In this second article covering the state of care for patients with learning disabilities, Kathy Oxtoby looks at the provision of care across four ICBs: South Yorkshire, Cornwall and Isles of Scilly, Lancashire and South Cumbria and Bath and North East Somerset, Swindon and Wiltshire.
Lancashire and South Cumbria ICB
In the North West, Lancashire and South Cumbria ICB have implemented a community forensic learning disability service (CFLDS) which supports people with learning disabilities who have complex needs associated with offending behaviour.
The aim of the service is to achieve better access to relevant treatment closer to home and in the community, and to increase the capacity to provide effective support for people with learning disabilities and forensic risks in community settings.
‘We work hard to support people to manage their risks and support community staff teams to maintain placements and avoid hospital/prison,’ says a spokesperson for the CFLDS.
Paul – not his real name – 49, is one example of a person the service supported alongside wider partners across Lancashire and South Cumbria in coming out of hospital after a prolonged period of time.
Paul was misunderstood for his aggression, and known for his love of dogs. ‘When we looked past the behaviour, we found a man who just wanted to feel safe,’ says the spokesperson.
He has a learning disability, schizoaffective disorder, and autism, and had been in a high secure hospital for 22 years (long-term segregation for 14 years).
He was considered ‘stuck in the system’ with no clear path forward. There had been aggressive incidents towards staff, but often his reputation preceded him.
‘Long-term segregation reinforced his institutional dependency, and staff were fearful and risk-averse due to historical incidents. His complex needs were simply misunderstood, and any approaches were not tailored to autism or trauma,’ says the spokesperson.
‘By embracing an autism-informed approach, Paul’s journey shifted from containment to connection.’
Regular multidisciplinary meetings involving his care team, CFLDS security teams and the inpatient team led to an agreement of shared risk management and honesty within the multidisciplinary team. ‘There was a unified vision to support Paul to move from high secure to a sustainable home, and a person-centered discharge plan was developed with him,’ says the spokesperson.
This focused on what was the right support and setting for Paul, with the aim of reducing restrictions and improving his quality of life.
It was acknowledged that the provider would require emotional support to ensure feeling of safety, and there would be shared risk taking – clear accountability across agencies to ensure continuity of care.
Paul moved into his self-contained flat earlier this year and is supported by two staff, 24 hours per day.
Within his first week of leave, he used a kettle for the first time in 20 years and ordered takeaway pizza. ‘He is now verbally communicating in full sentences, and work is ongoing with the Ministry of Justice to extend his community access,’ says the spokesperson.
South Yorkshire ICB
In South Yorkshire, the ICB says it is focused on practical system change that reduces health inequalities and improves outcomes for those with a learning disability.
ICBs are responsible for ensuring that healthcare for people with a learning disability is ‘safe, effective, and equitable’, says Dr David Crichton, chief medical officer at NHS South Yorkshire.
This includes commissioning and quality assuring both specialist and mainstream services, supporting programmes such as LeDeR (Learning from Lives and Deaths), promoting annual health checks, embedding liaison nursing in acute hospitals, and ensuring workforce training is in place.
This training includes the Oliver McGowan Mandatory Training (OMMT), which South Yorkshire has been delivering since early 2024, following two years of regional planning.
The training is co-delivered by facilitators alongside trainers with lived experience of learning disability and autism, embedding authentic insight into every session. There are now 20 trainers with lived experience employed through this.
Over 22,000 NHS and social care staff have completed this to date, which is more than 40% of the regional workforce. Rotherham, Barnsley and Sheffield providers are leading the way, with workforce training coverage between 80–95%.
The ICB also has a primary care pilot to ensure reasonable adjustments are recorded and visible across care settings, called the Reasonable Adjustment Digital Flag (RADF).
Alongside this, the ICB has a suicide prevention toolkit for autistic people, annual health checks, liaison nursing in hospitals to provide personalised support, an epilepsy safety initiative to encourage regional adoption of national safety checklists and menopause and learning disability awareness training.
‘These initiatives exemplify how practical, system-wide implementation of learning and workforce training can reduce inequalities and prevent avoidable harm,’ says Dr Crichton.
But, key challenges include workforce – there are ongoing challenges in recruiting and retaining specialist learning disability nurses and liaison staff – and consistency – evidence-based tools such as health passports and reasonable adjustments are not yet embedded universally, he says.
