NHS braces for onslaught from Jeremy Hunt in run-up to report on care failure The NHS is bracing itself for a fresh onslaught from the health secretary, Jeremy Hunt, who is preparing to make clear he expects some hospital trust bosses to lose their jobs when an extensive inquiry triggered by high death rates reports on Tuesday. The findings of a five-month inquiry into 14 hospital trusts with high mortality rates, which David Cameron ordered in February after the damning official report into the Mid Staffordshire care scandal, will reveal that failings - such as poor care, inadequate staffing and lax medical record keeping - were found to some extent at all of them. None of the 14 has been given a clean bill of health. All have some problems," said one official involved. The report will criticise senior figures at some of the trusts - chief executives, medical directors and board chairs - for not knowing about problems and doing too little to improve care standards and management. It will say that inquiry inspectors found junior staff, especially doctors, too scared to raise concerns in case they suffered as a result. The investigation, led by the NHS medical director, Professor Sir Bruce Keogh, is understood to have found serious problems in at least half of the 14 trusts. They include North Cumbria - which sources describe as "deeply worrying" - Basildon in Essex and Tameside in Manchester, where the chief executive and medical director resigned on 3 July after the Guardian detailed how NHS assessors had found often shambolic care there. But in the run-up to its publication there are concerns among some of the experts who undertook the investigation that Hunt will exaggerate the seriousness of some of their findings as part of his tough stance on the NHS's failure to always provide adequate care to patients. While problems of varying significance were found at all 14, inquiry team members were also impressed that some of the hospitals had taken decisive action to tackle historic problems that led to their inclusion on the list and now offered very good care. They also found some units of a hospital were exhibiting excellent medical practice while at the same time other departments were offering poor care, making an overall assessment of the hospital difficult and potentially unfair. Inquiry team members fear that Hunt may misrepresent what they describe as a thorough and honest but also fair and measured report. We don't want to be hiding poor practice. But equally, nobody wants this review of 14 hospitals to end up with them being pilloried and creating more horrible bad news stories for the NHS," one inquiry member said. Hunt has been criticised by the leaders of Britain's doctors and nurses for giving a false impression of how widespread problems are in the NHS. He has condemned uncaring nurses, the "normalisation of cruelty" in NHS care, "coasting" hospitals which do not strive to offer the best care and GPs for not taking back responsibility for providing out-of-hours services. But inquiry team members say that although all the hospitals will be issued with an action plan and told to make urgent improvements, none of them posed anything like the scale of risk seen at Stafford hospital, where between 400 and 1,200 are believed to have died between 2005 and 2009 as a result of poor care. "There wasn't one where we said: 'Oh God, if we'd not gone in there it would've been another Mid Staffs," said one inspector. Another said: "Some of the problems we found at some of the trusts were things that you could easily find if you looked at any batch of hospitals, even good ones." That is unlikely to stop Hunt from making clear in his statement to parliament that he expects the NHS to demonstrate what sources close to him say is "genuine accountability" for the failings Keogh's national advisory group of experts have exposed. "There may well be departures, but there won't be a blanket approach to departures," one said. His determination to see some NHS bosses quit has led to tension in the last few days with NHS England, Monitor, which regulates foundation trust hospitals, and the NHS's Trust Development Authority, which oversees all non-foundation trusts. Senior figures there have sought to dissuade Hunt from publicly seeking what one official called "heads on sticks" lest that deter talented NHS managers from taking the top job at trusts with historic problems. His ability to engineer departures is also constrained by the fact that many of the bosses of the 14 trusts have only been in the job a short time and that only Monitor or the board of the nine foundation trusts among the 14 can sack bosses, not him. Hunt is expected on Tuesday to seek to put trusts with ongoing problems into "special measures," which will oblige them to implement their action plans quickly. They will be offered a support team of officials to help them and will have their progress monitored. Each of the implementation plans will reflect the problems uncoveredand will also include recommendations on what the hospital concerned needs to do to improve areas such as out-of-hours care, infection control and end-of-life care. "Poor care in the NHS is completely unacceptable, which is why we commissioned this review into longstanding issues at these hospital trusts," Hunt said. For too long problems in the NHS have been allowed to go on unchecked. We will act in the best interests of patients and ensure that where problems are found we take action immediately. The Trust Development Authority plans to offer help and support to the five of the 14 trusts it is responsible for and does not expect any of the chief executives involved to have to stand down. But Monitor is examining what regulatory action it can take involving the five foundation trusts that are already in special measures because they have breached the conditions of their licence to operate and the four others, if action is necessary. While many of the 14 trusts' chief executives are thought to be safe unless Hunt and the media demand that some quit, several of the medical directors - the most senior doctors at the trusts - are thought to be potentially vulnerable. The chairs of some boards are also likely to come under serious pressure for not having exercised better oversight - a key failing in Mid Staffs identified in Robert Francis QC's official report. Although weekend media reports speculated that Keogh's team had uncovered anything between 3,400 and 13,000 excess deaths at the 14 trusts between 2010-11 and 2011-12 - the years in which high mortality rates, as judged by two key indicators, triggered the inquiry - the report will not give any such numbers. The report looks at what quality of care is like now. It's not a retrospective assessment of historically why they had high mortality rates," said one of those involved. In an early sign of the political battle that will follow the report's publication, Andy Burnham, the shadow health secretary, has said he will fight any Tory attempts to blame him for widespread failings in the NHS before 2010. "To be honest, I'm fed up of these general accusations being hurled in my direction," the former health secretary told Sky news. We had a reorganisation that completely distracted the whole NHS from these issues, and that is what I will bring to the attention of the House of Commons on Wednesday.