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?

The Health and Care of People with Learning Disabilities dataset - how many people are taking mental health medications?

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

For over 30 years, it's been clear that huge numbers of people with learning disabilities in England (and in other places too) are prescribed (told by their doctor to take) what are sometimes called 'psychotropic' drugs - drugs that are prescribed to change something about a person's mental state. Typically, these are drugs prescribed for reasons of 'mental health', although they might also be prescribed to change a person's behaviour. Recent research led by Sue Caton at Manchester Metropolitan University with co-researchers with learning disabilities has shown that people with learning disabilities are often not involved in decisions about what mental health medications they're taking (this link goes to a toolkit produced by the project that might help people get more involved in these decisions).

In England, NHS England and other organisations have been running the STOMP programme since 2016. STOMP stands for 'Stopping over medication of people with a learning disability, autism or both'. More recently STAMP ('Supporting Treatment and Appropriate Medication in Paediatrics) has been added by NHS England. Part of the aim of both these programmes is to reduce the number of people with learning disabilities and autistic people who are prescribed these drugs.

This blogpost will summarise some recent information about the percentages of people with learning disabilities being prescribed a range of mental health drugs. 

This blogpost will be the first 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.

There are a few reasons that I want to go into mind-numbing detail this time around (it's not ONLY that I like graphs). First, I'm not going to be doing these blogposts for ever, so I want to make the ones I do as full of information as possible for completeness. Second, I want to show what these kinds of datasets can do, in the hope that people will keep using them. Third, a recent 'consultation' has said that this is the last year that this dataset in this format will be produced. It will be replaced by something that might have more information and will cover all GP practices (a very welcome development), but will not have any way of directly comparing people with learning disabilities to people without learning disabilities (which is such a useful feature of the dataset as it stands).

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.

'Severe mental illness' and antipsychotics

Antipsychotics are a set of drugs that are supposed to be prescribed for people with mental health issues with labels such as psychosis, which in GP-record world (along with some other mental health issues) are classed as 'severe mental illness'.

In 2024/25, 7.6% of people with learning disabilities were diagnosed with a 'severe mental illness', compared to 1.0% of people without learning disabilities. A clutch of research projects have shown that mental health issues such as psychosis might be more common amongst people with learning disabilities, but nowhere near to the extent that GPs are diagnosing severe mental illness, with the suspicion that some people with learning disabilities are getting this label to justify them being prescribed antipsychotic drugs for reasons essentially of attempted behavioural control. These percentages haven't changed much from 2017/18 (7.6% of people with learning disabilities; 0.9% of people without learning disabilities).

In terms of sex (the term used in the dataset), more girls/women (8.0% in 2024/25) than boys/men (7.4% in 2024/25) with learning disabilities had a severe mental illness diagnosis, while there was no difference amongst people without learning disabilities. 

In terms of age bands, substantially more people with learning disabilities are diagnosed with severe mental illness from an early age (e.g. 10% or more from the age of 35-44 onwards) than people without learning disabilities, peaking at 16.3% of people with learning disabilities aged 65-74.

Antipsychotics. Overall, in 2024/25 13.8% of people with learning disabilities were being prescribed antipsychotics, compared to 0.9% of people without learning disabilities. For people with learning disabilities, this was a reduction from 15.5% of people being prescribed antipsychotics in 2017/18 (there was no change over time for people without learning disabilities). 

Fewer girls/women with learning disabilities were being prescribed antipsychotics (12.9% in 2024/25) than boys/men with learning disabilities (14.3% in 2024/25). 

In terms of age bands, the percentage of people with learning disabilities prescribed antipsychotics increases sharply from the age of 10 - from the ages of 25-34 years onwards, more than 10% of all people with learning disabilities in 2024/25 were being prescribed antipsychotics, peaking at 23.5% of people aged 65-74.

