Analysis

Learning disability nurses prepare to face the community challenge

Plans to move people with learning disabilities who are in residential hospitals back to their community were announced last month as part of NHS England’s transforming care programme for people with a learning disability or autism.

Picture credit: Alamy

The governments renewed pledge to transfer people with learning disabilities out of inpatient units was prompted by the Winterbourne View scandal of 2011. A BBC Panorama programme exposed abuse of patients at the Bristol residential hospital, leading to its closure.

However, a report by Sir Stephen Bubb published last year showed that admissions to inpatient care were still outnumbering discharges by about 40%.

NHS England predicts that, as community residential services are put in place, there will be a reduction of up to 50% in the number of inpatient beds, and some units will close altogether.

Co-ordination of services is a central aim of the plan, with clinical commissioning groups and local authorities in England joining forces to create 49 local transforming care partnerships.

Integrated budgets

Discharges for those who have been in inpatient care the longest will be speeded up and for

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Picture credit: Alamy

The government’s renewed pledge to transfer people with learning disabilities out of inpatient units was prompted by the Winterbourne View scandal of 2011. A BBC Panorama programme exposed abuse of patients at the Bristol residential hospital, leading to its closure.

However, a report by Sir Stephen Bubb published last year showed that admissions to inpatient care were still outnumbering discharges by about 40%.

NHS England predicts that, as community residential services are put in place, there will be a reduction of up to 50% in the number of inpatient beds, and some units will close altogether.

Co-ordination of services is a central aim of the plan, with clinical commissioning groups and local authorities in England joining forces to create 49 local ‘transforming care partnerships’.

Integrated budgets

Discharges for those who have been in inpatient care the longest will be speeded up and for people who have been in hospital five years or more, specific payments will be made by the NHS to local authorities so their needs can be met in the community. NHS and local authority budgets will be integrated, and there will be a £45 million fund from NHS England.

Calderstones Partnership NHS Foundation Trust in Lancashire, the only remaining stand-alone learning disability hospital trust in England, will begin closing down next July and services will be run by Mersey Care NHS Trust.

The trust has medium and low-secure settings for up to 223 people with learning disabilities. It runs a forensic service supporting offenders who also have a learning disability or extremes of behaviour that challenges. Patients will move to community care or new units in the north west of England, under the NHS plan.

Unison north west regional organiser Tim Ellis says: ‘The issue that both we and the NHS staff are concerned about is that more than half of the clients at Calderstones have convictions for serious offences such as assault, and placing them into the community requires a high level of support.

‘Annually we see about 20% of people who have gone out of Calderstones into a community setting either return or go into another secure hospital environment, and this does not include those who go back into the criminal justice system.’

The trust’s chief executive Mark Hindle says: ‘We continue to work closely with family members, our commissioners and others, including the Ministry of Justice, to ensure the proper care pathway for those we support from secure services into community settings.’

A trust spokesperson said all staff are expected to transfer to Mersey Care and that organisation will determine how they are deployed.

Critical role

RCN professional lead for criminal justice and learning disabilities Ann Norman says: ‘Nurses are critical to this plan’s success. They have a unique role in health facilitation, as they are able to understand and communicate people’s needs, and have a much greater depth of understanding for the people they care for. Learning disability nurses will be the enablers, to make sure people’s real, rather than perceived, needs are addressed.’

Speaking at RCNi’s learning disability conference in September, chief nursing officer for England Jane Cummings acknowledged the shortage of pre-registration training places in the speciality and added that although there are a number of good quality programmes available, these do not reach right across England.

According to the Nursing and Midwifery Council, there are 20,054 registrants with a learning disability qualification – 4,633 fewer than a decade ago. Almost three quarters of learning disability nurses (71%) have witnessed cuts to the services in which they work, a UK-wide RCN survey said in July.

The RCN’s poll of 1,100 learning disability nurses found 95% said there are not adequate community services to provide sufficient care and support to people with learning disabilities. The college is due to publish a report on the learning disability nursing workforce by the end of the year.

But Peter Beresford, co-chair of Shaping Our Lives, the national service users’ and disabled people’s organisation, says the contribution of social work is more important than nursing. ‘I don’t want to belittle the contribution of nurses, but learning difficulties is not a medical condition and we have known for years that what is most needed is social support, not medical intervention,’ he said.

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

‘As part of this, Health Education England has worked with Skills for Health to develop a skills and competency framework so providers can see where they need to build the expertise required for the new model of care set out, and take steps to do so’.

Read the Building the Right Support at tinyurl.com/q453pfb

Progess in ‘fast track’ areas

Six fast-track areas have drawn up plans to transform their learning disability services.

Greater Manchester aims to half its use of 130 inpatient beds by 2018/19. An outreach team will offer intensive support where needed and there will be a housing scheme to provide round-the-clock services.

Lancashire is developing an integrated community learning disability team and crisis intervention services.

Cumbria and the North East wants to reduce its use of non-secure beds by 52% (76 beds) and its use of low-secure beds by 43% (47 beds). Investment has been made to support people with attention deficit hyperactivity disorder and autism.

Hertfordshire is testing prevention and early discharge services for people with learning disabilities who have been in contact with the criminal justice system.

In Nottinghamshire , families will be offered parenting training and staff will be trained in understanding of behaviour that challenges.

In Arden, Herefordshire and Worcestershire , intensive community support teams will work with existing mental health crisis teams.

‘Focus on increasing investment’ Picture credit: David Gee

Debra Moore, pictured, an independent consultant nurse said: ‘The plans should be warmly supported. There needs to be a focus on increasing the investment in community teams, particularly nurses and healthcare assistants.

‘There should be strong partnership between community teams, housing and support providers to ensure those with the most complex needs are well served. Many community teams are already working at capacity and beyond, so there needs to be proper consideration of staff.

‘We must target interventions appropriately to ensure people with learning disabilities and their families can access swift and competent support that can anticipate and divert as well as deal with crisis situations.’

Phil Boulter, a learning disability consultant nurse at Surrey and Borders Partnership NHS Trust said: ‘As a nurse, this is an exciting opportunity to help shape future care and support, leading to improved outcomes and quality of life.

‘Services need to change to meet people’s needs, particularly for those with more complex needs.’

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