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This work is one of a series of reports into the organization and delivery of health and social care carried out by researchers at the Centre for Health Research and Evaluation at Edge Hill, Lancashire. This study investigated the utilization of health and social services by a sample of people aged 70 years and above on discharge from in-patient care and in the short period afterwards. The authors were concerned to explore how "active" users were during this process with reference to the principles of participation, representation, access, choice, information and redress. Two essential elements explored were the extent to which real opportunities were being provided for users to play an active role and their ability and willingness to assume such a role. Both qualitative and quantitative methodologies were utilized in order to provide sufficient breadth and depth to the investigation. The study revealed substantial evidence of a user-oriented approach to the delivery of welfare. It also demonstrates however that a number of areas remain in which it does not appear practicable to give priority to the wishes of the service user or for them to play an active role in their care.