By Michele Paduano
BBC Midlands health correspondent
Ambulance staff in the West Midlands have had their ability to speak up as whistle-blowers stifled for many years, an independent inquiry has found.
The investigation, commissioned by NHS England, also identified failings in financial governance at West Midlands Ambulance Service (WMAS).
That included the lease contract for the 60m Sandwell Hub, which may result in the tax-payer losing out.
Five senior and former members of staff spoke out to NHS England.
WMAS accepts it has learning to do, but says the report expresses confidence in the service's ability to address the issues raised.
The whistle-blowers included a finance director, medical, operations and quality control staff.
They raised issues through the Freedom to Speak Up scheme with the National NHS England Team.
The inquiry, led by Carole Taylor Brown, had terms of reference which included "Governance, probity, the difficulty of speaking up about these issues and the alleged behaviour of some senior leaders".
They also included whether the leasing of the ambulance hub in Sandwell followed NHS rules and whether additional payments being given to senior members of staff were being authorised in the right way.
The BBC has obtained the recommendations from the report, but despite a Freedom of Information request for the findings of fact, so far NHS England has not released them.
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