'Systemic failures' to blame for poor patient care, say health leaders In the worst hospitals are care homes, he said there was "a kind of normalisation of cruelty, where the unacceptable is legitimised and the callous becomes mundane." Today, Dr Carter and colleagues from organisations including Macmillan Cancer Support, the Royal College of Anaesthetists and the Florence Nightingale School of Nursing and Midwifery, acknowledge the scale of the task to eradicate poor care for the elderly. They say that "key areas" need to be changed to improve the situation - but pin the blame on the way hospitals work rather than staff themselves. They write: "The last year has seen a string of reports highlighting examples of inadequate care for older people in hospital. While there is much to be proud about within the NHS, sadly we know that patients on older people's wards are sometimes let down by systemic failings in our hospitals. Older people - who make up the majority of patients in hospital - must be put "at the centre of care" and given the opportunity to "make informed choices" about how they are treated, they say. And hospitals must have "a culture of honesty and openness that enables staff to raise concerns and challenge poor practice." One of the hallmarks of the Mid Staffordshire hospitals scandal, that led to up to 1,200 mainly elderly people dying due to sub-standard care between 2005 and 2009, was that staff concerns were often dismissed by managers. All relevant staff must be trained to care for older people, emphasise the letter's signatories, who also warn that there must be enough staff on duty to provide safe care. "Unfortunately, evidence suggests that older people in hospitals regularly suffer from a severe shortage of nurses and healthcare assistants," they write. The ratios of staff to patients on general wards - in which most patients are over 65 - are much lower than in others like paediatric wards. Nurses have complained that at times they are having to care for 15 patients. They also claim cuts to nursing numbers are affecting patients care: more than 7,000 nursing posts have been lost across England since the general election. Ministers claim that is because more care is being moved out from hospitals into other settings like GP surgeries and care homes, but the RCN is extremely worried that patient care is beginning to suffer. Mr Hunt wants more information on hospital standards to be available to patients, and last week proposed that an "Ofsted-style" rating system would be introduced to help end what he called the "crisis of care." Last night he said: "I want to drive up standards across health and social care - giving the public clear and transparent information about how their hospital or care home performs is an essential part of that."