The Health and Care of People with Learning Disabilities dataset: Health checks and flu jabs

We've known for a long time about the health inequities experienced by people with learning disabilities. We know these health inequities are big, resulting in much earlier typical ages of death compared to other people, and we know that these health inequities cut across a wide range of health conditions.

This blogpost will summarise some recent information relating to two health services responses to the heath inequities experienced by people with learning disabilities that should be preventative and available to everyone with learning disabilities - annual health checks and flu jabs. 

This blogpost is the sixth and final one of a series going into a lot of detail using information from the 'Health and Care of People with Learning Disabilities' dataset, compiled by NHS England. Every year (going April to March), this has taken information from GP information systems in England to produce statistics about the health and health treatment of just over half of people registered with a GP as a person with learning disabilities, often comparing them to the health and healthcare of people without learning disabilities. The most recent information available covers April 2024 to March 2025.

Annual health checks

Annual health checks are supposed to be available for all people registered as a person with learning disabilities with their GP in England aged 14 or over, with GPs being paid extra for every health check they do (it's not a compulsory part of the GP contract). When it existed, NHS England set a target that by 2023/24 at least 75% of registered people with learning disabilities should have an annual health check, although in its most recent operational guidance (for 2025/26) this target was omitted from its list of priorities.

The graph below shows the percentage of people with learning disabilities aged 14+ who had an annual health check in the last 12 months, from 2017/18 to 2024/25. From 2017/18 to 2019/20, almost 60% of people had an annual health check. In 2020/21 (arguably the height of the Covid-19 pandemic, with all its consequences for most routine health services being withdrawn), the percentage of people with learning disabilities rose dramatically to just over the NHS England target - 75.2% of people). From this point onwards it has generally risen very gradually, to 81.5% of people in 2024/25.

As I've discussed in previous blogposts, it seems that women with learning disabilities are slightly more likely than men with learning disabilities to get an annual health check (82.3% vs 81% in 2024/25).

In terms of age bands, the graph below shows that the percentage of people with learning disabilities getting an annual health check is a little lower at younger ages, but is consistently above 80% from the age of 35 onwards.

Flu jabs

People with learning disabilities registered as such with their GP are eligible for an annual NHS free flu jab on the grounds of being at higher risk for serious complications from respiratory diseases, and it is certainly the case that people with learning disabilities are much more likely to die from respiratory diseases than other people. The grim consequences of this were seen in the Covid-19 pandemic and the wrangling over prioritisation for Covid-19 vaccines, in the face of stark evidence that people with learning disabilities were much more likely to be dying from Covid-19. 

The graph below shows the percentage of people with learning disabilities getting a flu jab in the last 12 months, from 2017/18 to 2024/15. Before the Covid-19 pandemic (2017/18 and 2018/19), less than 20% of people with learning disabilities were getting flu jabs. The coming of the Covid-19 pandemic, with much more proactive vaccination strategies for many people with learning disabilities, resulted in big increases in flu jabs for people with learning disabilities (43.2% of people in 2019/20; 56.4% of people in 2020/21; 59.5% of people in 2021/22). Beyond this point, despite increasing numbers of people with learning disabilities getting an annual health check, the number of people getting a flu jab has dropped year-on-year, to just over half of people in 2024/25 (50.6%).

Once again, girls/women with learning disabilities are more likely to get a flu jab than boys/men with learning disabilities (54.8% vs 47.9% in 2024/25).

In terms of age bands, in 2024/25 just under 40% of children and young people with learning disabilities (up to the age of 17) got a flu jab - this then dips to 34% for young adults aged 18-24, before steadily increasing with age.

Conclusions

This blogpost has looked at two health service responses which are supposed to be available to everyone with learning disabilities and are designed to help in preventing some of the health problems which people with learning disabilities are more likely to experience.

Annual health checks have been around for a while, and have been the subject of NHS England targets that have now been deprioritised. The statistics say that these targets have been met and more than three quarters of people with learning disabilities are getting an annual health check. There are question marks about how comprehensive these annual health checks are (they are not standardised), particularly when many of them are not conducted face-to-face, and as we've seen time and again there are questions about what they can achieve in a context of continuing deaths by indifference or worse.

Free flu jabs for people with learning disabilities have also been around for a while, and a sharp increase during the Covid-19 pandemic showing that vaccinating a lot of people with learning disabilities is absolutely possible has since drifted downwards as the spotlight turns elsewhere.

Summing up

Across all six blogposts and a punishing amount of graphs and numbers, I think there are some common issues and questions, a few of which I'll list here:

1) What we don't know - ethnicity. There's nothing in this dataset about the impact of ethnicity on the health of people with learning disabilities and what health services do, when we know that ethnicity is really important in when and how people with learning disabilities die, and the discrimination and racism evident in many health and social care services.

2) What we don't know - the hidden majority. We are pretty certain that most adults with learning disabilities aren't registered as such with their GP service, so their experience (which is likely to be one of disadvantage) is not represented within this dataset.

3) What I didn't look at - geography. Although the information in this dataset is much more comprehensive in some parts of England than others, it can be examined by region and at a more local level. To general sighs of relief, I have stuck to looking at information for England as a whole, but ICBs and other organisations I hope are looking in detail at what the dataset says about their area, particularly as we know there are big inequalities in health and life expectancy generally across regions.

