This paper looks at the new challenges facing public services, taking health as a case study. Chronic disease presents a new and growing health challenge.This paper argues that reform to the health services currently on offer cannot address either the management of chronic diseases or the broader lifestyle issues that might promote better health. The authors argue for a new approach which they call co-creation since a set of new relationships between users, workers and professionals lies at its heart. Many of the seeds of this new approach can be found within the current system.