The NHS was attacked by its own boss yesterday when he called for a major change in elderly care away from hospitals that are "very bad places for old, frail people."
Sir David Nicholson, now head of the new NHS Commissioning Board, likened the situation facing elderly people in hospitals to the "national scandals about care of mentally ill patients" in the 1960s and 1970s.
He told the Independent newspaper a major change in care for the nation's ageing population was needed, suggesting new community-based treatment centres would provide the answer.
Mr Nicholson said: "If you think about the average general hospital now, something like 40 per cent of the patients will have some form of dementia.
"They are very bad places for old, frail people. We need to find alternatives."
But NHS union Unison has warned that a "chronic lack of funding" was standing in the way of delivering high-quality care for older people.
"Everyone deserves to be treated with dignity and respect - regardless of their age. And the overwhelming majority of NHS, home care and care home staff work hard day in day out to do the best for the people in their care," Unison leader Dave Prentis said.
Mr Nicholson disagreed, saying it wasn't the case that nurses needed to be more caring but a change in the model of care itself.
But of course this will cost money too. "We will be saying 'If that's the amount of money which is available, these are the sorts of things we will be able to deliver and these are the sorts of things that we can't.' That's a big change."
The NHS Commissioning Board takes over responsibility for all NHS services from the Department of Health in April.