Progress Report 2012/2013

Wales

Strengthening the Commitment (Scottish Government et al, 2012) is the report arising from the Modernising Learning Disabilities Nursing Review that was undertaken 2011 – 12. This review was initiated by Ros Moore, Chief Nursing Officer for Scotland on behalf of all the UK CNOs and involved people with learning disabilities, their families, learning disability nurses and other practitioners from across the UK. The report was formally launched in April 2012.

Recent decades have seen many reports published about learning disability nursing as might be expected in a profession where patterns and location of service provision have changed dramatically since the 1970s and in view increasing life expectancy and complexity of health need amongst people with learning disabilities. However, this most recent review of the profession was initiated in response to concerns that numbers of learning disability nurses were reducing whilst client need was increasing and that there had been a loss of focus and direction within this field of nursing practice.

What sets this report apart from previous reports is that not only does it make a series of recommendations but that structures to ensure implementation have been established at UK, national and local levels. Accordingly progress towards these recommendations is being monitored and this current document sets out progress within Wales to date (2012 –13). Each recommendation will be presented along with evidence of progress and also activities identified as the next steps. First, however, it is important to clarify how the implementation structure has been established within Wales.

Implementation within Wales

Strengthening the Commitment (Scottish Government et al, 2012) was launched in Wrexham in June 2012 at an event attended by the then Health Minister Lesley Griffiths AM. At this event a meeting was held to establish the All Wales Implementation Group that then had its first full meeting in December 2012. This group is chaired by Professor Ruth Northway and has membership from each of the Health Boards, three HEIs and the independent sector. To date the group have met on three occasions and are due to meet again in September 2013. The way of working established by the group is to have key goals identified for each meeting (relating to the recommendations) with information being collated between meetings in preparation for this discussion.

This group has representation at the UK implementation level through Jen French and Ruth Northway. Each Health Board has also established a mechanism for implementation at a local level (format dependent upon existing structures) and people with learning disabilities are involved in these processes both within the Health Boards and the HEIs.

Since the initial launch event in June 2012 two stakeholder events have been held in Llandrindrod Wells – one in November 2012 and the second in March 2013. These events have primarily been attended by nurses but some family members also came to the first one.

The following section of the report sets out the recommendations arising from Strengthening the Commitment (Scottish Government et al, 2012) and under each recommendation an indication of activity to date within Wales is provided along with the next steps to be taken.

1. The four UK health departments and the independent/voluntary sector should establish a national collaborative to enable better understanding of, and planning for, a high-quality and sustainable registered learning disabilities nursing workforce across all sectors.

Progress to date:

· Work is being undertaken by the Learning/ Intellectual Disability Nursing Academic Network to determine the number of places being commissioned for LD nursing across the UK and to note any trends.

· Within Wales the placements commission for LD student nurse places has increased in both the University of South Wales and Bangor University.

· Within Aneurin Bevan Health Board an issue in relation to workforce numbers over the coming 5 – 10 years has been identified and a succession planning programme has been instigated.

· Within BCUHB requirements are currently being reviewed within the context of a wider, Service review involving key stakeholders

· An independent sector network has been developed at a UK level and Welsh representation within this network has now been agreed.

Next steps:

· To improve data collection regarding learning disability nurses within the independent, voluntary and charitable sectors.

2. Systems to collect workforce data are required in each country, with links across the UK, for workforce planning for future provision of learning disabilities nursing. These should be able to capture information on service provision, educational and research requirements and should cover the independent/voluntary sector.

Progress to date:

· Within Wales a survey has been circulated to determine the number of RN(LD)s, their location and nature of employment, qualifications and age profile. This is a repeat of a previous survey conducted within Wales and will therefore allow for comparisons. For the first time, however, efforts have been made to engage the independent sector in this process. A specific process of trying to identify and target RNLD’s working outside of the Health Service is currently underway in order to obtain the most complete mapping possible. To date 271 responses have been received of which 19 are from RN(LDs) working outside the NHS in the independent sector, HEIs and charities.

· Hywel Dda Health Board has an integrated workforce plan which informs educational commissioning numbers annually. This includes a risk assessment of the age/gender profile. The priority of the LD service modernisation process is to focus on the Mental Health (Wales) Measure whilst considering the workforce profile against the clinical services strategy.

