Public faith in the NHS's ability to deliver good patient care and act swiftly to correct mistakes would be tested by damning reports exposing failings within two health trusts and a leading heart centre, doctors have warned.
Surgeons, nurses and management were severely criticised after official investigations highlighted the need for hospital authorities to take more heed of whistleblowers.
The commission for health improvement, the government's new watchdog on standards, criticised North Lakeland NHS trust, where elderly mentally ill patients were tied to commodes, and Carmar- thenshire NHS trust, where a patient died after having the wrong kidney removed. An independent report commissioned by the NHS executive said the Oxford heart centre was "on its knees and riven by internal conflict".
Ian Bogle, chairman of the British Medical Association, said the reports might leave the public "seriously concerned about the ability of the health service to deliver quality patient care, to learn from mistakes and to act swiftly when problems and concerns have been identified."
Abuse of patients could never be justified "but staffing shortages, excessive working hours and poor facilities can turn other, genuine, errors into tragedy". The NHS as a whole would continue to struggle until the effects of new investment were felt.
The Oxford inquiry, by a panel of experts in cardiothoracic services, highlighted staff reports of a "drinking club" culture within the centre, based at the John Radcliffe hospital, and found failures of leadership, antagonism between surgeons, difficulties in retaining nursing staff, complacency and secrecy.
The report, which made 34 recommendations, said a policy for treating whistleblowers seriously must be introduced. A senior nurse, Colette O'Keefe, who has been on sick leave for a year, alleged she and her children had been threatened after raising concerns about public care.
The health minister, John Denham, said the report "paints a picture of a dysfunctional team and, more than that, a failure to deal with problems when they were first raised". David Highton, chief executive of Oxford Radcliffe hospitals trust, said it would be "a catalyst for improvements".
Degrading practices at the Garlands hospital in Carlisle, administered by the North Lakeland NHS trust, might not have been repeated if whistleblowers among student nurses had been heeded in 1996, a CHI report concluded. Patients were sworn at, tied to commodes, and denied food, clothing and blankets.
The trust's chairwoman, Mary Styth, the chief executive, Alan Place, and the director of personnel, Catherine McCreadi, have been dismissed, and other senior management have received warnings.
Peter Homa, chief executive of the CHI, said: "The abuse of elderly people was appalling ... The culture of this organisation needs to change so that the rights of patients are understood across the trust."
Nigel Woodcook, acting chief executive for the trust, apologised to patients and their families for the "inexcusable mistreatment" and praised the courage of students and health care assistants who drew attention to it.
The CHI also criticised Carmarthenshire health trust for being slow to correct procedures following the death of a Korean war veteran, Graham Reeves, 70, of Burry Port, south Wales, who died at the Prince Philip hospital in Llanelli in February, after having his one healthy kidney removed by mistake.
It said the Prince Philip and West Wales general hospital in Carmarthen were stuggling to work as one organisation following a merger of the two trusts that ran them. Failure to share procedures in operating theatres posed "a significant risk", and the management of nurses was outdated. Three members of the surgical team that carried out the operation remain suspended pending displinary proceedings.
