Inclusion in Mainstream Healthcare

Read on the website Understanding Intellectual Disability and Health:

Government Policy in England: Inclusion in Mainstream Healthcare

The author reviews Valuing People’s policy, the limited progress in taking the agenda forward since 2001,outlining some key actions that should be taken to promote better health outcomes for people with intellectual disabilities.

Rob Greig

The Government’s White Paper, Valuing People, sets the policy agenda for the lives of people with learning disabilities into the 21st century. It outlines a radical agenda to ensure the health of people with learning disabilities improves, in particular by ensuring that mainstream health services take on their responsibilities to be inclusive of learning disabled people. This contribution reviews the reasons behind this policy, the limited progress since 2001 in taking the agenda forward, and outlines some key actions that should be taken locally to promote better health outcomes for people with learning disabilities.

The general health of people with learning disabilities is significantly worse than that of the general population, as the following facts demonstrate:

  • people with learning disabilities have a significantly increased risk of early death (Hollins et al, 1998).
  • death from respiratory diseases is 3 times that of the general population (Puri et al., 1995)
  • there is a failure to screen for, identify and treat a range of illnesses that are particularly prevalent among people with learning disabilities (e.g. thyroid dysfunction and congenital heart problems) (Rooney and Walsh, 1997; Brookes and Alberman, 1996).
  • more than 40% have a hearing loss, which is unidentified in 75% of cases (Yeates, 1995).
  • the prevalence of schizophrenia is around 3 times higher than in the general population, with an excessive and inappropriate use of antipsychotic medication (Emerson, 2001; Doody et al., 1998).

In spite of this, the response of the NHS has traditionally been poor. In the Government’s own words, the NHS ‘has failed to consider the needs of people with learning disabilities.’ This position has recently been highlighted through the Disability Rights Commission’s Formal Investigation into the health inequalities facing people with learning disabilities.

The aims of Valuing People.
In order to help address these issues, in 2001 the Government produced a White Paper for England called Valuing People: A New Strategy for Learning Disability for the 21st Century, which required a radical change in the way the NHS as a whole operates (Department of Health 2001). Valuing People primarily has a whole-life, social inclusion agenda, in which the promotion of positive health is an essential building block: unless people are well, they cannot take their place as full members of their communities.

The sections in Valuing People about health are therefore concerned with ensuring that people with learning disabilities benefit fairly and equally from NHS resources and initiatives and are not excluded from the health service needs of the whole population. Achieving this requires a major change in the way in which the NHS – both mainstream and specialist services – works with people with learning disabilities.

Rectifying the current situation.
Back in 2001, in some ways managers and clinicians could not be blamed for that position of neglect. The role of the NHS in relation to people with learning disabilities used to be seen as the provision of long-stay hospitals. Then the task was to close the hospitals, and a common misunderstanding of the social model of disability meant that many health authorities thought their responsibilities in relation to people with learning disabilities were largely finished once the hospitals were closed. Meanwhile, the specialist health services often undermined their own position by sending out a message (sometimes intentional, sometimes not) that mainstream services need not include people with learning disabilities because the issues and challenges were so great that specialist services would deal with them. The genuine concern to deliver a health service to people with learning disabilities resulted in specialist professionals carrying out tasks that would have better come from the mainstream NHS.

Five years on, with the publicity surrounding Valuing People, the development materials and support provided through the Valuing People Support Team, and the requirements of the Disability Discrimination Act, all make this position much less
understandable. Across the country, there are a number of positive examples of innovative approaches, with specialist services providing appropriate care and mainstream clinicians offering sensitive and inclusive healthcare, but these are still in the minority. In a review of Valuing People carried out in 2005, this author identified change on health issues as the weakest area of progress since the publication of the White Paper (Greig, 2005). Continue reading.

This entry was posted in English.

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