Some depressing findings in a national care review of 166 people with a learning disability in Wales in hospital settings show people often live there too long, people are being over-medicated and there is too much use of restrictive practices on people whose behaviours that challenge.

Today Vaughan Gething, Minister of Health and Social Services published this national care review which was commissioned by Welsh Government. It looked at 166 people with a learning disability that have health care and treatment in health settings provided or commissioned by the NHS such as secure hospitals and assessment and treatment units. He made a statement today.

Our view

We welcome this review that provides a comprehensive picture of the care and treatment of people with a learning disability in health settings.

Zoe Richards, Chief Executive Officer of Learning Disability Wales commented:

“Through the Improving Lives Programme we are working with Welsh Government to ensure that people with a learning disability in Wales experience support through services that promote healthy lives with choice and control over their own lives. We understand that there are times when people and families experience crisis and that there is a need for medicalised specialist support but this must be time limited and we must work towards people living their lives outside of a medical setting.”

Since Learning Disability Wales creation in 1983, at the same time as the revolutionary All Wales Mental Handicap Strategy, we have worked to promote the right of people with a learning disability to experience a full, stimulating and varied independent life and to enjoy all the advantages and responsibilities of being a citizen in their community.

Learning Disability Wales would like to see actions from this report happen immediately including the clarification of responsibilities between local authorities, health authorities and the inspection service and secondly, clarification on who is legally and financially responsible for monitoring care and support for each person.

Report findings

The report found that although there were some areas of good practice there were a number of issues that need to be addressed urgently. The report makes 70 recommendations.

Hospital is not a home

Patients were remaining in hospital units for a long time and were transferred between hospitals when alternatives in the community could have been considered. The average length of time was found to be 5 years, with one patient staying for 49 years. People should only stay in hospitals if there are no other ways to treat them safely.

Over use of medication

37% of patients who were prescribed mood stabilisers had no recorded primary or secondary diagnosis of mental illness. The main role of medication is therefore is to suppress behaviour rather than to treat a condition. This medication is not only inappropriate, it reinforces a negative attitude that learning disability is a medical condition that needs to be controlled with drugs. Medication should not be a quick fix when a person might need long term therapy and support. There should be more therapy staff.

Over-use of restrictive practice

Restrictive interventions are sometimes required when someone uses behaviour that challenges. But the review found many occasions where they had been applied. Restrictive practices should be the last resort. The use of restrictive practice should be in the patient’s hospital support plan and say clearly why they are needed.

Older people

More needs to be done for the ageing population. Many patients with a learning disability have another diagnosis such as dementia and autism. The right environment is needed with experienced staff.

Care Plans

This review found that not all patients had a care plan in place, and that not all care plans had been regularly reviewed. All patients should have a care plan and hospital support plan that should be written with the patient and reviewed regularly.

Listening to patients

In general, people said good things about their care. But they also said they would like some things to be different. Staff should keep asking patients how things can be improved and then check how they are doing.

Transition to community

This review found a significant number of patients who may be considered for transition to the local community. Patients who have been living in hospitals for many years can get used to living there. So transition requires careful planning and should involve the person and family to help them prepare.


This National Care Review has been commissioned by Professor Jean White, Chief Nursing Officer, Welsh Government, as part of the Welsh Government Learning Disability – Improving Lives Programme from the NHS Wales National Collaborative Commissioning Unit.

Improving Lives, Improving Care: National Care Review of Learning Disabilities Hospital Inpatient Provision managed or commissioned by NHS Wales, February 2020.

Easy Read: Improving Care: Improving Lives: What is it like for people with a learning disability who are getting care through hospital.

Vaughan Gething statement