Sir David Nicholson has said “cultural problems” remain at University Hospital of Morecambe Bay Foundation Trust’s scandal-hit maternity unit.

However, following a personal visit to the trust, the NHS England chief executive indicated his support for the retention of the unit at Barrow’s Furness General Hospital, which is at the centre of claims over a number of infant and maternal deaths.

In a letter to trust chief executive Jackie Daniel seen by HSJ, Sir David highlighted midwifery ratios, skill mix and reliance on agency staff as issues that needed addressing.

He also revealed NHS England would financially support a “reconciliation process” with families who had experienced poor care.

The letter, dated 6 September, said: “As you indicated, the culture within the unit still demonstrates a less than cohesive relationship between staff groups and this needs further attention.

“It was apparent that midwifery ratios, skill mix and reliance on agency staff were presenting significant problems and have the potential to limit the progress that can be made.

“The staff did indicate that the unit is difficult to recruit to, but I am sure this will be a priority for the board.”

Sir David said the distance between the trust’s sites was “certainly striking” and he appreciated the challenges faced by the trust “every day in transporting patients”.

Indicating support for the maternity unit, he said: “While it is not for NHS England to specify how and where your trust should provide services, I am personally of the view your strategic planning would be accelerated if your board is able to confirm the future of the Barrow maternity unit as one of the trust’s building blocks for the future.

“The unit serves a significant population and I think it is likely to be required in its current form for the foreseeable future.”

Sir David, who announced his retirement from NHS England earlier this year following sustained criticism over his leadership and handling of the care crisis at Mid Staffordshire Foundation Trust, urged the trust to work with local families.

“They still don’t feel that there is yet a culture of true transparency being demonstrated within the hospitals,” he wrote.

“They did say that they would like to see some form of reconciliation process with clinicians to help them move on.

“I have agreed to provide modest financial support to the CCG to enable them to establish a programme of work with the families, with the aims of facilitating a reconciliation process and piloting a range of patient safety initiatives.”

Campaigner James Titcombe, whose son Joshua died at the hospital in 2008, said: “This suggests an ongoing lack of openness and transparency that simply has to end if public confidence in the current leadership is to be maintained.

“Concerns like those raised by NHS England should not be secret matters only known about and discussed amongst an inner circle of trust executives and hidden from others. Such behaviour characterised the former trust leadership approach. Now staff and patients deserve better.”

Failings at the trust are due to be examined at an independent inquiry chaired by Bill Kirkup, a former associate medical director at the Department of Health who served on the Hillsborough Independent Panel. The inquiry could begin hearing evidence within months.