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'Serious deficit' of learning disability skills warned in nurse staffing guidance

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Future shortages of learning disability nurses that could lead to a “serious deficit of skills” in the workplace have been predicted in draft national guidance, which sets out recommendations for sustaining safe staffing levels.

An increasing number of health professionals approaching retirement, in combination with the reduction in the number of training places and courses available for this specialty, are already causing staffing problems that are set to worsen, according to NHS Improvement, which drew up the guidance.

“If this [staff shortage] isn’t addressed there will be a serious deficit of skills in the workplace”

NHS Improvement

The new learning disability services guidance is one of the first draft workforce documents to be published by NHS Improvement, with a raft of other guidelines across a range of clinical settings due out over the coming months.

It states: “The number of psychiatrists, nurses and allied healthcare professionals in training today is expected to fall short of future demand for their services. If this isn’t addressed there will be a serious deficit of skills in the workplace.”

“Organisations need to take an active role in ensuring clear data on demand and skills required is provided to workforce planners and those providing education and training,” added the document published for consultation by the regulator today.

Those behind the document said workforce planning needed to be reviewed and stressed the importance of recognising the individual contribution of specific professions to care among multiprofessional teams.

“We know from some of the analysis that we’ve done that there has been a dropping off of numbers of learning disability nurses,” said Professor Oliver Shanley, who is regional chief nurse for London and led the work on the guidance.

“When you look at the literature review for multiprofessional working there is a paucity of evidence base for [workforce planning tools]”

Oliver Shanley

“This work allows us to say because of the needs of people with learning disability, that workforce element should be re-looked at, and in terms of forward-planning we need to be confident that in the future we will have sufficient numbers of professionals,” he told Nursing Times.

The guidance, aimed at community and inpatient learning disability services, does not recommend a standard evidence-based method for calculating staffing in this setting, however it points to a series of existing documents to provide a framework for making decisions.

This is partly due to a lack of evidence for a workforce tool that applies to multiprofessional learning disability teams, according to Professor Shanley.

“Most NHS organisations will be using some form of tool but it hasn’t been standardised and that is because when you look at the literature review for multiprofessional working there is a paucity of evidence base for this. There is some for nursing, there is some for other professions but when you are looking for a coherent tool there doesn’t seem to be any,” he said.

Trusts are instead recommended to use professional judgement alongside “evidence-based processes” for managing staff deployment, according to the guidance – titled Safe, sustainable and productive staffing: An improvement resource for learning disability services.

Professor Shanley said this should include consideration of staffing numbers as well as a range of factors such as the professional experience of team members, opportunities for training and development, and access to supervision.

“We need the wider system, profession and public to help refine these [staffing documents] and the engagement phase is critical”

Ruth May

The guidance stresses the “pressing need” for future research on safe staffing in learning disability settings, which should look at the reliability of current workforce tools, as well as a range of factors including models of service provision and hospital communication passports.

It also points to the need to build an “adaptable contemporary workforce to respond to the changing world as a profession”, before highlighting a range of roles including nursing associates, advanced practitioners and apprenticeships.

“Emerging roles should only be used at the appropriate level of assessed skill, competence and attitude,” it adds.


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Ruth May

The guidance is one of seven safe staffing resources due to be published by the regulator for consultation in coming months.

NHS Improvement also published its staffing guidance on acute adult inpatient settings today. Both are out for consultation until 3 February.

The regulator’s executive director of nursing Ruth May urged the profession to contribute to the consultations.

“We have done so much in the last few years to better understand the evidence to support our decision making to ensure we get the right staff, in the right place at the right time. There still remains a great deal of debate in the professions on how we deliver this and it’s important it continues to be on the agenda for senior leaders and boards,” she said.

“We need the wider system, profession and public to help refine these [documents] and the engagement phase is critical. We want to hear back from NHS staff, managers and patients,” she added.


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