Mandatory training for learning disabilities and autism
The Learning from lives and deaths – People with a learning disability and autistic people (LeDeR) programme continues to find that people with learning disabilities and autistic people experience inequalities in access to health services. The second annual LeDeR report (2017), found that for a significant proportion of the deaths reviewed, the individual’s health was affected by factors that were avoidable, with a lack of awareness of the needs of people with learning disabilities and autism among health and social care providers. The report recommended the introduction of mandatory training for all staff, delivered in conjunction with people with lived experience of learning disabilities.
	In "Right to be heard" published in 2019, the government set out its intention to amend the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ("the 2014 Regulations"), to require all NHS and social care providers who carry out regulated activities to ensure that their staff have achieved the learning outcomes in respect of learning disabilities and autism relevant to their role. The CQC is responsible for monitoring compliance with the 2014 Regulations.
	The policy intention of the Department of Health and Social Care is to make an explicit requirement in legislation for all health and social care employees who perform CQC regulated activities to undertake training on learning disability and autism appropriate to their role.
	The Act introduces a duty in the Health and Social Care Act 2008 (HSCA 2008) on the Secretary of State to make regulations to require all health and social care providers who carry out regulated activities to ensure that their staff, who are employed for the provision of a regulated activity, receive specific training appropriate to their role on learning disability and autism.
	The Act also introduces a duty on the Secretary of State to produce a Code of Practice (CoP) which will provide guidance about the nature of the training including the content, delivery and the ongoing evaluation of the training. The Government must consult on the CoP and lay a copy of the draft code before Parliament prior to publication.
	The Act includes a provision which means that from commencement of the section, the 2014 Regulations and HSCA 2008 are to be read as including a requirement for all health and social care providers who carry out regulated activities to ensure that their staff receive specific training on learning disabilities and autism appropriate to their role.
	The amendments are designed to operate within the existing framework of the HSCA 2008. Section 20 (1) of the HSCA 2008 requires the Secretary of State, by way of regulations, to secure that services provided through regulated activities cause no avoidable harm to recipients. Section 20(2) provides that the Secretary of State may use regulations to impose any other requirement in relation to such regulated activities, particularly to ensure service quality and to secure the health, safety and welfare of service recipients. Section 20(3) provides a non-exhaustive list of what may be addressed by those regulations, including provision about the management and training of staff undertaking regulated activities.
	Section 21 contains a specific provision relating to infections acquired in health care settings. If regulations are made under section 20 which contain requirements relating to the prevention or control of health care associated infections, the Secretary of State must produce a CoP about compliance with these requirements. The Act adds a new section 21A which sets out provision for a CoP relating to mandatory learning disability and autism training. Section 22 contains provisions which outline the consultation requirements for the CoP required under section 21. The Act will expand section 22 to cover both CoPs.
	Section 23 provides that the CQC must issue guidance about the requirements of regulations made under section 20, other than requirements which relate to the prevention or control of health care associated infections (these are covered by the CoP provisions in section 21). Section 24 contains provisions outlining the consultation procedures for the guidance produced under section 23.
	Section 25 sets out the circumstances in which the CoP under section 21 and guidance under section 23 may be taken into account in relation to decisions or orders under the HSCA 2008.
	The 2014 Regulations are the regulations made under (amongst others) section 20 of the HSCA 2008 and set out the list of activities which are regulated by the CQC and the requirements which apply in relation to the way these activities are carried out.
	Regulation 18 of the 2014 Regulations currently provides that "Persons employed by the service provider in the provision of a regulated activity must receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform…".
	Regulation 21 provides a general overarching guidance provision which requires regulated persons to take into account any guidance when complying with requirements in regulations, and in the case of regulation 12 (as it applies to health care associated infections), take into account the CoP issued by the Secretary of State under section 21 of the 2008 Act.