Learning Disabilities, Autism and Neurodivergence Bill: consultation analysis

Section 2: Mandatory Training in the Public Sector

Introduction

The consultation highlighted the need for greater awareness, understanding, and training on learning disabilities and neurodivergence, especially for public facing staff in some public services. Options were presented for placing a mandatory training requirement on health and social care staff as well as, potentially, for those working in the justice system (which could include the police and prison staff), and in the education system (for teachers and other educators). The proposals set out were for such training to be inclusive of neurodivergence more generally, as well as learning disabilities and for mandatory training to involve or include people with lived experience, where possible.

Main Findings

Overall, 674 respondents provided comments at this section. Across responses, there was significant support for proposals to establish mandatory training for those working in health and social care:

“Absolutely…this training is vital for anyone in the public sector to be able to approach all individuals and provide a safe, supportive and effective service.” (Neurodivergent Individual)

There was also strong support for training in the education sector with some views that this was equally as important, if not more important, than training in the health and social care sectors. All those working in education from early years to tertiary education would benefit from relevant training, it was felt, and training in schools was seen as one of the best means of having a positive impact on improving attitudes and reducing stigma linked to learning disabilities and neurodivergence long term. Including training at university/ undergraduate degree level for relevant professionals was also encouraged as a means of tackling misconceptions and enhancing skills at an early stage.

Support for training was clear among both organisations (including public sector organisations) and individuals. Many cited previous negative experiences of contact with health, care and education professionals which they felt could have been averted if those professionals had been better trained/more aware of learning disabilities and neurodivergence.

While training for staff in the justice sector was mentioned slightly less often across responses (compared to health, social care and education), this was still very much supported where mentioned. Respondents reflected that the experiences of the justice system were likely to be very different for neurotypical people compared to neurodivergent people and agreed that mandatory training was one way to help raise awareness of this and to adapt practices. In addition to police and prison staff, it was suggested that court staff, solicitors, COPFS staff and those involved in the youth justice system would also benefit from mandatory training.

Several other suggestions were made for extending mandatory training to all public services/public sector staff as well as organisations receiving funding from the Scottish Government. Specific groups that were mentioned with some frequency included those working in social work services, housing services, residential and care home staff, employability and Social Security Scotland staff as well as emergency services staff. There were also a small number of respondents who felt that training should be extended to some private sector services, (e.g. public transport, banking and finance), as well as third sector providers.

Comments were also made that training should not be restricted to public facing staff but should include those in other roles too (including those at management level and those performing administrative or corporate duties). Some respondents suggested a more focussed approach may be needed rather than targeting such a wide audience from the start (with the initial focus being on health, social care and education) but noted that training for the wider service sector may be valuable in the long term.

Involving People with Lived Experience

There was also widespread agreement with proposals to involve people with lived experience in the training (as well as their families, carers and supporters). This included having people with lived experience input to the content and design of training as well as being involved in the training delivery, where possible. Involving people with lived experience in these ways would help to boost credibility and trust in the training delivered, it was suggested:

“Training should include all types of neurodivergence and should be developed in conjunction with people with lived experience, and preferably delivered by them.” (Neurodivergent Individual)

Several respondents noted that they would like to see a broad range of people with lived experience being involved, and stressed that it would be important to include people of different genders, ages and personal backgrounds to ensure that training input was representative. It was also suggested that co-production of any training relating to children and young people must involve neurodivergent children and young people in its development.

Respondents also felt that training needed to be tailored to specific public sector areas and thus informed by engagement with people who had lived experience of specific sectors.

Involving people with lived experience was also seen as potentially having the added value of creating new employment opportunities for people with learning disabilities and neurodivergent people.

The main reservations cited by respondents in relation to including people with lived experience were that those who are involved should have relevant skills in ‘training’ or some ‘training experience’ as well as having lived experience.

Overall, however, respondents to the consultation agreed that training would help create a greater understanding and awareness of learning disabilities and neurodivergence across the public sector, and that this, in turn, would help public sector workers have more confidence in their ability to meet people’s needs. It would also allay any fear or misunderstanding that staff may have when dealing with the people covered by the proposed Bill.

Several respondents also noted that such training would hopefully help neurodivergent people feel heard and more likely to access services.

