A specialist trust that has seen a high turnover of directors in recent years has been rated requires improvement for leadership by the Care Quality Commission.

Great Ormond Street Hospital for Children Foundation Trust was rated good overall and given outstanding ratings in the caring and effectiveness categories.

HSJ can reveal the three senior staff have left the trust in the past three months – including two to another children’s hospital.

Finance director Loretta Seamer left on 28 February.

Chief operating officer Dena Marshall took up the chief executive post at Royal Manchester Children’s Hospital in January. Associate medical director Jane Valente is leaving to take up the medical director role at the same hospital.

Since 2013, the trust has had four substantive medical directors, including two who shared the role, and two interims.

The CQC said since its last inspection in 2015 “the chair, three non-executive directors, chief operating officer (post now part of the deputy chief executive role), chief nurse and chief finance officer had changed”.

In 2015, the trust commissioned a report from the Royal College of Paediatrics and Child Health into allegations of invasive overtreatment of gastroenterology patients.

The trust has refused to release this report but made a second report from the college public, which looked at the changes made by the trust subsequently.

The CQC said there had been significant improvement in some areas but “many staff working in the service had not seen the original 2015 report and told the review team that they were not yet confident that the climate had changed and that their concerns could be raised and responded to in a climate of openness”.

The evidence supporting the CQC report also said: “The trust did not take a proactive role in using their considerable expertise and resources to show leadership in working together with other regional and local providers of children and young people’s care.

“The trust’s chief executive told us that as they did not fit with the local sustainability and transformation plans and were delivering specialist tertiary care, alignment was difficult. They lacked clear sense of the role GOSH had in delivering and developing long term national paediatric care and treatment. Therefore the trust was potentially missing opportunities to provide joint services for children across the national paediatric hospital network.”

In a statement, the trust’s chief executive Peter Steer said: “We acknowledge, when looking at leadership throughout the organisation and how we manage the governance of our services, we require further improvement. However, we have made progress in addressing some of our biggest challenges. This includes turning around the way we manage our waiting time data so it is transparent and reliable and ensures we are meeting all national targets and treating patients on time.

“This is demonstrated by the fact that in the month of the CQC inspection we had the most improved performance for referral to treatment times in the country. We have also conducted a lengthy and complex review into our gastroenterology service which is now driving through improvements in care and patient experience.

“Our mission ‘the child first and always’ is at the heart of everything we do and our staff should be very proud that the CQC received only positive comments from patients or their carers about our people throughout this inspection.”