This report is the fifth in a series of reports prepared to inform the work of the King's Fund London Commission. It emphasises the diversity of London's older people, and highlights the fact that individual requirements for well-coordinated, patient-centred care are incompatible with the complex pattern of service provision in the capital. The multiplicity of administrative boundaries and poor standard of information and monitoring systems means that the care of older people with multiple, chronic conditions frequently falls through the cracks. This problem is heightened by a lack of leadership. Overall, older people's services remain a 'Cinderella' area. There is a conspicuous lack of a system-wide perspective, or of effective monitoring. The report examines primary care, hospital and community health services and social care. It raises disturbing questions about access to hospital treatment for older Londoners living in deprived parts of the city.