A leading children's hospital has taken safety shortcuts in its operating theatres which has "created high risk activity", according to a report.
An internal review into Alder Hey Children's NHS Foundation Trust concluded that staff believe senior managers are aware of poor working conditions "and condone it".
The review has been leaked to Channel 4 News and comes more than a decade after the same trust was involved in a scandal over the retention of hearts and organs from hundreds of children.
The organs were stripped without permission from babies who died at the hospital between 1988 and 1996.
The latest review of operating theatres - by one of the trust's own directors - said "the level of risk is such that urgent action needs to be implemented to avoid an adverse outcome or serious incident", according to Channel 4 News.
The programme said the review was ordered following ongoing concerns over the operating theatre department.
It said the review was prepared by the director of nursing Gill Core, who sits on the trust's board, and was presented to the board in December.
Under the heading "safety concerns", the review says safety shortcuts "have created high risk activity", there is "limited reporting of incidents" - that is, near-misses and mistakes - and there is a belief that "the senior management and the board are aware of the working conditions and condone it".
The report goes on: "Some individuals have reported that the 'working environment is hostile' and there are numerous examples of staff feeling pressurised to undertake activities that they do not believe are safe."
It adds that the "perception of mistrust of management and the board is such that there is a widespread feeling of hopelessness that change will ever be achieved".
The report said the units are "not welcoming or child friendly". It said that for a children's hospital "there is a total absence of toys".
Even the scrubs suits used in the operating theatres are described as "shabby and mismatched".
The report does praise staff, saying: "It is immediately apparent that responses from theatre staff have centred on a desire to deliver the best possible service and the highest standard of care to patients."
But the review also says: "Staff have adopted some high risk practices in order to avoid cancellations; whilst safe outcomes have been maintained, the level of risk is such that urgent action needs to be implemented to avoid an adverse outcome or serious incident."
The regulator the Care Quality Commission (CQC) made an unannounced inspection in December after being directly approached by theatre staff.
A statement from the CQC said: "Concerns were raised with us and we carried out an inspection at Alder Hey Children's NHS Foundation Trust in December. The findings will be published soon."
In a statement to Channel 4, the trust said: "We acknowledge that there have been difficulties within the theatre team at Alder Hey for some time. Over the past year we have undertaken a range of measures to address these and make changes within the department.
"We recognise that changes to the culture of the department may take time and therefore we have made a long-term commitment to supporting the team."