Beds, budgets and burdens: learning disability expenditure v. workload across English health authorities. Comparative review.

Background: Following the closure of asylums and widespread changes in the population distribution of people with learning disabilities, there has been little investigation of changing expenditure requirements of health authorities in England.

Aims: To compare expenditure on learning disability health services across England with the burden of services regionally, as estimated by numbers of people with learning disabilities.

Method: A national database was set up using data from the National Audit Commission and the Department of Health. The spend/burden ratio was calculated and correlation tests for likely causes of inequality were applied.

Results: There is widespread discrepancy from the median spend/burden ratio of 10,260 UK pounds per person with learning disability. There is a positive correlation between ratios and levels of net exports of people funded by their local authority social services to reside "out of area". Comparative underspending occurs in rural areas.

Conclusions: There are inequalities in levels of spending on learning disability services. Comparison of regions suggests resources may not be allocated fairly. Health authorities should ensure that population increases are mirrored by appropriate adjustments in expenditure.