4) Poorer health, at younger ages. It will come as no surprise that across a whole host of health issues, people with learning disabilities are more likely to experience poorer health than people without learning disabilities. Even when overall rates of a health problem are similar, this tends to mask higher rates of the health problem amongst people with learning disabilities compared to other people at younger ages (when the rates of the health problem tend to be lower). Rates of the health problem are often higher amongst older people without learning disabilities, partly because they are surviving long enough to get these health problems and they also have had better health services that enable them to survive for longer. Allied with the relatively small numbers of people with learning disabilities with a potential health condition compared to everyone else coming through the GP's doors, it's likely that health services will be looking in the wrong places to identify early and treat effectively many health problems amongst people with learning disabilities.

5) Are health services paying enough attention to young adults with learning disabilities? Young adulthood is a crucial age for early identification and prevention of a whole host of health issues that will have long-term consequences for people with learning disabilities. While some problematic health service responses (like the prescription of anti-psychotic medications) become very common in early adulthood, there are inexplicable dips in preventive health service responses like flu jabs. What is going on here?

6) Are health services treating men and women with learning disabilities differently? Across the blogposts, there are quite a few instances where rates of diagnosed health problems and health service responses are quite different for men and women with learning disabilities, in ways that don't always seem to be easily explainable. We know that the way women and men with learning disabilities express distress, for example, can be interpreted very differently by social care and health professionals. Can gender-based assumptions be getting in the way?

7) Joining the dots. A database like this presents a series of individual health conditions and health service responses. What it doesn't do is join the dots - we know that people with learning disabilities are more likely to be experiencing multiple long-term health problems at earlier ages than other people. We also know that people with learning disabilities are are more likely to be prescribed with multiple medications for these long-term health problems, many of which can interact with each other and can also result in things like weight gain which have a further negative impact on people's health. Again, while health services are supposed to be paying attention to people with multiple health conditions, they aren't likely to be looking in the right places, at the right ages, to really make a difference to people with learning disabilities.

8) Monitoring vs action vs impact. Throughout this dataset, there are examples where specific initiatives (like STOMP for antipsychotic medication) are having a visible effect on reducing rates of prescription of antipsychotics amongst people with learning disabilities. This is the result of hard, focused, work over many years. But these initiatives are rare - most of the health service initiatives focused on people with learning disabilities have been about monitoring and checking, with progress usually slow and easily stalled with uncertain impacts on broader health systems or on people's health. There is also a sense of these initiatives pushing against the tide - in the case of STOMP, reductions in antipsychotic prescribing are accompanied by increases in the prescribing of antidepressants. 

9) This leads me to my last, more speculative point. In my mind, there is an increasing sense that the population of people with learning disabilities, as a group, is becoming more and more invisible in policy and in practice. The latest 10-year NHS plan has vanishingly little to say about people with learning disabilities, and there has not been a cross-government national policy in England relating to people with learning disabilities for 25 years. People with learning disabilities are increasingly being bundled into umbrella service and policy designations like 'neurodiversity', with less recognition of the huge diversity of people within these umbrella designations. I'm still haunted by the whiteboard in Dominic Cummings' office during the Covid-19 pandemic, with the question "Who do we NOT save?". If a group of people cease to officially exist in policy or service terms, then there is no responsibility to do any saving. 

10) Discrimination, inclusion phobia and social murder. If this seems a little apocalyptic, I would urge you to have a look at three books which take a longer and broader view than the latest health improvement initiative: Double Discrimination by Saba Salman, Learning Disability and Inclusion Phobia by Chris Goodey,  and People with Learning Disabilities, Erasure and Social Murder by Sara Ryan.

The Health and Care of People with Learning Disabilities dataset: Constipation, dysphagia and GORD

  Note: if you want to skip the graphs, go straight to the conclusions for a quick summary...

We've known for a long time about the health inequities experienced by people with learning disabilities. We know these health inequities are big, resulting in much earlier typical ages of death compared to other people, and we know that these health inequities cut across a wide range of health conditions.

This blogpost will summarise some recent information about people with learning disabilities relating to three health problems linked to the digestive system - chronic constipation (difficulty pooing), dysphagia (difficulty swallowing), and GORD (gastro-oesophageal reflux disease, when stomach acids leak up into the food pipe). 

This blogpost is the fifth of a series going into a lot of detail using information from the 'Health and Care of People with Learning Disabilities' dataset, compiled by NHS England. Every year (going April to March), this has taken information from GP information systems in England to produce statistics about the health and health treatment of just over half of people registered with a GP as a person with learning disabilities, often comparing them to the health and healthcare of people without learning disabilities. The most recent information available covers April 2024 to March 2025.

Chronic constipation

The graph below shows the percentage of people with learning disabilities where there is evidence on GP records that people have been diagnosed with or treated for chronic constipation in the last five years, or where people have been prescribed two constipation medications in the last 12 months (separated by at least 6 months). This is a complicated definition, but it presumably has been designed to only include people where constipation is an ongoing issue for people, rather than a one-off. There is no comparative information in the dataset for people without learning disabilities.

