In November 2011, The King’s Fund invited academics, practitioners, policy-makers and representatives from patient and voluntary organisations to discuss the care of very old frail people with complex health problems. Mindful of the work of others (NHS Confederation, the Local Government Association and Age UK 2012; The Mid Staffordshire NHS Foundation Trust Inquiry 2009), we focused exclusively on what could be done to build the confidence of vulnerable older patients with complex needs and their carers in the quality of care in hospital and at home. This report summarises the discussion, including recommendations framed in relation to levels of authority in the health and social care system. The King’s Fund is very grateful to the trustees of Leeds Castle for making the summit possible and to summit members for their contributions.