Introduction and Background

The new LeDeR policy sets out the core aims and values of the LeDeR programme and the expectations placed on care providers, including day opportunities, in delivering the programme from June 2021. It will serve as a guide to professionals working in all parts of the health and social care system on their roles in delivering LeDeR. This policy outlines a number of changes to existing LeDeR processes. Some of these changes, such as the new review process, will need to be implemented by local systems in line with the changes to the web-based platform which will go-live on 1 June 2021. Other changes, such as staffing models and local governance arrangements will need to change in line with the development of integrated care systems and relevant human resources processes. By 1 April 2022 all changes within this policy must be implemented by integrated care systems.

Posture and Health (why Posture Friends?)

The 2018 LeDeR annual report found that chest infections, pneumonia, aspiration pneumonia, and sepsis were the main causes of death. Mortality reviews also found that constipation, failure to recognise physical deterioration, and the inappropriate application of the Mental Capacity Act to physical health issues, were also significant factors in avoidable deaths. A key finding in both the Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD) and the LeDeR report is that poor postural management (positioning, alignment, body shape distortion) can have severe and life-threatening consequences. 

Poor postural management can lead to:

  • Respiratory problems
  • Swallowing difficulties and increased choking risk
  • Problems with the musculoskeletal system
  • Constipation
  • Pressure on internal organs
  • Recurrent pressure sores
  • Pain
  • Emotional and psychological problems


The national postural care strategy states that body distortion is not inevitable. The view that it is inevitable for a disabled person’s body to distort and become asymmetrical is a myth, and the right support can avoid this happening. Correct postural care can allow individuals to live an ordinary life, whether that means having a family, going to the pub or going on holiday. Having good postural care means we can have these ordinary, everyday opportunities.

Why is this not already being addressed?

  • Lack of awareness – people are often unaware of the consequences of postural management.
  • Lack of resources – not all areas have a postural management service and community therapy services are very stretched.
  • Challenges in implementing postural management programmes – particularly with night-time positioning.
  • Hospital admissions – postural management is not generally recorded.
  • Lack of consideration of postural management as a safeguarding issue.
  • Lack of understanding from commissioners about the importance of postural management – need for evidence for cost-effectiveness of the implementation of postural management.

Aims of Posture Friends

Our Posture Friends sessions aim to educate managers and staff about the importance of postural care. This includes demonstrating correct posture, the effects of poor posture and the importance of making cultural changes in our attitudes towards postural care. The sessions are set up to improve the health outcomes, mortality rates, experiences, and quality of life of people with a learning disability by empowering care deliverers who work in this sector with knowledge about general principles, which will help them with:

  • Respiratory function (particularly in the prevention of chest infections, including pneumonia/aspiration pneumonia and recognition of early signs of deterioration 
  • Eating and drinking (with regards to swallowing difficulties and choking risk)
  • Functional ability and ability to participate
  • Pressure areas
  • Pressure on internal organs
  • Tone and contractures
  • Pain and agitation 
  • Emotional and psychological problems (including self-image)
  • Caregivers’ own confidence, job satisfaction and stress levels
  • Recognise signs of discomfort and distress
  • Recognise early signs of acute or chronic deterioration
  • Understand the importance of an approach which focusses on prevention
  • Implement an Enabling Care Approach and foster a ‘questioning’ mindset
  • Optimise the potential for independence
  • Have an awareness the benefits of movement and activity, including standing/ walking programmes
  • Have an awareness of the roles of different Health Professionals, and how and when to signpost appropriately

Posture and positioning 

Posture means ‘the position (or alignment) of a person’s body in any position, for example in lying, sitting or standing’. An optimal posture is symmetrical. This means that it is identical on the right and the left sides of the body. It looks and feels stable, balanced and even. By contrast, an asymmetrical posture is different on each side of the body. For example, if the legs are both to one side, this is an asymmetrical posture. A person without impairment is generally able to adjust the postural alignment of their body, and to balance with minimal twists and effort. A person with an impairment may find this difficult and may need:

  • Assistance to achieve a position that is comfortable, and which allows optimal function, including being able to take a deep breath and cough.
  • Assistance to reposition themselves regularly to reduce the risk of pressure sores and pain.
  • Positioning aids or systems* to make the person’s alignment as symmetrical as possible. This will prevent the person’s posture from getting worse, and can, when done correctly, and gradually, ACTUALLY IMPROVE POSTURE!

For more information about posture and positioning, please refer to our Posture Friends Resource here.


Resources and next steps

If you found this information helpful and would like to attend the Posture Friends training, please sign up to our next available dates here or email HCPA on to find out more. For more detail about Learning Disabilities and Posture, please refer to our resource here. You can also find more information about learning disabilities and posture care at the below pages:

Government Guidance: Postural care and people with learning disabilities Click here
Government Guidance: Making reasonable adjustments to Postural care services easy read summary Click here
The Royal College of Occupational Therapy: Living well through activity in care homes: the toolkit Click here
The Royal College of Occupational Therapy: A-Z of activities Click here
Nice Guidance: NG93 Learning Disabilities and Behaviour that challenges Service design and delivery 2018 Click here