Letters Premature death in people with learning disabilities

Highlighting the contribution of visual problems

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2277 (Published 16 April 2013) Cite this as: BMJ 2013;346:f2277
  1. Rachel F Pilling, consultant ophthalmologist
  1. 1Bradford Teaching Hospitals, Bradford BD9 6RJ, UK
  1. rachel.pilling{at}bthft.nhs.uk

In response to your news story on the inquiry into people with learning disabilities,1 it is important to note that over 50% of those who died prematurely had visual problems.2

Researchers attributed premature death to problems with identifying needs and providing appropriate care in response to changing needs. Loss of vision often results in a change in behaviour and is often overlooked or misattributed through diagnostic overshadowing. One in 10 adults with learning disability has severe visual impairment,3 so improving access to eye care both in the community and in secondary care should be a priority area.

The report also noted that a lack of reasonable adjustments to facilitate healthcare and attendance at outpatient clinics contributed to premature death. Health Care for All acknowledged that reasonable adjustments “are not particularly difficult to make,”4 and a list of such adjustments for eye clinics has been published.5

The first step in improving elective healthcare is to ensure that healthcare providers know that the patient has a learning disability before the appointment. This facilitates communication with the patient and carer about the types of adjustment that might be appropriate. The proposal to recommend national flagging of learning disability on NHS information technology systems would improve this situation and should be seen as a crucial step in reducing inequalities in healthcare for people with learning disabilities.


Cite this as: BMJ 2013;346:f2277


  • Competing interests: RFP is chairman of Vision 2020 Learning Disability subcommittee.