· BCUHB Mental Health & Learning Disabilities Clinical Programme Group have developed a workforce plan that links to identified strategic priorities

Next steps:

· To adopt a range of strategies (including contacting housing providers) to try and identify as many RNLDs as possible living in Wales and encourage them to complete the survey. A cut of date for receipt of responses has been set as the beginning of December 2013

· To gather data regarding first employment destination of newly qualified RNLDs.

· To make workforce planning a specific agenda item for discussion by the All Wales group once data from the survey has been collated.

· To monitor the impact of the integration agenda on RNLDs

3. The development of new, specialist and advanced role opportunities should be considered in light of workforce planning, service development and education provision. In particular, this should focus on the roles of non-medical prescribing, psychological therapies and telehealth and in specific settings such as the criminal justice system, mental health services (particularly dementia) and autism services.

Progress to date:

· An initial mapping of specialist roles across Health Boards has been undertaken with a distinction being made between those who meet the Welsh Government requirements in relation to nurse specialist posts and those for whom an area of specialism is identified within their job title.

· The numbers meeting the requirements of nurse specialists is limited within Wales. In terms of areas of specialism being identified these include epilepsy, health liaison, dysphagia and behavioural support.

· BCUHB have been looking to develop specialist roles within identified areas (e.g. the development of Acute Liaison Nurse posts within the 3 DGHs, Mental Health Liaison Nurse and a recently developed Approved Mental Health Practitioner (AMHP)

• Following All Wales collaboration to develop the application for funding a MacMillan Specialist Nurse has been appointed to improve links between learning disability and cancer care services. Whilst based within Hywel Dda the post has an all Wales remit.
• An MSc Professional Practice is currently offered by the University of South Wales and within this it is possible to follow either a Learning Disability or Vulnerable Person Pathway. A module focussing on autism is available within this programme.

Next steps:

· The Macmillan Specialist Nurse post will commence in September and working with a steering group, the initial goal is to identify services and service deficiencies and then to prioritise areas for development. The project aims to fully involve people with learning disabilities and their families/carers when planning developments to ensure person centred approaches to cancer care are delivered.  This three year project will be formally evaluated by the University of South Wales and an initial report will be included in the 2013-14 Strengthening the Commitment Annual Report.

· To support increased numbers of LD nurses to undertake study at MSc level in order to facilitate achievement of the educational requirements specified by the Welsh Government for specialist roles.

· To identify the extent of need for diploma and first degree level courses to meet the needs of nurses who require qualifications at these levels

4. Each of the four countries should consider aligning their existing post-registration career frameworks for learning disabilities nursing to clearly articulate the knowledge and skills required by learning disabilities nurses at all levels and across all settings. These developments could be utilised across sectors (with appropriate adaptation) to give a coherent career framework

Progress to date:

· This recommendation is largely dependent on UK level activity. However, some initial activity has been undertaken in relation to post registration education within Wales.

· Some nurses are undertaking the MSc Professional Practice at the University of South Wales following either the Learning Disability or Vulnerable Person pathways

· In the north some nurses are undertaking a postgraduate taught pathway such as MSc/PgDip/PgCert Advanced Clinical practice or MSc in health and Social Care leadership available at Bangor University

· Within ABMU Health Board a process of alignment between the knowledge and skills identified as essential for posts and educational needs has been undertaken. This has included the established key skills within the Competency Framework for newly registered (BTEC in Positive Behavioural Support) for registered and non registered staff, and nurses to post – registration career Frameworks for LD nurses. This then relates to the KSF and informs personal development reviews encompassing both educational materials and assessment procedures. Learning paths which reflect Knowledge and skills needed by LD nurses at all levels and across community and residential services are therefore available.

· Also within ABMU a locally organised programme of leadership development has been delivered and evaluated. A leadership programme for Band 6 nurses has also been delivered.

Qualification Credit Framework (QCF) units are available, along with Credit Qualification Framework Wales (CQFW) units for registered and non registered staff. These credits can be used within a range of different qualification frameworks. The bespoke Accredited Learning (BTEC in Positive Behavioural Support) for registered and non–registered staff has also been re-levelled.

· Hywel Dda Health Board has developed an educational framework for all nursing staff from novice to expert; the framework is currently being signed off through the Learning & Development structure.

Next Steps:

· To use the data gathered via the survey currently being undertaken of RN(LDs) within Wales to identify the level(s) at which post registration education is required. HEIs and Health Boards will need to use this data and that gathered via personal development plans to identify priorities in terms of both subjects and levels required.

