The largest NHS trust in England has been rated inadequate after inspectors found poor leadership had led to low morale amongst staff and risks to patient safety.

Barts Health was given the rating after the Care Quality Commission (CQC) identified 65 areas where it must make improvements including a culture of bullying, poor end-of-life care and training that had led staff to become confused as to who was in charge at the trust.

The CQC had already placed the trust into special measures after Whipps Cross University Hospital in Leytonstone was rated inadequate in a report published in March.

Following that inspection the CQC decided to inspect both the Royal London Hospital in Whitechapel and Newham University Hospital.

Both were found to be inadequate after a series of unexpected visits by inspection teams in January found that patient safety was not given sufficient priority.

The trust had a low compliance with training, with under half of staff receiving the mandatory training booklet the trust had introduced to form the basis of improvements.

Due to a lack of beds, some patients were admitted to wards which were not appropriate for their needs, while the trust persistently failed to meet targets on waiting times and operations were repeatedly cancelled.

The majority of staff were found to be kind and compassionate but felt undervalued, and in some areas significantly below recommended levels which posed a risk to patients.

During the previous inspection, in November 2013, inspectors identified a culture of bullying and harassment in the trust which had not been tackled.

Barts Health, which also runs Mile End Hospital, St Bartholomew’s in The City and the London Chest Clinic, reported a debt of around £63million last year.

This is believed to have risen to around £90million due to liabilities relating to a private finance initiative for redevelopment.

Inspectors found the trust lacked strategy and vision, with directors lacking confidence in their own data to judge their own position in achieving national standards.

Trust chairman Stephen O'Brien, chief executive Peter Morris and chief nurse Professor Kay Riley all stepped down before the damning Whipps Cross report was published in March.

Iain Duncan Smith, Chingford and Woodford Green MP, had criticised the trust for not replacing the highest paid chief executive in the UK last year with a salary of up to £280,000. 

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said: "It is clear that the leadership issues we found at Whipps Cross were replicated at the other hospitals.

“It is three years since the merger which formed the trust – but there is still a lack of engagement with the staff, low morale, high levels of stress, even confusion among the workforce about who is in charge.

“It is worrying that the trust’s directors didn’t seem to have confidence in their own data – a basic requirement in assessing their performance.

“We met a very committed workforce who felt undervalued by trust leadership, but valued by their patients and colleagues, and their local managers.

“If the trust is to turn round – then it must focus first on the culture and on the leadership issues so that it can effectively deal with all the individual concerns which we have identified on this inspection.

“We will continue to work with the NHS Trust Development Authority to ensure that these improvements are made.”

Barts Health has been approached for comment.