Specialist Inpatient Rehabilitation for adults with a learning disability
The following sections provide an summary of the various elements of this workstream and indicates those areas that are complete.
Literature Review Task and Finish group - Complete
The literature review has provided a summary of the current evidence base for this area of clinical service delivery. Its purpose was to enable a fuller understanding of the rationale of whether there is a clear need to be met and rationale for the expectations of such services. An initial literature review was completed by colleagues in Plymouth University and this was expanded to search terms relevant to this area of healthcare service delivery but not specific to complex continuing care/rehabilitation work with learning disability.
Williams, J; Shahzad, S; Manandhar-Richardson, M; Jaydeokar, S; Bramwell, V; Garland, A; Hutchinson, C; Odiyoor, M (2024) Rehabilitation for adults with an intellectual disability and mental health and behavioural complexities: A scoping review in British Journal of Learning Disability https://
Accessible Summary of the paper
- Some people with an intellectual disability will need extra help with their mental health. People with more complicated needs might need support for a longer period of time.
- Longer term services can be in hospitals or in the community. These are called rehabilitation services.
- There is some research to show that rehabilitation services should be person-centred and help the person learn new skills. The staff should have the right training and should help the person improve their quality of life. Much more research needs to be done on rehabilitation services for people with intellectual disabilities.
Current use of inpatient services Task and Finish group
After meetings to review the type of information that the NHSE/I regional team hold and the lines of enquiry that would be possible from this, a decision was made to have an overview analysis of anonymised information already collected by NHSE/I and then to identify areas for a future proposal to deep dive into information collected through CTRs and other such processes.
Two papers for publication were identified to be developed from this task and finish group’s work.
Paper 1: Cross sectional data paper - complete
This considered the data about people who had been in hospital since March 2015, including those who were still in hospital on 12 February 2022. In summary this analysis found that at the single data level, patients in the Northeast & Yorkshire region, autistic patients and patients with acute admissions to mainstream adult mental health units were individual factors for reducing the length of stay.
Ward type (secure units), section type (part III of the Mental Health Act (MHA)) and restricted patients (part III of the MHA), and older ages are individual factors that increase the length of stay.
When considering multiple factors together, the results indicate that bed type, type of sections under the MHA framework, outcome of C(E)TR, and region were significant factors that impacted the length of stay. However, patient category (intellectual disability with or without autism or being autistic without intellectual disability) and type of inpatient unit (security) were not significant.
Jaydeokar, S., Hochard, K., Bakiler, E., Swithenbank, C., Hutchinson, C. and Odiyoor, M. (2025), "Factors associated with the length of inpatient stay of individuals with intellectual disability and autistic individuals across North of England", Advances in Mental Health and Intellectual Disabilities, https://
Paper 2: Longitudinal data paper is in peer review for publication in BJPsych Open
This paper reviewed data for all people who had a been an inpatient since 2015 and had been discharged at some time before March 2024. Key finding are that
- Patients under MHA Part III sections had a longer length of stay than those on MHA Part II sections – more than four times the length of stay.
- Patients admitted under the Criminal Procedure Insanity Act CPIA had a similar length of stay to those on MHA Part III sections with restrictions.
- Patients admitted to secure forensic, forensic rehabilitation, and rehabilitation services had a longer length of stay compared to any other bed types, including intellectual disability beds.
- Those admitted to independent hospital providers had almost double the length of stay compared to those admitted to NHS providers.
- Patients only admitted to inpatient services once had a longer length of stay compared to the total length of stay of those admitted two or more times.
A link to the full article will be added here when available.
Outcome Measurements Task and Finish group – Complete
The work of this group has taken a focus group approach to the development of a framework of outcome measures meeting with three groups a) people with a learning disability; b) carers of people with a learning disability c) professionals who deliver inpatient rehabilitation to people with a learning disability.
The ICHOM ( https:/
The review of the areas to be measured for inpatient rehabilitation and review of specific outcomes measurement tools suggested is complete and has been checked back with a further focus group.
Two papers for publication were identified to be developed from this task and finish group’s work.
Paper 1: a short briefing paper for NHS commissioners
This was completed in November 2025 and circulated via NHSE national and regional teams to ICB commissioning teams and directly to provider services engaged in QNLD pilot.
Paper 2: a peer reviewed journal article
This is being drafted and will provide the underpinning literature review that supported the framework’s development; the views of the focus groups and expand on the briefing sent to ICB commissioners.
A link to the full article will be added here when available.
Commissioning guidelines Task and Finish Group - Complete
This groups work was incorporated into the NHS England Mental Health Quality Transformation Team’s work on Commissioning guidelines.
In January 2024 NHSE produced the Commissioner guidance for adult mental health rehabilitation inpatient services. The needs of adults with a learning disability and autistic adults are specifically referenced within the document available here https://
Quality Standards Task and Finish group - Complete
North West NHSE LDA Programme provided initiation funding to the Royal College of Psychiatry College Centre for Quality Improvement’s (CCQI) Quality Network for Learning Disability (QNLD).
This funding was used to co-develop a set of quality standards specific to the inpatient rehabilitation pathway. The co-development with people with lived experience, clinical staff and academics used a Delphi approach to consensus. The first set of standards were completed in October 2022 and are published on their website here https://
Quality Standards 3 year Pilot - In Progress
The NW NHSE LDA Programme funding also covered a pilot of the standards supporting 20 hospital wards through the first year development process and second year accreditation process. The pilot group include different types of service that offer an inpatient rehabilitation pathway to adults with learning disability and includes non secure acute wards, non secure rehabilitation wards; secure wards and newly developed, (but not yet opened) acute inpatient wards.
Service Evaluation of Inpatient Rehabilitation for People with a Learning Disability – In Progress
The work of the task and finish groups highlighted a need to establish if the commissioning guidance and QNLD standards were impacting on quality of services that deliver inpatient rehabilitation stays and gain further information about the inpatient rehabilitation pathway.
NHSE-NW funded this service evaluation using learning disability programme funds. The aim of this evaluation is to understand concepts about rehabilitation, what this may look like for individuals with a learning disability, and how, going forward, standards and outcomes can be effectively measured.
This service evaluation consists of four aspects:
- A survey of inpatient units to gather preliminary data on rehabilitation in inpatient services - Complete
- Focus groups with experts by experience (in progress), experts by profession (complete), and family carers (In progress), to explore their understanding of rehabilitation and their thoughts on what needs to be considered at different points of the inpatient journey. This will lead to the development of co-produced audit standards for services - In progress
- Inpatient units will be given the opportunity to conduct a self-audit using the co-produced audit tool – in progress.
- A set of data standards will be developed that will be eligible for inclusion in future learning disability inpatient registers – not yet started, awaiting outcome from 3.
