Why we must secure the future of learning disability nurses

This article outlines the unique contribution of learning disability nurses, analyses critical workforce and education challenges, and provides new insights into the underdeveloped apprenticeship route—highlighting how current models successfully seen in adult and child nursing could be replicated as part of a bold, nationally coordinated recovery strategy and prevent the loss of this vital profession.

Authors:

Viki Aisworth Expert by Parental Experience
Tilly Ainsworth Expert by Living Experience
Jim Blair Expert by Professional Experience
Dani Harris Expert by Living Experience
Ismail Kaji Expert by Living Experience
Jessica Lister Expert by Professional Experience
Baroness Rosa Monckton Expert by Parental Experience
Lauretta Ofulue Expert by Parental and Professional Experience
Jerry Ofulue Expert by Parental and Professional Experience
Lloyd Page Expert by Living Experience
Scott Watkin Expert by Living Experience
Anna White Expert by Sibling Living Experience

To ensure healthier futures for people with a learning disability, there must be availability of a workforce that is trained to meet their needs. Learning disability nurses play a pivotal role across and within health and care settings to enhance health outcomes, address inequalities and provide specialist services.

They possess the fundamental clinical skills of a registered nurse, with the ability to adapt these to meet the needs of each person they work with, in addition to specific specialist skills, knowledge, attitudes, and values. Learning disability nurses also assess and deliver specialist health services such as specialist inpatient services or specialist prescribing pathways.

Yet, learning disability nursing is facing an existential threat at the very time that people with learning disabilities are dying on average over 20 years younger than their non-learning-disabled peers.

Despite the growing demand for this specialist workforce across NHS mainstream and specialist services, social care, private, voluntary, criminal justice and education sectors, the Registered Nurse Learning Disability (RNLD) workforce is in rapid, managed decline.

This stark reality is addressed here with solutions and includes the views of people with learning disabilities, their families and learning disability nurses on how to address this.

“Learning disability nurses bring a skillset that is truly unique, they are champions of care and signpost good practice for all other areas of health and social care.”

Anna, a sibling with a brother and a sister who have a learning disability

What do learning disability nurses do?

A learning disability involves significantly reduced intellectual and adaptive functioning that begins before adulthood. In England, around 1.3 million people live with a learning disability (NHS England, 2023), often accompanied by complex health conditions. These individuals face striking health disparities: 42% of their deaths in 2022–2023 were avoidable (NHSE, 2023), and on average, people with a learning disability die 20 years earlier than the general population, avoidably, due to health and care failings.

Learning disability nurses are uniquely trained to meet the complex health needs of this population. Yet, at the very moment their expertise is most needed, their numbers are falling fast.

As parents of a learning-disabled child, Jerry and Lauretta attest to the transformative impact of the involvement of a learning disability nurse in the care of their son, Otito. This unique support gifted them valuable time during what transpired unknowingly as the end of their son’s life. The learning disability nurse provided understanding and supported professionals with vital evidence to manage his care more effectively. Prior brick walls of communication were easily dismantled.

‘We felt empowered by the RNLD to give Otito a voice through the use of simple tools like mobile phones to record good days and bad days so that Otito was more visible as a boy than a patient,” they said.

Following the death of their son, they both became learning disability nurses as a result of their experiences with the support the learning disability nurse gave them.

Why are learning disability nurses important?

Learning disability nurses are health detectives interpreting verbal and non-verbal signals. Equal treatment does not mean treatment should be the same; adjustments are required to enable access for people, like individuals with a learning disability, who would not get the care, support or treatment they would need otherwise.

