A highly critical report has been published into the operation of four Greater Manchester hospitals.
The trust covers four Greater Manchester hospitals
The independent report follows a vote of no confidence in the managers of the Pennine Acute Hospitals NHS Trust by consultants and senior doctors.
The report makes 25 recommendations for change.
The trust covers North Manchester General Hospital in Crumpsall, Bury's Fairfield Hospital, Rochdale Infirmary and the Royal Oldham Hospital.
The report by Professor Sir George Alberti and Doctor Joan Durose, which was commissioned by Greater Manchester Strategic Health Authority, criticised the trust's chair, chief executive and former medical director.
"We believe that the chair and medical director have not demonstrated their role as leaders," said the report.
"If they had exercised leadership, particularly in their relationship with the medical staff, then much of the dissatisfaction felt across the trust could and should have been addressed.
"We note that the medical director has now left the trust."
It added: "We believe that the chief executive is a leader but that his style of leadership has caused difficulties with some parts of the trust." Don McKeckine senior consultant from Rochdale Infirmary said the report had fully justified their decision to hold a vote of no confidence.
"We think it is a damning report," he said.
"There are a lot of recommendations which will take time to digest and which do give us a way forward."
Chief executive Chris Appleby said he would not be resigning, adding: "I think the focus of the report is how we can take forward the recommendations for improving our provision."