An alliance of senior nurses has warned that unsafe staffing levels are becoming the norm in NHS hospitals.

According to the Safe Staffing Alliance (SSA), wards routinely have one registered nurse for every eight patients – an inadequate level to provide safe care.

A survey of 3,000 nurses by the Nursing Standard journal found that 40% said their last shift did not have a safe level of nursing coverage.

More than 75% of the nurses polled believed that another tragedy similar to that in Mid Staffordshire was likely in the NHS.

The Francis report identified poor nurse staffing levels as a major cause of the unnecessary deaths at Stafford Hospital.

The SSA, which includes representatives of the Royal College of Nursing (RCN) and the Patients Association, said that a ratio of one nurse to every eight patients is now considered acceptable in NHS hospitals.

However, they argued, it was not a safe minimum because any increase in the number of patients per nurse would increase the risk of serious harm.

“More than eight patients per registered nurse is the level considered to be unsafe and putting patients at risk,” the SSA said. “For nurses to provide compassionate care which treats patients with dignity and respect, higher levels will be needed and these should be determined by every healthcare provider.”

Dr Peter Carter, RCN General Secretary, commented: “What happened at Mid Staffordshire was a tragedy, and for nurses to say they predict another scandal is very worrying indeed.

“The issues of unsafe staffing levels, unregulated healthcare assistants, and a financially driven culture must be addressed.”

However, Health Minister Dr Dan Poulter insisted that the new Chief Inspector of Hospitals would intervene if hospital wards were inadequately staffed.

The Mid Staffordshire NHS Foundation Trust has been placed under administration by Monitor, the NHS economic regulator.

A report for Monitor said the Trust was “unsustainable” and recommended closing down its maternity, A&E and intensive care units.

The first Foundation Trust to go into administration, Mid Staffs will be run for the next 145 days by two analysts from Ernst & Young before it is reconfigured.

The report stated that the services it recommended for closure could be provided at hospitals in North Staffordshire, Wolverhampton and Walsall.

While Monitor said the Francis report was not the reason for its decision, it warned that Mid Staffs was “neither clinically nor financially sustainable”.

Mid Staffs received a £20m bailout in 2012, pending the Francis report’s publication. The report, which listed the Trust’s failures during four years in which over 400 patients died through neglect, did not inspire confidence in its future.

The administrators will seek to work with local commissioners and other healthcare organisations to produce a long-term plan for service delivery. Current services will continue during the 145-day administration period.

A local campaign group, Support Stafford, has called the plans for shutting down acute services in Stafford “unacceptable”.

Jeremy Lefroy, Conservative MP for Stafford, commented: “There is a vital need to retain acute services in Stafford and Cannock because the capacity elsewhere is simply not there.

“They also need to consider the huge disadvantage to local people who would have to travel much longer distances for their treatment, but also for hospital visitors who would have to do the same.”

The first criminal investigation into a death at Stafford General Hospital has found that a patient with a broken hip died as a result of not being given insulin.

Gillian Astbury, aged 66, died in 2007 in a diabetic coma after a new nursing team failed to read her clinical notes.

The Health and Safety Executive (HSE) is investigating the death as a possible criminal violation of the Health and Safety at Work Act, punishable by a fine.

This is the first criminal investigation arising from the Mid-Staffs tragedy, and the first instance of failure to give medication being considered as a crime.

Ms Astbury was admitted to Stafford General Hospital in 2007 with hip and arm fractures following a fall. Her partner reported finding her left without food or cleaning on several occasions.

The inquest jury concluded: “Nursing facilities were poor, staff levels were too low, training was poor, and record keeping and communications systems were poor and inadequately managed.”

The Francis inquiry said the Mid-Staffordshire NHS Foundation Trust had put “corporate self-interest and cost control ahead of quality and patient safety”.

However, NHS Chief Executive Sir David Nicholson blamed the deaths on the Labour Government’s infection control and waiting time targets, which he said monopolised clinical attention in hospitals.