The following sets out what people who experience the care and support from learning disability nurses think of them:

“Learning disability nurses support us in staying healthy in the community and make it easier to communicate with other professionals. They put support in place when being discharged from the hospital, giving me emotional support.” Scott, a man with learning disabilities
“They are a bridge for communications and behavioural methodologies to enable the person with learning disabilities to be calm and able to receive care.” Anna
“They are kind, respectful, have a laugh, take good care of us and also understand who we are. They are excellent. They have helped me to understand when I have urgent or minor health problems. They help with my care and treatment.” Lloyd, a man who has learning disabilities
“They gave me support, helped me with reasonable adjustments, what my treatment was. The learning disability nurses supported me with my physiotherapy appointment and helped me understand how to do the exercises.” Ismail, a man who has learning disabilities
‘Learning disability nurses can see the person behind the disability and see more than just the disability. They pave the way for Tilly’s treatment as well, liaising with services to let them know that Tilly is coming and what they need to do to make reasonable adjustments.” Viki, Tilly’s mother
“They understand me. I have a learning disability, and they make my life easier; they help me stay calm. It also helped me understand my body and stay healthy. They also helped me to ask for help with going to appointments.” Dani, a woman who has learning disabilities

Central roles of learning disabilities nurses

Effectively identifying and meeting health needs.
Reducing health inequalities through the promotion and implementation of reasonable adjustments; and
Promoting improved health outcomes and increasing access to health services and support services.
Enabling and delivering health screenings, investigations and checks to occur.
Supporting people with learning disabilities and their families to navigate health systems effectively. (Blair J (2023))

A clear visual representation of the five key elements within learning disability nursing is set out in the image below:

Diagnostic overshadowing

All too frequently, health professionals fall into traps of diagnostic overshadowing. Diagnostic overshadowing occurs when a health professional assumes that a person with learning disabilities’ behaviour is a part of their disability without exploring other factors such as biological determinants.

In relation to people with a learning disability, Emerson and Baines (2010) highlighted that it means “Symptoms of physical ill health are mistakenly attributed to either a mental health/behavioural problem or as being inherent in the person’s learning disabilities.”

Gates and Barr (2009) noted that diagnostic overshadowing is particularly pertinent when new behaviours develop or existing ones increase.

Given that people with learning disabilities have a much higher risk of experiencing a variety of diseases and conditions, physiological or pathological determinants in behaviour change must be explored. If they are not, people with learning disabilities can suffer poor care and may even die when their death could be avoided.

Gastrointestinal cancers are approximately twice as prevalent in people with a learning disability, and approximately 70% of people with a learning disability experience gastrointestinal disorders. Coronary heart disease is the second highest cause of death for people with a learning disability. (Blair J. (2016))

If there were no learning disability nurses?

The voices of those who have experience of being supported in their care and treatment by a learning disability nurse clearly express what would happen.

“We would not get our health needs met, and we would die earlier due to diagnostic overshadowing and not being supported to speak about our health concerns.” Scott
“If there were no learning disability nurses, I would be very stuck, and I would be upset, I think other health professionals don’t understand me.” Lloyd
“The number of deaths and tragedies that we already see would skyrocket. There is (very sadly) a very fine line that, if intervention is not identified in a timely way, then the person with learning disabilities will suffer as a result. Learning disability nurses are key to helping ensure these tragedies are averted.” Anna
“Without them, there would be so many tests and treatments that would not have been done, because professionals are too scared of the Tillys of this world or too busy to take the time to work out how best to deliver care to someone unco-operative. All of which could have a major impact on Tilly’s health.” Viki
“If the learning disability nurse had not been there, it would have been difficult to remember what I was told. I would not have had such a good outcome or experiences. I feel confident now.” Ismail
“Not good for my experiences of appointments or understanding my health.” Dani

Much must be done to ensure the future health and well-being of people with a learning disability by enabling the workforce to flourish, to halt the demise, and help ensure there are sufficient numbers of learning disability nurses going into the future. This will require commitment, vision and delivery from the Government and many others to make this a reality. Enabling creative solutions is necessary with a focused delivery plan to enact.

Workforce planning versus reality

The NHS Long Term Workforce Plan (2023) aims to double RNLD student places to over 1,000 by 2031. However, UCAS data showed a 36% drop in accepted learning disability nursing applicants from 630 in 2022 to just 405 in 2023 (RCN, 2024). Alarmingly, LIDNAN suggests fewer than 50 current learning disability students in England are on apprenticeship routes.

