Stafford Hospital: the scandal that shames the NHS
It is easy to categorise the Stafford Hospital scandal as a one-off.
But over the years as each and every aspect of the story has been uncovered, it has become clear it is a scandal that implicates the whole health service.
We know from the investigations that have already taken place that in the years leading up to 2008 many needless deaths occurred because of "appalling" levels of care.
Receptionists were left to decide which patients to treat, inexperienced doctors put in charge of critically ill patients and nurses were not trained how to use vital equipment.
Staff at the hospital, including doctors and nurses as well as managers, were clearly culpable - and some are still subject to investigations by professional regulators.
But in the NHS control is so centralised that no hospital is left entirely to its own devices.
The hospital would have been monitored by a primary care trust, regional health authority (which for some of the time was lead by Sir David Nicholson, the current NHS chief executive) and a number of regulators and patient safety bodies.
Staff working there were part of professional bodies, who pride themselves for putting patients first.Cost-cutting
And yet, the shocking standards were allowed to continue for years.
The trust which managed the hospital - Mid Staffordshire - was even able to climb up the ratings.
In 2007 it was given a good rating - the second highest - from the Healthcare Commission, the regulator which was supposed to keep an eye on quality.
It also achieved the elite foundation trust status, which is given to the best-performing parts of the health service.
The Stafford Hospital scandal
- From previous inquiries it is already known that patients needlessly died because of poor care.
- They have criticised a cost-cutting and target-chasing culture which led to wards being inadequately staffed and patients put at risk.
- Statistics show there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008.
- The public inquiry being published on Wednesday is actually the fifth major investigation into what happened
- It has focussed mainly on the commissioning, supervision and regulation of the trust from 2005 to 2009 - something relatives of those who died felt had not been properly covered by previous reports
Its bid was approved by another regulator Monitor and signed off in June 2007 by Andy Burnham, who was then a junior minister but later became health secretary and now holds the shadow post in opposition.
In fact, it was the decision by the board to go for foundation trust status that contributed to much of the cost-cutting drive that undermined care.
More than 150 nurses left the trust between 2006 and 2008.
But if the scandal was part of a wider NHS problem, it raises the question whether such bad care could be happening now, somewhere else?
The public inquiry, the findings of which will be published on Wednesday, also heard how nurses and doctors were put under pressure by managers to ensure targets were achieved and costs cut, even if that meant patients were put at risk.
Both factors (especially the need to cut costs) are very much present in today's NHS.
Peter Carter, the general secretary of the Royal College of Nursing, is concerned about what is happening and believes it is "certainly possible" failings albeit on not quite the scale of Stafford could be happening again.
He talks about the NHS being a series of "microclimates" where good practice can exist alongside bad, making it harder to detect.
Anna Dixon, of the King's Fund health think-tank, agrees, saying it is clear Stafford was and is not an "isolated case".
"We know from other reports that there are other hospitals where care is falling below acceptable standards, particularly for vulnerable patients."
But what has also become clear is that the failings are following a familiar pattern.
The problems being encountered are not on the whole to do with complex surgery or life-saving treatments, but instead are almost always related to basic care, such as help with feeding or going to the toilet or carrying out basic checks.
This is telling. The hospital patient population is very different to what it was just 20 years ago.
The ageing population and advances in medicine mean more and more people are living with chronic long-term conditions, such as heart disease and dementia, for which there is no cure.
These patients often need a complex array of support, both mentally and socially, for which fast-paced hospital environments are just not equipped for.
How the NHS deals with this is perhaps the biggest challenge it is facing. Many will be hoping the public inquiry provides some answers.