The health service in Gloucestershire has failed to learn the lessons of the Fred and Rosemary West case, according to an independent report commissioned by Gloucestershire health authority.

A survey carried out by barrister David Spicer found that 60 per cent of NHS managers and more than 75 per cent of GPs were unaware of NHS guidance on child protection. Only a quarter of relevant NHS staff had received training.

HA chief executive Jeff James said the report showed that work was needed to improve relations between organisations engaged on child protection work.

The HA is cutting£100,000 from its health visiting budget this year, a move criticised by the Community Practitioners' and Health Visitors' Association in the wake of the Towards a Healthy Environment in Child Protection report .

But Mr James said the cut would affect services for elderly people.