It is recognised that people with learning disabilities who also have a long-term condition or life-limiting illness are at a disadvantage compared to the rest of the population because they continually fail to access relevant care services. With so much negative publicity on known inequalities and the effects of poor outcomes (Mencap 2007, 2010, Parliamentary and Health Service Ombudsman (PHSO) 2011, Department of Health (DH) 2012), it has become increasingly difficult to ignore the specialist and complex care needs of this minority group. Consequently, there has been further development on strengthening the professional leadership in learning disability nursing and the developing role of learning disability nurses as specialists (DH 2007b, Gates 2007, Michael 2008). This article aims to explore the evolving role of the learning disability nurse and their unique contribution, specifically within the acute setting, and examines the nature of specialist nursing in practice.