Kent and Medway Mental Health NHS Trust

Updated 8 October 2026

Kent and Medway Mental Health NHS Trust changed name in October 2025 and was previously known as Kent and Medway NHS and Social Care Partnership Trust (KMPT). The name changed because patients, loved ones and community members did not feel it was clear that the trust provided mental health care.

The trust provides mental health and learning disability services, including some forensic and specialist services, to people across Kent and Medway, which covers a population area of 1.8 million. It operates from a number of inpatient and community facilities across Kent. The trust’s lead commissioner is Kent and Medway Integrated Care Board (ICB) and it had a planned turnover of £295.7m in 2025/26. 

The trust currently provides services to around 2,000 adults per year in hospital and 54,000 in community settings.

Services are provided in a diverse range of locations including urban city centres and rural areas, and 3,700 staff from around 66 countries are employed.

The trust has planned capital investment of £18.6m in 2025/26 of which more than half has been on two major schemes to develop a female psychiatric intensive care unit at the Littlebrook Hospital site, and a centralised s136 place of safety. This aimed to help with flow and reduce out of area placements. Both schemes were nearing completion. 

Services the trust provides:

• Acute wards for adults of working age and psychiatric intensive care units
• Community-based mental health services for adults of working age
• Mental health crisis services and health-based places of safety
• Community mental health services for people with learning disabilities or autism
• Community-based mental health services for older people
• Wards for people with a learning disability or autism
• Forensic inpatient or secure wards
• Long stay or rehabilitation mental health wards for working age adults
• Wards for older people with mental health problems
• Substance misuse services

From 1 April 2026, specialist community mental health services for children and young people were set to transfer to the trust. This service was currently provided by another local trust, North East London NHS Foundation Trust. From April 2026, the trust planned to start providing the local all-age eating disorder service. 

We looked for evidence of an inclusive and positive culture of continuous learning and improvement based on meeting the needs of people who used services and wider communities. We checked leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred, sustainable, and to reduce inequalities.

We undertook a trust level (well-led) assessment which included an onsite visit between 3 and 5 March 2026. We assessed all 8 quality statements in the well-led key question in this assessment. We assessed Kent and Medway Mental Health NHS Trust for leadership using our standard methods.

As part of this inspection we carried out interviews with the trust’s leadership team, including the chief executive, trust chair, chief medical officer, chief operating officer, chief nurse and chief finance and resources officer, as well as other senior directors. 

Twenty-two focus groups were carried out. These were as follows:

• Acute directorate leaders
• Forensic and Specialist Services directorate leaders
• Community directorate leaders
• Consultant psychiatrists
• Resident doctors
• Senior nurses
• Nurses
• Nursing assistants
• Allied health professionals
• Non-executive directors
• Network chairs
• Trade union representatives
• Associate hospital managers
• Mental Health Act administrators
• Approved Mental Health Professionals (AMHPs)
• LGBTQ+ network members
• Disability and wellness network members
• Faith network members
• Global majority network members
• Menopause network members
• Neurodiversity network members
• Working parents network members

We spoke with trust leads for equality, diversity and inclusion, estates and facilities, patient safety and safeguarding. We observed a public and a private Board meeting. We observed a range of trust meetings and committees and wrote to stakeholders including the Integrated Care Board (ICB) to seek feedback about the trust.

During this inspection we identified significant issues of concern in relation to the trust’s governance systems, which resulted in a breach of the following regulation:

Regulation 17 (1) (2) (a) (b) (d) (ii) (e) (f) Good governance

Prior to this well-led inspection, recent inspections of some of the trust’s Assessment Service Groups (ASGs) had been undertaken as follows:

• Community-based mental health services for adults of working age - March 2025

• Mental health crisis services and health-based places of safety - March 2025

• Acute wards for adults of working age and psychiatric intensive care units - September 2025

• Community-based mental health services for adults of working age - focused assessment - December 2025

• Mental health crisis services and health-based places of safety – focused assessment – January 2026

• Wards for people with a learning disability and autism – February 2026

• Community teams for people with a learning disability or autism – February 2026

Shared direction and culture 

Trust leaders were working hard to embed a consistent organisational culture, but significant challenges existed in relation to culture. Staff confidence in leadership, psychological safety and middle management capability were all key priorities for improvement. Many staff felt fatigued by ongoing change and raised concerns through the Freedom to Speak Up Guardian (FTSUG) rather than local channels because they didn’t feel able to speak up about concerns to local leaders. Cultural issues were particularly evident in acute services, where some staff described blame cultures and  inconsistent responses to errors, and concerns about leadership behaviours. Family and carer involvement in care and governance was also inconsistent, with an independent review highlighting procedural rather than meaningful engagement in safety-critical pathways. Despite these challenges, the trust had articulated clear organisational values and introduced initiatives such as the Culture, Identity and Staff Experience (CISE) programme and “Doing Well Together Improvement Plan” to strengthen culture, alongside extensive engagement to shape the new 2026 strategy. Leaders demonstrated learning from past strategic difficulties such as the community transformation programme.

