The need to manage such change is widely recognised – the NHS itself is in the middle of a
10 year reform programme, the ambitions of which are set out in The NHS Plan (Department
of Health 2000). There is growing recognition that existing perspectives, methods and
approaches (and the underlying theories that drive them) cannot be relied upon to deliver
the required change in the time and on the scale required (Bate et al, 2004). A key theme in
the exploration of such radical alternatives is the need to incorporate new elements and
perspectives in the frame and in particular to find ways to engage users much more actively