Is learning disability nursing facing the perfect storm?

Jonathan Beebee, from the RCN Learning Disability Nursing Forum, responds to the annual CQC report on the state of care

It was great to see Ian Trenholm, the Care Quality Commission’s (CQC) Chief Executive, on the news, reflecting that the reduced availability of registered learning disability nurses (RNLDs) is part of the oncoming “perfect storm” within health and social care.

He was speaking in the wake of the CQC’s annual report on the state of health and social care services, which said that 10% of inpatient services for people with learning disabilities and/or autism were rated inadequate in 2019, compared to 1% in 2018.
Is the reason there has been a tenfold increase in inadequate ratings for learning disability hospitals a direct response from the CQC to the criticism that its inspection and regulations have been unfit for purpose in the past?

Staff morale

I also wonder how the media coverage is affecting the morale of staff working in hospitals for people with learning disabilities and autism. The binary view we see in many reports and on social media that all hospitals are bad, and that the alternatives are good, feels damaging. 

By no means do I want to undermine the horror of the abuse that’s been uncovered, but if you’re a nurse working in one of these hospitals, how must you feel about your workplace? How do you feel about telling your mates what you do for a living? 

It is leading to a devalued and undermined workforce. It is undoubtedly making recruitment increasingly challenging. All these things are going to lead to an underperforming workforce which is going to affect quality. 

The government’s NHS Transforming Care programme, which has used the slogan “Homes not hospitals”, has received criticism that it has been solely focused on closing hospitals. Many learning disability nurses have roles in these hospitals. No new support model has been designed to replace these hospitals, so what are learning disability nurses’ future careers? There do not appear to be any career development pathways being opened up by this redesign.  

How do you feel about telling your mates what you do for a living?

Any investment has largely been in intensive support teams. These teams are peripatetic services that do infrequent visits, at a higher rate of frequency than community learning disability teams (CLDTs), but still with nowhere near the level of presence of nursing that is available in a hospital environment. 

Many CLDTs have already been cut back and had nursing reductions throughout austerity. This investment is a false positive, barely touching the edges of the reductions that have happened over the last 10 years. 

Five years ago, out of frustration at the paucity of skilled support available to people with learning disabilities and complex needs, I set up PBS4 as a non-profit social enterprise to provide nurse-led social care. At present, we support 27 people and employ four RNLDs, one registered general nurse, and two board certified behaviour analysts. 

Our clinicians lead the support teams in partnership with our managers and community NHS learning disability services to provide skilled support in people’s own homes. We support people to live independently in their own tenancies, avoiding out-of-area hospital placements, or other institutionalised care. 

There is a need for direct support, provided by nurse-led social care. Development and investment need to be focused here.

Find out more

Read the annual CQC state of care report

Join the RCN Learning Disability Nursing Forum

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