Learning disability nurses are the only professionals explicitly trained to:

Provide comprehensive health and behavioural assessments.
Tackle diagnostic overshadowing.
Design personalised, accessible care plans.
Deliver specialist health promotion and preventive care.
Uphold legal frameworks, including the Equality Act (2010) and Mental Capacity Act (2005).
Prevent unnecessary hospital admissions and reduce restrictive interventions.

Their work upholds the dignity, rights, and safety of individuals with learning disabilities—yet their future is in jeopardy.

Although 16,800 RNLDs are listed on the NMC register (House of Commons, 2025), the actual number is significantly lower than this data, including those who have retired, non-practising, or working in unrelated roles (due to the transferability of the RNLD skill set). Indeed, between 2010 and 2023, the number of RNLDs working in England’s NHS dropped by a staggering 44%, from 5,400 to a critical level of fewer than 3,000 (Nuffield Trust, 2023; NHS Digital, 2023).

Learning disability nurses, education crisis and apprenticeship gaps

Limited access and recruitment

RNLD training programmes are vanishing. At least 40% of universities have closed their RNLD courses (Council of Deans, 2022), creating regional training “deserts.” Apprenticeship options that have proved successful in other branches are barely available. RNLD apprenticeships are currently offered by fewer than 10 Higher Education Institutions, many of which are at risk due to unsustainable cohort sizes.

“Shall we continue to gently allow the number of nurses specially trained to offer targeted and meaningful support to be reduced without making a plan to protect this vital field of nursing? What does this say about the level of priority we ascribe to people with learning disabilities as a society?”

Jerry and Lauretta

In contrast, adult nursing apprenticeships are available through over 50 universities, supported by national recruitment campaigns and strong employer-university partnerships.

Just 214 students graduated as learning disability nurses in 2022, compared to over 7,000 in adult nursing (RCN, 2024b). In some regions, no universities offer LD nursing at all. If this trajectory continues, the entire profession could vanish within a decade.

This decline is not just alarming for patients — it undermines key national strategies. It threatens the promises made in the NHS Long Term Plan, the Equality Act, and the government’s commitment to inclusive workforce development (NHS England, 2019).

Learning disability nursing apprenticeships are critically under-promoted. There is no dedicated national campaign, and many candidates are unaware that the route exists. Further, Nursing Associate top-up routes—widely used in other fields—are underdeveloped in RNLD, denying a key progression path.

Structural and financial barriers

Many aspiring learning disability nurses are mature students with dependents. Indeed, the Learning and Intellectual Disability Academic Network (LIDNAN) advise that at least 50% learning disability nursing students completing programmes are over 31 years old, meaning they often have substantial financial commitments such as children and mortgages. Yet, learning disability nursing apprenticeships are sparse.

“It is no exaggeration to say that if it weren’t for learning disability nurses I”m not sure we’d still have Tilly with us.”

Viki Ainsworth

The Student Learning Disability Nursing Bursary, part of the NHS Learning Support Fund (LSF), recognises the need to encourage students into the field and offers a bursary of financial support to eligible nursing students who specialise in learning disability nursing. Whilst this funding includes a Training Grant of £5,000 per year and a Specialist Subject Payment of £1,000 per year for students, students remain responsible for the heavy annual tuition fees, and given the demand of the programme, few can also juggle the addition of supplementary part-time work.

The bursary goes a little distance in comparison to the favourable apprenticeship routes offered by other public services, such as the police, as seen in Table 1.

Table 1. Comparison of police apprenticeship and learning disability nursing degree

Feature	Police Apprenticeship (PCDA)	Learning Disability Nursing Degree
Pay during training	Full salary (typically £21,000–£26,000)	No salary; students rely on loans and grants
Tuition fees	Fully funded by police employer via Apprenticeship Levy	Paid by student via loans; partial support from £5k grant
Debt on completion	None	Average > £27,000 debt
Guaranteed employment	Yes – apprentice is employed throughout training	No – must apply for jobs after graduation
Recruitment marketing	Strong national campaigns (e.g. Be the Difference), dedicated recruitment workforce.	Limited national awareness or promotional campaigns. Nurses fit in recruitment activities into day job.
Flexibility for mature students	Paid employment supports those with families/commitments	Loan-based model a barrier for mature students
National coordination	Consistent model across all forces	No national apprenticeship; fragmented approaches

Consequences of inaction

The erosion of RNLD education and apprenticeship pathways has profound system impacts:

Rising use of restrictive interventions.
Delayed discharges and longer inpatient stays.
Closure of specialist services.
Higher reliance on agency staff.
Diminished safeguarding.
Families left coordinating complex care unsupported.