The percentage of people with learning disabilities recognised as experiencing chronic constipation stayed fairly static from 2017/18 (13.3% of people) to 2022/23 (13.5% of people). It dropped sharply in 2023/24 (to 9.5% to people) and was at a similar level in 2024/25 (9.8% of people). Girls/women are consistently reported to be more likely to experience chronic constipation than boys/men (11.6% vs 8.6%).

In terms of age band, in 2024/25 chronic constipation was less likely to be identified/treated in younger adults with learning disabilities (age 18-44) than in younger or older age groups.

Dysphagia

The graph below shows the percentage of people with learning disabilities with a diagnosis of dysphagia over time, from 2017/18 to 2024/25 (no comparative information is available for people without learning disabilities).

The percentage of people with learning disabilities with a diagnosis of dysphagia has increased rapidly every year, from 5% of people in 2017/18 to 13.1% of people in 2024/25. Girls/women with learning disabilities are consistently more likely than boys/men with learning disabilities to have a diagnosis of dysphagia (15.2% vs 11.7% in 2024/25).

In terms of age bands, the graph below shows that people with learning disabilities are more likely to have a diagnosis of dysphagia from young adulthood upwards.

GORD

The graph below shows the percentage of people with learning disabilities diagnosed with GORD over time, from 2017/18 to 2024/25 (there is no comparative information for people without learning disabilities). The percentage of people with learning disabilities with a diagnosis of GORD has steadily increased year-on-year, from 9.8% of people in 2017/18 to 13.9% of people in 2024/25. Again, girls/women with learning disabilities are consistently more likely to be diagnosed with GORD than boys/men with learning disabilities (15.3% vs 13% in 2024/25).

In terms of age bands, there is a similar pattern to dysphagia, with lower percentages of younger adults with learning disabilities (age 18-34) being diagnosed with GORD compared to younger and older age groups.

Conclusions

GP diagnoses of dysphagia and GORD have steadily increased over time for people with learning disabilities. Substantial numbers of people with learning disabilities (dysphagia 9.8%; GORD 13.9% in 2024/25) are now recorded by GPs as experiencing these health issues. This is likely to be because GPs are becoming more aware of these issues over time, although the percentages recorded by GPs are still lower than those suggested by research.

The picture for GP diagnosis/treatment of chronic constipation is different, with the number of people with learning disabilities recorded with chronic constipation dropping in the last couple of years (to 9.8% of people in 2024/25). These are much lower levels than those suggested by research, and are not what you would hope to see given the launch of an NHS England Constipation Campaign in 2023, unless we believe that this campaign led instantly to a reduction in chronic constipation. 

It is also not clear to me why girls/women with learning disabilities are consistently more likely to be diagnosed by GPs with chronic constipation, dysphagia and GORD. This difference has also come up in previous blogposts in this series, and I'm wondering if there something about gender differences in how people are viewed by social care and health professionals that need further examination.

It also seems that for constipation and GORD (but not for dysphagia) there is a dip in the number of people diagnosed in younger adulthood - is this reflecting better general health at these ages or social care and health systems less likely to be looking out for these health issues?

I would also mention that the information we don't have here such as the level of needs of the person and ethnicity are really important, particularly for these health issues.

Constipation, dysphagia and GORD all too often come up in coroners' inquests as features in what I would see as the preventable deaths of people with learning disabilities, even if coroners don't always see it that way. Once again, we see that for some health problems there is increasing recording in health systems, but there is little evidence of these resulting in improvements that matter.

The Health and Care of People with Learning Disabilities dataset: Cancer

  Note: if you want to skip the graphs, go straight to the conclusions for a quick summary...

We've known for a long time about the health inequities experienced by people with learning disabilities. We know these health inequities are big, resulting in much earlier typical ages of death compared to other people, and we know that these health inequities cut across a wide range of health conditions.

This blogpost will summarise some recent information about people with learning disabilities relating to cancer screening and cancer diagnosis - in the data released there is nothing on cancer treatment. 

This blogpost is the fourth of a series going into a lot of detail using information from the 'Health and Care of People with Learning Disabilities' dataset, compiled by NHS England. Every year (going April to March), this has taken information from GP information systems in England to produce statistics about the health and health treatment of just over half of people registered with a GP as a person with learning disabilities, often comparing them to the health and healthcare of people without learning disabilities. The most recent information available covers April 2024 to March 2025.

Cancer screening

In England there are national screening programmes for:

• Breast cancer - in this dataset information is available for 'female' people with and without learning disabilities aged 50-69.
• Cervical cancer screening - in this dataset information is available for female people with and without learning disabilities aged 25-64, in terms of both eligibility for cervical cancer screening and the completion of 'adequate' tests.
• Colorectal cancer screening - in this dataset information is available for all people with and without learning disabilities aged 60-74.

Breast cancer screening. The graph below shows the percentage of female people with and without learning disabilities (the label used in the dataset) aged 50-69 who were screened for breast cancer, from 2017/18 to 2024/25. In 2024/25, less than half of eligible female people with learning disabilities (48.8%) had been screened for breast cancer, compared to 62.6% of eligible female people without learning disabilities. For both groups, the rate of breast cancer screening has reduced slightly from 2017/18.

Cervical cancer screening. The first graph below shows the percentage of female people with and without learning disabilities aged 25-64 who were eligible for cervical cancer screening, by age band. Pretty much everyone in both groups was eligible for cervical cancer screening.

The next graph shows how many people actually had an adequate cervical smear test, from 2017/18 to 2024/25.

