Guidance on the need to access Specialist Adult Learning Disability health services

GGC - Referral Management
NHS GGC

This document has been drawn up to help referrers decide whether their patient (or the person that they support) would benefit from a referral to the local Learning Disability team. LD services fall between primary and secondary care and offer a wide range of health services for people with Learning Disability. For referrers without experience of working with the LD team, their role can sometimes be confusing. It can also sometimes be difficult for referrers to know whether their patient has an LD or not. This document should help clarify the role of the LD team, help decide whether the patient would benefit from accessing the team, and also gives some guidance around how to judge whether a person is likely to have an LD. If it still isn’t clear whether a referral is appropriate, then please phone and ask for a senior member of the LD team to contact you to discuss the referral.  

 

Supporting access to mainstream services

The Keys to Life recommends that people with LD use mainstream local services where, with reasonable adjustment, they meet their needs. With respect to most health needs, the role of the LD health team is to support and facilitate access to mainstream services where additional support is required. In this case, the LD service does not take primary responsibility for health problems, and responsibility remains with primary or secondary care.

Not all patients with a learning disability will require to access specialist LD services, and a patient should never be automatically redirected to the Specialist LD community team simply on the grounds that they have a learning disability. However, if patients are struggling to access an equitable service from mainstream services (due to their learning disability) then please phone the team to discuss whether the team could support this.

Direct input around mental health, challenging behaviour and LD specific health needs

The LD health team provide direct input in relation to:  

  • Mental health, challenging behaviour and health needs associated with autism (plus learning disability). In this instance, the LD health team take the lead and provide a full secondary care service and responsibility for those aspects of health care. Referrals for assessment and input should be made directly to the team.  
  • Specific input provided by Allied Health Professionals (OT, Physio, SLT and Dietetics) where this cannot reasonably be provided by mainstream services. This might be due to the impact of learning disability on the patient’s presentation or health needs, or because the complexity of multi-disciplinary care means that the Learning Disability team are required to work together to meet the patient’s health needs.  
  • Specific specialist services or interventions that are provided by LD services for people who also have a learning disability (such as autism diagnosis for patients who also have a learning disability, postural management for people with Profound and Multiple Disabilities, Sensory processing assessments etc) 

Identifying whether your patient has a learning disability

Some patients evidently have a learning disability and are well known to LD services. For other patients it can be less clear whether it is appropriate for them to access LD services. 

It is up to the referrer to ensure that there is a reasonable likelihood that the person has a learning disability prior to making the referral. If a full IQ score is available then this can be helpful (although bear in mind that WISC tests carried out in childhood often underestimate adult cognitive ability, and that adult WAIS tests carried out in the context of mental illness also generally underestimate Full scale IQ.). However, most patients have not had cognitive testing, and the referrer should use their clinical judgement to decide whether mainstream or specialist LD services are more appropriate.  

The table below will help guide as to whether a patient likely to require input from LD services. But if you are still not sure whether a referral should be made, please phone the team and a senior member of the team can get back to you to discuss. 

 

Unlikely to have a learning
disability/mainstream
services more likely to
meet needs		 More likely to have a learning
disability/LD services more
likely to meet needs
Attended mainstream school (unless with
significant one-to-one support).		 Attended Special Education services
(although caution must be applied as
certain Special Education schools will
accept pupils with other difficulties such as
ADHD or behavioural problems.)
Achieved mainstream qualifications (even
with support).		 Have not achieved any mainstream
qualifications including NVQ, HNC etc
Have a diagnosis of a specific
developmental disorder such as
dyslexia.		 Unlikely to have a diagnosis of a specific
developmental disorder such as dyslexia as
this is more likely to have been subsumed
by the diagnosis of "Global Developmental
Delay" as a child.
Have a diagnosis of "mild learning
difficulty".		 Have a diagnosis of "moderate learning
difficulty”
Literate - if a person has no difficulty in filling
out forms and reads novels for pleasure they
are unlikely to have a learning disability.		 A large number of people in NHS GGC
without a learning disability have poor
literacy skills and this alone is not helpful in
supporting a diagnosis.
Developmental milestones within normal
range (although a precise history may be
difficult to get, and people with a mild
learning disability may have normal
developmental milestones).		 Developmental milestones outside
normal range.
Educational problems not picked up until
late primary school/High school.		 Educational problems picked up at
nursery or early in primary school.
Have maintained a full time job at any point
in the past- especially any full time job
where literacy skills are required.		 Unable to maintain a full time job or in
supported employment.
Manage household finances without
support.		 Receiving external support with
household finances.
Manage day-to-day running of
household without support.		 Receiving external support with day- to-day
management of household.
Able to cook a complex meal
unsupported.		 May be able to cook unsupported, but
typically heating up prepared food or
cooking food that requires little preparation.
Full independent travel. May travel independently, but typically only
uses a small number of fixed routes and
unable to read timetables.
Does not identify as having a learning
disability, and does not have peers from the
wider community of people with learning
disabilities.		 Identifies as having a learning
disability, and has peers from the wider
community of people with learning
disabilities.
Has not needed to access Specialist Learning
Disability Services in the past (for any aspect
of health or social care.)( However, patient’s
whose families have previously provided all
necessary support should not be excluded
from accessing Specialist Learning Disability
Services).		 Has previously accessed and benefitted from
Specialist Learning Disability Services.
No relevant history of brain injury before
the age of 18.		 History of relevant childhood brain injury
(such as pre/perinatal problems, childhood
infections such as meningitis, or
significant head injury).
Additional physical health problems or known
syndrome associated with learning disability.

Please note that the above table may need to be scrolled horizontally or vertically in order to view all information, depending on your device.

In Children's Services, the term "learning difficulty" is generally used in an educational context. Children with a "moderate learning difficulty" are likely to have a mild learning disability, and children with a "mild learning difficulty" usually function above the learning disability range as adults.  

In the context of health and social care for adults, the meanings of the terms learning disability and learning difficulties are less clear cut and can be used interchangeably. Some people with learning disabilities may prefer the term learning difficulties, whilst some people with learning difficulties may prefer to identify themselves as having a learning disability. Professionals are not always careful to identify what is meant by the terms, and may make transcriptions errors leading to further confusion.  

(In exceptional cases, patients without a learning disability are accepted to LD services – but this would only be following discussion and assessment by the LD team and if there were good clinical justification.)  

Please note that we are not funded to provide a diagnostic service and we do not accept referrals simply to determine whether or not somebody has a learning disability. LD teams will sometimes carry out an assessment of learning disability as part of the referral/screening process or in order to support treatment, but this would only be in the context of a wider health need.

Finally, access to Social Work services, including specialist Learning Disability Social Work services is determined by national eligibility criteria. This guidance is only in relation to referral for health input from LD teams. LD services are now integrated, and if a referral is made to “the team”, health and social work will work together to establish whether Learning Disability Services best meets the patient’s needs. 

Editorial Information

Last reviewed: 16/01/2023

Next review date: 31/01/2025

Author(s): Specialist Learning Disability Services Governance and Senior Management team.

Version: 1.2

Approved By: Specialist Learning Disability Services Governance and Senior Management team

Reviewer name(s): Laura Nicholson, Sudhakar Sharma.