· To consider not only the topics and level of educational provision required but also to identify the most appropriate form(s) of delivery.

· To agenda the development and planning of educational provision for a future All Wales meeting

· To roll out within ABMU the leadership programmes to Band 5 nurses.

· To implement and evaluate the educational framework within Hwyl Dda

5. Commissioners and service planners should have a clear vision for how they ensure the knowledge and skills of learning disabilities nurses are provided to the right people, in the right places, and at the right time in a way that reflects the values- and rights-based focus of learning disabilities nurses' work.

Progress to date:

· The commissioned numbers of pre-registration student nurse places has increased in 2013 for both Universities of Bangor and South Wales compared with the previous three years.

· An initial mapping of pre-registration education programmes leading to RN(LD) in Wales has been undertaken to ensure that the values identified in Strengthening the Commitment are reflected within the curricula.

· Across Wales RN(LD)s are recruited to a range of different roles that encompass residential and community settings and also across sectors

· Nurses working outside of the NHS have access to the Positive Behavioural Support e-learning and other BTEC qualifications offered by ABMU HB.

· Within ABMU a work book has been created to support the development of Band 5 nurses.

Next steps:

· To undertake work to gain greater clarity regarding the staffing and educational requirements of the independent sector. This will include working with the Welsh Independent Healthcare Authority to encourage them to undertake a training needs analysis of their staff.

· To identify opportunities for healthcare assistants to gain access to nurse education

· To contact HSIW and CSSIW to identify areas where RNLDs are employed

· To determine the number of RNLDs working within the prison service and to seek to identify their training needs.

6. Commissioners and providers of health and social care should ensure the skills, knowledge and expertise of learning disabilities nurses are available across the lifespan. This should be enabled through effective collaborative working across health and social care structures.

Progress to date:

· A mapping of the core business of the learning disability services within the Health Boards has been undertaken. Unfortunately this has revealed that none of the Health Boards includes working with children and young people as part of their core business and therefore it is now extremely rare for LD nurses to work with children and young people with learning disabilities.

· In ABMU the Facing the Challenge service supports children whose behaviour challenges and their families. The team includes RN (LD) staff.

· Similarly, BCUHB’s Complex Needs Services works with children and their families and there are also several LD Nurses employed by Children’s teams across the North Wales region.

· There are some LD nurses working as school nurses and within children’s hospices but their numbers are not known.

· Within a number of Health Boards LD nurses are involved in working with young people and their families during the period of transition from children’s to adult services. Within ABMU they have a protocol specifically to support RN (LD) nurses in undertaking this role.

Next steps:

· To identify the needs of children and young people with learning disabilities within Wales and where appropriate the ability of RN(LD)s to meet these needs should be promoted. This should include promotion of the potential contribution to commissioners.

· To meet with Jane O’Kane to explore the need for RNLDs within school settings.

· To identify the needs of older people with learning disabilities within Wales and where appropriate the ability of RN(LD)s to meet these needs should be promoted. This should include promotion of the potential contribution to commissioners.

· To explore the potential of identifying the number of people with learning disabilities living in residential / nursing homes for older people.

· To contribute to the current mapping of the prison / forensic population of people with learning disabilities

7. Commissioners and providers of health and social care should ensure that learning disabilities nurses are able to collaborate effectively with general health services, including mental health services, to address the barriers that exist for people with learning disabilities to improving their health. This should include proactive health improvement, prevention, whole-family and public health approaches.

Progress to date:

· In response to an ombudsman’s report work has been undertaken to develop a care bundle and pathway for people with learning disabilities admitted to acute care settings. This is being piloted in one area

· Different Health Boards are taking different approaches to seeking to promote better access to healthcare. One HB (BC) has an established health liaison scheme and another is due to commence such a service (AB). Another HB employs a consultant nurse with a remit for this area of work.

· A post has recently been advertised within Hywel Dda HB (funded by Macmillan Cancer Care) for a post to improve collaboration between cancer care and learning disability services across Wales

· Within ABMU Health Board the increased utilisation of patient stories within the Health Board area has been extremely positive.

· Within ABMU Health Board have Community Nurses worked jointly with staff in Palliative Care to develop a pathway for people with Learning Disabilities and the Nurse Consultant is part of a group developing a Dental Pathway for people with learning disabilities.

