Patients' human rights were not observed

The Healthcare Commission audit found poor standards in most services and big regional variations. It referred six services for further investigation.

The watchdog warned that people with learning disabilities were being deprived of human rights and dignity.

Ministers plan structural reform of the current system.

Inspectors reported that many of the 4,000 learning disabled people who lived in residential care led bleak lives.

They described people sitting all day unoccupied, homes which offered little or no choice of food and locked toilets and bedrooms.

One inspector described a home with a lovely garden, which no-one ever used.

AUDIT FINDINGS Insufficient attention paid to safeguarding vulnerable people Care poorly planned and does not involve people with learning difficulties Services not monitored by commissioning organisations Lack of stimulating activities and opportunities Lack of leadership Staff training poor, and around a third of staff members were agency temps

The Healthcare Commission did not find evidence of physical abuse in any service.

But it did refer six services to local authorities under Protection of Vulnerable Adults protocols following concerns raised about the care of individuals or overall standards of care.

These included an individual being treated by Care Principles Ltd, of Stafford, which led to the local authority taking action to improve care.

The commission raised concerns following an allegation of abuse made by a person with learning disabilities being treated by Coventry and Warwickshire Partnership NHS Trust. This was invesitgated but not upheld.

The watchdog also expressed concerns about the behaviour of one person in relation to another being cared for by Sandwell Mental Health NHS and Social Care Trust, which led to action being taken by the local authority.

'Committed staff'

The commission said services were driven by committed staff working in difficult environments, but it warned of significant institutional failings.

It said services operated off the radar of the healthcare system, with poor leadership, poor training and no framework to measure the performance of services.

As a result of this, people with learning difficulties live in poor physical environments, are offered few choices in how they live their lives and are isolated from their communities.

It found many services where planning of care was poor and did not involve people with learning disabilities.

The commission made a raft of recommendations for change. Services have been told to draw up action plans, and strategic health authorities have been asked to monitor their implementation.

Spot checks

Eighty-five per cent of services have already reported that they have made or planned changes as a result - including improving training, increased the involvement of people with learning difficulties and enhanced physical environments.

The commission will carry out spot checks to ensure improvements are made, and ensure the findings will be fed back into its annual health check of NHS trusts.

HEALTHCARE COMMISSION AUDIT Covered 72 NHS trusts and 17 independent organisations providing 638 individual services The services support more than 4,000 people They include long-stay hospitals, campus-style accommodation, acute assessment and treatment centres, short-break and secure facilities Each service typically supports six to 12 people

Anna Walker, Healthcare Commission chief executive, said: "This report does paint a bleak picture.

"Services for people with learning difficulties are not generally unsafe but they are poor.

"These services are regularly neglected and too often old-fashioned and institutional.

"There are many members of staff working hard for the people they serve.

"But they operate in a system where too many people are not given choices and control over their lives.

"Care is not personalised, living environments are poor and activities are few."

Consultation

Care Services Minister Ivan Lewis said a consultation would be launched on how to reform support of people with learning disabilities.

This will include proposals to transfer responsibility for commissioning services from the NHS to local government and a focus on ensuring people have access to appropriate supported accommodation.

He said: "It is totally unacceptable for anyone with a learning disability to be treated in a way that compromises their human rights."

Steve Shrubb, of the NHS Confederation's Mental Health Network, said: "Everyone deserves to be treated with dignity and respect so providing services that are simply safe can not be acceptable.

"The report is clear that everyone needs to raise their game."

About 169,000 people in England use services for people with learning disabilities.