The government accepts this recommendation and recognises the importance of considering the specific needs of people with a learning disability, autistic people, and their families in health emergencies. Throughout the pandemic, a range of measures has been put in place to ensure people with a learning disability and autistic people are protected from the worst outcomes of COVID-19, including adding adults with Down’s syndrome to the group considered to be clinically extremely vulnerable. Access to testing in care homes was increased, regular retesting launched in high-risk supported living settings, and new guidance published on regular testing for their home care (domiciliary care) staff. NHS England and NHS Improvement also introduced ‘blended’ annual health checks, enabling general practitioner (GP) and practice support to continue during the pandemic, with both virtual and face to face appointments (when safe to do so) for people with a learning disability. The government recognizes the importance of enabling effective communication with people with a learning disability and autistic people. It is vital that public information on COVID-19 is accessible to all, which is why the government is committed to improving key COVID-related communications in a way that is accessible and inclusive. Progress in this area means that important health communications, for example regarding COVID-19 symptoms, Stay Alert and NHS Test and Trace content, are available in alternative formats, including easy read, BSL and audio. The government has welcomed many partnerships, including with disability organizations, that have helped to disseminate critical messages and advice. DHSC is working in partnership with the Cabinet Office Disability Unit who are considering cross-government guidance on producing alternative formats. Throughout the pandemic, the NHS has given guidance and support to local systems about the importance of supporting good communication and reasonable adjustments to care. This includes specific guidance for frontline staff on effective support for people with a learning disability and autistic people; delivery of online Care (Education) and Treatment Reviews; reasonable adjustments in hospital visiting; and information and training resources for vaccinators about how to make reasonable adjustments (for example vaccinating the person and their carer at the same time). A co-production group within NHS England has worked to develop easy read and accessible COVID-19 resources for people with a learning disability and autistic people. This has included easy read vaccination invite letters; accessible information sheets; and guidance and films on the virus, the risks, advice to keep safe and the importance of getting a vaccination. DHSC continues to engage with stakeholders to discuss issues for people with a learning disability and autistic people in relation to COVID-19. The inappropriate use of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in relation to some people with a learning disability has been consistently challenged by the government and the NHS including, in Autumn 2020, an expectation that GPs would review all the DNACPRs in place for their patients with a learning disability to ensure that they were appropriate. Throughout the pandemic, letters have been issued to the system from Senior NHS England leaders on this issue highlighting the inappropriateness of blanket approaches to DNACPR. At the start of the pandemic, the National Medical Director and the Chief Nurse issued a letter33 to the system reminding leaders of the importance of discussing patients’ individual wishes particularly in regard to DNACPR. The government commissioned the Royal College of Physicians to develop, in conjunction with the Society of Acute Medicine, an acute care toolkit. This was published on 1 April 2022 with the aim of supporting clinical staff in acute care settings to engage with and treat people with a learning disability and autistic people, ensuring that their needs are met.34