A beleaguered health trust has been put into special measures.
The action has been taken against the University Hospitals of Morecambe Bay NHS Foundation Trust after inspectors from the Care Quality Commission (CQC) ruled the quality of care provided was "inadequate".
Inspectors found the trust lacked a clear vision for its staff and its lack of clarity about the trust's future left employees feeling "disengaged and remote" from the executive team and the board, said England's Chief Inspector of Hospitals, Professor Sir Mike Richards.
Recruitment of nurses and doctors remained "a fundamental concern" with too much reliance on temporary staff, he added.
Among areas identified for improvement by the watchdog are: staffing levels and skill mix in all clinical areas must be appropriate for the level of care provided; the trust must continue to actively recruit medical and specialist staff in areas where there are identified shortfalls; nurses' records on the medical wards must improve; all staff must be aware of their responsibilities to both report incidents and implement remedial action and learning as a result.
As part of the special measures, NHS regulator Monitor will appoint an improvement director whose role will be to provide support and expertise but also to hold to account the trust which runs Furness General Hospital in Barrow-in-Furness, Royal Lancaster Infirmary, Westmorland General Hospital in Kendal and Queen Victoria Hospital in Morecambe.
An inspection team which included doctors, nurses, and hospital managers, trained members of the public, CQC inspectors and analysts spent three days at Furness General Hospital, Royal Lancaster Infirmary and Westmorland General Hospital in February.
They examined the care provided in accident and emergency, medical care, surgery, intensive/critical care, maternity and family planning, children's care, end of life care and outpatients. Inspectors also visited Royal Lancaster Infirmary and Furness General Hospital out of hours unannounced.
Inspectors acknowledged that care in some services, such as maternity and A&E, had improved since previous inspections but in other areas - despite previous concerns being raised by CQC - care had still not been addressed effectively, said the CQC.
Overall, the inspectors conclude that the quality of care provided by Furness General Hospital and the Royal Lancaster Infirmary both required improvement, while the Westmorland General Hospital overall was providing a good service.
Sir Mike said: "There is a long history of concern with the quality of service provided by University Hospitals of Morecambe bay NHS Foundation Trust - so it is disappointing to report that a number of the issues that have been identified in the past remain unresolved.
"I do not believe that the trust is likely to resolve its challenges without external support. This is why I am recommending that the trust is placed in to special measures. I am looking to Monitor and the other organisations responsible for healthcare in the area to work together to support improvement.
"Despite the reorganisation of the trust's clinical services, we have found a lack of clarity about the trust's plans for the future that has left the staff feeling disengaged and remote from the executive team."
Sir Mike added: "The trust and partner agencies will be developing an action plan to address the identified shortfalls and my inspectors will return to the trust to follow up on improvements in due course."
Adam Cayley, regional director at Monitor, said: "The trust has co-operated with Monitor in making some improvements in recent years but the Chief Inspector of Hospitals has reported on wider failings in care that must be addressed.
"The level of care and the quality of senior leadership at this trust has not been good enough, that's why we've put Morecambe Bay into special measures.
The regulator said it would take further action if improvements were not made.
An independent inquiry into care provided by the trust's maternity and neonatal services from January 2004 to June last year is currently taking place following a "high number of serious untoward incidents" including patient deaths.
The report from chairman Dr Bill Kirkup is due to be submitted to the Secretary of State for Health in the autumn.
David Morris, Conservative MP for Morecambe and Lunesdale, said: "Naturally I am disappointed to read the contents of this CQC report. I regularly meet with the chief executive and the Secretary of State for Health and I do feel that the University Hospitals Morecambe Bay NHS Foundation Trust is making progress. I should state that the trust has experienced considerable pressures since it was granted foundation trust status in 2010 under the previous Labour government, a status that Andy Burnham should not have allowed to be granted."
Mr Morris added: "Baroness Young, former chair of the CQC, has said that Mr Burnham withheld information prior to the 2010 election allowing trusts to self-assess, instead of being properly investigated. I discovered this last summer, as a result the CQC was restructured which I welcome."
The trust's chief executive, Jackie Daniel, said: "We are all incredibly disappointed to receive the overall (inadequate) rating for the trust. The reports reflect the fact that we are part-way through a process of significant improvement which is still going to take a number of years to complete.
"It isn't an overnight job to change the culture of a large complex organisation, but through the hard work and commitment of our staff, governors and partners, our hospitals are now much safer, with improved standards of care in a number of areas from two years ago when we started to turn them around."
She added: "Over the last two years we have seen significant improvements in areas such as mortality, staffing levels, A&E, complaints management, maternity, record keeping and appointments, many of which are recognised in these reports. It isn't all fixed and there is much more to do but I am confident that we have progressed, although at times not at the pace needed.