This paper considers the doctor's role in unravelling the causes of abuse of older people. The author argues that doctors have a responsibility to understand and address the ageism, ignorance and unthinking which lies is at the root of most institutional abuse.

A report by the Commission for Health Improvement into alleged poor care provided the stimulus for the development of an audit tool in a strategic health authority to assess and improve systems and processes of care.

Can models be set in place to prevent neglect and abuse in inpatient settings from becoming systemic? This article suggests that they can, and describes how the establishment of multi‐agency forums within care teams can help foster working practices that are open, accountable and respectful.

The Commision for Health Improvement report on Rowan ward made for disturbing reading. But until recently the building where the abuse documented in the report took place had a proud history, described in this article.