The changing role of users and carers in the care system is examined. The four main user groups are identified as those with physical disabilities, learning disabilities or mental health problems and older people. The growth of the Disabled Living Movement since the 1970s has radically altered thinking and policy, but changes in practice have been slower. Normalisation theory has dominated service development for those with learning disabilities. Difficulties in implementing a care in the community policy for mental health are discussed. Service rationalisation is identified as a key factor facing older people. Their number and poor organisation in terms of pressure group politics have hampered the development of an ideological focus to service provision. The growing recognition of the value and contribution of carers is considered. The implementation of empowerment and consumerism models to integrate users within the care system is discussed.