The regulatory system at Stafford Hospital was "wholly ineffective", a public inquiry heard.
Lawyers for Cure the NHS, a campaigning group made up of relatives whose family members died at the hospital, said the health system "completely failed".
The hearing is the fifth into the hundreds of higher than expected deaths at the hospital between 2005 and 2008.
Earlier inquiries into a 2009 report which condemned conditions at the hospital were heard in private.
The new coalition government ordered that an inquiry be held in public.
A Healthcare Commission report, issued in 2009, listed a catalogue of failings including receptionists assessing patients arriving at A&E, a shortage of nurses and senior doctors and pressure on staff to meet targets.
Jeremy Hyam, counsel for Cure the NHS, said: "The stark and worrying concern is that the regulatory system supposedly in place was wholly ineffective to prevent a dramatic lowering of standards not just for a matter of months, but for at least four years."
The inquiry is the culmination of more than three years of campaigning by members of Cure to expose the failings at Stafford Hospital"
End QuoteJeremy HyamCounsel for Cure the NHS
He asked how the hospital had managed to get Foundation Trust status, at a time when the care being given to patients was so poor it was capable of amounting to inhuman and degrading treatment under the European Convention on Human Rights.
"The inquiry is the culmination of more than three years of campaigning by members of Cure to expose the failings at Stafford Hospital," Mr Hyam said.
It was not just patient care which was failing but also the failure of the Mid-Staffordshire NHS Trust, and its supervisory bodies to prioritise patient safety over targets, he added.
Concluding his opening speech he said the inquiry was a chance to look at the regulation system within the NHS.
"The shocking experience of Mid Staffordshire suggests that despite the array of supervisory, regulatory and commissioning bodies within the health system, their individual and combine work completely failed... to maintain basic standards of care, dignity and respect for human rights," Mr Hyam said.
9 November 2010Last updated at 19:01 ETBy Michelle RobertsHealth reporter, BBC News
Women would need far fewer smears if the NHS switched to a new way of screening for cervical cancer, a Cancer Research UK scientist has said.
Good uptake of the HPV vaccine that can prevent the cancer means we can now start to move away from conventional testing, said Professor Peter Sasieni.
Girls who have already had the jab would only need the new type of smear test twice in their lifetime, he said.
Unvaccinated women would halve their number of checks from 12 to six.
Professor Sasieni, a Cancer Research UK scientist at Queen Mary, University of London, has advised the NHS screening programme in the past about how to improve screening and his recommendation to change the age range of women invited for screening was adopted.
HPV testing could prevent an even greater proportion of cervical cancer with just half the number of screens over a lifetime in women who have not had the HPV vaccine"
End QuoteProfessor Peter SasieniCancer screening expert
The professor, who presented his predictions at the National Cancer Research Institute conference in Liverpool, is now urging the government to consider making HPV testing the main method of cervical screening.
Currently, women are invited for a conventional smear test that takes a sample of cells from the cervix to be examined under a microscope in the lab to check for early warning signs of cancer.
The HPV test, which is carried out in a similar way to conventional smears, instead checks for an infection called human papillomavirus, or HPV, which is a known cause of cancer of the cervix.
Time for a change
Professor Sasieni said: "The UK cervical screening programme has done a fantastic job in reducing cervical cancer, but it is based on an old screening test.
"HPV testing could prevent an even greater proportion of cervical cancer with just half the number of screens over a lifetime in women who have not had the HPV vaccine."
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And young women who have had the HPV jab would only need two screens giving the "all clear", one at the age of 30 and another at the age of 45, he said. Any with worrying results would be referred for more testing and treatment as necessary.
Currently, women aged 25-49 are invited for cervical screening every three years, dropping to every five years between the ages of 50 and 64.
This means the average woman will undergo around 12 conventional smears in a lifetime.
Professor Sasieni says it is not that the old method is bad, more that it is now outdated and involves testing women many more times than necessary.
Data suggests one in five women do not turn up to have smears when invited.
Professor Sasieni says if HPV testing were to be rolled out from next year, it could be used nationally by 2015.
"With continued high coverage of HPV vaccination and targeting of screening resources towards unvaccinated women, cervical cancer should become a truly rare disease.
"And if the government plan for this change now, they could save hundreds of millions of pounds in the long run," he said.
