How many adults with learning disabilities in England are getting social care services - 2024/25 update

The Department of Health and Social Care have recently released their annual tranche of statistics concerning social care for adults in England (these were previously published by NHS Digital, then NHS England until this year). This blogpost is the latest in a series about social care statistics concerning adults with learning disabilities in England, updating the statistics to include the latest 2024/25 figures. While the underlying information used seems to be the same, there have been changes this year to how the information is extracted (from individual records of people drawing on social care) and how the information is reported. This has led to improvements in some aspects of the information made public about adults with learning disabilities (particularly in information about people aged 65+), but less specific information sometimes being reported on specific kinds of social care services people are using.

I have written a blogpost on the 2024/25 employment figures contained in the social care statistics, and I will be writing one on the 2024/25 information about social care finances.  This blogpost is about what the statistics say about how many adults with learning disabilities were drawing on social care in 2024/25. 

Question 1: How many adults with learning disabilities were getting access to social care in 2024/25?

From 2014/15 to 2023/24 the types of long-term social care support people get were grouped into one of six mutually exclusive categories: residential care, nursing care, direct payment only, support via a personal budget partly including a direct payment, a council-managed personal budget, and council-commissioned community support only. The way this is reported has changed a bit in 2024/25, with in effect the two categories of direct payment (direct payment only and support via personal budget partly including a direct payment) being lumped together. Importantly, a category of ‘unknown’ has been added, where a local authority does not appear to know what form of long-term social care support a person with learning disabilities is getting. 

The first graph below shows the number of adults with learning disabilities aged 18-64 getting various types of personal budget or council-commissioned community support at some point during the year from 2014/15 to 2024/25, the number of adults aged 18-64 in residential or nursing care, and the number of adults aged 18-64 getting an unknown form of long-term social care (this is new for 2024/25, and represented by an orange square in the graph).

This graph suggests that some trends have been consistent from 2014/15 to 2024/25 for adults with learning disabilities aged 18-64, while other trends have been less consistent over time.

The number of people in residential care has continued to reduce year-on-year from 26,975 people in 2014/15 to 20,070 people in 2024/25. The number of people in nursing care gradually dropped from 2014/15 (1,265 people) to 2023/24 (1,000 people), but increased in 2024/25 (1,075 people). Overall, although the number of adults aged 18-64 in residential care and nursing care continues to gradually decline over time, in 2024/25 they still represented 15% of all adults with learning disabilities aged 18-64 getting long-term social care.

The number of people getting social care in the form of direct payments (at least in part) increased from 2014/15 (34,845 people) to 2019/20 (44,875 people), dipped for two years coinciding with the height of the Covid-19 pandemic (to 44,195 people in 2021/22), and has since resumed its rise to 46,130 people in 2024/25. 

The most common form of long-term social care support recorded is the council-managed personal budget (the extent to which many of these feel any different to council-commissioned community services is debatable), which continued to increase fairly steadily over time (from 49,150 people in 2014/15 to 62,350 people in 2023/24). An apparent sharp drop to 56,060 people in 2024/25 matches almost exactly the number of people (5,955 people) newly classified in 2024/25 as getting an ‘unknown’ form of long-term social care. It is unclear to me why local authorities don’t know what long-term social care they are commissioning, and also why it seems that they were previously counting them as council-managed personal budgets.

Finally, while the number of people getting council-managed community support decreased substantially from 2014/15 (12,000 people) to 2020/21 (4,900 people), there have been big fluctuations since (currently recorded as 7,910 people in 2024/25).

In total 137,200 adults with learning disabilities aged 18-64 were getting long-term social care at some point in 2024/25. While there have been steady trends of increasing numbers of adults with learning disabilities getting long-term social care from 2014/15 to 2019/20 and from 2021/22 to 2024/25, from 2019/20 to 2021/22 during the height of the Covid-19 pandemic there were two years of decreases in these numbers. 

The second graph below presents the same information for adults with learning disabilities aged 65+. Because the number of people with learning disabilities aged 65+ using social care is much smaller compared to people aged 18-64, I have used a different vertical scale.

 

The number of people aged 65+ in residential homes (5,425 people in 2014/15) increased substantially up to 2018/19 (5,850 people), and with some minor fluctuations has remained at a similar level up to 2024/25 (5,875 people). With the exception of two years of decreasing numbers of people aged 65+ in nursing homes from 2018/19 to 2020/21, the number of people has increased year-on year from 670 people in 2014/15 to 920 people in 2024/25. For adults with learning disabilities aged 65+ getting long-term social care, 35% were getting this care in the form of residential or nursing care.

People aged 65+ getting long-term social care in direct payments at least in part increased year-on-year from 2014/15 (1,125 people) to 2021/22 (1,850 people) and has fluctuated since then (currently 1,690 people in 2024/25). 

As with adults aged 18-64, the most common form of long-term social care support recorded for adults with learning disabilities aged 65+ is the council-managed personal budget, which continued to increase fairly steadily over time (from 5,920 people in 2014/15 to 9,855 people in 2023/24). Again, an apparent sharp drop to 8,915 people in 2024/25 matches almost exactly the number of people (830 people) newly classified in 2024/25 as getting an ‘unknown’ form of long-term social care.

Finally, the number of people getting council-commissioned community support has decreased steadily over time from 2014/15 (1,430 people) to 2023/24 (685 people), although there was a sharp increase in 2024/25 (1,220 people).

Unlike the figures for adults with learning disabilities aged 18-64, there is a continuous year-on-year upward trend in the numbers of adults with learning disabilities aged 65+ getting long-term social care, from 14,570 people in 2014/15 through to 19,455 people in 2024/25. 