In 2024/25, 32% of female people with learning disabilities had had an adequate cervical smear test, around half the percentage of female people without learning disabilities (64.9%). Over time, the percentage of female people with learning disabilities having an adequate cervical smear test increased slightly (from 30.6% in 2017/18) whereas this decreased slightly for female people without learning disabilities (from 67.2% in 2017/18). So while the gap between female people with and without learning disabilities has narrowed over time (from a 36.6% gap in 2017/18 to a 32.9% gap in 2024/25), at this rate of change equality will take 62 years to be achieved.

Colorectal cancer screening. The Health and Care of People with Learning Disabilities provides information on all people with and without learning disabilities aged 60-74 over time, from 2020/21 to 2024/25. 

In 2024/25, 55.1% of people with learning disabilities aged 60-74 had had colorectal cancer screening, compared to 69.7% of other people in the same age range. This has increased faster for people with learning disabilities (from 43.3% of people in 2020/21) than for other people (from 62.7% of people in 2020/21). At these rates of change, equality will be reached in 12 years.

Cancer diagnosis

The graph below shows rates of diagnosed cancer recorded for people with and without learning disabilities over time, from 2017/18 to 2024/25. Overall, in 2024/25 people with learning disabilities were less likely to have a diagnosis of cancer than other people (2.1% vs 3.5%), a figure which has increased at a slower rate for people with learning disabilities (from 1.7% in 2017/18) than for people without learning disabilities (from 2.7% in 2017/18). 

Amongst people with learning disabilities, girls/women are more likely to be diagnosed with cancer (2.7% in 2024/25) than boys/men (1.8% in 2024/25), a larger gap than amongst other people (girls/women 3.8% in 2024/25; boys/men 3.3%).

In terms of age bands, although rates are relatively low up to age 44 they are marginally higher for people with learning disabilities than for other people - as rates increase sharply from the age of 45 onwards they become much higher for people without learning disabilities compared to people with learning disabilities, particularly for men.

Heart failure. In contrast to the figures above for coronary heart disease, in 2024/25 people with learning disabilities were more likely to have a diagnosis of heart failure than other people (1.3% vs 1.1%), a figure which has slowly increased for people with learning disabilities (from 1% in 2017/18) and people without learning disabilities (from 0.9% in 2017/18). 

Amongst people with learning disabilities, girls/women are slightly more likely to be diagnosed with heart failure (1.3% in 2024/25) than boys/men (1.2% in 2024/25), a different pattern than amongst other people (girls/women 0.9% in 2024/25; boys/men 1.3%).

In terms of age bands, rates of heart failure are consistently higher for people with learning disabilities than other people at all ages up to the age of 74.

Chronic Obstructive Pulmonary Disease (COPD). Overall, in 2024/25 people with learning disabilities were less likely to have a diagnosis of COPD than other people (1.3% vs 1.8%), a figure which has slowly increased for people with learning disabilities (from 1.1% in 2017/18) but stayed static for people without learning disabilities (1.8% in 2017/18). 

Amongst people with learning disabilities, in 2024/25 girls/women were slightly more likely to be diagnosed with COPD (1.4%) than boys/men (1.2%), although over time this figure has increased for girls/women with learning disabilities (from 1% in 2017/18) but stayed static for boys/men with learning disabilities (1.2% in 2017/18). Amongst other people, figures are similar for girls/women (1.8% in 2024/25) and boys/men (1.9%).

In terms of age bands, rates of diagnosed COPD are consistently higher for people with learning disabilities than other people at all ages up to the age of 64 - beyond this COPD is more commonly diagnosed amongst people without learning disabilities.

Stroke or transient ischaemic attack (TIA). Overall, in 2024/25 people with learning disabilities were slightly more likely to have a diagnosis of stroke or TIA than other people (1.8% vs 1.7%), a figure which has slowly increased for people with learning disabilities (from 1.6% in 2017/18) and people without learning disabilities (1.6% in 2017/18). 

Amongst people with learning disabilities, in 2024/25 girls/women were more likely to be diagnosed with stroke or TIA (2%) than boys/men (1.6%) - over time this figure has increased for girls/women with learning disabilities (from 1.8% in 2017/18) but stayed static for boys/men with learning disabilities (1.6% in 2017/18). Amongst other people, figures for girls/women (1.6% in 2024/25) are slightly lower than for boys/men (1.8%).

In terms of age bands, rates of diagnosed stroke or TIA are consistently higher for people with learning disabilities than other people at all ages up to the age of 74.

Conclusions

Rates of cancer screening across all screening programmes are much lower for people with learning disabilities than for people without learning disabilities.

With a lot of hard work, in some cancer screening programmes the rate of cancer screening for people with learning disabilities is slowly increasing, but the gap is still very large and won't be closed for many years to come, if at all.

At younger ages (up to age 44), cancer diagnoses are rare, but more common for people with learning disabilities compared to other people.

At older ages (from 45 onwards), when cancer rates start to increase sharply, cancer diagnoses are less common for people with learning disabilities compared to other people.