In the UK, girls aged 12 to 13 are offered the HPV vaccine that protects against two strains of HPV, types 16 and 18. Girls have three injections over six months, given by a nurse.
Uptake in English schools has reached about 80% and in Scotland 90%.
Dr Lesley Walker, Cancer Research UK's director of cancer information, said the very high uptake of the vaccine in the UK had been a real success story.
"This is exciting and poses interesting questions for the screening programme in terms of the best way to screen women in the future who have been vaccinated.
"But for now it remains vitally important that all women continue to take up the invitation to go for screening when they receive it."
More than 2,800 women a year in the UK are diagnosed with cervical cancer and almost 1,000 die from it every year.
Professor Julietta Patnick, Director of the NHS Cancer Screening Programmes, said they were looking at how best to incorporate HPV testing into their current screening programme.
"Any plans to use HPV testing as a primary screening method will require rigorous investigation and testing, as well as the development of robust quality assurance protocols and standards, before it could be implemented."
10 November 2010Last updated at 08:44 ETBy Dave LeeBBC World Service
Young offenders are more likely to have suffered a brain injury compared with the rest of society, a study suggests.
A survey of 197 young male offenders found about half reported having had a childhood brain injury - three times higher than in non-offenders.
Multiple head injuries were linked with carrying out more violent crimes, says the University of Exeter team.
Better assessment of injuries could help prevent re-offending, they add.
The researchers asked 197 offenders aged 11 to 19 years about their past medical history, convicted crimes, mental health and drug use.
They considered the effects of traumatic brain injury alongside other factors such as deprivation and lack of life opportunities to determine if a childhood brain injury contributed to future acts of criminal behaviour.
The study, published in the journal Neuropsychological Rehabilitation, found that while a brain injury alone is unlikely to increase a child's chances of criminal activity, it could play a factor in those already susceptible to crime, and may increase the chance of repeat offences.
"The associations between brain injuries and crime are very problematic," explained Huw Williams, associate professor of clinical neuropsychology at the University of Exeter.
"It may not be causal in the sense of increasing the chances of crime, but it may well be a factor in terms of re-offending."
Rehabilitation
Evidence suggests that brain injuries, particularly those causing a loss of consciousness, can lead to problems in attention, memory, planning and behaviour.
What we need to think about is better access to neuro-rehabilitation for children and linking that into schools so that when head injury happens there's a system in place."
End QuoteProfessor Huw WilliamsUniversity of Exeter
Professor Williams says it is important not to allow children displaying some of these characteristics to "drift" at school due to being unable to concentrate.
"What we need to think about is better access to neuro-rehabilitation for children and linking that into schools so that when head injury happens there's a system in place," he said.
This study is a follow up to previous research on adult prisoners which found around 60% had some degree of traumatic brain injury in their past.
In both studies a head injury was associated with a greater risk of re-offending, said Professor Williams.
The study also found that adults who said they had suffered a head injury were, on average, five years younger when they were first sent to prison than those who had not been injured.
Heather Shilling, operations manager at the Warwickshire youth justice service, believes that a fuller medical assessment can help make the justice system fairer for young offenders.
"Young people who have got memory difficulties can get into a lot more trouble when they're in the system than a young person who hasn't had an injury," she said.
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She added that it would be difficult to do a complete medical assessment on all young offenders, but simply asking people if they have been knocked out in the past would help both the offender and the police officers.
"A good example is of a young person that might slur their speech, if they've had a fairly extreme brain injury.
"If they're in the police station, the police officers interviewing them might think that they are under the influence of some drugs or some drink. It might be nothing to do with that.
"If the young person appears to be uncooperative, it can have a worse outcome for that young person."
"Knocked out"
The study showed that among young offenders, repetitive injuries were common; a third of those suffering head injuries reported having been "knocked out" more than once.
These offenders were also linked to more violent crimes.
"We found there was a relationship with three or more head injuries and greater violence in offending history," said Professor Williams.
"It might be a marker that these people are having much more violent lives, and the head injuries are a consequence of that, but it may also be likely that they are starting to have increased problems in terms of the neuro-cognitive effect of a brain injury.
"These are things like impulse control problems, not really reading other people that well, understanding the facial expressions of others, maybe being too quick to act on a feeling of threat.
