A Staffordshire NHS trust whose standard of emergency care led to patients dying needlessly showed a "lamentable failure of clinical leadership", reports revealed today.
At least 400 more people died than would have been expected in a three-year period, at Stafford Hospital and two separate reviews into treatment at the trust found patients' views were not taken seriously enough and were too easily dismissed.
The reports by Professor Sir George Alberti, National Clinical Director for Emergency Care, and Dr David Colin-Thome, National Clinical Director for Primary Care, found "significant" improvements had been made at Stafford Hospital and judged that services in Accident and Emergency were now safe. But they revealed there was an urgent need to make further improvements to other services and to rebuild local confidence in the trust.
Health Secretary Alan Johnson said: "While much has been done to rectify these, the two reports indicate that work still needs to be done to ensure quality of care at the hospital reaches the highest standard.
"Swift and decisive action is being taken to ensure that is the case. Stafford Hospital was exceptional, not typical, but all those working in the NHS can learn from this experience so that such events do not occur again elsewhere."
Professor Alberti's review found that the A&E department, which had come in for the most damning criticism in the Healthcare Commission report last month, was now providing "safe good quality care".
He found there had been major improvements in the emergency department with extra consultants, improved nursing skills and training of junior doctors.
But the review found there were not enough acute surgeons working in each of the surgical specialities. Also equipment deficiencies identified by the Healthcare Commission report were still to be rectified.
There were also "too few" qualified nurses and efforts were needed to improve nurse training and morale, the report found.
Care for the elderly should be "enhanced at all stages of the patient pathway" he found and called for patients and the public to be included in discussions and decision-making.
The review called for a change in culture at the hospital. It stated: "The Trust's staff need to change from a 'make-do' culture to a 'can-do' culture."
Dr Colin-Thome's review criticised previous practices at the trust and pinpointed a lack of patient engagement across the board.
He said: "To have poor care throughout the entire emergency care service as occurred at Stafford hospital within the Mid Staffordshire Trust is wholly unacceptable and uncommon.
"For it to be undetected by any other NHS organisation is disturbing. To have no individual clinicians systematically raising concerns is also uncommon and to me hugely disappointing."
He said the main responsibility for the failures during the scandal lay with the management board and staff and he attacked local reporting systems that should have highlighted problems at the hospital.
He explained: "The Mid Staffordshire hospital trust demonstrated a closed culture with a lack of sharing of data and information that allowed poor care to continue undetected.
"The culture of providing poor quality care was therefore allowed to continue for a period of time unrecognised."
The Healthcare Commission slammed the trust in early April in a damning report, describing its emergency treatment as "shocking" and "appalling".
The Commission, which has now been replaced by the Care Quality Commission (CQC), will now review the trust's progress on recommendations made in the original investigation report.
Julie Bailey, founder of Cure the NHS, which is campaigning for a full public inquiry into Stafford Hospital, said she was "disappointed" by the report and stressed that improvements still needed to be made.
The 47-year-old, whose elderly mother died at the hospital in 2007, said: "George Alberti is saying that the hospital is safe. We were told that all last year by the Healthcare Commission when, in fact, it was not.
"This is what we have been hearing over the last two years. There is nothing different. We still need urgent equipment in the A&E department, we've still got problems with staffing and the culture of the hospital.
"How many reports are going to have to come out to get them to do what they have to do?"
Mrs Bailey said up to four people a week were contacting her regarding problems at Stafford Hospital, and she stressed the need for a public inquiry.
Eric Morton, chief executive of the Mid Staffordshire NHS Foundation Trust, said: "Professor Alberti's report states that many improvements have already been made at Stafford Hospital but much still needs to be done.
"The trust's board are aware of this and are totally committed to driving through our transformation plan."
The trust said it had employed additional nurses, matrons, doctors and housekeepers since January last year and planned to take on another 20 nurses.
The Healthcare Commission inquiry found that patients admitted as emergencies suffered due to serious lapses in care.
Families described "Third World" conditions at the trust, with some patients drinking water from vases because they were so thirsty and others screaming in pain.
The Commission launched an inquiry after concerns were raised about higher than normal death rates in emergency care, in particular at Stafford Hospital.
The trust argued the anomalies were due to "problems with its recording of data and not problems with the quality of care for patients".
The Commission launched a formal investigation last year, sifting through more than 1,000 documents and interviewing some 300 people.
It found deficiencies at "virtually every stage", including inadequately-trained staff who were too few in number, junior doctors left alone in charge at night and dirty wards and bathrooms.
Some patients were left in pain or needing the toilet, sitting in soiled bedding for several hours at a time, and were not given their regular medication. Receptionists with no medical training were left to assess patients coming into A&E.
The investigation found heart monitors were turned off on wards because nurses did not know how to use them and some patients were left dehydrated because nurses did not know how to work intravenous fluid systems properly.
The report also found that the Government's target for patients to be seen within four hours in A&E meant patients could be taken to "dumping grounds" to avoid breaching the target.
The reviews released today both made a number of recommendations. Dr Colin-Thome called for all organisations, and particularly PCTs, to ensure they were "focusing on the broader picture of improving health outcomes rather than solely on interim process measures and be held to account for improving outcomes through the Commissioning Assurance System".
He called for PCTs to increase their capability and capacity to review, interpret and use data, and said all patient safety and quality of patient care data collected should be made publicly available.
Prof Alberti called for a five-year strategy to be implemented by the trust and an urgent and emergency care board to be established. He asked for two extra A&E consultants to be appointed and that lengths of stay on the emergency admissions unit be limited to 48 hours.
He also requested that the number of nurses in the "emergency care pathway" be increased and the training of nurses and other ward workers be enhanced.