This paper reports on an ethnographic study to explore the experience of dignity in the acute care of older people in four acute NHS trusts. It explores the prevalent view that acute care is not the right place for older people and the failure to acknowledge that the largest group of users are the very old, the frail and the dependent, which results in environments that are not friendly to older people generally, and are especially hostile to those with cognitive impairments. Added to this, a culture that is risk averse and defensive, where care is undervalued and where professional accountability and discretion are replaced by standardised checklists, pathways and audits, cultivates the attitude that if an aspect of care can't be measured it doesn't matter. Overall, getting the job done appears to matter more than how the job is done, so that the focus is primarily on the task rather than seeing the person. It describes how the failure of acute trusts to respond to the needs of the majority of their users - older people - results in the failure to provide dignified care and the impact of this on both the quality of care and patient outcomes.