Report on the National Audit of Learning Disabilities Feasibility Study (NALD-FS)

Abstract

Background
Concerns have repeatedly been expressed about the quality of healthcare that people with learning disabilities receive in the NHS. Clinical audit can be an effective method for improving the quality of healthcare especially when existing standards are poor. This feasibility study for a national audit of learning disabilities examined the acceptability of data collection methods and the role that audit data could play in raising the standard of care provided. The audit team used these results to recommend how a future national audit should be conducted, including recommendations for standards, recruiting services, data collection methods, and helping services use audit data to improve the quality of care they provide.
Findings
Results of the study confirm that the quality of care for people with learning disabilities falls below recommended standards. Variation in practice across study sites suggests that it is possible to improve the quality of care people receive.

Primary care standards in a national audit should address whether physical and mental health monitoring is adequate for people with learning disabilities. Based on stakeholder feedback, the audit should also collect information about interventions associated with these standards. Audit data should be reported to individual practices as well as at a commissioning level, to maximise engagement with quality improvement.

A national audit of secondary care should include acute and mental health providers, as well as specialist learning disability services. Private providers commissioned for NHS patients should also be included within the audit’s remit. Standards in secondary care should be centred on physical and mental health monitoring, staff training, reasonable adjustments and delivery of person-centred care. There should be a core set of standards applying to all types of service, and a subset developed to audit priority issues specific to each service. Experience measures for staff, carers, and patients are necessary