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2020/21 (arguably the height of the Covid-19 pandemic, with all its consequences for most routine health services being withdrawn), the percentage of people with learning disabilities rose dramatically to just over the NHS England target - 75.2% of people).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.