Strengthening the Commitment - The Interim Report of Scotland's National Implementation Group

The publication of Strengthening the Commitment: the report of the UK Modernising Learning Disability Nursing Review brought a welcome focus on learning disability nursing at UK and Scotland level. This interim report presents progress in Scotland. It provides an overview of successes, best practice and outlines the next steps in continuing our commitment to strengthening learning disability nursing and ensuring people with a learning disability receive the care they want, need and deserve.

Chapter 3. Strengthening quality

Recommendation 9. Demonstrating quality outcomes

Learning disability 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.

In Scotland’s Delivery Action Plan, we said we would:

  • promote and raise awareness of the Health Equalities Framework across Scotland
  • identify and fund sites to pilot the Health Equalities Framework
  • scope other outcome-focused health improvement measurement frameworks.


The Scottish Learning Disability Senior Nurse Group has considered a range of outcome frameworks, including the Health Equalities Framework, the Confirm and Challenge© model, HoNOS LD, Talking Points and the QoL Questionnaire Version 3. All were considered useful, but the group recommended concentrating efforts in adopting and implementing the Health Equalities Framework.

The authors of the Health Equalities Framework were invited to present their work at an event attended by 40 learning disability nurses from across Scotland in 2013.

Positive practice

The Scottish Government Learning Disabilities Policy Team and nursing directorate have funded a project to support and embed the Health Equalities Framework in practice. A project manager is being recruited to the Managed Care Network.

This will be a major regional programme involving four NHS boards. It will be divided into two phases:

  • training on, and implementation of, the Health Equalities Framework in all identified areas
  • collection and analysis of data to give a clearer understanding of the impact of the determinants of health on the lives of people with a learning disability.

For more information, contact Marion Paterson at:

“We think it is important that people with learning disabilities get to tell their story of learning disability nursing. If you only ask professionals, you will miss out what people with learning disabilities know.”

“We think carers’ stories are important too. Not just for speaking on behalf of the people they care for. We need to hear about their experiences.”

“We need to think about the barriers that people face when being honest about their services.”

Reference Group members

Recommendation 10. Quality improvement

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

In Scotland’s Delivery Action Plan, we said we would:

  • scope current improvement activity, identifying how learning disability nurses can engage and any barriers they face.

We asked local implementation groups to:

  • support the scoping exercise by providing information on local continuous improvement work.


The scoping exercise identified improvement activity being undertaken by learning disability nurses across Scotland.

The Keys to Life learning disabilities strategy is developing a national implementation plan to be led by the professional advisor to the policy team – a learning disabilities nurse. Utilising improvement approaches, the plan will set out a vision, four outcome statements and logic modelling to achieve the outcomes. It will be linked to the Scottish Government’s Programme for Government and national objectives.

Positive practice

NHS Forth Valley has established a programme of continuing professional development to support all senior charge nurses to implement Leading Better Care. Learning disability nurses are further developing this to include measures relevant to learning disability nursing in inpatient assessment and treatment services. The aim is to create a quality assurance framework that builds on Leading Better Care.

For more information, contact Allison Ramsay at:

NHS Lanarkshire has invested in creating a practice improvement and development nursing post in the Mental Health and Learning Disabilities Service. The main aim is to develop a number of the recommendations from Strengthening the Commitment locally and lead on practice improvement and development issues that help strengthen the profession.

For more information, contact Margaret Serrels at:

Recommendation 11. Preparing and developing learning disability nursing

Those who commission, develop or deliver education should ensure that all learning disability nursing education programmes reflect the key values, content and approaches recommended in [Strengthening the Commitment]. 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.

“Having people with learning disabilities involved in recruitment and training gives the message that we are important, respected, can make decisions and should be listened to. It will show nurses how they should see and treat us.

“We know what it is like to have a learning disability and how things feel. People with learning disabilities and carers could teach nurses these things better than professionals.”

Reference Group member

In Scotland’s Delivery Action Plan, we said we would:

  • ask higher education institutions to map and develop their existing undergraduate programmes against the National Framework for Pre-registration Learning Disabilities Nursing Field Programmes.


Both universities have mapped their programmes against the National Framework for Pre-registration Learning Disabilities Nursing Field Programmes as part of the National Model Action Plan.

NES held a ‘Thinking Space’ event in June 2014 to help develop creative approaches to supporting universities to meet the NMC Standards and ensure all students have the right knowledge and skills to support people with learning disabilities and their families.

Positive practice

Learning disability epilepsy specialist nurses from across Scotland have collaborated with the two provider universities to develop content and resources of sessions on epilepsy care and define expected learning outcomes. The sessions are timetabled in a stepped approach to build knowledge and skills over the universities’ three-year education programmes for learning disability nurses. Both universities have established links with the nurses and any or all of them can be called on to support the delivery of the programme. An article about this initiative was published in Learning Disability Practice (Powell, 2014).

