (ADASS) in England and vice chair of its board.

‘ADASS is committed to ensuring that people with learning disabilities are supported to lead meaningful, independent lives in their local community wherever possible. This is already the case in many parts of the country: it can and must be everywhere else.’

The RCN is due to publish a report on the learning disability nursing workforce before the end of the year.

Challenge

RCN professional lead for criminal justice and learning disabilities Ann Norman says that implementing the new plan will represent a significant challenge because of the ‘limited number of skilled learning disability nurses in the existing workforce’.

According to the Nursing and Midwifery Council there are 20,054 people with learning disability nursing qualifications on the register, or 4,633 fewer than there were ten years ago.

The 2012, Strengthening the Commitment: Modernising Learning Disability Nursing Review set out the various challenges facing the profession and the work that is required to ensure there is an adequate workforce to provide high-quality care.

More nurses needed

Ms Norman says that the aims of the NHS England plan are laudable, but that more learning disability nurses will be needed to implement it.

‘Quite simply, we need much greater investment in learning disability nursing to effect real and positive changes, and better outcomes for people on the receiving end of care,’ she says.

‘Nurses are critical to this plan being a success. They have a unique role in health facilitation because they can understand and communicate people’s needs, and because they have a much greater depth of understanding about the people they care for.

Brokers

‘Learning disability nurses will be the ‘enablers’ or ‘brokers’ who make sure people’s real needs, rather than perceived needs, are addressed.

Ms Norman adds: ‘This is not just about health needs, but about making sure people with learning disabilities have the same rights as everyone else in society.

‘People will rightly be concerned about being close to friends, family and community support. They will understandably feel unsettled by change and this will need to be dealt with sensitively.’

Peter Beresford, co-chair of national service users’ and disabled people’s organisation Shaping Our Lives, and emeritus professor at Brunel University London, says: ‘Saying the right thing does not make it happen.

Spending cuts

‘This is especially so when the government says it is committed to years of public spending cuts, particularly in local government budgets.

‘It is appalling after recent scandals that there is no immediate, clear commitment to end the institutionalisation of people with learning difficulties.’

Mr Beresford continues: ‘I do not want to belittle the contribution of nurses, but learning difficulties is not a medical condition. We have known for years that what is most needed is social support, not medical intervention. Yet key social work support continues to be cut.

Prejudices

‘The government must overcome its prejudices and put back in place the social work support and advocacy that are so important.’

Hazel Watson, head of mental health and learning disabilities at NHS England, says: ‘Learning disability nurses have a central role to play in building the right support for people with learning disabilities and/or autism, whether they are in specialist settings or otherwise.

‘In particular, our plan makes clear that there is a need to harness the skills and experience of staff already working in hospitals, and to support them to develop the new skills needed to deliver the best possible care under this new model.

Framework

Ms Watson continues: ‘As part of this process, Health Education England has worked with Skills for Health to develop a skills and competency framework so that providers can see where to build the expertise they need for the new model of care.’ This framework is set out below.

Health Education England, Skills for Care and Skills for Health will:

  • Work with existing service providers to review the skills and competencies of their workforces, identify their education and training needs, and facilitate new ways of working.
  • Ensure that education and training enable the wider workforce to meet the needs of people with learning disabilities in all settings.
  • Equip commissioners with the tools and confidence to commission workforce skills and competencies.

Essential support

According to an NHS England spokesperson, learning disability nurses working in acute hospital, primary care liaison, specialist inpatient and community roles provide essential support to mainstream services in ensuring the needs of people with learning disabilities are met.

The spokesperson adds that NHS England expects an overall increase in the requirement for learning disability nurses.

Professional verdict

Phil Boulter is a learning disability consultant nurse at Surrey and Borders Partnership NHS Trust:

He says of the NHS England plan: ‘This is is an exciting opportunity to help shape the future care and support that people with learning disabilities need, leading to improved outcomes and quality of life.

‘I firmly believe this plan is a viable option. Many areas have successfully achieved the closure of long-stay hospitals over the past 20 years.

‘I also recognise that services need to evolve to meet people’s needs, particularly for those with more complex needs.

‘Nurses, along with other members of the multiagency team, the individuals concerned and their families, all have contributions to make to ensure person-centred approaches are adopted

‘Nurses are well placed to support this initiative because they work in a diverse range of settings, and they can use their knowledge, skills and experience to inform and support individuals in their transitions from hospital to community settings.’

 

More information

Building the Right Support

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