We now know quite a lot internationally about cancer and people with learning disabilities - the ways that cancer screening programmes don't work well for people with learning disabilities, potential signs of cancer not being noticed early by health professionals, resulting in more emergency referrals to cancer services when people's cancers are already well advanced, and the absence or inadequacy of cancer treatments being provided for people with learning disabilities. Are apparently lower rates of cancer amongst people with learning disabilities because cancers simply aren't noticed by health professionals, and are people with learning disabilities simply less likely to live long enough to develop the most common types of cancer?

As is wearily familiar to those of you wading through this series of blogposts, we know all this, and yet...

The Health and Care of People with Learning Disabilities dataset: High blood pressure and cardiovascular disease

 Note: if you want to skip the graphs, go straight to the conclusions for a quick summary...

We've known for a long time about the health inequities experienced by people with learning disabilities. We know these health inequities are big, resulting in much earlier typical ages of death compared to other people, and we know that these health inequities cut across a wide range of health conditions.

This blogpost will summarise some recent information about people with learning disabilities relating to high blood pressure, and diseases of the heart and blood circulation. 

This blogpost is the third of a series going into a lot of detail using information from the 'Health and Care of People with Learning Disabilities' dataset, compiled by NHS England. Every year (going April to March), this has taken information from GP information systems in England to produce statistics about the health and health treatment of people registered with a GP as a person with learning disabilities, often comparing them to the health and healthcare of people without learning disabilities. It's a brilliant source of information that isn't used as much as it should be, and this is the final year when information in this format will be made available. The interactive information tool is quite hard to get your head around but it does make it quite flexible - for many things you can look at how things are by age, sex, region and even more locally than that, and for most things you can look back over at least the last five years. The most recent information available covers April 2024 to March 2025.

Before we start, there are a few cautions to bear in mind about this dataset. The information only covers about 6 in 10 people registered with a GP (54.6%), and coverage across different parts of the country is really patchy. There are also many people with learning disabilities who are not registered as such with their GP. Finally, it's really important to remember that all this information is based on what health systems and GPs record, which is likely to have its own biases, particularly when it comes to people with learning disabilities.

High blood pressure/hypertension

High blood pressure (also known as hypertension) often has no obvious signs, although it is easy to measure, and is a major risk factor for all sorts of health problems. 

In 2024/25, across all age groups fewer people with learning disabilities (11.1%) had an active diagnosis of hypertension than people without learning disabilities (13.7%). Rates of diagnosed hypertension have increased faster for people with learning disabilities (from 9.7% of people in 2017/18 to 11.1% of people in 2024/25) than for other people (from 12.9% of people in 2017/18 to 13.7% in 2024/25). For both groups most of this increase has happened in the last three years, so it may partly reflect more widespread blood pressure testing.

In terms of sex (the term used in the dataset), more girls/women (12.2% in 2024/25) than boys/men (10.5% in 2024/25) with learning disabilities had a diagnosis of hypertension, where there was no difference between sexes for people without learning disabilities (both 13.7%). 

In terms of age bands, there are higher rates of diagnosed hypertension amongst people with learning disabilities at all age bands up to 64 compared to people without learning disabilities, with rates of diagnosed hypertension increasing with age. Although rates of diagnosed hypertension continue to rise from the age of 65 onwards, older people with learning disabilities are less likely than other people to diagnosed with hypertension.

Major efforts are being made to increase blood pressure measurement/screening, as high blood pressure is a risk factor for so many health problems. 

In 2024/25, most people with learning disabilities (83.4%) had had their blood pressure checked in the last five years, with this figure increasing over time (from 80% in 2017/18). Fewer people without learning disabilities had had their blood pressure checked in the last five years (55.7% in 2024/25), with this figure reducing from the Covid-19 pandemic onwards (from 61.9% in 2017/18).

In terms of sex (the term used in the dataset), slightly more girls/women (85.4% in 2024/25) than boys/men (82.1% in 2024/25) with learning disabilities had had their blood pressure checked in the last five years; this difference was much bigger for people without learning disabilities (girls/women 64.1% in 2024/15; boys/men 47.3%). 

In terms of age bands, rates of blood pressure checks amongst people with learning disabilities increase sharply from childhood to young adulthood, with over 90% of people having blood pressure checks from age 25 onwards. Rates of blood pressure checks increase more gradually for people without learning disabilities, only reaching 90% from the age of 65.

Cardiovascular disease

The Health and Care dataset has very similar information about various types of cardiovascular disease (an umbrella term for all diseases of the heart and circulation of the blood), including coronary heart disease, heart failure, chronic obstructive pulmonary disease (COPD) and stroke.

Coronary heart disease. The graph below shows rates of diagnosed coronary heart disease recorded for people with and without learning disabilities over time, from 2017/18 to 2024/25. Overall, in 2024/25 people with learning disabilities were less likely to have a diagnosis of heart disease than other people (1.2% vs 2.6%), a figure which has stayed fairly stable for people with learning disabilities (from 1.1% in 2017/18) but has gradually decreased for people without learning disabilities (from 2.9% in 2017/18). 

Amongst people with learning disabilities, girls/women are less likely to be diagnosed with coronary heart disease (1% in 2024/25) than boys/men (1.3% in 2024/25), a much smaller gap than amongst other people (girls/women 1.8% in 2024/25; boys/men 3.5%).

In terms of age bands, although rates are relatively low up to age 54 they are marginally higher for people with learning disabilities than other people - as rates continue to increase from the age of 55 onwards they become much higher for people without learning disabilities compared to people with learning disabilities.