Training Content

There were a range of suggestions on what the training should include, as follows:

• Separate, specific training focussed on learning disabilities, on autism, and on neurodivergence respectively rather than jointly;
• Specific training in relation to Down’s Syndrome, ADHD, FASD and PMLD;
• Exploration of the links between mental health, learning disabilities, neurodivergence and autism, and complexities associated with dual/multiple diagnoses;
• Discussion of the difficulties/challenges of diagnosis and the validity of self-diagnosis;
• Exploration of the needs of those with more severe communication difficulties, including non-verbal communication, and additional mental health problems;
• Discussion of how learning disabilities and neurodivergence can intersect with other identities (e.g. LGBTQ+ status, ethnicity, physical disability, etc.);
• Separate training in relation to both adults and children and young people (including a focus on challenges associated with transition from youth to adult services);
• A focus on the unique experiences of women and girls;
• A focus on the needs of families/carers (including Armed Forces families);
• A specific focus on stigma and discrimination (to encourage reflection of personal attitudes, assumptions and prejudices);
• A focus on managing the impact and functional consequences of individuals’ conditions;
• Training on the adaptation of service environments, e.g. considering sensory triggers/sensitivities; and
• Practical strategies for staff, rather than generic awareness-raising (including such factors as communication and environmental needs):

In the same way that there was no consensus around who should be prioritised for mandatory training, there was also no consensus regarding what the focus and content of the training should be. While some welcomed a very broad approach that covered as many different learning disabilities and neurodivergent conditions as possible, a smaller number suggested that training should initially be limited to autism and learning disabilities (as currently in England), both to minimise confusion during the training, and also because they believed these were the most challenging conditions for people to understand. If training attempted to cover too much too soon it was felt by some that there may be a risk of dilution.

Several respondents also felt that Down’s Syndrome should be prioritised within training and felt that this was one disability that was historically often overlooked in training and awareness linked to learning disabilities.

There were calls for training to be neuro-affirming and also agreement that the training needed to cover issues relevant to both children and young people as well as adults. Respondents also urged that all training must be consistent with a Human Rights approach and must be inclusive, diversity and culturally sensitive, person centred and trauma informed.

Similarly, it would be important to ensure that the mandatory training aligned with existing legal requirements related to the inclusion and support of neurodivergent people and to consider ethical considerations in the development and delivery of training.

Training Levels

Some comments were made that the training content and level of detail should vary depending on both the sector being targeted and the specific roles of different staff being trained, with views that training for health staff (including NHS employees) should be at the highest/most advanced level. Other advocates of a tiered approach suggested that a ‘learning framework’ was needed (rather than just training) which clearly sets out the skills, knowledge and competencies expected of each service and each type of practitioner in the service.

There was consensus that all public services should have a minimum level of training to allow them to respond appropriately to individual needs including for example, reception and administrative staff, especially those who may have public-facing roles.

Overall, respondents wanted training to be delivered flexibly and proportionately with a basic level of understanding for all staff and more enhanced training for staff working in more complex roles or those which would require more regular contact with people with learning disabilities and neurodivergent people.

While a very small number of respondents agreed with the notion of training but were ‘unsure’ or ‘undecided’ if it should be offered on a voluntary or mandatory basis, the majority urged for mandatory training, perceiving that this would increase likelihood of uptake and ensure positive change.

Training Delivery Approach

There were several different suggestions for how training should be delivered, with the preference appearing to be for mixed, interactive and blended methods (i.e. face to face training complemented by e-learning or digital options). There were also calls for training to include case studies and videos of people with lived experience where possible, alongside being developed and delivered by those with lived experience:

“For best results the training should be an immersive, engaging experience with personal testimony from people with lived experience either in person or via videos, as well as practical exercises such as roleplay or problem solving. Training which is just a lecture, or a self-directed online course fails to engage people and risk reinforcing ingrained assumptions.” (LDAN Support/ Representative Organisation - Mixed Conditions)

The main sentiment was that training needed to be delivered in a way that was accessible and a small number of respondents suggested the need for a ‘learning resource’ (alongside training) which could be made widely available and accessible for anyone with an interest in learning (not restricted to public services alone).

