Leading change

A Learning Disability (LD) Nurse Consultant established a nursing forum at North Staffordshire Combined Healthcare NHS Trust, which has improved communication across the directorates, staff confidence and experience.

Where to look

NICE (2018) highlight that people with learning disabilities are now living significantly longer. Emerson and Baines (2010)  have reported, as well as others, that people with learning disabilities have poorer health than people without a learning disability and have differences in health status that are, to an extent, avoidable. The health inequalities faced by people with learning disabilities in the UK starts early in life and can be a result of barriers they face in accessing timely, appropriate and effective health care.

As they grow older, people with learning disabilities have many of the same age-related health and social care needs as other people, but they also face specific challenges associated with their learning disability. Many people with learning disabilities, especially those with milder disability, are not known to health or social services (Public Health England, 2013) and some may find it difficult to express their needs and be heard. Management of their needs can therefore be more complex than for other populations. This can create substantial pressure on services, which has not yet been fully quantified.

The Nurse consultant at North Staffordshire Combined NHS Trust noted that there was only one senior nurse representing the Learning Disability (LD) directorate at a Trust-wide nursing network group and this meant that good practice was not always shared widely across the directorate. Communication between frontline, clinical nurses and senior nurses within the organisation and the Trust-wide network was variable, often meaning nurses were working in silos within individual teams. This presented an opportunity to work differently to reduce unwarranted variation in practice.

What to change

A detailed review of current practice at the Trust identified that there was no formal continued professional development (CPD) pathway for learning disability nurses within the Trust. It also identified that practice, pathways and available resources within the Trust wasn’t always shared and discussions at the Trust-wide group didn’t always filter to the staff working on the frontline or back up to the group. Evidence-based practice was being applied effectively in some areas but not in others, and there was an interest in increasing evidenced-based practice and nurse-led research amongst the nursing workforce in learning disability services locally. The nurse consultant saw an opportunity to introduce a LD nurse forum so that staff could effectively engage and drive forward consistent practice across the Trust.

How to change

The LD Nurse Consultant, with the support of administrative staff sent an invitation to all nurses working in the directorate to attend the newly formed LD nursing forum, which is directorate wide.

The purpose of the forum is to:

• Provide nursing leadership to support the on-going development of safe, high quality, clinical services within the directorate;
• Provide a framework for professional communication across the nursing workforce within the LD directorate;
• Share information more effectively from the Senior Nurse Network, which facilitates greater involvement in Trust-wide nursing strategy and issues;
• Provide a platform to build and strengthen nursing leadership;
• Provide a framework for the nursing and care workforce to deliver and embed the 6Cs, the Trust vision and values under the transforming care agenda, and modernising Specialist Health LD Services; and,
• Encourage positivity.

At each meeting, a contemporary piece of LD nurse research is reviewed and evaluated, which has supported nurses to become more confident at reading and reviewing research for implementation in their practice. The group have also developed a CPD pathway specifically for LD nurses within the directorate focussing on clinical, nursing leadership and management development. The meeting is also used to share good practice within the directorate teams and provide peer support and challenge to ensure developments are efficacious.

The forum meets bi-monthly and there is now interest to develop these forums in other directorates to enable more effective communication throughout the Trust.

Adding value

Better outcomes – 25% of nurses in the directorate now attend the forum and have been regular attendees since it was set up. There is generally representation from each of the 5 directorate teams and there is now a clear CPD pathway for nurses working in the LD directorate, and better communication across the directorate and the Trust. Evidence based care is now routinely shared across the organisation.

Better experience – Nurses report they feel more supported in their role, have the opportunity to develop and can use the group to raise areas of interest, concern or ideas for further development. They also report feeling increasingly empowered which suggests the forum has helped to strengthen their professional identity, giving them confidence to implement evidence based practice.

Better use of resources – Team representation has allowed information to be shared more efficiently and equally across the teams, reducing delays and duplication which is positive. Good practice is shared for adoption in other areas and any issues are discussed and resolved as a team which has had a positive impact across the Trust.

Challenges and lessons learnt for implementation

Although simple in concept, the forum can be used as a platform for empowering nurses to feel confident in their practice and to share good practice more widely as well as driving forward change.

There were challenges in ensuring a good cross section of nurses attended the forum, to represent all teams within the directorate. Similarly, effort was needed to create the time and opportunity outside of the forum to develop some of the items and initiatives identified.

For more information contact

Jacquie Shenton
Nurse Consultant – Learning Disability
North Staffordshire Combined Healthcare NHS Trust
jacquie.shenton@combined.nhs.uk

Julie Anne Murray
Deputy Director of Nursing, AHP and Quality,
North Staffordshire Combined Healthcare NHS Trust
JulieAnne.Murray@combined.nhs.uk