Background Following the closure of asylums andwidespread changes in the population distribution of peoplewith

Declaration of interest B.F. & P.W. work for Gloucestershire, a rural county. Local experiences of lack of resources in services for people with learning disabilities, coupled with expanding population size, have caused concern over whether this reflects a nationwide problem. The importance of equity in mental health services (Acheson, 1998) is clear. Recent work has looked at allocation processes for mental health care and learning disability services (Glover, 1999; Bindman et al, 2000). Literature searches reveal no previous work investigating health authority spending on learning disability services or its reflection on population distribution. This seems pertinent, given widespread demographic changes following asylum closures and introduction of community services. While long-stay hospital placements have reduced, residential provision has rapidly expanded. Specialist residential care provision in some regions has allowed people with learning disabilities to be funded by their local social services to reside ‘out of area’ if similar local provision is not possible. If there are ongoing mental health needs, these should theoretically be funded by payment from the original health authority to the ‘out of area’ health authority through a service level agreement. This should compensate for any extra burden on health services in ‘receiver’ areas. We suspect that this often does not happen. Allocation formulas do not address the specific needs of the population with learning disabilities. Inherent difficulties in fair allocations and the need for better research are well recognised (Judge & Mays, 1994). We tackle this complex issue by ascertaining the correlation between health authority spending and the overall burden on learning disability services regionally.