This finding was identified through an investigation aiming to understand the factors that contribute to medication omissions to patients in learning disability secure units. The investigation examined the role and required competencies of learning disability nurses and emphasised that their specific skillset was crucial when administering medication to patients with complex needs.
In our conclusions, we highlight that this means that any shortage of these specialist nurses, alongside the way wards are designed, and ineffective communication between digital systems, could create the risk that medications are missed.
Key statistics on retention taken from the report include:
- Nursing and Midwifery Council (NMC) figures covering 2016-2020 show that numbers of learning disability nurses (RNLDs) are static at just over 17,100 for the 3 years 2018-2020. However, it should be noted that RNLD numbers from March 2016 to September 2020 show a decrease of 669 or 3.68%.
- Data from NHS Digital shows that the number of adult nurses has increased in the last 12 years, whereas the number of learning disability nurses has decreased by almost half.
- The percentage of adults with a learning disability is thought to be approximately 2.16% and children is 2.5%. Data from NHS Digital shows that by comparison, RNLDs are only 1.55% of the number of adult nurses (referred to as RGNs, registered general nurses).
Recognised shortage of nurses
This shortage has been recognised by those national bodies responsible for RNLD recruitment and retention.
NHS England and NHS Improvement have already launched the All-England Plan for Learning Disability Nursing which aims to ‘recruit, retain, develop and celebrate’ learning disability nurses.
The investigation identified that the retention aspect of the plan has been the hardest to implement. HSIB has made a safety recommendation focusing on the area of retention to help close that gap.
David Fassam, National Investigator at HSIB, says: “Our report highlights that the shortage of learning disability nurses may contribute to patients missing their medication.
“During our visits to mental health hospitals across the country for this investigation, we saw how dedicated staff were making sure that they provided care and dignity at the times when medication was administered to their patients. Patients benefit from seeing experienced nurses who are there consistently at times when medication is handed out. If learning disability nurses aren’t retained, there is a loss of that specialist training and specific skillset that they possess.
“We recognise the work and effort going on at a national level to address the retention gap; our report and subsequent recommendation provides further evidence to help target plans in the right direction and ensure the consistency of care for patients in learning disability secure units across the country.”
The investigation, following site visits to different areas in England, also concluded that design and layout and décor impacted on the behaviour of patients and the ‘atmosphere’ encountered on wards.
We found that wards that resembled a living space, rather than a clinical environment, were considered by the investigation to have a calmer, happier atmosphere.
The second safety recommendation set out in the report reinforces that health building guidance relating to learning disability secure units should reflect current clinical guidance on ensuring the design and layout provides a suitable environment for the patients and staff.