NHS staff should face prosecution if they are not open and honest about mistakes, according to a public inquiry into failings at Stafford Hospital.
Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients.
But inquiry chairman, Robert Francis QC, said the failings went right to the top of the health service.
He made 290 recommendations, saying "fundamental change" was needed to prevent the public losing confidence.
Responding in the House of Commons, Prime Minister David Cameron apologised to the families of patients.
He said he was "truly sorry" for what happened at Stafford Hospital, which was "not just wrong, it was truly dreadful" and the government needed to "purge" a culture of complacency.
Mr Cameron said a full response to the inquiry would follow next month, but he did immediately announce that a new post of chief inspector of hospitals would be created in the autumn.
Previous investigations have already established in harrowing detail the abuse and neglect from 2005 to 2008.
This inquiry looked at why the system did not prevent the problems or at the very lest detect them earlier.
In particular, it recommended:
* The merger of the regulation of care into one body - two are currently involved
* Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
* Hiding information about poor care to become a criminal offence as would failing to adhere to basic standards that lead to death or serious harm
* A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
* An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors
While it is well-known the trust management ignored patients' complaints, local GPs and MPs also failed to speak up for them, the inquiry said.
The local primary care trust and regional health authority were too quick to trust the hospital's management and national regulators were not challenging enough.
Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.
The Department of Health was also criticised for being too "remote" and embarking on "counterproductive" reorganisations.
The report said the failings created a culture where the patient was not put first.
But the inquiry said the change needed did not require further reform.
Instead, it urged everyone from "porters and cleaners to the secretary of state" to work together to shift the culture and adopt a "zero tolerance" approach to poor care.
Mr Francis said: "This is a story of appalling and unnecessary suffering of hundreds of people.
"They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety."
He said the public's trust in the NHS had been "betrayed" and a change of culture was needed to "make sure that patients come first".
The "appalling" levels of care that led to needless deaths have already been well documented by a 2009 report by the Healthcare Commission an anindependent inquiry in 2010, which was also chaired by Mr Francis.
They both criticised the cost-cutting and target-chasing culture that had developed at the Mid Staffordshire Trust, which ran the hospital.
Receptionists were left to decide which patients to treat, inexperienced doctors were put in charge of critically ill patients and nurses were not trained how to use vital equipment.
Cases have also been documented of patients left crying out for help because they did not get pain relief and food and drinks being left out of reach.
Data shows there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008, although it is impossible to say all of these patients would have survived if they had received better treatment.
Royal College of Nursing general secretary Peter Carter described it as a "powerful and monumental" report.
He said: "We welcome moves for overarching standards which enshrine what patients deserve from the NHS and from those who work for it.
"Appalling care cannot be tolerated and everything should be done to ensure that it does not happen again."
But campaigner Julie Bailey who's mother, Bella, died in 2007 at Stafford Hospital prompting her to set up Cure the NHS, which had been instrumental in pushing for the public inquiry, called for resignations.
"We've lost hundreds of lives in the NHS and we want accountability.
"We owe that to our society and to the deaths and the respect of all the loved ones that we have lost.
"We will go nowhere until we get accountability."
Katherine Murphy, the chief executive of the Patients Association, said the report was a "watershed moment" for the health service.
She said: "It is clear that he [Mr Francis] has understood some of the very real failings that patients and their families face day in and day out.
"It is clear from the report that there is a lot of blame to go around for what happened in Stafford. Unfortunately too many people have escaped genuine accountability."