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Improving the use of medicines in people with learning disabilities

Patients and the public expect health services to be high quality – safe, effective and a good experience. The appalling care and treatment of people at Winterbourne View, to say the least, did not meet that expectation. Amongst the many concerns was the inappropriate use of certain medicines. In particular, powerful medicines like antipsychotics. Used well and appropriately, these medicines have a place in clinical care. Used poorly and inappropriately, they can take the form of a restraint or “chemical cosh”. That’s why I was asked to bring together patient representatives, health professionals, commissioners, policy makers and others to form a consensus of action needed to improve the use of not just antipsychotics in patients with learning difficulty, but also antidepressants, anxiolytics and antiepileptics too.

The consensus was that we should commission three pieces of work to determine how well these powerful medicines are used for people with learning difficulties:

• A detailed examination of data about the use of these medicines in primary care
• An audit of Second Opinion Authorised Doctor decisions about use of these medicines in patients with learning difficulty detained under the Mental Health Act
• A collaborative improvement programme at local level to obtain an in depth understanding of medicines use and to test new ways of working.

This report is about the final element of this programme of work. It is the results of work at six sites caring for people with learning disabilities and observations in numerous settings. I would like to thank the patients and staff of these sites for being so open and willing to learn and improve. I would also like to thank the experts from NHS Improving Quality who guided the sites through the work. There was also great interest from many other sites who wanted to be part of the programme and I hope they too will learn from the results of this work. I am also grateful to the project board which oversaw the programme. In particular I would like to thank David Jack, whose son has learning disabilities. David’s family experiences were invaluable in guiding the work.

We know that optimal medicines use should be patient focused and outcome based. It should be safe, effective and evidence based. A patient and their clinician should decide and choose together which medicines to use, or indeed whether to use any medicines at all. Clinicians and patients should routinely monitor and review the medicines they are using. These principles should apply to all patients and to all settings, including inpatients with learning disability.

The three pieces of work identified by the consensus and the next steps are being published which will facilitate action to be taken to optimise medication and ultimately improve the lives of people with learning disability.