Compassionate and inclusive leadership 

Senior leaders acknowledged that middle leadership capability needed strengthening and focus on embedding a positive leadership culture. Senior leaders were implementing plans to improve cultural competency, psychological safety and support for managers, while the Executive Team continued to provide stable system leadership despite several interim arrangements. Stakeholders described trust leaders as open and collaborative, though Board‑level representation of global majority staff remained significantly low. Workforce Race Equality Standard (WRES) findings highlighted ongoing disparities in recruitment, disciplinary processes and experiences of discrimination, prompting a Race Equality Action Plan to improve progression, equity and leadership diversity. Succession plans for executive leadership roles and Fit and Proper Person checks were in place to maintain leadership continuity.

Freedom to Speak Up 

Improvements needed to be made to the culture within the trust because staff did not always feel able to raise concerns with their manager because they feared reprisal. However, staff did have a good understanding of how to raise their concerns confidently using the FTSUG. The FTSUG had taken actions, including the launch of a visibility campaign, to ensure staff were familiar with how to contact them. They produced a report which was scrutinised every six months to the People Committee and annually to the Board. Leaders were therefore sighted on the main themes and trends in staff sentiment and discussed how they had taken action to make improvements following staff feedback. 

Equality, diversity and inclusion 

The trust had begun strengthening equality, diversity and inclusion, with early improvements in cultural competence, bullying and harassment reduction and support for staff networks, but significant challenges remained. Implementation of the mandatory Patient and Carer Race Equality Framework (PCREF) was behind schedule, and disparities persisted in recruitment, disciplinary outcomes and experiences of discrimination for staff from the global majority and disabled staff. Board‑level representation of global majority staff remained low, and bullying and harassment from patients and the public had increased. This increase was particularly pronounced in staff from the global majority, 42.7% of whom reported bullying and harassment from patients and the public. Although the trust had introduced new initiatives such as reasonable adjustment processes, wellbeing passports, restorative practice training and plans for a shadow Board, leaders recognised that further work was needed to embed health‑inequality monitoring, strengthen inclusive leadership and improve how patient, family and carer voices informed governance and learning.

Governance systems 

The trust did not always operate with clear responsibilities, effective systems of accountability or robust governance arrangements. An independent quality governance review commissioned by the trust and reported to the Board in January 2026 assessed the organisation’s quality governance maturity as developing, with significant lagging features in safety-critical controls, governance discipline, assurance confidence, risk management, regulatory readiness and organisational culture. We found weaknesses in governance, risk management and assurance at both operational and strategic levels. Although risks were recorded through the Board Assurance Framework (BAF) and Trust Risk Register (TRR), these were not always being used effectively as dynamic risk management tools. Significant risks were not consistently reflected within corporate risk reporting, and risk mitigations often lacked sufficient detail, ownership, accountability and measurable actions. Assurance processes were fragmented and relied heavily on narrative reporting and individual knowledge rather than systematic, closed-loop assurance mechanisms. Data quality issues further undermined the trust’s ability to triangulate and use performance, quality and safety information effectively, reducing confidence in some assurance processes. Some governance groups lacked clear oversight and reporting arrangements, and we identified concerns regarding the quality and scrutiny of Quality Impact Assessments (QIAs) and Equality Impact Assessments (EQIAs). Board committees required strengthening in relation to the quality of information received, scrutiny of committee workplans and the effectiveness of escalation processes. The Quality Committee in particular required strengthening to improve its effectiveness. Reporting to key committees relied heavily on exception reporting and concise summary papers, and committee minutes did not always clearly demonstrate how assurance had been obtained. We found examples where significant operational risks, including community mental health waiting times, challenges within the medium secure forensic estate, workforce competency risks associated with agency staffing, delays in complaints handling and investigation processes, and risks relating to equality data and PCREF implementation, were not consistently reflected within strategic risk reporting. Leaders demonstrated awareness of many of these shortcomings and had commissioned external reviews and developed plans to strengthen governance, accountability, data quality, assurance and regulatory readiness. However, many of these improvements remained at an early stage and had not yet been embedded sufficiently to demonstrate sustainable improvements in governance effectiveness. Despite these concerns, there was evidence of progress in some areas, including implementation of the Patient Safety Incident Response Framework (PSIRF), improvements in learning from incidents and significant reductions in waiting times within memory assessment services.

Partnerships and communities 

The trust demonstrated strong and increasingly effective partnership working across the local health and care system, despite ongoing challenges in relation to its relationship with the local authority. Leaders collaborated closely with the Integrated Care Board, other local provider organisations, primary care, social care, voluntary sector organisations and emergency services to improve pathways, address long‑standing service challenges and prepare safely for major service transfers. Joint initiatives, such as redesigned memory assessment pathways, new crisis alternatives, strengthened Health‑Based Places of Safety and innovative discharge solutions like Clarendon Royal Community, helped reduce pressure on inpatient flow and expand community‑based support. Partners reported improved engagement, openness and alignment with shared priorities, reflecting a growing culture of collaboration and system‑wide problem‑solving across the trust.

