It’s Learning Disability Week (Monday 14 to Sunday 20 June), so we spoke to Tim Buck, our lead nurse for learning disabilities (LD) and autism, and interim named nurse for safeguarding adults.

Tim, who joined our team just after the first wave of the pandemic, spoke about how the role of his team is to reduce the health inequalities faced by people with LD. 

Age: 36

Lives: Tim recently bought a flat in Homerton, where there is lots of green space for him to indulge his love of the outdoors and running.

And: He only discovered his passion for working with people with LD when he took a weekend job at a residential home to help pay his rent – and loved it.

What was it like joining our Trust in the middle of a pandemic?

I joined last May so right after the first wave. It was unusual to see that while the wards were really busy, lots of other areas of the hospital were quiet.

I could feel that everyone was under pressure, however, they were all so welcoming and there was a real sense of focus.

Tell us how your role was affected

I work alongside two other LD nurses and we’re there to support our LD patients and their families, ensuring any attendances or admissions to our hospitals go smoothly. We also support and advise our staff, including training, and liaise with external teams.

Our roles didn’t change hugely due to the pandemic, though we did have to think a bit more about how we moved around our hospitals, for example if we needed to visit patients on Covid wards and those in the green zone, splitting that amongst the team so we didn’t pose an additional risk to them.

What was difficult for us was the impact on our patients – we didn’t see higher number of LD patients in our hospitals, but we did see a higher number of deaths. That was replicated across the country.

LD patients are certainly a high-risk group. They are more likely to have long-term health conditions, which we know is a risk factor; accessing and understanding information can also be more difficult for them, especially when the restrictions and guidelines kept changing which made it harder to protect themselves from Covid; and their reliance on others also meant they couldn’t isolate entirely.

Our focus during the pandemic has been to support our teams who were caring for some LD patients who were very sick with Covid-19. We wanted to give them the confidence in making the reasonable adjustments for these patients.

This could mean bringing in a familiar carer to sit with them and provide reassurance if they are struggling to tolerate an oxygen mask, or using different forms of simplified communication, or pictures, to explain things to them.

Reasonable adjustments are the small adaptions we make to provide equal care to LD patients, and equal does not always mean the same. When working with LD patients it’s really important that I work in collaboration with the multidisciplinary team, and we all work closely with those who know the patient best, and can tell us what has worked well for them in the past.

Our role is really important as it has become apparent over the last 20 years that LD patients face significant health inequalities, which has also been further highlighted during the pandemic. We’re in a good position at our Trust, having an LD team, as in some trusts, it’s a standalone post.

What’s next for improving the experience for LD patients in our hospitals?

I’m really excited that we’re launching our strategy next week (Tuesday 22) as it will set the pace for improvement over the next five years. We’ve also created an LD and autism policy, which helps consolidate how we’re providing care and gives staff clear guidance.

And we’re introducing mandatory LD training for all staff, it’s tiered in level of detail, tailored to each specific staff group and their involvement with LD patients, so from basic training to more advanced.

I’m also really grateful to my predecessor, Heather Woollard and Gary Etheridge, Safeguarding Director, for all their hard work in raising the profile before I joined our Trust. (You can read the In Conversation With Interview Heather gave just before she retired from our Trust, on our website.)

How did you end up an LD nurse?

I didn’t know what I wanted to do when I left school and I was good at art so I went to art college. I started working in a residential home for people with LD at weekends to help pay my rent, and I loved it.

I left art college and became a support worker, I stayed in that job for eight years, continuing while I did my nurse training. It was through the local community LD team I started to get to know the nurses and began to think about getting into that. I trained in York, near where I grew up in Yorkshire, where I worked for a few years after I qualified ten years ago, then I moved down to London.

I started as a community nurse in Westminster, tackling challenging behaviour which could leave people at risk of being excluded from services, or admitted to hospital. My role was to help them stay in the community. My first job in an acute setting was as an LD clinical nurse specialist with UCLH, which I really enjoyed. It was very different what I’d done before in the community, very fast-paced.

LD nurses in an acute setting is relatively new over the last decade or so as historically, LD patients lived in institutions and many of the nurses I’ve worked with and who mentored me as a student nurse, trained in these institutions.

I left UCLH for a matron role at a specialist LD unit with Central and North West London NHS Foundation Trust, and it’s from there that I joined our Trust.

What makes you passionate about what you do?

I like people, and getting to know them. When I started out as a carer I really enjoyed spending time doing fun stuff – going shopping and on day trips out – generally helping people to live their lives.

There’s no agenda with LD people, they’re just individuals who need your help and are really grateful for it.

Of course it can be a tough job, and you need to be patient. It’s so rewarding, especially when you get through the tough times and see a smile on the face of someone you’ve helped.

What message do you have for others caring for LD patients this Learning Disabilities Week?

The biggest advice I give to anyone with LD people is get to know them, and don’t make assumptions.

I think it’s important that as clinicians we don’t allow for ‘diagnostic overshadowing’ – when you see the learning disability, rather than the health problem they need your help with. That’s the biggest risk they face.

Take your time with them, and find out about them as a person.

Finally, what do you like getting up to outside work?

I love running and am just getting back into it. I was due to run the Yorkshire Three Peaks before the pandemic hit and it was cancelled – I lost all motivation and stopped running.

It’s been rescheduled to this October so now I really need to start training hard to be ready for it; especially as I also enjoy a pint!

It was also nice to get back up to Yorkshire recently and see family as it was really difficult only being able to talk to them on the phone due to the restrictions, especially when my mum had Covid as she lives alone. It was great to catch-up with her and my aunt.