From 2020/21 onwards, the Health and Care dataset has added information on people being prescribed antipsychotics when they don't have a diagnosis of severe mental illness or palliative care needs. In 2024/25, 8.2% of people with learning disabilities (6.9% of girls/women; 9.1% of boys/men) without a severe mental illness diagnosis were still getting prescribed antipsychotics, compared to 0.4% of people without learning disabilities or a severe mental illness diagnosis. The percentage of people with learning disabilities prescribed antipsychotics in the absence of a diagnosis of severe mental illness has reduced over time, from 9.3% of people in 2020/21 to 8.2% in 2024/25.

These prescriptions in the absence of a severe mental illness diagnosis also rise steeply for people with learning disabilities from an early age - 10% of adults with learning disabilities without a diagnosis of severe mental illness are prescribed antipsychotics by the age of 25-34.

Taking into account differences in the populations of people with and without learning disabilities in things like age and sex, in 2024/25 being prescribed antipsychotics was 14 times more common among people with learning disabilities than you would expect from general population prescribing rates; for those without a diagnosis of severe mental illness this rose to being 18 times more common.

Depression and anti-depressants

The Health and Care dataset has very similar information about GP diagnosis of depression and the prescribing of anti-depressants.

Overall, the percentage of people with and without learning disabilities diagnosed with depression has increased over time, for people with learning disabilities (15.9% in 2024/25, up from 14.6% in 2020/21) and for people without learning disabilities (14.7% in 2024/25, up from 13.6% in 2020/21). Rates of diagnosed depression overall are higher for people with learning disabilities.

Amongst people with learning disabilities, girls/women were more likely to be diagnosed with depression (20.0% in 2024/25) than boys/men (13.2% in 2024/25). In terms of age bands, from the ages of 25-34 years onwards, more than 15% of people with learning disabilities had a diagnosis of depression, peaking at 25.5% of people aged 55-64.

Anti-depressants. Overall, in 2024/25, 22.4% of people with learning disabilities were being prescribed anti-depressants, compared to 11% of people without learning disabilities. Girls/women with learning disabilities were more likely to be prescribed anti-depressants (27.2% in 2024/25, compared to 14.6% of girls/women without learning disabilities) than boys/men with learning disabilities (19.4% in 2024/25, compared to 7.5% of boys/men without learning disabilities). 

In terms of age bands, from the ages of 18-24 years onwards, more than 15% of people with learning disabilities were being prescribed anti-depressants, peaking at 34% of people aged 55-64.

The Health and Care dataset has also been reporting on people being prescribed anti-depressants when they don't have a diagnosis of depression. In 2024/25, 12.4% of people with learning disabilities without a diagnosis of depression were being prescribed anti-depressants, compared to 4.4% of people without learning disabilities or a diagnosis of depression. For both groups, this had increased slightly since 2020/21 (11.6% of people with learning disabilities without a diagnosis of depression; 4.3% of people without learning disabilities or a diagnosis of depression). Again, this was more common for women with learning disabilities without a diagnosis of depression (13.7% in 2024/25) than men (11.5%). 

In terms of age bands, from the ages of 18-24 years onwards, more than 10% of people with learning disabilities but with no diagnosis of depression were being prescribed anti-depressants, peaking at 17.3% of people aged 65-74.

Taking into account differences in the populations of people with and without learning disabilities in things like age and sex, in 2024/25 being prescribed antidepressants was twice as common among people with learning disabilities than you would expect from general population prescribing rates; for those without a diagnosis of depression this rose to being 3 times more common.

Benzodiazepenes

Benzodiazepenes are a type of 'sedative' - they slow down the body and mind and are prescribed for acute anxiety or sleep problems, and it is recommended that they are not prescribed for more than four weeks at a time. The percentage of people with and without learning disabilities being prescribed benzodiazepenes is decreasing over time. In 2024/15, 6.1% of people with learning disabilities were being prescribed benzodiazepenes (down from 7.6% in 2017/18) compared to 1.4% of people without learning disabilities in 2024/25 (down from 2.4% in 2017/18). 

Amongst people with learning disabilities, in 2024/25 similar percentages of women with learning disabilities (6.4%) and men with learning disabilities (6%) were being prescribed benzodiazepenes.

In terms of age bands, more than 5% of people with learning disabilities from the age of 25 onwards were being prescribed benzodiazepenes.

