The Troubled Families Programme (TFP) is a programme in England administered by the Ministry of Housing, Communities and Local Government (MHCLG). The programme conducts targeted interventions for families experiencing multiple problems, including crime, anti-social behaviour, truancy, unemployment, mental health problems and domestic abuse. This briefing examines the TFP since 2012, details MHCLG evaluations of the programme, and describes recent commentary and potential future directions for the programme.
E-Petition 221033 is entitled “Prevent avoidable deaths by making autism/learning disability training mandatory”. It was started by Paula McGowan who, in the preface, states:
My son Oliver was only 18 when he died in hospital on 11 Nov 2016. I believe his death could have been prevented if his doctors and nurses had received mandatory training. He had autism and a mild learning disability, and they weren’t trained to understand how to make reasonable adjustments for him.).
The petition says the following:
1 in 4 healthcare professionals has never had training on learning disability or autism. This is unacceptable. Two thirds want more training, and 1 in 3 think a lack of government leadership is contributing to the problem of avoidable deaths. The Government must ensure all healthcare professionals get mandatory training to address the huge health inequalities facing people with autism and a learning disability. For more information search for: LeDeR report 2018; CIPOLD 2013; Treat me well 2018.
The Government’s response
The Government responded on 25 July and said the following:
We want all staff to receive the support, training and professional development they need to support people with learning disabilities and autism, in line with employers’ existing responsibilities.
Our deepest sympathies are with Oliver’s family for their loss.
Everyone has the right to high quality, safe health care so it is crucial that all health workers are given the skills and education to confidently deliver care that meets the needs of all their patients. This is a priority for the Government.
All employers have a clear legal responsibility to make sure that staff are competent to perform their role as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014; regulation 18.
To support a consistent approach to learning disability education and training, the Department for Health and Social Care commissioned Skills for Health and Health Education England to develop a Core Skills Education and Training Framework. Published in July 2016, the Framework, which sets out the essential skills and knowledge needed for all staff working with people with a learning disability in health and social care settings, is structured in three tiers, or levels of training, to reflect the different levels of knowledge specific roles would require.
Tier one, which is relevant to the entire health and care workforce including ancillary staff, concerns general awareness skills and attitudes.
Tier two is aimed at developing the knowledge and skills of staff that are likely to have regular contact with people with a learning disability.
Tier three is aimed at enhancing the knowledge, skills and attitudes of key staff and is relevant to those who are managing care and support services for people with a learning disability.
Employers and/or commissioners of education should use the Framework as guidance for the development and delivery of appropriate and consistent education and training, as well as for identifying the skills needed for particular roles in line with their legal responsibilities. By doing so, this will result in safer and more effective practice.
To ensure that health and care staff also have appropriate knowledge and awareness of autism, the Department of Health and Social Care has commissioned the development of a Core Skills and Competency Framework for Autism, which will be in line with the tiered approach adopted by other core skills frameworks. The development of this framework is expected to improve the availability of general awareness training to all staff across the health and care system and wider public services to equip them to offer appropriate support to autistic people (Tier 1), as well as developing and enhancing the knowledge, skills and attitudes for roles that have regular contact with autistic people (Tiers 2 and 3).
The recent annual report of the Learning Disability Mortality Review (LeDeR) Programme highlighted that people with a learning disability are still dying prematurely due to avoidable factors. We recognise that more is needed to address this profound inequality.
As outlined by Caroline Dinenage, the Minister of State for Care, on 23 July, the Department is working with NHS England and other system partners to agree actions for each of the nine recommendations; the Government’s response will be published after summer recess (House of Commons Written Statement 906, https://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-07-23/HCWS906/).
Commons Library briefing papers
The House of Commons Library has published two briefing papers which cover training for healthcare staff in these areas:
- Commons Library briefing SN07058, Learning Disability, 18 September 2018 – particularly section 2.2. See also section 2.1 for information on the LeDeR report and other inquiries on this subject.
- Commons Library briefing CBP-7172, Autism – overview of UK policy and services, 22 March 2018 – particularly section 3.3.
As noted in the latter Library briefing on autism policy, NICE has estimated that half of people with autism also have a learning disability. Moreover, the Government’s response to the Learning from Deaths Review’s (LeDeR) second annual report, which was published in September 2018, noted that while the Review did not assess deaths of people with autism who did not have a learning disability, many of the actions would nevertheless benefit those who are autistic. Therefore, there is thought to be some overlap between policies relating to staff training for the treatment of patients with autism as well as patients with a learninng disability.
Written Parliamentary Question
The latest PQ response on this topic was provided by the Government on 27 June 2018.
Asked by: Cameron, Dr Lisa | Party: Scottish National Party
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to support the provision of continuing professional development in respect of learning disabilities for all front-line health staff.
