This chapter analyses the programme for health and social care of successive Conservative administrations between 1979 and 1997 and specifically those initiatives which explicitly aimed to promote an active role for service users at the stage of policy implementation. It outlines the demographic and economic trends coupled with the changes introduced in the National Health Service (NHS) and Community Care Act. The chapter explores both the broad ideological and philosophical shift which has been apparent in the delivery of health and social care over the last twenty years. It presents the broad ideological standpoint and beliefs held by the Conservative government on ascension to power outlined provide a context for the subsequent policy initiatives implemented. The culmination of welfare policy throughout the period heralded a shift from care in the acute hospital sector to the community and from the secondary to the primary sector.