Poll reveals public distrust of NHS governance

As Health Direct posts that the majority of British voters want an independent inquiry into the supervision of NHS hospitals today- over the rest of the week we will examine the chronic state of paperpushing, targets fixation and waste under labour’s maladministration.

An opinion poll by ICM Research found that 78 per cent of the public back our call, in conjunction with the Patients Association, for an independent inquiry into the supervision of NHS hospitals.

It comes as The Sunday Telegraph’s Heal Our Hospitals campaign has attracted pledges of support from more than 1,000 readers.

The call has been backed by Dr Phil Hammond, the writer and broadcaster, and by MPs from all three main parties.

Norman Lamb, the Liberal Democrat health spokesman, said “An independent inquiry is needed so that we can learn the lessons from this scandal.”

Nine out of 10 people per cent agree that nurses should focus on patient care rather than form filling, while eight out of 10 per cent want a review of hospital targets to ensure they work to improve quality of care.

Stafford’s former chief executive Martin Yeates was suspended on full pay following the scandal and could receive a generous pay off.

The poll also found that two-thirds of people want a stronger voice for patients in the running of their hospitals, following claims that local NHS watchdogs lack the power to hold chiefs to account.

Six out of ten per cent back the routine publication of comprehensive mortality rates.

It can also be revealed that Stafford Hospital is unable to give stroke patients and pregnant women vital scans over the week-end because of a shortage of qualified staff.

Patients presenting with a stroke on a Friday evening have had to wait 48 hours for a scan, thereby reducing their chance of a full recovery. Women suspected of suffering from potentially life-threatening ectopic pregnancies face similar delays.

In a blow to Labour the ICM poll found opinion evenly split on which party could be most trusted to run the health service.

The labour Government and the Tories polled 35 per cent each, despite Labour having long been regarded by voters as the party of the NHS.

One NHS campaign group warned that a repetition of the Stafford scandal was “absolutely inevitable”.

Geoff Martin, head of campaigns at the Health Emergency pressure group, said: “NHS Trusts are run as managerial fiefdom.”


Ten NHS trusts have worse death rates than shocking Mid Staffordshire

Ten health trusts have worse death rates than the hospital where at least 400 patients died needlessly because of “shocking and appalling” standards of care.

A damning watchdog report detailed a catalogue of failings at Mid Staffordshire NHS Foundation Trust, including dehydrated patients being forced to drink out of flower vases while others were left in soiled linen on filthy wards.

The scandal of poor care at Mid Staffordshire was only uncovered when unusually high death rates at the hospital triggered secret NHS alerts.

The Healthcare Commission has not investigated any of the 10 trusts that currently have worse scores than Mid Staffordshire, and the Care Quality Commission, which takes over from the Commission this week, has no plans to do so either.

Campaign groups and leading experts last night called for the trusts to be investigated. Professor Sir Brian Jarman, a former member of an inquiry into the deaths of heart patients at Bristol Royal Infirmary and an expert on Hospital Standardised Mortality Ratios (HSMRs), said routine investigations of high death rates could “undoubtedly” save thousands of lives every year.

Warning that some trusts were reluctant to admit failures because of a “blame and shame” culture within the NHS, he said: “Of course the regulator should be looking into these trusts, and others with high scores.

“It is important to work with these trusts to identify any possible failures and work towards improvements.”

The Sunday Telegraph’s Heal Our Hospitals campaign is calling for mortality rates to be published widely and in more detail.

Figures from Dr Foster, the independent health information firm, show that at the height of its problems, in 2007, Mid Staffordshire’s hospitals had the fourth highest rate of unexpected deaths in Britain.

The Trust had an HSMR of 127, meaning that 27 per cent more patients died than might be expected.

When the most recent annual figures were compiled last November, Mid Staffordshire’s HSMR score had fallen to 116.

By contrast, the worst death rate was at Basildon and Thurrock University Hospitals NHS Foundation Trust, in Essex, with a score of 132.

A spokeswoman for the Basildon trust said it had responded quickly to the finding by employing more doctors and creating a dedicated ward for cancer patients.

