Consultation outcome

Oliver McGowan draft code of practice on statutory learning disability and autism training: government response to consultation

Updated 19 June 2025

Introduction

Background

The introduction of a statutory requirement for training on learning disability and autism represents a significant step to improve the knowledge, skills and culture of staff in health and care services. We know that, on average, people with a learning disability and autistic people die earlier than the general population, and continue to experience poorer health outcomes and disparities in the quality of care they receive.

One tragic example of this is Oliver McGowan, a young autistic teenager with a mild learning disability, who died in 2016 after having a severe reaction to medication which he and his family had asked for him not to receive. Oliver’s parents, Paula McGowan OBE and Tom McGowan, have since campaigned for better training for health and care staff. We know there are others like Oliver, whose premature deaths may have been prevented by a better understanding of learning disabilities and autism. Every person with a learning disability and autistic person has the right to access high quality care and support.

In 2019, the government responded to a recommendation from the second annual Learning from lives and deaths - people with a learning disability and autistic people (LeDeR) report by committing to develop and test a learning disability and autism training package. Annual reports from the LeDeR programme are crucial sources of evidence that enable us to build a picture of the key improvements needed, locally and nationally, to tackle health disparities faced by people with a learning disability and autistic people.

The co-produced, standardised training package, The Oliver McGowan Mandatory Training on Learning Disability and Autism (‘The Oliver McGowan Mandatory Training’), was trialled in 2021 with over 8,000 participants and independently evaluated. The government has since made significant progress on the rollout of this training. Part one - an e-learning package - has been completed by over 3 million people. The training is named in Oliver’s memory, in recognition of his story and his family’s campaigning to improve awareness of learning disability and autism across health and care services.

In July 2022, the Health and Care Act 2022 introduced a requirement for Care Quality Commission (CQC) registered providers to ensure their staff receive specific training on learning disability and autism appropriate to their role. The requirement aims to ensure that staff working at all levels across the diverse settings that make up our health and social care sectors have the right knowledge and skills to provide safe and compassionate care for people with a learning disability and autistic people.

To support the implementation of this legal requirement, we published a draft code of practice in June 2023. The draft code set out the proposed standards that training must meet, in terms of both content and delivery. The draft code also set out information on The Oliver McGowan Mandatory Training, which is the government’s preferred and recommended training package for registered providers to meet the legal requirement.

About the consultation

The Secretary of State for Health and Social Care has a duty to consult on a code of practice about compliance with the legal requirement on learning disability and autism training. The Department of Health and Social Care (DHSC) conducted a public consultation on the Oliver McGowan draft code of practice on statutory learning disability and autism training from 27 June until 19 September 2023. The easy read version of the consultation ran from 4 September to 16 October 2023.

The consultation was published online, with an easy read version also available. Organisations and members of the public were able to respond through an online portal, by email and by post. DHSC set up a dedicated mailbox to accept emailed responses and to answer questions about the consultation.

The purpose of this consultation was to gather views on the extent to which the Oliver McGowan draft code of practice provides CQC registered providers with the necessary guidance to meet the legislative requirement introduced by the Health and Care Act 2022.

The consultation document posed a series of questions about the draft code of practice, which covered the following areas:

• introduction
• purpose of the draft code
• section 1: standards for training and related guidance
• staff roles and training
• training content and delivery, including involvement of people with a learning disability and autistic people
• monitoring, evaluation and accreditation
• further guidance on recruiting and supporting people with a learning disability and autistic people, procurement and record keeping
• section 2: The Oliver McGowan Mandatory Training on Learning Disability and Autism
• section 3: how to use the code to meet the training requirement

The consultation asked closed questions with multiple choice options for agree, disagree and not sure. It also had free text responses, where respondents could express their views up to a maximum of 250 words.

The feedback gathered from this consultation has been considered to inform the final version of the code. The code must be laid in Parliament for 40 days and is available online. After the 40 days have elapsed (on 6 September 2025), if neither House of Parliament resolves not to approve it, the code will become final.

This publication provides an analysis of the responses received and sets out the government’s response to the feedback we heard through the consultation.

