Learning Disabilities



What is a learning disability?

A learning disability is a reduced intellectual ability and difficulty with everyday activities – for example household tasks, socialising or managing money – which affects someone for their whole life.

People with learning disabilities are among the most vulnerable and socially excluded in our society. It is estimated that there are approximately 20/1,000 people with mild learning disabilities and 3-4/1,000 with severe and profound learning disabilities in the UK.

Over the past three decades, almost all the long-stays in hospital for people with learning disabilities have closed and virtually all people with learning disabilities are now living in the community and depend on general practice for their primary care needs.

There is often much confusion between what is a learning disability or a learning difficulty.

Someone must meet all 3 of these criteria for a learning disability diagnosis

  • Significant impairments in intellectual functioning (IQ below 70)
  • Significant impairment of social or adaptive reasoning. The person requires support to achieve their survival needs i.e. eating, drinking, planning, appropriate clothing for weather etc. and with social problem solving and reasoning
  • Impairment of onset before 14 years old.


What is not a learning disability?

  • It is not a mental illness
  • It is not Autism or ADHD in isolation. Autism is sometimes mistaken as a learning disability. Autism affects a person with their social interaction, communication, interests and behavior. Someone with Autism can have a learning disability but not always.
  • A person can have a learning difficulties on a scale might have a mild learning difficulty or a severe learning difficulty.
  • A person with an IQ score that falls slightly above 70 would be deemed to have a learning difficulty
  • The person may have a specific difficulty processing certain types of information i.e. numbers (dyscalculia), reading and writing (dyslexia), dyspraxia. These conditions are specific learning difficulties.
  • Blindness or deafness in isolation is not a learning disability. Although people with a learning disability can have, in addition to their learning disability diagnosis, have loss of hearing and/or sight)

Better working to support people with learning disabilities

Across Surrey we are working towards greater integration of health and social care for people with learning disabilities, in order to improve the service they receive.

This will mean creating a single team across Surrey County Council and the NHS, with staff receiving information and training on supporting people with a learning disability and/or autism and it will be a contractual requirement that services are able to accommodate their needs.

One of the key aims of our work is to ensure that more people can live in the community, with the right support, and closer to home.

To help achieve this, we have our county-wide Learning Disability Partnership Board, a county-wide Autism Partnership Board and the Learning Disability and Autism Programme Delivery Board.

We are also committed to service user and carer engagement and this is done through our local Valuing People groups:


Transforming Care

Surrey Heartlands CCG is working hard to make sure that fewer people with learning disabilities and/or autism will need to go into hospital for their care by improving services in the community.

We have plans in place for the discharge from all CCG beds for adults with learning disabilities and/or autism and, where people do need to stay in hospital, we will work to ensure their care is the best it can be so they can be discharged as soon as possible.

We have a small local Forensic community team (FIND) for people who have forensic support needs with a learning disability and/or autism and we are currently in discussion with our local providers with regards to providing settled accommodation and support for people with these needs.

We are also working in partnership with health, social care and our provider partners to:

  • Develop discharge pathways and community alternatives to hospital stays.
  • Carry out Care (Education) and Treatment Reviews (CTRS and CETRS) to ensure that all those involved in a person’s care and treatment are acting to ensure that the person can be discharged from hospital as soon as they are well enough to leave.
  • Conduct eight week visits for all adults and six week visits for all children and young people in out-of-area inpatient settings to ensure they benefit from increased focus on their care.
  • Maintain the quality of our learning disability and autism inpatient facilities. We will be working with Experts by Experience service users and carers to check the quality of our local services.


There is further information available on the following links:


Acute liaison and reasonable adjustments

When people are ill and need to go into hospital they may find it difficult to explain their symptoms. They may not be comfortable with the hospital environment and as a result may not receive the care they need.

Surrey Heartlands CCG is working in partnership with all our local hospital trusts in order to develop services which provide reasonable adjustments to help people with learning disabilities receive high-quality care.

Examples include making sure that every acute hospital has both adult and paediatric learning disability liaison nurses.

Please check with your local trust to see what services we have put in place to help you and your family receive the best care. The Surrey and Borders website has the relevant contact details.


Annual Health Checks

People with a learning disability often have poorer physical and mental health than other people. An annual health check can improve people’s health by spotting problems earlier.

All people with a learning disability are entitled to be registered on the GP learning disability register. From age 14 + they will be offered an enhanced annual health check.