Challenges also include data quality – under-registration on GP learning disability registers limits proactive care and service planning – and sustainability, as financial pressures threaten investment in preventative work, despite its long-term value, he says.
‘The evidence base for improvement already exists; the challenge is in consistent delivery, sufficient capacity, and sustained prioritisation, he says.
Dr Crichton says the Government’s 10-Year Health Plan ‘aligns with our ambition: to strengthen prevention, community-based support, and equality of access’.
‘In South Yorkshire, our vision is that neighbourhood teams will deliver more proactive, joined-up support through integrated community models, bringing together primary care, nursing, social care and the voluntary sector.’
Reducing waiting lists remains a key system goal, he says. For people with a learning disability, this means ensuring diagnostic and elective pathways are accessible and designed with reasonable adjustments in place from the start, preventing avoidable delays.
‘Over the next decade, we want care to be more local, proactive and inclusive, with fewer unnecessary hospital stays, faster diagnosis and treatment, and mainstream services that consistently make reasonable adjustments as standard.’
People with a learning disability ‘remain at a higher risk of premature and avoidable death – continued national and local focus is vital’, he says.
‘Mandatory training and the Oliver McGowan Code of Practice are powerful tools to change culture and practice, but must be matched by workforce capacity and systemic follow-through,’ he says.
‘As funding arrangements evolve, ICBs must continue to prioritise learning disability services and protect preventative interventions that save lives and reduce demand on acute care.’
Cornwall and Isles of Scilly ICB
In Cornwall and the Isles of Scilly, the ICB is working alongside Cornwall Council to improve local services for patients with a learning disability.
Susan Bracefield, acting chief executive at Cornwall and Isles of Scilly ICB, says she is ‘proud’ of this work which is a ‘direct result of our continued focus on investment and commitment to maximise funding to support people with a learning disability’.
The ICB is ‘particularly proud’ that ‘very few’ people with a learning disability need to be sent out of county for a mental health placement, she says.
In line with best practice and national guidelines, the ICB continues to invest in community placements including care market and training development to discharge individuals with a learning disability and/or autism who are in long-term hospital placements.
‘It is wonderful seeing someone have the keys to their own front door and open it for the first time, especially when they have been an inpatient on a mental health ward for a number of years,’ says Ms Bracefield.
Meanwhile, more than 75% of people with a learning disability who are on GP registers in the ICB area received a health check in 2024/25, and the number of people on that register is increasing, with 3,312 people in August 2025, compared to 3,248 in August 2024.
The ICB is committed to further increasing the number year on year, it says, by promoting the importance of health monitoring and supporting people to receive their health check.
‘Our specific focus this year is on exploring and addressing health inequalities experienced by women with a learning disability,’ says Ms Bracefield.
‘Here in Cornwall, we are working in collaboration with our local council to improve the quality of offer across services for people with a learning disability.Together, we commission an array of specialised services, including help to support people at home as well as empower individuals to use their experience positively to support peers.’
Examples of these include a service called Citizen Checkers, which supports people with a learning disability who are or have been an inpatient on a mental health ward, to help them resettle into the community. Another is Practice Partners, where a team of people with a learning disability who work with GP practices to ensure services work well for those patients with a learning disability.
The ICB also has a Hearing Families support service to help families of those with a learning disability to be heard, and CHAMPs, who employs and trains those with a lived experience of disability to ensure patients get equity in access to health services.
Bath and North East Somerset, Swindon and Wiltshire ICB
Meanwhile in the South West, Bath and North East Somerset, Swindon and Wiltshire ICB ‘remains committed to creating inclusive, co-designed services for people with a learning disability and/or autism, and are working closely with partners and people with lived experience to drive meaningful change, both in the community and in inpatient care’, says a spokesperson for Bath and North East Somerset, Swindon and Wiltshire ICB.
The ICB is developing a new state of the art inpatient unit to meet the needs of people with a learning disability, in partnership with Avon and Wiltshire Mental Health Partnership NHS Trust. Called the Kingfisher, the unit will open in March 2026 and provide therapeutic person-centred support closer to home, the ICB said.
‘We are also working with HCRG Care Group to transform our community learning disability and autism services, with our aim being to ensure there is equitable provision across Bath and North East Somerset, Swindon and Wiltshire, while also making it easier for people to access the specialist health support they need when they need it,’ says the ICB spokesperson.
‘These developments are part of our wider ambition to deliver personalised, preventative, and proactive care.’
