Services on the cheap?

Right, after proclaiming that there was no open chequebook for learning disability services in the last blog, I’ll now contradict myself and argue that ‘doing it on the cheap’ is going to ruin LD services over the next 20 years.

It’s also going to ruin my profession, which may indicate a degree of self-interest in all this, but bear with me. The Government White Paper: Valuing People directed Local Authorities and PCTs to, amongst many other things of course, close NHS beds. Not just ‘hospital’, large establishment beds, but all NHS beds.

This was a good move. People with learning disabilities are, of course, not intrinsically unwell, they are not ‘ill’ and do not require the NHS to provide them with a home. There is a higher incidence, especially for people with severe learning disabilities, of associated health needs. But, just as for you (assuming, presumptuously, that you dear reader have no disability yourself, apologies) or I, those needs need not determine where someone lives, and who runs it.

The lead role, therefore, has been handed to Social Care Providers (SCPs), Private Organisations (POs) and Charitable Organisations (COs): more appropriate services to be supporting the living arrangements of people with learning disabilities.

However, the NHS has been providing learning disability services for decades, and not all in hospital based units. Indeed, the NHS has done as much as SCPs, POs and COs in leading the way with, formally, Normalisation and latterly Person Centered Planning and, not ironically at all, Valuing People.

Within those services there were 100s, 1000s of staff, some with formal qualification, some without.

Now, with all honesty it’s the formal qualification element that concerns this blog. Learning Disability Nurse (RNLD) have a unique place in what will be the history of Learning Disability Care. Over 3 years their training takes in all aspects of potentially necessary care, from Staff Management to Drug Administration, from Behavioural Management to Gastrostomy Care and from Communication to Ethical Issues. It provides them with such a range of skills and background knowledge, that, post-qualification, they are well equipped to support people with a Learning Disability and the huge and varied types of needs they may have.

So far, so good for my CV. The point I am making is; that it is, or bloody well should be, a wonderful qualification for anyone supporting, and leading the care of, people with Learning Disabilities. There are thousands of us around the country with years and years of experience, and, significantly, many experiences of going through, and indeed leading, change. We’re not ‘Nurses’ in the Holby City sense, don’t go around in uniforms, and, the occasional pre-occupation with bowel movements apart, dispensed with a medical model approach decades ago.

But we’re in a difficult, incongruous, position. The NHS are leaving Learning Disability care; either by moving from being providers to commissioners, or to being neither. We are a difficult fit within new philosophies of care, by our own agreement, service/homes for people with a Learning Disability are not a health provision, so how does an NHS trained, Health Professional remain within them?

But there’s another, less complex and philosophically less challenging, issue involved. We’re expensive: twice as much as per hour as an experienced, NVQ-trained, Medication-trained Support Worker. And what do we offer that they don’t? On paper, when you’re costing a new service? When, in all honestly, you don’t want to accept, or understand, or appreciate what we can do?

The reality is that the persuasive combination of philosophy and cost, has meant that the new organisations and services that are now providing Learning Disability care, have been reluctant, or indeed downright hostile, in regard of employing Learning Disability Nurses.

And the consequence of this? Not just trained professionals losing a career, that’s sad, but not the main casualty. People with a Learning Disability are losing expertise, losing people with knowledge, experience and skills and I believe their care will suffer as a consequence.

Is there a 3-year non-NHS training course and subsequent profession to replace it? There does not appear to be (although the NHS is training more Learning Disability Nurses, for some reason) do people with the range and complexity of need that many with Learning Disabilities have, not deserve specifically and comprehensively trained professionals supporting them?

More than the philosophy of future service provision, the driving force behind decisions around skill mixes is money. Now, as I said in the first paragraph, my sentiments in this blog may seem at odds with my first, so I shall explain. Cost-effective services are a necessary evil, but there’s a line that needs to be drawn. Ensuring that money isn’t wasted, that available budgets are used effectively and that resources are allocated appropriately is one thing. Providing services on the cheap is something else, denying people with Learning Disabilities suitable skilled and trained professionals is not being cost-effective, it’s under-estimating the quality of care they require and deserve.

I could continue and could have gone into greater detail, but I must remember this is a blog and, well, I struggle with brevity. Maybe more for another blog. The next, however, will be about language; the thorny subject erroneously labelled ‘political correctness’ and about how my heroes let me down….


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