Northern Lincolnshire and Goole NHS Foundation Trust is to become the first trust in the country to re-enter a failure regime after inspectors found that patient safety and quality of care had "deteriorated".
The Care Quality Commission (CQC) made the 'special measures' recommendation following its latest inspection of Scunthorpe General Hospital and Diana Princess of Wales Hospital in Grimsby.
The trust has apologised for "letting down" its patients.
It provides services to 350,000 people across North and North East Lincolnshire and the East Riding of Yorkshire, was one of the first in the country to be put into the special measures regime in July 2013 after being identified as having higher than expected death rates.
It came out of the regime in April 2014 following improvements in care.
But during the latest visit to two sites, inspectors identified significant concerns in urgent and emergency care, outpatient and maternity services.
Although the latest mortality rates have been found to be "as expected", the health regulator still rated the trust as "inadequate".
Officials said they remained concerned about the organisation's culture, adding:
It highlighted a number of shortcomings, including:
- A "deterioration" of waiting times in a number of areas - data from November 2016 showed that two patients had been waiting for surgery for more than a year.
- Inspectors said they were "not assured" that emergency patients at SGH were offered food and water - out of 33 sets of notes reviewed, only one had documented that a patient had a drink of water.
- The regulator said it did not feel confident that if a child's health deteriorated that it would be recognised. The Paediatric Early Warning Score - an assessment to pick up when a child's health is in decline - was not in use in the emergency department at SGH and although used at the Grimsby hospital, it had not been consistently completed.
- The numbers of nurses and doctors on shift were not always high enough to meet the needs of patients.
- Inspectors said they found "poor leadership" in a number of services, particularly maternity services and urgent care.
- There were "poor infection prevention and control processes and standards of cleanliness" at SGH in the emergency department - inspectors noted several equipment trolleys were dirty and dusty, sharps bins were overflowing and cleaning schedules showed that the resuscitation room had not been cleaned since April 2016.
NHS Improvement said that it had accepted the recommendation that the trust should be put in special measures.
The trust was also placed into financial special measures by NHS Improvement last month - which means it is given support to help it get back on a stable financial footing.
Richard Sunley, interim chief executive at Northern Lincolnshire and Goole NHS Foundation Trust, said:
Ellen Armistead, deputy chief inspector of hospitals at CQC, said: