This paper discusses the results of a qualitative study of risk management for offenders with learning disabilities residing in low/medium-secure accommodation within an NHS hospital in Northern England. The study had two phases: first, 13 staff, including psychiatrists, psychologists, nurses and a social worker, were interviewed about their views on risk management at the hospital; second, 11 case studies, based primarily on interviews with patients, were undertaken. The study identified tension between an anamnestic approach to risk, predicated on the assumption that patients have a propensity to reoffend, and a rehabilitative approach, which attempts to bring about personal change. Reconciling these two approaches will require recognition of the limitations of risk analysis as a guide to the uncertain future.