The HSE commented that it will focus on “establishing whether there is evidence of the employer or individuals failing to comply with their responsibilities under the Health and Safety at Work Act.”

The case could have implications for many situations in which healthcare professionals administer medication.

Hospital ratings and a “duty of candour” for the NHS are among the measures announced by the Department of Health in its response to the Francis report.

A new Chief Inspector of Hospitals will be appointed to manage the appraisal of all hospitals, as well as individual hospital departments.

Health secretary Jeremy Hunt said the new measures would help to create a “zero harm” culture in the NHS, ensuring that the Mid Staffs tragedy was not repeated in other Foundation Trusts.

However, the Royal College of Nursing (RCN) drew attention to the dangers of systematic understaffing of hospitals.

All NHS staff will have a statutory duty to be honest about mistakes, and managers who fail in that duty will be barred from management roles – though the DH will not make it a criminal offence to cover up errors (as Francis recommended).

Hunt argued that it was necessary to strike a balance between ensuring “candour” and not creating a “culture of fear”. However, he claimed, the new review of patient safety would mean “a radical overhaul” focused on “high quality care and compassion”.

A code of conduct and minimum training standards for healthcare assistants will be developed, and nurses will have to work for a year as healthcare assistants before being funded for an NHS nursing degree.

In accordance with recent recommendations from the Nuffield Trust, a ratings system will be developed to assess hospital departments, with each hospital receiving an overall rating of ‘outstanding’, ‘good’, ‘requiring improvement’ or ‘poor’.

Peter Carter, General Secretary of the RCN, warned that understaffing was a fundamental issue that the review did not address.

However, Mike Farrar, Chief Executive of the NHS Confederation, said the DH had struck “the right balance between external assurance measures and internal changes focused on transforming the NHS culture.”

Sir David Nicholson, Chief Executive of the NHS, could be charged with corporate manslaughter in a private prosecution over Stafford General Hospital.

A member of the public has applied to Camberwell Green Magistrates’ Court for permission to charge Nicholson with corporate manslaughter and misconduct in public office, as well as perverting the course of justice.

Alan Edwards of Greenwich, London, a former investment banker, seeks to convince the court that Nicholson has a prima facie case to answer – i.e. that his guilt is plausible on the known evidence.

Edwards hopes to call on witnesses including members of the Cure the NHS campaign; CQC board member Kay Sheldon and former CQC investigator Heather Wood; and patient groups representing families.

“The regulatory system is just not fit for purpose,” he said. “That is why I am doing this and because there are serious failings across the health system which means things like deaths are covered up.

“We will seek full disclosure of all correspondence with David Nicholson’s office to find out about all of the information he received, what information he had and what he did with that.”

Nicholson has already claimed that the Labour government’s infection control and waiting time targets were responsible for the deaths because they distracted healthcare professionals from care quality.

Legislation allowing prosecution for corporate manslaughter was passed in the UK in 2007.

Private prosecutions for serious crimes are rare in the UK, though precedents exist. It is not clear whether Edwards will be cleared to bring the prosecution.

The Department of Health commented: “We see no basis for this case.”

NHS Chief Executive Sir David Nicholson has told the Health Select Committee he does not intend to resign over the Mid Staffs enquiry.

Nicholson, who led the Mid Staffordshire Foundation Trust for 10 months during the period when neglect and abuse of patients caused over 400 deaths, has blamed the Labour government for the abandonment of care.

With the endorsement of PM David Cameron, Nicholson also claimed he is what the NHS needs to see it through the critical period of reform.

An early day motion signed by 40 MPs has called on Nicholson to resign after the Francis report made it clear that he had failed to intervene in the regime at Stafford General Hospital when Chief Executive of the regional trust.

The Francis report made it clear that the trust’s focus on qualifying for Foundation trust status by slashing budgets and cutting staffing levels was the underlying reason for the Stafford General Hospital tragedy.