However, the statistics I’ve presented so far are for people getting long-term social care at some point in each year. The statistics also have snapshot figures on the number of people with learning disabilities getting adult social care at the end of each financial year, which we can compare to the number of people getting social care at some point during the year. The graph below shows this information for adults with learning disabilities aged 18+ (combining the figures for people aged 18-64 and people aged 65+), from 2014/15 to 2024/25. In 2020/21 and 2021/22, there is a clear reversal in the upward trend, before this resumes up to 2024/25.

There is also the question of whether the number of adults with learning disabilities getting long-term social care is increasing in line with projected increases in the number of adults with learning disabilities needing social care. The graph also includes projected numbers of adults with learning disabilities requiring social care support, taken from population projections published in 2012 and baselined for 2014/15. There are two projections using dashed lines - the dark blue dashed line is the number of adults with critical or substantial needs only, and the light blue dashed line is for the number of adults with critical, substantial or moderate needs. 

As the graph shows, up to 2019/2020 the number of adults getting long-term social care was just about keeping pace with the projected numbers of adults with critical or substantial needs (which is drawing the eligibility hurdle really quite high), but by 2024/25 the gap between the number of people projected to need social care and those actually getting social care was around 13,700 people. The gap is even greater if you take the projected number of adults with learning disabilities with critical, substantial or moderate needs (a gap of around 26,600 people in 2024/25).

Question 2: Where are people with learning disabilities living?

The headline social care statistics only report the living situations of people living in residential care and nursing homes, which I’ve covered above. Up until 2023/24, more detailed information was hidden away on where local authorities think adults with learning disabilities aged 18-64 getting long-term social care were living (see this past blogpost for an analysis of this information). In 2024/25, the way this information has been made available has changed quite a lot. The good news is that this information is now available for adults with learning disabilities aged 65+ as well as people aged 18-64. The bad news is that they have collapsed the detail of where people are living into four categories that to my mind feel pretty meaningless:

• Living at home or with family - supported (includes people living in approved premises for offenders, shared lives, sheltered housing, supported accommodation)
• Living at home or with family – unsupported (includes mobile accommodation, owner occupier, settled mainstream housing with family or friends, tenant, tenant with a private landlord)
• Not living at home – supported (night shelter, temporary accommodation, other temporary accommodation, refuge, rough sleeper, staying with family or friends in the short term)
• Not living at home – unsupported (prison, care home, nursing home, healthcare)

For what it’s worth, the graph below shows the information using these collapsed categories for people with learning disabilities aged 18-64 from 2014/15 to 2024/25. How this is more useful in understanding what kinds of places people are living in, and how things are changing over time, is beyond me.

 

For people with learning disabilities aged 65+ (for whom we only have information for 2024/25), the equivalent figures are:

• Living at home or with family – supported. 8,000 people
• Living at home or with family – unsupported. 4,650 people
• Not living at home – supported. 6,180 people
• Not living at home – unsupported. 85 people
• Living situation unknown. 545 people

Question 3: What do adults with learning disabilities think about the social care services they're getting?

At the same time as the publication of the 2024/25 social care statistics, information from the latest Personal Social Services Adult Social Care Survey for 2024/25 was also released by the Department of Health and Social Care. This is administered by councils to thousands of adults making use of social care services every year, and asks (in carefully developed and tested standard and easy read formats) a range of questions about people's experiences of social care services and about people's wellbeing and health.

The graph below presents responses to four questions in this survey from 2014/15 to 2024/25 for adults with a primary care need of learning disabilities. 

Overall, over 40% of people with learning disabilities report that their quality of life is at least very good, with this staying fairly stable over time except for a dip in 2020/21 (during the height of the Covid-19 pandemic) and levels returning to where they were before the pandemic by 2023/24. Around 75% of people with learning disabilities report that they are at least very satisfied with the services they get (the red line), with a temporary rise in 2020/21 (again potentially pandemic-related) and a return to pre-pandemic levels and possible a very gradual further decrease over time to 2024/25 (the 74.5% of people with learning disabilities reporting this in 2024/25 is the first time this figure has gone below 75% from the start of the current survey in 2014/15).

For self-rated general health (the green line), just over 70% of people with learning disabilities reported themselves to be in at least good health from 2014/15 to 2021/22 (through the height of the Covid-19 pandemic). However, since then the percentage of people reporting themselves to be in at least good health has started gradually dropping, standing at 67.8% of people in 2024/25.

Finally, from 2014/15 to 2017/18 just under half of people with learning disabilities rated themselves as not anxious or depressed. In 2018/19, there was an unexplained large jump in this figure for people with learning disabilities (though not for other groups of adults using social care) to just around 63% of people, where it was stayed ever since except for a dip in 2020/21. 

Although I haven’t reported the figures in detail in this blogpost, it’s worth mentioning that in this survey people with learning disabilities generally report a consistently much more positive experience than adults using social care with physical support needs or mental health support needs. The higher positivity of people with learning disabilities may be a genuine difference - it may also partly be a function of different question formats (people with learning disabilities are more likely to answer easy read format questions than other groups), and partly because people with learning disabilities were more likely to get help to answer questions, particularly from care workers, than the other two groups.

It’s also worth mentioning that the general lack of change in these ratings over a decade when things have got harder for a lot of people getting social care and including the COVID-19 pandemic, reinforces other research suggesting that these kinds of questions can be relatively insensitive to changes in people's circumstances.

Question 4: Are adults with learning disabilities equally likely to get long-term social care support wherever they live in England?

We regularly hear about the postcode lottery when it comes to all sorts of education, health and social care services across England. We also regularly hear about how there are real inequities in health and life expectancy depending on the relative affluence of the areas people live in. [we don’t appear to hear about these things regularly enough to do anything meaningful about it]

The two graphs below are a really simple way to get a handle on this, one graph for people with learning disabilities aged 18-64 and one for people aged 65+. Each tiny vertical bar is the number of people with learning disabilities in a particular council getting long-term social care per 100,000 people in the total population (to adjust for different councils having different numbers of people), then they’re just arranged from lowest to highest.