"All these kind of factors could be in the mix."
However, while the research appears to present alarming evidence, researchers insist parents should not overly worry if their child has had a head injury - as other social factors bear far greater influence on a child's future.
9 November 2010Last updated at 08:21 ETBy Helen BriggsHealth reporter, BBC News
The proportion of women giving birth at home has fallen slightly in England, according to new figures.
The National Childbirth Trust and the Royal College of Midwives said the drop in the home birth rate, from 2.9% in 2008, to 2.7% in 2009, was "disappointing".
The figures also show an increase in multiple births.
This was most marked in women over 45, where around one in ten had twins, triplets, quads or more.
Recent government policy has been to give women choice over where to give birth - whether in hospital, at home or in a birthing centre run by midwives.
It followed a dramatic fall in births at home in the UK in the last 30 years.
In the 60s, around one in three women gave birth at home. This fell to a record low of one in a hundred home births by the late eighties.
The proportion of home births has risen slightly every year since then, with a small decrease between 2008 and 2009, according to the figures from the Office for National Statistics (ONS).
Choice
In England, 17,834 women (2.7%) had a home birth in 2009, down from 2.8% of home births in 2008.
Wales fared better, with 3.8% of 34,574 births at home, an increase over the previous year.
In Scotland, 873 women (1.5%) had a home birth, out of 59,363 births. And in Northern Ireland, 91 women (0.4%) had home births out of a total of around 25,000 births.
Cathy Warwick, General Secretary of the Royal College of Midwives, said the drop in the home birth rate was "a real disappointment".
She said: "These figures suggest to me that we are not providing the choice that women want and deserve, and that commissioners are not doing enough to offer them that choice.
"My worry is that increasing pressures and demands being made on midwives and maternity services are driving out choice for women.
"There is a real need to look behind these figures to find out why our home birth rate is so low and why it is falling."
Mary Newburn, of the charity The National Childbirth Trust, said they believed women were finding it more difficult to book a home birth.
She said: "There is no evidence of a reduction in demand, but we know maternity services are additionally stretched due to a rising birth rate and too few midwives.
"The option of booking a home birth should be offered as a mainstream option for all women who want it, alongside options to book for care at a birth centre and at a hospital maternity unit."
The ONS figures show that overall, births fell in 2009, the first annual decrease since 2001.
There were 706,248 births in England and Wales in 2009, down from 708,711 in 2008, a 0.3% decrease.
Raising the dose of cholesterol-lowering drugs could prevent many more heart attacks and strokes, say researchers.
UK and Australian teams compared a standard statin treatment with a more intensive therapy, publishing results in the Lancet medical journal.
They concluded that higher doses cut heart attacks and deaths by 13%.
Experts warned that a bigger dose of the most popular statin could produce many more cases of side effects.
Statins cut levels of so-called "bad" LDL cholesterol, and the risk of heart attacks and strokes in higher risk patients.
Almost two million people in the UK are prescribed them, and one type is even available over the counter at pharmacies to patients assessed as at "moderate" cardiovascular risk.
Some studies have suggested that even greater benefits could be achieved if bigger doses of the drug were prescribed.
It may be safer to lower cholesterol using low doses of the more potent statins rather than increasing the dose of simvastatin"
End QuoteDr Louise BowmanStudy author
Aggressive therapy
The two studies in the Lancet were carried out at the universities of Oxford and Sydney, and pooled the results of dozens of other trials to give a more reliable verdict on the likely benefits and risks of doing this.
In the first study, when a standard statin regime was compared to an "intensive" regime, further drops in LDL cholesterol levels were produced.
In turn, there was a 15% further reduction in "major vascular events" - which included a 13% drop in heart deaths and non-fatal heart attacks, 19% fewer operations to treat heart disease, and a fall of 16% in the number of strokes.
The other study also revealed falls in LDL cholesterol and "vascular events".
Commenting on the study, two academics, Professor Bernard Cheung and Professor Karen Lam, from the University of Hong Kong, said that people with a "substantial" heart or stroke risk should have intensive statin treatment.
Even those with apparently low LDL cholesterol could benefit, they said.
They added: "At the population level, statins are underused, so the urgent priority is to identify people who would benefit most from statin therapy and to lower their LDL cholesterol aggressively, with the more potent statins if necessary."
