Strengthening the Commitment: Living the commitment

1 Our vision

When Strengthening the Commitment was published in 2012 it set out a clear agenda to meet the challenge of making sure that people with learning disabilities across the United Kingdom had the high quality support from learning disability nurses that they deserved, needed and were entitled to in modern, 21^st century health and social care services. Learning disability nurses had the opportunity to implement this agenda and to take their services forward to a new level: in the past three years they have seized that opportunity with both hands.

The population of people with learning disabilities is increasing across the UK. There are approximately 1.5 million people in Britain living with learning disabilities (Learningdisabilities.org.uk). Demographic projections suggest that the numbers of people with learning disabilities will increase by 14% by 2021 as many more children born with a learning disability live longer, more fulfilled lives into adulthood, and the increasing adult population of people with learning disabilities grows into older age. Yet we continue to have evidence that people with learning disabilities experience significant health inequalities and are dying at a younger age than people without learning disabilities.

People with learning disabilities

• Have poorer health than the general population
• Are more likely to need hospital services compared to the general population [26% compared to 14%] (Beacock et al., 2015)
• 97% of people with a learning disability who die had one or more long-term or treatable health condition (Heslop et al., 2013)
• Have difficulty accessing and using general health services
• Are 58 times more likely to die aged under 50 than other people
• Men with learning disabilities die, on average, 13 years sooner than men in the general population (Heslop et al., 2013)
• Women with learning disabilities die, on average, 20 years sooner than women in the general population (Heslop et al., 2013)
• 43% of deaths of people with learning disabilities were unexpected with repeated problems of delayed diagnosis, poor identification of needs and inappropriate care (Heslop et al., 2013)

Strengthening the Commitment recognised that the role and profile of learning disability nursing had changed significantly over the previous three decades and that the workforce had become widely distributed across the health and social care sector.

The values and principles that are important to people with learning disabilities, their families and carers and which were spelt out in Strengthening the Commitment continue to underpin learning disability nursing. The challenges set out remain as true today as three years ago and there are now new and emerging challenges that need a renewed, fresh focus to make sure we are responsive to the needs of people with a learning disability, and their families and carers while continuing to strengthen the learning disability profession.

Four clear challenges were identified to support the development of learning disability nursing:

• Strengthening capacity
• Strengthening capability
• Strengthening quality
• Strengthening the profession.

We knew that the actions required of the profession were considerable, that they would be taking place in a time of recession, uncertainty and increasing diversity across the four UK healthcare systems. As this report will demonstrate, UK government health departments, employers, educators, people with learning disabilities, their families and carers, learning disability nurses, students and wider health and social care staff have all risen to the challenges and are now delivering a significantly improved, person-centred and imaginative service for people with learning disabilities.

For example, the health and social care organisations in England are delivering a major programme to transform the care of people with learning disabilities. This includes a commitment to redesign care models and services which reduce the need for patient beds and support people in a place they call home. As part of this work new staffing models will be developed and the role of the registered learning disability nurse will be vital to ensure safe, compassionate and competent care in whatever setting.

This report celebrates the achievements made in the past three years and the positive impact that learning disability nurses have on health outcomes. The examples of positive practice in this report have been chosen to be representative of the wide range of innovative work that is taking place in all four countries. There are numerous examples of innovations and developments across the whole UK and the Fact File provides brief information of many of these. We hope that you will find these examples inspiring and useful as you work to improve learning disability services for some of the most vulnerable people in our society.