Tensions around service quality, levels of provision, management, the rights of patients and the role of the market raise questions about the identity of health service users. Are they simply patients in receipt of more or less adequate care, citizens exercising their social right to ‘free’ health care, discerning consumers or are such identities fluid and hybrid? This chapter focuses on the meaning and impact of ‘consumer’ identities in British health care by addressing three questions. First, has there been radical change in the portrayal of health service users within the narratives of policy since the early days of the National Health Service in terms of ascribed, possibly contested, identities? In a second respect, what evidence is there to suggest an accentuated ‘consumer’ consciousness on the part of health service users? And in a third regard, how might such change be explained and evaluated from a sociological perspective? An overview of relevant policies and examination of trends in relation to areas that include patient choice, complaints and litigation suggest that ‘consumerist’ aspects of the health service user can only be understood with reference to wider social perceptions and motivations around ideas such as trust, obligation and responsibility.