This commentary discusses whether a sufficient case has been made for specialism in hospital services as a viable alternative to existing generic services. The impact of developments in specialist care such as those outlined by Robyn A. Wallace and Helen Beange should be assessed as a means of reducing inequality. In particular, model services require assessment for reproducibility. However such developments do not negate the need to also strive to improve generic care. Indeed they cannot, for as things stand, there is no workforce planning to produce such specialists, so they will continue to be important isolated islands of skill, as well as focuses of leadership and quality development. This author contends that Wallace and Beange have raised an issue of importance to people with intellectual disability (ID) and those who work with them, if equal outcomes are indeed to be achieved. It is an issue that needs debate, and a debate that needs to occur quickly, lest an inadequate and inequitable status quo is simply maintained.