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Care England has launched a new good practice guide for professionals working in social care, supported living, and community settings to prevent choking deaths among people with learning disabilities.
The guide draws on national learning, regulatory expectations, and best-practice guidance to provide practical recommendations for providers, commissioners, managers, and frontline teams responsible for supporting people to eat and drink safely.
It was developed by a multidisciplinary working group comprising representatives from social care providers, Speech and Language Therapy professionals, regulatory colleagues and sector bodies, including Care England and Learning Disability England. The aim is to set out what good looks like in practice, not by prescribing inflexible rules but by supporting thoughtful, consistent and person-centred decision-making in everyday settings.
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The guidance also recognises that mealtimes are about far more than nutrition and shows how care providers can balance safety with choice, ensuring people continue to enjoy positive dining experiences without imposing unnecessary restrictions.
Prevention is a collaborative responsibility
In its foreword, the guidance states that choking is not an unpredictable accident. In most cases, risk develops over time and can be anticipated, understood and managed when the right conditions are in place. Preventing choking is not about removing choice or living overly restrictive lives. It is about creating environments where people are supported in eating safely, with dignity, confidence, and respect for who they are.
It also said that responsibility for choking prevention does not rest with a single role or profession. It rests with organisations, leaders, commissioners, practitioners and systems working together. It depends on clear plans and skilled, attentive support. It also depends on psychological safety for staff to speak up and on cultures that value learning rather than blame.
Professor Martin Green, Chief Executive, said: “What we tried to do with this guide is make it rooted in the realities and rooted in practice. We wanted something that was easy to use, and that would be recognised as a step-by-step approach, which will hopefully reduce the number of choking related deaths.”
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Top 10 essentials for preventing choking
The report lists 10 core expectations that should apply across all settings where people receive support with eating and drinking, including at home, in the community, and when eating out. They underpin this guidance and should be reflected consistently in everyday practice. These are:
- Know the person and their risks
- Follow agreed plans consistently
- Create the right environment
- Support safe posture and positioning
- Provide the right level of supervision
- Support pace and portion control
- Stay present and observant
- Act on concerns immediately
- Respect choice within safe frameworks
- Learn and improve continuously.
The guidance also includes sections on assessing and managing risk; equity and health inequalities; mealtime support and environmental factors; and supporting choice, control and capacity.
It also has a section on partnerships with families and advocates, as they have insights that staff cannot gather from records alone. They often understand a person’s history, routines, cultural food traditions and early signs of discomfort or anxiety. The report says that a strong partnership improves assessment, strengthens consistency, and reduces avoidable harm. It also supports dignity, identity and trust.
Phil Hughes from Learning Disability England said: “This guide is so important to help care workers keep people like myself safe while being supported with meals.
“It is also important as the guide helps our staff have up-to-date information and training to keep meal times safe for people like me. I also want to say that we need to do all we can to attract the right people into adult social care and give them the support they need to do their jobs well and stay in their roles.”
