Adults with a Learning Disability JSNA (2025) - Publications

All organisations have a duty under the Equality Act to ensure people with a learning disability can access work, education and services as easily as those without a learning disability.

All organisations should therefore:

• Be learning disability aware and support and advocate for changing attitudes to value people with a learning disability as individuals with unique strengths and needs, challenging stigma and discrimination of people with a learning disability.
• Ensure that all services are equipped to support people with a learning disability, including consideration for where there may be multiple health needs. The 4 P’s Reasonable Adjustments Model should be used to help services anticipate the likely needs of people with a learning disability and make reasonable adjustments.
• Support the development, implementation and uptake of the digital reasonable adjustment flag across the health and care system.
• Ensure all appropriate health and care staff complete The Oliver McGowan Mandatory Training on Learning Disability and Autism to ensure our workforces have the right skills and knowledge to provide safe, compassionate and informed care to people with a learning disability, emphasising the positive impact of early intervention.
• Use this JSNA as a key evidence base when completing Equality Impact Assessments (EqIA) and Health Equity Assessment Tools (HEAT) to ensure systematic recognition of those with a learning disability and appropriate action is identified and embedded as part of these assessments.
• Actively engage with people with a learning disability, including networks and groups that support the learning disability community and their families and carers to ensure the voice of people with a learning disability is present and heard to plan, develop and deliver effective services.
• Engaging with faith and community leaders to support people with a learning disability in different communities is something all services, projects and programmes working with this population need to consider as part of their communication and engagement planning.

All organisations need to support identifying people with a learning disability and promote the benefits of being on the learning disability register. This should include targeting specific groups including those:

• At transition age (14-18 years) ensuring people with a learning disability are preparing for adulthood.
• Under-represented in the data, including minority ethnic groups, homeless people and older people.

All organisations should take a Making Every Contact Count (MECC) approach by supporting annual health checks. This includes:

• Creating messaging and pathways that are learning disability friendly, promoting and ensuring access to these services for those delivering annual health checks. This should include key health promotion messages around prevention, early identification, treatment and risk factors for the conditions highlighted in this JSNA.
• Identifying proactive opportunities to promote annual health checks to people with a learning disability.
• The Working in Partnership with Learning Disabilities Board have taken an action to produce annual health check promotional material for both Warwickshire and Coventry. All organisations should look for opportunities to use this material.

All organisations to improve data collection, recording and monitoring of those with a learning disability. As well as the legal duty under the Equality Act, NHS England has placed duties on all NHS organisations to collect, analyse and publish information on health inequalities, including those with a learning disability, and set out how they will respond to addressing these inequalities.

All organisations should promote the use of Health and Social Care Passports, formally known as hospital passports, once the current work redesigning these is completed (led by Coventry & Warwickshire Partnership Trust) to ensure that people with a learning disability are well supported.

All organisations need to continue to support the work of Learning from Lives and Deaths (LeDeR) and respond to their findings and recommendations. LeDeR is a programme that reviews the deaths of people with learning disabilities and autism to improve their health and reduce health inequalities.

All organisations need to address the health inequalities experienced by this population where there are opportunities to do so, ensuring that workstreams that support health and wellbeing are learning disability friendly.

All organisations need to work to improve the uptake of cancer screening for those with a learning disability via health promotion as a critical way to help reduce and address health inequalities that those with a learning disability face. This includes:

• Addressing barriers to cancer screening appointments raised by people with a learning disability in Warwickshire through engagement with Grapevine as highlighted in this report.
• This report has made specific reference to the low uptake in breast, cervical and bowel cancer screening for those with a learning disability. Although not directly referenced in this JSNA, there are a number of other screening programmes, such as prostate, that should also be promoted to improve uptake.
• Promoting the uptake of the Coventry & Warwickshire Lung Health Check programme which screens people who smoke or have ever smoked for lung cancer.

All organisations need to support people with a learning disability to get the vaccinations they are eligible for. This includes:

• The flu vaccine, where people with a learning disability are identified as a clinically ‘at risk’ group but currently this population does not hit the 75% target uptake. Younger age groups should be particularly targeted as they have the lowest uptake.
• The pneumococcal vaccine, where guidance has recently changed (as of September 2024) as part of the immunisation schedule. This should support the uptake of the pneumococcal vaccine for people with a learning disability, although this is yet to be reflected in The Green Book for health professionals and immunisation practitioners.
• The COVID-19 vaccine which is offered to anyone on the learning disability register.
• Ensuring people with a learning disability are supported to get new vaccines in future.

