If a major problem is brewing in your hospital, don’t bank on the board spotting it before it becomes a scandal.

That is the stark message which emerges from an Audit Commission study published yesterday on how the boards of NHS trusts and foundation trusts assure themselves internal controls are in place and working.

The study of 15 trusts exposed a litany of shortcomings which meant boards could not be confident their institution was operating within the law.

One trust could not even produce a copy of its strategic objectives

Processes intended to provide assurance that legal and regulatory standards were being met had often been reduced to a paper chase divorced from the day to day running of the hospitals. One trust could not even produce a copy of its strategic objectives - surely a case for regime change.

The implication of the report is that another tragedy on the scale of Maidstone and Tunbridge Wells or Mid Staffordshire could be unfolding right now, with the board oblivious to what is about to envelop them.