Learning from Lives and Deaths: LeDeR Annual Report 2023
The LeDeR Annual Report 2023, published by King’s College London for NHS England, provides vital insights into the continuing health inequalities experienced by people with a learning disability and autistic people. LeDeR (Learning from Lives and Deaths) was established in 2017 to review deaths, identify avoidable causes, and highlight ways to improve care.
This year’s report examines deaths notified between January 2021 and December 2023, with a particular focus on people from ethnic minority groups, those with severe or profound learning disabilities, and autistic adults without a learning disability (pp. 15–16).
Mortality and causes of death
Adults with a learning disability continue to die far younger than the general population. In 2023, the median age of death was 62.5 years (p. 9), around 20 years below the national average. As the report records:
“Nearly 60% of adults with a learning disability who had a LeDeR review died before the age of 65 years” (p. 7).
Although avoidable deaths have fallen slightly since 2021, the risk remains high. In 2023, 13.6% of deaths were judged preventable and 25.3% treatable (p. 9). The most common avoidable causes were influenza and pneumonia (14.9%), digestive tract cancers (9.7%), and ischaemic heart disease (9.5%) (p. 9).
Quality of care
LeDeR reviews highlight both progress and continuing shortcomings. The proportion of reviews identifying good practice has risen steadily in recent years, but:
“37.2% faced delays in care or treatment; 28.4% had care where diagnosis and treatment guidelines were not met; and 23.2% experienced gaps in their care provision” (p. 9).
More than a quarter of people did not receive the reasonable adjustments they required (p. 45), and around one in four did not have a care package meeting their needs (p. 46).
Inequalities by ethnicity
The report highlights stark ethnic disparities. It notes that:
“Asian or Asian British adults with a learning disability died, on average, 20 years younger than White adults with a learning disability” (p. 50).
It also found that over half of deaths (51.8%) among Black, African, Caribbean or Black British adults were considered avoidable (p. 67). However, the report cautions that these analyses are based on relatively small samples, and results should be interpreted with care (p. 74).
Autistic adults without learning disability
Since 2022, LeDeR has collected data on autistic adults without learning disability. The report observes that:
“Suicide was a leading cause of death for autistic adults, particularly women, alongside accidental and misadventure deaths” (p. 71).
Common co-existing conditions included cardiovascular disease, diabetes and epilepsy (p. 76). Many reviews raised concerns about limited access to adapted talking therapies and a lack of autism-specific crisis planning (pp. 77–78). Again, the report advises caution as numbers remain relatively small.
Recommendations
The report calls for:
a) Consistent provision of reasonable adjustments and personalised care (p. 45).
b) Improved access to annual health checks, screening and vaccinations (pp. 21–23).
c) Expanded use of learning disability liaison nurses and autism-specialist practitioners (p. 87).
d) Tailored suicide prevention and crisis planning for autistic adults (p. 76).
It also highlights the need for further research into inequalities in the use of the Mental Capacity Act (p. 46) and the development of more representative datasets to monitor outcomes (p. 125).
Conclusion
The LeDeR 2023 report confirms that people with a learning disability and autistic people remain at a significant disadvantage in health outcomes. As the Staying Alive and Well group states:
“If we are valued and we are given the right support, we can live longer and healthier lives. If we are neglected, if we are not understood, if nobody notices we are unwell or unhappy – that can harm us, it can even kill us” (p. 11).
While some progress is visible, too many lives are still being cut short unnecessarily. Reducing this inequality remains a pressing national priority.
Anna Kennedy
5 September 2025
