The new requirement
Since 1 July 2022, all registered health and social care providers have been required to provide training for their staff in learning disability and autism, including how to interact appropriately with autistic people and people who have a learning disability. This should be at a level appropriate to their role.
This new legal requirement was introduced by the Health and Care Act 2022. It applies to:
- all services and all settings, not just specialist services for people with a learning disability and autistic people, and not just the places where people live
- all health and care staff as well as ancillary staff who may have contact with people with a learning disability and autistic people, such as administrative staff.
You still need to meet the requirements of Regulation 18. This requires you to provide employees with appropriate support, training, professional development, supervision and appraisal to enable them to carry out their duties.
We updated our statutory guidance on Regulation 18 in July 2022 to include 2 specific points about the new requirement:
- You must ensure that all staff receive training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role.
- Staff must receive appropriate supervision in their role to ensure they demonstrate and maintain competence in understanding the needs of people with a learning disability and autistic people, including knowing how to support them in the best way.
You need to be aware of this when reviewing your induction, training and supervision plans for all staff.
How this affects your service
You should be able to meet the needs of anybody using your service. The requirement also applies to people who are not directly using your service, but who your staff may have contact with. Autistic people and people with a learning disability are as likely as any person to use any regulated health or care service. Training your staff appropriately will help to improve the experience and outcomes for all people who use services.
We expect all providers in all health and care sectors to review what training and support they provide to staff in various roles, to ensure they are meeting their legal responsibilities.
The new requirement means many more members of your staff will need to have some form of training that is appropriate to their role.
It applies to all staff who have contact with, or may potentially have contact with, an autistic person or a person with a learning disability, whether that person is using the service themselves or if they are accompanying somebody. It also includes ancillary staff, for example receptionists, security guards, cooks and kitchen staff, or cleaners.
You need to decide how to meet the new requirement for these roles by assessing each member of staff, making sure that no one is left out.
For example, you might decide that a member of reception staff needs some awareness training as they may come into occasional contact with an autistic person or a person with a learning disability. In comparison, a healthcare professional would usually need a higher level of training.
Some staff may already have received training, but you should consider reviewing the suitability of any existing training and monitor its effectiveness, as well as how you support all staff in relation to the new requirement.
When assessing the quality of care provided by a service, we will check that staff are competent to deliver care and treatment to all people using services – including those with a learning disability and autistic people.
We do not tell you specifically how to meet your legal requirements in relation to training. You are responsible for ensuring your staff are appropriately trained to meet the requirements of the regulations.
To ensure that staff are competent to interact with autistic people or people with a learning disability you should:
- consider all the guidance available and all relevant circumstances
- decide for yourselves the most appropriate training to choose.
The government is required to develop, consult on and publish a Code of Practice. This will likely be called the Oliver McGowan Code of Practice, and will outline details of the training requirement, including standards it should follow. One of these will be to include autistic people and people with a learning disability when developing and delivering the content.
While this Code of Practice is being developed, we recommend that you familiarise yourself with the core capabilities frameworks for supporting people with a learning disability and for supporting autistic people (Skills for Health website). These give examples of what the Code of Practice is likely to require.
If you decide that a member of staff does not need such training, we expect you to be able to show us a record of how you've reached that decision if we ask.
What we will look at
Our main focus is on whether your service and your staff are delivering safe, person-centred care and treatment that safeguards people using services from abuse and improper treatment.
We will take a risk-based approach to this and will look more closely at your staff training and compliance with Regulation 18 if we identify areas of concern within the service. Where your staff have been trained, we will look at how you make sure that they are competent and are putting what they have learned into practice. If we see that staff have not yet received training appropriate to their role, we will check what action you have taken to mitigate any potential risks for people using services.
If we have concerns in relation to the care and treatment of a person with a learning disability or an autistic person, we will check certain areas, for example:
- how you make sure you get people's consent to care and treatment, or the consent of a person authorised to speak on their behalf
- whether people's care and treatment are appropriate, and that care meets their needs and reflects their preferences
- whether care and treatment are being delivered safely
- whether staff are treating people with dignity and respect
- whether you protect people from abuse and improper treatment
- the training provided to staff and training records.
Action we may take
We will always act where there is evidence of poor care or treatment. Our enforcement policy enables us to take into account a provider's specific circumstances before deciding whether it is necessary and proportionate to take any enforcement action.
If your staff have not specifically received training appropriate to their role to support people with a learning disability and autistic people, you may be in breach of Regulation 18. If this happens, we will decide whether we need to take regulatory action. We will act proportionately and consider each individual case.
The new legal requirement does not specify a training package or course for staff.
However, in 2021 the Department of Health and Social Care, NHS England, Health Education England and Skills for Care developed and trialled the Oliver McGowan Mandatory Training package on learning disability and autism with over 8,000 people. This training is named after Oliver McGowan, whose tragic death in 2016 highlighted the need for better training for health and social care staff when interacting with autistic people and people with a learning disability.
The Oliver McGowan Mandatory Training is the government's preferred and recommended training for health and social care staff to undertake to enable providers to meet the requirements of this regulation. We understand that work is ongoing to finalise standardised training packages for staff. Meanwhile, initial e-learning is freely available for staff of registered health and care services on Health Education England’s e-learning for healthcare website. Updates will be available from Health Education England.
The training package is co-designed and co-delivered with people who have lived experience. It will be divided into tiers depending on the needs of staff and levels of skills required.
See Health Education England's information on the Oliver McGowan Mandatory Training in Learning Disability and Autism.