Our new Primary Care Networks will be working hard to:

  • Increase the numbers of people with learning Disabilities having an annual flu vaccination.
  • Increase the numbers of people having the enhanced health check.
  • Reduce the use of unnecessary medication ( STOMP)


Learning from lives and deaths: People with a learning disability and autistic people (LeDeR)

Surrey Heartlands CCG is part of the national Learning from lives and deaths - People with a learning disability and autistic people (LeDeR) programme. The LeDeR programme is commissioned by NHS England. 

The aim of the programme is to support local areas to review the deaths of people with learning disabilities (aged four years and above) and autistic people (aged 18 years old and over), identify learning from those deaths, and ensure services are developed in order to address any learning from the review.  

For more information on the programme please visit the NHS England LeDeR website.

Anyone can report the death of a person with a learning disability or an autistic person to the LeDeR programme.  All deaths of people with learning disabilities who are aged four years and above should be reported and deaths of autistic people (with or without a learning disability) aged 18 years old and above.  Deaths can be reported online via NHS England.

Natalie Warman, Interim Associate Director for ICS Quality is the Local Area Contacts (LACs) for the Surrey Heartlands CCG programmeShe can be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it. 

You can read the latest LeDeR Annual Report to get an overview of the LeDeR programme and how this has been implemented in our local area. It provides an overview of the number of deaths that have been reported to LeDeR for these areas and summaries the learning that has come from the completed reviews.


Carer support

Providing care for someone with a learning disability can be very demanding and it is important to ensure that you make time to look after your own health and well-being, not least because in many cases carers support their loved one for the rest of their life. Across Surrey, support is available to help the person you care for reach their full potential, and to support you and your family.

Speaking to people who are facing similar challenges to you can help you make sense of things. Having a network of people who you can turn to for advice and support can be very helpful. Key to all this is understanding the rights you have as a carer enshrined in the Care Act 2014 and the Children & Families Act 2014. There are many things you will want to consider including planning for the future.

The Mencap website has advice on services and support available to you.




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Carers look after family; partners or friends in need of help because they are ill, frail or have a disability. The care they provide is unpaid.  This includes adults looking after other adults, parent carers looking after disabled children, and young carers under 18 years of age looking after siblings, parents or other relatives.' (Carers' UK).


Do you look after someone?

Do you look after an elderly, frail or disabled friend or relative who could not manage without you? Is this care unpaid?

These carers support leaflets, created by Action for Carers Surrey, provide useful advice and support for carers in Surrey:


Register as a carer 

It is important that everyone at your surgery is aware that you are a carer so that they can provide you with support and help if you need it.

GPs have a responsibility to support and work with you in your caring role but also to help you to maintain your own health. GP practices are required to identify and register all carers who use their practice, so please let your GP know if you are looking after someone.

  • Why Register? There are different types of help and support available to you as a carer. Once you are registered as a carer with your GP, access and referral to schemes and local services becomes much more straightforward.
  • How to Register. To do this simply complete a yellow Carer Registration Form, (or this version if you are under 18) available from your GP surgery, and hand it in at reception.

Importance of Covid-19 vaccinations for carers

It is as important as ever for carers to get vaccinated. Unpaid carers are one of the governments priority groups for COVID-19 vaccination. In Surrey Heartlands, 89% of carers are now fully vaccinated, which is fantastic. However, it is clear that carers from ethnic minorities are underrepresented, making up just 10% of this number. 

Dr Pramit Patel, a local GP in Surrey, explains in this video below why it is really important to tell your GP that you have caring responsibilities, and to explain that we are here to support carers from all communities and backgroundsLife can become very hectic especially if you are looking after someone, we know that carers often carry on regardless, but its important not to neglect your own health needs. You care, so we should care for you. 

Your GP practice will record on your medical records that you are a carer and you will be entitled to additional help and support. You may be given a Carers prescription which will help with access to lots of support. including advice and information, support groups and activities, training and respite breaks. If you have not previously registered as a carer with your GP practice, they will also explain how you go about receiving a Covid vaccination or booster. 



Surrey Carers Strategy 2021-2024: supporting carers in Surrey

Surrey Heartlands Health and Care Partnership and partners have published the Surrey Carers Strategy 2021 to 2024 which pledges their commitment to improve and develop services to better support unpaid carers. This video describes the approach taken to produce the strategy.

Unpaid carers carry out a vitally important role. People may not see themselves as carers, instead seeing caring as an extension of their family role: daughters, sons, or partners, for example, doing what families and friends do.

The Surrey Carers Strategy 2021 to 2024 sets out values and priorities for the next three years, reaffirming the commitment and determination to help carers continue caring if they are willing and able, and to support their health and wellbeing by achieving outcomes they have identified that matter most to them.

