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This article focuses on people with complex needs and the impact of Valuing People and Valuing People Now on improving their lives and opportunities. It considers the current situation and challenges, where most people with complex needs have experienced disadvantage and have not seen as much improvement in opportunities as others. Health needs are covered elsewhere in this journal, and so this article looks at the remaining priorities in Valuing People Now: housing and employment. The key issues are explored and the Sustainable Hub for Innovative Employment for People with Complex Needs, established as a result of the Valuing People Now employment work, is described. It explores the lessons learnt so far and the challenges faced, with a summary of the next steps.

Valuing People Now (DH, 2009) recognises that some people, particularly those with complex needs, have been missing out. It has made ‘including everyone’ a priority for the next three years. With reference to Tom's story, this paper will consider the reasons why people with profound and multiple learning disabilities (PMLD) remain among the most marginalised people in society today, what has changed since Valuing People (DH, 2001) and what needs to change in the next three years of delivering Valuing People Now (DH, 2009) if we are to rise to the challenge of ‘enabling extraordinary people to live ordinary lives’ (McConkey, 1998).

This paper revisits the aspirations of the authors for supported employment development from 1997 against a changing policy context with the introduction of Valuing People and Valuing People Now. It reviews developments in employment policy, innovation, the framework for funding supported employment and changes in the level of employment for people with learning disabilities since 1997. It summarises the progress in this area over the period, and suggests the need for further action to deliver the Government's vision of employment inclusion and to secure the rights of people with learning disabilities to a place in the workplace.

Traditionally, participation in the local community has been considered a crucial component of community living for people with learning disabilities. Highlighted in Valuing People (DH, 2001) and in Valuing People Now (DH, 2007), this concept ‐ now appearing as ‘inclusion’ ‐ has retained its prominence, and is an important area for service development and monitoring. Monitoring of community activities was undertaken pre‐ and post‐closure of two small day service facilities. The findings indicate that for this group of people (generally older with higher support needs) the closure of the day service facilities did not, overall, result in a significant increase in community activities. The availability of the time that the person had previously spent in specialist day services was not, by and large, used to develop social inclusion. Even though, for some individuals, some gains were recorded, overall these gains were considered a poor return for the hours released from the closure of the day service facilities.

This article examines the progress made in supporting people with learning disabilities to live in their own homes in the community over the past 40 years. The recent NHS campus closure programme has demonstrated once again that even people with complex support needs can have a better quality of life with improved outcomes in appropriate community accommodation. The article examines the work undertaken following Valuing People Now to develop the housing options of people with learning disabilities, including implementing a regional housing programme, developing a good‐practice toolkit for local authority commissioners and encouraging provider engagement. The barriers to progress are discussed, and areas are identified for future development in order to meet people's legitimate ambition to have a home of their own.

It is known that about seven per cent of the prison population have a learning disability, but historically very little has been done to support these individuals through the Criminal Justice System. Valuing People Now (DH, 2009) acknowledged that people with a learning disability within the Criminal Justice System should be included within the local implementation of the strategy. This article explores what has been achieved since Valuing People Now and what still needs to be done.

Prior to the launch of Valuing People (DH, 2001), Gordon Grant and Paul Ramcharan were appointed by the Department of Health as co‐ordinators of the Learning Disability Research Initiative (LDRI). The LDRI was a £2m research initiative, funded through the Department of Health's Policy Research Programme, linked to the implementation of Valuing People. The LDRI was brought to a conclusion in November 2007 with a final conference at which an overview report and accessible summary of the findings were launched (Grant & Ramcharan, 2007a, 2007b). In this paper we summarise the main findings of the LDRI with reference to Valuing People's main principles of rights, choice, inclusion and independence. In conclusion we consider how to build on the evidence base.

Following a series of inquiries and reports, health has become an increasingly high priority for the Valuing People Now programme and beyond, in local and regional health and social care systems. Programmes at national, regional and local levels are now in place and bringing the results described in this article, including health checks and the local self‐assessment framework, but much remains to be done to ensure that positive change is equitable and sustainable across and within the systems and continues to be driven by people with learning disabilities and their families. Changing current health inequalities will continue to require leadership at all levels.

It is widely known that a relatively small number of very expensive, often out‐of‐area, placements consume a relatively large proportion of the social care budget. Valuing People Now (DH, 2009) acknowledged that too often people are sent to expensive out‐of‐area placements. There is, however, little research in this area and no routinely collected information. In this collaborative piece of work between the Valuing People Now Team, the Challenging Behaviour National Strategy Group and the Tizard Centre we aimed to identify the characteristics of the highest‐cost placements in the South‐East of England.