Kent and Medway Mental Health NHS Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated effective as good. At this assessment the rating has remained good. Staff assessed the physical and mental health of all patients on admission. Staff provided a range of treatment and care for patients based on national guidance and best practice. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. However, the service did not always make sure patient’s care and treatment were effective because they did not always check and discuss patients’ health, care, wellbeing and communication needs with them. We found the service in breach of regulation 12 as the trust did not ensure that patients’ physical health needs were being supported by professionals from outside the organisation. This meant the effectiveness of patients’ care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 67 (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 make sure people’s care and treatment were effective because they did not always check and discuss patients’ health, care, well being and communication needs with them.

We reviewed 29 care records during the assessment. Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission.

Care plans did not always meet the needs of the person identified during assessment. Care plans were generic with few elements of personalisation. Care plans, physical health assessments and discharge planning were often not personalised and contained little detail. Some care plans included contradictory statements regarding the person’s insight into their mental ill health. Other care plans we reviewed contained "I" statements which were unlikely to have been expressed by the person. For example," I would like to remain concordant with my medication". Some patient’ care plans contained "I" statements even though they had not been able to participate in the creation of their care plans. However, some care plans we reviewed were robust and showed a good level of collaboration with the person. Staff updated care plans when necessary. Patients gave mixed feedback about whether they had a care plan and understood it. Some patients told us that they had a copy and knew what it contained, whereas other patients told us that they were unsure if they had a care plan in place. Staff told us that a new care plan was due to be rolled out in the coming months, which had been co-produced alongside patients with mental ill health and families and carers.

Most care plans we reviewed did not have positive behavioural support plans(PBS) in place that supported patient’s needs, such as patients who identified as being autistic or neurodivergent. Staff had not identified or planned for systems of support for these patients that met their needs. Staff we spoke with were often unsure which patients identified as being autistic or required a PBS plan. Of the PBS plans we reviewed, most were basic care plans with no reference to the patient’s diagnosis, sensory needs etc. However, on Cherrywood ward we viewed 2 PBS plans in place that were comprehensive and were created in conjunction with the patients who needed them. The trust was aware of the lack of training. We were also told that occupational therapists were working on developing better PBS plans for patients with autism spectrum disorder and neurodiversity. However, we did not see evidence of this on the days of the assessment.

We scored the service as 2. The evidence showed some shortfalls. The service did not always meet patients’ physical health needs and access to psychological therapies needed further improvement. However, the service delivered patients’ care and treatment in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These will include medication and psychological therapies.

The team included or had access to the full range of specialists. Each ward had a dedicated team of occupational therapists who provided on ward activities for the patient group. We observed patients actively taking part in the groups on offer, although some patients told us that there were too few activities. At Littlebrook hospital, the occupational therapies team supported patients to hold an exhibition for their artwork where patients could display and talk about the work.

The wards had access to clinical psychologists, art therapists and cognitive behavioural therapists but this team worked separately from the wards and worked across each individual site. The psychology team were able to provide group therapy and some assessment and formulations. Staff told us that there were too few psychologists within the team that it was felt they were unable to meet the needs of the patient group. Staff were unaware whether any work had been carried out to assess whether the current establishment levels of the psychology team were able to meet the needs of the patient group.

The wards had pharmacists who visited the wards regularly and held meetings with patients to discuss their medications and side effects.

Each ward had a dedicated peer support worker who was someone with their own lived experience of mental health illness.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Staff could refer patients to speech and language therapy (SALT), diabetic nurses, Tissue viability nurses (TVN) and dietitians who were external to the Trust. Each ward had access to a physical health nurse and St Martin’s Hospital had access to 2 registered general nurses who were specially trained in catheters and wound care.

Whilst patients’ physical health needs were assessed in a timely manner after admission, further improvement was needed to ensure that the ongoing management of patients’ physical health was consistently recorded, and consideration was given to involving specialist healthcare professionals to support their health needs. For example, there was no recorded evidence of a dietitian being considered or involved in the care of a patient who had a high body mass index. We also identified that staff had not liaised with other professionals regarding a patient who had a recorded diagnosis of epilepsy and had a recent seizure. Care plans did not always reflect the physical health needs of the patient, such as one patient had a diagnosis of arthritis which was not recorded in their physical health care plan and another patient was currently restricting food and water and was not included in their care plans. The lack of physical health care plans increased the risk of staff not being able to meet the needs of patients which could put them at risk of harm.

Patients we spoke with generally felt their physical health needs were being met. One patient on Upnor ward told us that the ward had accessed a special bed to support their physical health needs. Another patient had dietitian involvement and stated that their diabetes was being managed well by staff. The patient was confident in their robust care plan around their diabetes.

