The NHS in England is facing up to a 35% shortfall in learning disability nurses by 2020 unless action is taken to address the current education and recruitment “crisis”, according to an official analysis.
The analysis by Health Education England suggests a “really scary” 30% to 35% gap between the supply and demand for learning disability nurses, said national learning disability programme manager Tim Devanney.
“There was a very high level of concern and a high level of worry about the current situation”
However, he warned the prognosis could be even worse, as the model was based on “optimistic assumptions” and did not factor in increased demand from other health sectors including hospitals and prison healthcare.
This gloomy prediction came as learning disability nurses, lecturers, students and others gathered at a summit meeting in London, in an attempt to thrash out an action plan to address dwindling numbers entering the sector.
While concerns about the decline of learning disability nursing have been raised over the past decade or so, Mr Devanney said the model was created in a new effort to quantify the scale of the problem as part of the Transforming Care programme.
Depressingly, he said the conclusion was not much had changed since a 2011 Department of Health-commissioned report into the state of learning disability nursing, which called for urgent measures to prevent the depletion of the workforce, including a national recruitment drive.
“The thing that made us laugh and weep in equal measure was that when we looked at where we are now we found not that much has changed and we’re in no better place than we were back then – not for want of effort, not for want of trying,” he told the summit.
This work also included a snapshot survey of higher education providers by the Council of Deans of Health – as previously reported in Nursing Times – which found nearly half of universities that took part had serious internal discussion about not running pre-registration learning disability nursing courses in September 2018.
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The research shows that, as it stands, there will be no universities running pre-registration learning disability nursing courses in the South of England – with the exception of London – come September this year.
It also reveals a stark mismatch between demand for learning disability nurses and the geographical spread of training on offer.
Meanwhile, of five higher education providers approved to run apprenticeship courses – seen as a key new route into learning disability nursing – none are currently doing so.
“When we looked at where we are now we found not that much has changed and we’re in no better place than we were”
Tim Bryson, the programme lead for a series of regional summit events hosted by HEE and NHS England in May, said there was no getting away from the sense of frustration within a sector that has been calling for action for years.
“There was a very high level of concern and a high level of worry about the current situation facing learning disability nursing and the future sustainability of learning disability nursing,” he told the meeting.
“At the same time there was some frustration – again not surprising – with colleagues saying ‘Look – we have been saying this for some time, we have said this before’,” he said at the event, which was jointly organised by the Learning and Intellectual Disability Nursing Academic Network (LIDNAN) and the UK Learning Disability Consultant Nurse Network (UKLDCNN).
Key issues that had been previously highlighted included the need for a national marketing campaign for both pre-registration and post-graduate courses and a clear career framework for learning disability nursing, similar to the one launched in Scotland.
There were also calls to target schools to raise awareness of learning disability nursing as a rewarding and diverse career option.
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Mr Bryson said the new data and predictions, as well as findings from the four regional summits, had been fed into a report that has been presented to the national Task and Finish Group set up by HEE.
This also identified a number of short-term and longer-term measures designed to address the problem, he revealed.
“One of the things when that report is published – and I know it is working its way through HEE – is that it says very clearly this is an occupational group at risk, but also identifies short-term actions and longer term actions that are required to take it forward in order to remedy the situation,” he said.
“We have got to ensure that actually we have the leadership structures to support us”
Mr Devanney said immediate steps may well include work to encourage more graduates with relevant skills into learning disabilty nursing through shorter two-year pre-registration courses as well as ensuring the nursing associate programme was boosting the supply of learning disability nurses.
Medium-term steps could include the establishment of a “service provider consortium” to implement learning disability nurse apprenticeships, the creation of a career framework, and a suite of workforce development programmes for both learning disability nurses and the wider nursing workforce.
“We need to get to a point where recruitment to learning disability nursing is a system that works, is sustainable and moves forward,” he said.
Jo Lay, chair of LIDNAN, said the sector was not only facing a crisis in terms of recruitment but also “a crisis in commitment to learning disability”.
