With the deregulation of services, people with learning disabilities are now looked after across a wider range of organisations and by a wider range of care workers than ever before. In these situations, the fresh observations and reflections of nursing students on practice placements can be particularly beneficial in discerning gaps between theory and practice, and identifying potential courses of action to improve services for people with learning disabilities. For example, it appears that some professionals, highly skilled in their own disciplines, remain uncertain when delivering care to individuals with learning disability. This is partly due to a persistently confused use of terminology when referring to learning disability, because terms and their meanings tend to vary between disciplines. The unintended consequences of suboptimal care point to the need for careful learning disability awareness training across disciplines and throughout provider organisations. The authors advocate a single vision of care with a shared language if the support and treatment of people with learning disability is to improve.