For more information, contact Alison Corp at:

Recommendation 12. Maximising recruitment and retention

Updated strategic plans for pre- and post-registration learning disability 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 disability nursing programmes to meet future workforce requirements.

In Scotland’s Delivery Action Plan, we said we would:

  • implement the National Model Action Plan 2013–2014.


Edinburgh Napier University and Glasgow Caledonian University have continued to progress the National Model Action Plan, governed by the National Model Steering Group facilitated by NES. As part of this work:

  • a memorandum of understanding has been developed to promote collaboration across all universities and colleges in Scotland to support the aspirations of the National Model
  • two clinical–academic posts have been funded by the Scottish Government
  • Scotland’s Colleges has been commissioned to review, enhance and promote articulation routes.

We have seen learning disability nurse student commissions steadily increase since 2012: we currently commission 100 places each year.

Positive practice

The college sector in Scotland has been working in partnership with Edinburgh Napier University and Glasgow Caledonian University to explore models to widen access from non-traditional routes, promote local recruitment and retention initiatives and strengthen links with colleges, universities, and the independent and voluntary sectors to advance collaboration.

Local education partnerships involving the college sector, universities, NHS boards, local authorities, independent and voluntary sectors and other key stakeholders have been established across Scotland.

The NES-funded national marketing strategy, which includes a website with a route map around a qualification framework that involves a school, college, university and employer partnership, is continuing to meet its milestones.

The national Professional Development Award in Learning Disabilities promotes the delivery of standardised high-quality learning and teaching activities and supports Government strategic drivers to ensure an appropriately skilled and ambitious workforce.

For more information, contact Sybil Lang at:

Recommendation 13. Developing workforce knowledge and skills for the future

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

In Scotland’s Delivery Action Plan, we said we would:

  • develop further plans to maximise learning disability healthcare support workers’ contributions.

We asked local implementation groups to:

  • report on learning disability healthcare support workers’ engagement with national guidance (the NES Framework)
  • ensure that role development is discussed as part of support workers’ personal development processes.


NES produced the Improving Practice educational resource to enable support workers help people whose behaviour is perceived as challenging.

NES has a wider programme of work supporting healthcare support workers that aims to:

  • maximise the use of existing resources to support learning, identify gaps and further develop websites for support staff
  • improve access to information about learning and qualifications for support staff, including developing a new fund to support learning
  • develop a recognised career development pathway for staff in Agenda for Change bands 1–4 posts, bringing clarity to the differences between clinical healthcare support posts in bands 2, 3 and 4.

NES is designing and delivering a ‘train the trainers’ programme to support the roll-out of Improving Practice.

Positive practice

The NHS Lothian Strengthening the Commitment Local Implementation Group has delivered a programme of work across the area that includes the development of a two-day rolling mandatory training programme for healthcare support workers. The content was developed in response to findings from a training needs analysis carried out within the NHS Lothian Learning Disability Services earlier this year.

For more information, contact Eileen Duncan at: or Christina Bickers at:

Recommendation 14. Accessing supervision

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

In Scotland’s Delivery Action Plan, we said we would:

  • develop the learning disability nursing service profile tool to measure learning disability nurses’ engagement in regular clinical supervision
  • scope models of clinical supervision used in practice.

We asked local implementation groups to:

  • identify how many learning disability nurses have access to regular clinical supervision
  • provide examples of good practice in which engagement in clinical supervision has improved patient care.


The Scottish Learning Disability Senior Nurse Group has collected data on clinical supervision across Scotland that shows wide variability in how clinical supervision is practised in NHS boards. Clinical supervision appears to occur more regularly in community services or where psychological therapies are provided. Inpatient services seem less likely to have robust clinical supervision arrangements in place.

Learning disability nurses working in remote and rural areas, particularly the island boards where there may only be a single learning disability nurse, face particular challenges in relation to clinical supervision.

The Scottish Learning Disability Senior Nurse Group will develop a position statement/guidance on clinical supervision in learning disability nursing.

Positive practice

Nursing clinical supervision was introduced to the State Hospital in 2006 and is supported by a policy and framework informed by current legislation, evidence, guidance and professional standards. Embedded within the framework is an eclectic model for guiding clinical supervision practice that draws on the strengths of a number of recognised supervision models.

Clinical supervision is provided through individual sessions and on a group basis. Each nurse has a named clinical supervisor who delivers individual sessions; the minimum agreed standard is a one-hour session at least once every eight weeks. Ward-based nursing staff also have access to group clinical supervision, with group sessions led by two facilitators taking place every two weeks. The expectation is that nurses will access group supervision whenever possible, consequently optimising the opportunity to share experiences, reflect on practice and learn from each other.

A recent evaluation of the effectiveness of clinical supervision (Wilson, 2010) was positive, and a further national study is currently underway.

For more information, contact Lesley Murphy at:


Email: Scott Taylor

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