Assessments of need carried out so far have concentrated on single diseases or interventions rather than care groups or on people who have multiple pathologies. We therefore began a needs assessment for older people in a central London health authority. The health district--then called Parkside--covered 25 square miles in north London and had a resident population of 432,600 people, of which 7% were aged 75 years and over and 2% were aged 85 years and over. Estimates of the number of people with different disabilities and diseases were calculated using data from the General Household Survey, the office of Population Census Survey (OPCS) Disability Survey or other national or reliable surveys. Although the majority of older people were well--indicating a need for health promotion and disease prevention--we estimated the number of disabled older people in the district was in excess of 25,000, with the most common types of disability being those concerned with locomotion, hearing and personal care. Using data from the OPCS survey we were able to estimate there were 7328 people aged 75 years and over who were in the OPCS top five severity rating, which would mean that they probably required services. For mental health we estimated there would be approximately 6000 older people suffering from clinically significant depression, 6000 older people suffering from anxiety, and between 2740 and 4441 suffering moderate to severe dementia. A next step is to match an assessment of the prevalence of disease and disability, with an estimate of that being served locally.