Heart failure. In contrast to the figures above for coronary heart disease, in 2024/25 people with learning disabilities were more likely to have a diagnosis of heart failure than other people (1.3% vs 1.1%), a figure which has slowly increased for people with learning disabilities (from 1% in 2017/18) and people without learning disabilities (from 0.9% in 2017/18). 

Amongst people with learning disabilities, girls/women are slightly more likely to be diagnosed with heart failure (1.3% in 2024/25) than boys/men (1.2% in 2024/25), a different pattern than amongst other people (girls/women 0.9% in 2024/25; boys/men 1.3%).

In terms of age bands, rates of heart failure are consistently higher for people with learning disabilities than other people at all ages up to the age of 74.

Chronic Obstructive Pulmonary Disease (COPD). Overall, in 2024/25 people with learning disabilities were less likely to have a diagnosis of COPD than other people (1.3% vs 1.8%), a figure which has slowly increased for people with learning disabilities (from 1.1% in 2017/18) but stayed static for people without learning disabilities (1.8% in 2017/18). 

Amongst people with learning disabilities, in 2024/25 girls/women were slightly more likely to be diagnosed with COPD (1.4%) than boys/men (1.2%), although over time this figure has increased for girls/women with learning disabilities (from 1% in 2017/18) but stayed static for boys/men with learning disabilities (1.2% in 2017/18). Amongst other people, figures are similar for girls/women (1.8% in 2024/25) and boys/men (1.9%).

In terms of age bands, rates of diagnosed COPD are consistently higher for people with learning disabilities than other people at all ages up to the age of 64 - beyond this COPD is more commonly diagnosed amongst people without learning disabilities.

Stroke or transient ischaemic attack (TIA). Overall, in 2024/25 people with learning disabilities were slightly more likely to have a diagnosis of stroke or TIA than other people (1.8% vs 1.7%), a figure which has slowly increased for people with learning disabilities (from 1.6% in 2017/18) and people without learning disabilities (1.6% in 2017/18). 

Amongst people with learning disabilities, in 2024/25 girls/women were more likely to be diagnosed with stroke or TIA (2%) than boys/men (1.6%) - over time this figure has increased for girls/women with learning disabilities (from 1.8% in 2017/18) but stayed static for boys/men with learning disabilities (1.6% in 2017/18). Amongst other people, figures for girls/women (1.6% in 2024/25) are slightly lower than for boys/men (1.8%).

In terms of age bands, rates of diagnosed stroke or TIA are consistently higher for people with learning disabilities than other people at all ages up to the age of 74.

Conclusions

In this blogpost we're seeing similar patterns to those we saw in the previous blogpost about diabetes.

Across a range of diseases of the heart or circulation of the blood (cardiovascular diseases), and also for high blood pressure (hypertension), overall people with learning disabilities are less likely to be diagnosed than people without learning disabilities.

But this overall pattern masks what's happening at different ages. For almost all these cardiovascular diseases, at younger ages when they are less commonly diagnosed, rates of these diseases are higher for people with learning disabilities than for other people. It is only at older ages (65 or older), when these diseases are more common and when people with learning disabilities are less likely to have survived, that these diseases are more common amongst people without learning disabilities. 

There are also often different patterns in rates of disease when it comes to men and women with learning disabilities compared to men and women without learning disabilities. 

We know nothing about rates of cardiovascular diseases among different ethnic communities of people with learning disabilities. 

For me, this suggests that health services set up to screen, prevent (if possible) and treat cardiovascular diseases among people generally will be looking in the wrong places when it comes to people with learning disabilities, particularly when the number of people with learning disabilities will be relatively small in the crowds of people coming to their attention.

As we saw with blood glucose checks for people with diabetes, a large majority of adults with learning disabilities registered with GPs have had a blood pressure check in the last five years (although five years can be a long time in terms of checking blood pressure), probably a function of annual health checks for people with learning disabilities. But as with diabetes, is regular checking resulting in better prevention and treatment for people with learning disabilities with potential heart and circulation problems? 

I suspect that the answer to this question is likely to be no. I've been looking at the most recent LeDeR report for 2024, published in July 2026. One of the headlines repeatedly reported is about avoidable deaths, where in 2024 almost two fifths of people with learning disabilities whose deaths were reported to LeDeR had a death judged to be avoidable (39%), almost twice as many avoidable deaths as those in the 'general' population (21.1%). A horrific inequity.

The LeDeR report also breaks this down into two broad types of avoidable death:

• 'Preventable' deaths ("deaths that could potentially be avoided (prevented) through effective public health and primary prevention measures, such as vaccination, screening, and lifestyle interventions") and
• 'Treatable' deaths ("deaths that could potentially be avoided through timely and effective healthcare, including early diagnosis, appropriate treatment, and prompt management of deterioration"

In the LeDeR report appendix, figures for preventable deaths aren't that different for people with learning disabilities (14.0%) and the 'general' population (13.5%). But the figures for treatable deaths, which by definition are deaths that health services can do something about, are something else. Fully a quarter (25%) of the deaths of people with learning disabilities were from treatable causes, and were more than three times more likely than for the 7.6% of deaths of the general population.

