Mr Ledward left scores of patients with lasting injuries and the report severely criticised NHS managers and a culture where consultants were regarded as "gods".

Better NHS management should have picked up the problems earlier

Rodney Ledward inquiry report

But health minister John Denham said changes to the complaints procedure and plans for monitoring of doctors would now pick up on such cases.

He said: "For the first time now, chief executives of trusts know that they have a legal duty of quality in their organisations.

"That did not exist in the past and should have done. The whole point of introducing a new system is to pick up poor performance, weakness in performance much earlier in a doctor's career than happened in the case of Rodney Ledward."

The report said staff were prevented from blowing the whistle because of fears of consultants' status.

It says senior managers at the William Harvey Hospital in Ashford, Kent, also failed to investigate concerns when they were raised.

The report, by Jean Ritchie QC, concludes: "Proper and effective leadership in NHS management was lacking."

Mr Ledward, 62, was struck off after some patients at the William Harvey Hospital complained they had been left badly damaged by operations.

Banned

He was banned from practising by the GMC in September 1998 after being found guilty of serious professional misconduct.

The inquiry report says he rushed his clinics, ward rounds and surgery, pressurised patients into having surgery privately and performed unnecessary operations.

There were also allegations that he was drunk on occasions at the hospital and did not obtain proper consent for operations.

The report adds: "Rodney Ledward bears the greatest responsibility for the failures in his practice. But we have concluded that better NHS management should have picked up the problems earlier."

He removed one woman's ovaries without her consent and an unprecedented 198 claims for compensation have followed, with dozens already settled.

The Ritchie Inquiry, which was ordered by then Health Secretary Frank Dobson in March 1999, recommends that concerns about a doctor's performance are picked up and dealt with earlier.

The GMC should hold hearings on the basis of a balance of probabilities, as in civil hearings, rather than requiring the burden of proof required in a criminal trial.

Jean Ritchie QC: "It is a fundamental criticism"

And it says Assessment and Support Centres, proposed by the government to deal with allegations of misconduct and errors by doctors, if introduced could replace the need for the GMC's professional performance procedures.

Mr Ledward - understood to be living in the Republic of Ireland and to be seriously ill - once boasted of being "the fastest gynaecologist in the south-east".

He made the claim after performing hysterectomies on seven women in one morning.

David Astley, chief executive at East Kent Hospitals NHS Trust, apologised to the women affected and said: "The fact that there were problems with his performance only really came to light after he was struck off.

"When the full picture came to light, all Rodney Ledward's problems were taken seriously."

Changes had been made to the way the hospital operated and "a culture of openness" was being introduced.

The Patients' Association said it did not believe enough had been done to change the culture in the medical profession and that patients were still at risk from incompetent or corrupt doctors.

The Conservative Party said a guarantee of good quality care was needed for patients.