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Objectives: [1.] Inform European colleagues about current transformational changes in the organisation and delivery of care services in England to a vulnerable group of individuals with both intellectual impairment and multiple complex needs. [2.] Compare and contrast English strategic direction /policy with European Union commitments [3.] Stimulate debate on how such trends compare with the experiences of colleagues across Europe. Methods: Examination of key English policy drivers including: [1.] Valuing People Now (Intellectual Impairment). [2.] New Horizons (Mental Health). [3.] Putting People first (Social Care) against current European Union commitments Results: Review of the implications of: [1.] Demographic factors [2.] Economic considerations [3.] Diagnostic uncertainty [4.] Scandals as catalysts [5.] Personalisation [6.] People being cared for away from their home areas Conclusions: [1.] Cost, access and quality considerations are the priority areas under review. [2.] Though care systems vary enormously across Europe, public expenditure as a share of Gross Domestic Product is unlikely to increase in the short to medium term and this irrefutable fact will challenge strategic intentions and citizens’ expectations, especially in England. [3.] Both English and European Union strategic directions/policy contexts could be cynically viewed as being strong on principle and weak on implementation. [4.] There is a profusion and confusion of existing terminology. [5.] For individuals with intellectual impairment and complex needs and for their carers and families, what they all want is more choice, control and flexibility. [6.] Affected individuals in England appear more satisfied with the strategic direction than are their carers and families. [Copyright &y& Elsevier]