Taking into account differences in the populations of people with and without learning disabilities in things like age and sex, in 2024/25 being prescribed benzodiazepenes was 5 times as common among people with learning disabilities than you would expect from general population prescribing rates. 

Conclusions

Many more people with learning disabilities than other people continue to be prescribed mental health medications, often without a relevant mental health diagnosis. Nearly 1 in 4 of all people with learning disabilities registered with GPs are on antidepressants, and 1 in 7 people with learning disabilities are on antipsychotics. 

While STOMP and STAMP initiatives might be having some impact on reducing the number of people being prescribed antipsychotics and benzodiazepenes, the increasing numbers of people being prescribed antidepressants is threatening to cancel out any of these gains. 

People with learning disabilities, compared to people without learning disabilities, are particularly likely to be prescribed mental health medications in the absence of a matching mental health diagnosis. This isn't news, but it doesn't stop it being a scandal.

There are also some big gender differences amongst people with learning disabilities, with little sign of these gaps closing over time. Women with learning disabilities are more likely to be prescribed antidepressants and than men with learning disabilities,  and it's the other way round for antipsychotics.

Significant numbers of people with learning disabilities are being prescribed these drugs at much earlier ages than people without learning disabilities (often in relatively early adulthood) for potentially longer periods of time. This is really worrying, given what we know about the side effects of many of these drugs over time, their addictive properties, and their potential impact on how they make people feel.

From the Health and Care dataset. we don't know how many people with learning disabilities are being prescribed more than one mental health drug, although a research project in Jersey suggested that almost a quarter (23%) of people with learning disabilities were being prescribed two or more mental health drugs. 

We also don't know any more how many people with learning disabilities in inpatient units are being prescribed these types of medications. 

The reductions in antipsychotic prescriptions show what can be achieved with concerted, consistent, targeted effort over many years, but also just how big the gap continues to be between people with and without learning disabilities. The increases in antidepressant prescriptions show what happens in the absence of such effort - for all the government talk about reducing health inequalities, the general way that societies and health services operate is taking existing horrendous inequities and making them worse. 

Social care finances and adults with learning disabilities - 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.

I have written a blogpost on the 2024/25 employment figures contained in the social care statistics, and one on how many adults with learning disabilities were drawing on social care in 2024/25. This third blogpost in the trilogy will focus on social care finances relating to adults with learning disabilities in 2024/25.

Question 1: How much money are councils spending on social care services for adults with learning disabilities?

The two graphs below show gross expenditure by local authorities on social care for adults with learning disabilities from 2014/15 to 2024/25, broken down by categories of spending. One graph is on spending for adults with learning disabilities aged 18-64, and one for adults aged 65+ - it is really important to notice that the scales for the two graphs are very different (much more is being spent related to adults aged 18-64 than for adults aged 65+). It is important to remember that these figures do not include housing benefit (an essential component of supported living arrangements). These figures are also not adjusted for inflation, which as we enter a time of high inflation is going to be even more important to take into account. However, using 2014/15 as a baseline (there had already been big real-terms cuts to social care budgets by this point), the graphs also include lines of what expenditure would be if social care expenditure was increasing in line with inflation, using adult social care inflation figures from the previously available and invaluable PSSRU publication Unit Costs of Health and Social Care, and more recently from Kings Fund reports on social care.

 

A couple of observations. Overall, from 2014/15 to 2024/25, social services expenditure related to adults with learning disabilities continued its upwards trajectory in absolute terms, despite there being two years during the height of the Covid-19 pandemic when the number of people getting social care reduced. For adults with learning disabilities aged 18-64, expenditure increased at a compound annual growth rate of 5.9% per year, from £4.4 billion in 2014/15 to £7.8 billion in 2024/25. This represents 67% of all social care expenditure related to adults aged 18-64. For adults with learning disabilities aged 65+, expenditure increased at a compound annual growth rate of 6.9%, from £540 million in 2014/15 to £1.1 billion in 2024/25. This represents 8% of all social care expenditure related to adults aged 65+. Across both age groups, social care expenditure related to adults with learning disabilities represents 36% of all adult social care expenditure.

