I recently experienced an interesting juxtaposition of two meetings. The first, with a self-advocateled organisation, was concerned with helping it to expand and make use of its work on three key issues: advice on parenting skills for parents with a learning disability, accessible information on health for people with a learning disability, and training in the use of accessible information. The second was with a group of senior service managers who were seeking advice on how to re-organise and restructure their service organisations. The question, to which this article will return, is which of those sets of concerns and actions had the potential for the greatest impact upon the lives of people with learning disabilities? © 2005, Emerald Group Publishing Limited