· Health Fayres are held annually in Swansea and the RNLD’s from ABMU work collaboratively to develop these events and take an active part in the facilitation.

• Hywel Dda Health Board is currently revising its structure across the 3 counties this will include the principles of Strengthening the Commitment.
• BCUHB have a Health Liaison team which works collaboratively with primary and secondary care services in North Wales. The team provide quality checks for health screens provided by GPs and are activiely involved in rolling out individual Health Action plans. Liaison Nurse work into each of the 3 DGHs. The team have received awards for their uses of accessible information and employ a gentleman with learning disabilities as part of the team.

Next steps:

· To implement the acute care bundle across Wales

· To evaluate the liaison nurse posts in collaboration with colleagues from elsewhere in the UK

· To implement the revised service structure within Hywel Dda HB

· To implement and evaluate the dental care pathway within ABMU HB

· The mental health liaison post within BCUB will be filled

· To collect and analyse patient stories (both good and bad experiences)

8. Commissioners and service providers should ensure that specialist learning disabilities services for complex and intensive needs (including assessment and treatment services across all sectors) employ sufficient numbers of appropriately prepared and supported registered learning disabilities nurses. This highlights the need to support and develop the availability of specialist and advanced clinical skills and knowledge of learning disabilities nurses in all settings.

Progress to date:

· As previously noted some information to progress this recommendation will be captured via the survey referred to above

· Discussions are currently on-going between some HBs and commissioners regarding the how Some HB’s are presently having discussions with commissioners on how we can ensure that staff with the appropriate skills and knowledge are available to support people in these specialist settings.

· Within Hywel Dda HB an Autistic Spectrum Disorder (ASD) Service is being developed.

· Hywel Dda HB has National Autistic Society accreditation for the ASD continuing health care unit

· BCUHB is currently planning a new Assessment & Treatment service on the Bryn-y-Neuadd site and reviewing requirements in terms of the skills and knowledge required by the LD Nursing workforce

Hywel

Next steps:

· Hywel Dda HB have appointed a Lead Nurse for the ASD Service and the commitment to NAS accreditation for ASD continuing health care unit will be maintained

· BCUHB to develop new Assessment and Treatment Service to include profiling and meeting the educational needs of staff

· To undertake further mapping of additional / specialist client need and comparison with existing availability of specialist knowledge and skills within the existing RN(LD) workforce. Gaps between need and availability of appropriate support to be identified

· This will be used to inform discussion and planning regarding educational provision including mode(s) of delivery

9. Learning disabilities nurses, their managers and leaders should develop and apply outcomes-focused measurement frameworks to evidence their contribution to improving person-centred health outcomes and demonstrating value for money. This may require a specific piece of work to scope current frameworks.

Progress to date:

· ABHB has commenced discussions to pilot the Health Equalities Framework (HEF) as a means of collecting outcomes data

· Within ABMU HB the HEF is currently being examined and other outcome measures are being sought as means of comparison.

· Also within ABMU HB Band 7 nurses are currently working on service improvement projects as part of an LQI programme within the HB. Examples include the development of an effective Dementia Assessment Tool, examining the effectiveness of using the Mental Health Measure to support people with Learning Disabilities and LLAIS, a project to give a voice to people with Learning Disabilities in relation to their healthcare.

· Assessment and Treatment Outcome Reports , a holistic evidence based treatment process has been developed within ABMU HB and was shortlisted for the RCN Nurse of the Year Award in 2012.

· BCUHB are incorporating the use of Honos-LD within care pathway for Assessment & Treatment services

Next steps:

· To pilot the HEF within ABHB

· To undertake further work within ABMU to identify appropriate framework(s) to determine outcomes of nursing interventions

· To develop a means of assessing outcomes of Health Liaison posts

· To make outcomes measurement a key priority for the All Wales Implementation Group for 2013-14

10. Learning disabilities nurses should strengthen their involvement and links to transformational work, productivity improvement and practice development.

Progress to date:

· Examples of innovative practice have been showcased in a variety of settings including both local and national conferences

· The University of South Wales has completed a participatory research study that has examined people with learning disabilities’ views concerning abuse. This project aims to reduce abuse and promote appropriate action where abuse does occur. It has been showcased at local, national and international levels and a campaign is on-going to increase awareness to the key issues

· Nurses within ABMU HB have presented their work on patient stories, linked to experiences into secondary care within the HB, to the Chief Executive, and various other strategic groups.

