When Maggie McKinstry, Tricia Handley and Ian Hall carried out a review of service provision in specialist hospital placements, they were disappointed to find many practices that keep clients on the margins of society

A sample of people with complex learning disabilities had their specialist hospital placements reviewed by the authors. In this article they describe the inpatients’ environment, their daily life and the care they receive. Despite policy changes, this group of service users still experiences social exclusion and institutionalised practices in placements that are a long way from their homes. Community re-integration would be enhanced with care that is more person centred, carried out by qualified learning disabilities nurses, and in local placements with better links with community services.