Postural care pathway for people with learning disabilities

raising our sights

Many people with learning disabilities have additional physical issues that affect their mobility. For many, postural support can be critical in reducing pain, discomfort and creating the optimum situation for getting the best out of life.

Postural care is defined as support to protect someone’s body shape by using the right equipment and positioning techniques. This can be done to both protect and also to help restore body shape.

How many people might need postural support?

Although it is very difficult to know how many people with learning disabilities might need this support, we do know that there are approximately 16,000 adults with profound intellectual and multiple disabilities in England now and that this number is estimated to increase by on average 1.8% each year to 2026 (Mansell 2010)

This group of people will have complex physical disabilities including movement difficulties and a lack of control over their body posture all of which puts them most at risk of developing body shape distortions.

Policy context and recommendations

Raising Our Sights, Jim Mansell’s 2010 review, identified postural support as a key issue and recommended that NHS bodies should ensure they provide health services to adults with profound intellectual and multiple disabilities which focus on the protection of body shape.
(Recommendation 12)

Recent NICE guidelines on spasticity management for children and young adults also recommended timely access to postural equipment including sleeping and sitting systems.

The recent Confidential Inquiry into Premature Deaths recognised people with learning disabilities as a high-risk group for deaths from respiratory problems and recommended that Clinical Commissioning groups should ensure they commission expert, preventative services including include proactive postural Care support.

The provision of postural care services is patchy but new care pathway sets out approach

The provision of postural care services is patchy but this new care pathway sets out an approach.

Postural Care Pathway

However, within the context of this policy framework the provision of postural care services is patchy. Here at the Elf, we wanted to draw attention to a care pathway that has been developed by Postural Care, a Community Interest Company involved in promoting awareness of the issues and also developing and delivering training.

This has been developed with recognition that postural care is a 24 hour responsibility and consequently it is most likely that family members or direct support staff will be the people responsible for putting it into practice.

The pathway itself is divided into 5 steps

  1. Identification of the need for Postural Care for an individual and identification of those involved in support.
  2. Description of the current situation and the first measurement of body symmetry using The Goldsmith Indices®  and the coproduction of a plan with all those involved
  3. Stocktake of knowledge, confidence and competence of those involved
  4. Identification of whether person has access to equipment needed and planning for access if required.
  5. Variance measurement and if appropriate, provision of ongoing support

(The Goldsmith indices are a series of measurements of body symmetry. These measurements, to be seen as valid must be carried out by qualified measurers who have achieved a Postural Care CIC level 3 award in using the indices.)

Each step in the pathway is broken down into a series of questions which guide those supporting the person in identifying a way forward and recording the work they are doing.

Step one is both an assessment of need as well as a stocktake of personal resources to help. Interestingly, the second step focuses very clearly on co-producing a plan. As postural care is 24 hour responsibility, it is important for everybody who may be involved in delivering the plan to be involved in its development so they understand its rationale and feel confident and competent in its delivery.

Confidence and competence is a key component of the third step, where family expertise is recognised and valued. However, it is important that everybody involved in delivering the plan is competent in postural care. This is where Postural Care the company offer QCF (Qualification Credit Framework) accredited training courses to address this issue.

The courses offered however, must be understood in the context of how approaches and techniques will be used with individuals and it is here that the knowledge of the person held by family members and direct support staff is key.

The final step of the process recognises that as the need for postural care will be ongoing, it is usually not appropriate for people to be ‘discharged’ from support , but the expectation is that as the pathway is worked through and appropriate equipment and postural support strategies are put in place, levels of professional support will reduce, although person led monitoring should lead to re-engagement at any stage of the pathway should the need arise.

Conclusion and comment

It is clear that postural care is a critical part of securing a good quality of life for people with learning disabilities who have restricted movement. There is good evidence of the impact of poor postural care leading to health complications including scoliosis, respiratory problems, digestion difficulties etc.

The Postural Care Action Group,  a network of agencies concerned with improving practice has pointed out that the provision of appropriate support is patchy across the country, with examples of good practice, but also concerns about a complete lack of support in some areas.

The postural care pathway seems to be a good first step in setting out a clear approach to assessing need, working with those involved and developing strategies for support.

It would be good to hear from anybody currently supporting people with postural care needs about their experiences and also whether this pathway helps them in their situation. You can get in touch by commenting on this post, or through the feedback button at the top of this page.

Will this care pathway improve the provision of services and supports?

Will this care pathway improve the provision of services and supports?


Clayton S, Goldsmith J and Goldsmith L. It’s My Life, Postural Care Pathway (PDF). Postural Care Community Interest Company

Raising our sights: services for adults with profound intellectual and multiple disabilities, Mansell J, 2010, Department of Health

Spasticity in children and young People, NICE Guideline CG145.

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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