LEIGHTON Hospital has been rapped for having too few people at the top to run services smoothly.

But staff lower down the ladder have been praised for their hardwork and commitment despite extreme pressure caused by a shortage of management staff.

An inquiry by an independent national watchdog group says the Mid Cheshire Hospitals NHS Trust needs to recruit more middle managers to bridge the gap in its management structure and ease pressure on nursing staff.

The Trust, which runs Leighton in Crewe, was subject to a rigorous inspection by the Commission for Health Improvement (CHI) which spent a week at hospital quizzing staff and patients.

Inspectors found that ward managers were finding it difficult to fulfil their management function because of the need to carry out a 'hands-on role' due to limited nursing staff.

The hospital was also slammed for failing to renew anaesthetic equipment after being told three years ago by the Royal College of Anaesthetists to do so.

The CHI, which was formed last year, investigated the Trust as part of the Government's attempt to improve standards across the NHS.

Leighton's chief executive Simon Yates said the hospital had tried to keep management staffing costs to a minimum to concentrate on improving direct health care services.

With just 3.7% of costs spent on management, the trust is one of the most effective in the country.

But the trust is now prepared to implement the recommendations of the report and an action plan has been drawn up.

Mr Yates said: 'Nursing staff are under a lot of pressure and the report identified that we need more middle and senior staff in place.

'We have to now develop a competent and flexible workforce through a review of policies and systems.

'Unfortunately, we still get the same amount of money and we have to prioritise spending over a period of three years.'

The report found there were positive examples of team working with caring and responsive staff as well as the hospital having a firm policy in relation to dealing with violence and abuse to staff. Opportunities for training were also praised but it was noted that many staff find it difficult to attend mandatory training due to the excess of workload.

Mr Yates added: 'Again, it does come down to lack of staff, but I find it very positive that the staff we do have here have been recognised as caring team players.'