The demographics are clear; the UK, like most of the ‘western’ world, is an ageing society. Since the 1930s in England alone, the number of people aged over 65 has more than doubled and today a fifth of the population is over 60. In 30 years from 1995 to 2025, the number of people aged over 80 will increase by nearly half and the number of people over 90 will double. The implications of these data, for the NHS and Social Services over the next 20 years and beyond, are reasonably predictable. In 1998/99 the NHS spent 40% and Social Services spent 50% of their budgets on the over 65s. These percentages will inexorably increase although not necessarily in direct proportion to the population change.

The National Service Framework for Older People,¹ published by the Department of Health in May 2001, is a policy paper which recognises this challenge. It describes a fairly high level strategy plus the principles that need embedding to ensure that the needs of the elderly are at the heart of NHS and Social Services reforms; reforms envisaged by the NHS Plan, published in 2000, and Modernising Social Services, published in 1998. …