Poor care will ensue if managers impose a “command and control” culture that robs staff of authority to make decisions, a major report into the care of older people has found.

The Dignity Commission, set up by the NHS Confederation, Age UK and the Local Government Association in the wake of a highly critical report from the Health and Social Care Ombudsman last year, aimed to focus on the “underlying causes” of poor care of older people.

The commission has spent eight months gathering and reviewing evidence from around 40 organisations and held three days of public hearings last year.

In their report, published today, commissioners warn securing dignity is not just down to nurses and doctors. They say chief executives and hospital boards must run their organisations in a way that enables staff to do the right thing for the people in their care

The report calls on hospital boards to “embrace a devolved style of leadership” that respects the judgement of staff when they are the people working closest with older people and their families.

It also recommends maintaining the independence of older patients should be key measures of hospital performance and that staff be appraised for compassion as well as technical skills.

NHS Confederation chair Keith Pearson said: “Alongside the consistent application of good practice and the rooting out of poor care, we need a major cultural shift in the way everyone in care thinks about dignity to ensure care is person-centred and not task-focused.

“This will require empowered leadership on the ward and in the care home, as well as in the board room. It will mean changing the way we recruit and develop staff working with older people so they have the right values as well as skills.”

The report is being opened up to consultation until 27 March.