The Care Quality Commission (CQC) says it's concerned about a culture of bullying and racial discrimination at Nottingham University Hospital NHS Trust.
Recent inspections at the Queen's Medical Centre and City Hospital found that many staff were too frightened to speak up about the issues that resulted in the overall rating of the trust moving down from 'good' to 'requires improvement'.
The CQC carried out an inspection in June and July at emergency services and surgery departments at the Queen's Medical Centre and surgery at City Hospital, as part of CQC's continual checks on the safety and quality of healthcare services.
Following the inspection, the trust was issued with a warning notice requiring them to make improvements around leadership, risk management, governance and culture due to concerns found.
The report expressed concerns about the culture amongst staff and it said 'some board and executive team members 'lacked integrity'.
In addition to this, the report suggests there was a 'high level of anxiety' among staff in the emergency department.
Information received by whistleblowers described executive directors having poor relationships with staff with some staff not knowing who their leaders were, with many saying they were not visible or approachable.
According to the report, the board has not been "working effectively together to achieve its full potential".
The trust was rated outstanding for being caring, requires improvement for being safe, effective and responsive and inadequate for being well-led.
The overall rating for surgery remained as good and the overall rating for urgent and emergency services remained as requires improvement.
The trust says it's working hard to make the required changes.
Sarah Dunnett, Head of Hospital Inspections, CQC
Sarah Dunnett, CQC's head of hospital inspection, said: "Our inspection of Nottingham University Hospital NHS Trust found a number of areas where improvements were needed, particularly around leadership regarding the trust board and executive team, culture and risk management, to ensure patients receive safe and timely care and staff are fully supported.
"However, we also saw examples of good practice across the trust. For example, surgery services at both sites were managed effectively with high-quality patient care deemed a priority. Staff were caring, supportive and respectful and worked hard to achieve the best outcomes for patients."
She said the CQC would "monitor the service closely" to ensure changes were made.
This is not the first time the trust has come under fire.
Maternity services at both hospitals were downgraded to "inadequate" after inspectors found "several serious concerns" in December last year.
The notice gave the trust three months to make the necessary improvements.
However, the trust apologised and said it made “immediate changes” to staffing, training, staff feedback and IT.