Many European countries involve the public in decision making processes as part of health systems governance.1 Moreover, the National Health Service is increasingly committed to promoting the involvement of the public in setting priorities and shaping policy and local services.2 In the accompanying ethnographic study, Fudge and colleagues describe how user involvement, directed by policy, was implemented in the context of a local stroke modernisation programme.3 The study suggests that professionals and service users understand and practise user involvement in different ways according to “individual ideologies, circumstances and needs,” which has implications for the interpretation and implementation of policy and practice. The study is timely, given that the Department of Health wants to enhance public participation in health and social care and strengthen the onus on public bodies to consult with local communities about changes to services.4 This will present new challenges for services.

So what is the evidence on user …