Learning disabled patients could lose out from Lansley's health reforms

Why a specialist health commissioning body is needed for vulnerable learning disabled patients, by Dr Claire Royston, medical director of specialist provider Care Principles.

As the government looks to bring substantial changes to NHS commissioning methods through the implementation of the Health and Social Care Bill, I find myself extremely concerned that vulnerable, learning disabled patients with complex difficulties may not receive the appropriate assessment and treatment that addresses their individual needs.

The bill expects GP consortia to take responsibility for commissioning all services, but due to the relatively low number of vulnerable learning disabled patients, GPs are likely to have limited experience of this.

However, the percentage of adults with a learning disability detained under the Mental Health Act whose care is provided within the independent sector has risen significantly, from 15% in 1998 to 46% in 2008. It is therefore important that GP consortia are able to access the extensive knowledge base and clinical expertise within the independent sector to ensure that the interests of vulnerable patients with learning disabilities are protected, and appropriate and cost-effective clinical and care pathways are provided.

As I pointed out in a submission to the Health and Social Care Bill committee, one way this can be achieved is through the establishment of a specialist commissioning body, advised by appropriate psychiatrists, which would be significantly involved in the commissioning of services.  This body would have commissioning responsibility for three patient groups in particular - offenders with a learning disability, offenders with a learning disability and a personality disorder, and people with complex presentations of autism. It is these three groups that I feel will be most vulnerable as a result of the government's changes.

Historically, there has been an imbalance that has seen people with learning disabilities lose out when compared with those with mental health problems; and I firmly believe that a body whose remit is to focus on service provision for those with learning disabilities will help to redress this disparity.  This is especially true in the criminal justice system.

The government may be putting £3m into 40 diversion sites for adults and £2m for young people this year, but that is simply aimed at diverting offenders with mental health problems away from prison; it does not take into account the needs of those offenders with learning disabilities.

The commissioning of highly specialised services for the small but very vulnerable group of patients with a learning disability and challenging and/or offending behaviour that require secure treatment and care is a challenge. Having a specialist body that includes experts from the independent sector would bring together those responsible for commissioning services with those tasked with service delivery. This can surely only benefit the patient and ensure they receive the highest level of care and rehabilitation.

It's important that with the current health reforms, those vulnerable learning disabled patients aren't forgotten and that provisions are made to ensure their needs are met.