Healthcare inequalities for people with learning disabilities are not endemic in NHS, says Dr Fitzpatrick

GP Michael Fitzpatrick takes issue with the view that the NHS is riddled with prejudice against people with learning disabilities

The idea that health checks are the solution to the health problems of people with learning disabilities has become conventional wisdom – and is therefore exempt from the requirement to produce evidence to justify it.

Health secretary Alan Johnson has instructed the NHS to make improving healthcare for people with learning disabilities a priority following an official inquiry into a report published by Mencap in 2007. Death By Indifference presents six “shocking and tragic” cases in which the deaths of people with learning disabilities are attributed to professional “ignorance and indifference” resulting from “institutional discrimination” in the NHS. The real scandal obscured by these reports is that the healthcare needs of people with learning disabilities have become the focus of political posturing.

The concept of “institutional discrimination” was adopted by the Mencap report from the 1999 Macpherson inquiry into the death of Stephen Lawrence. The Macpherson report was popular with politicians and management, allowing them to evade responsibility for the inadequacies of the criminal justice system and shift the blame to frontline workers: perhaps this explains its appeal to health service chiefs. The authors of the Mencap report selected their cases with a view to illustrating their conviction that prejudices against people with learning disabilities – leading to systematic abuse and ill-treatment – are endemic in the NHS.

As somebody who has worked in the NHS for 30 years, and has had 15 years’ experience of the NHS from the perspective of a parent of a child with severe learning disabilities, I simply do not believe this to be true – and neither the Mencap report nor the subsequent government report present convincing evidence for it. I have encountered blinkered attitudes in the medical profession – in relation to race more than in relation to learning disabilities – but I do not believe they are shared by most health service workers. Professional self-abasement may be fashionable, but it does no favours to those who rely on our services.

There is a strong prejudice that delay in diagnosis (rather than inadequacies in treatment) is a major contributor to mortality from cancer in people with learning disabilities – as in the population more broadly. Whether more recent surveys satisfactorily demonstrate this remains unclear: the Mencap cases certainly do not. The value of health promotion interventions remains contentious in relation to the population as a whole. In relation to people with learning disabilities, as with people with mental illness, there is little evidence of their efficacy – and there are concerns about its intrusive character.

Just as health checks are the answer to the problems of patients, more training is the answer to every deficiency of the medical profession – and all the recent reports on people with learning disabilities insist that GPs and others in primary care are subjected to consciousness-raising sessions to overcome their ignorance and prejudice. But where is the evidence that training would be of any benefit?

Fears have been expressed that health checks for people with learning disabilities might degenerate into a box-ticking exercise. This has indeed been the fate of similar initiatives. The Baby P scandal confirms that outcomes may still be grim when professionals have ticked all the boxes.

Michael Fitzpatrick is a GP in Hackney

This article is published in the 4 December 2008 edition of Community Care magazine under the headline Why Mencap is wrong over the need for annual health checks

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