If no action is taken to improve the quality of learning disability nursing then we are likely to see more “Winterbourne View” care failings, warns Bob Gates
We must understand why such terrible care failings for people with learning disabilities happened at Winterbourne View. If we don’t understand and take action to improve care, “Winterbourne” may become synonymous with a long list of scandals like those that characterised residential services for people with learning disabilities in the 1960s.
We need to understand the context in which some learning disability nurses now work within the private sector - a context characterised by qualified nurses working in isolated settings with little peer support, little or no clinical supervision or access to continuing professional development, and no clear career structure to motivate them. In such settings they are often found overseeing many unqualified support workers with little or no formal training.
“We must develop a highly qualified, sensitive and caring workforce for people with learning disabilities”
Paradoxically, this growth in private sector provision has occurred as a result of previous adverse reports on standards of care for people with learning disabilities in the NHS, and it has been driven by central government policy. Many of us in the field have advocated for years that closing NHS campuses and moving people to the private sector was not, in itself, a solution to abuse and infringement of human rights. As NHS campuses have closed, the private sector has demonstrated an insatiable appetite for employing learning disability nurses. This has left some of them vulnerable to exposure to bad practice and has brought into sharp relief their ability to practise to the standard expected by the regulatory body.
Learning disability nurses need a clear career structure, like that which other nurses already have. They also need to be able to aspire to senior positions - which are notable by their absence. The most senior position they can aspire to is consultant nurse within the NHS - and these roles are dwindling. These nurses and the people they serve deserve better.
Educational programmes must be placed in a clear framework of human rights and disability legislation and, along with person-centred approaches to supporting people with learning disabilities, must be at the heart of our professional preparation and practice.
For learning disability nursing to develop, it must be promoted and supported by the health service, the Royal College of Nursing and the Nursing and Midwifery Council. This has begun with the recent UK-wide review of learning disability nursing, but there is urgent need to: ensure learning disability nursing is “modernised” to deliver person-centred care within a human rights based practice framework; address the lack of leadership at all levels; ensure there is a strong framework for clinical supervision for all nurses who work in a complex landscape of service provision; ensure there are transparent and rewarding career pathways.
We must develop a highly qualified, sensitive and caring workforce for people with learning disabilities. Carers of people with learning disabilities must be able to practise to a nationally prescribed set of competences, be held accountable through a code of conduct, and be struck off from a centrally held register if that practice is deemed unacceptable. Learning disability nursing is well placed to do this, but only with the appropriate support that other nursing specialties enjoy.
Learning disability nurses need to work at the heart of initiatives to develop services for their clients. Using their knowledge, skills and strong value base, they have the potential to promote the rights, independence and choice for their clients so they can lead valued and healthy lives.
Bob Gates is academic and professional lead for learning disability nursing at University of Hertfordshire and visiting professor of learning disabilities at the University of West London