More needed than just the NHS Mandate to reduce healthcare inequalities

The first Mandate between the Government and the NHS Commissioning Board should help to address some of the healthcare inequalities that persist for people with learning disabilities. But more needs to be done if people with learning disabilities are to get equal healthcare.

The Mandate sets out the ambitions for the health service for the next 2 years. In it are 2 objectives that specifically mention people with learning disabilities: to ensure people have a positive experience of care and to prevent people dying prematurely. 

Recognition from Government that this sometimes does not happen is very welcome. People with a learning disability are 58 times more likely to die before the age of 50 and 4 times as many die of preventable causes than the general population, according to Mencap.

The charity’s 2007 report Death by Indifference and 2012 follow-up 74 Lives and Counting outlined in stark detail the healthcare inequalities that still exist in acute services for people with learning disabilities that can even lead to death. Common failings include ignoring crucial advice from families and not meeting even basic care needs.

In a recent interview for Learning Disability Today, Jim Blair, consultant nurse intellectual (learning) disabilities at St George's Healthcare NHS Trust, said that, in general, good quality care for people with a learning disability in hospitals is at best patchy and at worst considerably substandard.

But healthcare in the community is also unequal, so the Board objective to ensure clinical commissioning groups “work with local authorities to ensure that vulnerable people, particularly those with learning disability and autism, receive safe, appropriate, high quality care” is also welcome.

While this is an important step in the right direction, even if the objectives are delivered – and it often takes policy direction from the top to ensure necessary changes are made – it will not be a case of ‘job done’. Many other factors will need to be addressed to ensure people with learning disabilities receive equal healthcare.

For example, the number of specialist learning disability nurses should be increased. Numbers are dwindling – down by about 50% since 1995 – which seems counter-intuitive, given the number of people with learning disabilities is increasing and their expertise is needed more than ever.

In addition, training needs to be improved for all healthcare staff – everyone from consultants to receptionists – so that they know more about people with learning disabilities and the issues affecting them.

There are many other areas that could be named – too many for a blog. Nevertheless, the Mandate is a good starting point. It shows it is on the Government’s radar as a priority, and should encourage providers to think about services for people with learning disabilities more carefully.

It will be interesting to see in two years’ time how much has changed.

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