There were also several views that training must be consistent across public services, i.e. that the same courses should be offered following a national training model such the NES Trauma Training Programme, for example. This would also make it possible for joint training to be delivered, it was suggested, with multidisciplinary training potentially offering sharing of knowledge, skills, experience and added value e.g. people working in statutory services could train alongside people in mental health, social care, social work or policing. Similarly, a small number of respondents suggested multi-disciplinary input to training development if a national approach was taken.

Comments were made that any core, mandatory, national training must be reviewed on a regular basis to ensure that it remains effective, up to date and reflects current data, research and legislation, and is continuously improved.

There were also calls for training to be accredited and carefully monitored to ensure that it remained fit for purpose and was of a requisite standard (with comments that badly designed training could do more harm than good if they perpetuated negative perceptions, stigmatisation and exclusion). Others suggested that accreditation may also be necessary to make it more robust but also more appealing to staff and to ensure buy in, as well as potentially linking training to existing professional accreditations, CPD and performance indicators.

Several respondents also commented that refresher training or regularly updated training must also be offered (to consolidate the training into practice) and that the approach to training must not be to deliver it as a ‘single event’. One-off or single event training was also described by some as being ‘tokenistic’. While several respondents agreed with the need for refresher training and enhanced training for selected specialists, there was no dominant view on whether any such additional or enhanced training should be mandatory or voluntary.

A request was also made that any development of mandatory training must intersect with and complement other training requirements (including legislative, regulatory and organisational), and national training already underway, especially within specialist contexts such as the justice system.

Concerns

The main concerns were that any training might be too generic and not sufficiently detailed to raise awareness to the extent that was required (with perceptions it may be too autism focussed and may not provide enough focus on valuing neurodivergence). Again, many respondents stressed that training must not cluster together autism and neurodivergence and that the nuances of each must be clearly and separately explored.

Caveats were also raised that the involvement of people with lived experience must be appropriately matched to the training content, i.e. training should be developed by and delivered by those with lived experience of the subject covered (such as autism training being developed and delivered by autistic people). Unless training was delivered by the most relevant persons for each topic, there were fears that false information could be shared which may perpetuate current misunderstanding and stigmas.

Even if training was delivered and attended by relevant staff, some respondents had doubts that staff would implement it correctly in practice, and concerns that putting the training into practice would not be properly monitored. Therefore, regular monitoring of compliance and implementation would be needed, it was felt, to ensure that training was being acted on. It was also suggested that there was a need for combining training with opportunities for active learning and continued growth through mechanisms such as supervision, peer support, reflective practice and wider support, as well as potentially recruiting local training champions to ensure that training was implemented correctly, achieved longevity of success, and could deliver real changes in practice and culture.

Similarly, while a national training programme received much support, some did raise cautions that there had historically been a number of efforts to require/ mandate training in the public sector but that bringing this to fruition had been problematic. Others cautioned that many professionals (especially those in health, education and social care) were already facing 'training burnout' and may find additional training too challenging to take on in addition to existing workloads/ professional demands. A carefully considered strategic approach to implementation and delivery was therefore encouraged.

Others commented that training alone may not be sufficient to tackle the biases that exist in the public sector workforce/more widely in society and that wider public education was required to break down some of the stereotypes and assumptions that exist around neurodivergence, in particular. One way to counter this was to ensure that people with these conditions were more represented among staff in the public sector to enhance inclusivity of services and make them more visible in society.

Several organisations, including Disabled Persons Organisations (DPOs) and other third sector organisations, expressed interest in being involved in the development and delivery of mandatory training in line with the proposals, and felt that they had much to offer in this regard (with several training courses/content already in place). However, there were also some concerns that the burden on learning disability services would be increased to help deliver the training, with a possible lack of capacity to meet future demand.

Overall, the main sentiment in relation to mandatory training was that it was welcomed, but only if it was consistent, regulated and accredited.

Reasons for Disagreeing

The main reasons given for disagreement with the proposal largely aligned with the concerns and caveats to support noted above. Concerns were repeated about training being too generic or attempting to cluster together too many different conditions rather than giving each the attention that they deserve. Similarly, respondents noted that they felt training could become too diluted unless carefully thought through and a reasonable number of respondents noted a preference to restrict training to autism and learning disabilities in the first instance.

