Opinion

Integrating health and social care will benefit patients

Funding essential to robustly implement the 2014 Care Act for people with learning disabilities.
This is me

We all want people with learning disabilities to live well and in a safe environment close to or with their families so they can achieve their potential. This might be possible with the implementation of the 2014 Care Act, which could potentially overhaul and transform the social care system but funding is essential for this to progress.

The RCNs Connect for Change report, published in February 2016, provided an update on learning disability services in England. It pointed out that promises made in the light of the Winterbourne View abuse scandal had not been achieved.

Suitable environments

There has been little change in the past five years, with many inpatient units not having developed, and people with learning disabilities still living far away from their loved ones

...

We all want people with learning disabilities to live well and in a safe environment close to or with their families so they can achieve their potential. This might be possible with the implementation of the 2014 Care Act, which could potentially overhaul and transform the social care system – but funding is essential for this to progress.


Perhaps health passports such as ‘This is Me’ could be integrated into social care

The RCN’s Connect for Change report, published in February 2016, provided an update on learning disability services in England. It pointed out that promises made in the light of the Winterbourne View abuse scandal had not been achieved.

Suitable environments

There has been little change in the past five years, with many inpatient units not having developed, and people with learning disabilities still living far away from their loved ones in far from suitable environments.

What is needed is robust support in the community with the right expertise to provide good quality health and social care to cater for individual needs. But instead, there has been a year-on-year reduction in the learning disabilities workforce.

The learning disability nursing workforce has seen the most dramatic reduction since 2010, with significant numbers of senior experienced roles being cut.

The Skills for Care discussion paper, published in May 2016, highlights the distinctive contribution nurses have made in adult social care. But its data shows a vacancy rate of 9% with a nursing workforce turnover rate of 35%, which is much higher than in the NHS where it is 14%.

Negative media coverage

The major reasons behind this are a lack of career progression and negative media coverage of care homes.

The number of learning disability nurses is reducing, despite the fact that they remain the only members of the nursing workforce specifically trained to care for the health and social care needs for people with learning disabilities.

I am a surgical nurse by background and I have first-hand experience of patients with a learning disability being admitted to an emergency unit. One patient in particular stands out for me, who I will call ‘Jack’.

Jack was placed in an inpatient unit in the community. As a result of his challenging behaviour, Jack had specific communication needs and was described by his father as ‘stoical’ when experiencing pain. Jack had chronic constipation and his relatives raised this issue frequently in his inpatient unit, where he did not have a key worker. He was admitted to hospital with severe abdominal pain as he was not responding to his usual analgesia.

Appropriate liaison support

On admission, he received morphine for his pain, which helped: an abdominal X-ray revealed severe faecal impaction. A best interest decision was made to take Jack to surgery to have a manual evacuation under general anaesthetic; this was to help resolve his severe pain and help manage more appropriately his acute constipation.

Later his bowel had perforated and he developed sepsis rapidly.

I wonder whether, with appropriate liaison support, his constipation would have escalated to the severity it did.

Services for people with learning disabilities need to be transformed more quickly, and the disconnection between workforce planning and service improvement needs to be resolved to support the integration of health and social care for people with learning disabilities.

Social care passports

I have seen good practice with staff using patients’ 'This is Me' social care passports to help the transition into health. Wouldn’t it be great to see health passports integrated into social care?

At my trust we have an experienced learning disability liaison nurse who works tirelessly with the transition, but there needs to be more collaboration between health and social care so that this becomes the norm.

By providing health and social care integration in the right place at the right time, the quality of care for people with learning disabilities will be greatly improved.

References
  • RCN (2016) Connect for Change: an Update on Learning Disability Services in England
  • Skills for Care (2016) Stimulating Debate on the Distinctive Contribution of Nurses to Adult Social Care. Skills for Care, Leeds

 


Sarah Seeley is a transformation nurse lead at Ipswich Hospital NHS Trust

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