The Trust employed physiotherapists who completed assessments for patients and ran groups. They could also support patients 1:1 when needed.

Whilst staff participated in a clinical audit programme every 4-6 weeks that included infection control and care planning, the programme was not always operating effectively. Audit processes failed to identify that post-dose physical health monitoring following rapid tranquilisation (RT) via intramuscular (IM) injection was not consistently completed. We identified similar findings at the time of our 2023 inspection.

Managers provided new staff with appropriate induction.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development). In August 2025, 85% of staff that required a one to one supervision within the previous 6 weeks had done so which achieved the Trusts compliance target. The Trust had identified areas for improvement and were currently reviewing how they could improve their completion rates of one to one supervision. The trust used an automated system to schedule notifications reminding staff and managers when the forms were due /overdue and could also send reminders to those who had a partially signed off form. Staff found supervision useful and constructive. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers provided staff with an appraisal of their work performance yearly. The percentage of medical staff that had had an appraisal in the 2024/2025 financial year was 100% for all wards apart from Foxglove ward where there had been long term sickness. Each ward had varying levels of completion for their appraisals, however, on average the trust was meeting their target of 95% for non-medical staff appraisal compliance. Most wards had fallen below the Trust target for non-medical staff appraisal completion. Upnor ward was a significant outlier with regards to this, 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.

Managers ensured that staff had access to regular team meetings. Staff attended monthly team days to discuss changes in practice, risks on the ward and other information prevalent to the ward.

Managers ensured that staff received the necessary specialist training for their roles. Some staff told us that they had completed training in motivational interviewing for substance misuse, as well as training in cognitive behavioural therapy. An occupational therapist at Littlebrook Hospital developed a day’s training for staff which would be rolled out in 2026, where there will be guest speakers from other services such as a physical health nurse, psychology and the police. The trust had a catalogue of additional training that staff could complete. Staff told us about bespoke training delivered by peer support workers, workshops on enhanced observations and seclusion and communication training on the use of talking mats.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff had received training in the Mental Health Act and 96% of staff had completed this. Cherrywood ward did not meet the compliance threshold of 90% for the Trust, with 80% of staff completing the training.

Staff had easy access to administrative support and legal advice on the implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were. However, there were reported staff shortages in some of the Mental Health administration teams.

The provider had relevant policies and procedures that reflected the most recent guidance, which staff had easy access to. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy (IMHA). Each ward had a named IMHA and information was present on each ward.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff recorded that patients understood their rights routinely. This was audited by the Mental Health Act team who shared the information with ward managers around compliance.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

The service displayed a notice to tell informal patients that they could leave the wards freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment

Staff completed regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

Staff held regular and effective multidisciplinary meetings which were attended by a variety of disciplines. However, on Fern ward we were told that one discipline rarely attends handovers or MDT meetings.

Staff shared information about patients at effective handover meetings within the team. Staff attend daily safety huddles to discuss risks on the ward. This was part of the services programme for reducing violence and aggression.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation.

The teams had effective working relationships with teams outside the organisation. Willow suite staff were able to reach out to other psychiatric intensive care units, within other organisations to ask for advice and share good practice. Littlebrook Hospital had good working relationships with substance misuses services (SMS), who support the mental health services with advice around the SMS pathway and community provision available to patients. Staff attended local safeguarding meetings with external stakeholders such as the police and local safeguarding teams to review open cases. The service had named links in social services and a police liaison officer.

We scored the service as 3. The evidence showed a good standard. The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives. The wards participated in smoking cessation schemes, healthy eating advice, and dealing with issues relating to substance misuse. At Littlebrook Hospital, staff had specialist training in substance misuse provided by the occupational therapies staff and each ward had an SMS champion. The SMS champions met monthly to discuss barriers to care and referrals to SMS providers. The staff linked in with substance misuse services to provide holistic care.

Ward activities helped promote a healthy lifestyle for patients. Activities such as walking groups, sports activities, going to the gym and cooking healthy meals supported patients to achieve this. At Littlebrook Hospital, patients also had access to an innovation fund for chickens which meant that patients were supported to look after chickens on the hospital site. The service also had a therapy dog that attended the ward twice a week.

Staff were complimentary of peer support workers and the bespoke work they do with patients who were dysregulated. Peer support workers could facilitate activities with patients such as walking, talking, and cooking.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored patients care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of patients themselves.

Staff told us they used recognised rating scales, such as Model of Human Occupation Screening Tool (MoHOST), 5p’s Formulation, Autism Spectrum Quotient (AQ50) and ADHD Pre-Assessment Scale to assess and monitor patient’s treatment progress at the point of admission and discharge.

Staff used technology to support patients effectively.

We scored the service as 3. The evidence showed a good standard. The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history