Learning disability nursing is at risk of collapsing completely due to a shortage of people entering the profession, nurses have warned.
The threats facing learning disability nursing were a key topic highlighted at the Royal College of Nursing’s (RCN) 2024 conference, held in Newport this week.
“We cannot allow our branches to be phased out. Patients need us.”
Holly Turner
Katie Welsh, chair of the RCN Learning Disability Nursing Forum, warned that “learning disability nursing is clearly on the brink”.
It comes after new analysis from the RCN revealed that just 405 new learning disability nurses were accepted onto pre-registration courses in England in 2023.
This represents a 26% decrease on the previous year and a 36% decrease compared to 2015, and the RCN warned that “the situation is even more shocking at regional level”.
Just five people have been accepted onto learning disability nursing courses in the South East in 2023, while the South West and East of England have 10 each.
Overall, only 2% of nursing courses accepted in 2023 across the four specialties were learning disability courses.
The decline in student numbers is reflected in a decline in the number of nurses in the workforce.
Moreover, the RCN analysis found that between September 2009, when records began, and January 2024, the number of learning disability nurses in the NHS in England fell by 44%, from 5,553 to 3,095.
Ms Welsh pointed out at the RCN conference that of more than 130 nursing and midwifery schools across the UK, only 32 are registered to offer learning disability nursing courses.
Furthermore, of the 32 courses, two in England had recently been cancelled due to a lack of applicants.
Welsh noted that the closure of these courses is a continuation of a recent “trend” of losing learning disability programs.
Welsh said a potential reason for the decline was the end of scholarships for nursing students in England, making it financially impossible for people to continue their studies.
Moreover, she said learning disability care scandals at hospitals such as Winterbourne View, Walton Hall and Muckamore Abbey Hospital had “had a negative impact on the perception of learning disability nurses and nursing”.
However, Ms Welsh said there were “myths” about learning disabilities which could deter people from entering the profession, including the idea that learning disability nurses “are not suitable nurses”.
“Myths about learning disability nursing need to be dispelled, including examples such as being told there is no future in learning disability nursing, which couldn’t be further from the truth,” she said.
“With the population living longer and more people having multiple and complex health needs, our knowledge and skills as learning disability qualified nurses are in demand now more than ever.”
Ms Welsh presented the council with a matter for discussion on whether updating the title of “learning disability registered nurse” would help address the challenges facing the specialty.
The current name has been in use since the 1990s, but before that it was updated approximately every 30 years to reflect changes in societal values, language, and clinical practice.
For example, Welsh noted that previous names for the specialty included mentally deficient nurses, mentally abnormal nurses and mentally handicapped nurses.
She said: “The RCN has been campaigning since 2016 about the decline in learning disability nurses.
“Despite some positive efforts being made across the UK to tackle this issue, case numbers continue to fall.
“If we really want to protect the field of learning disability nursing, it’s time to think radically – will a name change reflect the people we currently serve?”
“Myths about learning disability nursing need to be dispelled.”
Katie Welsh
In the ensuing discussion it was noted that learning disability nurses care for a wider range of people, including those with autism and other “neurodiversity” conditions, rather than just those with a learning disability.
Basil Ogbu, RCN member for the Eastern Region, suggested that “developmental care nurses” or “specialist support nurses” could be used as alternative names.
Holly Turner, a learning disability nurse who works with children from the east, agreed that updating the names would be beneficial but warned that more was needed to tackle the “fragmentation” of the specialty.
“I think the discussion needs to go much deeper than that,” she said.
“My main concern is that we are highly specialised and have limited opportunities for advancement,” Turner added.
“Despite overwhelming evidence of our value, there aren’t enough of us and our patients still die unnecessarily.”
She and other debate participants cited evidence from the latest Learning from Life and Death – People with Learning Disabilities and Autism (LeDeR) report, which found that 42% of deaths of people with learning disabilities in 2022 were preventable.
The report also found that women with learning disabilities die on average 23 years younger than women in the general population, while men with learning disabilities die 20 years younger.
Mr Turner added: “People with learning disabilities are losing their lives because of inaction – how can this be allowed?”
“Poor quality care causes avoidable deaths and we need to act urgently.”
She said there was evidence that having a learning disability nurse in acute facilities “dramatically improves outcomes and experiences”, but a third of NHS trusts did not have such nurses or had access to them out of working hours.
Meanwhile, she said the university where she trained was one of the universities that scrapped its learning disability nursing course.
“The collapse of LD nursing needs to be addressed and this may mean changing our name to reflect the broader scope of our practice,” Turner said.
“But that’s not the only step. There’s a lot of hiring, funding, [university] The location is just the starting point.
“We cannot allow our branches to be phased out. Patients need us.”
However, nurses who took part in the discussion agreed that changes to the title of the learning disability nursing position should not be made without the involvement of people with learning disabilities.
Jim Blair, a prominent learning disability nurse who chairs the RCN London board, said: “The view of people with learning disabilities, and my view, is that, well, they are not at the table when it comes to this.”
“Should we change? [the title]”No, we shouldn’t make changes or discuss changes without them.”