By Geoff Adams-Spink
Age & disability correspondent, BBC News website
An investigation into healthcare given to people with mental health problems and learning disabilities shows they often get worse treatment than others.
Staff attitudes to disabled people can make a big difference
The Disability Rights Commission (DRC) - which examined eight million health records - says the government could face legal action unless things change.
The study concentrated on primary care in England and Wales, which will soon fall under new equality laws.
The government says it has already started acting on the report.
The 18-month investigation shows that people with learning disabilities and mental health problems are more likely to have a major illness, to develop a serious health condition younger and to die sooner than the rest of the population.
Such people were less likely to have routine tests and screening to pick up signs of a problem in its early stages.
The DRC also found that people with learning disabilities and mental health problems face "real barriers" when accessing services.
"The acid test of a national health service is not whether it works for those who are generally healthy, but whether it benefits those with the greatest risk," said DRC chairman, Bert Massie.
He said that the response from the government and the NHS was "deeply inadequate", a situation which was made worse by "a dangerously complacent attitude and a lazy fatalism" on the part of the medical profession.
"This is completely unacceptable - we need to see a radical change in the commissioning, targeting and delivery of health services in order to close this gap quickly."
The British Medical Association (BMA) has described the findings as "extremely worrying".
"As doctors, we believe it is unacceptable for the healthcare needs of this group of people to be ignored," said Dr Sam Everington, who co-chairs the BMA's equal opportunities committee.
He said the report would be discussed by GPs at the BMA in the near future.
The Department of Health said it would be working with the DRC to develop a full response to the investigation.
Mental health charity Sane said it was "disturbing" that people with mental illnesses were at greatest risk of becoming physically ill through neglect.
The charity's Marjorie Wallace called for a "new drive amongst all health professionals to ensure that each time a person with mental illness receives medical help, they are given a physical health check".
Eight million records
The investigation spoke to senior health professionals, policy makers and disabled people themselves.
Researchers analysed eight million health records in three primary care trusts (PCTs) in England and one local health board in Wales.
The DRC says that in spite of increased needs of these two groups, important checks are provided less often.
For example, people with learning disabilities who have diabetes have fewer measurements of their body mass index, while those who have had a stroke have fewer blood pressure checks.
The investigation identified a problem known as "diagnostic overshadowing" - where symptoms of physical ill health are often seen as part of a patient's mental health problem or learning disability and are not properly investigated or treated.
More than 50% of people who spoke to researchers said they experienced difficulties when trying to see their GP.
They identified the attitude of reception staff, inflexible appointments and inaccessible information s being some of the causes.
A few said they were not registered with a family doctor or had been struck off the list for being too demanding.
The report did identify areas of good practice but the DRC says services are frequently working in isolation and initiatives developed by specialists have not become part of the mainstream.
The government is being urged to put in place a number of improvements to "close the gap".
"We agree with the broad thrust of the DRC's recommendations and have already started to act," said health minister Rosie Winterton.
She said £7m had been made available to almost 90 PCTs to employ "wellbeing nurses" to help mental health patients.
The department has also allocated £42m to PCTs to help them to implement further measures to improve the care of people with learning disabilities.