Children with learning disabilities in schools in England - 2025 update

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LeDeR Report 2025 - a first look

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Of those people where there was ethnicity information:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Statutory homelessness statistics and people with learning disabilities 2023 - getting even worse

This short blogpost updates a post from just over a year ago, using the latest statistics on statutory homelessness in England, as they relate to households with a person with learning disabilities living within them. As far as I can tell (and others are better placed than me to know about this) we know relatively little about homelessness among people with learning disabilities in the UK, although it looks like people with learning disabilities (often unrecognised) are more likely to experience homelessness.

To quote this typically lucid report from the House of Commons Library on statutory homelessness in England, "Local authorities have a statutory duty to secure accommodation for unintentionally homeless households who fall into a 'priority need' category. There is no duty to secure accommodation for all homeless people". 

There are a range of statistics presented in the live tables, one of which presents information on the number of households owed a homelessness duty broken down by whether anyone in the household has a list of particular support needs, which includes 'Learning disabilities'. Because of changes to the law in 2018, statistics are available for each quarter (three months) from April 2018 through to March 2023.

The graph below shows the number of households with a person with learning disabilities who were owed a homelessness duty in each quarter year. There are some fluctuations, but overall the number of households has rapidly increased. In Quarter 2 of 2018 (April-June) there were 2,670 households with a person with learning disabilities owed a homelessness duty - by the first quarter of 2023 (January-March) this had increased to 4,700 households, an increase of 76% in less than five years.

How big a proportion of households owed a homelessness duty are households with a person with learning disabilities? The graph below shows trends in two percentages over time. 

The first (the blue line) is the percentage of all households owed a homelessness duty by a local authority that are households with a person with learning disabilities. This shows that households with a person with learning disabilities represented 4.3% of all households owed a homelessness duty in Quarter 2 of 2018, increasing to 5.9% of all households in Quarter 1 2023.

The second, orange, line is the percentage of households with an identified support need owed a homelessness duty that are households with a person with learning disabilities. [Not all households owed a homelessness duty officially have a support need]. This shows that households with a person with learning disabilities represented 9.3% of households with a person with support needs owed a homelessness duty in Quarter 2 2018, increasing to 11.0% of these households in Quarter 1 2023.

This is not an area I know about at all well, so there may be horrible errors of interpretation here. And these statistics will clearly miss out a lot of people with learning disabilities who are homeless, for a variety of reasons. But to me these look like highly worrying statistics which are getting worse quickly, for which there is virtually no policy attention or action.

Update: David Abbott has alerted me to an excellent research project with autistic people who experience homelessness completed by his colleague, Beth Stone - I've linked to a blog describing the project, which also has links to more in-depth descriptions of the research.

Update 2: David's sent me this link to a must-read, authoritative report by Beth Stone and Emily Wertans for the Centre for Homelessness Impact on Homelessness and disability in the UK - published in May 2023. In fact - read this instead of my blogpost!

Winterbourne View 12 years on - 2023. Report card 4: leaving inpatient units

This blogpost is the final one of four looking at the Transforming Care programme through the prism of the national statistics regularly produced by NHS Digital/NHS England, updating a series of blogposts I last updated in 2022.

The first blogpost looked at statistics on the number of people being admitted to inpatient services, and where they were being admitted from.

The second blogpost looked at how far people were from home and how long they were staying in inpatient services.

The third blogpost looked at planning and reviews for people within inpatient services.

This final blogpost will focus on the number of people leaving inpatient services (charmingly called ‘discharge’) and what is happening leading up to people leaving. Getting people out of inpatient units has arguably been the major focus of activities under the Transforming Care/Building The Right Support banner. Again, at this point the impact of these programmes should be visible in the number of people getting ready to leave, how well people’s plans to do so are developing, and how many people are actually leaving to places outside inpatient services.

The first and most obvious question is whether people in inpatient services have a planned date to leave. The graph below shows the proportion of people in inpatient services with a planned date for transfer, from March 2015 to March 2023 (according to Assuring Transformation data). There have been some fluctuations over time but there is an overall trend of things improving up to March 2019, and things worsening from then to March 2023 where the figures look in some ways slightly worse than in March 2015. In March 2023 there was no planned transfer date for 57% of people in inpatient units, compared to 50% of people in March 2015. In March 2023, 18% had a planned transfer date within 6 months, although for 10% of people their planned transfer was overdue.

In addition to planned transfer dates, do we know anything about the plans themselves?

