The lawyer who uncovered the Mid Staffordshire care scandal has called for wards and units of hospitals which have too few nurses and doctors to look after patients safely to be shut down.
In an interview with the Guardian Robert Francis QC said wards should be closed until hospital bosses ensured they had enough experienced staff, with patients being sent elsewhere in the meantime.
"If you haven't got the right number of people to fly an aircraft properly, you don't fly the aircraft. You should not be operating if you haven't got enough surgeons on duty who are fit to operate [and] you should not be running a ward if you haven't got enough staff on duty to feed people", said Francis.
"What we need is much more honesty than we have at the moment, I suspect, about when we can't provide the service. And if we can't provide the service safely then actually that place would not provide it."
His 30-month public inquiry into poor care at Stafford hospital from 2005-09 resulted in a landmark report this year which has prompted a huge drive to transform quality of care, patient safety and the NHS's openness.
Francis also warned that patient safety would be undermined unless all NHS staff were put under his proposed "duty of candour" to admit when they commit or witness mistakes, rather than just hospitals and other NHS organisations collectively.
That is the preferred solution of the health secretary, Jeremy Hunt, who is finalising the government's response, expected next month, to Francis's 290 recommendations. Medical defence organisations have been lobbying against that part of Francis's proposals.
The QC also said he believed the NHS should introduce minimum safe staffing levels, another idea so far rejected by Hunt but backed by the Royal College of Nursing, the Patients Association and Labour.
Peter Walsh, the chief executive of the patient safety charity Action against Medical Accidents, backed Francis's calls.
"Closing unsafe wards had to be the ultimate sanction. You can't run wards or other medical facilities that are unsafe because they have too few staff to do the job. That is common sense," he said.
But Dr Mike Durkin, NHS England's director of patient safety, said that while Francis was right to link staffing levels and patient safety, NHS care providers should instead publish details of their staffing levels in their board papers, as some hospitals already do for individual wards.
He also rejected a duty of candour for all NHS personnel, claiming that it would prove very bureaucratic and distract staff from caring for patients.
Dr Johnny Marshall, director of policy at the NHS Confederation, which represents hospitals, said: "Staffing levels should be transparent for all patients to see" but rejected staff quotas as unnecessary. Levels of safe staffing should be decided locally, not nationally, he added.
A universal duty of candour "could have unintended consequences, creating a culture of blame and fear that could undermine efforts to improve patient safety. The appropriate place to apply such a duty is with healthcare organisations, whom we rightly expect to be transparent about their failings and the actions they are taking to correct them," he said.
