Gaps in services are now appearing due to learning disabilities nursing workforce shortages while the pipeline of new nurses coming into the specialty is also at significant risk, sparking calls for a national campaign specifically focused on it to boost numbers.
A consultant nurse, who is helping to tackle the workforce and education issues currently surrounding the specialty, said efforts were now being directed at turning things around, but a campaign would help “drive forward” the profession.
“We need to think about how we provide a positive portrayal of the learning disability nurse”
Rebecca Chester, chair of the UK Learning Disability Consultant Nurse Network, warned problems that had been escalating for years, driven in part by public perceptions of the sector, had been exacerbated by the removal last year of student bursaries in England and wider staffing shortages.
For example, the national shortage of nurses more generally has seen learning disability nurses increasingly hired for non-specialist services to help plug staffing gaps, Ms Chester told Nursing Times in an interview.
“We are finding that learning disability nurses are being employed in lots of other areas,” she said. “They are being employed within acquired brain injury units, child and adolescent mental health services, youth offending, the prison sector, forensics, mental health series, within school nursing. That is fantastic – and great credit that their skills are being recognised – but what it does is leaves a smaller pool of people that we are able to recruit into our learning disability services.”
Overall, recent figures from Health Education England’s draft workforce plan show there are 36.5% fewer – 842 – learning disability nurses working in the NHS compared with five years ago. HEE data from March 2017 shows learning disability nursing had the highest proportion of vacancies – 16.3% – compared with all other fields of nursing.
Ms Chester highlighted the current concerns around learning disability nursing had been instigated by more recent problems, with a large proportion of the workforce now retiring early due to former NHS rules that allowed those with “mental health officer” status to take their pensions at 55.
“We knew the changes to the bursary were going to have a greater impact on learning disability nursing”
Meanwhile, she acknowledged that attracting enough people into training had been an ongoing struggle – but it was the removal of student bursaries in England in autumn 2017 and the resulting fall in applicants that had exacerbated the issue.
New survey figures provided to Nursing Times show learning disability university courses in England had, on average, a third of course places empty at the start of this academic year – on top of 9% reductions in programme sizes following the funding change.
The UKLDCNN chair noted that “historically, learning disability nursing has been one of the least well-known courses that people can do”. Smaller course sizes – sometimes only 15 per year – compared with the hundreds on adult nursing courses and other fields of nursing meant universities were less focused on the specialty, she suggested.
A lack of awareness among the public about this field of nursing meant “generally we find a lot of people who go into it either already have some experience of working with people with a learning disability, or have a family member with a learning disability”. “We do tend to attract a lot of mature students,” she said.
Ms Chester said it was her experience that around 50% of learning disability nursing cohorts were mature students, which meant potential applicants with financial commitments were more likely to be deterred by having to take out a loan to pay for their degree.
“When the initial conversations were happening about the changes to the bursary, we knew it was going to have a greater impact than it would for say adult nursing and children’s nursing,” she said.
According to indicative data from the now defunct Higher Education Funding Council for England, this autumn learning disability courses in England had, on average, 33% of their course places empty. The snapshot survey of 21 – out of 24 – course providers in September also found this was on top of universities already having reduced the number of spaces on their courses by around 9%, compared with the year before.
The Council of Deans of Health convened a meeting with national organisations in November on how to tackle recruitment problems following reports that some courses were less than half full this year.
The sharp drop in applicants has been so great that some programmes have been cancelled. London South Bank University was unable to run its undergraduate course after it saw a 75% decline in applications this year, and has now launched a consultation on whether to permanently close the programme – along with its postgraduate diploma.
Meanwhile, the University of Hertfordshire has suspended student recruitment at two of its three sites offering undergraduate learning disability nursing training from September 2018.
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Even before the bursary change, courses had found it difficult to fill their places, said Ms Chester. She believed this was not only due to too little awareness of the field, but also society’s lack of recognition of the value of people with learning disabilities, in combination with high-profile cases involving care failings.
She referred to Winterbourne View, where care workers and nurses were found guilty of neglect and ill treatment of residents with learning disabilities following a BBC Panorama investigation in 2011.
“It’s right that poor care and abuse from Winterbourne View was publicised. People need to know about poor practice, but we also need to think about how we provide a positive portrayal of the learning disability nurse and raise awareness of this as a career option,” she said.
Reviews since the case had also led to a national, ongoing drive to move care away from hospital services and into the community – requiring more specialist health professionals, including nurses, she added.
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Ms Chester highlighted that there were already examples of gaps in services – where patients were not known to specialist learning disability services – and that any further declines in the size of the nursing workforce could cause the situation to worsen.
“We have examples now of people’s basic health needs not being met and one of the challenges is that learning disability services aren’t always directly involved, it’s based on whether a referral is made to the team,” she said.
“We have got cases in the media recently where people have died because of bowel impaction – some very basic treatable health care needs not being met,” she said, referring to the case of Richard Handley, who had Down’s syndrome and suffered lifelong constipation. An inquest earlier this year concluded his death in 2012 was preventable and that failings had occurred at numerous stages of his care.
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Ms Chester said it was important to emphasise the “unique contribution” of learning disability nurses, which was their skill in providing specialist assessment and understanding of specific health risks a patient might have, based on their syndrome.
“Professionals that aren’t trained to work with someone with a learning disability might say, ‘that is just part of their learning disability, part of their behaviour’, but actually there’s an underlying physical health cause to that,” she added.
It was this contribution that now needed to be harnessed as part of a national recruitment campaign to attract more people into the specialty, according to Ms Chester, who highlighted that a turning point had now been reached.
National organisations, including Health Education England and NHS England, had committed to tackling the problems, she said. A group of representatives from those organisations, plus charities and the UKLDCNN, was now meeting on a regular basis to discuss a marketing campaign for recruiting students, as well as other solutions, she said.
This would include looking at new entry routes, through nursing associate training and apprenticeships, as well as the use of two-year postgraduate degrees.
“I’m reassured there are now other options coming in, through nursing associate and apprenticeships. There are [new] ways we can grow the workforce but it’s very early days – it’s important that people get those roles in place and share their work,” said Ms Chester.
She said she believed a national recruitment campaign could take up to a year to set up, but work to raise awareness more generally about the specialty could begin imminently. “What we need to make sure is that there is action so there is a real campaign driving forward learning disability nursing,” she said.