The idea that the relationship between professional workers and communities and citizens should be one of equality is recent and remains novel to many in health care. The Eldon Street Association (the Eldonians) in Vauxhall, Liverpool UK can trace its origins to the refugees from the Irish potato famine of the 1840s; for over 150 years they have endured the worst health statistics in what was the first city of the British Empire. The worm finally turned in the late 1970s when the city council decided to forcibly remove the remaining inhabitants from their degraded housing conditions. This community organised itself, fought back, and reached new heights of self determination wherein professionals from a range of disciplines were only allowed access to partnership on democratic terms. For too long, they had felt exploited and abused by professionals who came in and stayed long enough to achieve the necessary experience for the career move, while being paid handsomely and usually leaving little of enduring contribution to the community.

In the ensuing 20 years, this community has taken charge of its own housing, employment prospects, education and training, environment, recreation and health, and social care.