A Sussex hospital trust has been criticised in a damning report into the case of an elderly pathologist who misdiagnosed more than 200 cancer patients.

Mid Sussex and three other NHS trusts were rapped for their role in employing Dr James Elwood as a locum during the Nineties.

The report by the Commission for Health Improvement (CHI) also criticised the Department of Health and warned hospitals throughout England were still failing to make adequate checks when employing temporary locum doctors.

It said patient safety may be at risk because of inadequate systems for rooting out incompetent doctors.

Dr Peter Homa, chief executive of CHI, said the failures by the four trusts were "shocking."

The CHI report was ordered after it emerged that 79-year-old Dr Elwood had wrongly diagnosed 27 cancer patients at Princess Royal Hospital in Haywards Heath and hundreds of other patients at hospitals in Swindon, Bath and Surrey between 1995 and 1999.

The CHI report found all four trusts had failed to carry out even basic checks on Dr Elwood's background and career when he came to work for them.

Mid Sussex had no record of any references, health checks or interview and the hospital made no checks with his previous employers to ensure he had worked there.

Dr Elwood worked at the Princess Royal Hospital on 13 occasions between 1991 and 1995 and on just two occasions during the period covered by the investigation.

He first came to the Mid Sussex trust in December 1991 on a personal recommendation from a consultant at nearby Crawley Hospital.

There was no record of his original application, references, health checks or interview.

The report said that, as Dr Elwood had been well-known locally, it came to the conclusion the recommendation was made by telephone as there was no written record of such a discussion.

There was no specific requirement to check with previous employers at the time Dr Elwood was used by the trust although trusts have always had a duty of care to check the background of their employees and to confirm their competence to perform the work for which they are employed.

The report said the checks should have been made anyway.

Dr Elwood had worked as a locum pathologist in three other trusts, the Royal United Hospital Bath Trust, the Frimley Park Hospitals Trust and the Swindon and Marlborough Trust where the bulk of his work was carried out.

Despite concerns being raised about his performance as early as 1995, investigations did not start until 1999.

In the largest review of tests ever conducted, more than 10,000 diagnoses by Dr Elwood had to be rechecked.

More than 200 people were found to have been wrongly diagnosed - seven suffered serious consequences as a result.

One woman had a breast removed unnecessarily and another patient was left in a "life-threatening" condition.

The report said: "In summary, CHI considers that none of the four trusts carried out adequate checks in the recruitment and retention of Dr Elwood.

"The four trusts failed to use adequate safeguards when employing Dr Elwood in terms of obtaining references, checking career history, in interviewing, in carrying out health checks and in his induction."

The report also criticised the lack of communication between hospitals which allowed Dr Elwood to move from one trust to another without concerns being passed on.

Since the news emerged about Dr Elwood last year, Mid Sussex has introduced a clear written procedure for the appointment of locums.

It maintains a Locum Register with details of locum responsibilities and reporting arrangements and a locum induction pack.

The trust says toughening up its procedures means the incident will never happen again.

A code for employing locums was introduced in 1997 by the Department of Health But the report said many trusts were failing to comply with the code's rules on checking the background of temporary doctors.

The report was strongly critical of the Department of Health's systems on employing elderly and locum doctors.

It said there was "too much reliance" on locums because of chronic shortages of pathologists and "poor workforce planning".

Trusts must seek a special order to employ doctors aged over 70, proving that there is a pressing need to employ them and that they are fit to practice.

But CHI said the procedure was simply a "rubber stamp and provided no safeguard for the employing trust or patients".

CHI was set up as the NHS's watchdog last year, charged with investigating problems in hospitals and trusts.