The graphs can have some extremes at each end because some councils (such as the City of London or the Isles of Scilly) are very unusual compared to most councils. Even taking this into account, both graphs show that you are much more or less likely to get some form of long-term social care support depending on where you live.

For adults with learning disabilities aged 18-64, there is wide variation in how likely you are to get long-term social care. Even knocking off the 5 most extreme councils at each end, you are more than twice as likely to get long-term social care in St Helens (587 people per 100,000) than you are in Ealing (263 people per 100,000). Of the bottom 10 councils, 9 of them are in London. Of the top 10 councils, 8 of them are in the north of England (spread across Merseyside, the North West and the North East).

It's also the case that there are many fewer adults with learning disabilities aged 18-64 getting social care than are registered with their GP as a person with learning disabilities. The mid-ranking councils in this graph are providing social care to 383 adults with learning disabilities per 100,000 people overall. Information from GP practices (from the Quality and Outcomes Framework) says that 590 people of all ages per 100,000 people overall are registered as a person with learning disabilities, and other information from GPs backs this up with more specific information for people with learning disabilities aged 18-64.

For adults with learning disabilities aged 65+, there is also wide variation in how likely you are to get long-term social care, although it is worth mentioning that the proportion of older adults with learning disabilities getting long-term social care is overall much lower than for adults aged 18-64. Some of this might be due to the brutal fact that people with learning disabilities don’t currently live as long as other groups of people (another inequity that we regularly hear about with little seeming impact on the fundamental action required). It might also be partly because some older adults with learning disabilities end up being identified as having a different ‘primary care need’ as they age and so are not visible in these statistics as people with learning disabilities.

Even knocking off the 5 most extreme councils at each end, you are more than three times as likely to get long-term social care in Liverpool (359 people per 100,000) than you are in Hampshire (112 people per 100,000). Of the bottom 10 councils, 8 of them are substantially rural counties (possibly where more affluent people tend to retire to, thus increasing the general age profile of the population). Of the top 10 councils, 7 of them are cities in the Midlands and North of England and 3 of them are in London, where the general age profile of populations may skew younger.

It's also the case that there are many fewer adults with learning disabilities aged 65+ getting social care than are registered with their GP as a person with learning disabilities. The mid-ranking councils in this graph are providing social care to 186 adults with learning disabilities per 100,000 people overall. Information from GP practices (from the Quality and Outcomes Framework) says that 590 people of all ages per 100,000 people overall are registered as a person with learning disabilities, and other information from GPs backs this up with more specific information for people with learning disabilities aged 65+.

Summing up

While the number of adults with learning disabilities getting long-term social care in England has started to increase again after drops in numbers during the height of the Covid-19 pandemic, the gap between how many people are likely to need services and how many people are actually getting services continues to widen. Many fewer adults with learning disabilities are getting long-term social care than are registered with their GP as a person with learning disabilities.

For adults with learning disabilities aged 18-64, pre-Covid trends in how people are getting their services seem to be continuing, with at least some use of direct payments and council-managed personal budgets continuing to increase, and residential care continuing to decrease, although there are recent upticks in the number of people in nursing care and getting services directly commissioned by the council. Worryingly, it seems that for a lot of people the council commissioning their social care doesn’t know how they are getting this social care.

For adults with learning disabilities aged 65+, there are some signs that longer-term trends are starting to be reversed. Council-commissioned personal budgets continue to increase, although direct payments may be starting to decrease and services directly commissioned by the council may be starting to increase. The number of people in residential care and in nursing has generally flatlined in the past decade, although there are signs that the number of people in nursing care is increasing. As with adults with learning disabilities aged 18-64, for adults aged 65+ it seems that for a lot of people the council commissioning their social care doesn’t know how they are getting this social care.

In a large survey collected by councils, Covid-era changes in how adults with learning disabilities reported their quality of life, satisfaction with services, anxiety/depression and general health have overall been quite temporary. Although these questions are quite insensitive to change, there are some signs that people are reporting their general health to be gradually getting worse since the Covid-19 pandemic.

As has always been the case, there are big variations across councils in how likely adults with learning disabilities are to be getting long-term social care. There are a lot of complicated reasons for this, but it is not right that depending on where you live you can be two or three times more likely to get long-term social care than if you lived in a different council area.

The way the information is reported has changed, with some new information for people with learning disabilities aged 65+ but a lot less detail on what kinds of places people are living in, to the point that (at least to my eyes) some of this information is pretty meaningless.

Employment and adults with learning disabilities in England - 2024/25 update

Towards the end of October each year, the government publishes statistics about adult social care for England for the previous financial year (in this case, April 2024 to March 2025). I have reported on aspects of these statistics in a number of blogposts over the years. This year the government has made some changes to how the information is collected and reported – the statistics are largely consistent with previous years, but sometimes with extra information reported and occasionally with less available information.

There are a few blogposts that I’ll be working on from these statistics – this updates previous posts on what the statistics say about the self/paid employment of adults with learning disabilities in England. These figures are provided by local authorities every year, and since 2014/15 have only been provided for people getting long-term social care (before 2014/15 it was the larger group of people known to local authorities as a person with learning disabilities, even if they weren't getting long-term social care support). This means that these figures don't include the much, much larger group of adults with learning disabilities who aren't known to local authorities or GPs and who don't get any kind of support related to their learning disability. It is also important to say that the quality of this information has been questioned at times.

What do the numbers tell us?

The first graph below shows the number of adults with learning disabilities aged 18-64 that councils say are in any self/paid employment, broken down by whether people are in employment for 16+ hours per week or less than 16 hours per week (and 1 hour a week can count in these statistics). Newly reported for 2024/25 is the number of people who local authorities say are in self-paid employment, but for an unknown number of hours per week – as the column for 2024/25 shows, these people seem to have been drawn from people previously stated as working less than 16 hours per week.

