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As we reach the halfway point of 2008 we should reflect upon the year so far for older people. Is this a time for quiet celebration or frustrated pessimism? Older peoples issues do seem to be increasingly on the governments radar. Ivan Lewis has been a staunch supporter of The Dignity in Care campaign and whilst we all recognise it when it (dignified care) is not there I suspect that most of us are still struggling to find a good measure of its presence. Our clinical governance structures, especially reviewing complaints can offer some help in the measurement of dignified care. Of course, most of our departments will continue to struggle with the dignity agenda, whilst recruitment and retention of staff (medical, nursing and therapists) is a problem. We must continually remind our chief executives and Trust boards (in both acute and primary care) that they must invest in their core business older people. We must continually plead for equitable distribution of scarce NHS resources if two thirds of acute hospital beds are occupied by older people, of whom two thirds have mental health problems, then before new services are developed or expanded the Trust board must be sure that they are adequately providing for their main patient group.

It is still too early to judge the impact of MMC and MTAS on the uptake of Geriatric Medicine as a career. My own perception over the recent few years is that the drive towards an increasingly consultant led service in acute hospitals further undermines our ability to cross the boundaries between acute, rehabilitation and community work. Gone, probably rightly so, are the days of the geriatrician whose job description included each of these. Increasingly departments must look to a mix of geriatricians who between them provide input in to these three areas with leads for each. By working more closely with our colleagues in primary care, medical and surgical specialties to identify frail older people we can help protect them from the negative impact of health services (delirium, hospital acquired infections, adverse drug effects, etc) and hopefully improve the overall quality of their lives.

Duncan Forsyth