All organisations need to promote advanced care planning for people with a learning disability, having conversations about end-of-life care at the appropriate time. This should be promoted through the systemwide all age Palliative and End-of-Life Care strategy led by the Coventry & Warwickshire ICB.

Given the evidence that people with a learning disability are more likely to experience poor mental health, all organisations should look for opportunities to maximise mental health and wellbeing support. This includes:

• Ensuring mental health and wellbeing support pathways are learning disabled friendly and promoting these with those who may refer (such as GPs).
• A continued focus on reducing hospital admissions for mental health conditions, supporting mental health needs in the community where possible.
• Targeted work on mental health and wellbeing for those living in the most deprived areas of county.
• As identified in the NHS Long Term Plan, support and adhere to stopping over medication of people with a learning disability and autistic people (STOMP) and supporting treatment and appropriate medication in paediatrics (STAMP) agendas to stop inappropriate prescribing of psychotropic medications.

The intelligence and insight from this JSNA will be included in the life course approach currently being scoped as part of the future work programme from April 2025 onwards, ensuring we continue to have a timely evidence base for this population to support appropriate decision making across partners of the Health and Wellbeing Board.

Promote healthy lifestyles and referral pathways for services that support health and wellbeing, including health risk factors, ensuring messaging and information is learning disability friendly. These should be promoted with professionals who support people with a learning disability, in line with the MECC approach highlighted in the overarching recommendations.

Target communications around vaccination uptake, engaging with social workers, support workers and care providers (social care teams) to build into annual reviews.

This JSNA has acknowledged that people with a learning disability live in a range of different housing options. We need to understand how to best influence all housing providers to ensure housing is appropriate for those with learning disabilities and adhere to the Building for Life principles.

• Commissioners have a responsibility to consider these findings and recommendations when creating market position statements, reviewing services and developing future commissioning models.
• Commissioners to promote these findings and recommendations with providers, services and organisations they work with and work with key stakeholders to adopt and respond to them.
• Commissioners to ensure services and providers have accurate recording set up to capture interactions with people with a learning disability.
• Commissioners of all services should be able to report on people with a learning disability by ensuring appropriate data is being collected and this data should be regularly monitored.
• Commissioners should support the dissemination of health promotion communications including vaccination and screening communications.
• Ensure provider staff are trained and equipped to support people with a learning disability.
• Consideration needs to be given to the provision of care homes, supported living and community offers for working age adults with dementia and frailty due to early onset of conditions in this population meaning support may be required at a younger age.
• Commissioners should ensure services are designed to allow accessible pathways from annual health checks into commissioned services.
• Commissioners should promote annual health checks in different settings, for example in residential homes, supported living accommodation and nursing homes.
• Commissioners should ensure services are promoting independence and empowerment including a statement in all relevant service specifications.
• Commissioners to support transitions, ensuring people with a learning disability are prepared for adulthood, as highlighted by engagement mapped in this JSNA.

• Findings from this JSNA should be shared with primary and secondary care, particularly highlighting the size of the expected population with a learning disability.
• Primary care should proactively cleanse their learning disability registers annually. This should include ensuring that coding for a learning disability is correct and consistent. Colleagues in CWPT should support primary care in this to ensure registers are cleansed accurately.
• GPs should seek to become accredited with the Learning Disability Friendly Badge.
• Promote and work towards the recommendations made in the “Learning Disability Annual Health Checks, 2023/24 Quality and Under-served Population Project” report from July 2024, available here on the Coventry and Warwickshire ICS website.
• Primary care to support improving the uptake of all vaccinations for those with a learning disability through promotion in annual health checks and other appointments.
• We need to create strong links into medical examiner officer (MEO) teams to support capturing community deaths, enabling accurate reporting into the LeDeR programme for learning disability and autism deaths.
• Ensure primary care are aware of the dementia diagnosis pathway through the Community Learning Disability Team within CWPT, who have specific tools to help diagnose dementia in people with a learning disability.
• Annual health checks to be used as an opportunity to ensure people with a learning disability are not receiving unnecessary medication in line with STOMP and STAMP agenda.