One of the largest hospital trusts in England should be put into a failure regime, inspectors said after they identified a series of problems at the organisation.
East Kent Hospitals University NHS Foundation Trust should be put into special measures, the Care Quality Commission has recommended.
The trust, which serves a population of more than 750,000 across five different hospitals, was rated "inadequate" by inspectors.
Concerns were raised about a culture of bullying at the organisation and inspectors identified staff shortages in A&E, children's care and at night.
Risks to patients were not always identified and when they were, not consistently acted upon, the inspectors said - and i ncidents involving patient safety were not always identified and reported.
There is a "worrying disconnect" between the trust's leaders and front-line staff and a number of clinical services were "poorly led", they said.
The inspection team also noticed that in a number of areas around the trust, the buildings and equipment were "poorly maintained".
At the William Harvey Hospital in Ashford, inspectors found that children's care need were not always met, records of waiting times in A&E "did not accurately reflect how long people had waited to be seen" and a number of outpatient clinics were "routinely overbooked" leading to long waiting times.
Meanwhile, surgery at the Kent and Canterbury Hospital was deemed "inadequate" and inspectors also identified staffing problems at the hospital.
A&E at the Queen Elizabeth the Queen Mother Hospital in Margate was also deemed to be inadequate after inspectors found staff shortages in the department and an over reliance on temporary medics. They said the hospital was "poorly led" and that services for children were "not effective".
The CQC has made a series of recommendations to the trust to help it improve services.
CQC's chief inspector of hospitals Professor Sir Mike Richards said: "We were extremely concerned at the disconnect we identified between the senior team and the staff working on the front line. We saw ineffective leadership in action across a number of clinical services, and that the board was at times receiving false assurance through governance procedures.
"It is a lack of effective leadership, alongside care failings across the majority of services we inspected, which has led me to recommend to the foundation trust regulator Monitor that the trust be placed in special measures. This will allow the trust to receive the additional support that I believe it needs to deliver safe, caring, effective and responsive services to the local populations it serves.
"We, alongside our partners in the wider healthcare system, will continue to keep a close eye on the trust and will inspect again in due course to assess whether or not adequate progress is being made."
Trust chief executive Stuart Bain said "Much of what is in the report we have already recognised and we are working to address. Following a staffing review, we have invested an additional £2.9 million to recruit 69 nurses where shortages exist (55 of these have been recruited already). We have also recently appointed an additional four general surgeons and will be recruiting a further three surgeons very shortly.
"We identified the need to improve our appointment system some time ago and have just completed a public consultation on our outpatient services that will allow us to make improvements to the services we offer patients. New appointment booking systems, more flexible appointments, and an investment of £28 million in improved facilities including a new hospital in Dover will start to address these issues.
"The report does recognise the committed and caring nature of our staff of which we can be very proud. Our task as leaders of the organisation is now to work with our staff and our partners including the Clinical Commissioning Groups to address the issues that have been raised and ensure we provide the residents of east Kent with high quality health care."