Inspectors have raised serious concerns about the way some NHS hospitals treat older people.
Three health trusts have broken the law when it comes to providing older people with essential standards of care on dignity and nutrition - a quarter of those reviewed. There were concerns about another three.
The Care Quality Commission (CQC) published the first 12 reports from an England-wide inspection programme into standards of care at 100 hospitals.
Only half of hospitals were providing essential standards of care as set down in the Health and Social Care Act 2008.
At the Alexandra Hospital in Worcestershire, part of the Worcestershire Acute Hospitals NHS Trust, inspectors expressed “major” concerns about nutrition.
They found “meals served and taken to the bedside of people who were asleep or not sitting in the right position to enable them to eat their meal”.
Hot dinners and puddings were left for 15 minutes to go cold before staff found time to assist patients.
While guidelines stated people should be offered a choice of food, one person’s meal was taken away because they did not want it and no replacement was offered.
Staff said they sometimes had to prescribe drinking water on medication charts to “ensure people get regular drinks”.
One older patient was noted as malnourished on admission but they were not reassessed until 16 days later.
Patients were also not weighed when they should have been.
The inspectors concluded that patients were “at risk of poor nutrition and dehydration”.
At Ipswich Hospital NHS Trust, inspectors found patients left in night clothes all day and not always taken to the toilet away from where they slept.
Records were not always up-to-date and staff spoke among themselves when caring for patients rather than to the patient.
Staff reported being too busy and over-stretched to provide the care they wanted to, inspectors noted.
Some patients were put to bed at 6pm even though they did not want to be.
At the Royal Free Hospital in Hampstead, west London, inspectors found staff did not always make sure people had enough to eat and drink.
While many patients got help with eating, some did not and had their trays taken away, and staff rarely asked patients if they had enough to drink.
Food and fluid charts were often “inaccurate, not completed and not up-to-date”, inspectors found.
Less major concerns were found at Imperial College Healthcare NHS Trust in London, Homerton University Hospitals NHS Foundation Trust in London and the Wye Valley NHS Trust.
Six trusts met all essential standards: Clatterbridge Centre for Oncology NHS Foundation Trust, Wirral University Teaching Hospital NHS Foundation Trust, Countess of Chester Hospital NHS Foundation Trust, Mid Staffordshire NHS Foundation Trust, Plymouth Hospitals NHS Trust and Sheffield Teaching Hospitals NHS Foundation Trust.
A national report on 100 hospitals will be published in September.
All the hospitals that are the subject of concern must now tell the CQC how they intend to improve.
The three hospitals failing to meet essential standards could face enforcement action if they do not show improvement.
Jo Williams, chairman of the CQC, said: “Many of these reports describe people being ‘cared for’ in the truest sense.
“Sadly, however, some detail omissions which add up to a failure to meet basic needs - people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink.
“These are not difficult things to get right - and the fact that staff are still failing to do so is a real concern.”
Michelle Mitchell, charity director at Age UK, said some of the anecdotal evidence, such as medical staff having to prescribe water to ensure patients are hydrated, was “wholly unacceptable”.
Patients Association chief executive Katherine Murphy said the “tragedy of contrasting experiences continues unabated”.
The CQC report covered pensioners over the age of retirement.
The Royal Free said it was disappointed by the report, adding: “As part of the action plan, we are rolling out a programme of ‘nurse rounding’ which ensures that every patient is reviewed by a nurse at least once an hour to ensure their comfort and needs are met.
“A comprehensive staff training programme is being introduced which includes thorough training in documentation standards.”
Siobhan Jordan, director of nursing and quality at the Ipswich Hospital, said it was also disappointed by the findings.
“The trust is working with families and carers to work in partnership with the hospital to maintain independence and encourage rehabilitation, asking family members to provide clothes for patients to wear,” she said.
Sir Keith Pearson, chairman of the NHS Confederation, said: “We in the NHS cannot tolerate the failure to meet minimum standards in any way, shape or form.”