Background The number of people with learning disabilities and significant health needs who have been placed in Cornwall from outside the county by other local authorities was estimated along with its effects on the individuals concerned and the health service.

Materials and methods Electronic health records of the local NHS trust for adults with learning disabilities were compared with the council’s social services learning disabilities register to screen for out-of-county placements. Records of individuals placed from outside the county over the previous three years were scrutinised to identify the reason for placement, capacity to consent, quality of transition and cost to local services.

Results A total of 155 of the 703 clients were from outside Cornwall, and 17 of the 155 had been resident in the county for no more than three years. All 17 lacked capacity to consent to placements at their places of residence. No close family members had acted as advocates for any of them. The cost to local learning disabilities specialist health services to provide unmet needs was found to be £117,000 per year.

Conclusions UK national guidance advocates the placement of individuals with learning disabilities close to their homes, yet out-of-area placements continue without proper consideration of good practice or the cost implications. Service users who do not have close family members to advocate for them appear to be especially vulnerable to this practice.