Across a lot of health conditions, the picture is of existing inequities between people with and without learning disabilities generally getting bigger over time, rather than gaps closing. In the United Kingdom, we have known about these inequities for at least 50 years and counting. Can someone give me a good reason why we shouldn't call this social murder?

The Health and Care of People with Learning Disabilities dataset: Diabetes

Note: if you want to skip the graphs, go straight to the conclusions for a quick summary...

We've known for a long time about the health inequities experienced by people with learning disabilities. We know these health inequities are big, resulting in much earlier typical ages of death compared to other people, and we know that these health inequities cut across a wide range of health conditions.

This blogpost will summarise some recent information about people with learning disabilities with a diagnosis of diabetes. 

This blogpost is the second of a series going into a lot of detail using information from the 'Health and Care of People with Learning Disabilities' dataset, compiled by NHS England. Every year (going April to March), this takes information from GP information systems in England to produce statistics about the health and health treatment of people registered with a GP as a person with learning disabilities, often comparing them to the health and healthcare of people without learning disabilities. It's a brilliant source of information that isn't used as much as it should be. The interactive information tool is quite hard to get your head around but it does make it quite flexible - for many things you can look at how things are by age, sex, region and even more locally than that, and for most things you can look back over at least the last five years. The most recent information available covers April 2024 to March 2025, with updates usually released every year in December.

Before we start, there are a few cautions to bear in mind about this dataset. The biggest one is that the information only covers about 6 in 10 people registered with a GP (54.6%) - not all the companies that own the electronic information systems used by GPs allow their data to be used (!). So coverage across different parts of the country is really patchy. The second caution is that there are likely to be many people with learning disabilities who are not registered as such with their GP. A third caution is that the extent to which this dataset includes people with learning disabilities in inpatient units really isn't clear. Finally, it's really important to remember that all this information is based on what health systems and GPs record, which is likely to have its own biases, particularly when it comes to people with learning disabilities.

Type 1 diabetes

Type 1 diabetes is an autoimmune condition where the pancreas stops producing insulin. The body attacks the healthy pancreas cells by mistake which causes it to stop producing insulin which the body needs to regulate blood sugar. Type 1 diabetes often runs in families and you are more likely to develop the condition if a close relative has the disease. Unlike Type 2 diabetes, there is no link between being overweight or inactive and developing the condition.

In 2024/25, 0.8% of people with learning disabilities had a diagnosis of Type 1 diabetes mellitus, compared to 0.4% of people without learning disabilities. These percentages haven't changed much from 2017/18 (0.7% of people with learning disabilities; 0.4% of people without learning disabilities). [I know the graph looks odd in terms of changes over time for different groups, but I've checked it multiple times and it's a quirk of rounding numbers up or down].

In terms of sex (the term used in the dataset), slightly more girls/women (0.8% in 2024/25) than boys/men (0.7% in 2024/25) with learning disabilities had a diagnosis of Type 1 diabetes, a similar difference (0.5% vs 0.4%) to people without learning disabilities. 

In terms of age bands, there are higher rates of Type 1 diabetes amongst people with learning disabilities at all age bands up to 64 compared to people without learning disabilities, peaking at 1.0% of people with learning disabilities aged 25-34. From the age of 65 onwards people with learning disabilities are equally or less likely than other people to have Type 1 diabetes, with no-one with learning disabilities aged 75+ reported as having Type 1 diabetes (compared to 0.3% of people without learning disabilities).

Type 2 diabetes

The Health and Care dataset has very similar information about diagnosis of what it describes as non-type 1 diabetes mellitus, which I am taking to mean Type 2 diabetes. Type 2 diabetes is a condition affecting the pancreas which leads to disruption of the hormone insulin and high blood sugars. Risk factors include being overweight, inactivity, having a family history of diabetes, or being from certain ethnic backgrounds. If left untreated, diabetes can lead to uncontrolled blood sugar, poor circulation and consequent damage to feet (including amputations) and eye problems.

The graph below shows rates of non-Type 1 diabetes recorded for people with and without learning disabilities over time, from 2017/18 to 2024/25. Overall, the percentage of people with learning disabilities diagnosed with non-Type 1 diabetes has increased over time, from 6.7% of people in 2017/18, to 8.0% of people in 2024/25. There has also been a less steep increase for people without learning disabilities (from 4.7% of people in 2017/18 to 5.5% of people in 2024/25). Rates of diagnosed non-Type 1 diabetes overall are higher for people with learning disabilities compared to other people, with the gap widening over time.

Amongst people with learning disabilities, girls/women are more likely to be diagnosed with non-Type 1 diabetes (9.0% in 2024/25) than boys/men (7.4% in 2024/25). This is the opposite pattern to people without learning disabilities, where girls/women are less likely to be diagnosed with non-Type 1 diabetes (4.9% in 2024/25) than boys/men (6.1% in 2024/25).

In terms of age bands, there are higher rates of non-Type 1 diabetes for people with learning disabilities overall at all ages from 10 onwards, with 8.5% of people with learning disabilities aged 35-44 having a diagnosis of non-Type 1 diabetes compared to 2.2% of other people, and 15% or more of people with learning disabilities having a diagnosis of non-Type 1 diabetes from the age of 45 onwards. While rates of non-Type 1 diabetes are higher for girls/women with learning disabilities than boys/men with learning disabilities up to the age of 44, this flips from the age of 45 onwards.

