We are an all‑age Learning Disability Community Service across Lancashire and South Cumbria, delivering specialist MDT support to people with learning disabilities who have complex health needs. Our service includes an Intensive Support Team (IST), Discharge Co‑ordination Team (DCT), Health Facilitation Team (HFT), specialist secure houses, and Water Meadow View – a learning disability and mental health acute inpatient provision.
We work across community, inpatient and specialist settings, supporting individuals, families and carers, and collaborating closely with primary care, acute trusts, social care and voluntary sector partners.
Respiratory disease remains the leading cause of premature mortality for people with learning disabilities, as highlighted in the LeDeR 2023 report. This risk is further compounded by health inequalities experienced by people from ethnic minority communities, which is particularly relevant to our local population in Lancashire.
Locally, high levels of deprivation contribute significantly to respiratory risk, including poor housing conditions, limited access to health‑promoting resources, lower vaccination uptake, and barriers to timely healthcare access. Many individuals we support experience difficulties communicating symptoms, which can delay recognition of deterioration and escalation of care.
We identified clear gaps in:
- Early identification of respiratory risk
- Consistent, proactive respiratory screening
- Education for people with learning disabilities, families and carers
- Workforce confidence and capability in recognising and responding to respiratory ill health
Addressing these gaps aligned strongly with our wider Healthy Lungs work and made participation in the KMCH pilot both timely and highly relevant.
How we embedded KMCH
LSCFT Learning Disability Services were actively involved in both Phase One and Phase Two of the KMCH pilot. Clinicians across the service accessed the KMCH online training and resources, providing feedback on usability, relevance and clinical application.
The pilot was led locally within the Pennine locality by Tracey Hartley‑Smith and Esther Smith, whose leadership was central to coordinating training uptake, supporting staff engagement and embedding KMCH tools into practice.
As part of Phase One, all‑age MDT respiratory clinics were established within the Pennine locality, led by Esther Smith. These clinics provided a practical forum to apply KMCH tools, including the screening tool, holistic assessment and respiratory care plan, alongside multidisciplinary discussion and shared decision‑making.
What has made the biggest difference
The most significant impact came from the establishment of MDT respiratory clinics alongside the KMCH training. These clinics created protected space for clinicians to bring complex cases, use the KMCH tools in a supported environment, and receive wrap-around MDT input.
A further key factor was that the KMCH pilot ran in parallel with our local Healthy Lungs project. This meant we were working at both a population level and a clinical workforce level simultaneously. While the Healthy Lungs project focused on delivering a respiratory health education programme for Lancashire minority ethnic communities – including co-produced workshops raising awareness of respiratory health and prevention – the KMCH pilot strengthened clinician knowledge, skills and confidence.
This dual approach created a strong alignment between community-level prevention and individualised clinical care. As awareness increased within underserved communities, clinicians were better equipped to respond proactively, identify risk earlier and deliver more personalised, preventative respiratory care.
Strong local leadership, visible clinical champions and access to practical, structured tools were key in helping the work gain momentum and credibility across the service.
Early learning and impact
Early learning from the pilot highlights the value of structured respiratory assessments for people with learning disabilities, particularly when embedded within MDT working. The KMCH tools supported more holistic conversations about respiratory health, linking physical health, lifestyle factors, environment and reasonable adjustments.
Clinicians reported improved awareness of early warning signs, clearer escalation pathways, and greater confidence in developing personalised respiratory care plans. While formal outcome data is still emerging, there is a strong sense that the work has positively influenced clinical thinking and practice.
Tips and lessons learned
Key learning we would share with other teams includes:
- The importance of visible leadership and clinical champions to drive engagement
- Embedding training alongside practical MDT forums to support application
- Recognising workforce pressures and competing priorities when planning roll‑out
- Allowing time for cultural change and confidence‑building, particularly in complex services
Despite strong engagement within pockets of the service, overall uptake was lower than hoped. This likely reflects wider system pressures and workforce change within the NHS. Future roll‑out would benefit from clearer messaging around the clinical significance of KMCH and its alignment with national priorities such as LeDeR and health inequalities.
Next steps for KMCH implementation
LSCFT Learning Disability Services plan to establish ongoing Respiratory MDT Clinics or consultation spaces accessible to all clinicians. These will support continued use of KMCH tools, consolidate learning from the pilot, and provide ongoing case‑based support.
We will also explore opportunities with the Senior Leadership Team to commission further KMCH training from Bradford District Care NHS Foundation Trust, with a view to widening workforce reach and strengthening system‑wide respiratory capability.
There is future potential to extend this work through closer collaboration with primary care, social care and wider system partners.
