Intended for healthcare professionals


People with intellectual disabilities

BMJ 2004; 329 doi: (Published 19 August 2004) Cite this as: BMJ 2004;329:414

Valuing people and Making Change Happen

Editor- I read with interest the editorial by sally Ann Cooper et al
and the responses.

The article clearly states the complexity of need in people with
intellectual disability and calls for action.
People with learning disabilities are amongst the most vulnerable and
socially excluded in our society. Very few have jobs, live in their own
homes or have choice over who cares for them. This needs to change: people
with learning disabilities must no longer be marginalised or excluded.

I have titled my response as 'Valuing People and Making Change

Firstly, because I wish to draw attention to the important Department
of Health document 'Valuing people', this document sets out how the
Government will provide new opportunities for children and adults with
learning disabilities and their families to live full and independent
lives as part of their local communities.

The white paper 'Valuing People: A New Strategy for Learning
Disability for the 21st Century' was published in March 2001. It is the
first white paper on learning disability for thirty years and sets out an
ambitious and challenging programme of action for improving services.

The proposals in the white paper are based on four key principles:
civil rights, independence, choice and inclusion. Valuing People takes a
life-long approach, beginning with an integrated approach to services for
disabled children and their families and then providing new opportunities
for a full and purposeful adult life. It has cross-Government backing and
its proposals are intended to result in improvements in education, social
services, health, employment, housing and support for people with learning
disabilities and their families and carers.

and Secondly, because of the recent government report titled 'Making
Change Happen'. The Health and Social Care Act, 2001 states that the
Parliament should be provided a report on learning disability once a year
and 'Making Change Happen' was the first report to be published in 2003.
The good news is that this report points to the fact that things have
changed for the better since the key document 'Valuing People' was
published and this report lists ten areas where change is evident.

The other point that I wish to address is the aspect of need. The
editorial highlights the fact that People with learning disabilities and
mental health problems have complex needs and care should be provided
according to need. In this context it would be useful to note that the
assessment instrument, 'The Camberwell Assessment of Need for Adults with
Developmental and Intellectual Disabilities' (CANDID) can be used in
people with Intellectual disaility. This was developed by modifying the
Camberwell Assessment of Need (CAN) and this is a standardised needs-
assessment instrument for adults with learning disabilities and mental
health problems. The CANDID is a brief, valid and reliable needs
assessment instrument for adults with learning disabilities and mental
health problems.

The key message is the fact that there is lot of complexity and there
is a need for marriage between policy and practice, otherwise as stated in
the article there is the risk that guidelines can unintentionally increase
health inequalities.


1. Sally-Ann Cooper, Craig Melville, Jillian Morrison. People with
Intellectual disbilities. BMJ 2004;329:414-15

2.Xenitidis K. Thornicroft G. Leese M. Slade M. Fotiadou M. Philp H.
Sayer J. Harris E. McGee D. Murphy DG. Reliability and validity of the
CANDID-a needs assessment instrument for adults with learning disabilities
and mental health problems.British Journal of Psychiatry. 176:473-8, 2000

3.Department of health, Valuing People: A New Strategy for Learning
Disability for the 21st Century, March 2001

4.Department of Health,Making Change Happen, 2003

Competing interests:
None declared

Competing interests: No competing interests

21 August 2004
K Valsraj
Specialist Registrar
Valsraj K
Maudsley Rotation