Learning, improvement and innovation 

The trust had developed a strong focus on research and improvement. Senior leaders understood the value of research projects and the trust now had stronger links with partners in research including education institutions and industry. Staff at all levels and from all disciplines were able to become involved in research projects. Staff involved in research were able to articulate the demonstrable impact their research had on local populations. For example, local people with suspected dementia were now diagnosed and treated faster in part because of an innovative research project involving the use of mobile low-field scanners. The trust was strengthening its improvement focus by rolling out the ‘Doing Well Together improvement programme’, which systematically grouped Quality Improvement, audit and transformation projects. A new ‘your experience matters’ process was soon to be launched, which aimed to improve the quality of data that was collected about patient experience. 

Environmental Sustainability 

The trust was improving its environmental sustainability. The current Green Plan was launched in 2025 and clearly laid out the trust’s roadmap to align with the NHS’s commitment to Net Zero by 2040. Action plans were included in the Green Plan which illustrated how the trust planned to realise its aims to reduce carbon emissions, build resilience against climate risks, and to ensure sustainability was embedded in all its work. Leaders worked closely with partners in relation to supply chains and procurement and in developing capital projects, to help achieve its aims set out in the Green Plan.

Updated 8 December 2025

We carried out an unannounced comprehensive assessment of the Brookfield Centre on 11 and 12 February 2026. The Brookfield Centre is a 13-bedded locked forensic rehabilitation and recovery inpatient service for adults detained under the Mental Health Act, including patients with learning disabilities and autistic patients. The service supports patients to step down from Tarentfort Centre, which is a specialist low secure unit. At the time of the assessment, 11 patients were receiving care.

At the previous inspection, carried out through an unannounced comprehensive inspection at Brookfield Centre on 28 March 2023 and announced activity at Brookfield Centre and Tarentfort Centre on 4, 5 and 6 April 2023, the service was rated requires improvement overall. Breaches were identified relating to safe care and treatment and staffing.

At this assessment, we rated the service as requires improvement. Governance systems and oversight processes were not always effective in identifying, escalating and resolving concerns promptly. During the assessment, we identified environmental concerns including damaged fencing, debris within the second garden area and kitchen hygiene concerns. We also identified concerns relating to medicines storage. This meant governance and oversight systems had not always identified and addressed risks within the service.

Outcome monitoring systems were not sufficiently robust to demonstrate that patients were receiving positive and sustained rehabilitation outcomes. Although staff supported patients to work towards greater independence and community living, leaders could not consistently demonstrate how rehabilitation interventions were evaluated, how patient progress towards rehabilitation goals were being measured or how the effectiveness of care and treatment was assessed. This meant leaders could not be assured that patients were consistently achieving positive outcomes or progressing towards greater independence and discharge.

The person-Led Care Planning Model and rehabilitation model were not consistently understood or embedded across the service. Local leaders were not consistently able to explain how rehabilitation outcomes were evaluated of how patients progress was measured. This created inconsistency in understanding and delivery across the staff team and reduced assurance that care and treatment was consistently focused on supporting patients to achieve their individual rehabilitation goals and aspirations.

Length of stay information and patient records showed some patients had experienced significantly prolonged admissions. However, leaders could not consistently demonstrate how rehabilitation interventions were supporting progression, reducing the risks associated with long-term admission or achieving meaningful rehabilitation outcomes. This meant there was limited assurance that care and treatment was consistently supporting recovery, independence and community reintegration.

Some staff reported inconsistent senior leadership visibility and said they felt disconnected from wider organisational priorities. This meant leadership and strategic direction were not always clearly embedded across the service.

However, patients consistently described staff as kind, supportive and reassuring. Patients were supported to develop independence, access meaningful activities and participate in decisions about their care and future goals. Restrictive practice remained low and staff promoted positive risk-taking, choice and autonomy. Multidisciplinary working was generally positive, physical healthcare oversight was robust and improvements had been made in relation to staffing oversight and mandatory training compliance since the previous inspection.

We used the principles of Right Support, Right Care, Right Culture to inform our assessment of the service. Patients received person-centred care from staff who understood their individual communication, emotional and support needs well. Staff used adapted and accessible communication approaches to support patients with learning disabilities and autistic patients to participate in decisions about their care and treatment. However, governance and oversight systems were not always effective in identifying and addressing concerns promptly, including environmental concerns identified during the assessment.

At this assessment, we identified 2 breaches of regulation relating to person-centred care (Regulation 9) and good governance (Regulation 17). We have asked the provider for an action plan in response to the concerns found during the assessment.

