Problems at Mid Staffordshire Foundation Trust were a “failure of clinical leadership and professionalism”, the medical director of the NHS has told the public inquiry.

Sir Bruce Keogh said it was not right to “put all the blame on managers” as it was not the managers seeing the patients

He added: “It wasn’t the CQC, it wasn’t the PCT, it wasn’t the SHA who treated patients badly at Mid Staffs - it was individual clinicians.”

The inquiry heard that in October 2009 Sir Bruce was contacted by a surgeon called Robert Greatorex who had just carried out a peer review of surgery at the trust with the Royal College of Surgeons. Mr Greatorex said he had never seen “a more dysfunctional surgical unit anywhere” and advised Sir Bruce all laparoscopic surgery be stopped.

Sir Bruce contacted the trust medical director and the service was suspended.  However, he was later contacted by one of the trust surgeons questioning his authority over them as a foundation trust.

Mr Greatorex broke the confidence of the trust, at whose behest the report had been carried out, to contact Sir Bruce because he was so concerned.

The inquiry was told the RCS had since amended its contracts to allow it to inform the regulator where serious concerns were found during a peer review. Sir Bruce said he hoped the rest of the royal colleges would follow suit and understood discussions were taking place at the moment.

Asked why the DH had not intervened sooner, he blamed the Healthcare Commission for not telling him or colleagues how bad things were.

During the afternoon’s evidence Sir Bruce was asked extensively about a wide range of issues including targets, quality and patient safety.

He revealed the National Patient Safety Agency’s National Reporting and Learning Service, which will become the responsibility of the NHS Commissioning Board when the Agency is abolished, is likely to be outsourced to an “NHS trust with an academic interest”.

He also told the inquiry he had asked NHS Choices to publish organisation level data on compliance with patient safety alerts after being persuaded by the charity Action Against Medical Accidents which recently found nearly 50% of trusts were failing to comply with at least one alert.

Sir Bruce repeatedly stressed the importance of patient voice in improving the safety and quality of care. However, asked how the patient voice was “embedded” in Richmond House, home of the DH, he admitted the flow of information was not good enough.