The trend in student numbers has now had enough time to stabilise, and the impact on the learning disability nursing workforce doesn’t look good: Health Education England recently highlighted a 50 per cent fall in the number of people applying for the pre-registration training programme between 2016 and 2018, risking a shortage of staff in the future. In 2017, the number of students accepted on to learning disability courses was just 350. For comparison, in acute nursing, numbers of applicants have continued to rise, and employers can expect a new supply of staff over the next few years (even if it’s not going to be enough to cover all the vacancies they already have). Health Education England doesn’t see the risk of significant staff shortages as a distant threat, it thinks the shortage in learning disability nursing graduates coming through will be a risk from 2020. Next year.
That’s bad news, and there’s no slack in the system as it is. As the Royal College of Nursing pointed out recently, the number of people in learning disability nursing roles has fallen by nearly 60 per cent since 2009 (in comparison, the number of acute adult nursing staff has increased by 9.8 per cent over the same period). Part of this may reflect the welcome move away from inpatient care, but the number of people working in the community has also fallen, by nearly 25 per cent over the same period. The NHS long-term plan included a number of welcome commitments to improve services for people with learning disabilities and autism but the issues around recruitment and training must be addressed if these pledges are to be met.
These shortages matter because nurses are vital to addressing the needs of people with learning disabilities using the NHS. We’ve known for several years that the NHS needed to work across the country on several different areas of care for people with learning disabilities, including sepsis and cancer care. At the same time, we’ve seen several scandals that exposed terrible abuse in learning disability care. Even without discovering the true extent of how bad the care being provided at Whorlton Hall was, the Care Quality Commission identified the use of agency staff and a lack of supervision as key issues at its last inspection before Panorama exposed the full extent of the scandal unfolding there.
It’s a gloomy outlook, but the issue does seem to be getting traction. During the Conservative Party leadership campaign, Matt Hancock talked about making changes to the nursing bursary, ‘especially in the areas of shortage we have’. He is now in a position of power to argue for such change having returned to the role of Secretary of State for Health and Social Care. There’s also a commitment to ‘promote’ roles in learning disability nursing in the Interim NHS people plan, along with improving access to training via apprenticeships. Health Education England’s July board papers confirm plans to expand apprenticeships along with other routes into learning disability nursing by more than 4,000 places over the next three years.
There are other moves afoot to boost training numbers. Simon Stevens, chief executive of NHS England, declared bursaries as being ‘back in play’ at our Leadership summit in July, while the government has yet to respond to the Augar Report, which called for the reintroduction of the maintenance grant for disadvantaged students, the removal of which was identified by Health Education England as one of the reasons for falling student numbers (remember that the bursary and maintenance grant are two separate things – the bursary covered the student fees of anyone undertaking a nursing course, while the maintenance grant would provide assistance with living costs to those most likely to need it). This a key issue for prospective students. As learning disability nursing trainees are often mature students, they may have family commitments and will likely already have experience as a clinician or care provider; for them, the idea of taking on thousands of pounds of debt is much more intimidating than it might be for younger candidates, such as the typical acute nursing trainee.
The longer that courses continue with unfilled places, the more likely it is that universities will reduce the number of learning disability nursing places they offer. We’ll post our analysis of these trends in December once UCAS has published the latest data on acceptances onto nursing courses. Returning the number of people training to become learning disability nurses to sustainable levels is key to protecting vulnerable service users and providing the quality of service the NHS wants to achieve. As Simon Stevens said recently: ‘If I had a learning disability, first and foremost, I’d want to be seen by a learning disability nurse.’