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Exclusive: New 'pillars' to improve learning disability care

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A leading nurse has developed a guide to help staff implement national standards of care for people with a learning disability.

Consultant nurse in learning disabilities, Jim Blair, has created four “pillars of evidence” to help staff deliver NHS Improvement standards that were introduced across the NHS last year.

“It gives people very clear guidance as to what the expectation is and what your expected outcome is”

Jim Blair

Mr Blair said he had been told by nurses working on the frontline that they were not sure what the standards meant or how to implement them.

He said: “People were saying ‘we get the standards, we like the standards, but how do we make sure we’re incorporating all of these things?’”.

In 2018, NHS Improvement developed four standards for learning disabilities which include: respecting and protecting rights, inclusion and engagement, workforce and a separate learning disability services standard for mental health trusts.

Trusts are required to meet these standards and by doing so will be identified as “delivering high quality services for people with learning disabilities”.

Mr Blair explained to Nursing Times that in order for the standards to be fully implemented, learning disability nurses and other healthcare professionals needed to gather data and evidence in relation to the care of people with learning disabilities across primary, acute and community care.

The four pillars are:

  • Referral to treatment from point of referral by GP to the treatment taking place.
  • Attendance at outpatients being successful so appointments happen rather than breaking down and not effectively occurring.
  • Reducing lengths of stay in acute hospitals for people with learning disabilities who tend to spend longer periods of time in acute hospitals than other members of society.
  • Reduce readmission rates to acute care post discharge within 12-48-hour period.

Each pillar is supported by a “tripod” which explains to staff in each sector, across primary, acute and community care, what action they should take to fulfil the pillar, noted Mr Blair, who is an independent consultant nurse in learning disabilities, a health advisor at the British Institute of Learning Disabilities and associate professor for learning disabilities at Kingston and St George’s Universities. 

Although each pillar gives specific actions for staff across the three sectors, Mr Blair explained that each pillar would not work without every sector completing its individual tasks.

As part of the pillars he has designed, nurses are called on to find data on how long it takes for a referral to treatment for those with a learning disability in comparison to people without and devise a plan of action as to how the differences in times can be addressed, for example.

“I would like to see that they become an integral part of service evolution”

Jim Blair

In addition, nurses have also been asked to find evidence to support reasonable adjustments to ensure a person’s outpatient appointment takes place and to find out what can be done to make it more successful next time if it does not.

Mr Blair said during his experience of working in learning disability care it was in outpatient services where things “often break down”.

He noted that an individual’s appointment might not happen because their appointment may be seen as challenging for them, or the individual could not wait long enough for the appointment or if there was no quiet place for them to wait.

“Yet solutions for that are quite easy,” said Mr Blair. He noted that implementing things like buzzer systems, having dimmer lights, and quiet areas to wait, were all examples of ways that could help an individual with a learning disability.

By implementing the pillars alongside the NHS Improvement standards, Mr Blair said he believed it would “significantly improve the evidence of reducing health inequalities and increase the quality of care outcomes for people with a learning disability, across primary, acute and community care”.

“It gives people very clear guidance as to what the expectation is and what your expected outcome is to be in reducing the health inequalities for people with a learning disability,” he said.

“It is early days but what I would like to see happen with them, is that they become an integral part of service evolution in relation to the health needs of people with a learning disability,” he said.

“They will address poor outcomes, demonstrate good practice and illustrate how things should and could be achieved” 

Jim Blair

“They will address poor outcomes, demonstrate good practice where it’s happening and illustrate how things should and could be achieved for people with a learning disability, alongside them and their families,” he added.

Mr Blair said he also hoped the pillars would help to reduce the number of people facing delays in treatment. 

He also flagged the importance of people with learning disabilities and their families being the “key centre element” to the pillars.

“They are integral to being engaged in this whole process and getting their feedback,” he noted.

Mr Blair explained to Nursing Times that although not implemented into policy yet, his pillars have received backing from senior nurses across the country, including deputy chief nurse for England, Hilary Garratt.

He is also in discussion with David Harling, head of learning disability at NHS England and NHS Improvement, and others in the health service in how to fit the pillars into the national standards.

Commenting on Mr Blair’s work so far, Mr Harling said: “The work Jim has been leading to develop the pillars, builds on his established portfolio, and compliments the range of strategic actions we are taking nationally to tackle health inequalities across the wider health and care system.”

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