The infirmary was built with private money

A report by the Commission for Health Improvement says North Cumbria Acute Hospitals NHS Trust lacks a clear strategy and is not treating some patients quickly enough.

The trust includes Cumberland Infirmary in Carlisle, which was built under the government's controversial private finance initiative (PFI) scheme.

The report comes less than a week after Nick Wood, the trust's chief executive, resigned just 18 months into the job.

The trust was created by the merger of Cumberland Infirmary and the West Cumberland Hospital in Whitehaven, 40 miles away, in April 2001.

Extensive problems

It has been dogged by problems ever since, struggling to meet government waiting time targets and balance its books.

The CHI report suggests the merger and the PFI scheme have contributed to many of the trusts problems, including tensions between the two hospital sites.

But it adds that these problems have only been exacerbated since the merger.

The report says it has serious concerns about the trust's ability to introduce changes that will improve patient care.

"The trust faces a substantial management agenda including continued integration of the two sites with different cultures and addressing the financial deficit," it states.

CHI also expressed concern about the trusts ability to reduce risks, criticising the fact that many senior positions in the trust were filled with temporary staff.

In addition, the report suggested many cancer patients are waiting too long for treatment once they have been diagnosed.

The trust has been asked to draw up an action plan to improve its performance.

Peter Homa, chief executive of CHI, said: "The trust needs to engage and listen to staff and stakeholders and to provide a clear vision and achievable action plan if it is to move forward and implement change in line with clinical priorities."

He added: "North Cumbria Acute Hospitals NHS Trust will be producing an action plan which, when implemented, should improve the quality of care for patients."

Dave Prentis, general secretary of Unison, said: "It has been plagued with problems right from the start which have been appalling for patients, bad for staff and must damage public confidence in our health service."

His comments came as the union published details of interviews with staff at the hospital.

Unison claims the hospital has cramped wards, doors hanging off and had sewage bubbling out of theatre sinks.

A spokeswoman for Cumberland Infirmary rejected the claims.