Kent and Medway Mental Health NHS Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last comprehensive inspection we rated this key question as Requires Improvement. At this assessment the rating has remained Requires Improvement. Staff did not always respect patients’ privacy and dignity. Staff did not always ensure that patients had access to their chosen faith provision. The service did not always promote the wellbeing of their staff and did not always support or enable staff to deliver person-centred care. However, staff treated patients with compassion and kindness. Staff actively sought patients’ feedback on the quality of care provided.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not always respect patients’ privacy and dignity. Staff did not always ensure that patients had access to their chosen faith provision. However, the service treated patients with kindness, empathy and compassion.

Staff mostly showed respectful, empathetic and supportive behaviour towards patients using the service. Interactions were warm and caring. For example, on Willow Ward, a person who was visibly upset was comforted by staff in a calm and gentle way. This showed staff understood how the person was feeling and responded with care and kindness. However, on Fern ward, multiple patients expressed that 1 staff member was hostile in their interactions, and they did not feel involved in decisions. One patient described the interaction with the staff member as being “talked at”. Some patients also told us that they had experienced staff not always knocking in their bedrooms doors before opening the observation shutters. This meant privacy could be compromised, especially when patients were getting dressed or resting.

Spiritual support was available through 2 chaplains who worked across all acute services groups. However, patients told us they found it difficult to access chaplaincy support when needed. There were no multi-faith rooms on any of the wards and no access to other faith provision outside of chaplaincy. This meant patients from different religious backgrounds did not have a dedicated space for prayer or quiet reflection, and feedback indicated this impacted how supported they felt in practicing their faith.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

Staff maintained the confidentiality of information about patients.

We scored the service as 3. The evidence showed a good standard. The service treated patients as individuals and made sure patient’s care, support and treatment met their needs and preferences. They took account of patient’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Patients told us they were given choices in their daily routines, including when to get up, what to eat and how to spend their time. This meant patients had more control which supported recovery. We observed staff encouraging choice and praising patient’s efforts in meaningful activities. This gave patients opportunities to build confidence, develop skills and feel included in their care.

Patients had opportunities to share their views and help shape the way care was delivered. We observed a community meeting on Fern Ward where staff listened carefully and responded with respect. Feedback from community meetings showed that patients wanted more exercise sessions. During our assessment, we observed a meeting taking place where patients were offered different options based on what they felt comfortable doing. Staff demonstrated they had listened to patients’ views and made changes to improve their experience.

Patients had a choice of food to meet their dietary requirements. Patients had requested for more vegan options on the food menu. As a result of this feedback, the menu had improved. We saw a good selection of food available, which demonstrated that staff had listened and responded to meet patient’s dietary preferences and cultural needs.

Staff personalised patient care to ensure that patients preferences and needs were met.

We observed a staff member respectfully using the pronouns that a patient identified with. We also observed a member of staff adapting how they communicated with patients. For example, some used visual aids or gestures. This helped patients feel recognised, valued and cared for as individuals.

Patients had access to information about their rights, advocacy services and support for carers. This helped them feel informed and supported in making decisions about their care.

The service made adjustments for disabled patients. The environment was easy to move around. There were ramps, wide doorways and accessible bathrooms for patients who use wheelchairs or had mobility needs. This helped patients feel safe. Staff told us that they had access to tools that aided communication with patients.

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Most patients we spoke with during our assessment told us they felt involved in their care planning. However, on Fern ward, multiple patients expressed that they did not feel involved in decisions about their care. Care plans and risk assessments, we reviewed, were not written in a way that reflected patients’ views about their care.

Staff regularly reminded patients detained under the Mental Health Act (MHA) of their rights. Although some patients we spoke with told us they were not aware what their rights were. Some patients were not aware that advocates were available to support them.

Staff provided patients with a choice around the food they ate. There were several options available and patients could choose what they wanted to eat. Patients generally felt positive about the food available and felt the food was of good quality. Food options were available that catered for all patients’ dietary needs. Most patients told us that they could make food or drink whenever they needed it. However, some patients and their families and carers told us that fruit and drinks were not always readily available and mealtimes were not flexible. Families and carers told us that there were not always clean mugs available for patients to use.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to patient’s needs in the moment and acted to minimise any discomfort, concern or distress.

Patients were able to provide feedback in a number of ways. Patients attended regular community meetings and a monthly patient forum to provide feedback to staff. They were also able to complete a monthly patient experience questionnaire. Staff updated the “you said, we did” boards to demonstrate how suggestions they had made had been implemented.

Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviour escalated. Patients had access to grab boxes and sensory boxes to provide distraction and an alternative to self-harm. Some wards also had access to sensory toys such as balance boards and fidget toys.

We scored the service as 2. The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Whilst most staff felt respected, supported and valued by their managers and multidisciplinary team, they did not always feel the same about how the trusts executive leadership team. Staff told us that there was pressure from senior leaders which led them to feeling replaceable by the trust. Staff told us that they felt burnout.

Staff had access to support for their own physical and emotional health needs through an occupational health service. Staff told us there is an increasing demand for psychology staff to support the staffing group with debriefs, post incident support and supporting burnt out staff.

The provider recognised staff success within the service. The trust had a recognition initiative which celebrated teams and individual staff members called Value in Practice awards.

Most wards had fallen below the trust target for non-medical staff appraisal completion. The trust target for appraisal completion was 95% and Upnor ward was a significant outlier with a completion rate of 31%. The trust explained that completion rates were low due to administration errors as forms had not been signed off by both the appraiser and the appraisee. Appraisals that were completed included conversations about career development and how it could be supported support workers told us that they felt there were no opportunities for career progression in their role.