Britain's state-run health service needs a fundamental change of culture to restore public trust after patients at one hospital received appalling care, an inquiry found Wednesday.
Elderly patients at Stafford Hospital in central England were left in soiled sheets for hours, unwashed for up to a month at a time and deprived of food and water to the point that some resorted to drinking from dirty flower vases.
Top lawyer Robert Francis, who led the public inquiry, said he had unearthed a "lack of care, compassion, humanity and leadership", which led to the "appalling and unnecessary suffering of hundreds of people".
Data shows there were between 400 and 1,200 more deaths than normal at Stafford Hospital between 2005 and 2008, but he said it was impossible to say whether these were caused by the neglect.
Prime Minister David Cameron said the scandal went to the heart of the public's faith in the NHS, a vast cradle-to-grave system of healthcare which has been free at the point of use since its creation in 1948.
The inquiry placed most of the blame on Stafford Hospital's management board, saying managers focused on meeting government targets and cutting costs—resulting in severe staff shortages—to the detriment of patient care.
But Francis said the scandal was allowed to continue because of failures "at every level" of the NHS, noting that a plethora of professional bodies and regulators had failed to raise the alarm.
"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."
In a statement to parliament, Cameron said he was "truly sorry" for the way the system had allowed "this horrific abuse to go unchecked and unchallenged" for so long.
He said he had a "deep affection" for the NHS, which played a prominent role in the opening ceremony of the London Olympic Games last year, but lamented: "This precious principle of British life was broken in mid-Staffordshire."
He announced a new post of chief inspector of hospitals and said regulators and professional bodies would be questioned on why no nurses or doctors had been sanctioned, or any prosecutions brought over the scandal.
Among its 290 recommendations, the inquiry proposes new "fundamental standards" of care which should be enforceable by law.
An earlier investigation by Francis in 2010 revealed standards of hygiene so low in Stafford that visiting relatives took it upon themselves to remove used bandages and dressings from public areas and even to clean the toilets.
On Wednesday, the lawyer 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 and called for an end to "gagging" clauses which punish whistleblowers.
Professional bodies largely welcomed the recommendations, while the families of patients who suffered at the hospital backed the focus on patients.
However, some campaigners were not satisfied.
Julie Bailey, whose mother died at Stafford Hospital in 2007, said she wanted to see the resignations of both David Nicholson, who held a senior post in the local health authority before becoming head of the NHS in England in 2006, and the head of the Royal College of Nursing, Peter Carter.
"We have lost hundreds of lives in the NHS and we want accountability. We owe that to our society," she told reporters.