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The Royal College of Psychiatrists Improving the lives of people with mental illness

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 organisations.


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 recommended standards.


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 inspection regimes.”


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 Slowie said.


·         Response from NHS England


Further information about the Learning Disability Mortality Review will be available in due course on the HQIP website.



Easy-read  information sheet for people with learning disabilities

Overview of the project

Information about the feasibility study and background

Information about the audit

Information about the standards, audit tools, pilot sites and the timeline

Overview NALD picture
Information project NALD

National Audit of Learning Disabilities - Feasibility Study,

21 Prescot Street, London, E1 8BB    

Fax: 020 3701 2761

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