Jimmy Savile abused 63 people connected to Stoke Mandeville Hospital, but one formal complaint was ignored, an independent report has found.
It found Savile's reputation as a "sex pest" was an "open secret" among some staff - but allegations probably did not reach managers.
The formal complaint - made in 1977 by a victim's father - should have been reported to police, it added.
A separate report said "elements of the Savile story" could happen again.
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The Stoke Mandeville report said the victims, abused from 1968-92, were aged eight to 40.
Health Secretary Jeremy Hunt said people were "too dazzled or too intimidated to confront the evil predator we now know he was".
The report found:
- Savile had "virtually unrestricted access" to clinical areas and patients during the 1970s and 80s
- several sex abuse claims were made against him from 1972-85, to different staff members, but only one was a "formal complaint"
- that complaint by a father "should have led to Savile's suspension from the hospital and a formal police report being made"
- there was probably no "hospital-wide intelligence" on Savile
- information known to junior staff and middle managers was "probably filtered out" before reaching senior managers
- over the past 40 years Stoke Mandeville had employed three doctors who had been "subsequently been convicted of sex crimes against patients"
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Lead investigator Dr Androulla Johnstone said there had been failures in the duty to protect victims
Dr Androulla Johnstone, the report's lead investigator, said the victims were "patients, staff, visitors, volunteers and charity fundraisers" - with almost half aged under 16 and 10 under the age of 12.
"Around one third of his attacks were against patients, just over 90% of the victims were female," she said.
"The sexual abuse ranged from inappropriate touching to rape.
"Savile was an opportunistic predator who could also on occasions show a high degree of pre-meditation when planning attacks on his victims."
Savile met Margaret Thatcher, then prime minister, to discuss the funding of Stoke Mandeville's spinal injuries unit in 1980 - and in the same year was appointed to oversee fundraising and rebuilding of the unit.
Dr Johnstone said supervision of Savile at this time was "absent" and - with "statutory functions… in the hands of a celebrity fundraiser" - government and NHS "lost control" of the project.
The Stoke Mandeville report said the hospital trust had tackled Savile's power and influence there "head on" from 1991, and managed to "diminish his authority" - but it took until 1999 to "resolve the situation".
"This says a great deal about the power of the man and the legacy of the historical permissions that had been given to him," it said.
'Weakness for celebrities'In another report, also newly published, former barrister and NHS executive Kate Lampard reviewed how Savile could have abused victims at 41 NHS hospitals.
"While it might be tempting to dismiss the Savile case as wholly exceptional, a unique result of the perfect storm of circumstances, the evidence we have gathered indicates that there are many elements of the Savile story that could be repeated in future," the Lampard report said.
"There is always a risk of the abuse, including sexual abuse, of people in hospitals.
"There will always be people who seek to gain undue influence and power within public institutions including in hospitals."
The report said society had a "weakness for celebrities" and hospitals must be aware of the risks.
Mr Hunt said: "Whilst no system can ever be totally secure from a manipulative and deceitful predator like Savile, we learned last year that there were clear failings in the security, culture and processes of many NHS organisations, allowing terrible abuse to continue unchecked over many years.
"What happened was horrific, caused immeasurable and often permanent damage, and betrayed vulnerable people who trusted us to keep them safe. We let them down."
Hattie Llewelyn-Davies, chairwoman of Buckinghamshire Healthcare NHS Trust, said: "On behalf of the NHS organisations that existed at the time and those that exist today, I want to say sorry to all of Jimmy Savile's victims.
"I know how difficult it must have been for you to come forward and tell your stories after such a long time."
She said Stoke Mandeville was now a "very different place" but no "sense of complacency" would be allowed.
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Hattie Llewelyn-Davies apologised to Savile's victims
Liz Dux, of law firm Slater and Gordon, which represents 44 of Savile's victims, said: "It beggars belief that a report which has revealed Savile was widely known as a sex pest at Stoke Mandeville can find no evidence of management responsibility."
She said victims deserved "more accountability".
The latest reports add to a series published last June.
Simultaneously, the Department for Education has published a string of reports by local authorities into allegations of abuse at a number of children's homes and schools.
In a written statement, Children's Minister Edward Timpson said that although the investigations were complete they had been unable to substantiate any of the allegations.
He said: "None of the investigations have been able to reach firm conclusions about whether the alleged abuse took place or not.
"Although many of them say the informant was credible, the lack of corroborating evidence has prevented them from reaching a definitive conclusion."
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