New National Guidance and Standards for Health Equality Framework+ (HEF+) in Wales

Two support workers are facing a service user. A report is placed in front of the image.

11 February 2026

New National Guidance and Standards have been published to reinforce the vital role of the Health Equality Framework+ (HEF+) in tackling health inequalities for adults with a learning disability.

NHS Wales Performance and Improvement’s Learning Disability Programme has collaborated with Health Boards in Wales to develop the guidance.

The guidance aims to provide clarity and support for Health Boards to complete the All-Wales Learning Disability Assurance Metrics, providing and delivering care that addresses health inequalities.

Read here | National Guidance and Standards for the Health Equality Framework (HEF+) in adults Learning Disability services

Bethany Kruger, Senior Improvement Manager, said:

“Adults with a learning disability face persistent and avoidable health inequalities, including reduced life expectancy and poorer outcomes compared with peers in the general population.

“The HEF+ is the UK’s only validated outcome measure designed to identify and address these inequalities. By capturing key determinants such as housing, employment, communication, social isolation, and service barriers, the HEF+ helps services monitor, understand, and improve health outcomes.”

First introduced in Wales in 2015, the HEF+ has already supported services in measuring outcomes and driving improvement. The new national guidance build on this work by defining minimum expectations for implementation, assessment, and follow-up, ensuring that adults entering specialist learning disability services receive timely, meaningful HEF+ assessments throughout their care journey.

The guidance promotes a multidisciplinary approach, with teams using HEF+ data to inform decisions, plan interventions, and improve care. Aggregated data can also guide service design, review, and commissioning at local, regional, and national levels, helping services target inequalities and improve outcomes for the people they support.

Using the framework consistently ensures care is person-centred, equitable, and accountable, while enabling services to demonstrate impact and prioritise health needs effectively.

The full national guidance and standards for HEF+ are available for Health Boards and specialist learning disability services across Wales.