NHS boss Sir David Nicholson has said he will not quit as he headed to a meeting of the board which has the power to sack him over the failings at Stafford Hospital.
Sir David remained defiant when approached by ITV News' Midlands Correspondent Rupert Evelyn in Manchester.
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The letter said he could "wipe out 470 disabled individuals" to help "revitalise the world economy" and "prevent World War III".