Summary

Demographics

A total of 461 responses were received to the consultation, including the easy read consultation, through both responses to the digital survey and email submissions. Of these responses:

• 182 (40%) were from organisations
• 183 (40%) were from people with professional experience
• 96 (21%) were from people with personal experience

For individual questions, answered by people with personal experience and people with professional experience (279 responses), 68% were female and 24% were male. The most common age range of respondents was 45 to 54 and 82% were from a white background. The area respondents came from ranged from 9% in East Midlands to 19% in South East England.​

For sector responses received from organisations and individuals with professional experience (365 responses) the most common focus of work reported was community adult social care (23%) and secondary health care (21%). Table 1 below shows the range of organisations and individuals with professional experience which responded.

Table 1: respondents’ main focus of work

Main focus of work	Percentage of respondents
Community adult social care	23%
Secondary health care	21%​
Other (including combined services)	19%​
Residential adult social care	10%​
Community health care	10%​
Primary health care	8%
Commissioning or local areas​	6%
Training and education ​	3%

Of the respondents:

• 59% worked for the public sector
• 22%​ worked for non-profit organisations
• 16% were from the private sector
• 3% preferred not to say

Of the respondents, 79% were in roles that were regulated by CQC.

Overview of responses

The majority of responses across all groups were supportive of the purpose and content of the code of practice. When asked if the overall purpose of the code was clear, 81% of respondents agreed. This included 77% of respondents from the non-easy read consultation and 98% of respondents from the easy read consultation. All closed questions had over a 50% agreement rate. Those who used free-text responses were more likely to raise practical concerns around implementing the code.

The full analysis of responses to all the individual consultation questions is set out in this document in the sections that follow. From this, we identified 10 key themes through the consultation feedback:

• guidance on the appropriate level of training for staff
• availability of training packages
• guidance on making training content and delivery relevant for local contexts
• representation of personal experiences in training content and delivery
• guidance on support for co-trainers with personal experiences
• concerns regarding staff and service capacity to undertake training
• guidance on monitoring and evaluation
• clarity on CQC regulation
• expectations on accreditation
• clarity on re-doing training

We considered all the points raised and how and where best to address them. Some feedback has been addressed through revisions to the code, detailed in the sections that follow.

Some respondents also provided specific feedback on their experiences delivering or undertaking The Oliver McGowan Mandatory Training which is beyond the direct scope of the consultation and code of practice. Such feedback has been considered separately with operational partners, and additional information has been added to NHS England’s existing FAQs on The Oliver McGowan Mandatory Training to provide clarifications on points of feedback. These FAQs are not statutory guidance and there is no legal requirement to adhere to them. However, they can be used to support local implementation and delivery of The Oliver McGowan Mandatory Training. The FAQs will be reviewed and updated over time, reflecting best practice from ongoing training delivery.

We have included the text for each standard in the code to show what was consulted on. This text does not reflect any amendments made to the revised version of the code.

Consultation feedback and government response

Introduction

Question

Do you agree or disagree that the purpose of the code is clear?

Summary of responses

The majority of respondents (81%) agreed that the overall purpose of the code was clear, 12% disagreed and 7% were not sure.

Feedback on Standard 1

Standard 1

All staff receive training that covers a minimum curriculum of capabilities from the ‘Core capabilities framework for supporting people with a learning disability’ and the ‘Core capabilities framework for supporting autistic people’ on the Skills for Health Supporting autistic people and/or people with a learning disability page. Further training beyond this minimum curriculum is proportionate and tailored to the requirements of staff at different levels and in different roles, taking into account the tiers and capabilities set out in the core capabilities frameworks.

Tiers of training

The core capabilities frameworks define 3 tiers of capabilities for health and social care staff:

• tier 1: for staff who require a general awareness of people with a learning disability and autistic people and the support they need
• tier 2: for health and social care staff and others with responsibility for providing care and support for a person or people with a learning disability or autistic people, but who would seek support from others for complex management or complex decision-making
• tier 3: for health and social care staff and other professionals with a high degree of autonomy, able to provide care in complex situations and may also lead services for people with a learning disability and autistic people

The core capabilities frameworks are incremental. This means that someone acquiring a tier 3 capability must already possess the relevant tier 1 and tier 2 capabilities.

Questions

Do you agree or disagree that Standard 1 is clear that all staff should receive training which covers a minimum curriculum of capabilities from the core capabilities frameworks?