Balance of risks
However, the study authors warned that simply raising the dose of the most commonly-used statin in the UK, simvastatin, the version available direct from pharmacies, might be counterproductive.
A rare side-effect of low-dose simvastatin is muscle weakness, known as myopathy. In some cases this can lead to more serious muscle damage.
At a low dose, three in 10,000 (0.03%) patients developed myopathy, but when a higher dose of simvastatin was prescribed, this jumped to nine in a 1,000 (0.9%).
Dr Louise Bowman, one of the researchers, said: "It may be safer to lower cholesterol using low doses of the more potent statins rather than increasing the dose of simvastatin."
This advice was echoed by the British Heart Foundation, which part-funded the study.
Professor Jeremy Pearson, associate medical director at the British Heart Foundation, said that simply "ramping up the dose" of simvastatin might not be the best option.
He said: "We know that cholesterol is a major risk factor for heart disease - cutting it cuts your risk of a heart attack. However it's been unclear whether going the extra mile to lower cholesterol even further, pays off."
8 November 2010Last updated at 19:28 ETBy Matthew HillBBC West health correspondent
A new way of checking up on care homes for the elderly in England will put vulnerable residents at greater risk, says a union representing inspectors.
Unison says the new system of written self-assessments will mean thousands of homes will avoid inspections altogether if they look good on paper.
But the Care Quality Commission, which introduced the system, said it would let inspectors focus on failing homes.
It also released figures it said showed adult care had improved significantly.
Whistleblowers
The new system replaces yearly automatic inspections for all homes.
It came into force in October and now means that homes which provide a good written self-assessment may not be inspected again, unless there is a serious complaint made about them to the commission (CQC).
Unison, which now represents about 700 inspectors, claims that the workforce numbers have halved since 2004.
Its officer for the CQC, Helga Pile, is concerned about the changes, and said the new inspections would take just a couple of hours, instead of a whole day.
She said: "Our members are really concerned about the lack of ability to really go into homes, spend enough time on site, really talking to people finding out about what is going on."
The carer who blew the whistle on a care home scandal in Somerset in 2007 is also warning the new system would have meant her own care home could have avoided inspections for years on end.
It was because Sarah Barnett raised her concerns over several deaths at Parkfields Care home in Butleigh in Somerset, that its nurse manager was found guilty of killing a 97-year-old resident and stealing drugs to feed her own addiction.
End QuoteA senior inspector for the CQC in England
Rachel Baker was sentenced to 10 years in prison earlier this year for the manslaughter of Lucy Cox.
Ms Barnett said: "My personal experience is that people will not blow the whistle, even if they have clear knowledge of what's been happening.
"And as for relying on relatives or people in the community, then you are relying on people who have no medical knowledge and are assuming they will raise concerns."
But the CQC has defended the new arrangements, which it says will allow time to concentrate on homes that are failing.
CQC director for the South West Ian Briggs said: "I can see that a move away from a one-size-fits-all regulatory regime of inspecting every six months, or every year… to a system that is more flexible that acts swiftly when we get information, is a new system.
"And everybody needs to get confident about how that system can work.
"I think we can rely on whistleblowers. We need to encourage them and we need to show them that if they report and whistleblow to us then we will act quickly and responsibly."
'Poor practice'
But a senior inspector for the CQC in England, who wants to remain anonymous, told the BBC: "Larger private providers could be good at filling out forms that can hide a multitude of sins.
"Therefore there will be no need for us to go out and check. As long as the assessments are done, we look like we have done our job.
"It is only when there are gaps in paperwork that we need to seek more information from a provider. We just don't know what's going on in care homes."
The CQC has published its final assessment of care provision under the old system.
It said 83% of care homes, home care services, nursing agencies and shared lives schemes were rated good or excellent, compared with 69% in 2008.
People were increasingly being supported to live in their own homes, rather in residential facilities, it said, and overall the quality of social care commissioned by councils was improving.
But CQC chief executive Cynthia Bower said "pockets of poor practice" remained.
The regulator also warned that further growth in provision would be needed to meet future needs.
Do you have a relative in a care home? What do you think of the shift to self-assessments? You can send us your views and experiences using the form below.
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Do you have a relative in a care home? What do you think of the shift to self-assessments? You can send us your views and experiences using the form below.