Updated 7 July 2025

Assessment date: 16, 17 and 18 September 2025

We carried out an unannounced comprehensive assessment of the acute wards for adults of working age and the psychiatric intensive care unit (PICU) provided by Kent and Medway Mental Health NHS Trust (formerly known as Kent and Medway NHS and Social Care Partnership Trust (KMPT), because we were required to follow up on actions taken by the trust following CQC issuing a warning notice to them in 2023 due to significant risks identified relating to the management of high risk medicines. We had also received information that gave us concerns about the safety of patients at the service.

The trust provides assessment and treatment for adults of working age with mental health issues in 9 acute wards and 1 PICU, based in 3 hospital sites across the trust.

Littlebrook Hospital, based in Dartford, has 4 wards; Amberwood is a 17 bedded male-only acute ward, Pinewood is a 16 bedded female-only acute ward, Cherrywood is a 17 bedded female-only acute ward and Willow Suite is a 12 bedded male-only PICU.

Priority House, based in Maidstone, has 3 wards; Boughton is an 18 bedded male-only acute ward, Chartwell is an 18 bedded male-only acute ward and Upnor is an 18 bedded female-only acute ward.

St Martin’s Hospital, based in Canterbury, has 3 wards; Bluebell is an 18 bedded male-only acute ward, Fern is an 18 bedded female-only acute ward and Foxglove is a 16 bedded female-only acute ward.

We rated the service as requires improvement. The service had made some improvements since our last assessment. The service had improved its auditing of emergency response equipment and staff now ensured that each patient received a physical health assessment on admission. Enough nursing and support staff was deployed to the wards to keep patients safe and a new medicines record keeping system (EMPA) had been put in place across the trust.

We also saw that staff effectively responded to patient feedback and ensured patients felt they could speak up and feedback about their experience. This was reflected in trust data that showed a high number of feedback submissions. Patients had access to a physical health nurse and St Martin’s Hospital had access to registered general nurses who were specially trained in catheters and wound care. Staff could describe significant positive changes to the culture on Chartwell ward.

However, at this assessment we found 4 breaches of regulation. We identified breaches of Regulation 12 (safe care and treatment), Regulation 13 (safeguarding), Regulation 15 (premises and equipment) and Regulation 17 (good governance).

The service was not always reporting incidents and near misses in a timely way. These incidents did not always inform the way patient’s care was being delivered.

Staff were not always using the systems and processes in place to deliver a high quality person-centred service.

The service did always have robust governance processes in place that allowed for sustained improvement within the service. The trust did not have effective processes in place to ensure that staff were fully trained and understood the electronic systems being used. The monitoring and recording of blanket restrictions were inconsistent. This impacted on leaders being able to maintain oversight of the quality and safety of the service being delivered.

The service did not always ensure that medicines were used safely or in line with national guidance. Although staff followed systems and processes to prescribe and administer medicines using an electronic prescribing and medicines administration (EPMA) system, there were some concerns around documentation, monitoring, and oversight of high-risk medicines.

Documentation for 'when-required' (PRN) medicines were used for the management of anxiety or agitation was inconsistent. Patient records did not always explain the rationale for administration, what de-escalation techniques had been attempted, or whether the medicine had been effective. This was noted across multiple wards and could lead to inappropriate use or increased risk of side effects.

The service had significant estates and maintenance issues with no robust process in place to record and monitor when these occurred and had been completed. There were several maintenance issues that had been raised a long time before our assessment. One of which dated back to 2012 and was still on the ward risk register.

Updated 18 November 2025

Assessment date: 9, 10, 11 December 2025

We carried out a focused assessment of the community-based mental health services for adults of working age provided by Kent and Medway Mental Health NHS Trust (formerly known as Kent and Medway NHS and Social Care Partnership Trust (KMPT). We were required to follow up on actions taken by the trust following CQC issuing a warning notice to them in March 2025.

During the assessment, we visited 3 sites The Beacon, Laurel House and Ash Eton.

Overall, safe improved from inadequate to requires improvement, while effective and well-led remained requires improvement. This meant the service had made some improvements, but patients were at risk of coming to harm because some processes were not yet being consistently used or fully embedded. We found the trust to be compliant with the warning notice that we served to the trust in March 2025, however further improvements were required. As a result of this we issued the trust with an action plan request to address the breaches of regulation identified following the December 2025 inspection.

Safety had improved, with better oversight in some areas. Waiting lists were being managed more effectively in most places, supported by patient tracking meetings and reviews that helped escalate urgent cases. The trust had also strengthened physical health monitoring by carrying out regular clinical audit, sharing weekly compliance information on cardiometabolic checks with clinical leads, and reviewing this in regular meetings (including senior review) so teams could follow up missed checks and target support where compliance was low.

However, at this assessment we found 2 breaches of regulation. We identified breaches of Regulation 12 (safe care and treatment), and Regulation 17 (good governance).