Do you agree or disagree that Standard 1 is clear that where further training is required, this should be proportionate and tailored to the requirements of staff at different levels and in different roles?

Do you agree or disagree that Standard 1 is clear that where further training is required, this should align with the tiers and capabilities set out in the core capabilities frameworks?

Please share any other thoughts you have on Standard 1.

Summary of responses

The majority of respondents (85%) agreed that Standard 1 is clear that all staff should receive training which covers a minimum curriculum of capabilities from the core capabilities frameworks for supporting people with a learning disability and autistic people, 10% disagreed and 4%​ were not sure. Due to rounding, percentages do not add up to 100%.

Of the respondents, 78%​ agreed that Standard 1 is clear that where further training is required, this should be proportionate and tailored to the requirements of staff at different levels and in different roles, 16%​ disagreed and 6% were not sure.

Of the respondents, 77%​ agreed that Standard 1 is clear that where further training is required, this should align with the tiers and capabilities set out in the core capabilities frameworks, 14% disagreed and 9% were not sure.

Some respondents asked for further detail on which specific tier of training staff should receive, such as more examples to be provided in the revised version of the code linked to specific roles or services.

Some respondents asked for clarification on what alternative training packages were available, aside from The Oliver McGowan Mandatory Training, such as training packages to achieve tier 3.

Government response

We have reviewed annex A of the code of practice and added 2 new illustrative examples to help employers understand which tier of capabilities their staff may need. This includes one example on primary care and one on emergency services which were the most common services seeking further clarification on the appropriate level of training. We have also made some improvements to example 1 in response to consultation feedback that it could be clearer that local authority staff who work in regulated health and care services are in scope of the legislation.

It is the employer’s responsibility to identify suitable training packages for their staff that meet the standards set out in the code of practice. To support employers to assess the training needs of staff, information on relevant training frameworks is set out in annex B of the code of practice. The Oliver McGowan Mandatory Training is the government’s recommended and preferred package to meet the legal training requirement. We are not currently aware of any alternative training packages that meet the standards in the code of practice, so this information has not been included in the final version of the code. It is possible that existing training packages may adapt to comply with the code of practice or new training packages may be developed in due course, and in turn, could be sufficient to meet the legal requirement.

The Oliver McGowan Mandatory Training covers tier 1 and tier 2 capabilities. However, some staff will need specialist training at tier 3 level, which can be highly varied and differ from person to person, based on their role. Individual employers have the responsibility to source the appropriate training.

Feedback on Standard 2

Standard 2

All staff receive training that enables them to explore how they will put their learning into practice. Examples include tailored materials and learning tools to help staff understand how to apply their learning to their specific work setting and the people they work with.

Questions

Do you agree or disagree that Standard 2 is clear that training must be tailored in content and delivery to help staff to put their learning into practice?

Do you agree or disagree that Standard 2 is clear on how training should be tailored to staff working in different settings?

Please share any other thoughts you have on Standard 2.

Summary of responses

The majority of respondents (79%) agreed that Standard 2 is clear that training must be tailored in content and delivery to help staff to put their learning into practice, 15%​ disagreed and 6% were not sure.

The majority of respondents (63%) agreed that Standard 2 is clear on how training should be tailored to staff working in different settings, 27% disagreed and 10% were not sure.

Some respondents, mainly organisations and professionals, asked for further advice on how training content, including that of The Oliver McGowan Mandatory Training, can be made relevant to practice.

Some respondents with personal experience felt there was a need to emphasise the importance of the representation of their diverse experience, particularly in relation to autism, within training content and delivery.

Government response

We have provided further clarification in the code of practice on how trainers can augment training to make it relevant to local contexts, as long as the standards in the code are adhered to. This includes specifying that providers can deliver training with a co-trainer that has personal experience of a specific service or setting relevant to the roles and responsibilities of learners. Where The Oliver McGowan Mandatory Training is being undertaken, the standardised training package, which has been co-produced and independently evaluated, should also be adhered to.

The code of practice sets out minimum expectations on co-production and co-delivery of training. We have provided further clarification that employers have flexibility to augment training with additional trainers with personal experience or materials if they wish to do so.

New examples have been added to NHS England’s FAQs on The Oliver McGowan Mandatory Training to demonstrate how the delivery of training can be made relevant to local contexts in practice. As these examples specifically relate to the delivery of The Oliver McGowan Mandatory Training, they have not been set out in the code but can be used as a tool to support local delivery of training.

