Decades of national health strategy in England on intellectual disability and the drift from evidence-based practice.

Over the past few decades, English health policy for people with intellectual disability has been shaped by legitimate concerns regarding care standards and the need for an inclusive health agenda. However, policies may be driven more by ideology than by empirical evidence. This editorial critically examines this premise using seven topical examples: (a) reduction of specialist in-patient beds, (b) mainstreaming healthcare, (c) specialist services challenges exemplified by children and forensic pathways for intellectual disability, (d) absence of application of outcome measures, (e) lack of a coordinated research agenda, (f) changes to mental health legislation and (g) the conflation of autism and intellectual disability. We highlight the risks of implementing large-scale system transformation without adequate evidence or evaluation of the impact of policy initiatives. We argue and provide recommendations for a rebalancing of policy towards evidence-based service design, investment in research and maintenance and development of specialist expertise.