A hospital trust has been rated "inadequate" by the care regulator after inspectors found a "worrying disconnect" between senior managers and frontline staff, and allegations of bullying.
The Care Quality Commission (CQC) said its inspection at East Sussex Healthcare NHS Trust last September led it to have serious concerns about its maternity, surgery and outpatients services.
It said a follow-up inspection on Tuesday found that, although there had been improvements, it was still concerned about cultural and leadership issues.
Its report found "staff were exhausted and under enormous pressure to deliver safe care in spite of chronic staffing shortages", while inadequate services at the maternity unit at the Conquest Hospital in St Leonards-on-Sea saw "risks to women and their babies from a poorly managed service".
It also found that staff working at the hospital "reported a culture of bullying and harassment, and a leadership that was described as a 'dictatorship'".
The report said one staff member said they felt "persecuted for speaking out", while a manager told inspectors they regularly had employees crying in their office due to bullying from a senior member of staff, who had boasted that they made anyone who spoke out leave and "then ensured that they didn't get jobs elsewhere".
Both Conquest Hospital and the trust's other main hospital, Eastbourne District General Hospital, were rated inadequate overall.
Medical and critical care at Conquest Hospital were rated as good, while improvements were required for accident and emergency, children's services and end of life care.
Surgery and maternity were both rated inadequate.
In Eastbourne - where bullying was also reported - critical care was rated good, surgery and outpatients were both rated inadequate, and accident and emergency, medical care, children's services and end of life care were said to be requiring improvement.
"Our inspectors found that there was a worrying disconnect between the trust's most senior managers and frontline staff," the report said.
"Staff were concerned about how change was implemented, low morale, bullying and harassment and a number of staff came forward to raise serious concerns with CQC about the culture of the trust and the care being delivered."
Inspectors found every service to be caring and compassionate and patients commented positively about the staff providing the care.
A rating of inadequate usually leads to trusts being put in special measures, but a decision is being deferred until the findings of the latest inspection have been fully considered.
Chief Inspector of Hospitals Professor Sir Mike Richards said: "When we inspected East Sussex Healthcare NHS Trust in September, we were extremely concerned at the disconnect we identified between the senior team and the staff working on the front line.
"We saw no sign of a clear vision and strategy and a lack of response to concerns raised by staff. We had specific serious concerns about maternity, surgery and outpatients.
"Our recent inspection indicates there have been improvements in important areas for patients, but I am still concerned about cultural and leadership issues at the trust. I will not be making a judgment about special measures until we have fully assessed the results of our most recent inspection.
"We, alongside our partners, will continue to keep a close eye on the trust and will inspect again in due course to assess whether or not adequate progress is being made."