There has been growing interest in modern times in people being able to play a more active part in their society, community and lives, as citizens, service users and patients. Such ‘user’ or ‘public/patient involvement’ has become a shared goal across all shades of politicians and policymakers. However it has become increasing apparent that some groups face many more barriers than others getting involved and this reinforces the difficulties that they may face and excludes their important perspectives from consideration. This report, based on a national research and development project funded by the Department of Health explores why some groups tend to be left out in this way and how they may be fully and equally included in the future. Using multiple research methods and engaging with a diverse range of service users from across the country, this report makes practical recommendations for the development of inclusive involvement in the future.