People with a learning disability to design ‘quality checks’ for NHS services

People with a learning disability are being asked to contribute to new tests which will help improve NHS services ranging from dentistry to acute care, NHS England has announced today.

The NHS Quality Checkers programme sees people with a learning disability employed to inspect local NHS services critically, to provide advice on how they can better meet their needs and those of other patients.

People with a learning disability can face significant barriers to accessing NHS services, whether it’s the use of complicated forms and language, confusing layouts of buildings, or staff who aren’t sure how to interact with them.

This contributes to people with a learning disability being less likely to use services, including important programmes like health checks and cancer screening; as a result, they are more likely than average to experience poor physical health than the rest of the population.

Quality checkers use their own experiences to assess the quality of care and support patients receive, giving a view that can be often missing from other forms of inspection.

Evaluation of quality checking programmes currently operating in some areas show them to be an effective and efficient use of resources, and to be associated with increases in quality and improved outcomes. Building on this success, NHS England are now seeking input on new resources which will help support a national rollout.

Scott Durairaj, NHS England’s Experience of Care Lead for Mental Health and Learning Disabilities, said: “The experience that people with learning disabilities have of health services directly impacts on how likely they are to use them, and therefore how healthy they’re likely to be.

“NHS Quality Checkers – designed and led by people with lived experience – have made a real difference to local services where they have been used; now we want to take it to the next level and make a significant contribution to improving health outcomes for this group of patients across England.”

“It is important to gain the backing from commissioners to implement this across the country and help to build momentum.”

Quality Checker inspections can be organised at any time by services such as GP and dental practices, where there are currently groups set up to perform them.

Quality checkers with a learning disability carry out the evaluation, including talking to other service users about their experiences, and judging services against criteria they themselves consider to be important.

Claira Ferreira, Commissioning Lead for Learning Disability, NHS Nene and Corby Clinical Commissioning Groups said: “Our Quality Checker Service has been invaluable in supporting us with values based commissioning and has helped the voice of people with learning disabilities to be heard.”

Feedback from current quality checkers has also demonstrated the positive impact this work is having on the individuals involved, as well on improving attitudes towards those with a learning disability and/or autism.

Suzie Fothergill, Skills for People, Newcastle upon Tyne, and Chairperson, Association of Quality Checkers said: “I have been employed as a Quality Checker for many years now, and trained a lot of people with learning disabilities to do the same.  I am so pleased that health services across the country will be able to have NHS Quality Checkers.  Our work inspires health professionals to makes services better, so that people with learning disabilities can have better lives where they are healthy, happy and safe.

“As a person with a learning disability, I am happy that I have had the chance to improve the way health services support people with learning disabilities”.

Gavin Barr, Quality Checker, Sunderland People First, said: “It is so important that people with learning disabilities are involved in quality checking health services. We are able to use our own experiences of what it means to have the right support.

“I really enjoy listening to patients and families and finding out what they think about services. It’s important to be able to bring our findings together and share these with health professionals in our training sessions. I like working as part of a team and hearing how our quality checks have made a difference. I think NHS Quality Checkers can make a big difference to the health of people with learning disabilities across the Country.”

As set out in Building the right support, the national plan to transform services for people with a learning disability over the next 3 years, NHS England is now seeking to make it easier for groups to set up to offer Quality Checks, and improve consistency across the country, by establishing a national programme to support these local quality checks.

To support the rollout, and in partnership with the Centre of Disability Studies at the University of Leeds and CHANGE (a disabled person’s organisation focusing on the equality and inclusion for people with learning disabilities), NHS England is asking people with a learning disability, their loved ones and carers, and local and national groups representing them, to help develop new resources.

Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (lead for mental health), said: “The CQC is pleased to see NHS England supporting using the knowledge and expertise of people who use services in assessing and improving quality of services.

“The voices of people, who use services, including the voices of people with a learning disability, are a vital source of information for providers and commissioners on the quality of care being provided. For CQC, they help inform when, where and what we inspect and our judgements and ratings of services.

“The NHS England Quality Checkers programme will help support people with a learning disability to measure and improve the quality of health care they receive.

“We will be actively working with NHS England once the trials are complete to examine ways that the results can be utilised by CQC, ensuring that we have a single shared view of quality and do not duplicate efforts, with the ultimate aim of improving quality of healthcare across England for people with a learning disability.”

The resources will include training kits for new Quality Checkers, as well as template assessments which will produce national standards to be measured and benchmarked, while allowing for different local circumstances and needs to be taken into account.

The programme aims to develop tools that can be used by Quality Checkers in seven different service areas:

  • Emergency Departments
  • Community Services
  • Acute Hospitals
  • Primary Care (GPs)
  • Dentistry
  • Mental Health Services
  • Learning Disability Services

Following the establishment of a national framework and an increase in the number of local Quality Checker services available, NHS England will then look to work with local Clinical Commissioning Groups and NHS providers such as hospitals and clinics to encourage take-up of these services.

The Quality Checkers minisite will feature regular updates and guidance on the programme, and contact details for the NHS Quality Checkers programme are as follows:


  1. Kathryn Kambitis says:

    Bath Royal United Hospital NHS Foundation Trust is currently in the process of our first Quality Check of services by people with learning disabilities.

  2. Helen says:

    Patient Led Assessments of the Care Environment (PLACE) are already undertaken and reported on annually, using patient representatives and previous patients to act as assessors. Premises/services get inspected and audited constantly, so will this be one more inspection to add to the growing number? I appreciated the impoirtance but is this not already considered under PLACE, where the inspections are led by previous patients or carers?

  3. Dorothy Jump says:

    Well about time they had a voice and me a Parent/Carer I have been complaining for sometime now regarding there services due to my son who has had major issues with appointments due to his anxiety issues and we felt it was a big ignorance with GPs and services and it was always what they thought and not what was best for people with Learning Disabilities and Autism also. Hope this is now a step forward. With my pressure on services I have been able to support my son to the way that’s been better for him but it’s been a nightmare. I am appalled the way the system works at present. There are also good services so make it worth while.

  4. Carol Leigh says:

    How does this fit with local Healthwatch at a time when many are getting budgets slashed? At least they have some power to ask for responses etc to recommendations….

    • NHS England says:

      Hi Carol,

      The funding of local Healthwatch organisations is a statutory responsibility for local authorities, and they act as a means by which people can raise concerns about local services or influence local decision making through Health and Wellbeing Boards and CCGs. NHS Quality Checks, carried out by people with a learning disability, will augment the role of Healthwatch, as well as that of the CQC, by giving health service providers a very focussed and patient experience-led inspection, so that those providers can identify and make the changes necessary to ensure that their services are more inclusive for people with a learning disability.

      Kind Regards
      NHS England

  5. Carol Leigh says:

    How does this fit with local Healthwatch at a time when many are getting budgets slashed?

  6. kevin riley says:

    Whatever improvements that my arise from your efforts does not mean that the now independent NHS Foundation Trusts that are responsible for service delivery will take up these “improvements”.

    Since 2013 these organisations are free from democratic control and that includes NHS England and it’s ever increasing (and very expensive “off shoots”)

    Why do you continue to mislead the public as to your ability in this respect?

    Kevin S. Riley Solicitor