A fifth of NHS hospitals are breaking the law on care of the elderly, according to a new report, with two trusts given prior warnings still leaving patients without intravenous fluids and one incontinent patient left unwashed despite asking for help.

The study, from the Care Quality Commission found half of hospitals are failing to provide all-round good nutrition to elderly patients while 40 per cent do not offer dignified care.

Of 100 hospitals investigated in England, 49 were found to have minor, moderate or major concerns about nutritional standards for elderly people.

In two hospitals, Alexandra Hospital (part of the Worcester Acute Hospitals Trust) and Sandwell General Hospital (part of Sandwell and West Birmingham Hospitals Trust), inspectors had major concerns about the way people were fed and given drinks.

Another 15 hospitals resulted in moderate concerns and a further 32 were listed with minor concerns.

There were minor concerns about the dignity and respect provided to patients in 28 hospitals while a further 12 were told of moderate concerns in this area.

Overall, one in five hospitals was found to be breaking the law on one or both standards relating to dignity and nutrition.

Just under half (45 hospitals out of 100) were fully legally compliant with the standards.

Today, the CQC told how a follow-up unannounced inspection to Alexandra Hospital found its concerns have been addressed and the hospital is now meeting essential standards.

However, when CQC inspectors returned to Sandwell General, they found that, although standards on nutrition had improved, people’s dignity was not always respected.

Of two wards visited (the emergency assessment unit and Newton 4), patients praised the emergency unit but on Newton 4 “inspectors observed incidents including a person who had been incontinent remaining unwashed for an hour and a half, despite asking staff for help”.

The trust has now closed Newton 4 and replaced it with two separate units for acute stroke and stroke rehabilitation, while general medical admissions have stopped.

During a follow-up inspection to James Paget University Hospitals Foundation Trust in Norfolk, inspectors found patients not being given appropriate support to eat and drink and “that people in need of intravenous fluids did not have infusions”.

A warning notice has now been issued to James Paget calling for swift improvements. Prosecution or restriction of services could occur if improvements are not made, the CQC said.

The CQC found several “key themes” in hospitals that failed to meet the essential standard on dignity.

These included call bells being put out of the reach of patients or not responded to quickly enough, staff speaking to people in a “condescending or dismissive way” and curtains not being closed around beds when personal care such as washing was done.

Responding to the CQC report, National Voices chief executive Jeremy Taylor said: “How often do we have to hear about the neglect of vulnerable elderly patients? How many reports will it take?

“Hospital chief executives must wake up and take responsibility. Where we don’t start seeing improvements we should start seeing resignations.”