On a contrasting note, a small number of comments were made that the proposed training was not fully inclusive, i.e. there were some individuals/conditions not covered within the proposed provisions of the Bill who may perceive it as unfair that mandatory training did not cover their own condition. It was felt that training needed to ensure equality of access and inclusion for all those with disabilities, regardless of the condition.

There was also disagreement on the basis that the ‘mandatory’ nature of the training and the wide reach of the proposal may be disengaging for some staff unless it was tailored specifically to their job/role and was pitched at the appropriate level.

Concerns around targeting too many people/services were also raised again, as well as comments that the training should focus on those working in health, social care, education and justice alone, or as priority areas. A minority view was also put forward that the proposals did not go far enough and that training should be made a requirement for all those entering the health and social care, education and social work professions, for example, before being able to practice.

A small number who disagreed specified that this was because the proposals did not go far enough to include people with lived experience, i.e. the co-production of training was not enough as it should be delivered and monitored alongside people with lived experience too. Families or people who care for people with learning disabilities and neurodivergent people should also be involved in the training, it was suggested.

There were also several concerns around the cost of training and overall cost of implementing this proposal with views that mandatory training on all the specified areas might be unrealistic in terms of resources and impact on staff time/capacity. One suggestion was made for piloting the training in one area or with one service sector and harnessing learning from the experience before widening it too far. A very small number indicated that they felt that the proposed training would be a waste of public money completely. Others again urged the need for a clear plan for financing and implementation of the training before taking this proposal forward (with clear timeframes), including specific details around how those with lived experience would be involved.

Other Comments and Considerations

The main other comments were also related to resourcing, with concerns around the cost of the training and questions about whether sufficient funding would be made available to achieve the proposals. It was suggested that specific budgets would need to be made available to local areas to facilitate the training, and that a ‘train the trainer’ model be used to allow local staff to take on training, rather than relying on centralised or limited training staff. This might include training trainers with lived experience/peer-to-peer training as having trainers with personal experience with learning disabilities and/or neurodivergence may enhance the authenticity and relevance of the training. Others suggested that training be delivered wherever possible by local providers who have capacity to offer high quality lived experience based training as an aspect of community wealth building.

As above, several other comments were made in relation to how the impact of mandatory training would be measured and there were calls for reassurances to be offered that delivery and implementation would be monitored, otherwise training may not result in the outcomes desired. A clear plan setting out accountability mechanisms was needed, it was felt.

Comments were also made about the importance of accompanying training with appropriate promotion and awareness strategies, i.e. to have a comprehensive communication plan to raise awareness about the importance of neurodivergence training and to promote understanding and acceptance across public service sectors.

There were also several suggestions that considerable training content/materials already existed and that there may be benefits in exploring how this could be extended or adapted to help meet this proposal, rather than developing new training from scratch. For example, it was felt that the education sector (spanning early years to tertiary education) may already have resources and materials which work well and which could be adapted for wider use. There were also suggestions that it may be worthwhile exploring if the Oliver McGowan Mandatory Training that is delivered in England could be extended to Scotland in the first instance - although others (both here and at later questions) argued against copying this model. A small number supported exploring models from countries with demonstrably successful training programmes that have a positive impact on the lives of neurodivergent people (e.g. Australia and Canada). Overall respondents agreed that it was important to explore opportunities for integration with existing programmes and build on training programmes where the groundwork has already been established, rather than designing such a programme from scratch.

A few comments were made that more thought needed to be given to how this proposal would sit alongside other developments. For example, with the new National Care Service set to launch, the Scottish Government should consider where this new mandatory training would sit in the new structure and who would have overall responsibility for delivering it.

Finally, some respondents indicated that they felt unable to answer questions regarding this proposal as more detail was required on how training would be delivered in practice and when, in order for them to provide a meaningful response.

Overall, however, the main views in relation to mandatory training were that it was very much supported and, for many, there were views that it should be considered for public sector staff or to extend beyond health and social care to encompass the justice and education sectors as a minimum. A small number of respondents indicated that they viewed this as one of the most important parts of the Bill.