The Government has a Way of Tackling Entrenched Health Inequalities Ready To Go – Will It Implement It?

The NHS is “in a critical condition” according to the recent Darzi report. The independent peer’s rapid review also shines a light on healthcare inequalities and persisting disparity in access to treatment for groups such as carers, people with a learning disability, and ethnic minorities. 

But what if the Government had a well-established, potentially life-saving, nationwide screening programme at its fingertips to help tackle structural health inequalities for society’s most disadvantaged people? A simple yet powerful intervention to detect health issues, benefit individuals, and save the health and care sectors money further down the line?

The Government needs to look no further than the annual health check scheme for people with a learning disability – potentially among the best innovations that most of us have never heard of. The checks were launched 15 years ago, following years of lobbying by disability campaigners.

The checks, usually provided in GP practices, are for anyone over 14 and include weight, heart rate, and blood pressure. Health professionals discuss how to stay well, check that prescriptions and vaccinations are up to date, and draft a health action plan. 

Uptake has always been sluggish, first under 2008’s Labour administration, then the Coalition and subsequent Conservative Governments. 

The 2022 NHS-funded annual review of deaths among people with learning disabilities shows that 27% of people who died avoidable deaths did not receive an annual health check in the year before they died. 

Anyone on their GP’s learning disability register should be offered a check. But only around 25% of people in England with a learning disability are on these registers.

There is no target encouraging health professionals to boost numbers on the register – although there is a target to ensure that at least 75% of people registered get checked. Neither are GPs obliged to provide checks, but there is a financial incentive if they do (they receive £140 per check). NHS figures show that only around 70% of registered patients get checked – a figure lower than the previous year.

Health checks are not a panacea, and no screening programme has 100% take up or is 100% accurate. But they are one piece of the solution to easing inequality for a marginalised group. And a solution is urgently needed. 

People with learning disabilities have a life expectancy more than 20 years less than that of the general population. A raft of evidence – across decades – demands action on this inequality, as Byline Times has previously reported.

Lord Darzi’s review refers to “particularly severe disparities in learning disabilities”, describing this group as twice as likely to die from preventable causes, and four times as likely to die from treatable causes. 

Umesh Chauhan, a GP and Professor of Primary Care at the University of Central Lancashire, says: “The learning disability health check is a very good reasonable adjustment but it’s taken quite a while to get to around 70% take up, and we still struggle to reach an adequate number.

“Some integrated care boards [NHS bodies that plan local services] are proactive in trying to encourage GP practices to do health checks, but there are still quite a lot of practices that don’t do any. There are also questions about the quality, in terms of the way they’re delivered.”

Problems include a failure to provide information in an easy-read format or to offer reasonable adjustments in surgeries, such as longer appointment times. 

“If somebody knows about and understands the health check and then still chooses to decline it, that’s fine,” Professor Chauhan adds. “But if you’re not offering it in the first place that, for me, is an issue. Is it okay to just send a text or a letter because ‘the process’ says you’ve got to send a letter? That’s not making an adjustment to engage with the person.” 

While the national picture with health checks is lacklustre, individual projects around the country show that it is possible to boost uptake.

In the Midlands, 39% of patients registered as learning disabled were having annual checks in 2020, but an awareness-raising campaign by health professionals and inclusion charity Grapevine pushed the figure above 71%.

As part of this work, a project launched a year ago encourages GP surgeries to become “learning disability friendly”. The criteria includes ensuring that people receive high-quality annual checks, having a “learning disability champion” in the practice, and offering longer appointments or home visits if necessary.

So far, seven surgeries have won the Learning Disability Friendly Practice accreditation, in a scheme run by NHS Coventry and Warwickshire integrated care board, Grapevine, and GPs Maisun Elftise and Ayesha Mahmud. 

Mahmud, who is also a parent of a young person with a learning disability, says this work does not add pressure to a surgery’s workload, but that “providing high-quality, personalised care will eventually save GPs time and effort”.

Elsewhere, work is underway way to increase health checks for learning disabled people of colour. 

The link between structural racism and health inequalities was underlined in a recent report from UCL’s Institute for Health Equity, while work from the NHS Race and Health Observatory shows that learning disabled people from ethnic groups have a shorter life expectancy thanks to poorer healthcare.

A collaboration between charities Learning Disability England (LDE) and the Race Equality Foundation (REF) aims to increase health checks among learning disabled people from black, Asian, and ethnic backgrounds.

“Too often, the focus is on families’ and communities’ behaviours, rather than on the structures that aren’t working in the way they should have been – annual health checks are one of these,” REF chief executive Jabeer Butt says.

As part of the project, campaigner Aisha Edwards shared her negative experience of annual checks: “They talk really fast and I’m there thinking ‘my brain can’t process that, can you just slow it down please’.” Edwards says that checks could be carried out by nurses in the community to encourage more people to have them.

Parent advocate and campaigner Ramandeep Kaur was also involved in the LDE and REF project. Kaur recently completed an MA on the exclusion of minority communities in research on health checks and has supported her son Harry, 17, at three annual health checks.

The first was a poor experience – an appointment during the school day (disrupting Harry’s routine) without any accompanying or easy-read or option for Punjabi translation. Kaur describes a “short, tick-box exercise” without a health action plan.

The following year, Kaur was offered a telephone slot but insisted on an in-person appointment for weight and blood pressure checks.

Harry’s most recent appointment was better. The nurse providing the health check agreed to use an easy-read checklist Kaur had brought to outline what Harry could expect to happen. 

Kaur and her son’s positive experience – albeit at the third attempt and thanks to Kaur’s ability to advocate for her son – should be standard. The fact that it is not is a missed opportunity, particularly given our self-proclaimed ‘mission-driven’ Government and its plan to transform the NHS into a “neighbourhood health service”.

Right under the Government’s nose lies an evidence-led, long-called for, but under-used programme with the potential to help ease entrenched inequality. It must not follow its predecessors and miss a trick by failing to throw its weight behind it.  

Saba Salman is the editor of ‘Made Possible: Stories of Success by People with Learning Disabilities – In their Own Words’. She is the chair of the charity Sibs, which supports the siblings of disabled children and adults