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Britain's state-run health service is in need of a fundamental change of culture to restore public trust after patients at one hospital received appalling standards of care, an inquiry found Wednesday.
The chairman of the investigation, top lawyer Robert Francis, said the failings at Stafford Hospital in central England had revealed the need for major reforms across the whole of the National Health Service (NHS).
Data suggests there were between 400 and 1,200 more deaths than normal at the hospital between 2005 and 2008, but it is impossible to say whether these were caused by the neglect.
Stafford Hospital's managers focused on meeting government targets and cutting costs to the detriment of patient care, Francis said, with often elderly people left sitting in their own faeces for hours at a time and left without water or food.
But Francis warned that such a scandal was only allowed to continue for several years because of failures "at every level" of the NHS, as he laid out almost 300 recommendations to reform the system.
"The NHS is full of dedicated, skilled people committed to providing the best possible care to their patients -- there is much to be proud of about what they do for us," he told a press conference in London.
"However the service so valued in this country and respected internationally is in danger of losing public trust unless all who work in it take personal and collective responsibility to root out poor practice wherever it is to be found."
An earlier investigation by Francis, published in 2010, revealed standards of hygiene so low in Stafford that families were at times forced to remove used bandages and dressings from public areas themselves, sometimes even cleaning toilets.
It found patients forced to soil themselves because they were not helped to the toilet, and left unwashed for up to a month.
Food was left out of reach of patients and there was often no help for those who could not feed themselves, while some patients were so thirsty they had to drink water from vases.
Francis said his investigations had found a "lack of care, compassion, humanity and leadership" at Stafford Hospital, which led to the "appalling and unnecessary suffering of hundreds of people".
In the report, he said this was primarily caused by a "serious failure" at board level, where top managers failed to listen to patients or staff and to address an "insidious culture" of poor standards and a disengagement by clinical staff from managerial and leadership responsibilities.
But he warned that the system of agencies, regulators and professional bodies that are supposed to look out for such problems "failed in its primary duty to protect patients and maintain confidence in the healthcare system".
"The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed," he wrote.
Francis said the NHS needed a "patient-centred culture" in which staff across the board take individual responsibility for their work, with a "zero tolerance" approach to poor standards of care.
He said there needed to be more openness to acknowledge when things have gone wrong, calling an end to "gagging" clauses which punished whistleblowers.
Families of patients who suffered at Stafford Hospital welcomed the report.
"We wholeheartedly endorse that it must be the patient that comes first. The patient must be the first priority in all that the NHS does," said a statement issued by the Leigh Day law firm which is representing 120 victims and families.
"The NHS needs urgent reform to regain its position as a healthcare system which we can all be proud of."