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.

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) 

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. 

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.