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Since Valuing People (Department of Health, 2001), there has been a marked change in landscape for housing support and service provision for people with a learning disability. Care and supported living options are now provided by a myriad of providers across the healthcare, social-care and independent sectors. Due to the complexity of such individualized care arrangements, and the non-traditional roles of such service professionals and providers, examination of professional role boundaries with service users is essential; traditional role boundaries are not easily transferable or considered within such professional supports and services. This article discusses important facets of professional boundaries that impact directly on such contemporary, learning disability, person-centred services.

The recent case of Jo, a Down's Syndrome child who was initially refused a heart and lung transplant (BBC TV 1996) has raised the issue of rationing health care. This article discusses the issues surrounding rationing and looks critically at some of the definitions and assumptions it is based upon. The historical and the future impact of various types of rationing upon people with learning disabilities is highlighted. The author argues that people with learning disabilities would benefit from a more explicit rationing system to enable decisions, made possibly on prejudiced grounds, at least to be challenged.