I would like to thank the many BGS members whose hard work has contributed to improving services for older people over the last few years.

The NSF for Older People's Services has provided a stimulus for this in England, but I know that there have been substantial improvements in services in Scotland, Wales and Northern Ireland as well.

I recently published my report on progress in England, "Better Health in Old Age". Overall it points to improvements in life expectancy at 65, which in the last ten years has increased by about 1.5 years in men and 1 year in women, with reduced death rates from cancer, heart disease and suicide, reflecting national priorities in these areas. These pieces of data provide grounds for optimism for people who are approaching old age.

Community services
There is good data to show that services are also improving. Older people are taking advantage of opportunities to look after their health, with increased uptake of vaccination programmes, cancer screening, smoking cessation and exercise. A big investment in community services, including intermediate care and support for family carers is helping to reduce delayed discharge from acute hospitals. Services for old age-related conditions (stroke, falls, continence, cataract and joint replacement surgery) are steadily improving. Age discrimination is less pervasive.

However, I also point out in my report that there is a need to push on with all of the above and address a number of serious problems, including the development of old age mental health services, health inequalities and dignity on the ward. Furthermore, there is a threat that just as intermediate care services are shaping up, with good leadership and greater involvement of geriatricians, PCTs might be tempted to shift priority to investing in chronic disease management programmes. These will only work where there is access to specialist expertise and to intermediate care services.

Having drawn a line under the achievements and outstanding problems three years after publishing the NSF, now is a good time to take stock, and set out short and medium term priorities and plans for the next phase for reforming services for older people.

Short term priorities
My three short-term priorities are: working with the executive community to develop our stroke units, integrated falls services and the on-going development of intermediate care services.

In the medium term
In the medium term, plans are to ensure that older people's needs are addressed in mainstream programmes of work. There are ten areas of activity: the forthcoming Green Paper on adult social care, reducing mortality from cardiovascular disease, improving diagnostic capacity in osteoporosis, the redesign of emergency response for people with stroke, falls and acute confusion, improving mental health services for older people, improving dignity on the ward, developing specialist networks (complex care teams) for people with complex needs, extending best practice end-of-life care for people with cancer to older people's care more generally, refreshing NSF Standard 8 (Promoting Health and Active Life) and ensuring appropriate IT investment for the Single Assessment Process.

Acknowledgements
In these activities I am fortunate to have the support of fellow national directors: Kathryn Hudson (Social Care), Roger Boyle (Coronary Heart Disease), Sue Roberts (Diabetes), George Alberti (Emergency Reform), Louis Appleby (Mental Health), Chris Beasley (Chief Nursing Officer), David Colin-Thome (Primary Care), Mike Richards (Cancer), Fiona Adshead (Deputy Chief Medical Officer) and Harry Cayton (Patient Involvement).

In all of this work I am also fortunate to be able to work closely with the English Council of the British Geriatrics Society. I believe there are great opportunities for geriatricians to increase their influence on national policy and in service developments for older people, by showing how improving services for older people is the key to getting services right for everyone.

Ian Philp