This report highlights very serious issues at Coventry and Warwickshire trust which need urgent attention

Dr Peter Homa, CHI

Particularly criticised was the practice of putting five beds in bays designed only for four.

This meant that some patients not only missed out on privacy, but could be harder to treat in an emergency situation.

Peter Homa, CHI's chief executive, said: "This report highlights very serious issues at Coventry and Warwickshire trust which need urgent attention if local people are to have confidence in their health service.

"The trust is currently forming an action plan in response to our report and this must demonstrate clearly what steps will be taken to improve patient care."

The trust management were described as "aggressive", and reluctant to consult with others.

The report added: "Relationships between some senior medical consultants and trust managers are very poor."

Some senior staff, it said, felt too "intimidated" to raise concerns.

The trust was recently forced to reinstate a consultant suspended after raising concerns about a colleague.

CHI is an independent health inspectorate which is systematically looking at all the hospital trusts in the NHS.

This is one of the first occasions on which a routine inspection has uncovered such a depth of problems.

The inspection of the Coventry hospitals revealed unhygienic conditions, with some areas described as "dirty and unmodernised".

Patient safety is our major concern

David Loughton, trust chief executive

The emergency admissions unit was said to be "extremely cramped", with hospital bosses urged to urgently review it.

Trust chief executive, David Loughton, said that "immediate steps" were being taken following the report.

Safety changes

He said: "Patient safety is our major concern. We are reviewing protocols on patient transfers and the practice of putting five beds in bays designed for four stopped in August."

He said that he accepted that managers had focused on creating the new hospital rather than the existing sites.

"This has been achieved following a fierce debate about the site but the people of Coventry will have a brand new �290m hospital by 2006."

The trust is also building a 13-bed extension to the Emergency Admissions Unit.

Its medical director, Dr Jim Macartney, said that death rates were likely to be higher within the hospitals because the area had no hospice.