Media playback is unsupported on your device Media caption "A story of appalling suffering": Watch Robert Francis QC's statement in full

NHS staff should face prosecution if they are not open and honest about mistakes, according to a public inquiry into failings at Stafford Hospital.

Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients.

But inquiry chairman, Robert Francis QC, said the failings went right to the top of the health service.

He made 290 recommendations, saying "fundamental change" was needed to prevent the public losing confidence.

His report comes after the families of victims have voiced anger that no-one has been sufficiently punished for their roles.

Senior managers were able to leave the trust with little sanction, while most doctors and nurses involved have escaped censure from their professional regulators.

Responding in the House of Commons, Prime Minister David Cameron apologised to the families of patients.

He said he was "truly sorry" for what happened at Stafford Hospital, which was "not just wrong, it was truly dreadful" and the government needed to "purge" a culture of complacency.

Mr Cameron said a full response to the inquiry would follow next month, but he did immediately announce that a new post of chief inspector of hospitals would be created in the autumn.

Previous investigations have already established in harrowing detail the abuse and neglect from 2005 to 2008.

This inquiry looked at why the system did not prevent the problems or at the very lest detect them earlier.

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

The final report contains 290 recommendations over nearly 1,800 pages. Stafford Hospital: Q&A Stafford Hospital: The victims

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 as would failing to adhere to basic standards that lead to death or serious harm

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

'Remote'

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.

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.

This is a story of appalling and unnecessary suffering of hundreds of people Robert Francis QC 'I sat through the whole inquiry'

But the inquiry 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 and adopt a "zero tolerance" approach to poor care.

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."

He said the public's trust in the NHS had been "betrayed" and a change of culture was needed to "make sure that patients come first".

Target driven

The "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.

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." NHS staff say they are 'penalised for caring' Stafford Hospital report timeline

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.

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.

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.

There has been anger from some quarters after nobody lost their jobs as a result of the public inquiry.

James Duff's wife Doreen died in the hospital. He said: "Not one person has lost their job over this - instead they have been promoted and some people have been moved sideways.

"This has been a disaster yet nobody is accountable."

Sir David Nicholson has the focus of anger from families affected by the scandal. He is chief executive of the NHS and was briefly in charge of the Regional Health Authority while death rates were high at Stafford Hospital.

He responded to calls for him to go saying: "I think it's perfectly understandable, I understand the anger that they feel, the upset that they feel about the treatment of their loved ones in Mid-Staffordshire hospital.

"I absolutely understand all of that. At the time I apologised and in a sense I apologise again to the people of Stafford for what happened, but apologies are not enough.

"We need action, we need to make things happen."

Reaction

Royal College of Nursing general secretary Peter Carter described it as a "powerful and monumental" report.

He said: "We welcome moves for overarching standards which enshrine what patients deserve from the NHS and from those who work for it.

"Appalling care cannot be tolerated and everything should be done to ensure that it does not happen again."

But campaigner Julie Bailey whose mother, Bella, died in 2007 at Stafford Hospital prompting her to set up Cure the NHS, which had been instrumental in pushing for the public inquiry, called for resignations.

"We've lost hundreds of lives in the NHS and we want accountability.

"We owe that to our society and to the deaths and the respect of all the loved ones that we have lost.

"We will go nowhere until we get accountability."

Katherine Murphy, the chief executive of the Patients Association, said the report was a "watershed moment" for the health service.

She said: "It is clear that he [Mr Francis] has understood some of the very real failings that patients and their families face day in and day out.

"It is clear from the report that there is a lot of blame to go around for what happened in Stafford. Unfortunately too many people have escaped genuine accountability."

BBC West Midlands special investigation, The Hospital That Didn't Care, on BBC One at 10.35pm on Wednesday, 6 February.