Monitoring care quality is integral to modern health service delivery. This paper describes how a specialist mental health assessment and treatment inpatient service for people with intellectual disabilities put in place a process to improve and reprovide the service, following an audit, in partnership with local stakeholders. In describing the process the paper highlights the need for transparent and honest working relationships with stakeholders, along with the role of audit and monitoring of quality to determine the ‘health’ and effectiveness of services. This included evaluating the continuing need for service and maintaining an agenda driven by needs rather than beds, based on best practice.