The challenges we cannot ignore

Last month the RCN published our UK review into learning disability nursing. The report is a clear signal that we have reached a pivotal moment for our profession. People with learning disabilities continue to experience stark and avoidable health inequalities, including preventable illness and premature death. Last week, the latest Learning Disabilities Mortality Review (LeDeR) – commissioned by NHS England – revealed that over half of adults with learning disabilities die before the age of 65. This figure is just 15% for the general population.

As learning disability nurses, we know about this disparity, and have known it for years. Yet the systems designed to support people with learning disabilities are still not consistently safe, accessible or equitable.

At the same time, the nursing profession tasked with addressing these inequalities is under sustained pressure. Workforce numbers are declining, while demand for learning disability nursing expertise is growing across increasingly complex systems. Many learning disability nurses are working in roles that are not labelled as such, meaning their contribution is often invisible in workforce data and planning. If a workforce cannot be clearly seen, it cannot be properly supported or protected.

The education pipeline is equally fragile. Fewer applicants, uneven regional provision and limited placement capacity are narrowing the route into this important field of nursing. And we know how important those placements are - they are where students truly understand the scope, complexity and value of learning disability nursing. When those opportunities are inconsistent, so too is the future workforce.

Early career transition adds further pressure. Newly qualified nurses are stepping into highly autonomous roles, sometimes as the only learning disability nurse in a team. This can be empowering sometimes but, more often than not, it can lead to isolation, moral distress and decisions to leave the field altogether.

Running through all of this is a deeper issue: learning disability nursing is still widely misunderstood. Nurses and students are too often placed in the position of having to explain, justify and defend their role. This misunderstanding affects recruitment, career progression, commissioning decisions and ultimately whether people with learning disabilities receive the care they need.

Reflections on the recommendations in the report

The case studies within this review bring into sharp focus the difference that skilled learning disability nursing makes, and the very real risks when that expertise is absent. They remind us that this is about people’s lives, safety and rights.

The evidence is compelling and consistent: learning disability nursing is a safety-critical field. It prevents harm, reduces inequalities and enables lawful, person-centred care in systems that are often under significant strain.

Our report calls for learning disability nursing to be explicitly recognised and protected, for workforce planning to reflect where nurses are actually practising, for education to be stabilised and for early career support to be strengthened. The report also emphasises the need to improve visibility, career pathways and understanding of our role across systems.

Taking this forward together

This week is the RCN’s Learning Disability Forum in Focus Week – and these issues have never been so important. Our report brings together brutal truths about how learning disability nursing is being slowly depleted – and the impact this is already having on the people we care for. But the report is just the beginning, it’s now up to us as RCN members to utilise the report as a focal point for demanding change. 

We must demonstrate bold leadership to ensure progress against these recommendations. It’s essential that we are able to work with partners across the UK to ensure that the findings of this review translate into tangible improvements in policy, commissioning and practice.

The role of the RCN Learning Disability Forum in this will be crucial. As your Forum Steering Committee we will continue to listen to and be guided by the voices of members working across learning disability nursing. 

Learning disability nurses, students and people with lived experience must shape what happens next. This cannot be a top-down process. It must be owned by the profession and those who we support.

If we act together with clarity, accountability and purpose, we have a real opportunity to secure the future of learning disability nursing and strengthen its role as a cornerstone of safe, equitable care across the UK. RCN members, whether you work in learning disability nursing or just have a strong interest in what we do, read the report and join the forum today to be part of the change that is so desperately needed. 

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It’s Forum in Focus Week at the RCN, and we’re celebrating the RCN Learning Disability Nursing Forum. Explore the work of the forum and information about the learning disability nursing specialism - and stay tuned to our channels all week for more stories, insights and updates.