Since 1990 policies on increasing the participation rates of disabled students have been successful in terms of recruitment although statistics hide inconsistencies between courses and programmes within universities and also between universities. Because of this relative success, attention has shifted to the quality of students’ educational experiences. This chapter explores the nature of the challenges in learning and teaching identified by staff and students. It considers five broad groupings of challenges and dilemmas: the nature of the subject and the design of the curriculum, the chosen methods of teaching and learning, the particular specific institutional context, personal dimensions, and the four Ds (defining disability, the Disability Discrimination Act [DDA], disclosure and dyslexia).