Care for People with Learning Disabilities

Adults with learning disabilities have the same legal rights to social care under the Care Act 2014 as any other adult with care and support needs. They are entitled to a care needs assessment, and if eligible, a care and support plan funded (subject to means testing) by the council.

They also have specific rights under the Equality Act 2010 — reasonable adjustments must be made by public services, employers, and service providers to ensure they are not disadvantaged by their disability. The NHS, local councils, and other public bodies must consider the Equality Act in all their activities.

If a person with a learning disability lacks mental capacity for specific decisions, the Mental Capacity Act 2005 applies. Decisions must be made in their best interests, following proper process. Their wishes and preferences must still be sought and given significant weight even if they cannot formally consent.

For most adults with learning disabilities, supported living is the preferred and recommended model of care. In supported living, the person has their own tenancy (either alone or sharing with others) and a separate care and support package is commissioned to provide the level of assistance they need. Keeping housing and support separate means that if the support arrangement changes, the person keeps their home.

Residential care in a registered care home may be appropriate for people with very complex or profound needs where the supported living model cannot safely provide sufficient support. However, the principle of least restriction and the importance of community inclusion should mean residential care is considered only when other options cannot meet needs.

Government policy (Building the Right Support) aims to reduce the number of people with learning disabilities living in inpatient mental health settings and to develop community-based alternatives. Local Transforming Care Partnerships work to implement these changes in each area.

People with learning disabilities have significantly higher rates of health conditions (including epilepsy, mental health conditions, diabetes, and heart disease) than the general population, and their health needs are often underdiagnosed and undertreated. NHS England recommends that adults with learning disabilities are offered an Annual Health Check by their GP. These checks are free and cover a wide range of health issues.

People with learning disabilities should be on their GP's learning disability register to ensure they receive appropriate reminders and reasonable adjustments. Hospitals and other healthcare settings must make reasonable adjustments — including accessible communication, extra appointment time, and carer support — to ensure people with learning disabilities can access care effectively.

If you are concerned about the healthcare a person with a learning disability is receiving, contact the local Learning Disability Liaison Team (available in most NHS Trusts) or a Health Facilitator — a specialist NHS nurse who supports people with learning disabilities to access health services.

Care and Treatment Reviews (CTRs) are independent reviews commissioned by NHS England for people with a learning disability or autism who are in — or at risk of being admitted to — inpatient mental health or assessment and treatment units. CTRs are chaired by an independent reviewer (typically a professional with expertise in learning disability) and attended by the patient and their family or advocate, the clinical team, a commissioner, and a peer reviewer. The review examines whether inpatient care is necessary, what the barriers to discharge are, and what needs to be in place in the community for a safe return home. NHS England has a legal duty to commission CTRs for people admitted to inpatient settings, and families can request a CTR if they believe one has not been arranged.

Building the Right Support (BTRS) is the Government's national plan, first published in 2015 and updated since, to reduce the number of people with learning disabilities and autism in inpatient settings. Despite significant effort, progress has been slow and the number of people in inpatient units remains stubbornly high. BTRS commits to developing community-based services as alternatives to hospital admission — including crisis support, community forensic services, and intensive support teams. Local Transforming Care Partnerships (TCPs) were the vehicles for delivering BTRS at a local level. Families who believe their relative is unnecessarily in an inpatient setting should contact their ICB's learning disability commissioner and request a CTR and discharge planning meeting.

Hospital discharge planning for people with learning disabilities has specific challenges. The Mental Health Act 1983 and the Mental Capacity Act 2005 both potentially apply; in cases where a person is detained under the Mental Health Act, discharge requires approval by the responsible clinician and community mental health team. The council is responsible for arranging post-discharge social care but must be given sufficient notice and funding must be confirmed before discharge occurs. For people in NHS-funded inpatient placements who need complex supported living arrangements after discharge, the process often involves the NHS, the council, specialist housing providers, and family — and can take months to organise safely. Families should be involved in all discharge planning meetings and have the right to request advocacy support through the local council.