The Health Act 2009, section 2 requires health bodies, including the Care Quality Commission (CQC) as the key regulator of the health and social care sectors to have regard to the National Health Service (NHS) Constitution. It is important not to reinforce ageist constructs which align growing older with vulnerability and frailty or alternatively with independence and an impossibly vigorous self-reliance which requires older people to fight rather than celebrate their changing bodies. This chapter assesses the extent to which state provision has been able to ameliorate the effects of inequalities generated over life courses in older age. Ageing tends to deplete the social, economic, and political capital of those who need and provide significant amounts of care. The chapter shows how the present market which depends, to a large extent, on public funding is failing to provide decent services for all. It argues that the market is developing in ways that suggests that inequalities will deepen as consolidation increases.