To much fanfare, in July the government published its 10-year health plan for England, Fit for the Future.
It has three parts. The easy read version describes them like this:
- We will give you more healthcare in your neighbourhood and at home
- We will use more technology to make it easier for you to see a doctor and get healthcare. Technology means things like apps, computers and the internet
- We will help you stay as healthy as possible. Like making it easier for you to choose healthy food and do more exercise.
What are the prospects of this plan for helping people with learning disabilities to live longer and healthier lives?
There’s too much detail in the plan to go through in this column, but the first thing I would say is that people with learning disabilities are hardly covered at all.
Change for the worse
There is one mention of them in the main text of the 168-page document: “Individuals with learning disabilities die about 20 years earlier on average. Care from a neighbourhood team will improve their life outcomes through more holistic, ongoing support.”
Have people with learning disabilities always been absent from health service policy?
We do have a recent point of comparison – the NHS Long Term Plan published in 2019. This mentions people with a learning disabilities 47 times in the main text of its 134 pages, with a range of actions mentioned throughout.
Did this greater, specific focus have a positive impact? This sentence “On average, adults with a learning disability die 16 years earlier than the general population” suggests that, if anything, things have got worse for them between 2019 and 2025.
Institutional discrimination
Is it possible that a fully inclusive health service, where people with learning disabilities don’t have to be labelled to have their health needs met, will happen through the Fit for the Future plan?
We obviously don’t know yet, but history strongly suggests that, in the absence of specific and closely monitored initiatives, people with learning disabilities are routinely subjected to institutional discrimination at the hands of health services.
For example the Stop the Over Medication of People with learning disabilities Programme (STOMP), which aims reduce the over-prescription of antipsychotic medicines to people with learning disabilities, is starting to make an impact, with antipsychotic prescription rates falling.
However, rates of antidepressant prescriptions for people with learning disabilities, which are not covered by STOMP, have been consistently increased.
A target about making sure people with learning disabilities get annual health checks has been dropped from NHS priority and planning guidance
With this in mind, it is worrying that a national target about making sure that people with learning disabilities get annual health checks has been dropped from the NHS priorities and operational planning guidance for 2025-26.
Ironically, the only target left for people with learning disabilities is about the startlingly ineffective programme to reduce their number in inpatient units.
Also concerning is that information about the health of people with learning disabilities is becoming harder to find and use, with the publication of important reports documenting health inequalities (such as the Learning from Lives and Deaths [LeDeR] review) regularly delayed by months, the tools to interpret health datasets being temporarily unavailable for months with no
fix in sight, and comprehensive online information about children and adults with learning disabilities not having been updated since 2021 and scheduled to be
scrapped altogether.
With no comprehensive strategy for people with learning disabilities in England since 2009, it feels to me as if a fog of invisibility is coming down – a fog so thick that we won’t even know what is happening to them.