According to these figures, in 2024/25 there were 6,365 adults with learning disabilities aged 18-64 getting long-term social care in any form of self/paid employment. This historically low figure has been flatlining for 4 years in a row. Consistent across the years is that a minority of the people in employment (29% of people in 2024/25) are working for at least 16 hours per week.

Also newly reported for 2024/25 are equivalent figures for people with learning disabilities aged 65 or over (working age no longer stops at 65). In total, 405 adults with learning disabilities aged 65+ were reported to be in some form of self/paid employment, with a similar percentage of people (27%) working at least 16 hours per week.

What do these numbers mean in terms of employment rates? The graph below shows the employment rates for adults with learning disabilities aged 18-64 over the same time period. The columns show the overall employment rate - in 2024/25 this was 4.6%, compared to 75% for adults generally in March 2025. This is the lowest employment rate for adults with learning disabilities recorded since the statistics were changed in 2014/15. The equivalent employment rate for adults aged 65+ is 2.1%. 

The lines on the graph show employment rates for men and women with learning disabilities separately up to 2023/24 – changes to the way information is reported for 2024/25 means that I couldn’t find the information to produce equivalent calculations for 2024/25. Employment rates for men (the purple line) are consistently higher (5.1% in 2023/24) than employment rates for women (the blue line) (4.1% in 2023/24 with this gender employment gap staying fairly stable over time.

The next graph below sounds an appropriate note of caution about the reliability of information on self/paid employment provided by councils, and there have also been some important changes to what is reported in 2024/25. This shows, for all adults with learning disabilities aged 18-64 getting long-term social care, whether councils say they are: 1) in self-paid employment; 2) not in employment but actively seeking work (and presumably therefore liable to potential benefit sanctions); 3) not in employment but not actively seeking work. There is also a fourth category, where councils say they don't know the employment status of the person. New in 2024/25 is an additional category of voluntary work only – this used to be collected back in the mists of time so I’m not sure if this is newly collected this time round or it was collected all along and it’s been newly reported.

Over time, the number of people whose employment status is unknown has decreased from 44% of adults with learning disabilities aged 18-64 in 2014/15 to 18% of people in 2024/25 (although there has been an increase from 2023/24 to 2024/25). Newly reported information for 2024/25 shows that almost as many adults with learning disabilities aged 18-64 are doing voluntary work only (5,980 people) as are in any form of paid/self employment (6,365 people). There has also been an increase for two years in a row of the number of people reported to be not in employment but actively seeking work.

For the first time in 2024/25, equivalent information is reported for adults with learning disabilities aged 65+, where the employment status of 22% of people (4,310 people) is reported as unknown. While the majority of adults with learning disabilities aged 65+ are reported not be not in paid work and not actively seeking work/retired (13,165 people; 67%), there are still over 1,000 people (1,090 people; 6%) who are not in paid employment but actively seeking work. Smaller numbers of adults with learning disabilities aged 65+ are in paid/self employment (405 people; 2.1%) or doing voluntary work only (490 people; 2.5%).

The final graph below shows employment rates of adults with learning disabilities aged 18-64 by English region. These mainly reflect the reducing employment rates over time seen nationally, with only the South East and the North West to some extent bucking this trend. Compared to other regions, there are consistently low employment rates in the West Midlands, East Midlands and North East, with a large recent drop in employment rates in Yorkshire & Humber. A person with learning disabilities in the South East is almost five times more likely to be in paid/self employment than a person in the North East.

Overall, this update shows further reductions in employment rates (from a ridiculously low base) for adults with learning disabilities getting long-term social care, with most work being extremely part-time, a gender employment gap, and big regional variations. 

As far as we know, many more than 4.6% of working age adults with learning disabilities want to work. We know that secure, stable paid employment for people with learning disabilities is associated with better physical and mental health, and we know that supported employment is highly cost-effective. Are punishment withdrawals of benefits in an already punitive system going to be the answer?

Children with learning disabilities in schools in England - 2025 update

I've been very bad at writing this blog for a couple of years now. I'm going to write blogposts a bit more often again, mainly just to do regular updates of statistics related to people with learning disabilities. There are unlikely to be hot takes or deep insights, and there will be graphs. 

This blogpost updates previous blogposts I've written about Department for Education annual statistics concerning children and young people identified within the English education system as children/young people with learning disabilities, recorded in an annual census of schools that takes place in January each year.

 In the Special Educational Needs (SEN) statistics there are a number of mutually exclusive categories of SEN, three of which concern children with learning disabilities – Moderate Learning Difficulties (MLD), Severe Learning Difficulties (SLD) and Profound & Multiple Learning Difficulties (PMLD). There are a number of other SEN categories recorded within these statistics (Specific Learning Difficulties; Speech, language and communication needs; Social, emotional and mental health; Autistic spectrum disorder; Visual impairment; Hearing impairment; Multisensory impairment; Physical disability).

Within the annual census, a child can be classified as having a ‘primary need’ in one of these categories, and optionally classified as having an additional, ‘secondary need’ in another category. Most importantly in terms of how children are supported, children may have a special educational need that has been judged to require specific support in the form of an Education, Health and Care (EHC) plan (previously an SEN Statement). Beyond that, DfE statistics now only report an additional much larger number of children at a level of ‘SEN support’, which has no requirements to specifically support a child.

This blogpost simply  goes through what some of these statistics say about the education of children and young people with learning disabilities, as identified within the education system. I would strongly recommend looking at Special Needs Jungle for brilliant, in-depth analysis and opinion about these and other statistics.

The first question is simply – how many children and young people with learning disabilities are recorded in DfE statistics?

