A crisis-hit NHS trust has been issued a fresh warning over patient safety following a formal sanction by the Care Quality Commission (CQC), the body responsible for regulating health and social care in England. The Northern Care Alliance NHS Foundation Trust, which operates across Greater Manchester and treats over a million patients annually, received a Section 29a notice on 13 August. This type of notice is used by the CQC to highlight "significant concerns" about a trust’s leadership, risk management, patient safety, handling of complaints, staff wellbeing, and inclusion. The notice suggests that systemic issues within the trust could lead to harm or the risk of harm to patients. The trust has faced multiple investigations into patient safety concerns and allegations that patients have been harmed or died due to poor care. A joint investigation with Channel 4 News uncovered that a dozen whistleblowers have come forward, warning that failings at the trust could become the next major health scandal. These whistleblowers claim that deaths and injuries caused by poor care have been ignored or downplayed. The trust has already faced serious regulatory action from both NHS England and the CQC. In June, NHS England warned that the trust could be fined or lose its license to provide care after identifying "fundamental failures" and expressing concerns that more patients could be harmed. Earlier in 2023, the trust was issued a Section 29a notice for surgery services at Salford Royal Hospital, where patients were left in pain due to staffing shortages. Staff at the trust have raised concerns about deteriorating conditions, with one anonymous employee stating they would not want a family member to be operated on by the trust. The staff member described the situation as "dire," with high sickness rates, staff crying, and exhaustion. They noted that staff often work without lunch or toilet breaks and that inexperienced nurses are being used in operating theatres without proper training or support. In response, the trust stated that it has training, supervision, and competency processes in place for all theatre roles. It emphasized that staff must complete appropriate training and assessments before working independently and encouraged concerns to be raised through Datix reports. The trust is currently facing a deficit of £141m and has set a target to reduce this to £28.8m by year-end. To achieve this, the trust plans to implement unpaid breaks and reduce spending on agency staff. Another staff member criticized these measures, stating that the trust’s management continues to downplay the staffing issues. Recently, hundreds of critical care service staff went on strike, following earlier action from surgical theatre staff. During the walkouts, the trust was forced to declare a critical incident, warning of a potential temporary loss of critical services. This week, hundreds of staff across the NCA’s four hospitals, represented by the union Unison, are set to strike for two days in a dispute over overtime pay. Unison North West regional organiser Kevin Dolan stated that the department is "chronically understaffed" and workers are covering shortages without receiving the pay outlined in their contracts. The trust stated that the concerns identified by the CQC were consistent with known issues and were being addressed. It added that the CQC's well-led assessment recognized progress in strengthening clinical leadership across the organization. The trust is implementing improvement programs throughout its services to address performance and quality issues and has reorganized to ensure clinical leadership of improvement, working with the oversight and support of the CQC and NHS England. The trust emphasized its commitment to delivering safe, high-quality care and acknowledged the efforts of its 20,000 staff. The CQC stated it could not comment further on the notice until it publishes its full report.