This report states that patient and public engagement has been on the NHS agenda for many years, but the impact has been disappointing. There have been a great many public consultations, surveys, and one-off initiatives, but it argues that the service is still not sufficiently patient-centred. In particular, it looks at a lack of focus on engaging patients in their own clinical care, despite strong evidence that this could make a real difference to health outcomes. This paper argues that a more strategic approach is required to create the necessary shift in beliefs, attitudes and behaviours.