· Work within ABMU HB has been nominated to the RCN Nurse of the Year Award, and various other awards and recognitions.

· A few ABMU nurses have been put forward for awards within the HB and have been show-cased in the HB celebrating excellence events.

· Staff from ABMU HB and the University of South Wales have collaborated to develop a health promotion tool to encourage women with learning disabilities to access cervical screening.

· BCUHB have an award-winning, Nurse-led, Dysphagia service which was cited as an example of good practice by the NPSA

· Within BCUHB  NISCHR have just awarded a grant to investigate mindfulness-based interventions for people with LD anger control issues in which there will be nursing involvement

· Nurses from both HBs and HEIs are involved in advising the Welsh Government in relation to a number of strategic developments relating to both policy and practice. They are also involved in similar activities at HB level.

· The Learning Disability Advisory Board that advises the Welsh Government has two members who are RN(LD)s one of whom represents nursing and the other who represents research.

Next Steps:

· Whilst there has been considerable progress in this area transformational work needs to be further encouraged and evidence of impact more widely disseminated. This will be actioned by each Health Board and collated at a national level.

· Within ABMU HB a proforma is being developed and will be circulated to capture all the good practice and innovation that is happening within the directorate. A blog is also being developed to share good practice, the intentions are that this will be viewed via the intranet.

· To submit examples of good practice for inclusion in the UK web resource

· To establish a section relating to Strengthening the Commitment on the CNO web pages

11. Those who commission, develop or deliver education should ensure that all learning disabilities nursing education programmes reflect the key values, content and approaches recommended in this report. They should also ensure that nurses in other fields of practice develop the core knowledge and skills necessary to work safely and appropriately with people with learning disabilities who are using general health services.

Progress to date:

· The first year of the new under-graduate course in Wales has been reviewed to ensure that there is learning disability input for all student nurses.

· The value base of the LD specialist field within these programmes has also been assessed to determine that the value base of Strengthening the Commitment is evident

· The MSc Professional Practice at the University of South Wales offers all students the opportunity to one or both of the modules relating to vulnerability that include a focus on meeting the needs of people with learning disabilities.

· All HEIs involve both RN(LD)s and people with learning disabilities in educating students from other fields of nursing practice and midwifery

· Bangor University also include Radiography, BSc Medical Science and OT students in their sessions for undergraduates

· Within ABMU a Consultant Nurse is employed specifically to focus on increasing access to healthcare and part of this role involves the delivery of education programmes within primary and secondary care.

· The University of South Wales offer LD undergraduate nurses opportunity to undertake BTEC in PBS during their 2^nd year.

· Hywel Dda Health Board has developed an educational framework that incorporates learning for acute general hospital staff including registered/unregistered workforce and also experts in specialist LD care. The suite of modules are designed to facilitate the journey of novice to expert in making reasonable adjustments for the delivery of healthcare for people with a Learning Disability; Induction Learning Disability awareness session for all HDHB, a Master class, and a Learning Disability Champions course

Next steps:

· To monitor against this recommendation the new programmes as they move into years two and three of the undergraduate pre-registration course.

· To monitor the uptake of learning disability related courses by non RN(LD) practitioners (HEI’s)

· To implement the new framework in Hywel Dda HB from September 2013

12. Updated, strategic plans for pre- and post-registration learning disabilities nursing programmes are necessary for each country of the UK to support flexibility and ensure an efficient and sustainable model of delivery for the long term. This highlights the need for appropriate numbers of places on pre-registration learning disabilities nursing programmes to meet future workforce requirements

Progress to date:

· Agreement has been reached that two specialist LD under-graduate programmes will be maintained in Wales at present

· The number of places commissioned on pre-registration courses for 2013 has increased in both University of South Wales and Bangor University

· Agreement has been reached by ABMU HB with University of South Wales that individuals who have experience of working in LD services and hold level 3 NVQ qualification obtained in LD services and BTEC meet entry criteria for degree nurse training.

· The University of South Wales is developing distance learning materials that will facilitate more flexible entry to under-graduate nurse education programmes.

· The service and education liaison group in North Wales (SLATE) is an established forum to discuss pre and post registration nursing requirements

Next steps:

· To continue to monitor recruitment and retention of student nurses in the context of service demand

· To map the nature and extent of existing post-registration education and to identify gaps (when compared with training needs analysis and service user needs analysis) and most effective means of delivery (to include distance learning and e learning)

13. Education providers and services must work in partnership to ensure that educational and developmental opportunities for nonregistered staff are developed and strengthened and their benefits are evidenced through appraisal systems, and that educational and development opportunities are available for registered learning disabilities nurses to support their ongoing development, reflecting the needs of people with learning disabilities.