Ms Lay said there was a need to “be honest about why people maybe aren’t applying for this profession”.
“This is about recognising this may be part of a bigger issue with nursing across the board at the moment and the removal of the bursary but also about the commitment to our profession and what other people are saying about it – how much do our individual higher education institutions actually support and talk positively about our role?” she said.
Other key concerns raised at the meeting, hosted by the Royal College of Nursing, was the lack of senior leadership in learning disability nursing and the need for a more co-ordinated approach when it came to championing the profession and fighting its corner.
In particular, Ms Lay said she was deeply concerned at the lack of learning disability nurse leadership within Public Health England.
“If we’re talking about health inequalities who is going to be leading this? Who can we go to who is going to be providing that leadership and focus for us? That is something that we really need to think about,” she said.
Meanwhile, Rebecca Chester, chair of the UKLDCNN, flagged up a 50% reduction in learning disability nurse leadership roles including nurse consultants, modern matrons and band 7 roles in the NHS.
“We have got to ensure that actually we have the leadership structures to support us and carry that voice of learning disability nursing in order to support the needs of people with a learning disability,” she said.
The bodies behind the summit have already met with the chief nursing officers of all four UK nations and the plan is to go back to them with the action plan informed by the event.
“We have got to stop other fields of nursing jumping on our bandwagon and take our sweets away”
Earlier this year, Ms Chester wrote to the then health secretary Jeremy Hunt to raise concerns about undergraduate learning disability nursing courses and the fact many have been withdrawn.
In his response – received this month – and shared with the meeting, he said the Department of Health was working with Health Education England, the Department for Education and higher education regulator the Office for Students “to monitor the implications for both student choice and health and care workforce supply in the longer-term”.
He went on to highlight recent campaigns to promote nursing to young people applying for courses this September and the more recent “We are the NHS” multimedia nursing recruitment drive.
However, delegates expressed their disappointment that the focus appeared to be on other fields of nursing – despite the fact the learning disability sector has long called for a national ad campaign.
Helen Laverty, professional lead for learning disability at the University of Nottingham, said she had been lobbying for 17 years for a national advertising drive to promote careers in learning disability nursing.
“So the money gets found this January and all of a sudden the focus is on mental health, the focus is on adult, the focus is on child,” she said.
“Hang on – this was our initiative and what we wanted,” she said. “We have got to stop other fields of nursing jumping on our bandwagon and take our sweets away. I am absolutely sick to death of it.”
“The time for talking has to stop – it is time for action”
RCN president Cecilia Anim, who chaired the summit and whose daughter Ruth has a learning disability, said it was more than clear the time for talking was over.
The reduction in learning disability training places combined with the impact of abolishing the nursing bursary, which has had a devastating impact on applications from mature students, meant “learning disability nursing is in a weaker position than ever before” and this was ramping up pressure on existing staff, she said.
“We desperately need action which is appropriately resourced to tackle the crisis in recruitment, so that people like Ruth will receive the high level of care they truly deserve – we cannot let them down,” she said
“This includes learning disability liaison nurses at the hospital, more training places, more nursing students and, most importantly of all, a long-term plan to address the big gaps in the workforce,” said Ms Anim.
“This has not been achieved yet and there is much more to be done,” she said. “The time for talking has to stop – it is time for action.”
At its recent annual congress, members of the RCN voted overwhelmingly in favour of a resolution calling for urgent action to preserve the field of learning disability nursing.
Simon Jones, chair of the RCN’s Learning Disability Nursing Forum, said the college was taking various steps as a result.
College chief executive and general secretary Janet Davies had been due to meet Mr Hunt to highlight key concerns before he moved on, but the hope was a meeting would still happen with new incumbent Matt Hancock.
Mr Jones also revealed plans for a new film to promote the benefits of a career in learning disability nursing.
He said the £15,000 project would help explain and extol the virtues of learning disability, which he described as the “best job in the world” with plans to launch the film to co-incide with the 100-year anniversary of learning disability nursing next year.