Katy Welsh looks back at 40 years in learning disability nursing
Katy Welsh, Professional Lead Nurse, RNLD and Queen’s Nurse look back at a career of change, challenge and purpose.
I wanted to share my reflections. As I look back over four decades in Learning Disability Nursing, I feel immensely proud of how far our profession has come and grateful for the people I’ve had the privilege to work alongside. What began in 1985 as a career shaped by institutional care has evolved into one grounded in rights, independence, choice and inclusion. It has been quite a journey.
The early years: From institutions to independence
My nursing career began during a very different era. Training at Langdon Hospital in Dawlish, then a long‑stay institution, meant working within a strongly medical model. People lived in shared dormitories with little privacy, limited belongings, and almost no choice in daily routines. Activities, meals and family contact were all restricted.
After qualifying in 1988, my first post was in a small residential home on the Langdon grounds. Most of the residents had moved from locked wards and were just beginning to experience ‘ordinary’ life. My role shifted entirely: from task‑based medical care to a person‑centred approach focused on developing skills like cooking, shopping and household tasks. Seeing people reclaim choice, deciding what to watch on TV or when to wake up, was genuinely heartwarming.
A move into community care
In 1990, I joined the Community Learning Disability Team in Torbay, working with both children and adults. Following the Community Care Act, the social model of disability was becoming firmly established and nurses increasingly took on care‑management roles. At times, this blurred our identity as nurses, but it also helped reshape services around the lives people wanted to lead.
During this period, I was seconded as a hospital liaison nurse, one of the first such roles nationally. This was vital work, challenging diagnostic overshadowing, advocating for equal treatment and ensuring reasonable adjustments in hospital settings. Simple steps such as offering a side room, access to a favourite object, or tailored communication made a significant difference for patients and families.
Reform, rights and persistent inequalities
The Valuing People white paper in 2001 marked a turning point, strengthening rights, choice, independence and inclusion for people with learning disabilities. Over the following years, services continued to evolve - moving away from large residential homes to supported living, where people have their own tenancies and support.
Yet despite this progress, premature mortality remains a stark and unacceptable inequality for people with learning disabilities. In Devon, we created Primary Care Liaison roles to bridge gaps between specialist and mainstream services, supporting people to access fair, timely and effective healthcare. Although annual health checks (introduced in 2009) were hoped to be transformative, the 2026 LeDeR report still shows 40% of deaths as avoidable. Nurses remain key to changing this through education, advocacy, and accessible information.
Leadership through change — including a global pandemic
My years as a Primary Care Liaison Nurse and later Team Manager were among the most meaningful in my career. Then Covid‑19 arrived, challenging how we worked overnight. With services in lockdown and face‑to‑face contact heavily restricted, we had to rethink everything. Adapting to remote working was a steep learning curve but everyone pulled together to support our most vulnerable people.
In 2021 I was appointed Professional Lead Nurse. It has been a privilege to work with such a skilled and committed workforce. I’m especially proud of our efforts to 'grow our own' nurses. Between now and 2030, 28 staff are already on pathways to becoming Registered Nurses or Nursing Associates in Learning Disability Nursing, with more apprenticeship opportunities coming.
Looking forward with hope and confidence
As new national priorities and mental health reforms emerge, our role will continue to grow. Learning disability nurses are essential in tackling health inequalities, preventing unnecessary hospital admissions and shaping proactive, community‑focused support.
What gives me confidence for the future is simple: our purpose. When we remember why we do this job - to make a positive difference in people’s lives - our profession continues to adapt, lead and thrive.
As I step back and reflect, I can honestly say that Learning Disability Nursing has been the best career choice I could have made. Thank you to everyone across Devon Partnership Trust for your dedication, compassion and kindness. In challenging times, looking after yourselves and each other matters more than ever.