Failing hospital was warned about staff

Severe problems identified two years ago at NHS trust branded Britain's worst

A hospital trust branded the worst in Britain by the NHS regulator last March was the subject of an unpublished report two years earlier which concluded its general surgical team was "dysfunctional".

The report by the Royal College of Surgeons (rcs) on Stafford hospital in the West Midlands recommended in 2007 that surgeons undergo "psychological assessments" to improve working relationships and that the safety of surgical procedures be checked.

But it took a year to replace one of the surgeons and the trust's overall response was "inadequate", according to Dr Val Suarez, former medical director. She said a further review of surgery at the hospital was needed.

The existence of the Royal College of Surgeons report, and the failure to implement its recommendations, was disclosed by Dr Suarez during evidence to the independent inquiry into Mid-Staffordshire NHS Foundation Trust, which concluded its hearings this week.

The inquiry was launched in September after an investigation by the Healthcare Commission in March 2009, which delivered the most savage indictment of any NHS organisation in the commission's five-year history. It condemned "appalling" standards of care among emergency admissions which may have contributed to more than 1,000 deaths. The disclosure of the existence of an earlier report into the hospital will raise questions about why the College's conclusions were neither revealed nor acted on.

It took until 2009 for the Healthcare Commission to intervene after monitoring revealed that death rates at Stafford hospital after emergency admissions were 27 to 45 per cent above average in the three years to 2007-08, equivalent to between 400 and 1,200 more deaths than at comparable hospitals.

The Commission uncovered deficiencies including a shortage of nurses, lack of equipment and an "unacceptably casual approach to assessing its own performance". The chairman and chief executive of the trust resigned in advance of publication of the report.

In July, the Government announced the independent inquiry, chaired by Robert Francis QC. Hearings have been held in camera but anonymised summaries are published. A spokesperson for the RCS said: "[The report] has not been published because we do not have the power to publish it. It belongs to the trust. Our recommendations are not something we can enforce."