The second worst mortality rate, of 126, was at Wrightington, Wigan and Leigh NHS Trust, in north-west England, which has now launched an action plan to tackle the problem, including moves to treat more patients on specialist wards.

Andrew Foster, chief executive of the Wrightington trust, said: “We recognised what the figures were telling us and we are delighted with the progress we have made in reducing our HSMR and to have a sustained improved performance which we intend to continue.”

The other eight trusts whose mortality rates are worse than Mid Staffordshire – based on the most recent annual data from Dr Foster – are Blackpool, Fylde and Were Hospitals (123), George Eliot Hospital, Nuneaton (120), Swindon and Marlborough (120), North Middlesex University Hospital (119), Bolton Hospitals (118), Queen Mary’s Sidcup (117), Tameside Hospital (117) and Mid Cheshire Hospitals (117).

Since the data was prepared, Swindon and Marlborough has been renamed Great Western Hospitals NHS Foundation Trust and Bolton Hospital has been renamed Royal Bolton Hospital NHS Foundation Trust.

Health trusts are not obliged to investigate or act on their own HSMR scores, and many choose instead to dismiss high scores as statistical anomalies. All of the trusts contacted by the Sunday Telegraph insisted they had made improvements in the standards of care.

Campaigners warned that the scandal of Mid Staffordshire could be repeated unless high HSMRs were examined as a matter of course.

A spokesman for the Patients Association said: “We are amazed that trusts could have these high mortality rates and yet not automatically face any action. HSMRs are a blunt instrument but even a simple follow-up might uncover wider problems.”

Geoff Martin, of the Health Emergency campaign group, said: “There should be an investigation into these trusts and others with high mortality rates and the rates should be a matter of clear public record.”

Ben Bridgewater, a leading consultant cardiac surgeon and an expert on mortality rates at the Royal College of Surgeons, said: “You might look at 10 hospitals and find nine of them are actually doing a good job, but you would at least find the one that wasn’t, and that is surely the point of regulation.

“It is hardly ever the case that high mortality rates do not indicate hospitals where patient care could be improved. Publication of mortality rates was one of the recommendations of the Professor Ian Kennedy inquiry into death rates at Bristol back in 2001, and it hasn’t been achieved for reasons I don’t understand. This information is known within the NHS but hard for patients to find.”

Cardiac surgeons already have their individual mortality rates published but this is not the case for other treatments.

Ben Bradshaw, the health minister, hinted that the labour Government was reconsidering, saying: “I have asked the medical director to review available measures that can be used by trust boards and to accelerate their publication on NHS Choices.”

Professor Sir Bruce Keogh, medical director of the NHS, ruled out investigation of the 10 trusts with high HSMRs but said: “It would be irresponsible of trust boards not to investigate high mortality ratios.

“The HSMR is an aggregate measure of mortality for the organisation and hence a rather blunt, but useful, indicator of trouble.”

The Health care Commission launched its investigation into Mid Staffordshire after receiving seven alerts about potentially serious failures of care between July and November 2007.

The alerts, based on mortality for particular conditions such as kidney failure or stroke, are sent to trusts and watchdogs but not made public.

They are compiled by experts at Imperial College, London, led by Professor Jarman, under a system introduced in May 2007.

The investigation found that Mid Staffordshire managers failed to act quickly enough because they were convinced the HSMRs were incorrect.

It called for trusts in future to “conduct objective and robust reviews of mortality rates and individual cases rather than assuming errors in data”.

Professor Jarman added: “If HSMRs are acted upon promptly then undoubtedly thousands of deaths could be avoided. We are always open to hearing ways of improving the reliability of the figures, but for now high ratios are a solid indicator that something is going wrong.”

Andrew Lansley, the shadow health secretary, said: “The public has a right to know the extent to which patients benefit from treatment in each hospital, patients’ views on the standard of care they receive as well as the views of staff about how good a service the hospital provides.”

A spokeswoman for the Healthcare Commission said it did not agree that all high HSMR scores should be investigated. She said: “We would expect a trust that had a high HSMR to already have a sense of why that would be.

