Concerns over surgical safety have been exposed in a report into Gloucestershire's two main hospitals.
Surgery at both Cheltenham General Hospital and Gloucestershire Royal Hospital is now rated 'inadequate' and the overall rating of the trust has dropped from 'good' to 'requires improvement'.
The Care Quality Commission (CQC) has issued the trust which runs the hospitals with a warning notice to make significant improvements to areas of surgery including safety, leadership and managing risk.
The report goes on to say that "staff had raised concerns regarding staffing and low morale but didn't feel they were listened to".
In April and June this year, the CQC carried out an unannounced inspection of the trust's surgical services. This was done in response to concerns received about the safety and quality of the services. These included staff whistleblowing, and the number of serious patient safety incidents reported over the previous year.
It was noted how the hospitals visited were "incredibly busy" and the impact that staff shortages were having.
Catherine Campbell, CQC head of inspection, said: "We found there was a lack of trust in senior leaders and a fear of speaking up.
"Inspectors were told when staff did raise concerns they were not always supported or treated with respect.
"Some staff said they had tried repeatedly to raise concerns and due to either a lack of response or a negative response, eventually they had become disengaged and focused instead on day-to-day service provision.
"There was also a disconnect in the governance of the trust, so senior leaders were not sighted and hence had not taken action to rectify issues and matters arising in wards and departments.
"There were some cultural challenges within the trust and leaders did not always promote equality and diversity in day-to-day work."
The trust has shared its improvement plan with the CQC, which says it will continue to monitor to ensure it is putting the needed improvements in place.