Background Although children with learning disability (LD) have complex needs and are known to experience particularly poor health outcomes and more frequent and lengthier hospital admissions, it is not known how well hospital services are meeting their needs to ensure they receive safe care.

Aim and methods We conducted a mixed-methods study focused on equality of hospital care for children with LD in England. Phase 1 data collection was carried out in 15 specialist children’s and 9 non-specialist hospitals and included interviews with 65 senior managers, including a subset of 11 LD nurses, and survey data from 2261 staff. Phase 2 took place in 6 of these hospitals and included interviews with 89 ward staff.

Results Phase 1 survey data revealed that compared with looking after children without

LD, staff looking after children with LD felt less able to deliver safe care, less confident to safely manage challenging behaviour and felt they worked in an environment that was less safe for meeting their needs. A number of personal and environmental factors as well as professional practices were identified during Phase 1 interviews to impact on the safety of those with LD.

However, when asked if they were able to provide safe care to children with and without LD, few ward based staff drew any distinct differences between the needs of the two patient groups. Whilst they reported feeling largely able to deliver safe care they did identify a number of barriers related to staffing levels and training; the environment and access to appropriate equipment; and the presence of parents.

Conclusions There is clearly a need for staff to be better informed and equipped to manage the complexities associated with caring for children with LD in hospital.