Core safety processes were still not consistent across all locations. For example, at the South Kent Coast team, some records we reviewed did not show future appointments booked in line with local guidance. This meant that patients were still not being contacted and monitored consistently in line with trust policy across all teams. The completion of risk assessments and risk management also remained inconsistent, with the newer CRAM (clinical risk assessment and management) approach to managing risk was still being rolled out. The new risk assessment process was not used consistently across the services we visited, and some care records were missing up-to-date care plans and risk documentation in the expected format. Staff could navigate records and knew the patients they supported, but risk information was often held within progress notes and was time consuming to access because risk events were not consistently recorded in event logs. This increased the risk of staff missing key information about a patient and their care needs.

The service had a referral and triage process in place, with regular referral meetings attended by a multidisciplinary team, and staff understood how to escalate risk concerns. Staff also recognised the importance of supporting carers and signposting them to assessment and support where consent was given. The introduction of dashboards (including Power BI) supported oversight of waiting lists and highlighted patients with no contact, but this was not embedded consistently across all locations at the time of the assessment.

Governance arrangements were in place but were not yet effective at sustaining the improvements required. The quality of care records, risk assessments, waiting list oversight and caseload management all required further improvements. Staffing had improved overall, but the service was still mid-way through implementing a staffing model change, with further reviews and completion work still underway. We identified the positive progress the trust had made in strengthening oversight since our last inspection. For example, multidisciplinary working was described as a strength, and the RED (risk evaluation and decision) board approach was reported as consolidated and used consistently across locations.

Updated 21 January 2025

We carried out an inspection of the trust’s mental health crisis services and health-based places of safety on 4, 5 and 5 March 2025. The crisis services and health-based places of safety form part of the trust’s mental health services in the community. This inspection was completed as part of CQC's Adult Community Mental Health Programme. We also inspected community-based mental health services for adults of working age as part of the programme. The programme of inspections contributes to CQC's commitment to inspect the standard of care in community mental health services across the country. We undertook a short notice announced, comprehensive inspection of this service, looking at all 5 key questions to assess if services are safe, effective, caring, responsive and well led. Home treatment and rapid response teams are specialist teams of mental health professionals including nurses, doctors, social workers, psychologists, occupational therapists, and support workers who provide short term support to people experiencing a mental health crisis. They aim to prevent admission to a hospital by providing treatment and support to a person in their own home. Staff provide people who use services with intensive support and treatment in a person's home, rather than a hospital setting, for those experiencing mental health crises or emergencies. These teams offer a range of therapeutic interventions including assessment, crisis intervention, medication management, therapy, and support for carers. They can help people manage and resolve their crises while minimizing disruption to their lives. Health-based place of safety (HBPoS) also known as a 136 suite, is a designated space within a hospital or other health facility where individuals detained under Section 136 of the Mental Health Act can be safely assessed. This secure environment allows health professionals to determine the best course of action for the individual's mental health needs, whether that's further assessment, treatment, or discharge. A health-based place of safety is not a ward for long-term admission but a place for initial assessment. People can be detained in a place of safety for up to 24 hours, allowing for the necessary assessment. Kent and Medway NHS and Social Care Partnership Trust have five home treatment and rapid response teams: •Dartford – based in Littlebrook Hospital, Dartford and covers the Dartford, Gravesham and Swanley areas •North East Kent – based in St Martins’ Hospital, Canterbury and covers the north east of the county including Thanet •South East Kent – based in St Martins’ Hospital, Canterbury and covers the south east of the county including Ashford •West Kent – based at Priority House, Maidstone and covers West Kent. •Medway – based at Medway Maritime Hospital, Gillingham and covers Medway and Swale. The trust has 3 health-based places of safety (HBPoS) located at hospitals in Canterbury, Maidstone and Dartford. Each is situated on the ground floor. The HBPoS at St Martin’s Hospital in Canterbury and at Priority House in Maidstone have 2 rooms for patients detained under sections 135 or 136. There is 1 room at Littlebrook Hospital in Dartford. We spoke to 38 staff of various grades and roles. We spoke to 12 people who use services. We reviewed 25 care records. Medicines inspectors reviewed a further 10 people’s records. We observed handover and risk management meetings, and shadowed home visits. We reviewed meeting minutes, incidents and policies. We also reviewed information such as performance data and policies supplied to us by the trust, both during and after the inspection site visit. The team that inspected the mental health home treatment and rapid response services and health-based places of safety comprised 5 CQC inspectors, 1 Mental Health Act reviewer, 3 CQC pharmacist specialists (also referred to as medicines inspectors), 2 specialist advisors, and 2 experts by experience (people who have experience of using, or caring for someone who uses, services). We last inspected the service as part of a focused inspection in October and November 2018 when we rated the assessment service group as good overall. At our last inspection we found concerns around the environment and provision of information to patients of the health-based places of safety, incident reporting, and administration of clozapine reporting in the community.

Updated 30 July 2015

We rated the Knole Centre neurological rehabilitation ward for adults who require rehabilitation following an acquired brain injury or non-progressive neurological illness by Kent and Medway NHS and Social Care Partnership Trust (KMPT) as good because:

• Staff received training that was specific to the needs of their patients to assist them deliver good care and treatment.

• The ward had a system of governance in place to identify and monitored risks for patients. Staff learnt from incidents to ensure patient safety.