This strategy has been developed in line with ‘Together for Carers’, a memorandum of understanding between health and social care and a wide range of partners to work together to enhance support for carers of all ages. As well as the summary version of the strategy, you can read a full version and an easy read version.


The Care Act 2014

The Care Act 2014 is the biggest change to English adult social care law in over 60 years. Key areas of the act include:

  • General responsibilities on local authorities including promoting people’s wellbeing, focusing on prevention and providing information and advice.
  • The introduction of a consistent, national eligibility criteria.
  • New rights to support for carers, on an equivalent basis to the people they care for.
  • Legal right to a personal budget and direct payment.
  • The extension of local authority adult social care responsibility to include prisons.
  • New responsibilities around transition, provider failure, supporting people who move between local authority areas and safeguarding.

Surrey County Council are working with residents, carers and key partners to keep the residents of Guildford and Waverley informed about the upcoming changes. Further information about the Act is available on the Surrey County Council website.

Carers Support and Resources

A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. Anyone can be a carer – a 15-year-old girl looking after a parent with an alcohol problem, a 40-year-old man caring for his partner who has terminal cancer or an 80-year-old woman looking after her husband who has Alzheimer's disease. The Surrey County Council Surrey Young Carers Joint Strategic Needs Assessment helps the CCG and our partners understand the needs are of young carers living here in Surrey and what more needs to be done to support them.

Resources for all carers


Are a Surrey-wide service who support all carers through a variety of services including Adult Carers Support, Young Carers Service, Moving and Handling and Giving Carers a Voice.


This website is full of resources for carers in Surrey as well as professionals.


Carer’s Allowance is a benefit for people aged 16 and over who look after someone with substantial caring needs.


Your one-stop-shop for practical information and support for carers. Clear, simple, straight forward advice and support about your caring journey or the journey of a carer you know.


The UK's only national membership charity for carers, Carers UK is both a support network and a movement for change.


Crossroads Care Surrey is the leading provider of respite breaks for carers and the people they care for in Surrey.


If you care for someone who is elderly, frail or disabled, speak to your GP about having a flu jab along with the person you care for.


A step-by-step guide to the practical help, support and advice that's on offer and how to get it, including how to look after someone.


Surrey Council and the NHS have produced a leaflet offering essential information for carers in Surrey.


Provides information to enable people to live more independently. They also offer information for carers such as the GP break service.


An e-learning course that aims to help carers find resources, technologies and support. The course also focuses on how carers can look after themselves in order to prevent caring responsibilities from becoming overwhelming. Learn more about this course on the Carers UK website.


Working across different platforms (online, iOS and Android) and devices, Jointly app is a central place where carers can store important information about the person they are looking after and share this information with other family members who are involved in the care. Jointly combines a number of useful features including group messaging, calendar, task allocation and medication management.


Resources and support for all carers in Surrey


Resources for Adult carers

  Offers, benefits and discounts available exclusively for carers and people with care needs. Parent carers can access specific information including financial support.
  Parent carers can find additional support through Family Voice Surrey. This is a forum for parents to offer a strong, collective voice and network with others.


Young adult carers are young people aged 16–25 who care, unpaid, for a family member or friend with an illness or disability, mental health condition or an addiction.

Resources for young adult carers

  Offers, benefits and discounts available exclusively for carers and people with care needs.
  Young carer and young adult carers in England have the right to information and to an assessment of the support they need from the council. This guide explains what those rights are. It also tells you what should happen when you talk to the council about being a young carer or young adult carer.


A young carer is someone under 18 who helps look after someone in their family, or a friend, who is ill, disabled or misuses drugs or alcohol.

Resources for Young Carers

  Young carer and young adult carers in England have the right to information and to an assessment of the support they need from the council. This guide explains what those rights are. It also tells you what should happen when you talk to the council about being a young carer or young adult carer.
  If you are a young carer and looking after a member of your family there is a site for you, which includes their latest newsletter.
  A useful summary poster to help with learning and raising awareness of young carers.
  Information and resources for those involved in supporting young carers across Surrey.
  Follow on Twitter for updates on how Military Young Carers can access support in Surrey.


Need someone to talk to?

The feelings that carers experience as they go through their caring journey can be some of the most confusing and overwhelming they will ever encounter. For many, family and friends can help 'lend an ear', and can be an invaluable resource in unburdening the carer of the emotional stresses that caring invariably brings; the important thing is for the carer to have access to someone who they can ‘off load’ to.

