Rooting out age discrimination is the latest NHS priority, and Ian Philp is charged with spearheading the drive.He talked to Carol Harris about life after the national service framework

'Elderly people are infantilised by society and in the NHS, and that means they have to put up with gross infringements of dignity.We have older people lying in their own excrement and urine, and they are not involved when decisions are made about whether to resuscitate them.'

Professor Ian Philp, national director for older people's services - or czar for elderly people as he is less formally known - argues that with many policies based on age, the NHS is 'no worse than society generally but no better either'.

So maybe it is no accident that the first priority of the national service framework for older people is 'to root out age discrimination'.

Professor Philp believes changing attitudes will remove barriers to providing good services.

'But there is an enormous amount of good practice, too, and the framework emphasises spreading, across the entire service, the good practice that we know goes on now, so we level up to the best.

'Stroke units are one example - if 40 per cent of the country can provide good stroke services, then the rest of the country can, too.

'We are saying that there must be no age restriction limiting access to services.We want older people to have equal access to mainstream facilities such as smoking cessation programmes and cancer services and exercise programmes.'

That said, he also wants services such as flu vaccinations targeted at older people because they are more vulnerable, which must have an adverse impact on providing other services.

But extra money attached to the framework - the£120m to replace large 'Nightingale wards' already announced in the Budget - is likely to fall a long way short of what is needed to meet the projected increase in demand for services from an ageing population that will grow by a third in the next few decades.

'Look, we are doing nothing less than re-designing the NHS for the 21st century through the frameAN IL Y works, ' he says. 'Older people use about half the healthcare and social services in the UK. If we get it right for older people we get it right for everyone.

'The extra money itself is not enough. The funding issue is also about what we do with the money already in the system as well as the fairly substantial increase already promised.'

Professor Philp argues that a holistic approach will be crucial to improvements for services to people of all ages.

He is also enthusiastic about the demands within the framework to address inequalities for older people from ethnic minorities.

'Assessment procedures should integrate people's own views and priorities.

'I want people who work in hospitals as interpreters to become advocates for the older person, and standards to be set which integrate people's own views and priorities.'

Sensitivity to different cultural needs is embedded in the framework - not one size fits all.

'But so much is down to leadership and priorities. We have to look at this in terms of leadership, resources and workforce commitment.'

And Professor Philp refuses to be scared off: 'It is challenging, but do-able. We cannot define a narrow territory. We have to take it head-on.'

He sees the local strategic partnerships as the big change. 'Multicentral working is the tricky part.

But this is the first opportunity to integrate health and social care, transport, housing - just about every aspect which is needed to make people's lives better.

'Many of the changes will be catalysts which have an impact on the whole system. It is like judo, where you use the size and strength of the person to make them go in a particular direction.

'We want the sheer size of the NHS and its structure to be the means to make changes which have an impact throughout the whole system.'

An age-old commitment While he was a student, Ian Philp was keen on a holistic approach to medical practice but found it integral only to paediatric and geriatric medicine.

His first job was in his native Scotland in Edinburgh, where he worked with Professor Jimmy Williams.

'He was inspirational - his services for elderly people were fantastic, and I realised after a while that they were not typical of services everywhere, 'says Professor Philp.

'A really important thing he told me was to ask old people how they feel about dying.It is something health professionals often avoid or see as unimportant, but it is something older people have thought about and faced up to.

'It is not that they want to die, but they know it is going to happen and want to make it a good death.

'I really believe that the spiritual and social needs of our patients are as important as the physical ones and we must, as professionals, support them in those ways.

'My grandfather was a role model for me, too.He died of lung cancer and I was a junior doctor in the hospital where he spent the last few weeks of his life, so I was living and working very close to him and realised how important that was for us.'

Professor Philp was appointed professor of healthcare for the elderly at Sheffield Institute for Studies on Ageing nine years ago at the age of 33 - despite a far from orthodox academic career.'I went into general practice for a stint because I wanted to understand how care was organised, 'he says.'It taught me a great deal about areas such as dementia care, about support for carers and how to look at services from the point of view of the patient.'

A framework to boldly go forward The principles enshrined in the framework have met a positive response.This is despite the fact that the document comes almost exactly one year overdue and with little new funding attached.The bulk of the measures within it build on commitments made in the NHS plan and funds promised in the Budget.

Age Concern England has been holding its breath since November 1998, when then health secretary Frank Dobson promised a framework by April 2000.

Nonetheless the charity describes the result as 'a great leap forward'and its anti-discrimination measures as 'bold'.

These centre on an audit of all age-based policies to be carried out by October 2001 and an analysis of services so that benchmarking can be in place by the following October.

The principle has been widely applauded, although Dr Andrew Dearden, chair of the British Medical Association's community care committee, warns that rights for elderly people could lead to a 'backlash', with younger people losing out on services.

That is not the way czar for elderly people Professor Ian Philp sees it - he believes tackling care of the elderly will improve general services across the NHS.One thing is for sure, older people make up a large part of the traffic in hospitals and primary care.

And even Dr Dearden doesn't think it will be difficult in practical terms to eradicate age discrimination from access-to-treatment decisions.He says: 'Age is simply another factor to consider like general health, build and so on.'

The timetable has also caused alarm.The targets are laid over five years - but it 'sounds like a 10-year implementation programme', warns Janice Miles, NHS Confederation policy manager.

National service framework for older people. www. doh. gov. uk