In this article, the author comments on the paper "On the need for a specialist service within the generic hospital setting" (Wallace & Beange, 2008), which raises critical issues regarding effective models of healthcare delivery for individuals with intellectual disability (ID), particularly within a hospital setting (but not necessarily limited to that setting). The problem, as well as the solution proposed in the paper, address both broad and very individualised questions about effective models of healthcare delivery for this population. The creation of a supportive specialised unit within a generic healthcare environment can be viewed as an ethical and philosophically sound response to principles of normalisation and a desire for inclusionary models of healthcare. It can also be viewed as a pragmatic way to maximise the impact of scarce specialised resources. As the extensive literature cited indicates, reaping the benefits of medical advances on behalf of individuals with ID has often resulted from a push towards increased civil rights and a reduction in patterns of discrimination, especially in healthcare. There have been fewer examples of promoting structural change in methods of healthcare delivery. This author contends that the structural change advocated in the paper focuses on the attainable within a defined context, while also stressing the potentially critical impact on the healthcare experience of a very vulnerable population. The specialised consultation role proposed by Wallace and Beange would minimise the need for change in other areas of the healthcare system, whether within the hospital setting or within the wider community care environment, in order to achieve measurable success. However the success of this model should provide the impetus for broader systemic change.