• Patients could access psychological therapies as part of their treatment. The ward had a wide range of staff that came from professional backgrounds to support patients. The ward used appropriate clinical outcome scores to show patients progress was monitored by quantifiable measures. Staff produced a yearly outcome report for the trust.

• Care plans were in place that addressed patients’ assessed needs and they were reviewed weekly by the staff team at the multi-disciplinary team meetings.

• Staff received training in the use of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

• Patients were treated with compassion, respect and dignity. They were positive about the way staff treated them. They were involved in the planning of their care. Their wishes and needs were integrated into their care plans.

• Patient were admitted based on their clinical need and beds could usually be available quickly. Patient usually stayed for a twelve week period and could have week end stays at home.

• There was a range of therapeutic activities available, on both an individual and a group basis. These included bespoke therapies like hydro therapy, exercise groups and walking practice.

• Ward managers provided good leadership and were visible and accessible to both patients and staff.

• The ward did not separate facilities for men and women, according to paragraph 16.9 of the Mental Health Act Code of Practice, and national guidance regarding the provision of same sex accommodation

• Staff members did not have access to all parts of the ward. Staff members did not have keys to all the doors and used adapted objects such as coins to turn the locks. This presented as a potential risk to patients and staff in the event of a fire.

• There were incidents where staff had not signed medication records to show that prescribed medication like thickening agents for patient’s food had been given to patients.

Updated 12 April 2017

We rated community-based mental health services for people with learning disabilities as good because:

• We looked at ten care records for people who used the service. All of these included a risk assessment and all records had been reviewed recently. The trust, in collaboration with partners, had developed the complex care response procedure across the teams which meant people who used services could receive a same day assessment of risk to reassess needs in order to prevent any further deterioration of mental state, which may have resulted in a hospital admission. Comprehensive assessments were documented in each of the care records we reviewed and were carried out at the person’s first appointment. All of the care records we reviewed had care plans. People’s needs were assessed and care was delivered in line with their individual care plans. Assessments were completed in a timely manner and the care plans were detailed, personalised, focused on maximising independence and holistic. All of the records we looked at had a health action plan included.

• The teams were situated in buildings that were clean and well-maintained. There were clear protocols available to guide staff on how to respond should an alarm be activated on site and staff we spoke with were able to describe the response guidance.

• There were sufficient staff to deliver care to a good standard and the staffing rotas indicated that there were sufficient staff in each of the teams. Staff we spoke to understood the vision and direction of the organisation. Staff felt part of the service and were able to discuss the philosophy of the service confidently All of the staff we spoke with were highly satisfied working in the service. The senior management team held monthly leadership forums where senior clinicians and managers came together from the service line and discussed, for example, the quality of service provision and service developments.

• People who used services told us they were supported well to live safely in the community and that their needs were met, including if they needed additional support. The teams offered a treatment model based on individual care and treatment pathways. People were supported through transitions between services, for example from children’s services to adult or from inpatient services to the community. People were involved in drawing up information to accompany them in their move. We observed interagency working taking place. Staff created strong links with primary care, the learning disability community teams, mental health acute inpatient services, social services and residential care homes being particularly positive examples.

• All of the people we spoke with and their relatives and carers complimented staff providing the service across the teams. People who used the service told us that they were treated with compassion, dignity and respect and that they were supported to make their own choices in their daily life. Staff we spoke with showed they knew the people who used services well. Staff told us confidently about their approach to people who used services and the model and philosophy of care practiced across all of the teams. They spoke about the emphasis they put on ensuring any treatment or support interventions were individualised and centred on the person and co-produced with them and their family or carer. Staffs’ approach was person centred, highly individualised and recovery orientated. People or their representatives told us they were fully involved with every aspect of their treatment and care planning.

• Key performance indicators and performance data was available to staff relating to waiting times from referral to assessment and onto treatment. Information on performance in key areas was collated and summarised by senior managers and published monthly. Staff participated in clinical audits to monitor the effectiveness of services provided. They evaluated the effectiveness of their interventions. The teams carried out audits against the National Institute for Health and Care Excellence (NICE) guidelines on promoting good health and preventing and treating ill health for people with learning disabilities and autism. Staff told us that they received feedback from incident investigations in regular team meetings and that they learnt key themes and lessons and developed action plans if they needed to make changes.

• People who used services and their families we spoke with all knew how to make a complaint, should they wish to do so. This included how to contact the Care Quality Commission. Staff confidently described the complaints process and how they would handle any complaints.

However:

• All relevant documentation about care planning was not filed in the care planning section of the electronic care records which made it difficult to locate information in a timely manner.

• There were 15 people waiting up to a year for psychology. We had concerns about psychology waiting lists during our inspection in 2015 and on this inspection we found improvements had been made however some people assessed as low risk were having to wait up to a year. These people were being supported by other community services and told to contact the mental health team should there be any concerns.

