East of England Ambulance Service report criticises management
Sickness levels are too high among ambulance staff in the east of England, inspectors have said.
East of England Ambulance Service bosses must also take more responsibility and be "accountable for their actions", their report said.
Among 25 recommendations, it also said the process of handing over patients to hospitals is not "sufficiently robust".
The ambulance service said it would review the findings of the independent report and submit a formal response.
Chairman Dr Geoff Harris, said many of the issues raised were being tackled in the "turnaround plan", which was published in April.
'Sense of helplessness'
"The Trust's turnaround plan has recognised many of the issues we need to address and we are focussed on implementing this, together with recommendations from the governance review to improve services for our patients," Dr Harris said.
The document was commissioned by NHS managers after major concerns were raised about the East of England Ambulance Trust.
Dr Anthony Marsh, who wrote the report, said the trust's board and senior management team had "developed a sense of helplessness".
The management structure is "overly layered" and there is a feeling the board does not listen, Dr Marsh said.
The ambulance service started in 2006 when three trusts merged and has since been criticised for response times and the quality of care of patients.
Dr Marsh criticised internal and external communications and disparate plans to improve the service, saying "it still feels like three trusts".