Well, if people are leaving the inpatient unit to go home in some sense then my expectation would be that the person’s local council should be aware of the plan to leave. The graph below shows information from Assuring Transformation based just on those people with a plan to leave – for this group of people, are councils aware of the plan? Over time, the proportion of people with a plan that their council is aware of dropped substantially from 2015 to 2019, although this has improved again up to March 2023. Despite this recent improvement, by March 2023 the proportion of planned transfers where the council was aware (63%) was still lower than it was in March 2015 (69%). Of concern is that in March 2023 for 22% of people with a planned transfer it wasn’t known whether the council was aware of the plan or not, an improvement from 2019 but still worse than in March 2015 (7%). At the very least this suggests that the close working between health and social care envisaged as central to Transforming Care/Building The Right Support is less than universal.

  

There are other signs too of haste in planning for people to leave. The Assuring Transformation statistics report whether a range of people (the person themselves, a family member/carer, an advocate, the provider clinical team, the local community support team, and the commissioners) have agreed the plan to leave. For those people with a plan to leave, the graph below reports the proportion of their plans that have been agreed by different people, from March 2016 to March 2023. Over time, the proportion of plans agreed by anyone and everyone potentially involved has plummeted. Only 27% of plans had been agreed by the person themselves in March 2023, compared to over two thirds of people (69%) in March 2016. Similar drops are reported for the proportion of family/carers (from 60% to 23%) and advocates (from 64% to 26%) agreeing the plans.

By March 2023, transfer plans had been agreed by a minority of provider clinical teams where the person was supposed to be moving to (from 83% in March 2016 to 31% in March 2023), a minority of local community support teams in the area the person was supposed to be moving to (from 69% to 28%) and a minority of those commissioners who are reporting the information the graph is based on! (from 83% to 31%). To what extent are these actually feasible and sustainable plans that will result in a better life at home for people in inpatient services, and what are their chances of breaking down?

The final graph in this blogpost series is one of the most important – how many people have actually been transferred from inpatient services, and where have they gone? The graph below adds up monthly ‘discharges’ from inpatient services in the Assuring Transformation dataset in six yearly blocks, from October 2015 through to September 2022. It’s also one of the most complicated graphs in this series, so I’ll go through it in a bit of detail.

The first thing to say is that overall the number of people ‘discharged’ from inpatient services increased from 2015/16 (2045 people) to 2017/18 (2,265 people), but has since decreased to 1,710 people in 2021/22 (although the COVID-19 pandemic undoubtedly had an impact on the number of people leaving inpatient units, this presumably isn't a continuing issue into 2022?).

Of the people who have been ‘discharged’, in 2021/22 almost one third of people (525 people; 31%) moved to independent living or supported housing. Another third of people (540 people; 32%) moved to their family home with support, making almost two thirds of everyone ‘discharged’ from inpatient services (63%). This is a big increase from the 41% of people 'discharged' to these living circumstances in 2015/16.

Where did everyone else go? For almost two fifths of people in 2021/22 (305 people; 18%) their ‘discharge’ was actually a transfer to another inpatient unit, confirming the picture of ‘churn’ of people passed around inpatient services found elsewhere in this series. Around one in six people (270 people; 16%) moved into residential care. Given that some inpatient services have re-registered themselves as residential care homes with the CQC and a panoply of 'step-down' and other services are registered as care homes, it is unclear to what extent people are leaving an inpatient service to move somewhere more local and homely, moving somewhere very similar to where they were, or not actually moving at all.

In 2021/22, there were also another 165 people (10%) who moved to an ‘other’ location – again it is unclear what these ‘other’ places are, but are they wildly different from where people were moving from?.

Overall, there are signs of some changes over time in where people are being ‘discharged’ to. Fewer 'discharges' are to other hospital inpatient units and residential care, and more 'discharges' are to people's families with support.

So in this final post in the series, there are definite signs that Transforming Care/Building The Right Support has not continued to support the 'discharge' of more people out of inpatient services, although almost two thirds of those people who are leaving are now moving to independent or supported living or back to the family home. There are real worries about the feasibility and sustainability of some of these plans, and the extent to which many people ‘leaving’ inpatient services are actually leaving for something radically different or being churned around a system that doesn’t call itself an inpatient service system but looks mighty similar to the people living within it. The fact that for around one in six people being 'discharged', they are actually being moved to another inpatient unit, is to my mind something of an indictment of the inpatient service 'system' and Transforming Care's lack of fundamental impact upon it.

None of these past four blogposts gets to the heart of what this failure has done to countless people and those close to them since the BBC Winterbourne View programme was aired (and in the years and decades before then). Surely the government must see that, after 12 years, something radically different is required?