Staff at a hospital under a heavily-criticised health board have been dubbed some of the "unhappiest" ever seen in a damning report leaked to ITV Wales.
Wrexham Maelor Hospital was described as the "perfect storm of a collapsing estate" after a visit from The Royal College of Physician's (RCP) president.
Dr Andrew Goddard, RCP President, said investment from the Betsi Cadwaladr University Health Board or the Welsh Government was "desperately needed".
He said: "Our virtual visit to Wrexham in May 2021 introduced me to the unhappiest group of consultants I've ever spoken to in my career, bar one.
"We heard about a perfect storm of a collapsing estate, ineffectual or non-existent IT, and staff shortages."
One consultant physician described how the hospital is struggling to recruit staff.
They said: "Our medical rotas are teetering on a knife-edge: we're two resignations away from a collapse.
"We're struggling to recruit... Recruitment and retention are going to become an increasing problem in Wrexham."
Another staff member describes how trainees are being spread more thinly post Covid-19.
"There just aren't enough people on the rota", the trainee said.
"The choice is between going into clinic or leaving very junior doctors to cover a ward on their own."
The report describes a historical lack of investment in the estate, facilities, IT and the workforce, which is "ultimately affecting recruitment".
It added: "People will simply choose to work at more modern hospitals, where they feel heard and valued. Whether this investment comes from the health board or from Welsh government. It is desperately needed."
Betsi Cadwaladr University Health Board has previously been rocked by controversy - being placed into special measures before patient deaths at units raised concerns.
Betsi Cadwaladr University Health Board
A timeline of events
A timeline of events
2015 - Betsi Cadwaladr University Health Board is placed into special measures because of improvements needed in governance and maternity and mental health services.
November 2020 - BCUHB taken out of special measures and into targeted intervention.
December 2020 - Patient death on the Ablett Unit.
January 2021 - Jo Whitehead becomes Chief Executive.
April 2021 - Patient death on the Hergest Unit.
June 2021 - Member of staff writes anonymously to Jo Whitehead.
'There was almost a mutiny'
The RCP carried out a virtual visit of Wrexham Maelor Hospital on May 21 this year. It gave staff the opportunity to give feedback so the report could offer constructive recommendations.
A staff member said: "If we get suddenly busy on a Friday evening, they'll panic and open an area of the hospital without enough doctors. It isn't safe, but it happens again and again. It's so reactionary."
The report found that doctors at Wrexham consider their workload to be excessive, and this is having a negative effect on patient safety and flow, as well as workforce wellbeing.
"There's a big loss of trust. Last summer, there was almost a mutiny. It was a really difficult time," a consultant physician said.
The RCP report concluded that the consultant body at Wrexham felt frustrated, angry and ignored.
"Their relationship with managers and executives at a health board level has almost entirely broken down", it said.
"However, it was reassuring to hear that recent staff management changes at a site level were beginning to repair some of the damage locally.
"Nevertheless, the unhappiness of these consultant physicians, combined with a historic underinvestment in facilities, estate and IT at Ysbyty Wrexham Maelor, will result in serious damage to the reputation of the hospital and its ability to recruit and retain doctors if the executive does not take immediate action to repair this relationship."
Dr Nick Lyons, Executive Medical Director at Betsi Cadwaladr University Health Board, said: "Covid-19 has affected everyone working in the health service, and we need to ensure that colleagues are supported to do their jobs to the best of their ability. I really do recognise the stress, pressure and workload our clinicians are grappling with.
"Working with our clinical teams, we can make real progress in addressing the concerns they have raised. We have a good foundation on which to build, as identified in the report, including the good teaching experience of junior doctors and some of the innovation that has taken place during the pandemic."
The Welsh Government said the health board has taken the report "extremely seriously" and has drawn up action plans to address the recommendations.
A spokesperson said: "We recognise the huge pressures NHS staff have been under for a sustained period of time and it is vital any concerns over their wellbeing and morale are addressed.
"The health board is working closely with the college advisors and are committed to progressing these actions."