Feedback on Standard 3

Standard 3

All staff receive a minimum amount of live and interactive training that is co-produced and co-delivered by people with a learning disability and autistic people. For staff who require a general awareness of learning disability and autism, this is a minimum of one hour of live and interactive training with a person with a learning disability and an autistic person. For staff with responsibility for providing care and support for a person or people with a learning disability or autistic people and for staff with a higher level of autonomy, who manage complex care or lead on learning disability and autism services, this is a minimum of one day of in-person training. This is in addition to a compulsory e-learning module of at least 90 minutes covering the tier 1 capabilities set out in Standard 1 which all staff must complete.

Questions

Do you agree or disagree that Standard 3 is clear about the length (one hour in addition to 90-minute e-learning) of live and interactive training required for staff who require a general awareness of learning disability and autism?

Do you agree or disagree that Standard 3 is clear regarding the length (one day in addition to 90-minute e-learning) of live and interactive training required for staff with responsibility for providing care and support for people with a learning disability and autistic people, and for staff with a higher level of autonomy who manage complex care or lead on learning disability and autism services?

Do you agree or disagree that Standard 3 is clear that live and interactive training must be co-produced and co-delivered with at least one person with a learning disability and one autistic person?

Please share any other thoughts you have on Standard 3.

Summary of responses

The majority of respondents (79%​) agreed that Standard 3 is clear about the length (one hour in addition to 90-minute e-learning) of live and interactive training required for staff who require a general awareness of learning disability and autism, 13% disagreed and 8% were not sure.

Of the respondents, 75% agreed that Standard 3 is clear regarding the length (one day in addition to 90-minute e-learning) of live and interactive training required for staff with responsibility for providing care and support for people with a learning disability and autistic people, and for staff with a higher level of autonomy who manage complex care or lead on learning disability and autism services, 15% disagreed and 11% were not sure.

Of the respondents, 75% agreed that Standard 3 is clear that live and interactive training must be co-produced and co-delivered with at least one person with a learning disability and one autistic person, 16% disagreed and 9% were not sure.

Some respondents raised questions about how to support co-trainers with personal experience, such as provision of wellbeing support and guidance on payment.

Some respondents raised concerns about the length of training required leading to unintended impacts on services if staff capacity is significantly reduced and backfill is not available. This concern mostly related to the one-day, in-person requirement to complete Tier 2 training. Others raised similar concerns that this could unintentionally lead to staff completing Tier 1 when they should be completing Tier 2.

Government response

To help mitigate concerns that staff may unintentionally complete the wrong tier of training, we have added 2 additional examples in annex A of the code of practice to support local decisions about which tier of training staff should undertake. As outlined under ‘Feedback on Standard 1’, this includes one example on primary care and one on emergency services which were the most common services seeking further clarification on the appropriate level of training.

In the code, we have included a link to NHS England’s FAQs on The Oliver McGowan Mandatory Training, which contains new examples on how organisations have successfully delivered the training at the appropriate tier for staff. This will further support employers to ensure staff complete the right level of training and provide examples of how operational impacts have been mitigated by organisations. As these examples specifically relate to the delivery of The Oliver McGowan Mandatory Training, they have not been set out in the code but can be used as a tool to support local delivery of training.

We have also included a link to NHS England’s employer resources webpage on The Oliver McGowan Mandatory Training, which includes information on how to ensure co-trainers are best supported to deliver the training, such as signposting to tools for trainers to talk about personal experiences, and job descriptions and payment guidance.

Feedback on Standard 4

Standard 4

All staff receive training that is based on evidence and is quality-assured through trialling, ongoing evaluation and accreditation. People with a learning disability and autistic people must be meaningfully involved in these processes.

Questions

Do you agree or disagree that Standard 4 is clear that staff must receive training that is evidence-based?

Do you agree or disagree that Standard 4 is clear that staff must receive training that is subject to an accreditation process?

Do you agree or disagree that both the content and delivery of training should be subject to an accreditation and quality assurance process?

Do you currently offer your staff training on learning disability and autism which has been accredited? If you answered yes, please provide details of the accreditation process that the training is subject to, including any relevant accreditation bodies.

