Consultation on Learning disability and autism training for health and care staff

We propose that the mandatory training covers the following:

• an understanding of what learning disability and autism mean for different individuals
• the skills to support and care for someone with a learning disability or an autistic person
• awareness of the statutory framework (e.g. the Human Rights Act 1998, the Mental Capacity Act 2005, the Equality Act 2010, the Children and Families Act 2014), the Autism Act 2009) and the rights of people with a learning disability or autistic people, and how these impact on the way they provide support 
• autism and highlight the differences between autism and learning disability. The Autism Core Competency Education and Training Framework will provide a basis for assessing what skills and knowledge staff in different roles will need, and can inform our implementation plan

Should the 3 main elements to learning disability and autism training include the above? 

I agree with the proposals

Could you please provide the reason for your answer above? Should other elements be included?

We agree that the three elements proposed should be included.

The skills required to make reasonable adjustments may vary between different types of clinician. For example, optometrists who deliver a locally commissioned eye care pathway which provides adapted sight tests for adults and children with learning disability and/or autism currently undertake a distance-learning course delivered by the Wales Optometry Postgraduate Education Centre. The course specification includes learning Makaton symbols, non-verbal communication, and different methods to obtain visual acuity measurements. It also covers potential eye conditions encountered in people with learning disability and/or autism and the management of these. 

The Directorate of Optometric Continuing Education and Training (DOCET) provides online learning on Examining patients with learning disabilities. DOCET is a special Committee that was set up by the Department of Health in 1989 to oversee the management of government funds set aside for the provision of optometric continuing education and training for all UK registered optometrists.

The College of Optometrists’ Guidance for Professional Practice includes recommendations on Examining Patients with Learning Disabilities. The Guidance highlights the Mental Capacity Act 2005 and the Equality Act 2010, and recommends making reasonable adjustments when examining and communicating with a patient with learning disabilities.

The optical sector is currently working with NHS England to develop a new framework for eye healthcare for children with learning disabilities in special schools. This will include a competency framework for providers, which will cover the skills needed to understand and care for children with learning disabilities. It is hoped that the new framework, which is intended to deliver the commitment in the NHS Long Term Plan to ensure that children with learning disabilities have their needs met by eyesight and other services, will expand to cover other people with learning disabilities in future. 

Given this range of existing and planned specialist provision of eye healthcare for people with learning disabilities, we suggest that in the context of eye healthcare, the proposed new mandatory training for all health and care professionals should only need to cover the overarching skills required of all health and social care professionals.

Do you agree that awareness of how the Mental Capacity Act impacts on the way in which support is provided needs to be a significant part of training for all staff? 
I agree with the proposals 

Could you please provide the reason for your answer above?
We agree with this proposal. Most optometrists will already have a good understanding of the Mental Capacity Act and the Equality Act, and will be used to dealing with people with autism and/or learning disabilities.

Are there additional elements which need to be covered by training on awareness of autism and the needs of autistic people?
N/A

For more information about staff roles and training, please refer to chapter 3 on the consultation document.

We propose

• employers should assess the level of training needed for each member of staff, based on their role, using the 3 tiers of the Learning Disability Core Skills Education and Training Framework and have responsibility for ensuring that training was undertaken
• the Department of Health and Social Care should consider what support employers might need in making this assessment
• training might be undertaken as: 
  
  1.  part of pre-registration training
  2.  induction on recruitment (where a member of staff could not demonstrate that they had undertaken the training e.g. as part of pre-registration training, or at another employer)
  3.  part of continuing professional development
  4.  apprenticeships in health or social care
   
• provision should be made for documenting training undertaken and standards attained (e.g. through a training passport) to allow portability between different health and care employers.

