Patients were "routinely neglected" at an NHS hospital after management became preoccupied with cost-cutting and targets, an independent report has concluded.
The Mid Staffordshire NHS Foundation Trust, which runs Stafford Hospital, lost sight of its responsibility to provide safe care, the damning report found.
The probe was launched into events at Stafford Hospital after another report last March from the Healthcare Commission revealed a catalogue of failings at the trust, which also runs Cannock Chase Hospital.
Appalling standards of care put many patients at risk, and between 400 and 1,200 more people died than would have been expected in a three-year period from 2005 to 2008, the commission found.
Inquiry chairman Robert Francis QC made 18 recommendations for both the trust and the government in his final report after hearing evidence from more than 900 patients and families.
But Julie Bailey, who founded the campaign group Cure The NHS after the death of her mother at the hospital, described the report as "absolutely outrageous", adding: "All he's done is recommended another independent inquiry."
Mr Francis, presenting his report at a press conference near Stafford, said: "I heard so many stories of shocking care. These patients were not simply numbers, they were husbands, wives, sons, daughters, fathers, mothers, grandparents.
"They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives."
He said evidence gathered during the inquiry into events at the trust between January 2005 and March 2009 had shown clearly that for many patients the most basic elements of care were neglected.
Patients were left unwashed, at times for up to a month, and food and drinks were left out of reach of patients, the inquiry found.
Mr Francis also identified a chronic shortage of staff, particularly nurses, as being largely responsible for the sub-standard care give to patients. He also said that while many staff did their best in difficult circumstances, others showed a disturbing lack of compassion to patients.
Mr Francis said: "The evidence gathered by this inquiry means there can no longer be any excuses for denying the scale of failure. If anything, it is greater than has been revealed to date.
"People must always come before numbers. Individual patients and their treatment are what really matters."
Health Secretary Andy Burnham said: "This was an appalling failure at every level of the hospital to ensure patients received the care and compassion they deserved. There can be no excuses for this.
"I am accepting all of the recommendations in full."
He added: "This was ultimately a local failure, but it is vital that we learn the lessons nationally to ensure that it won't happen again - we expect everyone in the NHS to read the report and act on it.
"These events were unacceptable and do not reflect the experience of millions of patients that use the NHS every day or the dedication and professionalism of the majority of NHS staff."
Mr Francis recommended that the Department of Health launches an independent examination of how regulators and bodies such as strategic health authorities monitor hospitals, with the aim of learning lessons about how failing trusts are identified.
The report found patients were left in dirty bedding and were caused "considerable suffering, distress and embarrassment".
It said: "Requests for assistance to use a bedpan or to get to and from the toilet were not responded to. Patients were often left on commodes or in the toilet for far too long.
"They were also often left in sheets soiled with urine and faeces for considerable periods of time, which was especially distressing for those whose incontinence was caused by Clostridium difficile.
"Considerable suffering, distress and embarrassment were caused to patients as a result."
The inquiry also found that the attitude of some nurses "left much to be desired".
It added: "Some families felt obliged or were left to take soiled sheets home to wash or to change beds when this should have been undertaken by the hospital and its staff.
"Some staff were dismissive of the needs of patients and their families."
The inquiry heard from 966 members of the public and 82 current or former members of staff at the trust.
The report said it was difficult to believe some of the lapses in care "could have occurred if there had been an adequately implemented system of nursing and ward management".
It detailed failings in hygiene, including razors being used on more than one patient, shared washing bowls and patients not having their teeth cleaned.
Some patients were also admitted to dirty rooms where the previous occupant had suffered diarrhoea caused by Clostridium difficile.
The report said the recording of patient falls was of "questionable accuracy" and there were issues with incomplete nursing records, inaccurate recording of times of death and sparse details of patients' medical histories.
It said the trust was too focused on meeting targets, in particular the four-hour waiting time target for A&E.
The study added: "A&E was chronically understaffed in terms of consultants and nurses during the period under review.
"There were frequent changes in management, which led to a sense of lack of leadership and support of staff."
While Mr Francis concluded that Stafford Hospital should not be closed, he did recommend that the Health Secretary reviews whether to remove Mid-Staffordshire's status as a foundation trust.
Announcing his findings, the QC said: "It is now clear that some staff did express concern about the standard of care being provided to patients.
"The tragedy was that they were ignored and, worse still, others were discouraged from speaking out."
The inquiry concluded that the trust's board - which exacerbated its problems by cutting staff when it was required to save £10 million in 2006/7 - was "disconnected" from what was actually happening in the hospital.
Mr Francis also said he believed some staff and managers at the hospital had attempted to minimise the significance of the Healthcare Commission report, rather than reflecting on their roles in the trust's deep-rooted failings.
Under questioning from journalists, Mr Francis refused to say how many unnecessary deaths he believed had occurred at Stafford Hospital.
"That this hospital had more deaths happening than other comparable places is undeniable," he said. "I am not prepared to put a figure on it. I don't think it's possible or helpful to put numbers on that."
The inquiry chairman, who said the failure at Stafford could not be laid at the door of any one individual, concluded his remarks by stressing that the NHS must put patients first.
"Statistics, benchmarks and action plans are tools, not ends in themselves. "They should not come before patients and their experiences.
"This is what must be remembered by all those who design and implement policy for the NHS."
The General Medical Council (GMC) said several doctors involved in Mid Staffs had been referred to it for investigation but would not disclose how many.
The Nursing and Midwifery Council (NMC) has also opened a case file and is investigating at least one nurse. It is also considering whether other nurses should be investigated.
Niall Dickson, chief executive of the GMC, said: "This is a distressing report that reveals significant failings at Mid Staffordshire Trust.
"The report highlights a number of very serious issues about the quality of patient care, including concerns about the conduct and performance of some doctors working at the trust.
"The medical director has referred several doctors to the GMC and we are working closely with the hospital to ensure that we have the information we require to investigate and, if necessary, to suspend or restrict their practice during the investigation."