Updated 1 March 2019

• The team bases were safe for use by patients and staff.
• Patients who were prescribed anti-psychotic medicine received regular monitoring of their physical health.
• The service employed enough staff to meet the needs of the service. Staff felt supported by the trust, completed mandatory training, received supervision and had access to training opportunities.
• Staff had manageable caseloads that were reviewed regularly. They completed detailed risk assessments and had support from the multidisciplinary team when their patients presented as high risk.
• Staff had a good understanding of how to safeguard patients from abuse. They knew how to report incidents and were supported to gain learning from them.
• Staff had access to a secure system where they could access and record information regarding patients’ care and treatment. Staff could to access this system remotely to record important updates and support their time management.
• Staff carried out comprehensive assessments of patients’ needs and completed detailed care plans that addressed these identified needs.
• The service employed clinical psychologists and occupational therapists who provided a range of interventions to improve treatment outcomes and promote independence.
• The service had good links with internal and external agencies where patients, and their carers, could get support with social, dietary and physiological needs.
• The service carried out a programme of audits around clinical documentation and physical health monitoring of patients on anti-psychotic medicine.
• Patients, and their carers, were universally positive about the care and treatment they received. Staff knew their patients and treated them with compassion and respect.
• Patients, and their carers were fully involved in decisions about their care and treatment. The service offered them exceptional support in the early stages of their diagnosis.
• Admiral nurses supported families with all aspects of living with dementia. Healthcare assistants instilled hope in families by introducing them to emotional and practical support.
• The service actively collected feedback, from patients and their carers, about their experiences of the service. Responses received were extremely positive.
• The service was proactive in ensuring referrals were appropriately triaged and patients were seen and treated in a timely manner. All teams provided a duty service that could respond to emergencies.
• The service responded to patients’ individual needs. Patients had a choice in what services they received support from. It was proactive in engaging patients and provided satellite sites to support patients from rural areas.
• The service promoted dementia friendly communities and supported the concept of patients supporting each other. The service used feedback from complaints and compliments as learning opportunities.
• The service had experienced senior managers and team leaders who staff felt were supportive and approachable. Staff enjoyed their jobs and felt supported by their colleagues.
• The service maintained operational oversight through a well-structured schedule of meetings. Staff had access to an informative intranet site and the general public similarly had access to a user-friendly internet site.
• All teams were accredited, or in the process of applying for accreditation, to the memory service national accreditation programme. The service involved themselves in many innovative projects to improve patient experience.

However:

• Staff reported the current risk assessment template on the trust’s electronic care record system did not cover all risk areas common to older people with mental health issues. They also told us this same system could be hard to access, or respond slowly, during busy times.
• The service did not have a consistent approach to some areas of clinical practice, such as recording supervision; measuring outcomes for patients who attended groups; and recording patients’ capacity or consent to treatment.
• Due to commissioning arrangements, most areas of the trust were unable to provide a crisis service for patients with a diagnosis of dementia. Some teams were experiencing excessive waiting times for neuropsychology assessments.
• Some interview rooms did not provide adequate soundproofing to maintain patients’ privacy and confidentiality. The service did not always have appropriate dementia friendly signage and features and some sites did not provide enough parking for people with disabilities.

Updated 24 February 2022

Updated 12 April 2017

We rated the long stay/rehabilitation mental health wards for working age adults as outstanding because:

• All six of the rehabilitation units were clean, well maintained, and without exception patients told us that they felt safe.

• The service model optimised patients’ recovery, comfort and dignity. The patients’ care plans were robust, recovery focussed and person centred. There was a clear care pathway through the service with associated treatment and therapy options. The recovery star approach was firmly embedded and used in all of the rehabilitation units. Some units used this as the basis for planning care needs. There was a varied, strong and recovery-orientated programme of therapeutic activities available every week in each of the units. Patients had an excellent level of access to a wide variety of psychological therapies either on a one to one basis or in a group setting. All patients and staff told us that the ability to self-cater enabled them to gain vital knowledge and skills in preparation for their discharge and more independent living.

• There were enough suitably qualified and trained staff to provide care to a very good standard. Staff had the skills to deliver high quality care and treatment. Throughout the rehabilitation units the multidisciplinary teams were consistently and pro-actively involved in patient care and everyone’s contribution was considered of equal value.

• Staff managed risk well. They made and recorded robust risk assessments. Staff were confident in how to report incidents. They told us about changes they had made to service delivery as a result of feedback following incidents. Lessons learnt were shared across all of the rehabilitation service.

• There was evidence of best practice in the application of the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). All staff we spoke with had a good understanding of the MHA, the MCA, Deprivation of Liberty Safeguards (DoLS) and the associated Codes of Practice. The majority of the units cared for people detained under the MHA, where units had no patients currently detained, we looked at records retrospectively.

