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Does learning disability nursing have a future?

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A damning report on care for those with learning disabilities comes at a time when the future of the nursing specialty is under review. Emma Vere-Jones reports.

The first audit by the Healthcare Commission of inpatient services for people with learning disabilities in England makes depressing reading.
The commission found ‘significant institutional failings’, which it says deprived people of human rights and dignity. There were concerns about quality of care and service management, with poor leadership, poor training and no framework to measure performance (NT News, 4 December p3).
The report, published last week, comes at a critical time for learning disability nursing. Three major documents are currently out for consultation – a five-year government strategy for learning disability services, launched the day of the commission’s damning comments – and two review of nurse training released by the NMC and the Department of Health (NT News, 6 November, p2).
‘The consultations have potentially far-reaching consequences for learning disability nurses and services,’ said Ann Norman, RCN professional nurse adviser for learning disabilities.
She described the future of the specialty as ‘hanging in the balance’.
‘It feels like so much is happening at the moment. My real concern is the impact all this will have on the specialism and on the people these nurses are caring for,’ she said.
A key priority of the DH plan is to improve health services for those with learning disabilities. Ms Norman says this requires two firm commitments – to plug gaps in funding and to ensure commissioners give greater support to frontline staff.
‘Learning disability nurses must be given much greater leadership opportunities and more support, because they have specialist skills to ensure that people with learning disabilities receive a much better service than they currently have,’ she adds.
But nurses are concerned about plans in the consultation to shift responsibility for the commissioning of all services deemed ‘non-health related’ from the NHS to a social care body in local government.
Michael Brown, chairperson of the National Network of Learning Disability Nurses, argues that, if health inequalities and health improvement agendas are to be met, these services would be better kept within the NHS.
He said: ‘If the NHS in England was failing people on cancer care, would we transfer cancer care to social care or would we fix the NHS? What does it say about the NHS if we can’t provide adequate care to our most vulnerable people?’
There is also concern that learning disability nurses could be shifted out of the NHS and into social care – possibly to the detriment of clinical standards and access to training.
This is especially worrying as the two other consultations could significantly affect the specialty’s workforce. The Modernising Nursing Careers post-registration consultation maps a future in which nurses follow one of five career paths – none of which specifically includes learning disabilities. The consultation itself admits nurses may ‘fear fragmentation of care’ and a ‘diminution of core values and skills’.
At the same time, the NMC’s consultation on pre-registration training questions whether there is still a need for a separate learning disabilities branch or whether such skills could be incorporated into generalist nurse training.
Mr Brown argues separate pathways must be protected if the profession is serious about addressing the needs of the specialty. ‘There needs to be a clearly defined career pathway for learning disabilities, both before and after registration’.
Nurses emphasise that the commission’s report provides ample evidence to support the need for a distinct specialty in learning disabilities.
‘Vulnerable groups are not being given an adequate service,’ said Ms Norman. ‘That’s the reason that we need to retain the specialty and make sure we’ve got people with the skills to do the job.’

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