Health care that fits: reasonable adjustments, the dentist and STOMP

Section 20 of the Equality Act 2010 sets out three duties. A service must change a way of doing things that puts a disabled person at a substantial disadvantage, change a physical feature that does the same, and provide extra help, which the Act calls an auxiliary aid, where that would avoid it. The service cannot charge the disabled person for any of this. The duty applies to GP surgeries, dental practices, hospitals and screening services alike, and NHS England's page on reasonable adjustments gives examples: easy read letters, a priority or longer appointment, a quiet space to wait.

Without a shared record, adjustments have to be asked for again at every new place, and the NHS has built a way round this. The Reasonable Adjustment Digital Flag is a marker on the person's national NHS record which shows the adjustments they need, so that any publicly funded health or social care service treating them can see it.

To use it, write down the adjustments your son or daughter needs, ask them which matter most, and ask the GP surgery to record them and add the flag. The details are on NHS England's page about the flag. The information is shared on the basis of implied consent, and the person can object to it being shared. Check that your son or daughter is also on the GP's learning disability register, which is what brings the annual health check from age 14. The wider picture of support is in the learning disability family guide and the disability care pillar.

Preparation helps as much as any adjustment. Before an appointment, talk through what will happen using words and pictures your son or daughter knows, and show them where it is if the place is new. Write down two or three things you want to ask, and one thing they want to say for themselves. Bring the list of medicines, and the hospital passport if there is one. It describes how the person communicates, what upsets them and how they show pain, and it is useful at a GP or dental appointment too.

In the room, the doctor should speak to your son or daughter first. You are there to help them understand and be understood, not to answer for them. If a decision about treatment is one they cannot make even with help, the Mental Capacity Act requires the person making it to act in their best interests and to consult anyone caring for them. Making decisions for a grown-up son or daughter covers who has the final word and when.

1. 1

   Find a general dental practice

   The starting point

   Any NHS dentist can be asked for an appointment. If you cannot find one taking NHS patients, the integrated care board for your area manages dental services and may be able to say where there is one.
2. 2

   Ask for the adjustments

   Before the first visit

   A visit to see the room and meet the dentist with no treatment, a quiet time of day, short appointments, and a familiar person in the room. Under the Equality Act an NHS dental practice has to make reasonable adjustments like these.
3. 3

   Ask for a referral if treatment cannot be done there

   Community dental service

   The dentist, the GP or another health professional such as the community learning disability team can refer. The service decides whether to accept the referral. Where professional referral is not possible, some areas accept one from a family.
4. 4

   Treatment in the way that works for the person

   Clinic, home or hospital

   Community dental services work from clinics and health centres, and some visit people at home. Where treatment is not possible awake, it may be offered with sedation or under a general anaesthetic in hospital.
5. 5

   Back to the ordinary dentist for check-ups

   Afterwards

   Specialist care may be for one course of treatment. Once it is done, the person may be discharged back to their general dentist for routine care, so keep that practice.

The route above follows the NHS England clinical standard for special care dentistry, which says that most people with additional needs are seen in general dental practice and that specialist care is for when their treatment needs more than a practice can give. How to reach a dentist at all is covered by the NHS guide to finding a dentist.

Treatment is not free because of a learning disability. It is free for some groups, including people on income-related Employment and Support Allowance and people on Universal Credit whose income is below a set amount, and the NHS Low Income Scheme can help others. The NHS page on who gets free dental treatment has the full list.

Between appointments, cleaning teeth at home does more than any single visit. If your son or daughter needs help with it, or will only let one person near their mouth, write down how they like it done so anyone helping does it the same way. Mouth, nail and foot care covers how a carer helps with brushing and dentures.

LeDeR (Learning from lives and deaths) is the NHS England programme that reviews the care people with a learning disability received. Its 2025 report on cancer found that among adults whose cancer it classed as avoidable, only 30% had had all the screening offered for their age and sex. The reasons it recorded included invitations that got no reply and people declining. An invitation letter that nobody reads with the person is easy to miss.

Nobody has to be screened, and your son or daughter can decide not to go. The GOV.UK guide on cancer screening and reasonable adjustments explains that where someone cannot consent, the staff must decide whether screening is in their best interests. There is an easy guide to cervical screening to read together first.

Sight and hearing changes can be mistaken for a change in mood or behaviour: somebody who stops joining in, or turns the television up, may not be able to see or hear it properly. Sight loss and care at home and hearing loss and care at home cover the day-to-day side.

LeDeR looked closely at constipation in its report for 2023. More than half of the people in its sample were taking two or more medicines that commonly cause constipation, and very few were recorded as having been helped to understand what normal bowel habits are. The GOV.UK guidance on constipation and reasonable adjustments was written to help families and staff catch it early. It is worth asking the GP to write a bowel plan into the health action plan, so that anyone supporting your son or daughter knows what normal looks like for them. Where behaviour has changed and nobody knows why, pain is one of the first things to rule out, and challenging behaviour and positive behaviour support covers how to look for the cause.

Weight is checked at the annual health check, and it is worth asking what the number means rather than just hearing it. Some medicines add weight, which is one reason the STOMP programme below asks for regular reviews. Day to day, regular meals the person has helped to choose and cook, and some movement they enjoy, help both weight and the bowels. Healthy living with a carer's help has practical ideas.

These medicines are called psychotropic medicines. They include antipsychotics, antidepressants, sedatives and anti-seizure medicines. Some are prescribed for a diagnosed mental illness or epilepsy, and that is not what STOMP questions. Others are prescribed for behaviour that others find challenging, which is not a diagnosis, and NHS England says that use should be started by a specialist, reviewed regularly and have a plan for stopping. Side effects listed by NHS England include sleepiness, weight gain, a higher risk of diabetes and movement problems. STOMP is not against medicines: it asks that each one is doing more good than harm.

How a family asks for a review:

1. Make a list of every medicine, what it is for, when it was started and who prescribed it. If nobody knows why one was started, write that down.
2. Note what you have seen since it started: sleep, weight, appetite, bowels, mood, and whether the reason for it has changed.
3. Ask the GP for a structured medication review, or raise it at the annual health check, which includes one from age 14. If a psychiatrist prescribed it, ask for the review to include them.
4. Take the NHS England STOMP and STAMP family guide with you, and ask for the answer and any plan to reduce a dose to be written down in easy read.

If your son or daughter cannot take part in the decision, the doctor must still consult the people caring for them before deciding what is in their best interests. NHS England's STOMP page sets out what services are expected to do.