This book examines the challenges in enabling people who are 'experts by experience' to participate in an agenda which is largely dominated by 'top-down' managerial practices. Several themes run through the book. The enactment of power is examined closely, as is the value of maintaining a grassroots approach, driven by the views of those with direct experience of health and social care services. Based on an unique collaboration between academics, carers and care users who have worked together on a project to develop the involvement of service users and carers in social work education, this book identifies practices that go beyond good intentions to bring about significant change. The contributors share their experiences of participation between people who care, people who use care services and those who provide care services. The values and skills for active involvement of carers and service users in the delivery of care services are discussed and contracted with participation models which merely function as management audit tools or as public relations exercises. The current climate of political and professional commitment to such service user and carer involvement is assessed and critically reviewed.