Do you agree or disagree that Standard 4 is clear that staff must receive training that is subject to ongoing evaluation?

Please share any other thoughts you have on Standard 4.

Summary of responses

The majority of respondents (86%) agreed that Standard 4 is clear that staff must receive training that is evidence-based, 10% disagreed and 4% were not sure.

Of the respondents, 78% agreed that Standard 4 is clear that staff must receive training that is subject to an accreditation process, 14% disagreed and 7% were not sure. Due to rounding, percentages do not add up to 100%.

Of the respondents, 76%​ agreed that both the content and delivery of training should be subject to an accreditation and quality assurance process, 14% disagreed and 10% were not sure.

Of the respondents, 40%​ currently offer staff training on learning disability and autism which has been accredited, 17% do not and 43% were not sure.

Of the respondents, 82% agreed that Standard 4 is clear that staff must receive training that is subject to ongoing evaluation, 8% disagreed and 10% were not sure.

Some respondents asked for further detail on how training completion and outcomes should be monitored and evaluated.

Some respondents, mainly organisations, asked for more detail on how CQC will regulate the training requirement on learning disability and autism. This included clarification on whether CQC will expect providers to complete The Oliver McGowan Mandatory Training or whether any training package which meets the standards set out in the code of practice will be acceptable.

Some respondents, mainly organisations, asked for more clarity on accreditation, for both The Oliver McGowan Mandatory Training and alternative or further training packages, to ensure that staff receive training which complies with Standard 4. This included confusion on whether there is a set or preferred accreditation body that organisations are expected to use.

Government response

The approach taken by employers to monitor and evaluate training will ultimately depend on the specific training package adopted and their local mechanisms. For example, some employers may already have an approach to monitoring and evaluating training in place that they may wish to extend to the training on learning disability and autism that their staff undertake to meet this legal requirement, or the training package they procure may already include mechanisms for monitoring and evaluation of learning. Taking a prescriptive approach would risk local contexts or existing processes being overlooked, which was another element of consultation feedback. We have therefore sought to strike a balance in the code to allow some local flexibility while setting out the minimum expectation that all staff should receive training that is based on evidence and is quality assured through trialling, ongoing evaluation, and accreditation. People with a learning disability and autistic people must be meaningfully involved in these processes.

Further information can be found on NHS England’s Oliver McGowan Mandatory Training webpages about how it has been, and will continue to be, evaluated. This will help employers and training providers understand how to carry out monitoring and evaluation in their local contexts. As these examples specifically relate to the delivery of The Oliver McGowan Mandatory Training, they have not been included in the code but can be used as a tool to support local delivery of training.

An independent, long-term evaluation of The Oliver McGowan Mandatory Training is now underway, which will take place over 36 months. People with a learning disability, autistic people and their carers will be actively involved at all stages of the research.

We have worked with CQC to review and clarify wording in relation to regulatory activity in the code. This includes clarifying that CQC will consider whether the legal training requirement has been fulfilled and whether the code has been complied with. Providers will be expected to show to CQC how they have met the legal requirement, which may include completing The Oliver McGowan Mandatory Training. In the code, we have also added a link to CQC’s webpage on the training requirement on learning disability and autism, which contains further information.

To ensure ongoing quality assurance of training content and delivery, the code sets out that training must be subject to an accreditation process. There is the expectation that any such accreditation and quality assurance process will use the standards set out in the code in addition to other quality standards as determined by the accreditation or quality assurance body. Registered providers must source training that has been independently accredited and quality assured, ensuring that any training meets the expected standards set out in the code.

We have clarified in the code that NHS England has an approved trainer process in place for The Oliver McGowan Mandatory Training that will be replaced by an accreditation process when an accreditation body is appointed. The awarded organisation will be confirmed in 2025 and will be required to co-produce accreditation standards and co-deliver an accreditation scheme. The ongoing work to establish an accreditation body for The Oliver McGowan Mandatory Training is outlined on NHS England’s Oliver McGowan Mandatory Training webpage. NHS England will add further information once an accreditation body and scheme is confirmed.

To further support quality assurance of training delivery, particularly before formal accreditation is in place, DHSC has commissioned Skills for Care to develop and maintain a list of quality assured training providers that can deliver Oliver’s Training to the adult social care workforce. See Skills for Care’s page on the quality-assured care learning service.

