The role of social work with vulnerable adults has changed markedly in many countries, including England and Wales following the 1990 NHS and Community Care Act. The basis for this paper is a small qualitative study of the social work role in helping people entering residential or nursing care in the independent sector following an emergency hospital admission in England (Phillips and Waterson 1997). This double transition is an under-researched area (Bywaters 1993; Downs and Crossan 1999). Furthermore, the literature on hospital discharge to date relates to developing policy objectives (Department of Health 1989, 1992, 1994a) or a critique of them (Pearson 1994; Cresswell 1994; Nazarko 1994) or the impact on practice, highlighting issues of inter-disciplinary cooperation (Rachman 1993; Higgins et al. 1994; Davies and Connolly 1995a; Clark et al. 1997; Healey et al. 1999). Until very recently, there has been much less about the users and carers perspective of the effects on the social work role in this area (Hardy et al. 1999; Henton et al. 1999; MacDonald 1999; Chesterman et al. 2001; Hellstrom and Hallberg 2001). The research findings review the core tasks of care management and point to a devaluing of the 'social' dimension, which had previously been the mainstay of hospital social work, and which is precisely what users and carers continue to value. Whilst this paper is written from a UK perspective, and focuses on a small study of an atypical area of work, this finding raises issues of wider interest to those concerned with the health and social care of vulnerable adults in a range of transnational contexts. It raises fundamental questions about the nature of contemporary European social work.