How the reasonable adjustment digital flag can help identify and support people with a learning disability

Summary

Sebastian Gonzalez, hub topic lead and learning disability lead nurse at Barts Health NHS Trust, reflects on the lack of progress made in reducing health inequalities for people with a learning disability despite a number of reports and recommendations over the last few years. He highlights the new reasonable adjustment digital flag that is being implemented across the NHS, which allows the sharing of detailed information across the healthcare system about the reasonable adjustments individuals require. Sebastian asks you to explore what your organisation is doing to implement the reasonable adjustment digital flag to help identify and support patients with a learning disability.

Content

Since the publication of the Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD),[1] we have been aware of the profound health inequalities across the country. Currently, it is estimated that 1.5 million people with a learning disability live in the UK,[2] and more recent data show that, on average, adults with a learning disability die 19.5 years earlier than the general population and that 40.2% of their deaths are considered avoidable.[3]

The National Confidential Enquiry into Patient Outcome and Death report 

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) is a UK based charity that reviews the quality of healthcare in order to improve patient safety and outcomes. In 2026 they published a study report: Learning Together: A Review of the Quality of Care Provided to Adults with a Learning Disability When Admitted to Hospital Acutely Unwell (NCEPOD).[4] More than a decade after CIPOLD first exposed the health inequalities experienced by people with a learning disability, the findings of this report demonstrate that significant challenges remain and that further action is needed to improve patient safety and healthcare outcomes.

The study focused on adults aged 18 years and over with a learning disability who were admitted to hospital as an emergency between 1 July and 30 September 2024. Data were gathered from a range of sources, including clinician questionnaires, primary care questionnaires, organisational questionnaires, surveys completed by healthcare professionals, patients and carers, and detailed reviews of patient case notes.

Key findings:

• Incorrect use of the terms learning disability and learning difficulty.
• Underuse of flagging and alert systems.
• Failure to consistently implement reasonable adjustments.
• Poor adherence to the Mental Capacity Act.
• Limited involvement of people with a learning disability in their own care decisions.
• Unequal access to specialist learning disability services.

A focus on flagging and alert systems

The study found that hospital services often failed to accurately identify and flag people with a learning disability. One of the key expectations introduced in 2018 through the Learning Disability Improvement Standards for NHS Trusts was that organisations should have mechanisms in place to identify and flag patients with a learning disability, autism, or both, from the point of admission through to discharge. Yet, the report highlighted that while 89.7% of the organisations reported having flagging or alert systems in place, only 52.2% of patients had these alerts.

The issues were compounded by the incorrect use of the term learning difficulty, an issue well known to people with a learning disability and those that support them.[5] Furthermore, the report identified a key link between the use of flags and the provision of reasonable adjustments, highlighting how adjustments were more likely to be made when patients had been accurately identified and flagged.

Moving forward

Throughout the years, several reports have provided evidence of the poorer outcomes experienced by people with a learning disability and have made recommendations on how to improve their care. Despite this, it remains clear that there is still a long way to go in reducing the health inequalities experienced by this patient group.

While the process of identifying and flagging patients may seem administrative in nature, it represents an essential patient safety mechanism that helps ensure individuals receive healthcare that is reasonably adjusted to meet their needs. In addition, an effective flagging system enables organisations to monitor outcomes closely, including incidents involving this group of patients. This, in turn, can support more effective service planning and ultimately contribute to improved patient outcomes.

The reasonable adjustment digital flag[6] being implemented across the NHS represents an opportunity to go beyond simply identifying and flagging patients. Not only does it allow for detailed information about the reasonable adjustments individuals require, but it also promotes the sharing of this information across the healthcare system.

If your role involves improving patient safety, consider exploring what your organisation is doing to implement the reasonable adjustment digital flag, and how it identifies patients with a learning disability and ensures they receive the support they need. Small changes in these areas have the potential to make a significant difference to patient experience and outcomes.

References

1. Heslop P, et al. Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) Final report. Norah Fry Research Centre, 2013.
2. Mencap. Learning Disability Research and Statistics. Last accessed 5 July 2026.
3. White SA, et al. LeDeR Annual Report Learning from Lives and Deaths: People with a Learning Disability and Autistic People. The Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London. Last update June 2026.
4. Tavaré A. Learning Together A review of the quality of care provided to adults with a learning disability when admitted to hospital acutely unwell. NCEPOD, 2026.
5. Mencap. Learning Difficulties: Types, Causes and Symptoms. Last accessed 5 July 2026). 
6. NHS England. The reasonable adjustment digital flag action checklist: what you need to do to achieve compliance. 25 March 2024.

About the Author

Sebastian Gonzalez is the Learning Disability Lead Nurse at Barts Health NHS Trust, providing strategic and clinical leadership to improve the quality, safety and accessibility of healthcare for people with learning disabilities across one of the largest NHS trusts in the UK. With extensive experience spanning acute and community services, Sebastian has led the development of policies, training programmes, quality improvement initiatives, and service innovations that promote equitable care and reasonable adjustments for people with learning disabilities and autistic people.

His primary area of interest is improving access to acute healthcare for people with a learning disability and reducing the health inequalities they continue to experience. He is particularly passionate about driving system wide change, embedding person-centred care, and ensuring healthcare services are accessible, inclusive, and responsive to the needs of individuals with learning disabilities and their families.