The report reveals poor communication between staff

An NHS watchdog identified a failure to investigate high death and complication rates after certain procedures, and variations in waiting times for tests.

A plan for reform at the Mid Yorkshire Trust must be in place by next month.

It is the first time that the Healthcare Commission, which inspects NHS bodies, has taken such a step.

An investigation carried out by the watchdog found managerial failings "from the most senior level down" and serious disputes between doctors.

The trust - which appointed a new chief executive in the spring and has already cut waiting times - said it was making changes.

We...want to apologise to patients for in the past not having maintained the high standard of care that we aim to provide John Parkes, Trust chief executive

The commission launched its investigation in February after a member of staff reported concerns over how allegations of poor performance were handled.

It focused on the gastroenterology department at the trust, which covers hospitals in Wakefield, Dewsbury and Pontefract.

It found there was "feuding" within the department at Pinderfields Hospital, which trust managers were unable to resolve.

The commission also found there had been a breakdown of communication between doctors in the department and related surgical teams.

It said: "Some staff behaved inappropriately to such an extent it posed a potential risk to patients."

Confusion

The investigation also found managers failed to properly investigate the reasons behind high death and complication rates for some procedures carried out in the department between 1999 and 2004.

The Healthcare Commission said this was despite concerns being raised inside and outside the trust over the previous five years.

It said the doctors should undergo a skills assessment, and that some should receive additional training.

The trust was created with the merger of three hospitals in 2002, but the commission found there were still variations in the quality of services provided.

There were also concerns over disparities in waiting times between sites. In 2003, patients had to wait up to three years for diagnostic tests at Pinderfields Hospital, compared to Dewsbury where waits were less than a year.

Progress report

Anna Walker, chief executive of the Healthcare Commission, said: "The trust has been troubled since its inception, partly due to two difficult mergers, but the leadership has failed to tackle the resulting problems."

Ms Walker added: "Since our investigation started, some improvements have been made, particularly in gastroenterology, but the fundamental and systemic problems in the trust mean that extra help is needed."

Trust chief executive John Parkes said: "We take the report's findings very seriously and want to apologise to patients for in the past not having maintained the high standard of care that we aim to provide."

He said they had developed an initial action plan.

Health Minister Lord Warner said the trust had already begun to improve its performance.