By politics.co.uk staff
Patients are partly responsible for the "toxic cocktail" behind the NHS' worst failures, the health service ombudsman has suggested.
Dame Julie Mellor's latest report found a reluctance to complain by patients, carers and families was a key part of the problems within the system.
The news will come as a blow to patients' organisations who have sought to pin all the blame for unnecessary deaths at NHS hospitals like Stafford on NHS staff.
But Mellor also found an excessive defensiveness from NHS staff, as well as confusing differences in complaints procedures between hospitals and too much deference to senior colleagues on wards.
"There is a toxic cocktail of reluctance by patients to complain and defensiveness by hospitals in handling complaints," Mellor said.
"This means concerns and complaints are going unheard or unaddressed. Only strong leadership from boards will deliver the culture change and improvement on wards that we all agree the NHS needs."
She called for moves towards an open culture of feedback and improvement, a fresh focus on "putting things right" on wards and "a new culture of collaboration" between leaders and staff on wards.
Such a culture change could prove difficult to achieve in a system dominated by hierarchy and seniority.
Patients and staff providing feedback to the study which led to the report complained that they "closed ranks" and that an official at a hospital's patient advice and liaison service department "barely looked at me and dismissed me with a leaflet".