Essential healthcare for people with learning disabilities: barriers and opportunities.

Abstract

The past 30 years have seen far-reaching and radical changes in our attitude towards people with learning disabilities and in the values that inform and guide the development of services for them and their carers. A growing emphasis on the provision of services in the community has led to the closure of long-stay hospitals and greater inclusion in the wider society. Successive governments have set out to create the conditions under which community care may be successfully developed. The delivery of health services as an essential part of community care has been placed firmly within this framework, as shown in the extension of the Health of the Nation strategy to people with learning disabilities1. Elsewhere, a comprehensive consensus statement on the development of a responsive framework for the healthcare of people with learning disabilities has been provided2. As the Department of Health acknowledges3, however, ‘Significant problems were reported in the re-shaping and development of appropriate and accessible primary, specialist and continuing health care services, especially for people with complex or additional physical or mental health care needs’. This conclusion is confirmed in many statements from people with learning disabilities and their carers4. This paper is concerned with the reasons why access to and quality of primary healthcare services have posed such problems, with a focus on the role of the general practitioner (GP).