Societies based on market driven economies have deeply embedded value systems that inherently favour economically productive younger citizens and marginalise non-productive older citizens. Health services reflect the societies they serve. One manifestation of institutionalised ageism is overt and covert rationing of health care that discriminates against older people. This might be acceptable if the clinical outcomes of treating older people were inferior. However, the notion of age based rationing of treatment has become unsustainable and unethical as robust evidence has accumulated that shows comparable outcomes for treatment of older and younger people.

In England, decades of health service underfunding have provided an environment in which ageism has flourished—it is endemic.1 Whenever a clinical stone is turned over, ageism is revealed—for example, in cancer services,2 coronary care units,3 …