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

Chapter 2. Strengthening capability

Recommendation 5. Maximising the contribution of learning disability nursing

Commissioners and service planners should have a clear vision for how they ensure knowledge and skills of learning disability nurses are provided to the right people, in the right places, and at the right time in a way that reflects the values- and rights-based focus of learning disability nursing.

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

• identify an appropriate comprehensive model that incorporates an outcomes framework and self-assessment tool to support local nursing service quality improvement and development of a values-based service
• scope opportunities to integrate learning disability nursing practice in the Leading Better Care programme.

We asked local implementation groups to:

• scope and identify tools to measure and improve quality of care for people with learning disabilities.

“It is really important to get the right people for the job of a learning disability nurse.”

“Many of the recommendations of Strengthening the Commitment will not get to happen if people with learning disabilities do not know what to expect and what their rights are. Human rights are meant to be a strong theme in Strengthening the Commitment. But it’s not only nurses who need to understand these.”

Reference Group members

Progress

The Scottish Learning Disability Senior Nurse Group undertook a scoping of outcome models, considering the Confirm and Challenge^© model, HoNOS LD (Health of the Nation Outcome Scales for People with Learning Disabilities), QoL (Quality of Life) Questionnaire and Health Equalities Framework. This group concluded that the Health Equalities Framework should be rolled out across Scotland.

The scoping exercise showed that while activity to engage learning disability nurses in Leading Better Care has been taken forward across Scotland, the engagement could be strengthened.

Positive practice

NHS Greater Glasgow & Clyde has embedded the Leading Better Care programme within the ongoing professional development programme for all mental health/partnership senior charge nurses. Corporately led by the Nurse Director and driven by the Professional Nurse Advisors Group, this has resulted in all band 7 learning disability nurses undertaking the Leading Better Care programme. Senior nurses have consequently been supported to apply the methodology to areas of service improvement, delivering positive results (particularly in the development of improvement plans) when used alongside clinical audit. The Learning Disability Professional Workplan uses the Leading Better Care framework to define and deliver on various areas of ongoing work. Going forward, band 6 staff will also undertake the programme to further strengthen the contribution of learning disability nursing staff in NHS Greater Glasgow & Clyde.

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

Recommendation 6. Working with people of all ages

Commissioners and providers of health and social care should ensure the skills, knowledge and expertise of learning disability nurses are available across the lifespan. This should be enabled through effective collaborative working across health and social care.

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

• commission the Scottish Learning Disabilities Observatory (SLDO) to complete a systematic review of evidence underpinning children’s nursing practice and potential application to learning disability nursing practice, with an initial focus on children aged 0–5 years.

We asked local implementation groups to:

• complete learning disability nursing service profile and workforce data to capture where learning disability nurses work across the lifespan.

“Everyone’s story is different, everyone has different life experiences. The more people learning disability nurses hear from, the more they will learn about people with learning disabilities.”

Reference Group member

Progress

SLDO was established in 2014 to work as a strategic partner to the learning disabilities policy team in providing high-quality accessible evidence to support policy-makers and practitioners to address the very poor health and health inequalities experienced by people with learning disabilities. The first steering group meeting was held in October 2014, with two of Scotland’s nurse consultants in learning disabilities as members.

The service profile captures differences across NHS board areas in relation to learning disability nurses’ involvement in supporting children and families with learning disabilities.

NES is taking forward a project on working with families. A project lead has been appointed to explore current and potential models and roles for learning disability nurses in relation to supporting children with learning disabilities and families.

Positive practice

NHS Highland is looking at the experiences of parents with learning disabilities of support they have received from learning disability nurses and other services in the run-up to the birth of their child and the first few months following birth. This will help to identify good practice and gaps in provision that will shape how nurses work with parents with learning disabilities in the future.

For more information, contact Jonathon Gray at: jonathangray@nhs.net

Recommendation 7. Addressing health needs

Commissioners and providers of health and social care should ensure that learning disability nurses are able to collaborate effectively with general health services, including mental health services, to address barriers that exist for people with learning disabilities to improving their health. This should include proactive health improvement, prevention, whole-family and public health approaches.

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

• develop a learning disability nursing service profile to collate baseline data on existing liaison, health improvement and public health roles
• work with NHS 24 to develop accessible health information on NHS Inform
• establish links with Healthcare Improvement Scotland.