Answering member: Caroline Dinenage | Party: Conservative Party | Department: Department of Health and Social Care
Employers have a statutory responsibility to provide sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using health services, including those with a learning disability.
The Learning Disability Core Skills Education and Training Framework, published in July 2016 sets out the requisite skills and competencies that staff need to deliver care and support to people with a learning disability. The Framework sets out the necessary skills across three tiers. Tier 1, knowledge for roles that require general awareness of learning disabilities; Tier 2, knowledge and skills for roles that will have some regular contact with people with a learning disability and Tier 3, knowledge and skills for those providing care and support for people with a learning disability. Training should be provided in line with this Framework.
Health Education England (HEE) is currently producing eLearning materials to support Tier 1 learning disability awareness training. This free online training will be available to all staff in 2019. HEE will also be writing to all education providers reminding them of the Learning Disability Core Skills Education and Training Framework and ask them to ensure that all staff groups include Tier 1 awareness training as a minimum.
HEE also uses a workforce development fund to support the ongoing development of staff, with spending focused on priority areas, including staff working with people with learning disabilities and/or autism. Examples of the type of development that is supported includes, Positive Behavioural Support, Total Attachment Theory, Leadership programmes, Mindfulness-based Stress Reduction, Learning Disability Mortality, Building the Right Support, Early Positive Approaches to Support, Restraint Reduction, Positive Behavioural Support Workshops for family carers, Forensic learning disabilities skills, Trauma informed care and Autism.
All nurses receive learning disabilities training as part of their pre-registration education. Curricula are set by individual education providers, to standards set by the professional regulators.
Additionally, since April 2015, newly appointed health care assistants, including those who will provide care and support to people with a learning disability have been undergoing training as part of the national implementation of the Care Certificate. The Care Certificate equips new staff with the knowledge and skills which they need to provide safe, compassionate care across a range of areas, including the care of people with a learning disability.
We have committed that there will be a response to each of the recommendations of the Learning Disabilities Mortality Review Programme annual report, including the recommendation on training. The response will be published soon.
27 Jun 2018 | Written questions | Answered | House of Commons | 156445
Date tabled: 21 Jun 2018 | Date for answer: 25 Jun 2018 | Date answered: 27 June 2018
Early Day Motions
The following Early Day Motion was tabled on 11 June 2018:
That this House recognises the health inequalities that exist for people with learning disabilities and autism, including inequalities in primary healthcare; understands that health inequalities lead to reduced life expectancy for people with learning disabilities and autism; welcomes learning disability and autism provider Dimensions’ campaign #MyGPandMe to encourage the use of reasonable adjustments for people with learning disabilities and autism in general practice; notes that Dimensions’ research shows that 98 per cent of GPs believe they would benefit from learning disability and autism training; and urges the Government to introduce mandatory learning disability and autism training for all primary healthcare professionals led by the experts, people with learning disabilities and autism themselves, to reduce health inequalities.
11 Jun 2018 | Early day motions | Open | House of Commons | 1365 (session 2017-19)
Primary sponsor: Lamb, Norman | Party: Liberal Democrats
Other sponsors: Cunningham, Jim · Bottomley, Peter · Shannon, Jim · Morris, Grahame M · Rimmer, Marie
Number of signatures: 21
- Health Inequality: Autism and Learning Disabilities (HL Deb 10 May 2018 cc108-124GC)
CommunityCare.co.uk, 20 September 2018
BBC News, 2 October 2018
Department of Health & Social Care Press release, 12 September 2018
The Guardian, 12 September 2018
The Independent, 15 August 2018
[This is a report of a survey completed by the Royal College of Nursing, explained in their press release here.]
Nursing times, 1 August 2018 [subscription required]
Nursing Times, 8 May 2018 [subscription required]
- Department of Health & Social Care, NHS England, The Government response to the Learning Disabilities Mortality Review (LeDeR) Programme Second Annual Report, September 2018
- Department of Health & Social Care, Think Autism strategy governance refresh, March 2018
- Health Education England, Facing the Facts, Shaping the Future: A draft health and care workforce strategy for England to 2027, December 2017
- Department of Health, Skills for Health, and Health Education England, Learning Disabilities Core Skills Education and Training Framework, July 2016
- HM Government, Think Autism – Fulfilling and Rewarding Lives, the strategy for adults with autism in England: an update, April 2014
Independent/sectoral comment, research and analysis
- National Autistic Society, Why autism training is vital for all healthcare staff, 18 October 2018
- British Journal of General Practice, GPs’ confidence in caring for their patients on the autism spectrum: an online self-report study, May 2017
- Royal College of General Practitioners, RCGP Position Statement on Autistic Spectrum Disorders, June 2016
- Mencap, Treat me well, campaign (calls on NHS staff “to make reasonable adjustments for people with a learning disability which can help to save lives”).