I suppose it is human nature to try to focus on the feel-good sides of life and shield ourselves from difficult or unpalatable realities.

But being responsible for people's health needs makes us face up to to the tougher sides of life, such as trying to tackle health inequalities.

In my opinion, there is no more difficult task - for managers or frontline staff - than looking after the welfare of people with learning difficulties. Those who do so with proper commitment, composure and compassion will always have my admiration.

Even though advances have been made in care and services, we do not always get it right. This is not, in the main, by intent or design. But what we did yesterday with high aspirations can, in the current context, be seen as out-dated or inadequate.

Supported living

Supported living services for people with learning disabilities are currently a major concern of ours - and so they should be. Such services do not get many public pats on the back and are not easy to run, for staff or managers. Failures are often highlighted, whereas the day-to-day commitment and successes often go unpraised.

One thing is for sure: these services are important to the clients, their families and our staff. Supported living is an issue we are grappling with right now, along with many other commissioners and providers of such services.

In the 1980s, I played a part in the process of closing down the traditional long-stay learning disability hospitals in East Lancashire. The intent was to return clients to the community in appropriate settings. It largely worked, based on individual plans, local services and money following clients out from the institutions. Does that sound familiar?

Policy shift

The government's white paper Valuing People gave us a new way forward, with the most comprehensive policy and guidance in nearly 30 years. This has been updated recently. The key principles of adult clients having rights, independence, more choice and social inclusion were emphasised - but did we ever quite reach our top-line goals?

Some services were better than others, and as traditional health commissioners and providers, our models were understandably biased towards health and not based on social care in the fullest sense.

Today, there are a range of providers scarcely seen 20 years ago, such as not-for-profit service providers from the voluntary sector. Their social care models show us there is another way forward.

Way forward

For many compelling reasons, we have chosen to embrace this type of provision. This will allow us to concentrate on what we do best in the health-related arena and give service users more independence and choice in their lives. The aim is to bring the service into line with best practice and with individual rights and choices.

Of course, there are anxieties and questions from clients, their families and staff. But we are endeavouring to include everyone in the process, with firm pledges that everyone will be supported throughout any possible changes.

We know we have moved on a quantum leap from the iniquities perpetrated in the 19th and much of the 20th centuries, but the process of seeking improved provision goes on. It is nearly 20 years since we closed the large institutions, hidden in rural locations away from the community gaze.

We moved on to better provision, better facilities and, in most instances, to better care in the 1980s. Now is the time to make another move forward, giving clients even more dignity and choice through a modern, social care model that is appropriate for their needs. We owe it to them to do so.