The purpose of this paper is to stimulate debate on how to define and enact public responsibility to children with complex health care needs and their families. We present a program, developed using the Auditor General's framework for accountability that involves Community Care Access Centres, schools and Saint Elizabeth Health Care, a complex care nursing provider. The case study illustrates how public responsibility was successfully enacted at a local level within existing policies for children with complex health care needs. There is no urgent need for policy to "catch up" with reality. Rather there is a need for the cross-sectoral development of programs that support policies.