Commenting on the report from the Royal College of Nursing which examines the levels of care on older people's wards Jo Webber, NHS Confederation deputy director of policy, says driving improvements means tackling a complex range of issues.

She said: "We know that in too many cases, older people on NHS wards have been let down by poor care when they are vulnerable and most need help. This is truly unacceptable and we cannot allow it to continue. Getting care right for every patient, every time should be what every NHS organisation strives for.

“The answer however lies in tackling a complex range of issues in areas like culture, values and styles of leadership. Staffing levels may well be an issue in some parts of some hospitals, but we should avoid leaping straight to the simplistic solution that we need more nurses everywhere.

"The recommendations in this report mirror many of those contained in our recent Delivering Dignity report, which emphasised the need to empower ward sisters to take greater responsibility for setting high standards of care.

"There are factors other than staff ratios that are crucial to improving the care provided to older people. We need to look at the way we recruit and train staff so they have the right values as well as skills. We also need to trigger a major cultural shift in the way staff approach their work so they see the person, not the task. NHS organisations need to be much stronger in requiring staff to challenge practices they believe are not in the best interests of the people in their care."

On the issue of staffing ratios Dean Royles, director of NHS Employers, added:

“Mandatory staffing levels can not guarantee safe care. We do not believe that imposing a crude system of staffing ratios is the right way to tackle poor care. Each NHS hospital and service has different demands on its services. Arbitrary ratios could limit organisations' ability to plan care in a way that is best for the patient. The last thing we want is a minimum standard becoming a ceiling rather than a floor.

"Indeed the RCN's report says decisions about safe care should be decided by local organisations, giving greater control to ward sisters to plan safe staffing levels."