Many senior managers simply do not know whether their trust meets service standards, including national targets on hospital admissions and discharges and speed of treatment, the survey shows.

Some others admit candidly that their trusts do not come up to scratch. But the survey shows that chairs are often more confident in their organisation's performance than their executive directors.

Chairs, chief executives, medical directors and chief nurses were asked how they measured up in areas where a quality failure would mean that the trust board 'would be hung out to dry by public opinion' (see figures 3a, 3b).

Citing earlier failures in cervical screening, the report says it is difficult to believe that chief executives would not want to be sure that samples were processed in line with national guidelines.

'Yet the survey found that 15 per cent of medical directors and 11 per cent of chief executives could not be sure, and that 2 per cent and 5 per cent respectively were sure that the guidelines were not being followed.

'Though these numbers seem low, it is barely credible that we were able to find a single trust where the chief executive remained in ignorance of what was going on in the cytology screening laboratory.'

It goes on: 'Likewise, after many of the headlines regarding the discharge of psychiatric patients, it beggars belief that... 25 per cent of chief executives were not sure they had up-to-date discharge arrangements, and 36 per cent were not sure whether all psychiatric patients were discharged on the authority of a consultant and that case notes would bear this out.'

And it says: 'Again it is hard to credit that with all the efforts to promote better door-to-needle time for patients with possible cardiac problems, that a quarter of chief executives could not be sure their A&E services could deliver the national standard.'

The report goes on to describe the low priority given to medical records as 'disappointing', with a third of medical directors lacking confidence that they could trace the surgeon and anaesthetist from operation notes.

'One wonders if they would say this in court, and hopes that they will never have to.'