The first graph below shows the number of children with a statement/EHC plan with a ‘primary SEN need’ of MLD, SLD and PMLD, from 2010 to 2025 (apologies for the acronyms).

The graph shows that in 2025, almost 76,000 children in England had a statement/EHC plan and were identified as children with learning disabilities. 

For children with MLD this was 34,755 children in 2025, with a large decrease of 31% from 2010 to 2018 but an increase of 23% from 2018 to 2025 - the number of children in 2025 is still less than the number of children in 2010. 

In 2025, there were 31,271 children with a statement/EHC plan and identified with a primary need of SLD, an increase in numbers of 24% from 2010 to 2021 but with numbers staying static from 2021 to 2025.

Finally, in 2025 there were 9,911 children with a statement/EHC plan and identified with a primary need of PMLD, an increase of 16% from 2010 to 2018 but with fluctuating numbers and a possible small decrease since.

 

The second graph below shows the number of children with a ‘primary SEN need’ of MLD, SLD and PMLD at the level of SEN Support, from 2015 to 2025 (the reporting of statistics changed in 2015).

The graph shows that in 2025, 173,000 children in England were identified as children with learning disabilities at the level of SEN Support. For children with MLD this was 170,228 children in 2025, with a 16% increase from 2015 to 2016 and a 30% decrease from 2016 through to 2025.

In 2025, there were 1,859 children with a primary need of SLD at the level of SEN Support, with numbers increasing by 5% from 2015 to 2016 and decreasing by 44% from 2016 to 2025. 

Finally, in 2025 there were 695 children at the level of SEN Support with a primary need of PMLD, with an 11% increase from 2015 to 2018 and a 31% decrease from 2018 to 2025.

How many children with learning disabilities are being educated in mainstream schools or special schools? The graph below shows the percentage of children with statements/EHCPs in mainstream vs special schools from 2010 to 2025.

The percentage of children with a primary need of MLD and a statement/EHC plan in mainstream school dipped from 51% in 2010 to 43% in 2017, with the percentage increasing again to 59% in 2025. 

For children with a statement/EHC plan and a primary need of SLD, the percentage of children in mainstream schools decreased from 17% in 2010 to 12% in 2018, and has stayed static from 2018 to 2025. 

For children with a statement/EHC plan and a primary need of PMLD, the percentage of children in mainstream school was around 14% from 2010 to 2016, 15% from 2017 to 2020, and 16% from 2021 to 2025.

For children identified at the level of SEN Support (I haven’t included a graph on this), in 2025 almost all the children with a primary need of MLD (99.8%) and the vast majority of children with a primary need of SLD (90.1%) or PMLD (87.8%) were in mainstream schools.

Although it’s not an ideal marker of the financial circumstances of families, eligibility for free school meals is collected within DfE statistics. 

The graph below shows the proportion of children with statements/EHCPs associated with MLD, SLD and PMLD and the proportion of children at the level of SEN Support eligible for free school meals, from 2015/16 to 2024/25. There are a number of trends in this graph:

1) There are big increases over time in the percentage of children eligible for free schools across all groups in the graph

2) A greater percentage of children with a statement/EHCP are eligible for free school meals compared to children with the same label at the level of SEN Support

3) Children with a label of MLD are most likely to be eligible for free school meals, followed by children with a label of SLD and then children with a label of PMLD.

In 2024/15, 51% of children with a label of MLD and a statement/EHCP were eligible for free school meals (47% for children with MLD at the level of SEN Support). 47% of children with a label of SLD and a statement/EHCP were eligible for free school meals (41% for children with SLD at the level of SEN Support). 40% of children with a label of PMLD and a statement/EHCP were eligible for free school meals (30% of children with PMLD at the level of SEN Support).

At what age are children with learning disabilities identified in schools? The graph below shows how many children for every 1,000 total children in school had a statement/EHCP at each age from age 5 to age 15 in 2025. 

For children with MLD, there were big increases in the number of children with a statement/EHCP through the later ages of primary school and into the early years of secondary school, with slight decreases beyond this point.

For children with SLD, there was a steady increase in the number of children with a statement/EHCP through the school years.

For children with PMLD, the highest numbers of children with a statement/EHCP were in the earlier years of primary school, with slight decreases beyond this point.

Finally (horror of horrors) I'd like to post the table below. This shows, for 2025, the proportion of children with labels of MLD, SLD and PMLD with a statement/EHCP, broken down by the ethnicity labels used in the pupil census. These are compared to the proportions for all children in schools. Lilac means that children from a particular ethnic group with labels of MLD, SLD or PMLD are more likely compared to the proportion of all children from that particular ethnic group in schools. Orange means that children from a particular ethnic group with labels of MLD, SLD or PMLD are less likely compared to the proportion of all children from that particular ethnic group in schools.

I'm not qualified to offer an interpretation of what these figures mean (getting an EHCP is one endpoint of a very long and complicated process, with all sorts of factors impinging on this). All I will say is that the picture is complicated, with very different patterns across MLD, SLD and PMLD for specific ethnic categories as used in the pupil census.

As I've said, I'm not in a position to offer a deep interpretation of these numbers, but I hope it is useful to see them set out like this. I'm not seeing a massive and sustained increase in the number of children with the labels of MLD, SLD and PMLD, certainly taking 2010 as the baseline. If anything, recent years suggest that the number of children with these labels being supported with an EHCP is flatlining. On the long view from 2010, there is also little change in the proportion of children with these labels in mainstream schools. 

However, poverty amongst children with these labels is sharply and consistently increasing year on year, and there are different patterns of EHCPs for children with MLD, SLD and PMLD across different ethnic groups.

What all of these statistics miss is children who are not in school, for any number of reasons. Without having some understanding of this, we only have a partial picture of children with learning disabilities in England.

