The term ‘learning disability’ is a social construct whose defining characteristics change in response to political and social influences. Service provision has also had to respond to these influences. Recently, services for people with a learning disability have faced two potentially conflicting factors: the first is the belief that service provision should be shaped by ‘need’ rather than strict adherence to criteria (Scottish Executive 2000). The second, more pragmatic viewpoint, reflects increasing pressure on learning disability services to use scarce resources in the most efficient manner. The former stance leads to a broadening of criteria for accessing services, while the latter tends to lead to a greater adherence to learning disability criteria.