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NHS staff should be prosecuted for wilful neglect or the mistreatment of patients, according to a major review of the health service.
Professor Don Berwick, a world expert on patient safety, also recommended new criminal offences for healthcare organisations that withhold information.
But he stressed the offences should be used only in a "very small number of cases" and that unintended errors should not be criminalised.
His report, which follows a five-month inquiry, failed to call for a statutory duty forcing NHS staff to tell patients about poor care.
"Achieving a vastly safer NHS will depend far more on major cultural change than on a new regulatory regime," it said.
It also did not recommend centrally-set minimum staff levels, calling instead for new national guidance on safe staffing numbers to be set by health regulators.
Patient groups immediately criticised the report's "broad brush" approach and claimed the "endless number of reviews" were just becoming a distraction.
Professor Berwick, who was health adviser to Barack Obama, was asked to investigate patient safety by David Cameron in the wake of the Mid-Staffs hospital scandal.
A long-standing admirer of the NHS, he described it as an "international gem" that was the envy of countries around the world.
He told Sky News that the main thrust of his recommendations was for a "learning NHS" where hospitals know about mistakes elsewhere and can avoid repeating them.
He backed calls for a review of staffing ratios so that wards are always properly manned but insisted a single number fixed by law would not work.
He recommends that the National Institute for Health and Care Excellence (Nice) devise a formula NHS leaders would use to check they have the right number of staff.
"We think that's a lot smarter than a simple statutory number that would not be responsive to a local context," he said.
The expert made clear that mistakes and problems would always happen, as with any organisation, but insisted harm to patients should not be accepted as inevitable.
"By introducing an even more transparent culture, one where mistakes are learnt from, where the wonderful staff of the NHS are supported to learn and grow in their capacity to improve the NHS, and patients are always put first, the NHS will see real and lasting change," he predicted.
Health Secretary Jeremy Hunt added: "The report makes clear that the NHS could lead the world in patient safety.
"Nothing less is good enough for the patients and families who rely on it and this Government will back our hard-working NHS staff to make this a reality."
Earlier on Sky News, Mr Hunt said of fixed staff levels: "A targets culture where there are lots of things imposed from the centre can be very counter-productive."
However, shadow health secretary Andy Burnham declared: "All the experts are now telling the Government to get a grip on staffing levels. The time for excuses is over.
"While ministers dragged their feet, over 800 nursing jobs were lost last month alone - now totalling almost 5,000 since the election.
"David Cameron must now urgently intervene to ensure safe staffing levels in our hospitals. These dangerous cuts to nursing posts prove you can't trust the Tories with the NHS."
The report was broadly welcomed by industry groups, including the British Medical Association and Royal College of Physicians.
But the Patients Association condemned it for being too "broad brush" and failing to come up with specific, practical measures to address the NHS' problems.
Chief executive Katherine Murphy said: "This is yet another report heavy on platitudes and good intentions but light on practical solutions. It falls far short of what is needed."
Mr Hunt "may well think that this report is fantastic, but the patients and relatives that have been let down will not agree with him at all", she added.
The Government will consider the report and the Francis Inquiry's conclusions about Mid-Staffs before responding in full in the autumn.