This introduction presents an overview of key concepts discussed in the subsequent chapters of this book. The book focuses the ethical considerations with specific reference to the age group under study. It traces the origins of 'participation' by users of public services up to 1979 to provide a historical context. The book explores ways in which users of public services have, since the 1960s, increasingly played an active role. It analyses social and economic circumstances of the elderly population of the United Kingdom. In December 2000 The Health and Social Care Bill reinforced the message that 'patients are the heart of a modern National Health Service (NHS)'. Emphasis was given to the introduction of competition into the provision of services along with other market-oriented principles with the ostensible aims of improving quality and 'getting closer to the service user'.