This article presents the authors' response to the invited commentaries on their paper (Wallace and Beange, 2008). On the point of "specialism", the authors emphasise a fundamental premise of their argument: the proposed "specialist" hospital-based service is inherently enmeshed within generic services at the hospital level, rather than being a separate entity. Its aim is to ensure that patients with intellectual disability (ID) receive the "same" quality of healthcare as that received by patients in the general population accessing generic hospital services. This means, for example, that if a patient with ID has a serious gastroenterological health problem which would normally require specialist attention, then access to the gastroenterologist in the hospital will be facilitated and supported by the specialist service. The authors are "not" advocating a model in which the specialist service would have its own gastroenterology service. Furthermore, in contrast to other specialist disciplines in medicine, such as a cardiologist who deals with diseases of the heart, the specialist in ID does not routinely deal directly with diseases of the brain. Rather, the specialist physician deals with those health conditions that are associated with the biopsychosocial circumstances of having ID. Thus, future research on the impact of such specialist health services should look towards evidence of the impact of specialist health services for other disadvantaged groups (such as the indigenous population), rather than their impact on cardiac mortality (where the evidence is overwhelmingly in favour of cardiac services).