Strengthening the Commitment - The Interim Report of Scotland's National Implementation Group

Chapter 1. Strengthening capacity

Recommendation 1. Location and employment

The four UK health departments and the independent/voluntary sector should establish a national collaborative to enable better understanding of, and planning for, a high-quality and sustainable registered learning disability nursing workforce across all sectors.

In Scotland’s Delivery Action Plan, we said we would:

• attend UK collaborative events to represent Scotland
• host the Scottish learning disability nursing independent sector event
• scope and understand where learning disability nurses are practising in the independent sector nationally, in collaboration with Workforce 20:20 and Information Services Division (ISD)
• engage with local authority commissioning colleagues to identify all commissioned services in which learning disability nurses may work.

We asked local implementation groups to:

• scope, understand and report to the National Implementation Group where learning disability nurses are practising in the independent sector
• invite independent learning disability nursing representation on local implementation groups.

"It is our right to get the same good care no matter where we live."
Reference Group member

Progress

Members of Scotland’s National Implementation Group have worked with key partners from the four countries to hold engagement events with the independent and voluntary sector. The inaugural meeting of the Independent Sector Collaborative took place in October 2013, agreeing to:

• strengthen links between higher education institutions and independent and voluntary sector providers
• improve outcomes in relation to workforce planning, selection of students, clinical placements, learning and teaching, and support lecturers to keep up to date with practice issues
• drive up quality by requesting organisations in the collaborative to identify good practice examples demonstrating the role and added value of learning disability nurses working in independent and voluntary sector services.

Learning disability nurses from the independent sector in Scotland attend the Scottish Learning Disability Nursing Network events and are represented on the Scottish Learning Disability Senior Nurse Group, the National Implementation Group and NHS Education for Scotland’s (NES’s) Programme Board.

Work has started through the Scottish Learning Disability Senior Nurse Group to understand where learning disability nurses are practising in the independent sector. Further work is required to engage with local authority commissioning colleagues to identify commissioned services in which learning disability nurses may work locally.

Positive practice

Danshell Group has a consultant nurse in Scotland who is central to professional and organisational development of the nursing workforce. The consultant is involved in a range of activities in addition to clinical work, including teaching, supervision, research and clinical governance. Current and planned activities involve training the nursing workforce in the use of outcome measures (such as the Health Equalities Framework and LifeStar tools) and delivering a leadership and development course for registered nurses. The consultant sits on the Scottish Learning Disability Senior Nurse Group and Scotland’s National Implementation Group for Strengthening the Commitment.

For more information, contact Debra Moore at: debra.moore@danshell.co.uk

Recommendation 2. Strategic workforce planning and development

Systems to collect workforce data are required in each country, with links across the UK, for workforce planning for future provision of learning disabilities nursing. These should be able to capture information on service provision, educational and research requirements and should cover the independent/voluntary sector.

In Scotland’s Delivery Action Plan, we said we would:

• design a learning disability nursing workforce data census
• work with the Programme Manager (Nursing & Midwifery Workload and Workforce Planning Programme) to develop the Mental Health/Learning Disabilities Workload Measurement Tool
• submit an analysis of workforce data prepared by local implementation groups to inform future workforce planning.

We asked local implementation groups to:

• complete an accurate workforce data census and submit it to the National Implementation Group
• share data collated with NHS board workforce planning leads to inform ISD.

Progress

We have seen a 3.1% increase in learning disability nursing posts across Scotland over the last year (ISD data).

The Scottish Learning Disability Senior Nurse Group is working with the Programme Manager (Nursing & Midwifery Workload and Workforce Planning Programme) to develop the Mental Health/Learning Disability Workload Management Tool.

The Scottish Learning Disability Senior Nurse Group developed a scoping tool that has been sent to all NHS boards. Returned data has been analysed and a final report, which will be published separately, is being developed. Results from the scoping exercise will be used to help shape priorities for Scotland’s National Implementation Group going forward.

Positive practice

Working across policy areas, The Keys to Life, Scotland’s learning disability strategy, commissioned NHS Greater Glasgow & Clyde to develop a NHS ‘blueprint’ for specialist services. The board subsequently developed the Learning Disability Change Programme, which has produced a ‘Strategy for the Future’ that seeks to define the unique contribution of adult specialist learning disability services in the board area. Detailed analysis of the learning disability nursing workforce has been undertaken as a key element of the Learning Disability Change Programme to gain a full understanding of imminent and long-term workforce change. NHS Greater Glasgow & Clyde consequently is now in a position to forecast future workforce requirements, develop a workforce plan that encompasses succession planning and create appropriate learning and development opportunities for new recruits to the board.

