NHS England has taken enforcement action against a major health trust over multiple safety concerns, warning that it cannot be sure more patients won’t be harmed, The Independent can reveal.
The sanction means Northern Care Alliance NHS Foundation Trust, in Greater Manchester, could be fined or lose its license to provide care if it does not improve.
It comes after a string of serious concerns were raised about patient safety, including in its gynaecological services, after an audit of hundreds of cases at Salford Royal Hospital in 2024 found dozens of women, including cancer patients, were “harmed” after their diagnosis and treatment were delayed due to admin failures.
Now, a damning document, seen by The Independent, reveals NHS England found the trust has been “unable to provide assurance” that it has a clear and consistent structure “that will ensure no further patients may suffer harm”.
It said: “There have been a series of escalating quality concerns over the previous 18 months, for which the licensee [the trust] has been unable to respond at the expected pace. The cumulation of quality concerns and the licensee’s [the trust’s] response has resulted from a fundamental failure in quality governance.”
The concerns come after whistleblowers previously told The Independent that the gynaecology services at the trust were falling apart, alleging that leaders had neglected to address safety risks for patients, who had diagnoses and treatment delayed.
NCA has also faced a major scandal over spinal surgeon John Bradley Williamson, who in 2023 was found to have harmed dozens of patients, including 23 who had misplaced screws inserted in their spines, leaving them in chronic pain.
A further independent inquiry into the care of his patients criticised past investigations by the trust, warning it failed to address his behaviour. NCA has since been told it must offer all of his patients a review of their care.
In October 2025, as revealed by The Independent, the NHS watchdog, the Care Quality Commission, handed the trust a warning notice after it surgical patients had been left lying in pain.
The CQC launched a new inspection of the trust hospitals, including its gynaecology services, in May, the findings of which are yet to be reported.
The NHS England document, seen by The Independent, reveals that in January 2025, the trust was put under enhanced scrutiny by NHS England due to concerns it had been unable to assure that it was tackling issues in spinal and gynaecology services, including backlogs in care.
NHS England, which was monitoring trusts’ gynaecology services, including delays to diagnosis and treatment, said scrutiny had since been “stepped down” due to evidence of improvement. However, it added, “several clinical harms have been identified as part of all the incidents and patient reviews; all incidents demonstrated failures of governance”.
Its enforcement letter warns that if the trust fails to comply with its requirements, which includes regular reporting on its progress, it will face further action. This action includes fines or, in the most severe cases, stripping the trust of its licence to provide care.
In an email to staff on Thursday, seen by The Independent, the trust said: “We need to get better at spotting problems early and acting quickly, learning when things go wrong and making sure issues do not happen again.
“We understand how serious these issues are and the impact they have had on patients and families.”
Earlier this year, the trust’s chief executive, Owen Williams, announced he would be stepping down from his role in September, while The Independent understands several senior managers and executives have also left the trust in the last six months.
In a statement responding to the enforcement action, Mr Williams said he recognised the seriousness of NHS England’s concerns.
He said: “Over the past 18 months, we have worked with NHS England to improve services, respond to Care Quality Commission concerns and strengthen governance across the organisation.
“While the concerns include spinal, gynaecology and other surgical care, the undertakings are about wider organisational improvement.”
“Real improvement has already been made, and we are committed to building on it. We have introduced a new organisation structure to move decision-making closer to patients and made progress in some areas, including gynaecology, but more needs to be done to make improvement consistent and lasting.”
NCA said it accepted the formal enforcement from NHS England, which will provide a more “structured” oversight of the trust. NHS England was approached for comment.
