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NICE guidance aims to support behaviour that challenges


Tagged In:  NICE

The National Institute for Health and Care Excellence (NICE) is developing new guidance to encourage local authorities and NHS bodies to provide specialist community care for people with a learning disability and behaviour that challenges.




It's estimated that there are 1.2 million people with a learning disability in England. Of those, between 10% and 17% are likely to display behaviour which is 'challenging' i.e. harmful to the person themselves or to others around them.

In 2014, NICE announced that it was going to develop its first set of guidelines on behaviour that challenges in the context of learning disabilities. Full guidance was finally published in May of the following year, covering a range of topics, including service user and care experiences, assessment, risk factors and interventions by learning disability nurses and other health professionals from occupational therapists to people in speech and language therapy jobs.

Now NICE has published follow-up draft guidance that focuses specifically on care in the community, with the aim of reducing the numbers of people with a learning disability and challenging behaviour who are admitted to psychiatric wards or residential homes. In accordance with the NHS Transforming Care Programme, the guideline provides evidence-based recommendations to support children, young people and adults with a learning disability and behaviour that challenges to be able to live their lives in the community like everyone else. Aimed mainly at commissioners and providers of health and social care services, the guidance is also relevant for health and social care practitioners, including learning disability nurses, psychologists, mental health nurses and community nurses.

"Providing better and local support will ensure that someone who needs treatment doesn't have to be away from home," said Professor Gillian Leng, NICE's Director of Health and Social Care and Deputy Chief Executive. "Our advice, once final, will set out how services can deliver good care to meet their needs."

Key recommendations in the draft guideline include:

  • Local authorities and clinical commissioning groups (CCGs) should jointly designate a single lead commissioner who is responsible for commissioning health, social care and education services for people with a learning disability, including those whose behaviour is described as challenging. 
  • The lead commissioner should work to pool budgets or other resources for health, social care and education with neighbouring authorities, to develop local and regional services. He or she should develop local or regional plans that have a single care pathway and point of access.
  • Staff working with people with a learning disability and behaviour that challenges should get to know the person they support, find out what they want from their lives and actively involve them in all decisions that affect them.
  • Community learning disability teams should work with the person who displays behaviour that challenges and their family and carers to develop a behaviour support plan.
  • Local authorities should ensure that parents and carers of people with a learning disability and behaviour that challenges have support to care for that person from psychologists, psychiatrists, community learning disability nurses, speech and language therapists, physiotherapists and occupational therapists.
  • Commissioners in health and social care should provide reliable, flexible and varied options for respite care, including both breaks away and support at home.
  • Local authorities should ensure that staff have the skills, knowledge and qualities they need to support people effectively, as outlined in the general principles of care section of NICE's guideline on challenging behaviour and learning disabilities.

The draft guidance consultation was completed on 20 November and the final guidance is expected to be published in March 2018. 

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