For both adults with learning disabilities aged 18-64 and adults with learning disabilities aged 65+, increases in expenditure ran ahead of inflation. This indicates local authorities trying to protect these budgets, while at the same time falling short of what would be needed given projected increases in the population of adults with learning disabilities needing social care support. It’s also important to remember that this social services expenditure includes expenditure from people’s own pockets in the form of client contributions (of which more later).

The two line graphs below show trends in expenditure on specific types of social care service for adults with learning disabilities aged 18-64 and 65+ (with different scales for the two age groups). Spending on supported living continues to increase and has now substantially overtaken spending on residential care - these two are by far the largest components of social care expenditure to support adults with learning disabilities. These are also the two categories of social care spending showing the biggest recent increases, although higher inflation means that most categories of social care spending are increasing in absolute terms (even if not in real terms) after some years of relatively flat spending.

 

 

Question 2: How much are people paying for social care in 'client contributions'?

When looking at the figures above on expenditure, it is important to remember that this is gross current expenditure - it does not take account of any income that might be coming into local authorities providing social care services. One source of income is 'client contributions' - money for social care support that is paid by people drawing on social care support or those close to them.

The two graphs below show the amount of income received by local authorities in client contributions for different types of social care support, for services for adults with learning disabilities aged 18-64 and for adults with learning disabilities aged 65+. As with the earlier overall expenditure graph, using 2016/17 as a baseline the graphs also include lines of what expenditure would be if client contributions for social care only increased in line with inflation.

For both adults aged 18-64 and adults aged 65+, the biggest types of client contributions were for residential care and contributions under the 'fairer charging' regimen and its successors. Also for both age groups, client contributions over time have increased faster than inflation, particularly in recent years. The compound annual growth rate for client contributions for adults with learning disabilities aged 18-64 in absolute terms is 7.4%, from £307 million in 2016/17 to £542 million in 2024/25. For adults with learning disabilities aged 65+, the compound annual growth rate in client contributions is 8.9%, from £66 million in 2016/17 to £129 million in 2024/25. This means that 8% of all social care expenditure related to adults with learning disabilities comes from client contributions.

Question 3: Are services charging more over time?

Unit costs (how much money services charge per person per week) for residential care and nursing care for adults with learning disabilities continued their upward trend in 2024/25 for adults aged 18-64, with a period of relatively little change in unit costs being replaced by big year-on-year increases partly related to increased inflation. For adults aged 18-64, the average cost to local authorities of residential care was £2,224 per person per week and nursing care £2,058 per person per week. Unit costs were cheaper in 2024/25 for adults aged 65+ compared to adults aged 18-64 (£1,441 per person per week in residential care; £1,319 per person per week in nursing care), with unit costs. It is worth noting that unit costs are higher for these services for adults with learning disabilities aged 18-64 than for any other group of people getting social care. 

 

Summing up

Social care spending for adults with learning disabilities reported in 2024/25 seems to accelerate longer-term trends, with increases just above inflation, continued increases in spending on supported living, and both supported living and residential care being the biggest types of social care spending. Big increases in inflation have had a huge impact on the increasing costs of social care services for adults with learning disabilities. Client contributions also continue to rise much faster than inflation year-on-year, as do unit costs. 

With people with learning disabilities and those close to them paying more and more in 'client contributions' (two thirds of a billion pounds in 2024/25), is scarce public and personal money being spent in the best ways? Why do so few people with learning disabilities own their own homes, when people are charged so much to effectively rent a place that is all too often, as George Julian documents here, dangerously awful? Why is so much professional time (and money) being spent on fending off and humiliating people who might need a little bit of help now and again in the name of eligibility, rather than investing in people to help them get the most out of life? I do worry about writing this kind of blogpost now, when the hills are alive with pernicious cries of 'overdiagnosis' and 'burden' on councils. and people with learning disabilities are increasingly being erased in blanket policy and service formulations of neurodiversity. Spending less isn't any kind of solution - working with people with learning disabilities and those close to them to spend it better is.