Progress to date:

· Health boards are aware of the Cavendish report and have commenced work in response to its recommendations. ABMU HB are developing an action plan to implement the recommendations

· Within ABMU Health Board is committed to staff development and non-registered staff’s training needs are identified through annual appraisal and training needs analysis.

· Hywel Dda Health Board have planned to address the needs of non-registered staff as part of the new pathway noted in relation to recommendation 11.

· Hywel Dda  HB has a reducing restrictive practice initiative (now in its third year) which promotes the development of appropriate environments of care and a workforce competent in PBS.

· Within HD HB all clinical staff complete PBS certificate or Diploma via EDEXCEl /BETEC workplace and online learning. Live alerts are sent to all clinicians and POVA dept of all relevant incidents allowing timely de brief and learning from incidents. Annual and interim reports are produced on use of restrictive practices and factors influencing its use.

· The service and education liaison group in North Wales discusses educational development across the service. Aspects of pre-registration course are open to registered and non-registered LD staff in the locality. Registered LD Nurses are given the opportunity to be involved in recruiting and teaching/learning of student nurses at Bangor University.

· BCUHB and Bangor University have a lecturer / practitioner post.

Next steps:

· Implementation of the action plan within ABMU HB

· Implementation of educational pathway in HD HB

· Continuation of the reducing restrictive practice initiative within HD HB

14. Services should provide systems to ensure that learning disabilities nurses have access to regular and effective clinical supervision and that its impact is monitored and evaluated on a regular basis.

Progress to date:

• ABMU HB has a policy on clinical supervision and regularly audit the process. This determines frequency rather than outcomes of supervision and has highlighted some disparities in frequency between different areas of the service. Some development sessions regarding supervision are planned.
• Hywel Dda HB has a clinical supervision policy in place throughout services and also Community of Practice in place for practitioners to network and share practice as per its principles
• BCUHB has a policy on clinical supervision

Next Steps:

· ABMU to examine how improvements can be made to ensure that more equitable clinical and professional supervision can be delivered to nurses within the HB.

· Further information to be gathered regarding the ‘supervision passport’ that is being used in some areas.

· To undertake an audit of clinical supervision across Wales

15. Leadership in learning disabilities nursing needs to be strengthened in practice, education and research settings with robust, visible leadership at all levels, including strategic and national levels. Services must ensure all learning disabilities nurses in clinical practice have access to a dedicated professional lead for learning disabilities nursing. In addition to existing leadership and development programmes, a UK-wide cross-sector project to nurture and develop aspiring leaders in learning disabilities nursing will be led by the four UK health departments.

Progress to date:

· Six students from Wales attended the leadership workshop held in Leeds in July for third year student nurses.

· Representatives from Wales are involved in taking forward this agenda at a UK level

· Nurses within ABMU HB are being supported to attend relevant leadership development workshops outside of the HB.

· ABMU HB Band 7 nurses are currently working on service improvement projects as part of an LQI programme within the HB.

· ABMU HB have developed learning paths for LD nurses which reflect knowledge and skills needed by LD nurses at all levels and across community and residential services. This has included delivery and evaluation of locally organised leadership development programmes for Band 7 LD nurses.

· Within ABMU HB Qualification Credit Framework (QCF) units are available, along with Credit Qualification Framework Wales (CQFW) units for registered and non-registered staff.

· ABMU HB nurses have access to Free to Lead Free to Care Programmes within the HB.

· Within BCUHB LD Nurse have access to Leadership courses, including an Msc in Health & Social Care Leadership

· BCUHB currently has a “Tall Poppies” leadership programme which currently includes an LD Nurse

· Within BCUHB LD Nurse are and have been involved in a range of service improvement forums and activity including Clinical Improvement Groups (CIGs) relating to identified clinical priorities (i.e. Challenging behaviour, Mental health, PMLD and Forensic Issues).

Next steps:

· ABMU HB to develop an implementation plan to roll out leadership skills programme to Band 6 and 5’s.

