Senior managers at a hospital trust did not respond effectively to concerns over a surgeon carrying out unnecessary or incomplete breast cancer operations, a report has found.
An independent report by lawyer Sir Ian Kennedy found concerns about Ian Paterson dated back to 2003.
He allegedly carried out "cleavage sparing" mastectomies while at the Heart of England NHS Foundation Trust.
The report made a number of recommendations.
Solihull Hospital previously found the surgeon breached guidelines over a procedure that involved leaving behind breast tissue to provide an improved cleavage.
The recommendations relate to better transparency, improved recording of information, the role of regulators, encouraging staff to raise concerns and increased scrutiny.
The report found senior managers at the trust did not respond effectively until 2007 and said their response was neither sufficiently robust nor rigorous.
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Report author Sir Ian Kennedy: "Opportunities were missed on a number of occasions"
Sir Ian's report said the case had lessons for the whole NHS.
"It is a story of clinicians at their wits' end trying for years to get the trust to address what was going on.
"It is a story of clinicians going along with what they knew to be poor performance.
"It is a story of weak and indecisive leadership from senior managers. It is a story of secrecy and containment."
Sir Ian said the breast surgeon, who has been struck off by the General Medical Council, was allowed to carry on operating on women for several years despite a series of concerns raised about him by other medical staff.
He added: "I was shocked by how long it took for effective action to be taken. Why was there not in place a system that could properly address the needs of women?"
The report said the trust had "a huge task on its hands to win back some measure of confidence".
It added: "[Staff] have lost confidence in the management of the trust, they...feel betrayed that no one listened to them, that things were allowed to go unchallenged for so long, that they cannot trust those charged with leading the trust."
The review found the trust board was excluded from access to much of the information by senior managers and made no formal effort to assert itself and become involved.
Sir Ian said: "The board is responsible for everything that happens in the trust and if they are going to sleep on the job and don't hold their chief executive to account then they have failed."
Up to 400 women are believed to be suing the trust for failing to take action over the claims.
NHS England said it "fully supports the recommendations that Sir Ian details in his report".
Trust chairman Lord Philip Hunt said: "I wish to give a full unreserved apology to all patients and their relatives. This was completely unacceptable and I am very sorry indeed."
He said a taskforce would be set up in January and that would oversee the implementation of Sir Ian's recommendations.
Following the suspension by the GMC last year, it referred the case to officers at West Midlands Police.
A spokeswoman for the force confirmed its investigations are continuing.
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