The government, professional groups and campaigners are all on the same page when it comes to people with learning disabilities. Homes, not hospitals, are the way forward.
The exposure of poor care at Winterbourne View, a service for people with learning disabilities, in 2011 prompted the government to re-evaluate care provision for learning disabilities. It proposed to move all people inappropriately in inpatient units to community care by June 2014. This deadline came and went without this being achieved.
Subsequently a national initiative, the Transforming Care programme, has pledged to reduce the number of inpatient beds by up to 50% by 2019. In line with this, community-based services will be developed to create ‘meaningful alternatives to hospital-based care in the country’.
But there’s a catch. An estimated additional 10,000 staff including frontline and managerial staff will be needed to adequately support people moving into the community according to the latest report by the Association of Chief Executives of Voluntary Organisations (ACEVO) released in February.1 And at the moment, in nursing anyway, the staff are just not there.
The Royal College of Nursing (RCN) simultaneously released a report, Connect for Change: an update on learning disability services in England, outlining the severe shortage of learning disability nurses. It conducted a survey of 1100 learning disability nurses: 85% said that there were not enough of the right services in the community to support people with learning disabilities.
The RCN report says ‘the cuts made to learning disability nursing numbers are the most dramatic reductions observed across all fields of nursing in all NHS settings. If there was ever an intention to phase out this specialised strand of nursing, cuts to the workforce and the supply line are sure-fire ways to achieve it’.
Increased community provision is the theme that ties these two reports together. Yet this cannot happen without the staff or the services.
Declining numbers is a trend seen across the nursing workforce and has been extensively documented over the last few years. But as shown in Figure 1, the downward trend in learning disability nursing is the most extreme in comparison to other branches of nursing. In the past five years, the learning disability nursing workforce in England has been cut by a third. This equates to over 1700 posts cut since May 2010. Around 540 of those jobs have been senior and experienced nurses with an overall reduction of 40% in band 7 and 8 nurses.2
Learning disability training places have also been cut by 30% over the past decade, and numbers have been consistently low since 2011.2
Ann Norman, lead of the learning disability nursing forum at the RCN, says this could be attributed to the perception that there is no future in learning disability nursing. ‘What I’ve heard and noticed is that some universities don’t think it’s as important to have a lecturer in learning disability training as others do. Some universities manage it very well but some do not.
‘I think there’s also an attitude that it is a small branch of nursing so institutions have stopped offering this course. It’s naivety,’ she says. This means that there are less new nurses entering this field.
It is important to note that while there is national data on how many learning disability nurses there are, there is no breakdown of whether these nurses are in inpatient units or in the community. Ross Wyatt, a third year learning disability nursing student and a community volunteer in the Twitter group @WeLDNurses, said that this would be a helpful tool to pinpoint where the gaps are. ‘At the moment there is just no way of seeing how many nurses there are working in the community,’ he says.
A Health Education England (HEE) spokesperson told IN they are ‘predicting an increase of up to 1800 learning disability nurses by 2020’.
‘[There will be a] focus on developing those services in the community as that is where the patient of the future will need to be treated. HEE has been working with NHS England and other national partners to set out a far-reaching plan to transform services for people with a learning disability, and we are confident that we can support and make quick, significant and lasting improvements to their care and lives.’
The HEE spokesperson also said that they are working with education institutions Skills for Health and Skills for Care to support the planning and delivering of this workforce change, ‘including help to access relevant tools (such as competency frameworks), funding streams and training’.
During 2013/14 the number of learning disability nursing training places available was 628 compared with 664 places in 2015/16.3 However, the uptake of places varied from the number commissioned and was sometimes lower than expected.
On 1 March, @WeLDNurses hosted a Twitter chat discussing the RCN Connect for Change report. Many of the participants expressed a desire to work in the community but said that their only barrier at the moment appeared to be the lack of jobs available in community settings.
Mr Wyatt, believes that once qualified it would be easy for a learning disability nurse to move between inpatient settings and the community as no extra training would be required. ‘People are interested in doing those roles and would be keen to be involved in community provision for learning disabilities,’ he says.
It adds up
There is also a strong financial case for moving care into the community. NHS England has indicated that the average cost of placing someone in a hospital is £175,000 a year.1 The most recent data from the Personal Social Services Research Unit Shows that the average annual cost of residential care in the community for adults with autism and complex needs is just under £112,000 if all needs are adequately met.1
One of the key recommendations in the ACEVO report is to establish a Social Property Fund to facilitate the transitions of inpatient settings and build capacity in community-based services.
The report also argues for an independent evaluation of the Transforming Care programme to ensure that 2019 does not pass before adequate community care is delivered.
‘This is not something that we will remedy quickly,’ says Ms Norman. The RCN is calling for a long-term strategy to stengthen the commitment to learning disability nursing.
‘We’re not going to let go of this issue, it’s something that is a big priority for us. We believe there is a strong future for learning disability nursing,’ she concludes.
As IN wraps up our conversation with Mr Wyatt, he says that his long-term dream would be to work in a community learning disability nursing role. Hopefully for him and many others with the same ambition the number of vacancies
will catch up with those wishing to work there. But it will take more of an effort than is currently on show.
1.The Association of Chief Executives of Voluntary Organisations. 2016.Time for Change: The challenge ahead. https://www.acevo.org.uk/sites/default/files/ACEVO...
2. The Royal College of Nursing. 2016. Connect
for Change: an update on learning disability nursing in England. https://www.rcn.org.uk/professional-development/publications/pub-005525.
3. Health Education England. 2014. Investing in people for health and healthcare: Workforce plan for England, Proposed education and training commissions for 2014/15. https://www.hee.nhs.uk/sites/default/files/documents/Workforce-plan%202014-15.pdf.