David Matthews examines how a series of radical shifts in service provision have reflected underlying societal changes. Now that the social care model has overtaken the medical model, it is time to cherry pick the best bits from past models and evolve a new approach to care

The Valuing People White Paper confirmed that the general health of people with learning disabilities is very poor (Department of Health 2001). Despite the initiatives it unveiled, only limited progress has been made in recent years. This paper suggests that the failure is due to the ideological foundations underpinning service delivery. It will examine how such patterns of care evolved, discuss relevant publications and offer some thoughts on how further progress can be made.