“It is not a matter of ‘forcing’ them – good managers generally have a sense of why their death rates are what they are. There are many reasons why a trust’s mortality rates may be high – that is why we do not use them in our annual ratings of performance.”


Lawyers use NHS as £100m cash cow

Lawyers are earning £800 an hour from the National Health Service and taking “indefensible” fees of tens of millions of pounds in legal disputes.

The money is coming from a labour government scheme intended to compensate patients for medical blunders and inadequate care, an investigation has found.

The compensation lawyers are claiming costs and “success fees” worth about £100m a year out of the scheme. In some cases the payouts claimed are 10 times more than the damages won by the patient.

Health professionals warn that it could get much more expensive. There is an estimated backlog of cases against the NHS amounting to £12 billion in claims, of which lawyers could get up to £6 billion.

The NHS Litigation Authority (NHSLA), which operates the compensation scheme, has lambasted the fees in a submission to Lord Justice Jackson, the judge. He is reviewing civil litigation costs.

The document warns that some “no-win, no-fee” lawyers are allowed to charge the NHS compensation scheme £804 an hour to pursue patients’ claims.

It states: “The whole costs structure is indefensibly expensive in relation to the compensation awarded or agreed. It is difficult to believe that it would be sustained were it not for the lack of motivation to change it.”

Mark Simmonds, the shadow health minister, said the huge fees being earned by the lawyers would be better spent on patient care. “It is unacceptable in some cases that the legal fees are many times higher than the awarded damages,” he said.

Bertie Leigh, a lawyer who defends the NHS in litigation cases, said he regards many of the cases he sees as a “buccaneering attack on the funds of the NHS”.

In one case involving Barking, Havering & Redbridge Hospitals NHS Trust, a legal firm claimed nearly £78,000 in costs and fees, having won just £7,000 for a female patient. A Liverpool firm submitted a legal bill for £4.4m for a single case.

The figures for 2007-8 show that more than one in four NHS trusts are paying out more in legal costs than in damages. The clinical negligence scheme paid £264m in compensation in 2007-8 of which £90m was in claimants’ fees.

Compensation lawyers say the success fees help to cover the cost of fighting cases they lose.


NICE U turn as kidney cancer patients to get Sutent drug on NHS

Terminal kidney cancer patients will receive an expensive drug on the NHS, following a U turn by the labour Government’s drugs rationing body.

The National Institute for Curbing Expenditure (Nice) has approved the use of Sutent, which costs around £27,000 a year, in its final decision yesterday.

But the body will turn down three other kidney cancer drugs insisting that they are not “cost effective” for the health service.

Nice sparked outrage in August last year when it initially turned down Sutent, claiming it was too expensive.

At the time patient groups and cancer charities accused the body of condemning sufferers to an “early death”.

The drug, which can prolong life for months, is used in the treatment of patients with terminal kidney cancer.

Since its initial draft guidance on the use of the drug Nice has agreed with the labour Government to look more favourably on drugs which prolong life when it makes it decisions.

This, coupled with an offer from Pfizer, the company which makes Sutent, to cut the price, means that the drug will be approved for use on the NHS.

Under the agreement, Pfizer will pay the £3,139 cost of the first six-week cycle of the drug, with the health service paying the rest of the costs.

Three other kidney cancer drugs, Avastin, Nexavar and Torisel, are expected to be rejected because the body has deemed them too expensive for the benefits they provide.

Around 7,000 people are diagnosed with kidney cancer in Britain every year and an estimated 3,600 could be eligible to receive Sutent.

Earlier this year it was announced that the drug, also called sunitinib, would be given to patients in Wales, paid for by the Welsh Executive, even before the Nice announcement.

Prof Robert Hawkins, Cancer Research UK Professor and Director of Medical Oncology at Christie Hospital Manchester, said: “I am delighted that Sutent will be available.

“It will remove a great deal of anxiety and uncertainty for people diagnosed with renal cancer to know that modern, effective treatment is now available to them.”

James Whale, from the James Whale Fund for Kidney Cancer, said: “Finally, we have justice for the kidney cancer community. This positive recommendation from Nice will allow thousands of kidney cancer patients in England and Wales access to this life extending treatment.