· To examine at an all Wales level the potential to link new and recently qualified nurses together to share aspects of leadership development

· To circulate the evaluation of the student leadership workshop when available

· To raise concern regarding the reducing number of senior posts in learning disability nursing in Wales

16. Learning disabilities nurses need mechanisms to share best practice and develop the evidence base to continue to advance as a profession. Services must support learning disabilities nurses to participate in appropriate networks. A UK academic network for learning disabilities nursing will be created to support this drive.

Progress to date:

· There has been representation from Wales at each meeting of the UK Learning / Intellectual Disability Nursing Academic Network (LIDNAN) and lecturers from within Wales are taking the lead and/ or involved in a number of the workstreams.

· The University of South Wales hosted a recent meeting of the UK LDIAN and one member of staff gave a presentation. Some practitioners also attended.

· Two staff at the University of South Wales have published a text book concerning Safeguarding Adults in Nursing Practice.

· LD nurses within Wales have been active in making presentations at local, national and international conferences and in submitting papers for publication.

· The University of South Wales have held a number of lunchtime seminars in which their own research has been showcased as well as presentations by researchers from other universities. The seminars have been free to attend and have been accessed by people with learning disabilities, student nurses, family members and clinical staff including nurses.

· Two student nurses from University of Bangor took first and second places in the RCN Wales Student Nurse of the Year Awards 2012

· A quarterly LD Research meeting is open to all staff from education, health and social services in North Wales. The meeting is well attended and is where current research ideas/proposals are shared.

· BCUHB have an LD Clinical Effectiveness Group involving LD Nurses.

· Nurses from a number of HBs regularly attend and present at Challenging Behaviour Community of Practice Forum

· Staff from Wales are presenting at the Paperclip Challenge Workshop on 20^th September

Next steps:

· Within ABMU a page regarding Strengthening the Commitment is being developed to go on to their intranet.

· To develop a Strengthening the Commitment section on the CNO web pages

17. Learning disabilities nursing research should be extended to ensure practice now and in the future is evidence based and the impact of interventions can be demonstrated. Services and education providers must ensure that all existing and future schemes for clinical−academic careers have appropriate representation of learning disabilities nursing.

Progress to date:

· This is still at an early stage but over the past 12 months there has been a noticeable increase in practitioners expressing an interest in being involved in research and/ or undertaking research within their clinical area.

· Staff at the University of South Wales have secured research funding and studies are planned relating to end of life care, diabetes self-management and needs of residential support workers when supporting older people with learning disabilities who have increasing health needs. RN(LD) are Principal Investigators in two of these projects and members of all project teams.

· Bangor University has also secured NISCHR funding to investigate the use of mindfulness with people with learning disabilities. There will be nurse involvement in the project.

· The “Question-Aires” ( A service-user led research group) in collaboration with staff from Bangor University, LDAN and support from Involving People are developing a study “Do people with a learning disability know what healthy eating is?”. The project has recently obtained ethical approval

· Within Wales 4 RN(LD)s have PhDs and at least three are currently undertaking doctoral studies.

· One clinically based nurse has been successful in securing a Florence Nightingale Scholarship to assist with the funding of PhD studies

Next steps:

· To commence the research studies noted above.

· To commence evaluation of the Macmillan specialist nurse.

· To explore opportunities will to secure further research funding to facilitate collaborative studies between HEIs and HBs.

Delivering This Programme

It can be seen from the information set out above that progress has been made in relation to each of the recommendations and priorities for future work have been identified. However, in identifying this programme of work the implementation group have also noted three key areas of concern that they feel need to be addressed in order to progress the work:

· Leadership – it has been noted that in some areas of Wales learning disability services have become part of mental health services and this has resulted in fewer senior nursing posts in learning disability nursing and hence in a diminution of direct influence at senior levels. It is felt essential that there is appropriate, adequate and visible leadership in each area to ensure that the recommendations set out in Strengthening the Commitment are achieved.

· Clinical supervision – variations both within and between Health Boards have been noted along with the potential to note frequency of supervision rather than quality of supervision. It is proposed to undertake an audit of provision but it is recognised that greater commitment of resources will be required in order to achieve this recommendation.

· Contribution across the lifespan – at present few RNLDs work with children as it is not seen as the core business of learning disability services and not commissioned. However, it is felt that the RNLD has knowledge and skills that could assist children and their families and that their involvement in this area of work should be explored within Health Boards. Similar issues apply to the potential contribution to the care of the growing population of older people with learning disabilities.