<p>It has long been recognised that good quality services for people with a learning disability offer a mixture of professional staff who provide primary care and specialist services with direct care staff supporting people in their homes and day placements. With the continuing development of provision for people with a learning disability, there are increasing demands made of the skills and knowledge base of direct care staff (Larson et al 1999). A typical role may now encompass direct personal care, education, skills teaching, support in daily living skills, facilitating relationships, monitoring health and managing behaviours which challenge.</p>