Measuring blood glucose

The Health and Care of People with Learning Disabilities dataset also records how many people with a diagnosis of diabetes mellitus (Type 1 and Type 2) have had their blood glucose measured in the last 12 months (HbA1c), as a way of checking how well people are generally doing in managing their diabetes. This is a basic measure of how well health services are regularly monitoring people with diabetes - it doesn't say anything about how well people are managing their diabetes or what help people are getting beyond regular monitoring.

The graph below shows what percentage of people have a diagnosis of diabetes and have had their blood glucose checked in the last 12 months, from 2017/18 to 2024/25. For people with learning disabilities in 2024/25, 8.1% of people had had their blood glucose checked - this is compared to the 8.8% of people with learning disabilities in 2024/25 with a diagnosis of either Type 1 or Type 2 diabetes. So most people with learning disabilities and diabetes, but by no means everyone, had had their blood glucose checked in the last 12 months. For people without learning disabilities in 2024/25, 5.4% of people had had a blood glucose test in the last 12 months, out of the 5.9% of people with a diagnosis of Type 1 or Type 2 diagnosis. 

For people with and without learning disabilities, the percentage of people getting a blood glucose test has increased over time. For people with learning disabilities, this is an increase from 6.8% of people in 2017/18 to 8.1% of people in 2024/25; for other people this is an increase from 4.7% of people in 2017/18 to 5.4% of people in 2024/25. This has been a steady year-on-year increase, except for a dip during the Covid-19 pandemic in 2020/21.

But as we've seen earlier on, the percentage of people with learning disabilities with a diagnosis of diabetes has also increased over time, and at a faster rate than for people without learning disabilities. This means that the gap between people with a diagnosis of diabetes and those with a blood glucose test has increased slightly over time for people with learning disabilities (the gap was 0.6% of people in 2017/18 compared to 0.7% of people in 2024/25). 

As we saw earlier, in relation to diabetes diagnoses, more girls/women with learning disabilities than boys/men in 2024/25 had had their blood glucose checked in the last 12 months (9.1% vs 7.5%). This is the opposite way round for girls/women vs boys/men without learning disabilities (4.8% vs 5.9% in 2024/25).

In terms of age bands, the age pattern of blood glucose checks closely mirrors the age pattern of diabetes diagnoses (particularly for the more common non-Type 1 diabetes) that we saw earlier, being much more common for people with learning disabilities at virtually all ages.

Taking into account differences in the populations of people with and without learning disabilities in things like age and sex, in 2024/25 a diagnosis of Type 1 diabetes was 1.6 times as common and a diagnosis of non-Type 1 diabetes 1.9 times as common among people with learning disabilities than you would expect. 

Conclusions

Both Type 1 and Type 2 diabetes are more commonly diagnosed amongst people with learning disabilities compared to other people, and are increasing faster over time. In 2024/25, around 1 in 11 people with learning disabilities had some form of diabetes diagnosis, compared to 1 in 17 people without learning disabilities.

These differences are biggest in almost all adult age groups.

Girls/women with learning disabilities are more likely than boys/men with learning disabilities to have a diagnosis of Type 2 diabetes and to have blood glucose checks - this is the opposite way round to the population of people without learning disabilities.

This dataset doesn't tell us anything about ethnicity and diabetes amongst people with learning disabilities, which we know is an important issue among people without learning disabilities.

Most (but not all) people with learning disabilities with a diagnosis of diabetes are getting a regular blood glucose check - this is increasing over time, but is not quite keeping pace with the increasing numbers of people with learning disabilities with a diagnosis of diabetes.

There are also a few things I want to say about this that will come up time and time again (if I ever get round to other blogposts about this dataset)...

1) I think this info shows the value of the huge effort involved in setting up regular health checks for people with learning disabilities, as long as they are done well. I suspect that annual health checks have been crucial in spotting diabetes (especially Type 2 diabetes) and in regularly monitoring people's diabetes, particularly among younger adults with learning disabilities.

2) However, while this monitoring clearly has important benefits for aspects of people's health, monitoring on its own is not enough. The evidence for weight management or physical activity programmes working well for people with learning disabilities is not brilliant, and we are not paying any attention to the 'causes of the causes' (in Sir Michael Marmot's phrase) like poverty and where people are living. 

3) I think the information about age is really important and is often overlooked. For diabetes (and for a whole host of other health issues) we see a clear pattern of health problems starting much earlier for more people with learning disabilities. Which is unlikely to be where GPs and health services are generally expecting to see, or be screening for, these health problems. It's also the case that among people without learning disabilities, many health conditions are most common at much older ages. Bluntly, many people with learning disabilities don't live that long, so overall figures across all age groups tend to minimise health inequities between people with and without learning disabilities.

4) Relating to the point just above, it's important to remember that although percentages of health issues like diabetes are more common amongst people with learning disabilities, in terms of absolute numbers of people they can be swamped by the numbers of people without learning disabilities. The Health and Care of People with Learning Disabilities dataset covers 55% of people in GP practices in England - scaling up figures from the dataset would mean there are just over 28,000 people with learning disabilities diagnosed with Type 2 diabetes in England, compared to 3.5 million people without learning disabilities. Easy to ignore in mainstream health services, or an easily manageable number of people for health services to pay attention to and make a big difference?