A Free Nursing Care
If someone with a severe learning disability is assessed as needing to be cared for in a home registered as a nursing home, it cannot be said that they have no nursing needs; the new test for the registered nurse contribution to care will be applied to them, just as it would to anyone else in a nursing home. That will be good for local authorities which have had to pay for one-to-one care for people assessed as severely challenging.
The RNCC nursing tool says that the High band is meant for complex needs requiring frequent mechanical, technical or therapeutic interventions. These people will need frequent intervention and re-assessment by a registered nurse throughout a 24 hour period, and their physical or mental health state will be unstable and/or unpredictable.
Medium category people will have ‘multiple’ care needs, needing the intervention of a registered nurse on at least a daily basis, and access to a nurse at any time. Their physical, behavioural, and psychosocial needs are stable and predictable, and likely to remain so if treatment and care regimes continue.
Thus it is open to authorities and clients or their families to argue that they should be seen as qualifying for registered mental nurse care.
However, the fact of the matter is that most people with a moderate to severe learning disability are resolutely cared for, regardless of the challenge they may present to staff, in residential care homes, where, by definition, nursing care cannot be provided to the residents. Free Nursing Care will not be available for them, because none of the care provided is required to be provided, planned, supervised, delegated or monitored by a registered nurse (even if one happens to be working in such a setting).
B Continuing Care
The new guidance on continuing care is not expressed so as to cover the client group made up of people with a learning difficulty. We do not think that this apparent exclusion can operate absolutely to exclude anyone with a learning difficulty – that would be discriminatory, and irrational, for they might have a dual diagnosis, the other half of which renders them eligible for a nursing input, whether that be illness related, physical disability related, or mental health related.
Readers are referred to the guidance Valuing People for more information on this topic. It should be noted that the previous circular which governed health services for learning disabled people has been cancelled – HSG 92/42.