“The options previously available to us have been limited and are inadequate for the majority of patients. For some, sunitinib is the only hope.”


Health Direct asks how many people have been condemned to an early death by labour’s killer quango whilst it dragged it’s feet over spending NHS money?

NHS is killing patients with learning disabilities, regulators find

The National Health Service is failing people with learning disabilities, according to a report published yesterday on the deaths of six disabled patients.

Regulators blame hospitals and local authorities for “significant and distressing failures” that led to the six patients receiving inadequate care because of their disabilities.

Ann Abraham, the Health Service Ombudsman for England, said the findings suggested that a wider pattern of poor care for people with learning disabilities which was “an indictment of our society”.

Mark Cannon, 30, died after being admitted to hospital with a broken leg. Staff failed to give him any pain relief or to administer the correct medication to control his epilepsy. Renal failure and a severe chest infection were diagnosed only after considerable delays.

Martin Ryan, 43, starved for 26 days following a stroke because a feeding tube was not fitted and he was left too weak to undergo surgery.

Four other cases, all of which ended in the death of the patient, followed a similar pattern, with nurses and doctors accused of complacency or discrimination.

Families of the six put pressure on nurses and doctors to administer proper treatment, but were ignored and dismissed.

When they pursued their complaints formally, they were dealt with inadequately, leaving them “drained and demoralised”, the report says.

The six cases are the subject of a rare joint review by the by the Health Service and Local Authority Ombudsmen entitled Six Lives, which was published yesterday.

It has ordered a total of £120,000 to be paid to compensate the families for the distress caused in the care of their relatives.

Ms Abraham said that serious mistakes were made and ordered the NHS to overhaul its procedures for treating people with learning disabilities.


Labour’s health databases will break the law

The NHS detailed care record and the secondary uses service are among two public sector databases deemed “almost certainly illegal” in a report by the Joseph Rowntree Reform Trust.

The trust, which funds campaigns to promote civil liberties, warned that a quarter of public sector databases appear to fall foul of human rights or data protection law.

Privacy problems

The report, which assesses 46 databases from different labour government departments, says more than half of public sector databases have “significant problems with privacy or effectiveness and could fall foul of a legal challenge”.

The trust found that fewer than 15 per cent of the public databases assessed are effective, proportionate and necessary.

Red ratings

The NHS detailed care record and the secondary uses service are both given a red rating by the trust, signifying they is almost certainly illegal under human rights or data protection law.

The NHS summary care record is given an amber rating, meaning the trust believes it has significant problems and may be unlawful.

The report says databases rated as red should be scrapped or redesigned immediately. Amber databases should be independently reviewed.

The computer registers — including the DNA database, the national identity register, the Contactpoint child protection database and the health service patients’ register – all breach human rights and data protection laws, the Joseph Rowntree Reform Trust reports.

It argues that they should be scrapped or fundamentally redesigned to take privacy objections into account.

The report, whose joint author, an academic expert on privacy at Cambridge University who is one of the most respected in Britain, warns that ministers are planning to spend a further £100 billion on information technology databases over the next five years while only 30% of big information technology projects succeed.

Claims by the labour government that the databases make the provision of public services such as health easier are dismissed as “illusory”.

In fact, the giant repositories of personal data can expose people to greater risk, particularly the most vulnerable, the research says.

More than half the nearly 50 state databases have “significant problems” in protecting privacy, it adds. Only one in seven of the databases assessed by the study was “effective, proportionate or necessary”.

The report is the most comprehensive and damning study of the creeping culture of state surveillance.

It has been overseen by a team including Ross Anderson, professor of security engineering at the University of Cambridge’s computer laboratory.

Campaigners and opposition MPs say the rapid emergence of Britain as a “Big Brother” society is transforming the relationship between the citizen and the state.

One of the planned databases condemned by the report is a Home Office system to store information on every telephone call, e-mail and internet visit made in Britain.

Jacqui Smith, the home secretary, had been planning to announce the database in a bill last October.

She backtracked after officials in her department reportedly expressed concerns about the legality of the plan. Ministers had been planning to release a consultation paper on their plans in January.