We asked local implementation groups to:

• complete the learning disability nursing service profile tool and submit to the National Implementation Group.

Progress

The scoping exercise has helped establish baseline data on existing liaison, health improvement and public health roles.

The Scottish Consortium for Learning Disability has been working with NHS Inform to develop their “Easy Read Zone”. This work is now being taken forward as part of The Keys to Life.

Positive practice

NHS Dumfries & Galloway has developed a network of “Learning Disability Champions” to improve the healthcare journey for people with learning disabilities. The Champions’ course is delivered over eight months and incorporates a placement that gives participants the opportunity to fully appreciate the complex needs of some people with learning disabilities who may access NHS services. A range of participants complete the course, including ward staff from primary care and acute areas, physiotherapists, occupational therapists, mental health nurses, midwives and district nurses.

Participants are expected to complete a work-based project to benefit people with learning disabilities. Projects have included developing an easy-read patient information leaflet, creating resource packs and producing DVDs about coming into hospital.

For more information, contact Libby Paisley at: libbypaisley@nhs.net

Learning disability nurses in NHS Lanarkshire have worked with colleagues in sexual health to deliver on the standards from the Scottish Government Sexual Health and Blood Borne Virus Framework (2011–2015). This has included the development and delivery of awareness-raising sessions on capacity and consent to sexual activity to provide a value base for all staff, and acknowledging the sexual rights of adults with a learning disability. Accessible information was developed in consultation with service users as part of a sexual health toolkit that was launched at a joint event with sexual health services in March this year.

For more information, contact Margaret Serrels at: margaret.serrels@lanarkshire.scot.nhs.uk

Recommendation 8. Providing specialist services

Commissioners and service providers should ensure that specialist learning disability services for complex and intensive needs (including assessment and treatment across all sectors) employ sufficient numbers of appropriately prepared and supported registered learning disability nurses. This highlights the need to support and develop the availability of specialist and advanced clinical skills and knowledge of learning disability nurses in all settings.

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

• work with NES to further develop positive behaviour support (PBS) education resources for the learning disability nursing workforce
• commission a managed care network pilot to build capacity with identified pilot sites.

We asked local implementation groups to:

• accurately complete the workforce data census and submit to the National Implementation Group
• investigate the added contribution of learning disabilities nurses in meeting the needs of people with complex and intensive care needs through case studies.

Progress

NES has developed three resources to support the learning disability nursing workforce working with people with complex and specialist needs:

• Thinking about Me? supports staff to deliver the best possible care for people with learning disabilities and understand psychological factors
• Improving Practice is an educational resource for support workers to help them help people whose behaviour is perceived as challenging
• Promoting Positive Partnerships is a series of video clips that show family carers talking about their experiences of caring for their son or daughter and the support they have received from health and social care.

The Scottish Government sponsored Edinburgh Napier University to host a four-day seminar programme delivered by Dr Gary LaVigna in June 2014. The programme, which provided training in PBS and applied behaviour analysis (ABA) for learning disability practitioners, was attended by 42 health professionals from NHS boards across Scotland, including learning disability nurses, psychologists, speech and language therapists and occupational therapists.

An evening family seminar was attended by 26 family members. Their feedback included the following.

“All health staff who come in contact with my son should know about PBS or ABA. They are meant to be learning disability specialists but some don’t know the basics of behaviour.”

“This seminar was a great opportunity to share my fears with other families; my son is 3 [and is] awaiting a diagnosis.”

Positive practice

Fife commissioned a joint health and social care model to support individuals with learning disability and complex psychological needs. The model, which was developed and designed to reflect the individual needs of clients, is a nurse-led service but is staffed by local authority social care workers, with nurses adopting a managerial and professional advisory role.

The service uses a holistic approach to care that reflects the ethos of PBS with a periodic service review (PSR) based on Dr LaVigna’s work. The PSR identifies the main person-centred values of the PBS model and provides a quality assurance system to ensure their implementation.

The service has been successful in providing high-quality care to clients, which has been reflected in the consistently good grades awarded by the Care Inspectorate. It is currently ranked as grade 6 for all themes, including Leadership, Care & Support, and Staffing.

For more information, contact Lorraine Kirkaldy at: lorraine.kirkcaldy@nhs.net