A review of disability services following the murder of a disabled woman by her mother has found no fault with healthcare staff who cared for her, but says it will happen again if adult disability services are not improved and better funded.

Donella Knox, from Blenheim, was jailed for four years in December for the murder of her daughter Ruby, who was severely intellectually disabled and diagnosed with severe autism spectrum disorder.

Ruby's death at the hands of her sole caregiver for 20 years triggered a review of her health services, which was released today.

Paediatrician Rosemark Marks, who led the review, said she found no deficiencies in the care provided by Nelson Marlborough District Health Board staff.


"Indeed several members of staff went above and beyond in their efforts to support Ruby and Donella," she said.

But there were areas where services could be improved, both at the Nelson DHB and nationwide.

If Ruby had been aged under 17, concerns would have been raised with authorities about potential abuse, Marks said. But the process and safeguards were not comparable for adults.

"New Zealand needs a process for vulnerable adults that is clear and resourced to assess situations of concern and ensure appropriate action," Marks said.

The review found that carer support and disability services were underfunded and that caregivers were not always trained to deal with severe disabilities.

There were also problems with the transition from paediatric to adult health services, and a lack of specialists to treat people with both an intellectual disability and mental health problems.

Unless disability services for adults were improved, cases like Ruby's would happen again, Marks said.

Nelson Marlborough Health chief medical officer Nick Baker said the review validated the tireless efforts and expertise of staff who cared for Ruby over the years.


"It does, however, identify recommendations to improve our provision of health services for people with high and complex needs," he said.

It was unlikely that the DHB would have to deal with a similar chain of events, he said. But it was likely that staff would have to deal with more cases of young people with high needs.

In a press conference in Nelson this afternoon, Marks also made some pointed remarks about the disabled sector in New Zealand.

"I remind you that governments allocate resources not only according to needs, but also with an eye on what the public wants.

"If people and lobbyists loudly demand more roads – that is what they will get.

"Until as a society we learn to value all our citizens including those with disability, our leaders will not consider they have a mandate to prioritise spending taxpayers' money on improving services for people with disability over the many other demands facing them.

"We need to learn to include all members of the community. An inclusive society is a just society. We need to learn not just to tolerate difference but to celebrate difference."