We must not lose specialist skills in learning disabilities

17 February, 2009

Avoidable deaths of people with learning disabilities highlight the importance of the RNLD qualification, says Richard Brittle

In the 30 years since I qualified as a learning disabilities nurse, everyone interested in the subject – parents, carers, social workers and learning disabilities nurses (RNLDs) – has known that acute health services find it difficult to care for the physical health of people with learning disabilities.

I remember RNLD students discussing the poor care that their clients had experienced in hospital, and saying that someone would have to die before anything was done.

Unfortunately, a significant number of deaths have occurred. These are graphically documented in Death by Indifference (Mencap, 2007). Anyone reading the report will see that the deaths were avoidable.

As a result of Mencap’s findings, the Department of Health is setting up a confidential inquiry into the premature deaths of people with learning disabilities in NHS care.

Death by Indifference should be required reading for practitioners, managers and policymakers in the general health services, which are so rightly criticised. However, I wonder how many have heard of the report, let alone read it and realise that it has led to this inquiry.

It would be wrong to imply that all people with learning disabilities receive poor care in hospital – my students see examples of excellent practice. However, we need to ensure that poor practice and avoidable deaths are eradicated.

The DH is commissioning a public health observatory to provide data on learning disability. This body will also be charged with ensuring medical students and NHS professionals receive training on learning disabilities, equalities and human rights.

Learning disability is a vast subject, in respect of physical health, communication and a host of other considerations. Pre-registration nursing courses do not have enough time to cover their own specialties – particularly the adult branch – so how can they be expected to shoehorn in additional education?

The DH and NMC are exploring changes to nursing education. One much-vaunted proposal is the introduction of the generic nurse. This would involve dropping learning disabilities from pre-registration education, and replacing it with optional post-registration courses.

If this proposal were accepted, we would lose the only professional qualification in learning disabilities available. Where RNLDs practise in PCTs, it is recognised that they offer a significant benefit. Surely, instead of consigning the RNLD to the scrap heap, should we not only retain the pre-registration course but develop it further?

Learning disabilities nursing should be recognised by the wider family of nursing – and particularly the NMC – as a worthwhile profession, rather than as a poor relation. Health services should be making proper use of these nurses’ skills as part of their strategic response to Death by Indifference.

Along with the public health observatory initiative, involving RNLDs in this way would help to ensure that people with learning disabilities receive high-quality health care. It should also mean there are no more avoidable deaths among these vulnerable people when they come into contact with general health services.

Reference

Mencap (2007) Death by Indifference. London: Mencap.

AUTHORRichard Brittle, RNLD, CertEd(HE), Med, is health lecturer (learning disability), University of Nottingham School of Nursing, Midwifery and Physiotherapy.

Readers' comments (3)

Magdalene Porteous | 4-Apr-2009 11:58 am
I worked in the community with adults with severe learning difficulties. The manager was only trained in Learning Disabilities. I do not feel that this qualification was in any way sufficient, as she related any signs of physical illness to a behavioural problem, thus in my experience the health of the S.U was at great risk. The overall care was of a very poor standard, to the detriment of the S.Users. The lack of General Adult trained nurses was very obvious and many, many serious illness were ignored, with serious consequences. No one locally seemed to listen, and I took the case to the NMC
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Jayne Wilson | 29-Apr-2009 1:47 pm
I think you raise an interesting point. i qualified as an RNLD in 2008, but feel that our training lacked the "typical" clinical nursing skills, however, emphasis on my course wasn't just on people's behaviour, but recognising the impact of health on behaviour. of realising that behaviours may be due to physical pain or discomfort or just not feeling 100%, and the importance of consulting a doctor or district nurse at the earliest signs. i am disturbed that this particular RNLD didn't do this. dependant on where we work, the role of the RNLD is differant to that of the RGN, although i do regret not having more clinical skills taught prior to qualifying, the training we did receive did reflect our sometimes quite broad role as RNLDs.
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Anonymous | 18-Feb-2010 11:20 am
You raise some good points. I was trained a very long time ago, when the training was delivered within the hospital and believe me we covered a lot a clinical nursing skills in physical as well as mental health. It was a more holistic type of training and I feel confident dealing with my client's physical and mental health needs. The present training is good but should include a placement within a general hospital or have a more generic first 18 months followed by the specialism.
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