Monitor told Medway Foundation Trust to take urgent action to improve or risk changes being imposed on its leadership.

The trust had already been placed in special measures following the Keogh review of trusts with high mortality rates and last month the Care Quality Commission identified problems in its midwifery and maternity services.

Monitor took the action after determining Medway’s problems were broader than those uncovered by Sir Bruce Keogh in August. The regulator is also concerned by the trust’s continued poor accident and emergency performance.

Jonathan Guppy, Monitor’s senior enforcement officer, was appointed Medway’s improvement director to help it tackle its problems. He has found that although the trust is focusing on specific quality of care issues it is lacking a “credible clinical strategy for the organisation as a whole”.

The trust is now expected to prepare and implement a clinical strategy and Monitor has imposed a new licence condition that would mean it could step in to make high level decisions if it is unsatisfied with its response.

Monitor regional director Paul Streat said: “We know that staff are working hard to improve the quality of the trust’s services, but we need the organisation’s leadership to do more to make sure that urgent change happens quickly. The new licence condition gives us the power to make changes at the top if the current leadership fails to deliver.”