This has now been delayed amid speculation at Westminster that Gordon Brown has ordered ministers to ditch all controversial and potentially unpopular legislation in the run-up to the general election, expected in 2010.

The report says Britain is alone among developed countries in the pace at which it is expanding national database systems.


Hospital was upgraded in spite of deaths

A Staffordshire hospital was granted flagship status despite providing such “appalling” emergency care that “there is no doubt that patients will have suffered and some of them will have died”, the health service’s quality watchdog said last week.

Alan Johnson, the health secretary, apparently failed to pass on patients’ concerns at a time when Monitor, the foundation trust regulator, was considering MidStaffordshire NHS Trust’s application to become a foundation trust.

The Healthcare Commission presented its findings as a success for its new data mining techniques, after unexplained death rates for emergency care at the hospital triggered concerns in 2007 that led to a formal investigation the following year.

But the case also raises questions about the commission’s previous assessment of the hospital, which rated Mid-Staffs’ quality of care as “fair” for the two years preceding its foundation trust application, but at a time when the commission now says patients were almost certainly dying as a result of poor care.

Between 2005 and 2008, some 400 more patients died than would have been expected on standardised death rates, although Sir Ian Kennedy, the commission’s chairman, stressed that without a detailed examination of all case notes it was impossible to say “how many of those died through bad care”.

The commission found untrained receptionists deciding the order in which patients were seen. There were also too few doctors and nurses as the trust cut staffing to create a surplus to boost its foundation trust application, an absence of essential equipment from infusion pumps to defibrillators, and some nurses turned monitors off because they did not know how to use them.

While the Healthcare Commission had growing concerns about Mid-Staffs from the summer of 2007, Anna Walker, its chief executive, said she had “no idea” that Monitor was considering the hospital’s application for foundation trust status, which was granted in February 2008. “I discovered by accident after they had taken the decision,” she said.

Monitor admitted that it did not speak to the commission during its assessment, instead relying on the commission’s published verdict that the quality of care was “fair” and accepting the local NHS view that the elevated death rates were because of “coding errors”. William Moyes, Monitor’s chairman, said it now actively consulted the commission, nationally and locally, and examined patient complaints when making assessments.

Julie Bailey, whose mother died at Stafford, in December 2007 founded a group to campaign about deaths and poor care at the hospital.

She said she had written to Mr Johnson highlighting patient concerns on January 5 2008, ahead of Monitor’s decision. A reply from his office had simply referred her back to the hospital, she said.


Children’s lives put at risk by poor care at specialist hospital

Children’s lives were put at risk by the poor standard of care at a specialist hospital, according to the second damning report into health provision to be published this week.

An investigation by the Healthcare Commission found that there was a shortage of beds at Birmingham Children’s Hospital NHS Foundation Trust as managers “struggled” to meet rising demand for treatment.

This meant that seriously ill young people were admitted late while others were sent to different hospitals miles away from their families.

Surgeons warned that theatre staff were poorly trained, handed them the wrong instruments and even knocked their hands during critical operations. In addition, managers failed to act when they were warned of the dangers by consultants, the report said.

Paul O’Connor, the hospital’s chief executive, resigned two weeks ago.

It comes just days after another report by the watchdog found that as many as 1,200 patients may have died needlessly at Mid-Staffordshire NHS Foundation Trust, as managers put targets and cost cutting ahead of care.

Describing the situation in Birmingham, Anna Walker, the chief executive of the Healthcare Commission, said: “While we have no evidence of serious incidents causing harm to patients, the standard of care has not been as good as it should have been in some cases.

“The response to safety concerns has been slower than ideal. It is deeply concerning that serious issues were raised but not properly or rapidly addressed over several months. While I would not say there were ‘third-world’ conditions, there were serious potential risks in the way care was provided.”

Birmingham Children’s Hospital is one of only four specialist hospitals for young people in England, caring for 140,000 patients in 2007-8.

Last year it was rated “excellent” for use of resources by the Healthcare Commission although only “fair” in terms of quality of services.

Senior staff at nearby University Hospital Birmingham NHS Foundation Trust met managers from the children’s hospital last June to discuss their concerns about standards of care.

