This article describes a study into the current organizational arrangements for commissioning and providing specialist health services for people with learning disabilities (LD) in England. It describes significant variability in spend and service design and suggests a link between that and weak leadership and commissioning systems. The article also considers the potential impact of recent UK NHS reforms. It concludes that these reforms are likely to exacerbate this variability unless the health service invests in senior leadership with the capacity to take on board the learning disability agenda, and unless greater accountability for the delivery of national policy is placed within the public health care system.
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