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Why we need a branch system in pre-reg training

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As the future of nurse education comes under the spotlight, Steve McNally argues that generic training would jeopardise the care of people with learning disabilities

Readers will be aware that generic training is one of the future options presented in the recently closed NMC consultation on pre-registration nurse training. I believe that learning disability and mental health nursing could be harmed by such a move. I should declare an interest because my practice background is in the above specialties – but, in any case, there are compelling reasons why the branch system of training should be maintained and strengthened.

Patients receive a better service from a nurse who has had an appropriate specialist preparation. If you were mentally ill, for example, would you prefer to be supported by a nurse who had been specially trained in mental health nursing or a nurse who had been trained generically?

Learning disability nursing is the branch most vulnerable to generic training plans. One aspect that frustrates practitioners in the field is the repeated querying of the contribution of learning disability nursing. This has a negative impact on student recruitment. The difficulty in recruitment, and subsequent loss of students to other branches (as they become uncertain
about career prospects), is then cited as a reason why the branch is no longer viable. Thus the cycle of uncertainty continues. One positive aspect, however, is that learning disability nurses who do complete their courses tend to be resilient and committed practitioners.

Despite also being vulnerable, mental health nursing does have the benefit of a higher place on the national agenda. The implementation of the Mental Health Act 2007 introduced some important amendments to the 1983 legislation, including the broadening of the group of practitioners who can carry out the functions undertaken by the approved social worker and the responsible medical officer.

Even if the intention is to maintain some element of the smaller branches in generic training, the risk is that these specialist aspects would be lost among nurses’ generalist training needs.

The need to develop competent general nurses would inevitably be the dominant theme of a new programme and this would be likely to supersede assurances regarding the inclusion of former branch content.

Another concern about a move to subsume the smaller branches into a single programme is that it could also signal their demise as post-registration options. Many students embarking on mental health and learning disability nursing programmes have been older than the ‘typical’ student, or have joined due to a personal connection such as having a relative with a learning disability.

It is hard to envisage a student with that profile completing a generic programme before they are able to reach the work they really want to do. This could lead, in time, to the complete loss of one or more of the specialisms due to low applicant numbers at post-registration level.

Last year’s audit report by the Healthcare Commission on learning disability services in the NHS, A Life Like No Other, reinforced the need for skilled nursing leadership and for commissioners to give more support to frontline learning disability nurses. As recently as December 2007, the trend towards fewer commissioned student places was described by the Department of Health as ‘worrying’.

The DH’s recently published guidance on Good Practice in Learning Disability Nursing refers to this area as a ‘person-centred profession with the primary aim of supporting the well-being and social inclusion of people with a learning disability through improving or maintaining physical or mental health’. I could not have put it better myself.

What rationale, then, could there be for relinquishing the only professional preparation dedicated to meeting the needs of people with learning disabilities? Finally, in the consultation, has anyone sought the views of people with learning disabilities or mental health problems regarding which model of training they, as consumers, would prefer?

Steve McNally is a lecturer practitioner in learning disability nursing at the School of Health & Social Care, Oxford Brookes University

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