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Short note: the inequities of healthcare for those with learning disabilities

The Institute of Health Equality has published a summary report on A Fair, Supportive Society, commissioned by NHS England, which shockingly highlights that those with learning disabilities will die 15-20 years sooner on average than the general population. Many of the early deaths of people with learning disabilities could be reduced through improved healthcare and preventative actions. Children with learning disabilities are also at increased risk of mental health conditions, including depression; and half of the increased risk of mental health difficulties is attributable to poverty, poor housing, discrimination and bullying.

In response to this appalling state of affairs, the report makes 11 important recommendations:

1. NHSE, with PHE, DHSE, DWP, the Association of Directors of Children’s Services (ADCS), HMT, the Home Office and Other Government Departments (OGDs) and stakeholders, should develop an evidence-based integrated strategy that supports households holistically, from identification of a learning disability through to related early years support, and also onwards throughout life.
2. Joined-up working is key. Teams from the above-mentioned departments and others in the community, should integrate to improve outcomes through action on specific social determinants of health for people with learning disabilities. For example, to reduce poverty and simultaneously improve the physical and social environment for people living in deprived areas.
3. To ensure no one is left out, early identification rates should be improved and information-sharing rationalised across all agencies and across registers, such as sharing all age General Practice (GP) Learning Disability registers with local authorities and to inform the education, health and care (EHC) plan process.
4. DfE and Health and Social Care Commissioners should lead the change in the ‘choice architecture’ by removing unhealthy options at influential institutional settings, such as in hospitals and care settings, to support healthier behaviours for people with learning disabilities, and to support the parents of children with learning disabilities to do the same.
5. DfE and NHSE should adopt the ‘equal right to sight’ approach and work together with charities to appropriately design eyesight and hearing tests, administered to all children in special and mainstream schools within their first year of joining.
6. The DfE and NHSE should formally require that specific actions are included in the education, health and care plan process from the beginning, to ensure improved take-up of: appropriate-to-age screening tests, improvements in health behaviours, and improved action on the social determinants of health.
7. DWP and DHSC, with the Joint Health and Work Unit (JHWU), should learn from trials and existing programmes, and work with local authorities and employers to ensure that employment offers for people with learning disabilities are available nationally, and provide stakeholders with a timetable that delivers this as rapidly as possible.
8. The Government, specifically DWP and DHSC, should undertake a systematic review of how it supports people with learning disabilities, ensuring that access to work, homes, benefits, health and care services and education are adequate. A review of the sufficiency of the personal budget for EHC plans is advised, to identify whether or not this is being adequately rolled out to those in most need.
9. PHE, local authorities and NHSE should support coordinated campaigns for greater integration of people with learning disabilities into mainstream society, to reduce discrimination and stigma and support representation. This should include a push towards more inclusion of children with learning disabilities within mainstream schooling. To build on progress made by NHSE, public sector employers should be mandated to provide opportunities for those with learning disabilities, and private sector employers should be incentivised to do the same by supporting apprenticeships for people with learning disabilities.
10. A hearts and minds campaign is recommended, led by a collaboration of learning disability campaign groups close to the cause, to improve attitudes towards people with learning disabilities. This should build on successful campaigns for other minority groups. Alongside this, a review of general attitudes and perceived safeguarding requirements and procedures within professional, community and educational settings may be useful to understand detrimental attitudes towards people with learning disabilities. This work should be evaluated given that there is little evidence regarding effective practice in this area. Further, tougher and more visible punishment of crimes against those with learning disabilities should be considered by the Home Office.
11. Friendship support groups should be made available to all people with learning disabilities. As a part of EHC plans, children and young people with learning disabilities should be linked with friendship groups, and to networks that will support their participation in society. A wellbeing plan for adults with learning disabilities should consider not just the medical needs arising from their disability, but also their social interaction needs. Professionals should be required to link people with a learning disability with appropriate friendship support groups.

We very much hope that these recommendations will be taken seriously by the government and implemented quickly. We will keep readers updated on any significant developments.