Feedback on further guidance

Question

Further guidance on procurement sets out that registered providers are responsible for ensuring that their staff undertake training on learning disability and autism at least every 3 years or more regularly if a member of staff requires it.

Do you agree or disagree with this approach?

Question

Please share any other thoughts you have on the section in the draft code on ‘Further guidance on recruiting and supporting people with a learning disability and autistic people, procurement and record keeping’.

Summary of responses

The majority of respondents (67%) agreed that ​registered providers should be responsible for ensuring that their staff undertake training on learning disability and autism at least every 3 years or more regularly if a member of staff requires it, 20% disagreed and 13% were not sure.

Some organisations and professionals asked for clarity on whether the training content would be kept relevant to users from different settings. There were also suggestions of a less intensive refresher module.

Government response

We have revised the wording in the code to make clearer that we expect training to be re-done at least every 3 years, to avoid misinterpretation that a shorter or different training programme can be undertaken.

Further detail on how the training content will be kept up to date can be found in NHS England’s FAQs on The Oliver McGowan Mandatory Training.

Feedback on section 2

Section 2 details The Oliver McGowan Mandatory Training, including the training curriculum and delivery requirements for the training.

Questions

Do you agree or disagree that the code clearly sets out which tier of the training [The Oliver McGowan Mandatory Training] is appropriate for staff to complete?

Do you agree or disagree that the code clearly sets out how the training [The Oliver McGowan Mandatory Training] meets the standards set out in section 1 of the code?

Please share any other thoughts you have on section 2 of the draft code.

Summary of responses

The majority of respondents (61%) agreed that that the code clearly sets out which tier of the training is appropriate for staff to complete, 28% disagreed and 12% were not sure.

Of the respondents, 68% agreed that the code clearly sets out how the training meets the standards set out in section 1 of the code, 20% disagreed and 12% were not sure.

Government response

As outlined above in ‘Feedback on Standard 1’, we have reviewed annex A of the code of practice and added 2 new illustrative examples to help employers understand which tier of capabilities their staff may need. This includes one example on primary care and one on emergency services. We have also made some improvements to example 1 in response to consultation feedback that it could be clearer that local authority staff who work in regulated health and care services are in scope of the legislation.

It is the employer’s responsibility to identify suitable training packages for their staff that meet the standards of the code of practice. To support employers to assess the training needs of staff, information on relevant training frameworks is set out in annex B of the code of practice.

The Oliver McGowan Mandatory Training is the government’s recommended and preferred package to meet the legal training requirement and we are not currently aware of any alterative training packages that meet the standards in the code of practice.

Feedback on Section 3

Section 3 details how to use the code to meet the training requirement. This includes information on applying the code of practice, how compliance is judged and what happens if a registered provider does not meet the requirements in the code of practice.

Question

Do you agree or disagree that it is clear from the code how registered providers can ensure they are complying with duties to train staff to work with people with a learning disability and autistic people?

Summary of responses

The majority of respondents (56%) agreed that it was clear from the code how registered providers can ensure they are complying with duties to train staff to work with people with a learning disability and autistic people, 26% disagreed and 18% were not sure.

Government response

As outlined above in ‘Feedback on Standard 4’, we have worked with CQC to review and clarify wording in relation to regulatory activity in the code. This includes clarifying that CQC will consider whether the legal training requirement has been fulfilled and whether the code has been complied with. Providers will be expected to show to CQC how they have met the legal requirement, which may include completing The Oliver McGowan Mandatory Training.

We have clarified in the code that NHS England has an approved trainer process in place for The Oliver McGowan Mandatory Training that will be replaced by an accreditation process when an accreditation body is appointed. The awarded organisation will be confirmed in 2025 and will be required to co-produce accreditation standards and co-deliver an accreditation scheme. The ongoing work to establish an accreditation model for The Oliver McGowan Mandatory Training is outlined in NHS England’s FAQs on the training. NHS England will add further information once an accreditation body and scheme is confirmed.

To further support quality assurance of training, DHSC has commissioned Skills for Care to develop and maintain a list of quality assured training providers that can deliver Oliver’s Training to the adult social care workforce. See Skills for Care’s page on the quality-assured care learning service.