They then wrote a highly critical report that was obtained by a Sunday newspaper under the Freedom of Information Act before it had even been seen by the children’s hospital, prompting the Government to order an official investigation in December.

The Healthcare Commission found that because of increasing demand for treatment at the hospital, average bed occupancy was running at more than 98 per cent.

This led to 28 per cent of admissions being cancelled on the day and 70 children a month being sent to other hospitals for treatment because there was no room for them in Birmingham.

The report said this is a “special concern” for patients with liver problems, who need to be seen urgently.

Many members of staff also warned it was “very challenging” to get access to operating theatres for urgent but not life-threatening cases. There are only two days on which neurosurgery sessions take place, meaning that children admitted after Wednesday have to wait until the following Monday for treatment unless they are put on the emergency list.

This situation was said to have led to several “near misses” and was a risk to patients.

The watchdog found that “almost all” consultants were worried that they could not use interventional radiology to diagnose patients because demand was so high.

Surgeons said theatre staff did not always know what instruments were required for operations, and sometimes consultants brought their own equipment because the hospital did not have it.

Leadership of the neurosurgical ward was said to be inadequate, driving nurses to resign.

The watchdog concluded that it was “deeply concerning” that serious concerns had been raised but not dealt with properly, causing “alarm and anxiety” among patients and their families.

It made 12 recommendations about how the children’s hospital can improve, including monitoring demand better and working on its relationships with consultants.


Ditherer Brown’s PFI U Turn

After a dozen years of wasteful, expensive over spinning and under delivering Stalinist Brown has created a new PFI process.

Seven private sector consortiums are to be given a form of quasi-monopoly on a potential £2bn-£3bn ($3bn-$4bn) market for building health centres, community hospitals and perhaps some local authority facilities.

The Department of Health is expected to announce the winners of the so-called Express Lift (local improvement finance trust) project soon in a move which could in time also open up more of the NHS’s community health services to competition from the private and voluntary sectors.

Under Lift projects, the private sector forms joint companies with primary care trusts – and sometimes local authorities – which finance, build and run GP surgeries and other health facilities. Contracts typically last for 20 years and the public sector owns a 40 per cent equity stake.

Some 47 Liftcos – which use some of the techniques of the private finance initiative – have so far been set up.

More than 220 buildings with a capital value of about £1.5bn are under construction or open, with more to come under the deals already signed.

Half of the country’s 150 primary care trusts, however, still do not have a Lift deal – chiefly those outside the big cities.

Under Express Lift they will be able to choose from the winners of the framework contract without the need for a full EU-style tender. The hope is to cut procurement time from a typical two years to a few months, massively reducing the costs and speeding up the programme.

Sir William Wells, a former regional health authority chairman, is now chairman of Ashley House, whose Odyssey Healthcare is expected to be one of the winners.

“We have been building these great palaces of PFI hospitals like they are going out of fashion, when in fact they are going out of fashion,” he said. “Even cancer care is now moving out of hospital and into people’s homes. This new approach should be far more flexible and – at a time when capital is going to be in very short supply – much more affordable for the NHS than PFI.”

Lift buildings typically cost £3m-£7m, and raising money this way was far easier amid the credit crunch than raising finance for big PFI projects, Sir William said. He added that in time Liftcos could take over a primary care trust’s entire property portfolio.

The National Audit Office has judged the Lift programme to have gone well, although MPs on the Commons public accounts committee have questioned the value for money and the rate of return Liftcos make.


Labour’s NHS targets may have led to 1,200 deaths in Mid-Staffordshire

NHS managers have been accused of putting targets and cost-cutting ahead of patients as a report found up to 1,200 people may have died needlessly due to “appalling standards of care” at a single hospital.

An astonishing litany of failings at Mid-Staffordshire Hospitals trust was uncovered by the Healthcare Commission in one of the most critical reports of NHS treatment ever published.

Last night there was concern from patient groups that managers who should have spotted the failings at the trust but failed to raise the alarm have now been promoted to key jobs in the NHS and healthcare regulation.