However, Nicholson – who started driving through Lansley’s NHS reforms on the ground long before the Health Act became law – avoided saying anything to the Health Select Committee that might lead them to doubt the safety of the reforms.

Instead, he placed the blame for the disaster on two policies that were specific to the Labour government: treatment access targets and infection control targets.

“There were a whole set of changes going on and a whole set of things we were being held accountable for from the centre, which created an environment where the leadership of the NHS lost its focus,” he argued.

Furthermore, he claimed, the NHS “is at maximum risk over the next few days”, when the old structures are dissolved and the new ones become fully operational, and he is the only person able to manage those risks.

Critics may suspect that Nicholson has won Cameron’s support by placing the blame on the Labour government and distracting attention from the threats to patient safety that are intrinsic to the current NHS reforms.

Monitor has placed Mid Staffordshire Foundation Trust under administration, saying it cannot be sustained in its current form.

The combination of the trust’s current financial difficulties and the impact of the Francis report has proved impossible to surmount.

Monitor will appoint special administrators to run Mid Staffs and plan its reorganisation – with options including the dissolution of the trust.

Mid Staffs is the second Foundation Trust to be placed under administration this year: the first, South London, was judged to have failed financially but not clinically, with PFI debts being a major factor.

Mid Staffs is also facing financial problems, having been bailed out with £20m from the DH in 2012, and having to cut its costs by 7% this year. Its small size – only two acute hospitals – counts against it economically.

However, it is also under pressure not to let its clinical standards slip, following the Francis report into over 400 preventable deaths at Stafford Hospital from 2004 to 2008.

The growing panic in the trust was exposed when a Stafford Hospital paramedic abused health campaigner Julie Bailey on Twitter, saying that he hoped she became seriously ill and found the nearest hospital shut down.

Julie Bailey’s ‘Cure the NHS’ campaign is credited with having led to the Mid Staffs enquiry. Her mother was among the people who died due to serious medical neglect at Stafford Hospital.

Monitor sent a ‘contingency planning team’ into Mid Staffs five months ago. Its report into “sustainable options for alternative clinical models in the area” will shortly be published, the regulator said.

The special administrators will have 150 days to develop a plan for service reconfiguration, working with local commissioners.

Professor John Caldwell, Chairman of Mid Staffordshire FT, said: “We have accepted for some time that MSFT working alone cannot produce a long lasting solution to the issues we face to ensure financial and clinical sustainability.”

Given that the financial constraints of FT status previously led the trust to experience a disastrous breakdown of care, finding a solution there is a key challenge for the NHS reform programme.

The public enquiry report on preventable deaths at Stafford General Hospital has placed emphasis on improving the ‘transparency’ and regulation of the NHS.

The long-delayed report by Robert Francis QC recommends bringing together economic and care quality regulation.

However, it does not – as had been predicted – recommend that the NHS have the power to take back Foundation Trusts into public ownership.

In addition, it blames the breakdown of care at Stafford Hospital, which caused 400 to 1,200 preventable deaths, on a “systemic” failure rather than calling for leaders to be held responsible.

The Staffordshire-based organisation Cure the NHS said it would continue to campaign for the dismissal of those who “covered up” the scandal, including NHS Chief Executive Sir David Nicholson.

The scandal of poor care at Stafford General Hospital between early 2005 and early 2009 has been called the most serious failure of care standards in NHS history.

The local PCT, the Healthcare Commission and the Royal College of Nursing all denied that anything was seriously wrong. Only local campaigners kept the number of deaths and the suffering of patients in the public eye.

During an extended phase of patient neglect that Francis calls “appalling”, Mid Staffordshire NHS Trust gained Foundation Trust (FT) status.

The first enquiry in 2010, which was internal to the NHS, concluded that a “chronic shortage” of nursing staff caused by the hospital’s drive to meet the financial conditions to become an FT was the main cause of the problems.