LeDeR Report 2025 - a first look

 This is a blog post based on my first reaction to the much delayed latest version of the LeDeR report. As you’ll see, I didn’t get as far through it as I planned, for reasons that I hope to explain.

There are a few things about the report that I found a bit odd. The first is that the report is listed as a 2024 report (of LeDeR information in 2023), even though it wasn’t made public until September 2025. When I write anything, the date on it will be when it’s published, not when I handed it in. Listing this as a 2024 report makes invisible the long delay in its publication.

I also didn’t really understand the decision to only include 2021, 2022 and 2023 information in the report (although the authors don’t always stick to this). I get the logic of combining across multiple years to look at some issues where there are smaller numbers of people, but taking as your baseline 2021 (in the second year of the height of COVID-19 pandemic) seems odd when there is more or less national LeDeR information going back to 2018. The reviewing methods have changed over time, but this happened in June 2021 so the 2021 data will include both old and new reviewing methods anyway. Where possible, starting in 2018 would give the reader some handle on what was happening before the COVID-19 pandemic.

The foreword to the main report also says “This year, due to unforeseen pressures on the NHS, there have been somewhat fewer completed reviews than anticipated, affecting reviews during the latter part of 2023 in particular. This limitation may mean there are fewer completed reviews of deaths due to certain conditions, such as seasonal flu”. First, I think these pressures were quite foreseeable, and right from the start of the LeDeR programme it has been a struggle to get reviews completed. Second, I’m not clear if this is a backlog – given the extensive delay to the publication of the report, couldn’t ‘late’ reviews of 2023 deaths have been included in the analyses? Or is it that these missing reviews are never going to happen, which raises real questions about the ongoing feasibility of the LeDeR programme in the absence of focus and investment. As far as I tell from the latest LeDeR report, there were reviews for 77.9% of notifications of deaths in 2021, 83.3% in 2022, and 67.1% in 2023.

Looking through the easy read report against the more detailed reports and infographic, I have some worries about how some important information is shown in the easy read report. I’m particularly thinking about median age of death. The infographic and main report says that this was 62.2 years in 2022 and 62.5 years in 2023, a difference of between 3 and 4 months. The easy read report says “This year, the average age of death is 63. Last year, the average age of age was 62. I know it is one year difference, but it needs to be better”. I don’t think this is right.

When looking at big reports like this, I often start by looking at the detailed data tables right at the end of the report or added as an appendix. This can help me to understand the numbers a bit before reading the words in the main report that interpret what they mean, so I have some ideas and questions that I hope the main report will explain.

I haven’t had the stamina, and I can’t expect you as a reader to have the stamina, to go through all of these, mainly because I got stuck on some straightforward inconsistencies in the first table that I couldn’t get beyond. In the main report this is Table 1.1 (and in the Appendix Table 1.1), which among other things breaks down the number of people with learning disabilities who had died by age group and sex (as recorded at birth). First thing – the number of people in 2023 whose sex was ‘not known’ is different across the two tables – 234 people in the main report table, and 233 people in the Appendix table. Second thing – the Appendix table breaks this down by age group, but the number of people of ‘not known’ sex in each specific age group adds up to 333 people rather than 233 people. I can appreciate that this kind of information is incredibly messy, and also that mistakes like this can happen. I also don’t know that it would make a massive difference in the overall messages to take from the LeDeR dataset. But if a justification for the huge delay in publication is forensic scrutiny of the data from the LeDeR team, NHS England and DHSC…?

I haven’t gone through the whole report checking for these kinds of issues, because there are some other things I need to do before I retire like washing up and sleeping, but it does put me on edge when looking through the rest of the report. Partly to see if there was information going back to 2018 that I could use for longer-term trends, I also looked at the LeDeR report for 2022 (published in 2023). Here I found some other differences that I don’t really understand. The 2025 report said that there were 3,451 notifications of deaths of adults with learning disabilities in 2021, and 3,593 deaths reported in 2022. As far as I can tell, the equivalent data from the 2023 report was 3,096 notifications of deaths in 2021 and 3,044 notifications of deaths in 2022. I don’t know why there are these big differences.

Finally, I want to mention some trends over time about various ways in which the state might deal with, notice, and investigate deaths of people with learning disabilities – these trends aren’t mentioned in the easy read version of the 2025 report. This information is all subject to caveats that not all people with learning disabilities who died have been notified to the LeDeR programme, not all people notified to LeDeR have been reviewed, and not all reviews included this information. They also use information from the two most recent LeDeR reports, which as we have seen can be inconsistent in the information they report.

DNACPRs. The percentage of adults with Do Not Attempt Cardio Pulmonary Resuscitation orders looks like it’s been consistently increasing over time: 69.8% of people in 2018/19; 71.9% of people in 2020/21; 72.5% (or 74.2%) of people in 2021; 72.1% of people in 2022; and 75.5% of people in 2023.

Coroner reporting. There are huge unexplained differences between the figures in the earlier report (22% reported to a coroner in 2018/19; 19% reported to a coroner in 2020/21; 25% reported to a coroner in 2022) and in the 2025 report (40.5% reported to a coroner in 2021; 41.1% reported to a coroner in 2022; 36.4% reported to a coroner in 2023). I don't know why this is.

Police investigation. It looks like information on the percentages of people’s deaths where there was a police investigation has been reported for the first time in the 2025 report: 4.4% of people’s deaths in 2021; 3.8% of people’s deaths in 2022; 2.2% of people’s deaths in 2023.

Safeguarding enquiry. Again, it looks like the percentage of people’s deaths where there was a safeguarding enquiry (I don’t think this is reported anywhere in the main report text, but it is in the Appendix) was reported for the first time in the 2025 report: 16.5% in 2021; 9.2% in 2022; 7.0% in 2023.