The investigation into care between 2005 and 2008 found overstretched and poorly trained nurses who turned off equipment because they did not know how to work it, newly qualified doctors left to care for patients recovering from surgery at night, patients left for hours in soiled bedclothes, and reception staff expected to judge the seriousness of the condition of patients arriving at A&E.;

Doctors were diverted away from seriously ill patients, in order to treat ones with minor problems, to make the trust look better because they were in danger of breaching the Government’s four hour waiting time target.

The trust – which was under pressure to save £10m from its annual budget – was more concerned with hitting targets, gaining Foundation Trust status and PR marketing and had “lost sight” of its responsibilities for patient care, the report said.

It is not clear how many patients died as a direct result of the failures but the Commission found that mortality rates in emergency care were between 27 per cent and 45 per cent higher than would be expected, equating to between 400 and 1,200 ‘excess’ deaths.

Sir Bruce Keogh, medical director of the NHS, described the failures as a “gross and terrible breach of trust” of patients.

Health Secretary Alan Johnson offered his apologies to patients and staff who suffered as a result and immediately ordered two more inquiries.

Patients of Mid-Staffordshire NHS Foundation Trust described one ward as a “war zone” and people were often left waiting in A&E; for hours covered in their own blood and without pain relief even though they had serious injuries.

Others were left without food or drink, some received the wrong medication – or none at all – and blood and faeces was left on lavatories and floors.

Trust chief executive Martin Yeates and chairman Toni Brisby both stepped down two weeks ago and Mr Yeates, who is paid a salary of £160,000, is suspended on full pay while an independent investigation is carried out.

But patient groups were angered that Cynthia Bower, who was chief executive of the West Midlands Strategic Health Authority – the organisation with responsibility for checking standards at the hospital – from July 2006, is to set to become the new head of the health super-regulator the Care Quality Commission.

Her predecessor David Nicholson at the forerunner of West Midlands Strategic Health Authority – which was Shropshire and South Staffordshire SHA – left in 2006 but is now the head of the NHS, as its chief executive.

Sir Ian Kennedy, chairman of the Healthcare Commission, said the report is a “shocking story” and that there were failures at almost every stage of care of emergency patients.

“There is no doubt that patients will have suffered and some of them will have died as a result,” he said. “Trusts must always put the safety of patients first. Targets or an application for foundation trust status do not lessen a board’s responsibility to its patients’ safety.”

The problems first emerged after the hospital was reported in 2007 to have high mortality rates among patients.

But the trust’s board of directors “fobbed off” NHS investigators by saying the rates were a result of statistical errors.

Yesterday the Healthcare Commission concluded this was not that case. The report stated that staff members claimed care of patients had become secondary to government-imposed targets.

The report said there was a “reluctance to acknowledge or even consider that the care of patients was poor”.

Nurses were threatened with the sack because of the number of breaches of the target to treat A&E; patients within four hours and felt they were “in the firing line”.

Patients in danger of breaching the target were put in a ‘clinical decision unit’ which was a “dumping ground” for patients in order to “stop the clock” on the waiting time.

Relatives came forward to report, nurses shouting at patients, staff failed to treat patients with compassion or dignity and respect, lack of help with meals or drinks, and failures to treat bed sores. One comapred the hospital treatment to the “Third World”.

A survey found two thirds of doctors would not be happy to have a relative of theirs treated at the hospital.

Director of the Patients Association Katherine Murphy said: “How can any patient have trust in the managers and systems that have allowed this disaster to run and run?

“It is not enough for the Chairman and Chief Executive to take the fall for this.

“Government targets have directly impaired safe clinical practice and money and greed for Foundation Trust benefits has taken priority over patients’ lives.”

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing (RCN), said: “There is also something very wrong when trusts are achieving foundation status by putting the health of their budgets over the care of their patients as detailed in the accounts of trust board meetings.”

Eric Morton, the new chief executive of the Mid-Staffordshire NHS Foundation Trust, said: “We would like to take this opportunity to offer our very sincere apology. We would like to reassure the local community that our focus is, and will remain, on providing high quality, efficient and safe healthcare for the people of Staffordshire. “

Professor Sir George Alberti, national clinical director for urgent and emergency care will now lead an independent review of the trust’s current A&E; services.