It also noted the severe negligence implied by persistent failures to provide “the most basic elements of care” to patients in terms of hygiene, pain relief, feeding and hydration.

The Labour Government twice refused to open a public enquiry into the Mid Staffs scandal, but the Coalition Government did so in 2010.

In May 2011, Nicholson warned that the Francis report would conflict with the direction of NHS reform: it would recommend the unification of Monitor with the Care Quality Commission (CQC), when their roles were being moved further apart; and it would recommend that the NHS take back FTs that failed to maintain care standards, when FT status was being made obligatory.

The 12-month delay in the publication of the Francis report may be linked to these issues – certainly, the recommendation concerning FTs has been dropped. While the joining of Monitor with the CQC is still recommended, it appears unlikely given that Monitor is now concerned only with enforcing competition.

Other recommendations in the Francis report include:

• A “duty of candour” towards patients and the public for all healthcare organisations, including a ban on gagging clauses and a requirement to publish all upheld complaints on the organisation’s website.

• Only registered people may care directly for patients.

• The CQC should develop a team of specialist hospital inspectors.

• GPs should be responsible for monitoring secondary care services received by their patients.

Health Secretary Jeremy Hunt has said that “the crisis in standards of care” is the single greatest problem facing the NHS. However, how the recommendations of the Francis report can be integrated with the market agenda of the NHS reforms – for example, how the “duty of candour” compares with the commercial confidentiality insisted on by independent health providers – remains to be seen.

The Government’s preferred candidate for the role of Chairman of the Care Quality Commission was a Conservative MP from 1997 to 2001.

David Prior lost the North Norfolk seat to Lib Dem candidate Norman Lamb, who is now a Health Minister.

However, Prior – whose father, Jim Prior, was a Tory Cabinet Minister – has promised that the CQC will be “completely independent”.

He identified his main priority as early intervention where care is failing: “A key role for the CQC is to spot difficulties very early so that we never have a Mid-Staffs type situation or a Winterbourne View happening again.

“From a regulator’s point of view, it is very important to act extremely promptly and have the risk analysis available and up to date all the time, so you can head some of these things off at the pass.”

A qualified barrister, Prior has also worked in the steel industry and is Chairman of the Norfolk and Norwich University Hospital NHS Trust.

Speaking to the parliamentary health select committee, Prior said that CQC inspectors needed to be mindful that NHS and social care organisations had to meet both clinical and financial priorities.

“We can do an inspection on a Monday and find that the care given in a care home is terrific, but then they go bust on a Tuesday,” he commented.

“If you go back to the predecessor organisations of the CQC, they were focused more on governance, structures, and leadership and less on outcomes. I think you’ve got to do both.”

Using more specialist inspectors rather than generalist ones might be part of the solution, he argued.

The publication of the public enquiry report on Mid Staffordshire Foundation Trust has been delayed until January 2013.

Originally due for publication in April 2012, the report had already been delayed for six months until 15 October.

According to enquiry chair Robert Francis QC, the further delay is due to the “complex and sensitive” nature of the report process.

The Mid Staffs enquiry (from November 2010 to December 2011) attempted to investigate the reasons for a decline in standards of care at Stafford General Hospital that led to over a thousand preventable deaths between 2005 and 2008.

NHS Chief Executive Sir David Nicholson said in May that the final Francis report is likely to recommend measures that conflict with Government policy.

In particular, he is likely to recommend that the DH retain the power to take FTs back into NHS control – which would be impossible within the terms of the Health and Social Care Act.

But while the further delay to the enquiry report may avoid calling aspects of the NHS reform into question, it also interrupts the development of the new structure for quality regulation.

The final version of the National Quality Board’s regulations for local and regional Quality Surveillance Groups, due to be published this autumn, is supposed to take account of Francis’ conclusions.

It is understood that senior NHS figures likely to be criticised by the report have already been notified.