The paper presents the main changes that have been introduced in the English Ltc system in the last two decades. After a general description of the structure of the long term care system as it has historically developed in England in the last 50 years, the essay addresses the main changes that occurred as a consequence of the 1993 community care reforms and of the following new programmes that have been introduced after that, aimed at empowering consumer choices, at better recognising the rights of disabled people, and at offering a new cash for care programme. Finally, a review of the role played by social and institutional actors in the revision of the system is presented.only subscribers can see the full article