Mencap is the UK's leading learning disability charity, working with people with a learning disability, their families and carers. We believe people with a learning disability should have choice, opportunity and respect with the support that they need.

  Mencap welcomes the opportunity to respond to this inquiry. Our response will concentrate on the health inequalities facing people with a learning disability, and show how responses to health inequalities are once again leaving this group of people behind.

1.  THE HEALTH INEQUALITIES OF PEOPLE WITH A LEARNING DISABILITY:

  People with a learning disability face specific health inequalities, as highlighted in Mencap's 2007 Death by indifference report, and the Disability Rights Commission's 2006 report Closing the gap.

—  The Disability Rights Commission report showed "people with learning disabilities die younger than other citizens. They also have high rates of unmet health needs"[21]. They highlighted a "fatal complacency" in the NHS that people with a learning disability "just do die younger".

—  People with a learning disability are 58 times more likely than others to die before the age of 50.[22]

—  Overall mortality among people with a learning disability is three times that of the general population (even with external causes of death taken into consideration).[23]

—  In people with a learning disability aged 20-29 years, mortality was nine times higher in men, and 17 times higher in women.[24]

—  Mencap's 2004 Treat me right campaign showed 70% of GPs had received no training to help them treat people with a learning disability and 90% felt that a patients learning disability made it more difficult to make a diagnosis.

  People with a learning disability are less likely to receive screenings, suffer poorer health, and health services struggle to meet the needs of this client group.

These inequalities are not related to geography, but to this particular group of people.

2.  THE FAILURE OF EXISTING SCHEMES TO TACKLE THE HEALTH INEQUALITIES OF PEOPLE WITH A LEARNING DISABILITY: [25]

  The types of health needs common in the general population differ from those most commonly experienced by people with a learning disability, and some health needs are specific to people with a learning disability.

  Health initiatives in the mainstream try to tackle lifestyle related causes of death like ischemic heart disease, certain types of cancer and stroke. These are not the lead causes of death for people with a learning disability.

  People with a learning disability are more likely to die from:

—  Respiratory disease eg pneumonia and aspiration pneumonia

—  Congenital cardio vascular disease

—  Stomach, oesophageal and gall bladder cancers

  They are more likely to suffer from:

—  Constipation

—  Reflux disorder

—  Epilepsy

—  Osteoporosis

—  Hyperthyroidism (especially people with Down's syndrome)

  Current public health initiatives to tackle inequalities which focus on geographical or social deprivation will not only fail to close the gap for people with a learning disability, but may increase it.

  Tackling the health inequalities of people with a learning disability is not just about extending current programmes to include them, but developing new initiatives that tackle the specific needs of this group to produce equal outcomes

  The government will not meet its legal obligations under the disability equality duty unless it takes action to promote equality in healthcare for people with a learning disability.

3.  POSSIBLE ACTIONS:

  To tackle these inequalities, action needs to be taken that specifically meets the needs of people with a learning disability.

  One targeted action that appears to be having an impact on health inequalities for this group is annual health checks.

  Evidence from annual health checks introduced in Wales reveals that 51% of those with a learning disability who received a health check had newly identified health needs. 9% had a serious health problem. Subsequent checks a year later identified further new health needs among 68% of people, and serious problems were identified in 11%. These figures highlight the need for health checks to take place at least once a year.[26]

4.  CONCLUSION:

  The health inequalities agenda clearly relates to people with a learning disability, but attempts to address these inequalities have largely missed this group. If attempts are not made, in line with disability discrimination law, to address their specific needs then current initiatives will once again leave people with a learning disability behind, and prevent them from having the healthy lives that give them the best opportunity to be full and active citizens in their communities.

January 2008

22   DRC, Background evidence for the DRC's formal investigation into health inequalities, 2006. Back

23   Tyrer F; Smith L K; McGrother C W, Mortality in Adults with Moderate to Profound Intellectual Disability: A Population-based Survey, Journal of Intellectual Disability Research, 51, 7, 520-527 (July 2007). Back

24   Ibid. Back

25   Cooper, S-A., Melville, C., Morrison, J. (2004) People with intellectual disabilities. Their health needs differ and need to be recognised and met. British Medical Journal, 329, 414-415. Back

26   DRC, http://www.drc-gb.org/about_us/drc_wales/newsroom/news/investigation_exposes_healthca.aspx (November 2006). Back