Across the piece, it looks like less attention and less scrutiny is being paid of the deaths of people with learning disabilities.

I will stop there for now – this has already turned into a longer blog post than I was planning (no surprise there). I may return to other aspects of the LeDeR report at some point, but I am quite worried about the inconsistencies that have emerged on a cursory look.

All the more recent LeDeR reports can be found here  https://www.kcl.ac.uk/research/leder 

Social care statistics and adults with learning disabilities in England - 2023/24 update

Every year NHS Digital (now absorbed into NHS England) publish statistics collected by councils related to social care and adults with learning disabilities in England. Data tables for 2023/2024 (a lot of this involves delving into the CSV databases rather than it being easily available) were released on 31st October. As with my blogpost on this last year, I've just gone for 8 things that jumped out at me rather than a lot of detail and graphs:

1) After several years of continuous increases in the number of adults getting long-term social care up to 2019/20, since then the number of adults with learning disabilities getting social care support has stalled, particularly among younger adults. In 2023/24, 135,205 adults with learning disabilities aged 18-64 got social care support at some point in the year, less than the 135,430 people getting social care support in 2019/20. However, the number of adults with learning disabilities aged 65+ getting social care support has continued to increase, from 17,715 people in 2019/20 to 19,125 people in 2023/24.

2) Using projections about the increasing number of adults likely to need social care support from 2014/15 to 2023/24, there are between 13,000 and 24,000 adults with learning disabilities who need social care support but are not getting it.

3) While the number of adults with learning disabilities aged 18-64 living in residential care and nursing care continues to (slowly) decrease, the number of adults with learning disabilities aged 65+ living in residential care and nursing care has been increasing from 2020/21 to 2023/24. Adults with learning disabilities aged 65+ are now 22% of all adults with learning disabilities in residential care and 47% of all adults with learning disabilities in nursing care.

4) For the first time in 2023/24, over 50,000 adults with learning disabilities aged 18-64 getting social care support were living with family (or friends) on a settled basis (50,110 people) - well over a third (37%) of all working age adults with learning disabilities getting social care support. The number of adults with learning disabilities aged 18-64 getting social care support who were recorded as staying with family/friends on a short term basis (730 people in 2023/24) is smaller but increasing. 

5) Council spending on social care for adults with learning disabilities was £8.1 billion in 2023/24, up  12.1% (not inflation adjusted) from 2022/23.

6) Council spending on social care for adults with learning disabilities is over one third (36%) of all council social care spending on adults.

7) In 2023/24, £583 million in social care spending for adults with learning disabilities was paid for by 'client contributions'. This is an increase of 13.7% from 2022/23 and constitutes 7% of all council social care spending for adults with learning disabilities.

8) Among working age adults with learning disabilities getting council social care, the rate of people in any form of paid employment dropped to 4.7% in 2023/24, a historic low, with the gender employment gap remaining (5.1% for men; 4.1% for women).

New evidence of ethnic inequalities in healthcare among people with learning disabilities - the Health and Care of People with Learning Disabilities dataset 2022/23

As the LeDeR report continues its yearly documenting of the shocking/not shocking health inequalities experienced by people with learning disabilities in England compared to other people, over the course of this year we've seen some attention beginning to be paid to some jaw-dropping health inequalities within the population of people with learning disabilities. In particular, a major review commissioned by the NHS Race and Health Observatory , 'We Deserve Better', has magnified continuing LeDeR reports of grim health inequalities according to the ethnicity of people with learning disabilities. Most stark was the information on median ages of death from any cause - while this was bad enough for white people with learning disabilities (62 years). it was even worse for people with learning disabilities from 'other' ethnic groups (49 years), people from Black, Black British, Caribbean or African ethnic groups (40 years), people from Asian or Asian British ethnic groups (33 years) and people from 'mixed/multiple' ethnic groups (30 years).

Yesterday (7th December 2023) NHS Digital/NHS England published the latest yearly information from over half of GP practices in England about the health of people with learning disabilities, relating to 2022/23. 'The Health and Care of People with Learning Disabilities' is a brilliant source of information that deserves to be much more widely known and I hope is being widely used at both national and local levels. This year for the first time this dataset includes some limited information on ethnicity. While there will hopefully be more information to come in future years, it does provide some information that has been weirdly absent so far.

First, it provides information on the ethnicity of people registered with their GP as a person with learning disabilities, compared to people not registered as a person with learning disabilities (because the dataset is geographically patchy, this is probably the fairest comparison rather than national Census 2021 data). The recording of ethnicity in GP records is better for people with learning disabilities than other people, with ethnicity not recorded for 2.9% of people with learning disabilities compared to 6.3% of people without learning disabilities, and 4.4% of people with learning disabilities compared to 6.5% of people without learning disabilities choosing not to have ethnicity information on their GP record.

Of those people where there was ethnicity information:

• 79.9% of people with learning disabilities compared to 74.8% of people without learning disabilities were from a white ethnic group
• 9.8% of people with learning disabilities compared to 13.4% of people without learning disabilities were from an Asian/Asian British ethnic group
• 5.7% of people with learning disabilities compared to 5.5% of people without learning disabilities were from a Black/African/Caribbean/Black British ethnic group
• 2.9% of people with and without learning disabilities were from a 'mixed/multiple' ethnic group
• 1.7% of people with learning disabilities and 3.5% of people without learning disabilities were from an 'other' ethnic group

These are very broad ethnic categories putting very different communities together, and information from schools which uses more specific ethnic categories (and breaks down information according to whether children have been given labels of Moderate Learning Difficulty, Severe Learning Difficulty or Profound Multiple Learning Difficulty) shows that these specificities really matter (a summary table is available in Appendix 2b of the 'We Deserve Better' report).  But just as we know that the deaths of people with learning disabilities from white ethnic backgrounds are disproportionately likely to be notified to the LeDeR programme, it's highly likely that people with learning disabilities from some communities are less likely to be recorded as such in GP registers. It's also important to say that the 'We Deserve Better' report found that much of the ethnicity coding in GP registers was outdated and unclear, so the accuracy of the findings reported here could be improved.

