Frequently asked questions :: Improving Health and Lives

This is where we show you where to find the answers to questions we get asked a lot.

What are ‘learning disabilities’?

People with learning disabilities have significant and widespread difficulty in learning and understanding. They will have had this difficulty since childhood. The term ‘learning disabilities’ does not include specific learning difficulties such as dyslexia, specific social/communication difficulties such as Asperger’s syndrome or significant and widespread difficulty in learning and understanding that are acquired in later life. People with learning disabilities are more likely to have autism than people who do not have learning disabilities. Find out more.

How many people have learning disabilities?

Approximately 300,000 children and 900,000 adults in England have learning disabilities. However, most adults with learning disabilities do not use specialist services for people with learning disabilities. Approximately 200,000 adults in England use specialist services for people with learning disabilities or are known to health or social care services as have learning disabilities. Find out more.

How can I find out how many people have learning disabilities in my area?

We have web pages through which you can find out how many children in your area we expect to have learning disabilities (or autism) and how many adults are recognised by GPs as having learning disabilities.

Do people with learning disabilities have poorer health than others people?

Yes. People with learning disabilities are more likely to die at an early age than other people. Children and adults with learning disabilities are also more likely than their peers to have more sensory impairments and poorer physical and mental health. Find out more.

How can I best collect information about the health needs of people with learning disabilities in my area?

There are two main ways you can collect information about the specific health needs of people with learning disabilities in your area. First, you can undertake periodic local health audits. Second, you can extract information already held in information systems operated by local GPs and hospitals.

Why do people with learning disabilities have poorer health than others people?

The main reasons people with learning disabilities have poorer health are: (1) increased risk of exposure (and possibly greater vulnerability when exposed) to well established ‘social determinants’ of poorer health such as poverty; (2) some specific genetic causes of learning disabilities are also associated with some specific health risks; (3) people with learning disabilities often have communication difficulties and poorer understanding of health; (4) people with learning disabilities are less likely to lead ‘healthy’ lifestyles; (5) people with learning disabilities are at risk of being discriminated against when trying to access or use health services. Find out more.

What needs to be done to address this problem?

Education, health and social care services need to work together to improve the daily living conditions of people with learning disabilities, improve people with learning disabilities’ understanding of health and make ‘reasonable adjustments’ in how services are provided that take account of the specific needs of people with learning disabilities. Find out more.

What are the statutory responsibilities of health care organisations in relation to people with learning disabilities?

Health and social care organisations have statutory responsibilities under the Equality Act 2010 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 to make ‘reasonable adjustments’ in how services are provided in order to reduce the preventable inequalities in health experienced by people with learning disabilities. Find out more.

What are 'reasonable adjustments'?

In law, all public sector services have a legal duty to make ‘reasonable adjustments’ to the way they make their services available to people with learning disabilities, to make them as accessible and effective as they would be for people without disabilities. Reasonable adjustments include removing physical barriers to accessing health services, but importantly also include making whatever alterations are necessary to policies, procedures, staff training and service delivery to ensure that they work equally well for people with learning disabilities. We have undertaken a survey of what reasonable adjustments NHS Trusts are making and host a searchable directory of adjustments.

What reasonable adjustments should health care organisations be making?

Health care organisations should be making reasonable adjustments that help people with learning disabilities access and make the best use of primary and secondary health care. They range from providing information in ways that are more accessible for people with learning disabilities to providing specific health care screening for people with learning disabilities (e.g., annual health checks). Find out more.

What are the key commissioning actions to help ensure that people’s healthcare improves?

Commissioners should ensure that the health inequalities faced by people with learning disabilities locally are identified and documented in the Joint Strategic Needs Assessment. They will need to work in partnership with relevant partner agencies to commission services which address the determinants of health inequalities, such as poor housing and unemployment, and should ensure that people with learning disabilities and their families have access to information and services which support healthy lifestyles. Commissioners should focus on increasing the number and quality of health checks for people with learning disabilities, as we know that health checks identify unmet health needs. They should also ensure that health services are accessible to people with learning disabilities by checking that reasonable adjustments are in place in the services they commission. Using the Self-Assessment Framework (SAF) can help commissioners measure progress. Find out more.

What are annual health checks for people with learning disabilities?

Since 2009 Primary Care NHS Trusts have been required to offer GP practices in their area additional funds (through a Directed Enhanced Service) to enable them provide annual health checks for adults with learning disabilities. The checks should be undertaken by a provider with appropriate training and be based on a local protocol that included the following: a review of physical and mental health with referral through the usual practice routes if health problems are identified; health promotion; a review of chronic illness; a physical examination; a review of epilepsy; a review of behaviour and mental health; a syndrome specific check; a check on the accuracy of prescribed medications; a review of co-ordination arrangements with secondary care; a review of transition arrangements where appropriate. Find out more.

Why are health checks important?

People with learning disabilities have poorer health than their peers. This is, in part, due to the difficulties they face in recognising ill-health and using primary care health services. Providing annual health checks for adults with learning disabilities have been shown to be an effective way of identifying health conditions that were previously not known about. As such, they are possibly the most important ‘reasonable adjustment’ that can be made in primary health care services to address the health inequalities faced by people with learning disabilities. Find out more.

How can I find out how many health checks have been done locally?

We publish the information collected each year on the uptake of health checks by adults with learning disabilities in England. Find out more.

How do we ensure that health checks are delivered effectively?

We have worked together with many different people to provide an audit tool that will help people judge how well they are doing at delivering health checks and what they could do to deliver them more effectively.

What actions can improve healthcare delivered by acute/general hospitals?

Hospitals need to be able to identify people with learning disabilities on their record systems so that they can put appropriate reasonable adjustments in place. Developing a culture in which everyone understands reasonable adjustments is important, as is the provision of accessible information at all stages of the care pathway. Developing clear care pathways including admission and discharge protocols which take account of the additional support needs of people with learning disabilities is important. People with learning disabilities and family carers know best about what they need and should be involved in service development and evaluation. All staff need to understand the Mental Capacity Act, and hospitals should monitor how well it is being implemented. Find out more

How can I find out how well my local health services are doing at supporting people with learning disabilities?

Each year NHS Trusts in England are supported to undertake a self-assessment process. This is a way of working that gets people together to discuss, and decide, how well they think their local and regional health organisations are working to improve the health of people with a learning disability. You can see the 2011 results here.