Hilton's article is a clear and challenging description of the current state of play. ^{Reference Hilton1} I understand her declaration of interest – ‘I work in a trust where I perceive older adults’ services to be less well-funded relative to services for younger adults’ – has been deemed controversial by some. How can this be? She is simply stating her perception of things and that perception is congruent with the truth of the matter in every mental health trust in the country, andin every settingin which older people receive sponsored care. ²

Things were much worse before we created specialist services, when older patients were housed in 50-bed wards and received no therapeutic input. ² It was deemed they did not need therapy because they would not benefit from it. Yet older people and those of us who have worked with them have never shouted loudly for equality, preferring to make modest best-use of the resources made available to us.

I was astonished, when working for a while in a learning disability setting, to find that individuals with dependency and behavioural profiles quite commonly seen in old age services were regularly being supported with care-packages costing several times the top rate payable for older people with dementia.

Perhaps now is the time to ask for more.

Sadly, the Healthcare Commission's review ducks the issue, preferring to cite commendable examples of good practice and pursuing the line that age-related services should be abandoned. ^{Reference Hilton1} That should bury the problem and make it less visible – just as it was when we came in. ²