In October 2019 the Royal College of Psychiatry, Quality Network for Learning Disability (QNLD) Services, published ‘Standards for adult community learning disability services.’ ACPPLD members raised concerns about the representation of specialist learning disability physiotherapy within the 1st edition of these standards.
After two years of collaborative working on the Quality Network for Learning Disability Services Advisory Group and Accreditation Committee, I am pleased to say that Physiotherapists are a Type 1 standard (Type 1: Criteria relating to safety, rights, dignity, the law and fundamentals of care, including the provision of evidence-based care and treatment). Also, throughout the new edition, other standards have been adjusted which has reduced the bias towards mental health and the standards are now more balanced to represent the needs of all adults with a learning disability.
In October 2019 the Royal College of Psychiatry, Quality Network for Learning Disability (QNLD) Services, published ‘Standards for adult community learning disability services.’
These standards were developed to support services to evaluate and improve their management processes and standards of care. They set out requirements and recommendations against which services could be reviewed and rated through a process of self and peer review. The QNLD process is managed by and governed by a self-appointed advisory group. There is also a project group, from within Royal College of Psychiatry, that looks after the day to day running of the network including liaising with services, collecting data, arranging reviews and events and managing the membership (for a service to be part of the standards you need to take out a membership, which costs £2,430 (+VAT) per year.)
ACPPLD members raised concerns about the representation of specialist learning disability physiotherapy within the 1st edition of these standards. The main concern was that each standard in the document was given a type criteria, defining whether a standard is essential (Type 1) expected (Type 2) or desirable (Type 3). Specialist physiotherapy was rated as a Type 3: desirable for a service to meet, or criteria that are not the direct responsibility of the service. This did not represent the important role that specialist learning disability physiotherapist’s play in supporting those adults with a learning disability who have a physiotherapy need, either by supporting access to mainstream services or by direct intervention. This could have meant that some adults with a learning disability would not have access to specialist physiotherapy.
The ACPPLD also raised concerns that the document was heavily biased towards the needs of adults with a learning disability and challenging behavior, with little reference to, or detail on, the provision for services for adults who have associated physical disabilities such as cerebral palsy and PMLD; or additional physical health needs such as dysphagia, falls, pain, pressure ulcers and postural support needs. This resulted in the document not representing the health needs of all adults with learning disabilities.
In response, the ACPPLD National Executive Committee (NEC) contacted the QNLD to request that Physiotherapy be a Type 1 criteria.
The QNLD responded to say that there had been an admin error and physiotherapy should be a type 2 criteria. The ACPPLD NEC challenged this response, repeating again that physiotherapy should be type 1. The QNLD were not able to adjust the category any further during the pilot study period. However, the standards would be reviewed in the autumn of 2020 and they invited a representative of the ACPPLD to join the advisory group and accreditation committee, who would be reviewing the standards.
I joined the Quality Network for Learning Disability Services Advisory Group and Accreditation Committee in February 2020 representing the ACPPLD NEC. My role was to attend meetings; participate in the pilot site peer reviews; contribute to the review of the community standards documentation; actively support opportunities to promote the role of the specialist learning disability physiotherapist and feedback to the NEC and wider ACPPLD membership. I also liaised with the CSP for support and guidance.
There were significant delays to the first year of the QNLD Community Standards Project due to the COVID 19 pandemic, therefore the review cycle was delayed. The 2nd edition of the ‘standards for adult community learning disability services’ were launched in December 2021.
I am pleased to say that Physiotherapists are now a Type 1 standard. Also, throughout this new edition, other standards have been adjusted which has reduced the bias towards mental health and the standards are now more balanced to represent the needs of all adults with a learning disability.
However, there remains a focus on mental health and my ability to influence was limited as all RCPsych quality networks must comply with the RCPsych College Core standards framework, so ultimately this document was always going to have mental health bias and as a result may not be relevant to all community teams.
The 2nd edition of the standards can be found here. https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/learning-disability-wards-qnld/qnld-community---second-edition-standards.pdf?sfvrsn=dcfd68f2_4
If you experience any impact of, or issues arising from the publication of these standards please contact the ACPPLD NEC.
Executive Officer ACPPLD NEC.
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