These failings breach the Equality Act (2010), the Care Act (2014), and the UN Convention on the Rights of Persons with Disabilities (2006).

A five-point plan for recovery

We call for a Government-supported Crisis Workforce Plan that includes:

Protect and expand learning disability nursing education

Ring-fenced funding for undergraduate and postgraduate RNLD programmes.
Ensure every region has a training provider.
Embed learning disability nursing into national health recruitment campaigns.
Introduce paid learning disability nursing apprenticeships aligned with teaching and policing.

Deliver a National Apprenticeship Strategy

Secure funding guarantees for learning disability nursing programmes.
Mandate employer participation in offering paid learning disability nursing apprenticeships.
Use Apprenticeship Levy sharing to enable PVIs to participate.
Develop mature-student-friendly financial support (e.g., childcare and travel grants).

Include RNLDs in workforce planning

Integrate learning disability nursing targets in all NHS and ICB workforce plans with robust data collection and monitoring systems.
Offer golden hellos and retention incentives for underserved areas.

National governance and leadership

Establish a co-led learning disability nursing national directorate (involving lived experience and clinicians).
Appoint a Learning Disability Chief Nursing Officer and Director by Experience.
Create a national Learning Disability Panel to guide system strategy.

Introduce a Learning Disability Act

Enshrine access to learning disability nursing-led care in law.
Legislate service and workforce minimum standards.
Strengthen legal accountability for health inequality.

Conclusion

Learning disability nursing, as has been clearly expressed in this article, is not an optional extra—it is a professional lifeline for thousands. The current trajectory of decline is not inevitable but is the result of national neglect. Apprenticeships, if adequately supported, could be a significant part of the solution.

The government must act now with urgency, ambition, and parity to secure the future of RNLDs and the people they support. It is always vital to remember that even salt looks like sugar; don’t think all you see is all that there is. This is central to what learning disability nurses do.

References

Blair, J (2023). Healthier Futures: Addressing the health inequalities faced by people with a learning disability and their families. https://committees.parliament.uk/writtenevidence/122329/html/
Blair.J, (2016) ‘The health needs of people with learning disabilities: Issues and solutions for GP and hospital services.’ British Journal of Family Medicine March / April 16 pp37-41 https://www.bjfm.co.uk/the_health_needs_of_people_with_learning_disabilities_issues_and_ solutions_25769832825.aspx
Council of Deans of Health (2022). Learning disability nursing: programme sustainability report. Available at: https://councilofdeans.org.uk
Emerson E., Baines. S., (2010) Improving Health and Lives: Learning Disability Observatory
Gates B and Barr O. (2009) Learning and intellectual disability nursing. Oxford: Oxford University Press
House of Commons (2025). Mental Health Bill [HL]: Written evidence (MHB64). Available at: https://publications.parliament.uk
NHS Digital (2023). Education and training statistics. Available at: https://digital.nhs.uk
NHS England (2023). Long Term Workforce Plan. Available at: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.21.pdf
NHS England (2023). Learning Disability Mortality Review (LeDeR) Report.
Nuffield Trust (2023). The workforce crisis in learning disability nursing. Available at: https://www.nuffieldtrust.org.uk
Nursing and Midwifery Council (2023). NMC Register Report. Available at: https://www.nmc.org.uk
Royal College of Nursing (2024). UCAS analysis briefing.
UK Government (2010). Equality Act.
UK Government (2014). Care Act.
United Nations (2006). Convention on the Rights of Persons with Disabilities.

Jim Blair

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Learning Disability Today