The 2009 Equality Bill will, if enacted, make age based discrimination in the provision of health care and social care illegal for the first time in the United Kingdom. In a speech in 2008, the then health secretary, Alan Johnson, said, “Old age is the new middle age. Health and social care services need to adapt to the changing needs of today’s older people . . . to promote health in old age and help older people to maintain independence and quality of life.”1 People over 65 already account for more than 60% of hospital bed days and most expenditure on health and social care. In 2007 there were 8.2 million people aged over 65 in England and Wales, but this is projected to increase to 11.6 million by 2026—an increase of 46%—with similar projected rises in the prevalence of disability and dependency.2 Core users of health care will continue to be older people, many of whom will be frail, have long term conditions, and rely on support from social services or informal carers. A demographic shift in the ratio of retired to working people and multiple competing demands on health services and local government make …