Learning disability nursing ‘on a cliff edge’
Learning disability nursing is at risk of complete collapse due to a lack of people going into the specialty, nurses have warned.
The threat facing learning disability nursing was a key topic highlighted at the Royal College of Nursing (RCN) Congress 2024, held in Newport this week.
“We cannot allow our branch to be phased out, our patients need us”
Holly Turner
Katy Welsh, chair of the RCN learning disability nursing forum, warned: “Clearly learning disability nursing is facing a cliff edge.”
It came as new RCN analysis revealed that only 405 new student learning disability nurses were accepted onto pre-registration courses in England in 2023.
This represented a 26% decrease from the previous year and a 36% fall from 2015, with the RCN warning that the picture was “even more shocking on a regional level”.
There were only five acceptances onto learning disability nursing courses in the South East in 2023 and 10 each in the South West and the East of England.
Overall, just 2% of all nursing course acceptances across the four specialties were for learning disability courses in 2023.
The decline in students is mirrored by a drop in nurses in the workforce.
Further RCN analysis showed a 44% decline in the number of learning disability nurses in the NHS in England between September 2009 – when records began – and January 2024, from 5,553 to 3,095.
Speaking at RCN Congress, Ms Welsh noted that out of the more than 130 schools of nursing and midwifery across the UK, only 32 were registered to provide learning disability nursing courses.
Furthermore, of those 32, two courses in England had recently been discontinued due to a shortage of applications.
The closure of these courses continued a “trend” being seen in recent times of learning disability programmes being lost, noted Ms Welsh.
In terms of potential reasons for the decline, Ms Welsh cited the axing of the student nursing bursary in England making it financially inviable for people to study.
In addition, she said learning disability care scandals such as those at Winterbourne View, Whorlton Hall and Muckamore Abbey Hospital had a “negative impact on how learning disability nurses and nursing are perceived”.
Meanwhile, Ms Welsh said there were “myths” about learning disability that could be putting people off entering the profession, including the idea that learning disability nurses are “not proper nurses”.
“We have myths around learning disability nursing that need to be debunked, including the example where people are told there is no future in learning disability nursing – this couldn’t be further from the truth,” she said.
“The population is living longer with more presenting with multiple complex health needs; our knowledge and skills as registered learning disability nurses has never been more demand.”
At congress, Ms Welsh put forward a matter for discussion on whether updating the title of ‘registered nurse in learning disabilities’ might help address the challenges being faced by the specialty.
The current title has been in use since the 1990s, but before this it was updated around every 30 years to reflect changes in social values, language and clinical practices.
For example, Ms Welsh noted that previous names for the specialty included mental deficiency nurses, mental subnormality nurses and mental handicap nurses.
She said: “The RCN has been campaigning about the decline in learning disability nurses since 2016.
“And whilst there has been some positive action to address this across the UK, the decline in numbers persists.
“If we really want to preserve the field of learning disability nursing, it’s time to think radically. Would changing our title reflect the current populations we serve?”
“We have myths around learning disability nursing that need to be debunked”
Katy Welsh
In the discussion that followed, it was noted how learning disability nurses cared for a wider range of people than those with a learning disability, such as those with autism and other ‘neurodivergent’ conditions.
Basil Ogbu, an RCN member from the Eastern region, suggested that “developmental care nurse” or “specialist support nurse” could work as alternative titles.
While agreeing that updating the title could be beneficial, Holly Turner, a learning disability specialist nurse working with children, also from the Eastern region, warned that more steps would be needed to address the “collapse” in the specialty.
She said: “The discussion, I think, has to go much deeper than that.”
“My main concerns are we’re highly specialist and there are limited opportunity for progression,” added Ms Turner.
“There aren’t enough of us despite overwhelming evidence of our worth, and our patients are still dying unnecessarily.”
She and others during the debate cited evidence from the latest Learning from lives and deaths – people with a learning disability and autistic people (LeDeR) report, which found that 42% of deaths of people with a learning disability in 2022 were avoidable.
The report also showed that women with a learning disability were still dying, on average, 23 years younger than women in the general population, and men with a learning disability were dying 20 years younger.
Ms Turner added: “People with a learning disability are losing their lives due to inaction, when is this ever acceptable?
“Poor quality healthcare causes avoidable deaths and we need to address this urgently.”
She said evidence showed that the presence of learning disability nurses in acute settings “dramatically improves outcomes and experience” – but a third of NHS trusts had none in post and there was no out-of-hours access to these nurses.
Meanwhile, she said the university where she trained was one of those that had dropped its learning disability nursing course.
“We need to address the collapse of LD nursing and potentially this does mean changing our title to reflect the broad scope of our practice,” said Ms Turner.
“But it can’t be the only step; we need mass recruitment, funding and an expansion of [university] places just as a start.
“We cannot allow our branch to be phased out, our patients need us.”
However, nurses in the debate agreed that no changes should be made to the learning disability nursing title without the involvement of people with learning disabilities.
High-profile learning disability nurse Jim Blair, who is chair of the RCN London board, said: “My view and the views of people with learning disabilities is, well, they’re not in the room to discuss this.
“Should we change [the title]? No, we shouldn’t change or discuss change without them.”
