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This response agrees with Stuart Cumella that it is reasonable to challenge the priority accorded by government to people with learning disabilities and to question the power of the mechanisms for implementation of Valuing People. At the same time, however, it argues for a mature political approach, encouraging the taking of opportunities that are available and the shaping of structures and initiatives which are part of the implementation arrangements. Finally, it challenges Cumella's interpretation of person‐centred planning and seeks to offer some clarity on best use of person‐centred approaches.

This article reviews the evidence on the benefits of innovative practice‐based social work, in the context of attempts to improve multi‐agency collaboration through structural change, procedural regulation and process redesign. It concludes that the model can generate improvements in productivity and in responses to customer needs.

This article discusses the results of a comparative evaluation of a social worker in primary care with her equivalents in an area team. Direct referral is found to be more efficient than referral to the area team, enabling the attached social worker to manage a higher workload and improved levels of contact with service users and the primary care team. The options available for service users are thus enhanced, with consequent cost advantages for the social services department.

Many parts of the world are developing specialist mental health services for people with a learning disability. Government policy in England appears to favour a move in the opposite direction. The general aims of mental health services for people with a learning disability are indeed similar to those of the rest of the population, but distinctive clinical skills are required to assess, treat and support effectively people with a learning disability who have mental health and/or behavioural problems. There is therefore a need for specialist services to meet the needs of this population, which should include acute admission facilities, outreach services in the community and long‐term support.

Support workers have more day‐to‐day contact with people with a learning disability than any other group of staff, but a high proportion are unqualified and untrained, and there are problems in recruitment and retention. This paper uses undisclosed participant observation and life history methods to analyse the experiences of a support worker in six agencies that provide community‐based care for people with learning disabilities. It was found that a lack of training is associated with limited awareness of the needs of people with learning disabilities, and contributes to stress among staff. Some support workers manage stress by disengaging from their clients. Person‐centred approaches had limited impact, and even agencies committed to person‐centred planning can be reluctant to implement it with clients with severely impaired communication. The greatest commitment to staff induction and training and person‐centred approaches was found in small organisations managed by families. It is possible that large residential care providers are more likely than small agencies to have extended lines of management and standardised procedures, and further research is needed to assess whether these factors are associated with disempowerment of staff and clients.

The importance of rehabilitation in promoting independence is recognised in current policy directives on the provision of care to older and disabled people, but has not been widely established within the spectrum of services provided by local authorities. AWorcestershire‐based re‐ablement service presents an effective model of joint working to provide comprehensive multidisciplinary assessments and a therapeutic intervention service aimed at reducing dependency and promoting service users' choice and control over their care programmes.

Valuing People has been widely welcomed by learning disability services. But it promises a major expansion of unenforceable assessments which will divert practitioners from responding to the needs of their clients into the production of reports.