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Health inequalities

People with a learning disability have worse physical and mental health than people without a learning disability.

Inequalities

People with a learning disability have worse physical and mental health than people without a learning disability.

On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population; and the life expectancy of men with a learning disability is 14 years shorter than for men in the general population (NHS Digital 2017).

Poor quality healthcare causes health inequalities and avoidable deaths

Premature deaths

The Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) found an average age of death of 65 for men and 63 for women in a sample of 247 people with a learning disability in the UK. This is significantly less than the average age of death of 78 for men and 83 for women in the general population (Heslop et al. 2013). In other words, on average women with a learning disability died 20 years sooner than women in the general population, and men with a learning disability died 13 years sooner than men in the general population.

CIPOLD also reported the average age of death for different levels of impairment:

•          67.5 for people with a mild learning disability

•          64 for people with a moderate learning disability

•          59 for people with a severe learning disability

•          46 for people with profound and multiple learning disabilities

Poor quality healthcare causes avoidable deaths

The Confidential Inquiry into premature deaths of people with a learning disability also found that 38% of people with a learning disability died from an avoidable cause, compared to 9% in a comparison population of people without a learning disability (Heslop et al. 2013, p. 92). Note: Mencap uses the term avoidable death for deaths that could have been avoided by the provision of good quality healthcare.

Allerton and Emerson (2012) analysed large-scale data to investigate the access to good quality healthcare for British adults with a chronic health condition or impairment. 309 people in the sample had a learning disability. The research found:

40% of people with a learning disability reported a difficulty using health services, compared to 18% of people with no chronic health condition or impairment

12% of people with a learning disability reported a lot of difficulty using health care services, compared to just 3% of people with no chronic health condition or impairment.

Access to healthcare

A number of barriers are stopping people with a learning disability from getting good quality healthcare

These barriers include:

  • a lack of accessible transport links
  • patients not being identified as having a learning disability
  • staff having little understanding about learning disability
  • failure to recognise that a person with a learning disability is unwell
  • failure to make a correct diagnosis
  • anxiety or a lack of confidence for people with a learning disability
  • lack of joint working from different care providers
  • not enough involvement allowed from carers
  • inadequate aftercare or follow-up care

(Heslop et al. 2013; Tuffrey-Wijnes et al. 2013; Allerton and Emerson 2012).

Barriers that stop people with a learning disability from getting good quality healthcare:

  • a lack of accessible transport links
  • patients not being identified as having a learning disability
  • staff having little understanding about learning disability
  • failure to recognise that a person with a learning disability is unwell
  • failure to make a correct diagnosis
  • anxiety or a lack of confidence for people with a learning disability
  • lack of joint working from different care providers
  • not enough involvement allowed from carers
  • inadequate aftercare or follow-up care.

Health promotion initiatives

Annual health checks

49.7% of patients with a learning disability received an annual health check in 2016/17, an increase from 43.2% in 2014/15 (NHS Digital 2017).

Flu immunisation

There has been a small increase in the proportion of patients with a learning disability receiving flu immunisation in recent years, from 40.8% in 2014/15 to 41.9% in 2016/17 (NHS Digital 2017).

Cancer screening

Breast cancer screening for people with a learning disability has decreased in recent years, with the largest decrease seen in women aged 65 to 69, from 54.6% in 2014/15 to 51.7% in 2016/17.Cervical cancer screening is much lower for women with a learning disability (30%) than in the general population (70%) (Glover 2017). Meanwhile, colorectal cancer screening for eligible patients with a learning disability aged 60-69 has increased from 68.6% in 2014/15 to 79.5% in 2016/17 (NHS Digital 2017).

Mental health

Depression diagnoses have increased recently. In 2016/17, 13.2% of patients with a learning disability had an active diagnosis of depression, compared to 12.2% in 2014/15 (NHS Digital 2017).

GORD

GORD (gastric oesophageal reflux disease) diagnoses have increased amongst patients with a learning disability in recent years, from 6.8% in 2014/15 to 7.8% in 2016/17 (NHS Digital 2017).

 

Annual health checks

There are a number of possible reasons why more people with a learning disability don’t receive health checks

For example, some practices do not participate in the health check scheme. If a person is on the learning disability register and their GP practice is not part of the health check scheme, they are still meant to be included in the number of people eligible for health checks. However, in some cases they have not been included

Some people with a learning disability are known to GPs but do not receive Local Authority services. In some areas not everyone who could be eligible for a health check is included on the register(Emerson et al. 2011; Glover and Niggebrugge 2013).

In addition, some people are invited to take part in a health check but do not attend. Studies have shown that this can be improved through nurses or health facilitators encouraging attendance with follow up phone-calls and reminders (Perry, 2010; McConkey et al, 2015).

 

Research references

Here you'll find full referencing for the Mencap research and statistics pages.

Research references

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