Do you agree that the different levels of training should reflect the Learning Disability Core Skills Education and Training Framework (and in due course, the Autism Framework)? 
I agree with the proposals

We propose that locally employers should assess which level of training staff need and ensure that they get it 
I agree with the proposals

What support might employers need in determining the appropriate level of training for a member of staff - e.g. a more detailed tool for assessment?
Employers are best placed to assess which level of training their staff need. The current Learning Disability Core Skills Education and Training Framework is clear, and in the case of optical practices, optometrists would fall under tier 2, as professionals who provide direct support to people with learning disabilities.

We do not propose that all staff should have face to face training; just those with roles which mean they will be in regular contact with people with a learning disability or autistic people in Tiers 2 and 3. Do you agree or disagree with the proposals? 
I agree with the proposals

Should there be a standard form of documentation, to act as a training passport, portable between employers, indicating when and where training was undertaken, and documenting the specific skills developed?
Yes. We agree that learning disability and autism training must be portable between employers. The Department should include representatives from the optical sector in its discussions about how to design the system, as for example, optical professionals already develop specific skills through accreditation courses, which would benefit from being included in the training passport.

We propose:

• the Department of Health and Social Care, working with appropriate partners such as Health Education England and Skills for Care, and professional bodies, agree a common curriculum for mandatory learning disability and autism training
• professional bodies, including the medical and clinical royal colleges, regulators and Postgraduate Deaneries, agree how the curriculum would be reflected in clinical education and training, and expectations for continuing professional development for regulated professions
• the Department of Health and Social Care will work with people with a learning disability and autistic people to develop materials and identify good practice, to support the common curriculum for learning disability and autism training
• e-learning will be developed by Health Education England to provide foundation-level training for all staff (and which can be used for training for staff in Tier 1 roles in particular);
• that apprenticeships should reflect the Skills Frameworks
• encouraging a culture of practice leadership, potentially developing competence in sharing good practice and coaching in specialist staff (e.g. in Tier 3) supporting people with a learning disability or autistic people

We propose that a common curriculum for the content of training in learning disability and autism for health and social care staff should be developed which could inform implementation of professional standards. 
I agree with the proposals 

What support are employers of health and social staff likely to need to ensure their staff can have mandatory learning disability and autism training? 

What best practice are you aware of in delivering training on learning disability or autism? 

As described in our comments on question 1, the locally commissioned eye care pathway providing adapted sight tests for people with learning disabilities and autism incorporates distance learning training delivered by the Wales Optometry Postgraduate Education Centre, which covers the skills and knowledge required to meet the needs of these patients.

Who should be responsible for ensuring the promotion of best practice in how to support people with a learning disability or autism (e.g. through guidance or training for trainers)?
People with learning disabilities and / or autism and the patient groups that represent them are well placed to identify and promote best practice.

How quickly after taking up a post should new members of staff who have not previously received training, have to complete training? 
The timeframe should be flexible so that it can be covered at an appropriate point in the induction of new starters, depending on the demands of their role. We think any member of staff who is likely to be frequently involved in providing eye healthcare services to people with learning disabilities should complete the training within 12 months of taking up their post.

We propose the Department of Health and Social Care would work with:

• key partners such as NHS England and with people with a learning disability and autistic people and employers, to develop a framework for involving people with a learning disability or autistic people in training, drawing on the best existing practice;
• people with a learning disability and autistic people with stakeholders such as Health Education England, and providers of higher education, to identify good practice in how best to involve people with a learning disability and autistic people in clinical training.

What are the barriers to involving people with a learning disability or autistic people in delivering training as proposed? 
N/A

What support or advice might be needed for people on how to best involve people with a learning disability or autistic people in developing training?
N/A

What support might be needed for people with a learning disability or autistic people to ensure they have the right skills to participate in training?
N/A

How should people with a learning disability or autistic people be remunerated for participation in training to health and social care staff?
N/A

We propose:

• the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are amended to place duties on employers to ensure staff undertaking regulated activities have learning disability and autism training at the requisite level for their role;
• we will explore with NHS England how the NHS Standard Contract can be used to require providers to ensure staff have learning disability and autism training at the requisite level for their role;
• the Department of Health and Social Care should provide a timeline as part of their implementation plan for ensuring the entire health and social care workforce are trained. 

