'Care and compassion': why does it go wrong?

This editorial is in response to Care and Compassion, the latest report published by the Parliamentary and Health Service Ombudsman (2011). The report identifies and discusses ten separate investigations following complaints regarding the care of older people within the NHS. Each account provides a unique story of the experiences faced by older people and their families during a period of ill health. Ann Abraham, Health Service Ombudsman for England, highlights that prior to this, each of the individuals referred to in the report led full, worthwhile lives, valued by themselves, their families and friends. Each case paints a disturbing picture of the consequences when things go wrong in the management and delivery of health care for older people whilst in hospital, during discharge and following discharge into the community. Unfortunately nine of the ten patients within the report died during the events outlined. It is essential that health-care staff learn from such incidents to improve service and care provided to individuals.