Bereaved families are being left in the dark and left to suffer when the NHS investigates patient deaths, according to a damning new review by the Care Quality Commission (CQC).
The health watchdog identified a string of problems with the investigation process and found NHS Trusts in England are "immediately on the defensive" about failures in care.
It said there are "system-wide" problems in the approach to loved ones including a level of "acceptance and sense of inevitability" when people with a learning disability or mental illness died early.
Families described a poor experience of investigations and told the CQC they were not consistently treated with respect, sensitivity and honesty.
One parent said: "I was put in a room. I shall never forget what the nurse in the room told me. She said, 'You have got to accept that his time has come.' Bearing in mind my son was just 34 years old."
The CQC said grieving families were not being included or listened to in official investigations into patient deaths.
They were also left without clear answers as to what happened which added to their distress.
Another family member told the regulator that they had "more courtesy at the supermarket checkout" following the death of their loved one.
She said: "You're viewed as a pain in the neck really, it's a bit like if you keep complaining about the washing machine but the machine is out of warranty.
"I've had more courtesy at the supermarket checkout than I've had at the trust."
Not one NHS trust was "getting it right", the CQC's chief inspector of hospitals Professor Sir Mike Richards said.
Sir Mike said: "We found that, too often, opportunities are being missed to learn from deaths so that action can be taken to stop the same mistakes happening again.
"Families and carers are not always properly involved in the investigations process or treated with the respect they deserve.
"We found this was particularly the case for families and carers of people with a mental health problem or learning disability which meant that these deaths were not always identified, well investigated or learnt from.
"This is a system-wide problem, which needs to become a national priority."
The assessment, which paid particular attention to deaths of patients with mental health conditions and learning disabilities, is based on evidence from visits to 12 NHS trusts, a national survey of all NHS providers and interviews and discussions with more than 100 families.
The authors examined 27 death investigations and found that only two of the reports contained a "satisfactory response" to the family or carers of the person who died.
Loved ones were not always informed or kept up to date about investigations - often causing them further distress.
Health Secretary Jeremy Hunt is expected to accept all 18 recommendations set out in the report in a speech to the Commons on Tuesday.
These include setting a national standard into how NHS trusts investigate deaths and appointing a senior board member at each organisation to lead on patient safety.