Salford Royal Hospital's emergency care criticised by inspectors
A hospital that was lauded by ministers as a beacon of good practice has been told it "requires improvement" by the health watchdog. 
Care Quality Commission (CQC) rated Salford Royal's urgent and emergency services inadequate for safety after an inspection in August and September.
was previously one of only two in England to receive two consecutive ratings of outstanding.
Northern Care Alliance (NCA) NHS Trust said it accepted the recommendations.
It also runs three other hospitals across Greater Manchester, including Fairfield General Hospital in Bury, Rochdale Infirmary and Royal Oldham Hospital.
Other issues highlighted included staff shortages, training, governance and some care concerns. 
Salford Royal merged with Pennine Acute Hospitals Trust (PAHT) in 2016 to form the NCA. 
NCA had not had a full CQC inspection since its creation, but its "outstanding" rating was derived from Salford's last "outstanding" rating in 2018, and the "good" rating for PAHT in 2020.
In its latest report, the CQC found staff "working incredibly hard under pressure".
But leaders did not "operate effective governance" and some staff expressed reservations about raising concerns.
red whether the NHS trust was well-led overall and checked specific services where the CQC was already aware of risks, including:
watchdog rated the trust as "requires improvement" overall, and for being safe, effective, responsive and well-led. 
It was rated "good" for being caring.
Head of hospital inspection Karen Knapton said new leaders had already started to make improvements but they "weren't fully embedded".
"We found staff working incredibly hard under pressure to deliver the best possible care to patients", she said.
Inspectors did find some evidence of outstanding practice, including support for victims of domestic abuse at Royal Oldham and a staff-led initiative to build a garden at the Fairfield site.
But leaders did not always "actively and openly engage with patients and staff to plan and manage services" and complaints and incident investigations sometimes took too long.
Inspectors also found "differences in policies and clinical practice which did not reflect best-practice" and that "leaders did not operate consistent, effective governance processes throughout the service".
Staff did not always feel respected, supported and valued, though they remained focused on the needs of patients, they added.
Dr Owen Williams, NCA chief executive, said: "We fully accept the CQC's judgement and their recommended areas for improvement."
He said he recognised that improvements already being made "do not go far enough at this moment in time" and said staff were "determined to work together to get better results for the people we serve".
Dr Williams thanked "totally caring" colleagues who are working "incredibly hard" at "a time of unprecedented demand" under "a level of pressure the likes of which many of us have not experienced before".
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