Strengthening The Commitment: The Report of the UK Modernising Learning Disabilities Nursing Review

Executive summary

The issue

There are approximately 1.5 million people in Britain living with learning disabilities.^A That number is likely to grow by 14 per cent between 2001 and 2021^B as advances in science and care mean many more children with learning disabilities live longer, more fulfilled lives than has ever been the case before and the increasing adult population of people with learning disabilities grows into older age. While this is very welcome, the governments of the four countries of the UK must be sure their health and social care systems are ready for the changing health needs of people with learning disabilities.

Learning disabilities nursing has always had a major input into the health of people with learning disabilities, their families and carers, and demand is likely to grow. However, as a result of changes in societal attitudes to people with learning disabilities and to their care, learning disabilities nurses have become geographically dispersed within a range of public and independent sector providers and are employed in a variety of roles. The overall number of learning disabilities nurses has consequently decreased over time, with many now nearing retirement.

What we want to achieve

The UK Modernising Learning Disabilities Nursing Review wants to ensure that people with learning disabilities of all ages, today and tomorrow, will have access to the expert learning disabilities nursing they need, want and deserve. That requires a renewed focus on learning disabilities nursing and may require service and strategic investment in building and developing the workforce. The review aims to set the direction of travel for learning disabilities nursing to ensure we can meet current and future demand and that the workforce is ready and able to maximise its role throughout the entire health and social care system. We also want to ensure the best staff experiences and career opportunities for learning disabilities nurses and, most importantly, the best experience of support and care for people with learning disabilities, their families and carers.

The review makes a number of detailed recommendations (seen throughout this report and summarised in Table 2) that are about "strengthening the commitment" to learning disabilities nursing across the public sector. Underlying them are four clear organising principles for supporting reform.

Strengthening capacity

Accurate information on where learning disabilities nurses are working both within and outside the NHS is important for workforce planning and to ensure education programmes remain relevant. Further work is required across the four countries to scope the workforce, including those working in the independent/voluntary sector and in social care, so that strategic workforce development plans are developed and enacted. There should be a clear statement about what we want from learning disabilities nurses going forward and they should be enabled to plan their career development to meet the needs of people with learning disabilities now and in the future.

Strengthening capability

The values base for learning disabilities nursing remains strong and we should ensure that systems retain and reinforce attitudes and abilities to deliver person-centred and strengths-based approaches. At the same time, skills, knowledge and competencies are changing and must be extended to reflect the changing needs of people with learning disabilities.

Evidence clearly shows that people with learning disabilities have poorer health than the general population. In addition, many have difficulties accessing and using general health services. Learning disabilities nurses have an important role to play in supporting timely access to services, as well as contributing to preventative and anticipatory care.

Strengthening quality

All four countries are currently engaged in significant programmes of system transformation, efficiency and quality improvement. Learning disabilities nurses must embrace that movement and consider how they can demonstrate impact through measurable outcomes and evidence-based interventions that improve safety, productivity and effectiveness alongside traditional person-centred approaches.

A well-prepared, developed and supported workforce at all levels (including nonregistered staff) is essential to the delivery of quality health care for people with learning disabilities and education and training throughout the career pathway is key to achieving this.

Strengthening the profession

Strong leadership will be crucial to ensuring the recommendations from this report are taken forward and that existing networks for learning disabilities nurses across the UK continue to provide a powerful platform from which to celebrate, promote and develop their unique contribution. These have tended to be developed mainly for NHS staff, so a key step is for the learning disabilities nursing profession to embrace members from all sectors to create a critical mass of leaders working together to effect change and advocate for the profession and those they serve.

The way forward

We do not underestimate the challenge this will present. All this will take place in a time of recession, uncertainty and increasing diversity across the four UK health care systems. However, the demographic factors set out above cannot be ignored, and that's why high levels of commitment and engagement from key players are needed. UK government health departments, employers, educators, people with learning disabilities, their families and carers, learning disabilities nurses and wider health and social care staff are all crucial to its success.