An analysis of organisational culture of health and social care services shows that policy ideals do not always match the reality of daily practice, for example when people with learning disabilities are not included in decisions about their care. Ensuring that services adopt more person-centred approaches often requires cultural change, which in turn requires leadership, staff education and collaboration. These tasks can be difficult and managers may have to offer rewards and impose penalties to improve culture and practice in their organisations. Their goals should be shared, specific, measurable, achievable, realistic and carefully timed, and continual monitoring and evaluation may be needed to sustain progress. Cultural change achieved in this way should be ultimately cost effective.