Do you agree with our proposal to use the Regulated Activities regulations to place further requirements on service providers who carry on regulated activities within the meaning of the Health and Social Care Act 2008 with a view to ensuring that all staff whose role may involve interaction with people who have learning disabilities or autistic people have received appropriate training in learning disability and autism? 
I do not know if I agree or disagree

Please explain your answer.
Most optical practices are not regulated by the CQC. However, all optometrists and dispensing opticians are regulated by the General Optical Council (GOC) and required to meet the GOC’s Standards of Practice. This includes requirements to be competent in all aspects of their work, comply with Continuing Education and Training (CET) requirements, and recognise and work within the limits of their scope of practice. 

Many optical practices will also be subject to the new Standards for Optical Businesses which the GOC intends to implement during 2019. These require businesses to ensure that their staff are suitably trained, qualified and registered.

Do you agree that we could use the NHS Standard Contract to place requirements on providers to ensure unregulated staff have received appropriate training in learning disability and autism? 
I disagree with the proposals 

Please explain your answer. 
Although optical practices providing extended services (including the locally commissioned pathway for people with learning disabilities) are subject to the Standard Contract, there’s no need to make provision for ‘unregulated’ staff in optical practices because all clinicians are already covered by the GOC’s requirements.

What do you think we should do to ensure that self-employed staff / lone practitioners/ partners undertake training to an appropriate level?
All self-employed practitioner optometrists providing eye healthcare to people with learning disabilities are already subject to the GOC’s regulatory requirements as discussed above.

We propose:

• the Department of Health and Social Care and the Department for Education explore with CQC and Ofsted how they can monitor learning disability and autism training in their inspections;
• NHS Improvement Learning Disability Standards are used as vehicle for ensuring Trusts are implementing mandatory learning disability and autism training; 
• the Department of Health and Social Care work with NHS Digital and other stakeholders in identifying appropriate datasets to monitor uptake of learning disability and autism training; 
• the Department of Health and Social Care commission a formal evaluation into the impact of mandatory learning disability and autism training once the new arrangements are fully embedded.

We envisage that CQC and Ofsted inspections will provide a robust means of ensuring mandatory learning disability and autism training is happening. Do you agree? 
I do not know if I agree or disagree

Please explain your answer 
Most optical practices are not regulated by the CQC. As mentioned above – their patients are already protected by General Optical Council regulation of clinicians and most optical practices. In addition, the vast majority of optical practices in England provide NHS-funded sight tests and are therefore subject to NHS contractual requirements.

How might people with a learning disability be involved in assessing or monitoring mandatory learning disability and autism training? 
N/A

What do you think are the likely costs of implementing mandatory training for health and care staff in learning disability and autism? 

Optical practices vary in size, ranging from small, independent practices with only a handful of staff, to large multiple businesses. 

For small practices, the indicative costs for tier 2 training outlined in the consultation document (c. £900 for a two-day training course plus lost staff time) will be a significant and disproportionate burden if each practice has to deliver its own training. 

It may be feasible for groups of practices in a geographical area to deliver this training jointly, for instance through Local Optical Committees. Where that is not possible, independent practices and very small groups of practices should be eligible for financial support for training costs from commissioners, as they are providers for ‘whom it would be uneconomical or impractical to establish their own training sessions.’

What evidence is available on the economic benefits of mandatory training?
N/A

What evidence can you provide on the current provision of learning disability and autism training around the country? 
As discussed in our comments on Question 1, many optical professionals undertake specialist training in learning disability and autism awareness in order to become accredited to deliver an eye care pathway for children and adults with learning disabilities and / or autism. This might include the Wales Optometry Postgraduate Education Centre course, which has been peer-reviewed by Dr Margaret Woodhouse OBE, an academic with a special interest in the visual needs of people with learning disabilities. 

Other optical professionals undertake specialist training as part of their Continuing Education and Training under the General Optical Council’s CET framework.

Submitted: April 2019