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Julie Bailey was appalled by the treatment her mother received at Stafford Hospital, where she said patients were drinking flower water from vases
There needs to be a "fundamental change" in the culture of the NHS to ensure patients are cared for properly, a public inquiry says.
The conclusion by the Francis inquiry comes after a £13m investigation into the Stafford Hospital scandal.
Previous investigations have already established in harrowing detail the abuse and neglect that contributed to the deaths of hundreds of patients.
This inquiry said the failings went from the top to the bottom of the NHS.
The 1,781-page report catalogued missed opportunities at every turn between 2005 and 2008 - and said the findings still had relevance today four years after they first came to light in a 2009 report by the Healthcare Commission.
Time to care?
James Moore, who has left the NHS after working in A&E for 15 years, said reports of abuse made him "ashamed to be a nurse".
He blamed poor management rather than nurses no longer caring.
He drew parallels with being a waitress: "The restaurant gets busier, the waitress works harder and harder with the same resources and things start getting missed, she drops a meal here or there and people don't get their food on time and complaints are made".
Instead of dealing with the workload he said managers made the problem worse: "They'll ask the waitress to fill out more forms to tick that she's done certain things, then the restaurant gets busier and busier and the nurse has more and more forms to fill out."
While it is well-known the trust management ignored patients' complaints, local GPs and MPs also failed to speak up for them, the inquiry said.
The local primary care trust and regional health authority were too quick to trust the hospital's management and national regulators were not challenging enough.
Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.
'Remote'The Department of Health was also criticised for being too "remote" and embarking on "counterproductive" reorganisations.
The report said the failings created a culture where the patient was not put first.
"Start Quote
End Quote Robert Francis QCThis is a story of appalling and unnecessary suffering of hundreds of people"
But the inquiry - chaired by Robert Francis QC - said the change needed did not require further reform.
Instead, it urged everyone from "porters and cleaners to the secretary of state" to work together to shift the culture.
In particular, it recommended:
- The merger of the regulation of care into one body - two are currently involved
- Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
- Hiding information about poor care to become a criminal offence
- A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
- An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors
Mr Francis said: "This is a story of appalling and unnecessary suffering of hundreds of people.
"They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.
"I have today made 290 recommendations designed to change this culture and make sure that patients come first.
"We need a patient-centred culture, no tolerance of non-compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership, caring compassionate nursing, and useful and accurate information about services."
In a letter to Health Secretary Jeremy Hunt accompanying his report, Mr Francis said there needed to be a "fundamental change" in culture.
Target drivenThe "appalling" levels of care that led to needless deaths have already been well documented by a 2009 report by the Healthcare Commission and an independent inquiry in 2010, which was also chaired by Mr Francis.
They both criticised the cost-cutting and target-chasing culture that had developed at the Mid Staffordshire Trust, which ran the hospital.
Receptionists were left to decide which patients to treat, inexperienced doctors were put in charge of critically ill patients and nurses were not trained how to use vital equipment.
The Mid Staffs public inquiry
- The public inquiry is the fifth major investigation into what happened
- It has focused mainly on the commissioning, supervision and regulation of the trust from 2005 to 2009 - something campaigners felt had not been properly covered before
- It was chaired by Robert Francis QC, who also led the fourth major investigation
- It sat between November 2011 and December 2012 and cost £13m
- More than 160 witnesses appeared at the hearings and one million pages of evidence have been sifted through
Cases have also been documented of patients left crying out for help because they did not get pain relief and food and drinks being left out of reach.
Some staff have said they tried to raise the alarm but were silenced by senior managers.
Helene Donnelly, who worked as an A&E nurse at the hospital, said: "It went right to the top. People didn't want to know and that is why things got so extreme."
Data shows there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008, although it is impossible to say all of these patients would have survived if they had received better treatment.
While the Francis inquiry has solely focused on what happened at Stafford Hospital, there is mounting concern in the wider NHS about basic standards of care.
Recent reports by the Patients Association and Care Quality Commission have both raised the issue.
At the start of the year prime minister David Cameron said he wanted to make improving care one of his top priorities for 2013. He is due to make a statement on the latest report later.
Mr Cameron pointed to the money being made available for training, particularly around dementia, the extra ward rounds being introduced in hospitals and the roll-out of the new "family and friends" test patient survey as evidence of this.
BBC West Midlands special investigation, The Hospital That Didn't Care, on BBC One at 10.35pm on Wednesday 6 February.
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