Quality statement 4: Named lead practitioner

Quality statement

People with a learning disability and behaviour that challenges have a named lead practitioner. [2015, updated 2019]

Rationale

Children, young people and adults with a learning disability, and their families and carers, can find it difficult to get support from the right services at the right time. Having a named lead practitioner to coordinate support can help with this and make sure that services work together. The person and their family or carer should be given a choice of lead practitioner that takes into account any personal needs, such as cultural or religious needs. The lead practitioner can also get to know the person and their family or carer, and involve them in decision making, which can improve understanding of the care and support the person needs. The lead practitioner can also improve outcomes for people with a learning disability by consistently making sure their care and support needs are met, and allowing them to feel empowered and involved in their care.

Quality measures

Structure

a) Evidence of local arrangements to ensure that named lead practitioners are responsible for coordinating care and support of people with a learning disability and behaviour that challenges.

Data source: Local data collection, such as records from community learning disability teams or GP practices.

b) Evidence of local arrangements to ensure that lead practitioners have access to all agencies involved in supporting people with a learning disability and behaviour that challenges.

Data source: Local data collection, such as review of service level agreements.

Process

Proportion of people with a learning disability and behaviour that challenges who have a named lead practitioner.

Numerator – the number in the denominator who have a named lead practitioner.

Denominator – the number of people with a learning disability and behaviour that challenges.

Data source: Local data collection, such as records from community learning disability teams or GP practices.

Outcomes

a) Proportion of people with a learning disability and behaviour that challenges who feel satisfied with services.

Numerator – the number in the denominator who feel satisfied with services.

Denominator – the number of people with a learning disability and behaviour that challenges.

Data source: Local data collection, for example, using surveys, focus groups and other methods of gathering the views of people using services, such as those used in the Challenging Behaviour Foundation and Mencap's valuing the views of children with a learning disability.

b) Proportion of people with a learning disability and behaviour that challenges and their families and carers who feel satisfied with involvement in decision making.

Numerator – the number in the denominator who feel satisfied with services.

Denominator – the number of people with a learning disability and behaviour that challenges and their families and carers.

Data source: Local data collection, for example, using surveys, focus groups and other methods of gathering the views of people using services and their families, such as those used in the Challenging Behaviour Foundation and Mencap's valuing the views of children with a learning disability.

What the quality statement means for different audiences

Service providers (such as social care providers, community mental health teams, community learning disability teams and disabled children's teams) ensure that there is a named lead practitioner for each child, young person and adult with a learning disability and behaviour that challenges. Service providers are in regular contact with the lead practitioner, keeping them informed and involved in decision making.

Health and social care practitioners (such as social workers in a disabled children's team or community learning disability team, community learning disability nurses or allied health professionals) with appropriate skills and knowledge act as the named lead practitioner for a child, young person or adult with a learning disability and behaviour that challenges. They get to know the person and coordinate support to meet their long-term needs. They work in partnership with the person, and their family or carers, to arrange regular meetings to discuss the person's care and support, and invite people in the person's support network to the meetings, if this is what the person wants, or when decisions are made in a person's best interests (if the person is over 16, and in line with the Mental Capacity Act 2005). They identify gaps in support and service provision and report these to the lead commissioner. They develop and review the care and support plan with the person with a learning disability and behaviour that challenges, and their family or carers.

Commissioners (such as local authorities, clinical commissioning groups and lead commissioners) ensure that services assign a named lead practitioner, for example, a social worker (in a disabled children's team or community learning disability team) or community learning disability nurse, for a child, young person or adult with a learning disability and behaviour that challenges. They are in regular contact with the lead practitioner, making sure that no decisions are made without involving them and the person with a learning disability and behaviour that challenges.

People of all ages with a learning disability and behaviour that challenges have one person, called the 'lead practitioner', who they can talk to about their support. The lead practitioner is a person who understands learning disability and behaviour that challenges. They might be a social worker or a nurse. The lead practitioner meets regularly with the person, gets to know them and makes sure they get the support they need.

Source guidance

Learning disabilities and behaviour that challenges: service design and delivery (2018) NICE guideline NG93, recommendation 1.2.10

Definitions of terms used in this quality statement

Named lead practitioner

A named practitioner with appropriate skills and knowledge, such as a social worker in a disabled children's team or community learning disability team, or community learning disability nurse, who gets to know the person and coordinates support to meet their long-term needs. Their responsibilities include working in partnership with the person to:

  • arrange regular meetings to discuss the person's care and support, and invite people in their support network, including the family, carers, independent advocates and practitioners from all services that support them

  • recognise and use the expertise brought by all members of the person's support network (not only those who are paid)

  • develop and review the person's care and support plans with community learning disability teams or relevant children's services (for example, disabled children's teams) and service providers.

[NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, recommendations 1.2.10, 1.2.12 to 1.2.14 and 1.2.16]

Carer

Someone who provides informal care and support to a child, young person or adult with a learning disability. It does not cover staff who are paid to provide care or support.

[NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, terms used in this guideline]

Behaviour that challenges

Behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or physical safety of the person, or others around them. It also includes behaviour that is likely to severely limit, or result in the person being denied, access to and use of ordinary community facilities.

[Adapted from NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, terms used in this guideline]

Equality and diversity considerations

Lead practitioners may find it particularly difficult to communicate effectively with children, young people and adults who have severe or profound learning disability. They may need to call on additional support to help them communicate with the person. This could include involving speech and language therapists, or working with family members or social care providers who know the person well to find ways of improving communication. Lead practitioners may also use augmentative and alternative communication approaches such as manual signs, pictures, objects and aids to help people to communicate well.