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I recently experienced an interesting juxtaposition of two meetings. The first, with a self‐advocate‐led organisation, was concerned with helping it to expand and make use of its work on three key issues: advice on parenting skills for parents with a learning disability, accessible information on health for people with a learning disability, and training in the use of accessible information. The second was with a group of senior service managers who were seeking advice on how to re‐organise and restructure their service organisations. The question, to which this article will return, is which of those sets of concerns and actions had the potential for the greatest impact upon the lives of people with learning disabilities.

The purpose of this paper is to describe the first 15 months of operation of an innovative specialist national public health observatory for intellectual disability.

The paper provides a narrative account of aims and achievements of the service.

In the first 15 months of operation the observatory has: made available to those involved in commissioning health and social care services, a wealth of information on the health needs of people with intellectual disabilities; identified specific improvements that could viably be made to increase the quality of future information; and begun working with local agencies to support them in making the best use of the available information.

People with intellectual disabilities experience significant health inequalities. This paper describes an innovative approach to helping local agencies make the best use of available information in order to commission services that may reduce these inequalities.

Linking together four other articles in the journal, this commentary aims to discuss how and why national policy and its implementation in England have helped or hindered a reduction in dependency and increase in independence for people with a learning disability.

The paper is primarily a personal view, drawing on examples from policy, practice and research, written to be challenging and provocative about the current limitations of policy and its delivery mechanisms in the current political and economic climate.

The lack of a clear consensus about “prevention” in the learning disability sector and a failure to give sufficient time to effect cultural change that will help reduce dependency, allied to a set of system dynamics that militate against creative commissioning and the use of evidence, are collectively resulting in effective action to promote independence being limited to places that are characterised by creative thinking and effective leadership.

The paper argues for a fundamental change in the prevailing approach to commissioning and accountability in public services.

Valuing People presents a range of challenges for managers and other stakeholders. Partnership boards are charged with leading the change process. The paper sets out the steps that the West Sussex Board has taken to meet these challenges and describes in particular a ‘framework for frameworks’ that the Board has adopted to produce truly person‐centred and inclusive plans. The paper concludes that stakeholders can be empowered to find their voice where planners commit to an inclusive process.

This paper gives a brief overview of the background to current efforts to help more people with learning disabilities take up direct payments. It reflects on some of the challenges involved for stakeholders, and describes the positive steps that many partnership board areas are beginning to take.