What is the National
Audit of Learning Disabilities - Feasibility Study (NALD-FS)?
The National Audit of Learning
Disabilities - Feasibility study began in May 2013 and finished in
April 2014. The study aimed to determine:
1) whether a national clinical audit could
feasibly generate reliable data about the quality of care provided
by health organisations to people with learning disabilities.
2) whether a national clinical audit is
an effective way of driving improvement within NHS
The feasibility study included a small number
of primary and secondary care sites (general acute and mental
health). The pilot sites were based in South Wales,
Lancashire, London, and Nottinghamshire. In primary care,
information about patients were extracted from GP systems.
Secondary care sites were asked to gather and report back
information on: reasonable adjustments; physical and mental health
assessments; staff training; improved communication with patients
and carers; and other issues relating to the health care of people
with learning disabilities.
Every participating site received a local
report which benchmarked their performance against other sites
taking part in the audit.
Learning Disability review of
feasibility study and future plans
Results of the Learning Disability Clinical
Audit Feasibility Study have now been published. Results of the feasibility
study (involving 12 GP practices, 9 acute hospitals, and 7 mental
health services across England and Wales) indicate that the quality
of care for people with learning disabilities falls below
In primary care, there was reported to be a
low uptake of annual health checks, unsatisfactory physical health
monitoring and health promotion. Secondary care services were found
to have difficulty identifying people with learning disabilities.
Learning disability was not included in mandatory training
programmes and some staff reported feeling out of their depth when
caring for this patient group.
NHS England has welcomed the feasibility study
– commissioned by HQIP and carried out by the Royal College of
Psychiatrists – and outlined how it will support work such as the
Learning Disability Self-Assessment Framework. However NHS England
has taken a decision to proceed with a National Learning Disability
Mortality Review, rather than a clinical audit.
NHS England national clinical director for
learning disability Dr Dominic Slowie recognised the good work of
the feasibility study, stating that it ‘has a number of useful
findings about methodologies to be applied in any future clinical
audit of the care for people with a learning disability’, and that
NHS England believes collecting reliable data on healthcare
experiences and outcomes for people with a learning disability is
‘key to improving outcomes for them’.
He added that NHS England would also
incorporate insights from the feasibility study into the ongoing
development of the Learning Disability Self-Assessment Framework.
Dr Slowie said: “We will require all hospitals to audit reasonable
adjustments to care as part of the standard contract from 2015 and
are working with the CQC to establish review of care for people
with learning disabilities in all settings as part of their new
However, he also pointed out there have been a
number of developments since the feasibility study was first
commissioned (in 2012), particularly the Confidential Inquiry
into the Premature Deaths of people with Learning Disabilities
(CIPOLD) report in 2013. This Inquiry was funded by the Department
of Health and recommended the establishment of a national review of
the causes of death in people with a learning disability.
“Against this context, NHS England does not
intend to establish a clinical audit at this time but has committed
to establishing a learning disability mortality review drawing on
the valuable insights this feasibility study demonstrated,” Dr
Download the response from NHS England here
Further information about the Learning
Disability Mortality Review will be available in due course on the