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20th November 2014

I’m one – are you?

cute female nurse writing on schedule at workMencap has warned of a shortage of specialist nurses trained to care for people with learning disabilities, which they say is putting the lives of thousands of vulnerable people at risk.

A long time ago in a different world, I and many other earnest young people were launched into the world as newly-qualified learning disability nurses. Back then in the Dark Ages we were given the title Registered Nurse, Mental Handicap (RNMH). For those of you who feel uncomfortable with this title, you should know that we were the first wave of MH labelled nurses; our predecessors just 6 months before had borne the title of Registered Nurse, Mental Subnormality.

Big Changes for the profession

During our three-plus years of training we had been in a vanguard of nurses who were moving out of hospital-only experience with our client group and learning to operate in a world where people with learning disability did not necessarily live in long stay institutions.

I seriously doubt that at the time any of us realized that this would be the slow death of our profession.

Now, before you get all righteous on me, I do not for a moment suggest that we should not have moved away from the hospital model of care and support for people with learning disability. Absolutely not. But one of the consequences of pushing a social model of care back in the 1970s has been the demise of the role of nurses in learning disabilities and now we are seeing the negative outcome for people’s wellbeing.

Missing the point?

When we recognised that people with a learning disability were not sick, we forgot to recognise they had specific needs when they became sick. We forgot that the majority of general practitioners (The G in GP is a clue here) do not understand that some patients cannot explain or describe their pain easily. We forgot that not everyone can understand the reminder letters to attend clinics, check ups, flu jobs and dentists. We neglected to remember the number of co-morbidities associated with some genetic conditions like Down Syndrome. We took our eyes off the ball.

I work with some of the most insightful, bright, committed social care professionals in the business, but at no point in their training did they touch on the specific health needs of the people they would be working with. It was assumed that the rest of the NHS could pick this up. But this was at a time when the rest of the NHS were struggling to pick up the problems people were presenting them with, let alone the ones growing hidden under the surface.

Where does that leave us?

Mencap reports that no NHS hospital in England has 24-hour learning disability (LD) nurse cover and more than 40 per cent of NHS trusts do not even employ a single LD nurse. NHS workforce figures show that there has been a 30 per cent cut in the number of LD nurses employed in the health service over the past five years.

When I go to teach student LD nurses I am at pains to boost the importance of the role they will have in securing good health and access to care for the people they will be supporting. I am always dismayed that I seem to be one of very few people telling them this.

Every year, three people a day with learning disability die needlessly. Mencap is asking the government to ensure that every NHS hospital has dedicated learning disability liaison nurses.

The coalition Health minister Norman Lamb "strongly shared Mencap's view that the NHS has to change". He said: "We've commissioned more student places for learning disability nurses, and we are working to encourage more people to consider this as a career path."

Well he had better get a move on. We dinosaurs are at risk of disappearing.

Ginny Tyler – QCS Learning Disability Expert Contributor

(Apparently now an RNLD)


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