Public involvement is a key theme within the post-reform NHS, with an emphasis on involving people in healthcare decision-making, improving accountability to the public, and developing a stronger focus on the consumer. This text seeks to establish a framework for public involvement in healthcare. Focusing on purchasing, the authors describe the central factors driving involvement, and the organizational structures and processes which underpin it. Recommendations are made for the development of effective strategies for public involvement in healthcare purchasing. A discussion of current issues and debates is set within a wider theoretical and historical examination of the concepts of "citizenship and "accountability", detailing the role of the consumer in the context of the major changes in the organization and delivery of public services which have taken place in Britain in the last two decades.