Low take-up of services among black and minority ethnic communities is still frequently explained as being due to ‘cultural’ and social preferences, despite evidence to suggest that users have little faith in services and lack support to use them. With poor representation at senior levels of the NHS workforce, black and minority ethnic users also emphasise the need for better training for all staff. Despite the importance given by the Department of Health to ‘choice’ and involvement, user participation remains an ambition rather than a reality for black and minority ethnic users.