For more information, contact Tom Kelly at: Tom.Kelly@ggc.scot.nhs.uk

Recommendation 3. New ways of working and new roles

The development of new, specialist and advanced role opportunities should be considered in light of workforce planning, service development and education provision. In particular, this should focus on the roles on non-medical prescribing, psychological therapies and telehealth and in specific settings such as the criminal justice system, mental health services (particularly dementia) and autism services.

In Scotland’s Delivery Action Plan, we said we would:

• develop a learning disability nursing service profile tool to support local areas to collate data on current practice roles, including advanced practice roles
• report on learning disability nurses’ expertise and qualifications.

We asked local implementation groups to:

• submit local service profiles to the National Implementation Group
• identify gaps in current learning disability nursing provision
• identify prioritised new, specialist and advanced roles required for the future development of the profession: based on local demography, these roles will be informed by the NES pre- and post-registration learning disability nursing frameworks.

Progress

New, specialist and advanced roles developed since April 2012 include:

• two advanced practitioner posts in learning disability and mental health in NHS Grampian
• two clinical academic roles in the two universities that provide learning disability field nursing programmes to support the national model
• a learning disabilities palliative care specialist practitioner in NHS Greater Glasgow & Clyde
• a part-time forensic charge nurse in NHS Borders.

Some boards are also extending roles. Nurses in NHS Lanarkshire, for example, have completed training in autism diagnosis and are now able to offer this service.

The scoping exercise shows a range of specialist nursing posts across Scotland, mostly in community settings. Specialist nursing roles have been identified in relation to epilepsy, autism, forensic services and liaison roles. In addition, a significant number of community nurses have undertaken the Community Health Specialist Practitioner Qualification and most of the specialist nurses have completed some form of specialist education to underpin their practice.

Further analysis of the scoping data is being undertaken and will be used to help shape priorities for Scotland’s National Implementation Group going forward.

Positive practice

Following identification of the need to develop forensic services in the Borders, funding was agreed in August 2012 to support the development of a new forensic clinical team that includes a part-time forensic charge nurse. The forensic team has continued to develop: two staff nurses are now affiliated members and are being supported to develop their forensic knowledge and skills by, for example, completing NES’s New to Forensic Mental Health programme.

For more information, contact Marion Paterson at: marion.paterson@nhsborders.scot.nhs.uk

Recommendation 4. Career choices

Each of the four countries should consider aligning their existing post-registration career frameworks for learning disability nursing to clearly articulate the knowledge and skills required by learning disability nurses at all levels and across all settings. These developments could be utilised across sectors (with appropriate adaption) to give a coherent career framework.

In Scotland’s Delivery Action Plan, we said we would:

• develop a post-registration developmental framework that reflects the key priorities of the review
• share the post-registration framework with the other UK countries via the UK Strengthening the Commitment Steering Group.

We asked local implementation groups to:

• use the post-registration framework to inform the development of the learning disability nursing workforce.

Progress

NES developed the Career and Development Framework for Learning Disability Nursing in Scotland in 2013. The framework sets out a clear career pathway that serves to:

• outline developmental needs of the existing registered learning disability nursing workforce in terms of values, knowledge and skills to enable planning that reflects key priorities for workforce development set out in Strengthening the Commitment
• clearly articulate how learning disability nurses’ post-registration development can be linked to existing national development opportunities and generic pillars of practice
• act as the foundation for informing future developments in post-registration learning disability nursing education, research and scholarly activity.

The Scottish Learning Disability Senior Nurse Group produced a paper to help individual nurses, teams and managers to exploit the opportunities offered by the Career and Development Framework. Two events for learning disability nurses included sessions to further support them in using the framework and NES’s Effective Practitioner resources, which are designed to support role development.

Positive practice

NHS Forth Valley community learning disability nurses and prison healthcare nurses worked together using Effective Practitioner resources to develop closer joint working between the two services to improve the care pathway for prisoners with learning disabilities. Resources included a self-assessment tool to identify individual training needs, workshop sessions to enable sharing of good practice and identify service gaps, and action planning resources to develop a work plan over the next six months.

For more information, contact Allison Ramsay at: allison.ramsay@nhs.net

"Strengthening the Commitment talks about the values a learning disability nurse should have, but we think it needs more detail. We think we need to show clearly what having the right values really means.

"Having a toolbox of values, skills and knowledge could help with the monitoring of a nurse’s work. It could help people with learning disabilities know what to expect from a nurse and help them say how good their care is.

"We hope that a toolbox would help make a learning disability nurse’s job description the same everywhere.”

Reference Group member