While acknowledging some progress on governance issues had since been made, the CQC noted it had found a ‘closed' and ‘defensive' culture and a ‘fear of retribution' among staff if they spoke up.

Dominic Hardisty, AWP chief executive, said: ‘Whilst disappointed with the outcome of the well-led inspection, we are pleased to have been rated good in our adult community services and adult wards, which is a tribute to the hard work of our staff.

‘This demonstrates a commitment to, and track record of progress, and over the last year we implemented a range of additional improvements in those areas identified by CQC to further enhance the experience for our patients, staff and stakeholders.'

AWP said it had been able to address some of the issues identified by the CQC immediately, while adding good progress had been made on others.

The trust said this had been illustrated by an increase in the number of staff who said it was inclusive and compassionate and numbers recommending  it as a place to work at a 10-year high.

In addition, AWP said a culture review had shown clear signs of improvement and it had strengthened the role of patients/families/carers in the design and delivery of services.

A board summit was held to discuss and reflect on equality diversity and inclusion (EDI) issues raised during the inspection and AWP has continued EDI reciprocal mentoring for senior leaders.

In addition, the trust said it had implemented the national Patient and Carer Race Equality Framework to reduce health inequalities that people from black, brown, and other minority ethnic communities experience.