An already under-fire hospital in east London has been rated inadequate after inspectors found a raft of problems including patients experiencing delays in their treatment and not enough nursing and medical staff to ensure safe care was provided.
The Care Quality Commission (CQC) said there was also a "culture of bullying and harassment" at Whipps Cross University Hospital in Leytonstone.
Handovers between medical staff were unstructured and staff did not have the time to and were not encouraged to report incidents, its report found.
They were not aware of any improvements as a result of learning incidents and there were low levels of compliance with mandatory training.
Patients nearing the end of their life were not identified and their needs were therefore not always assessed, while operations were often cancelled due to a lack of available beds.
The hospital also persistently failed to meet the national waiting time targets, with some patients experiencing delays of more than 18 weeks from referral to treatment.
Morale was low and staff did not want to speak with the inspection team for fear of repercussions.
The CQC said a previous staff survey for the trust as a whole found work related stress to be 44%, the joint highest rate in the country for an acute trust, while 32% recommend it as a place to work - the third lowest in the country.
The trust was £13.3 million off its financial plan at the end of September 2014, with it forecast to be £64.1 million in deficit by the year's end.
The regulator said it inspected the hospital as a direct response to concerns raised from a number of sources, stakeholders, patients, local politicians and others.
"Overall, we rated this hospital as 'inadequate'," the report concluded.
"We found urgent and emergency care, medical care (including care for older people), surgery, services for children and young people, outpatients and diagnostic imaging and services for those patients requiring end of life care were inadequate. Significant improvements are required in these core services.
"We found that maternity and gynaecology and critical care require improvement.
"We rated this hospital as inadequate for safe, effective, responsive and well-led, and rated caring as requires improvement."
Two healthcare assistants were jailed in August 2013 for abusing elderly female patients on the hospital's geriatric ward while a third received a suspended sentence for ill-treatment or neglect following a Metropolitan Police inquiry sparked by a student nurse who acted as a whistleblower.
That same month Barts Health NHS Trust was issued with three formal warnings by the CQC after inspectors found "unsafe" conditions at the hospital including filthy maternity wards and water placed out of the reach of elderly patients.
Inspectors spent six days at Whipps Cross in November, visiting the hospital unannounced twice and identifying 15 areas where the trust must make improvements.
Since the inspection CQC has issued four warning notices requiring the trust to improve the care and welfare of patients, its system for assessing and monitoring services, staffing levels, and handling of complaints.
They found a reorganisation of staffing in 2013 had a damaging impact and staff were overstretched, while there was an atmosphere which did not help in recruiting or retaining permanent staff.
Some agency staff had not been trained properly in their roles and there were not enough nurses or doctors to ensure safe care was provided.
The average bed occupancy was so high that it was affecting the flow of patients through the hospital, with patients admitted to wards which were not appropriate to their needs.
Patients were cared for in recovery areas, others were transferred out of critical care beds before they were ready to.
Chief inspector of hospitals, Professor Sir Mike Richards, said: "Our inspection of Whipps Cross University Hospital has highlighted a number of serious concerns surrounding poor leadership, a culture of bullying, and low staffing which has led to risks to patient safety.
"I note that many of the failings which we found on inspection in November 2013 are still not resolved. In some areas there has been little progress - and this has been affecting the quality and safety of patient care.
"I know that Whipps Cross University Hospital has been through a period of considerable upheaval, with the reorganisation and re-grading of nursing posts in 2013 still affecting morale even now. I do appreciate how unsettling this can be. There is a large section of the population in East London who depend on this hospital and they are entitled to services which provide safe, effective, compassionate and high quality care.
"Barts Health NHS Trust has not given sufficient priority to safety."
Copyright (c) Press Association Ltd. 2014, All Rights Reserved. Picture (c) Katie Collins/PA Wire.