As well as this, the 'Health and Care' dataset includes information on the percentages of people with learning disabilities getting annual health checks and having a flu vaccine, broken down by these broad ethnic categories.

For annual health checks, overall in 2022/23 71% of people with learning disabilities were recorded by GPs to have had an annual health check in 2022/23. This conceals substantial differences between ethnic groups, where the figures were:

• 74% of people with learning disabilities from a white ethnic group
• 68% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group
• 68% of people with learning disabilities from an Asian/Asian British ethnic group
• 64% of people with learning disabilities from a 'mixed/multiple' ethnic group
• 62% of people with learning disabilities from an 'other' ethnic group

Worryingly, there were particularly low rates of annual health checks among people with learning disabilities where ethnicity data were missing (48%) or the person had chosen not to have ethnicity information recorded (57%), perhaps showing a certain degree of disengagement on the part of GP practices.

For flu vaccines the differences are even bigger. Overall in 2022/23 56% of people with learning disabilities were recorded by GPs to have had a flu vaccine in 2022/23. This conceals big differences between ethnic groups, where the figures were:

• 61% of people with learning disabilities from a white ethnic group
• 46% of people with learning disabilities from an Asian/Asian British ethnic group
• 41% of people with learning disabilities from a 'mixed/multiple' ethnic group
• 38% of people with learning disabilities from an 'other' ethnic group
• 35% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group

Worryingly, there were also low rates of flu vaccines among people with learning disabilities where ethnicity data were missing (41%) or the person had chosen not to have ethnicity information recorded (47%).

These ethnic inequalities in rates of flu vaccination for people with learning disabilities mirror the most recent information we have (mid-2022) about COVID-19 vaccinations (see this blogpost for details, using information from OpenSafely). This reported that among 16-64 year-olds with learning disabilities who weren't judged to be 'Clinically Extremely Vulnerable', 73% of people in a white ethnic group had received 3 doses of the COVID-19 vaccine, compared to 53% of people in an 'other' ethnic group, 50% of people in a 'mixed/multiple' ethnic group, 47% of people in a South Asian ethnic group, and 40% of people in a Black ethnic group.

This is one small corner of all the health information that could be broken down according to ethnicity, but it clearly shows big ethnic inequalities in getting something basic (like an annual health check, or a flu vaccine) that everybody with learning disabilities is entitled to. And these vaccines make a big difference. The 'We Deserve Better' report reported that before the COVID-19 pandemic, flu/pneumonia was the most common cause of death among people with learning disabilities from Asian/Asian British groups (17%) and from 'other' ethnic groups (16%), and the second most common cause of death for people from Black/Black British/Caribbean/African ethnic groups (16%) and from white ethnic groups (14%). During the COVID-19 pandemic, COVID-19 was by far the most common cause of death for people with learning disabilities across all ethnic groups, although there were big differences in the percentages of people within each ethnic group who had died from COVID-19:

• 60% of people with learning disabilities from a 'mixed/multiple' ethnic group
• 38% of people with learning disabilities from a Black/African/Caribbean/Black British ethnic group
• 31% of people with learning disabilities from an Asian/Asian British ethnic group
• 29% of people with learning disabilities from an 'other' ethnic group
• 26% of people with learning disabilities from a white ethnic group

The 'We Deserve Better' report documents the huge range of causes of the extreme ethnic inequalities in health amongst people with learning disabilities and provides clear recommendations for what needs to be done. This new information from the 'Health and Care' dataset, although limited, clearly points to a practical agenda for action on the part of health services in terms of proactively focusing on ethnic inequalities in people getting vaccines. Without action, data is nothing. But without data, action is clueless.

What do the latest statistics say about social care and adults with learning disabilities? 8 key messages (and 0 graphs)

Every year NHS Digital (now absorbed into NHS England) publish statistics collected by councils related to social care and adults with learning disabilities in England. Data tables for 2022-2023 were released on 19th October. Rather than inflict my usual graphalanche, here are 8 things that jumped out at me:

1) Since 2019/20 the number of adults with learning disabilities getting social care support has stalled. In 2022/23, 152,175 adults with learning disabilities got social care support at some point in the year, less than the 153,145 people getting social care support in 2019/20. 

2) Using projections about the increasing number of adults likely to need social care support from 2014/15 to 2022/23, there are between 14,000 and 22,000 adults with learning disabilities who need social care support but are not getting it.

3) While the number of adults with learning disabilities aged 18-64 living in residential care and nursing care continues to decrease, the number of adults with learning disabilities aged 65+ living in residential care and nursing care has been increasing from 2020/21 to 2022/23.

4) 49,145 adults with learning disabilities aged 18-64 getting social care support were living with family (or friends) on a settled basis in 2022/23 - well over a third (37%) of all working age adults with learning disabilities getting social care support.

5) Council spending on social care for adults with learning disabilities was £6.3 billion in 2022/23, which might be keeping pace with or even outstripping inflation.

6) Council spending on social care for adults with learning disabilities is almost one third (32%) of all council social care spending.

7) For the first time in 2022/23, over half a billion pounds in social care spending (£513 million) for adults with learning disabilities was paid for by 'client contributions'. This is 8% of all council social care spending for adults with learning disabilities.

8) Among working age adults with learning disabilities getting council social care, the rate of people in any form of paid employment remained at 4.8% in 2022/23, a historic low, with the gender employment gap also remaining (5.2% for men; 4% for women).

There is much more in the statistics (and I have updated my graph stash), but I see no signs of 'recovery' or 'building back better' here.