DURING the past week, the Independent has been reporting the scandal of abuse of people with learning disabilities in two residential homes in Buckinghamshire. People who read these reports could not fail to have been shocked. Yet the unpleasant truth is that similar tales of neglect and cruelty have been reported many times in the 40 years since the first scandals in the old, large mental- handicap hospitals came to light, and will very likely be reported again.

Mencap's chairman, Lord Rix, met the Secretary of State for Health, Virginia Bottomley, this week, and she put the question to him, 'How do we stop this?'. It is my hope that, in the wake of that meeting and another held yesterday between the Learning Disability Coalition and Department of Health officials, we will soon see some good-practice guidelines issued, aimed at stopping the range of abuse and neglect. In the meantime there are several areas where change would make abuse less likely.

Any serious approach to improving the lot of people with learning disabilities starts with civil rights. As long as such people lack rights, there will seem to be nothing wrong with them being treated in a way that we would find unacceptable for ourselves. Quite simply, a lack of rights always means an easy acceptance of discrimination by one's fellow citizens and an unspoken tolerance of abuse.

Closely allied to the matter of civil rights is self-advocacy: helping people to speak for themselves, and being willing to listen to them. People with learning disabilities who are routinely got ready for bed by 7pm and have no dressing-gowns to cover the indignity of their nightwear do not challenge the system that does this to them. Those who eat at noon because staff want to eat at 1pm are obliged to accept this as the natural order of things.

People are denied knowledge of such rights as they may have in order not to inconvenience those who should serve and care for them. People with profound disabilities are often denied their limited expression because the messages might seem disturbing, confusing or against the grain of their home's rules. Yet even these most severely disabled people do communicate by sounds, expressions, gestures; and they should be listened to.

But as well as dignifying the status of those with learning disabilities, there are important changes needed to their pattern of care and support. Too often, standards seem to be based on costs, rather than on the determination to provide a decent quality of life. In both public and private sectors, purchasers of learning disability services are being invited to screw down costs, to the extent that some of the payments now on offer are probably insufficient to meet even basic standards. Existing guidelines for local- authority-regulated homes tend to apply to the elderly rather than those with learning disabilities and leave large areas to local discretion. For example, rules about the numbers appropriate to live in one home range from dozens to single figures. It is hard to live a normal life in a house with two dozen others.

Training, which is at the moment inadequate, should follow a strategy that offers paid staff (professional and non-professional alike), volunteers, and the huge unsung army of family carers, access to basic skills and principles. Many of them are doing jobs they are incapable of. Ironically, much valuable expertise was locked up with the patients in the old large hospitals and the skills have not always been transferred along with residents to the new community homes.

Inept kindness can maim and kill people as easily as deliberate cruelty. Examples include toenails left to grow over and under and into the toes of a resident; an autistic boy subject to an intensive regime of behaviour modification which will not in a hundred years change his behaviour; someone with epilepsy exposed to a regime of multiple anti-convulsants which imperil his health without relieving his epilepsy.

As for those who manage homes for people with learning disabilities, there is growing evidence that their skills are increasingly biased towards accountancy and administration to the detriment of understanding and managing the people in their care, both staff and clients. This imbalance needs to be corrected, and internal and external monitoring systems set up, involving people with relevant knowledge who can measure performance against appropriate standards. Parents of children with learning disabilities report school inspectors visiting special needs units within local schools and being surprised to find children with severe disabilities present, rather than in hospital. Where should healthy children be but in school? Staff in adult residential services and training centres (for learning social and occupational skills and continuing eduation) complain that neither managers nor inspectors have a clue about the rationale or the structure of their work, and can offer no support.

If changes were to be made on all these aspects, it would do much to help. But a deeper cultural and attitudinal shift is also needed, if those in homes are to feel integrated into a shared community of supporters and residents, in turn part of a wider community of people who are interested and involved, and quite often present. To do this we need to establish acceptable arrangements for visitors to drop in on those in residential care. When things went badly wrong in large hospitals it was not for lack of people around to notice. But in small homes, this may well be the case. Six-monthly inspections, and even unannounced inspections, are no substitute for regular visitors. In our anxiety to give residents the privacy to which they are entitled, we can end up giving the staff privacy, while residents who have no friends are in effect isolated from the outside world, unsafe and denied personal privacy behind their closed front door.

As a society we should find the lack of rights and the treating of adults as children just as shocking as we do the periodic reports of physical abuse. But an effective response makes demands on each one of us. If we do not accept personal responsibility for change, collective responsibility means nothing. Who do you know with a learning disability?

The writer has worked for 30 years with people with learning disabilities, and has been chief executive of Mencap since 1990.

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