A regional troubleshooting team called in to the crisis-hit Barts and the London trust has found failures of performance in 'critical areas'.

The report of the review team - which was invited in by the trust board - reveals how years of uncertainty and structural change at the two East End hospitals have taken its toll on staff and managers, and made good access to services 'patchy at best'.

It exposes 'significant disconnection' between clinicians and the executive management team, a lack of clarity and accountability at board level, little agreement on overall policies, and poor relations with local GPs.

Management and leadership failings are a major theme in the report, which recommends a board development programme, as well as personal development plans for individual board members. But the leader of the review team, London regional director of nursing Christine Beasley, told HSJ that managers did not lack ability: 'I mention in the report that individual members of the management team are all hard-working and talented. There's a need to bring them together into a high-performing team.

'The previous chief executive (Ray Pett) retired last month, so obviously the trust will be looking for a new chief executive as a matter of course, ' she added.

Ms Beasley added that the allocation to the trust of over£3m in modernisation funds would help the trust, which was determined 'to use this as an opportunity to turn things around'.

The trust welcomed the report's findings, and released figures suggesting it has significantly improved its performance in some areas, and its financial position, in the past three or four months. It now has 36 patients waiting 16 months and over, compared with 107 three months ago; inpatient waiting times are 1.5 per cent off target, the fourth successive monthly improvement; and it is£150,000 short of its budget plan - its best financial position to date.

A detailed action plan will be presented to the trust board on 1 November.