This discussion paper is about the provision of services for people with learning difficulties who may also be: blind or partially sighted; deaf or have partial hearing; physically disabled, epileptic, autistic, elderly, profoundly disabled or may show very disturbed behaviour at times. The paper deals with the philosophy or fundamental principles behind the service, consideration of the needs of individuals, the formation of individual plans and a section on the staff which considers staffing structures, staff support and specialist skills.