It’s important to know that there are other options available though. Confidential support offered by the local carers' services is a good place to start but for some, having a professional counsellor maybe a preferred option.

Counselling can help make sense of the role carers have, whether in specific areas such as dealing with bereavement or separation from a loved one, or with the more general feelings of stress, anxiety and depression.

If you are a carer and would like to explore the option of speaking to a counsellor, please speak to your GP in the first instance. Alternatively, the following organisations can provide help and guidance to find a counsellor local to where you live:


Resources and training for health professionals who support carers in Surrey

Employers, teachers, GPs, nurses and other professionals who come into contact with carers and young carers during the working day can get support and training from the Action for Carers Surrey website.


Remember you aren't on your own.

Debbie Hustings, our Partnership Manager for Carers, will be happy to advise. You can email her at This email address is being protected from spambots. You need JavaScript enabled to view it.

Alternatively, please pick up the phone or drop us an email.



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Overcoming your needle phobia (fear of needles)


This page explains more about needle phobia and provides practical advice* on how to overcome it. If you have any questions or concerns, please speak to a doctor or nurse caring for you.


What is needle phobia?

Needle phobia is a fear of medical procedures that involve needles or injections. It is very common, affecting at least one in 10 people, and is nothing to be ashamed of. Fortunately, simple exercises and practice can help to overcome it.

Many patients with needle phobia may have had a lot of blood tests or procedures as a child. A fear of needles and injections often, but not always, results from bad memories of needles earlier in life.


What are the signs and symptoms?

For many people, fear of needles is linked to fainting or feeling faint. When the fear is triggered (for example by seeing blood, or thinking about an injection), heart rate and blood pressure increase (as with other kinds of fears), but then rapidly drop. It is this fall in blood pressure that can cause fainting.

Many people do not confront their fear because they are embarrassed. Other people do not feel faint or actually faint, but do feel panicky when their fear is triggered.


What can I do to overcome my fear of needles?

There are a number of things you can do to help overcome your fear.

  • Tell the person who is coordinating your care, giving you your injection or doing a blood test about your worries. They may be able to answer any specific questions you have, and help you cope with the procedure, for example by chatting to distract you. Don’t worry, staff looking after you will not be annoyed or think you are a wimp when you tell them – they would like to know so that they can help to make it easier for you.
  • Think about whether there has been anything which has helped you to cope with needles in the past. Can you use something like this to help you again?
  • If your fear is linked to fainting, or feeling faint, you can learn an applied tension technique (see the next section for more information).
  • If you feel panicky (for example your heart races, your chest feels tight and your stomach churns), but you do not feel faint, you can learn a breathing for relaxation exercise (see the next section for more information).

These exercises are safe in pregnancy and with most medical conditions.

Remember, the needle will not be unbearably painful. It will hurt a little but there are things you can do to help with feeling anxious, such as distracting your thoughts and using relaxation techniques.


Is there anything I can do to help myself?

Applied tension

Applied tension is a simple technique to increase blood pressure back to normal levels so that you do not faint.

This is how you do it.

  1. Sit down somewhere comfortable.
  2. Tense the muscles in your arms, upper body and legs, and hold this tension for 10 to 15 seconds, or until you start to feel the warmth rising in your face.
  3. Release the tension and go back to your normal sitting position.
  4. After about 20 to 30 seconds, go through the tension procedure again until you feel the warmth in your face.
  5. Repeat this sequence so that you have practised the tension five times.


If you can, practise this sequence three times every day for about a week, before moving on to facing your fear.

If you get headaches after doing this exercise, take care not to tense the muscles in your face and head. Also, be careful when tensing any part of your body where you have any health problems.


Breathing for relaxation

Sit in a comfortable position, with your back upright but not stiff. Let your shoulders and jaw relax. Put one hand low down on your belly. Take a long, slow, deep, gentle breath in through your nose and out through your mouth. Try to breathe right down into your belly, but don’t force it. Just let your body breathe as deeply as is comfortable for you. Do this for five breaths.

If possible, practise this exercise three times every day for a week, before moving on facing your fear.


Final steps: facing your fear

Once you have mastered the above exercises, the next step is to start to face your fear of needles. It is important to take one small step at a time! Develop a ‘fear ladder’ – a list of all of the situations related to needles which you fear, arranged in order of difficulty. Put the easier ones at the bottom – like the first rung of the ladder. This might include thinking about procedures involving needles, seeing pictures of them, watching them on TV and in real life, and actually having them done.

Rate each situation on a scale 0 to 10, where 10 is the most difficult and 0 is the easiest. There is an example of a fear ladder below.


