A government hit-squad has held a crisis meeting with managers at a trust stung by revelations of horrifying abuse of elderly mentally ill patients.

North Lakeland Healthcare trust is the first NHS organisation to face an investigation by the Commission for Health Improvement, which officially started work on 1 April.

Many of the trust's senior managers have already been suspended, following a damming report which found that patients at Kielder House had been fed while using the lavatory and subject to a range of degrading treatments.

Chair Mary Styth was sacked when the report was published last month.

CHI director Dr Peter Homa called a meeting with acting chief executive Geoff Bland and Northern and Yorkshire regional public health director Dr Bill Kirkup last week, to set out the terms for CHI's work.

CHI medical director Dr Linda Patterson is to be sent into Lakeland this week while Dr Homa chooses an investigative team that will include experts in mental health, nursing and geriatric care.

A CHI spokesperson denied that the investigation would lead to chief executive Alan Place, currently suspended, being sacked: 'This doesn't affect the chief executive's position. It will depend how the region wants to handle it.'

CHI does not have the power to sack NHS staff but can recommend dismissals to health secretary Alan Milburn. The investigative team will visit the trust within 'two to three weeks' the spokesperson added.

CHI deputy director Jocelyn Cornwell said the inspectorate's role was 'to help' the trust put the recommendations detailed in the report in place.

Dr Kirkup has blamed a 'dysfunctional relationship between the chair and chief executive' as well as 'flawed internal investigations' for the lack of action to stop the abuse. Problems first came to light in 1996 but were not fully investigated until new allegations surfaced in 1998.

Apart from Mr Place, four other members of staff have been suspended. Other members of staff are being investigated.

A trust spokesperson said: 'We will co-operate with CHI to ensure action is taken so that this never happens again.'