How can this happen in the 21st century?

An independent inquiry into Stafford Hospital – where patients were starved, dehydrated, left in agony, and told to lie in their own faeces – has heard how:

* The hospital's emergency assessment unit was so unsafe that staff branded it "Beirut";


* Job cuts left nurses so overstretched they became "immune to the sound of pain";

* Receptionists decided which casualty arrivals should be seen first, based on a "gut feeling" of who looked the most unwell;

* When hospital bosses were given notice of a damning inspection report, published last year, they responded by hiring a public relations team and promised to "get MPs on side";

The inquiry, led by Robert Francis QC, was ordered following last year's damning Healthcare Commission report in which regulators described care of patients at Mid Staffordshire Hospital trust as the most appalling scandal they had ever encountered.

More than 900 patients and families, and scores of staff, have given evidence to the inquiry, which is examining the care of thousands of patients treated between 2005 and 2009.

Findings of the inquiry, which were handed to ministers on Friday, are expected to focus on how a culture of "fear and bullying" prevented failings from being exposed.

Mortality rates suggested that there were at least 400 more deaths than might have been expected in a three-year period, while relatives told how their desperate loved ones had been left to drink from flower vases.

In the wake of the scandal The Sunday Telegraph launched the Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care, and which has been backed by more than 5,000 people.

Closed sessions of the inquiry heard how patients were left in agony, screaming for pain relief, while others were left without medication, food and drink, and left on commodes for long periods.

Basic hygiene was neglected, with one female patient left unwashed for the last four weeks of her life, the inquiry heard.

Nurses told how pressure to hit a Government target for all patients to be treated within four hours of arrival at A&E meant that patients were moved when they were soaking wet, or were left in an assessment unit for hours, or even days, without proper care.

In evidence, staff were highly critical of senior managers who enforced 160 job cuts to cut costs as the trust applied for coveted "foundation status".

When the status was awarded, staff were rewarded with £25 Marks and Spencers vouchers, to the disgust of many, the inquiry heard.

An obsession about the project blinded the board to the problems being suffered by patients, doctors said.

A former hospital worker described how in a conversation about hygiene, Martin Yeates, chief executive until he resigned last May, said the hospital "could not possibly" keep its lavatories as clean as those in the local Asda supermarket.

Staff giving oral evidence to the inquiry reserved much of their strongest criticism for Jan Harry, the trust's director of nursing from 1998 to 2006, when disastrous changes to the organisation of wards were introduced, and plans for swingeing job cuts agreed.

Mrs Harry, who was chief nurse when the trust decided to axe 52 nursing posts told the inquiry that she could not recall the decision, and was "not aware" of plans to drastically alter the ratio of trained to untrained staff.

She also said she had not been involved in separate discussions about 20 job cuts - a situation she admitted was "extraordinary".

Mrs Harry said it was not her job to monitor standards on the wards – a claim later described as "absurd" by Dr Peter Carter, general secretary of the Royal College of Nursing.

Toni Brisby, a former trust chairman, said the evidence provided by Mrs Harry was "at odds" with her recollection that the head nurse had been a strong advocate of proposals to change the way nursing was provided, and had assured the chairman that the loss of 52 posts would not harm patient care.

During the inquiry, Mrs Harry said she had no major concerns about the care provided at Stafford Hospital.

Mrs Harry left the trust "by mutual agreement" in June 2006. She told the inquiry that savings from the ward reorganisation had been "fortuitous" and that changes had been intended to improve patient care.

She said she wanted no part of the trust's financial recovery plan.

In previous evidence to the Healthcare Commission, she said resulting cuts to the number of qualified staff had not been her intention, and occurred after she left the trust.

A year after her departure, she was hired by Dudley Group of Hospitals trust to run a cost-cutting programme as it prepared a bid for foundation status.

After the trust won the status in 2008, its inspection rating dropped from good to weak, and last autumn it failed a basic hygiene inspection, though it has since improved.

Mrs Harry went on to work at Salisbury Foundation trust as interim director of operations between December 2008 and May 2009.

Her replacement at Mid Staffordshire Hospitals, Dr Helen Moss, who left in December to take up a training role across the East Midlands, was criticised by some staff for not acting quickly enough to tackle problems uncovered, but others praised her attempts to make changes.

Helen Morrey, director of operations at Mid Staffordshire trust from 2006 until last year, admitted "risk assessments" about the impact of job cuts were inadequate and accepted responsibility for a failure to thoroughly investigate complaints by patients.

Ms Morrey was put on paid leave last July, before leaving the trust in November.

Kate Levy, the trust's head of legal services, is currently suspended over allegations that she asked for a rewrite of a damning report into a patient's death because she did not want the trust to receive "adverse publicity".

Antony Sumara, who replaced Mr Yeates as chief executive of the trust, said the organisation was committed to work "openly and transparently and will tolerate nothing less from our staff".

Julie Bailey set up the campaign group Cure The NHS after the death of her mother Bella at Stafford Hospital in 2007.

The campaigner said the hospital's treatment of patients had been "absolutely horrific," while those who tried to speak out had been silenced. The group is calling for a public inquiry into the supervision of all hospitals.

"Our biggest concern is that this could happen again, elsewhere, unless an inquiry looks at how this was allowed to happen; the system of regulation, the role of the Department of Health, and its ministers. Nothing else will do," she said.