Doctors caring for elderly patients in hospital are being forced to prescribe water for them in order to ensure they have enough to drink.
Inspectors from the Care Quality Commission (CQC), the NHS watchdog, found nurses sometimes left patients so thirsty that the only way for doctors to ensure they had enough liquid was to add "drinking water" to hospital medication charts.
The revelation comes in the first reports from the CQC into dignity and nutrition of elderly people treated by the NHS, which reveals a failure to attend to the most basic requirements of care. The Health Secretary, Andrew Lansley, who ordered the reports, said the failings were "unacceptable".
Of the first 12 NHS trusts inspected, three failed to meet the essential standards required by law of respecting and involving people in their care and meeting their nutritional needs. Less serious concerns were identified in three further hospitals, giving a 50 per cent overall failure rate. The reports are the first of 100 inspections carried out, which are continuing. They follow a decade of investigations that have revealed an NHS riddled with ageist attitudes, in which elderly patients are neglected, poorly treated and marginalised. Shortage of money and resources is not the problem but rather, as the NHS Ombudsman said in a scathing report last February, an "ignominious failure" to look beyond a patient's clinical condition and respond to their social and emotional needs. A spokesman for the CQC said the 50 per cent failure rate was likely to be reflected nationally.
The worst offender was Alexandra hospital, Redditch, Worcester, where the CQC expressed "major concerns" about the failure to ensure elderly patients had enough to eat and drink. The Royal Free hospital in London and Ipswich hospital also failed to meet the standards required by law.
At Alexandra hospital, inspectors saw meals being served to patients who were asleep. Trays were left out of reach, patients were not offered help to cut up their food and one patient was seen trying to tear a tomato apart with their fingers. Nobody was routinely offered handwashing before or after eating. Although the trust said it offered a choice of dishes, one patient who declined a meal had it taken away without being offered any alternative.
Medical staff explained how they prescribed drinking water on medication charts "to ensure people get regular drinks". Inspectors saw examples of this being done and were told it "worked". Ward staff said they were aware of drinking water being prescribed and that this was done to "make sure people get enough fluids".
The reports on the 12 trusts also highlight how patients were not weighed, making it impossible to check if they were losing weight. Malnutrition is a major problem among elderly patients, affecting 185,000 discharged from hospitals in England in 2008-09, and the problem is rising.
Others were not treated with dignity, involved in their own care or were spoken to in a condescending manner. One man said hospital staff talked to him "as if I'm daft".
Mr Lansley said: "The inspection teams have seen some exemplary care, but some hospitals are not even getting the basics right. That is unacceptable."