Leading article: An unhealthy mindset that must be eliminated

In the great, swirling debate about reform of the British health system, the dangers of creating a "two-tier" service in which the rich and the poor enjoy different standards of treatment is a recurring theme. Yet the reality is that we already tolerate a two-tier service; except that the divide is not between the rich and the poor, but between the majority of patients and the mentally disabled.

A Disability Rights Commission investigation two years ago found that patients with learning difficulties are less likely to receive the care they need. And that point was rammed home with some force yesterday in the report of an independent inquiry headed by Sir Jonathan Michael, the former chief executive of Guy's and St Thomas' NHS Foundation Trust.

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Sir Jonathan looked into the cases of six mentally disabled individuals, highlighted by the charity Mencap, who died in the care of the NHS. He also investigated the general quality of treatment offered to patients with learning difficulties. The conclusions are shaming. People with learning disabilities are suffering "discrimination, abuse and neglect" across the health service. The cases highlighted by Mencap turn out to have been merely the tip of an iceberg of abuse.

When reports deliver a verdict of "institutional discrimination" there is a tendency for the debate to become rather abstract. We need to remind ourselves what such discrimination means in practice. It means patients such as Mark Cannon, who died eight weeks after being admitted to hospital with a broken leg. Mr Cannon had to wait three days before being given pain relief. It means patients like Martin Ryan, who went without food for 26 days while in hospital following a stroke. It means the physical and sexual abuse suffered by mentally disabled patients in the care of health trusts in Sutton and Cornwall.

The problem is not one of legislation, but the fact that the laws already in place to protect such patients, in particular the Disability Discrimination Act, are being routinely ignored. Sir Jonathan's report recommends tougher inspections and more training for medical staff, rather than new laws. This is the right emphasis. Another sensible recommendation is that the carers and families of those with learning disabilities should routinely be involved as partners in the delivery of their health treatment. This is elementary stuff. Carers and relatives are best acquainted with the needs of the patient since they spend so long with them. Medical practitioners need to be instructed to access that expertise as a first resort.

But we need something more too. We need a shift in attitudes throughout the health service and, indeed, society itself. Some of the reaction to this report has exposed a rather ugly mindset that regards the treatment of those with learning difficulties, or indeed the wider disabled community, as an issue of secondary importance. Such attitudes need to challenged and eradicated. Until they are, the abuses will continue.

The frustrating thing is that treating the mentally disabled properly would not require great expense or the distribution of special expertise. As Sir Jonathan points out in his report, "addressing the difficulties faced by people with learning difficulties accessing high standards of healthcare does not require specialist knowledge about learning disabilities. What matters is that people with learning difficulties are included as equal citizens".

That is the crucial point. This is not about special treatment, it is about equal treatment. And those with learning difficulties should not be forced to wait a moment longer to receive it.