The kind of neglect that disgraced Stafford hospital, where patients were left in soiled sheets, sitting on commodes for hours and often denied pain relief, exists across the NHS, the health secretary, Jeremy Hunt, has said.
The report from a public inquiry into the scandal at Mid Staffordshire NHS foundation trust is due within weeks and is likely to ignite a fresh debate about care in the NHS, especially when costs are being cut and there is massive managerial change.
An earlier independent inquiry, led by Robert Francis QC, found "stories of shocking care". The Healthcare Commission, the NHS regulator at the time, estimated that 400-1,200 early deaths could have occurred as a result of the problems from 2005 to 2008.
Hunt said the new inquiry, also chaired by Francis, would focus attention on what the health secretary had made his priority since taking the post last September: the quality of care as well as actual treatment.
However, the problems could be even more widespread in the health system than he had previously acknowledged, he said. "I think we are going to have a huge debate in the next few months following Francis about how we return all parts of the NHS to its core values of care and compassion, which are at the heart of the reason why it was set up," Hunt told the Guardian.
"The reason that everyone is really interested in Francis is because, whilst we don't believe there is anywhere else that has got the problems that Stafford hospital [had], everyone can sense that there are little bits of Stafford dotted around the system. So we have a big debate about values and how we do that."
Hunt has previously admitted that ministers could not guarantee there were no other cases like the scandal at Stafford hospital. Last year, he told the BBC Panorama programme there could be "pockets" of similar problems in the NHS and the social care system.
His admission that similar problems, albeit on a smaller or more isolated scale than those in Staffordshire, exist across the system goes further still. Such a warning will be particularly sensitive as the first Francis report, in 2010, blamed many of the problems in Staffordshire on the trust being "preoccupied with cost cutting, targets and processes".
The health service is having to make the biggest cost savings in its history, in a £20bn "efficiency programme" that ministers say is designed to cut costs of existing care but that critics claim is leading to cuts in services.
The NHS is also undergoing its biggest ever shakeup, with GPs set to take overall charge of patient care from April.
A survey by Health Service Journal last year asked professionals in the NHS, most of them hospital directors, how confident they were that "the regulatory bodies and wider governance systems would pick up a Mid Staffs-style care failure if it was happening somewhere in the NHS". Nearly half, 44%, said they were "not confident" or "not at all confident". Only one of the 63 managers who replied was "very confident".
Peter Carter, the chief executive of the Royal College of Nursing, also admitted the risks. "Hospitals are rarely universally excellent and rarely universally poor," said Carter, pointing out that investigators at Staffordshire found examples of very good care, while the worst problems were in two departments and two particular wards.
"I agree with the secretary of state: you just don't know what you are looking at," said Carter, who urged ministers and regulatory bodies to insist on much more detailed performance monitoring.
