The NHS was rocked by new allegations of abuse yesterday after inspectors found an "embedded culture" of poor care, unprofessional behaviour and threats by staff at a hospital trust where five mothers died in childbirth in 18 months.
In one case, a midwife at Barking, Havering and Redbridge University Hospitals NHS Trust overheard a colleague telling a woman in labour, "Hurry up or I will cut you".
In another case, a woman having contractions every two minutes was turned away by midwives. As she returned to her car, nurses had to run after her with a wheelchair after passers-by noticed her trousers were covered in blood.
It is the third time in recent years that inspectors have identified catastrophic failings by NHS staff to provide basic care to patients.
In spot checks on 100 hospitals earlier this year, the Care Quality Commission, the NHS regulator, found patients in a fifth of trusts were stripped of their dignity and left hungry and unwashed, in breach of the law.
The failings have raised fears that NHS nursing and medical staff are losing the habit of caring. An independent commission set up by Age UK, the NHS Confederation and local authority associations is examining whether changes in society, the NHS or personal values are to blame.
Despite a decade of tougher regulation, the CQC investigation of Barking, Havering and Redbridge trust found "a culture of abuse had been a consistent problem for many years" but had "not been dealt with effectively by senior managers".
The greatest concern was over maternity services where patients were left alone for hours while in labour, waiting for drugs to relieve pain, or for caesareans. One woman said she begged staff for four hours for an epidural because she was in pain and when the consultant entered the delivery room he was joking with a colleague.
The CQC, which has issued three warning notices to the trust in the past six months, said the trust could not cope with the number of births, which was being reduced from 10,000 to 9,000 a year by sending patients to other hospitals. It said there were "signs of improvement" since the appointment of a new chief executive, Averil Dongworth, last February.
Seven midwives have been disciplined, a "long list" are awaiting disciplinary proceedings, and the head of midwifery has been moved to another post, Ms Dongworth said.
Despite the damning verdict from the CQC, Andrew Lansley, the Health Secretary, yesterday gave the go-ahead to plans to move A&E and most maternity services to Queen's Hospital, Romford, from King George's, Ilford, the trust's two main hospitals. But Mr Lansley said the change would not take place until services at Queen's had been brought up to standard.
Margaret Hodge, MP for Barking, described the plan as "madness".
The trust has a deficit of £118m, and has set a target to cut 850 jobs by 2013. The CQC said the planned cuts were "worrying" when the number of patients treated "continues to rise".
Ms Dongworth apologised to patients for the past failings. "Poor attitudes and rudeness by staff are unacceptable. We have got to change the whole culture in the trust," she said.
Professor Trish Morris-Thompson, chief nurse at NHS London, which is responsible for failing trusts in the capital, and a member of the commission on caring, said: "The question I want to look at is why abusive staff are not being challenged by colleagues."
Louise Silverton, deputy general secretary of the Royal College of Midwives (RCM), said there were deficiencies "throughout the whole maternity system".
Case studies: Delays that ended in death
Violet Stephens died in Queen's Hospital, Romford, in April, after being admitted with pre-eclampsia, a life-threatening condition.
The report into her death found there was a failure to administer a blood transfusion, a delay in the decision to deliver her baby, and when she was found unresponsive and gasping for breath, it took 25 minutes for a cardiac arrest call to be made.
Three months earlier, Sareena Ali, 27, and her baby daughter died when Ms Ali suffered a ruptured womb while labour was being induced. By the time doctors reached her she'd had a cardiac arrest and they had to perform an emergency caesarean.
Her baby was stillborn and Ms Ali died five days later.
Sarah Harman, a solicitor for Ms Ali's family, said she had since been contacted by more than 50 former Queen's Hospital maternity patients. Negligence proceedings are being taken on behalf of 20.
She said: "As well as poor care and lack of communication, patients suffered due to junior staff dealing with situations beyond their competence."