Care for older people needs a fundamental shift towards caring for them in the community rather than hospitals that are “very bad places”, the chief executive of the NHS Commissioning Board has said.

Sir David Nicholson likened the situation facing older people in hospitals to the “national scandals” of the 1960s and 1970s surrounding the care of mental health patients.

Sir David told the Independent newspaper that a revolution in care for the UK’s ageing population was needed, and said new community-based treatment centres would be key to the changes.

“If you think about the average general hospital now, something like 40 per cent of the patients will have some form of dementia,” he told the newspaper.

“They (hospitals) are very bad places for old, frail people. We need to find alternatives.”

Sir David also said that preventing falls and managing long-term conditions was a priority, as was treating common conditions in the community, and said money would be spent to keep patients with dementia out of hospitals.

He said: “The nature of our patients is changing - and changing rapidly. You are getting a larger and larger group of frail, elderly patients who are confused.”

He likened the change in elderly care to the shift in attitude towards mental health patients half a century ago, saying: “I would compare it with where we got to with the big asylums.

“If you remember what happened in the 1960s and 1970s, there was a whole series of national scandals about care of mentally ill patients.

“The response was not just to say that the nurses who looked after these patients needed to be more caring, but actually there was something about the way we treated these patients and the model of care that needed to change.”

The NHS Commissioning Board takes over responsibility for all NHS services from the Department of Health in April, and will be accountable to Parliament but not Health Secretary Jeremy Hunt.

Sir David said the commission would be prepared to question ministers over NHS budgets, and said it would inform the public how much the NHS believed it needed to spend to improve life expectancy and keep waiting lists down.