Distress rating

Having an injection in my arm   10/10
Holding a needle   9/10
Touching a needle   8/10
Watching someone else having an injection in real life   8/10
Watching someone having an injection on TV or online   7/10
Looking at photos of injections   6/10
Listening to someone talking about having an injection   6/10
Thinking about having an injection   5/10


Tips on creating your fear ladder

To climb your fear ladder you will have to think about, or act out, each step so try to include some situations which are not too difficult. These are the ones you will start with. Think about what makes a difference to how difficult a situation is. For example, you might find it easier to look at a picture of a smaller needle than of a large one.


Tips on climbing your fear ladder

  1. Start with the least difficult item (for example thinking about having an injection, in the table above).
  2. Plan enough time so that you can stay with the fear long enough to feel your anxiety peak, stay on that level for a while, then gradually reduce. Staying with the fear allows you to see how anxiety makes you feel. Remember that anxiety drops on its own over time.
  3. Begin to use the applied tension or breathing exercise.
  4. Go into the feared situation, and stay with it until your anxiety has started to drop.
  5. Take some time to relax, perhaps using the breathing exercise.
  6. When you feel confident with one situation, move up to the next step of the ladder. You may need to practise with one situation a few times before you are ready to move on to the next one.


Overcoming your fear will take some time and practice, but it will make life less stressful and you will feel less anxious.


Key points

  • Don’t be ashamed of being scared of injections – you are not alone.
  • Tell health professionals about your worries.
  • Think about what helps.
  • Learn applied tension technique if you faint or feel very faint, or breathing for relaxation exercise if you feel panicky.
  • Overcome your fear one step at a time.


*Information sourced from a Guide to overcoming your fear of needles from Guy's and St. Thomas' NHS Foundation Trust.




Review Date: 2021-06-17
Review Due: 2022-06-17
Model Publication Scheme Class: Not part of the MPS

Help and support for you and your family


Our vision is to enable people within Surrey to enjoy the best possible health by commissioning healthcare services that meet local needs. This section of the website provides a list of local patient support groups, services and organisations available to you as a Surrey resident. We want to ensure that local health services meet the needs of our population - which is why we want everyone to get involved in the decision-making process. Please see our How To Get Involved section for more information.




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Social Prescribing


Social prescribing, sometimes referred to as community referral, is a means of enabling GPs, nurses and other health and care professionals to refer people to a range of local, non-clinical services. Their health is affected by a wide range of social, economic and environmental factors including employment, housing, debt, social isolation and culture. These factors do not respond to traditional health interventions. 

Social prescribing seeks to address these needs through a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice, walking, singing and a range of sports. It is particularly useful for people who need more support with their mental health, have one or more long-term conditions, are lonely or isolated, or have complex social needs that affect their wellbeing. 

There is a growing body of evidence that social prescribing can lead to a range of positive health and wellbeing outcomes. Studies have shown improvements to an individual’s quality of life and emotional wellbeing, mental and general wellbeing and levels of depression, anxiety and loneliness. This has resulted in the reduced use of traditional NHS services such as A&E attendances, outpatient appointments, inpatients admissions or seeking a GP consultation.  

Find study data responding to the question Does social prescribing work? on The Kings Fund website. 


Social Prescribing in action

Together with Music pilot

Elderly residents from Keswick Care Home and children aged 10 and 11 from Eastwick School in Bookham are bridging the gap between generations, using music making to inspire confidence and tackle loneliness, anxiety and isolation.  

The innovative Together with Music pilot, is the result of a collaboration between Mole Valley District Council (MVDC), Surrey Downs Integrated Care Partnership (ICP) and Intergenerational Music Making (IMM). The 6-week pilot follows a time of isolation and has supported those living with dementia and challenging circumstances to create a stronger, healthier, intergenerational local community.   

Each session has been creatively unique, encouraging development and exploration within the music making. This project includes a variety of pre-composed and improvised music making, interactive musical and sensory activities, song-writing, choral singing and musical performances from both the young and old. The sessions, facilitated by senior music therapist Marion Barton, conclude with talking time which gives the young and old an opportunity to establish relationships, share stories and discuss the week ahead. 

The aim of this ground-breaking project is to work towards a national best practice model that can be rolled out across the country.  

Lilian, 97 year old resident, Keswick Care Home said “It’s been wonderful. We’ve been doing all sorts, they’ve been making us laugh and that’s a good thing. They’re lovely children and we’re so pleased that they come and entertain us because that’s what we need, it makes a lot of difference to us.” 

Watch this heart-warming film to discover more about this project