The #weldns chat on 4^th July 2017 offered the Learning Disability Nursing community and other stakeholders the opportunity to reflect on the current state of the profession, including the strengths and weakness, while also horizon scanning for opportunities to ensure that people with learning disabilities families and carers could expect person centred, safe and effective care in the future.

An examination of person centred care in learning disability nursing resulted in many process and outcome statements that could in many cases be applied to working with team members and colleagues further a field as much as the person experiencing the service. These referred to supporting people to achieve the aspirations and desires through working with the individual’s strengths and needs, this was most succinctly phrased by @debradma who referred to creating the conditions for people to flourish. As the conversation developed a new depth of resulted, questioning what makes person centred care different forpeople with learning disabilities. Several attributes and requirements of nurses were identified, the ability to facilitate care across the whole health, social care and private/voluntary/independent sector, enabling mainstream healthcare professionals to deliver their expertise through the identification and implementation of reasonable adjustments, that this would promote health and wellbeing. It was recognised that Learning Disability Nurses often were required to be reflexive, triangulating the views of families and mainstream health professionals, with their expert assessment of the individual including their views and to construct a consensus as to the way forward, often capitalising on these experiences to teach educate and inform mainstream health professionals. This prompted a consideration of a more macro perspective of person centred care in learning disability nursing, that of co-production, co-creation and its links with person centred planning – the latter being amethodology and suite of tools to develop the aforementioned consensus. This conversation was placed in the current challenging workforce context of reducing numbers of learning disability nurses working in the NHS in England, the suspected reduction in student intake this coming autumn based on the implications of the 2015 spending review, and the demographics that will mean many will reach Mental Health Officer retirement age in the next five years.

However, there were many reflection, thoughts and ideas as to how this care may be productively provided and delivered in the future. While traditional definitions of person centred care predicated on the interpersonal relationship between professional (nurse) and user of the service, it is observed that the care environment has become and will become more technical and dependant on information technology. Several chat participants (perhaps unsurprisingly for a Twitter chat) recognised and were attempting to grasp this nettle to ensure that the people they worked with were able to benefit. However this was balanced by others who anticipated pitfalls for people with learning disabilities in the use of information technology. What could be observed are two main implications for this disruptive technology, firstly that it will likely redefine the idea of an individual’s social ability, while without having a digital health facilitator, many could be left behind. It would be beneficial to further explore this latter concept, and in all likelihood this will comeback for a further WeLDNurses chat.

There was generalised agreement that the values of learning disability nursing of promoting independence, empowerment, and inclusion underpin practice, promoting health and autonomy. Within this enabling people with learning disabilities, families and care workers to (self) manage, is a crucial activity, and the ability to inspire and educate are essential. This requires strategic shared purpose on a local level, which can guide the targeting of support, whether this is crisis resolution, intensive support or preventative working. Evidence indicates that people with learning disabilities are more likely to experience multi morbidity, which is likely to increase in the future, and as such will be more prone to issues when care is uncoordinated, in this context the learning disability nurse of the future is going to be required to be a whole system navigator who can employ education and social learning to support choice making and timely health outcomes for the people they work with.

There was some debate – and a likely subsequent chat – about the clinical skills that a learning disability nurse might require. While some defined this in context of physical observations, monitoring and treatments, like blood pressure, Early Warning Systems, and PEG feeding respectively, others questioned whether behavioural analysis, autism diagnosis, mental state exams could be included. In the context of this consultation, it was unclear whether these skills would be considered ‘clinical’, and further consideration of this area might be required. Subsequent acknowledgement must go to the diverse roles and environments that Learning Disability Nurses work in and the clinical skills that may be required, however it is unclear as to whether future nursing courses to prepare for all these eventualities. Several identified specific advanced physical clinical skills may be required in the future, like venepuncture, cannulation and phlebotomy could be beneficial in specific services. This prompted a question as to advanced practice and what this might entail, the Royal College of Nursing are currently credentialing advanced practice, and to qualify along with an MSc, a prescribing qualification is required. There was one Learning Disability Nurse prescriber participant on the chat who advocated the need for research in this area.

Research in learning disability nursing in and of itself is required and more advanced practitioners will be required to ensure the evidence remains contemporary. Leadership is required to enable, inspire and mould the next generation of Learning Disability Nurses, one particular participant identified the need for politics and political awareness being an important attribute, when facilitating, coordinating and leading care across the whole system.

The thirty plus participants in this conversation identified that these skills, knowledge and experiences are transferable to other client groups and alternative environments however outside of this Learning Disability Nursing makes and can make a uniquely valuable contribution to the health economy, the whole system and wider society.

Thanks to all those that contributed, the WeLDNurses Team, and in particular @JamesRNLD for reviewing and feedback on the above.

@dmarsden49