‘Learning disability nurse deserts’ developing across England, as RCN calls for government to rescue specialty

New analysis from the Royal College of Nursing (RCN) has shown that parts of England risk becoming ‘learning disability nurse deserts', with collapsing student numbers in every region, and courses closing.   

The crisis could leave vulnerable people without access to vital care, the College warns, with the government urged to show 'unparalleled ambition' to invest and reimagine the specialty.  

Between 2015 and 2023, the East of England has experienced an 89% reduction in the number of students starting learning disability courses, with the South West (67%) and North East (65%) also seeing substantial falls. For the whole of England, there has been a 36% decrease in the number of acceptances onto learning disability courses in just eight years. Now, in the South East, not a single university offered the degree in 2024.   

Most of the period analysed covers after the nursing bursary was scrapped and universal maintenance support removed for nursing undergraduates.  

Reforms to nurse education have been particularly damaging to learning disability nursing, a specialty that draws heavily from mature students. Figures show that the numbers accepted onto courses have fallen by a third since 2015. The RCN says mature students have varied and rich life experiences that make them excellent candidates. They made up nearly three-quarters of all acceptances in 2023. [NOTE 1]   

The new analysis comes as it is also revealed that the numbers of learning disability nurses employed in the NHS in England fell by nearly half (43%) under the previous government between May 2010 and July 2024, from 5,368 down to 3,034 [NOTE 2].   

The RCN is now calling for the government to show ‘unparalleled ambition' in re-imagining learning disability nursing in the modern world, urging ministers to incorporate a new vision into the refreshed NHS workforce strategy. This must include support for regional action to address severe workforce crises, where the future pipeline of learning disability nurses is under threat. Additionally, it is vital that a loan forgiveness model is introduced for those who commit to delivering the specialty in public services and that greater financial support is made available during study through universal maintenance grants.     

It comes as the government last week proposed a 2.8% pay uplift for NHS nurses, an offer the College says will further deter people joining the profession and becoming learning disability nurses.  

Earlier this year, it was reported that nearly 1 in 3 NHS trusts in England do not have an acute learning disability liaison service or specialist staff to ensure people with learning disabilities get support [NOTE 3]. This has led to learning disability nurses being substituted for other nurses without their specialised training, reducing the standard of care patients are receiving.  

Without action, the RCN warns that number of vulnerable people going without specialist care could increase. Lord Darzi's report into the NHS in England highlighted the ‘particularly concerning drop in the number of learning disabilities nurses' and the need to investigate further the wide disparity in life expectancy for people with learning disabilities.  

RCN Chief Nursing Officer Lynn Woolsey, said:   

“Learning disability nursing is an incredibly rewarding career, supporting some of the most vulnerable to live happier and healthier lives. But the specialty has suffered years of neglect and underinvestment, causing recruitment to collapse and decimating workforce numbers. It is a tragedy. 

“When there are so few learning disability nurses, care needs go unmet or those with learning disabilities and their families may have to travel hundreds of miles for treatment. This appalling situation isn't the fault of this government, but it is theirs to fix.  

“Transforming the care for people with learning disabilities couldn't be more urgent. That starts with investing in the workforce that delivers their care. This means fair pay, funding nursing education, and loan forgiveness as key fundamental policies to get recruit and retain more nurses.”  

Jackie O'Sullivan, Executive Director of Strategy and Influence at learning disability charity Mencap, said:  

“Having access to a learning disability nurse can be a matter of life and death.  

“A shocking 42% of deaths among people with a learning disability in 2022 were avoidable, mainly because of difficulties accessing care and treatment.  These specialist nurses help people get the care they need, both in hospitals and in the community, and vitally make sure that someone's learning disability isn't used as a reason for them to be refused treatment or - in some cases - resuscitation.   

“The NHS England 10-year plan needs to address this current workforce issue which means it is a postcode lottery as to whether people with a learning disability have a learning disability nurse available to them. It should commit to increasing recruitment of these skilled roles.  

“People with a learning disability and their loved ones must be able to trust that health services and healthcare professionals are able to understand and meet their needs.”  

Ends  

Notes to editors   

NOTE 1 – Between 2015 and 2023, the number of mature student acceptances dropped by 33% from 430 to 290. However, following the bursary removal, mature student acceptances dropped by 35% (from 400 in 2016 to 260 in 2017) and showed only modest recovery, peaking at 435 in 2021. Between 2022 and 2023, there another significant decline by 26%, falling from 390 in 2022 to 290 in 2023.  

NOTE 2 - The latest NHS Workforce Statistics were published by NHS England [Thursday 24th October 2024], shows that the number of learning disability nurses employed by Trusts in NHS England was 3,034. This is a 43% drop from May 2010 when the Conservatives were elected to office, when the total was 5,368. 

NOTE 3 – A freedom of information (FOI) request made by Nursing Standard as part of their investigation into acute learning disability liaison services, found that nearly one in three NHS Trusts in England do not have a specific acute learning disability liaison service with a learning disability registered nurse. Of the 110 NHS Trusts who responded, 15 had no service in place and a further 17 described only having a ‘safeguarding team' rather than a dedicated liaison service.