• The staff were kind, caring, passionate about their work and involved patients fully in decisions about their care. We saw good, professional and respectful interactions between staff and patients during our inspection. Staff showed patience and gave encouragement when supporting patients. We observed this consistently throughout the inspection. Patients told us that they were the priority for staff and that their safety was always considered. The atmosphere throughout the units was very calm and relaxed. Staff were particularly patient focussed and not rushed in their work so their time with patients was meaningful. Staff were able to spend time individually with patients, talking and listening to them. We did not hear any staff ask a patient to wait for anything, after approaching staff. We saw evidence of initiatives implemented to involve patients in their care and treatment. Patients told us that the staff across the rehabilitation service consistently asked them for feedback about the service and how improvements could be made. The service was particularly responsive to listening to concerns or ideas made by patients and their relatives to improve services. We saw that staff took these ideas into account and used them when they could.

• All staff had good morale and they felt well supported and engaged with a visible and strong leadership team, which included both clinicians and managers. Staff were motivated to ensure the objectives of the trust and the service were achieved.

• Governance structures were clear, well documented, followed and reported accurately. There were controls for managers to assure themselves that the service was effective and being provided to a good standard. Managers and their teams were fully committed to making positive changes. We saw that changes had been made to maintain improvements in quality through the use of audits. The service had clear mechanisms for reporting incidents of harm or risk of harm and we saw evidence that the service learnt from when things had gone wrong.

• We inspected these services previously in March 2015 and not all the essential standards were met. The rehabilitation wards were rated as inadequate in the safe domain. During this inspection visit we found that considerable improvements had been made in these areas and the essential standards had now been met.

However:

• The provider should consider the skill mix of qualified and non- qualified posts as staff commented that there is little career progression opportunity from Band 5 to Band 6 nurses and from Band 3 to Band 4 support workers.

• The provider should consider whether all staff should wear personal alarms at all times on the wards.

• The provider should review which team is responsible for up-loading care programme approach review meeting minutes on to the electronic care record system. Currently the community mental health teams are responsible and the compliance % is under target. The staff at the rehabilitation units have expressed an interest in taking this task over to ensure the target is met.

Updated 24 February 2022

Updated 12 April 2017

We rated substance misuse services in Kent and Medway NHS and Social Care Partnership Trust as outstanding because:

• Bridge House was exceptionally clean and well maintained and without exception, patients told us that they felt safe. The ward was well equipped and fixtures and fittings were provided to a high standard.

• There were enough suitably qualified and trained staff to provide care to a very good standard. The provider employed some staff with lived experience of addiction which further enhanced the skill mix and diversity of staff available. Skilled staff delivered care and treatment. Throughout the ward the multidisciplinary team was consistently and pro-actively involved in patient care and everyone’s contribution was considered of equal value.

• We found that patients’ risk assessments and care plans were robust, recovery focussed and person centred. The assessment of patients’ needs and the planning of their care was thorough, individualised and recovery focused. Staff considered and met the needs of patients at all times.

• Staff were confident in how to report incidents and they told us about changes they had made to service delivery as a result of feedback following incidents.

• All patients received a thorough physical health assessment by both the consultant and a nurse on admission to the ward and staff identified and managed risks to physical health. Patients had an excellent level of access to a good variety of psychological therapies either on a one to one basis or in a group setting. The service model optimised patients’ recovery, comfort and dignity. There was a clear care pathway through the service with associated treatment and therapy options. The patient successful completion rate for the detoxification programme was over 96% during the preceding year. There was a varied, strong and recovery-orientated programme of therapeutic activities available every week. Aftercare for all patients was arranged before admission to Bridge House. This included aftercare in the community with specialist teams or longer term residential rehabilitation. The ward offered ex-patients and their families and friends the opportunity to contact staff for support and/or information after discharge

• Staff interacted with patients and their approach was kind, respectful and professional at all times. Staff continually interacted in a positive and proactive way. The atmosphere was really welcoming, friendly and warm. Staff were particularly enthusiastic, dedicated and motivated by their work. Staff spoke respectfully about their patients at all times and demonstrated an excellent understanding of their issues with a non-judgemental approach.

• The trust carried out a monthly friends and family test, asking how likely a patient would be to recommend the services to family or friends if they needed similar care or treatment. All patients asked in December 2016 said they were extremely likely to recommend the service.

• All patients and staff told us that the quality and range of food offered was of a high standard.

• All staff had good morale and told us that they felt well supported and engaged with a visible and strong leadership team, which included both clinicians and managers. Staff were motivated to ensure the objectives of the organisation and of the service were achieved.

• Governance structures were clear, well documented, followed and reported accurately. These are controls for managers to assure themselves that the service was effective and being provided to a good standard. Managers and their team were fully committed to making positive changes. Changes were carried out to ensure that quality improvements were made, for example through the use of audits. The service had clear mechanisms for reporting incidents of harm or risk of harm and we saw evidence that the service learnt from when things had gone wrong.

However:

• Staff could not be sure that patients were able to securely store all of their possessions in their bedrooms as there were no locks on the doors.Although no patients or staff raised any issues or concerns about bedrooms doors not being lockable, we did consider that the security of patients’ belongings could be compromised.