6. A learning disability nurse in every hospital? (resolution)

Essex Branch

That this meeting of RCN Congress asks Council to lobby for a learning disability liaison nurse in all hospitals.

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Progress report

Council Committee: NPPC
Committee decision: Covered by existing work
Council member/other member/stakeholder involvement: David Miller, Kevin Bell
Staff contact: ann.norman@rcn.org.uk

The RCN Learning Disability Forum and a network of LD consultant nurses are already discussing this issue with the RCN Nursing Department Adviser as part of a wider project highlighting the value of LD nurses and the current challenges posed by declining numbers of nurses in this specialty.

The RCN Learning Disability Forum took the work forward in June 2010 by hosting an RCN LD nursing summit between the LD consultant nurses UK group and other expert contributors (including the resolution’s proposer).

This followed further debate at an RCN Congress 2010 fringe event and RCN members will be updated on progress and activities at RCN Congress 2011.

The resulting consensus focused upon three RCN priorities: workforce, leadership and education.

An RCN position paper was launched in January 2011 which sets out the background, key issues, evidence and action plan for 2011 and beyond. ‘Learning from the past – setting out the future’ has gained support and respect from all DH LD country leads. An announcement in February 2011 by Scotland’s CNO, Ros Moore, set out the commitment of all four DH leads and funding in 2011/12 to support LD nursing profile, education, and career pathways to support people who have a learning disability whether in acute hospital settings or elsewhere in the community.

Debate report

The health inequalities of people with learning disabilities were brought into sharp focus during this debate. Proposer David Brown, Essex Branch, started with some statistics – people with learning disabilities are twice as likely to be admitted to hospital each year than the general population, and on average have shorter life expectancies.

Reflecting on the move from residential hospitals to care in the community for those with learning disabilities, he said: "Now when they are ill or injured, they go to ordinary wards or outpatients clinics that are simply not ready for the increased needs of these patients."

Speakers agreed that the proposition of having a learning disability liaison nurse in every hospital would go some way to helping these patients through explaining procedures, planning person-centred care and helping others in the health care team to do their jobs effectively. Seconder Dr Michael Brown, Chair of the RCN Learning Disability Nursing Forum, said: "It is vital that all nurses, wherever they practice, have access to specialist learning disability nurses."

The hall was shocked to hear from Andrew Frazer, RCN Emergency Care Association, who told how the death of a patient with learning disabilities could have been avoided if the learning disability nurse hadn't been off sick. He said: "I urge Congress to support this resolution so no further vulnerable adults die unnecessarily."

Carol Hall, Chair of the RCN Education Forum, supported the resolution, but urged caution. She said: "We do not want tokenism. We must have a situation where everyone has individualised care and support."

Penny Mannings, Greater Bristol Branch, felt that liaison nurses cannot get rid of the problem alone, and called for mandatory training on learning disabilities for all hospital staff – from doctors to those who serve meals.

The proposer closed the debate by saying: "This idea is not the be all and end all. It is, however, a significant start in the right direction." Congress agreed, supporting the resolution with 92.39% of the vote.

FOR   425 – 92.39%
AGAINST  35 – 7.61%
ABSTAIN 16

Background

There has been a great deal of evidence to support the fact that people who have a learning disability do not receive equal health care treatment or a good health service. There are significant unmet health needs that often go unrecognised, and this has an impact upon the quality of life and life expectancy of people with a learning disability.

People with learning disabilities are frequent users of hospital services and their experiences can often be of poor quality; the cumulative evidence of poor quality care spans all service provisions across the UK. In its 2006 report Death by indifference Mencap highlighted the premature death of six people with a learning disability; this report followed hard on the heel of the Disability Rights Commission (DRC) formal inquiry Equal treatment: closing the gap in the same year. In England, these reports triggered the 2008 independent inquiry Healthcare for all, headed by Sir Jonathan Michael.

In 2008/09 NHS Quality Improvement Scotland (QIS) undertook a review of services offered to people with learning disabilities across all NHS boards, and published recommendations for developments to build on existing good practice. Most NHS boards in Scotland now provide a learning disability liaison service, but the recent Scottish NHS QIS national overview report Tackling indifference (2009) demonstrated that this is just one element of delivering a high quality health service to people with a learning disability. In Northern Ireland the current focus centres around staff within acute care settings, and guidance is being developed which will offer support. The Welsh Assembly Government Community Nursing Strategy 2009 contains recommendations for the development of learning disability nursing.

The issues that people who have a learning disability face is being raised in all four UK countries, and there is supporting evidence that suggests specialist nursing support from learning disability nurses offers an effective model of delivery. Liaison nurses play a crucial role in raising the profile and status of people with a learning disability in hospitals and this is valued where it implemented. There are examples of such initiatives in all four UK countries.

References and further reading
NHS Quality Improvement Scotland (2009) Tackling indiference: healthcare services for people with learning disabilities. National overview report – December 2009, Edinburgh: NHS QIS.