Kent and Medway Mental Health NHS Trust

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection we rated this key question as Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Staff did not feel respected, supported and valued by the senior leadership team within the trust. Governance processes were not robust. Teams did not always use the systems and processes available to ensure they delivered care that was of high quality.

We found the service in breach of regulation 17 as the Trust did not have robust governance processes in place that enabled staff to review the quality and safety of their service effectively and make improvements that were needed. However, staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff collected and analysed data about outcomes and performance.

This service scored 62 (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 clearly communicate changes to the staff team. The culture on the wards impacted on multidisciplinary relationships and patient outcomes. They did not always understand the challenges and the needs of patients and their communities.

Whilst staff knew and understood the provider’s vision and values and how they were applied in the work of their team, staff at St Martins hospital reported that Fern ward had a closed culture. They were concerned that the ward was medically led and not therapeutically informed. Both patients and staff raised concerns about the poor attitude of one member of staff. We raised these concerns with the trust.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Although some staff told us that communication from the executive leadership team could be improved.

Staff could explain how they were working to deliver high quality care within the budgets available.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. However, staff felt that leaders did not always embody the culture and values of their workforce and organisation.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

Leaders had the skills, knowledge and experience to perform their roles.

Leadership development opportunities were available, including opportunities for staff. Staff received regular supervision and had good access to suitable training so that they could develop in their role. One ward manager had recently completed training in trauma-based care and was booked onto a course on self-harm. Another ward manager described how she had been supported by a mentor, which supported their wellbeing. However, therapies staff reported that additional training to support the development of the psychology team was limited.

While local leaders were visible in the service and approachable for patients and staff, staff told us that the executive team did not have a visible presence on the wards. The ward managers didn’t always feel supported by the trust’s executive team, and they felt there was a sense of anxiety that came from senior levels of staff. Some staff told us that they were not involved in decisions about governance and felt they were told what to do. However, the ward manager for Chartwell ward did describe the support from the executive team when the ward was changing. Staff could describe significant positive changes to culture on Chartwell ward.

Ward managers described being well supported by their matrons and senior leaders. Staff felt supported by local leaders.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where patients felt they could speak up and their voice would be heard.

The provider had a Freedom to Speak Up Guardian. Managers reminded staff of this resource in team meetings and signposted them to available resources.

Patients and carers had opportunities to give feedback on the service they received. Between September 2024 and August 2025, there had been 366 feedback submissions to the family and friends test, across the 10 wards. The wards were also gathering feedback using Patient Reported Experience Measure (PREM) since February 2025. This showed a largely positive response to the care and treatment being provided.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. Some staff told us that their ward manager role-modelled by speaking up on their behalf and additional training was offered to the team as a result.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff were trained in equality, diversity, inclusion and human rights.

Managers put reasonable adjustments in place for staff members to help them carry out their role.

The provider undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the patient group.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have good governance processes in place to ensure the service was able to make sustained improvements. They did not always act on the best information about risk, performance and outcomes.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings, to ensure that essential information, such as learning from incidents and complaints was reviewed.

Staff had implemented recommendations from reviews of deaths, reported incidents, complaints and safeguarding alerts at the service level.

The governance system and processes in place were not robust enough to ensure that the service made sustained improvements over a period of time. Despite managers undertaking and participating in local clinical audits the audits did not always identify quality and safety issues. For example, post-dose physical health monitoring following rapid tranquilisation (RT) via intramuscular (IM) injection was not consistently completed in line with local or national policy. We found examples of missing or delayed observations. This meant that patients were put at risk of harm. The blanket restrictions review tools did not include all blanket restrictions that were in place at the time of our inspection or provide a rationale for why the restriction was put in place. Incidents were not consistently being reported which affected the trusts ability to learn lessons and prevent the incident from reoccurring.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

Staff maintained and had access to the risk register at ward and directorate level. Staff at ward level could escalate concerns when required.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care.

Although there were electronic systems in place to support the collection of data from wards and directorates, staff did not always know how to use the systems or where current information was being stored. Staff recorded patient updates in the progress notes rather than in specific areas of the patient record system. This meant that information in care records was difficult to find. For example, reviews for rapid tranquilisation were recorded in various places on the electronic records system. Staff we spoke with could not locate current consent to treatment forms for patients detained under the Mental Health Act and were often using the paper copies on the ward. Ward staff were unable to find important pieces of information throughout our inspection, such as ligature risk assessments. We were not assured that staff could access patient information they needed to inform patient care and therefore could put patients at risk of harm. We were not assured that leaders had clear oversight of team performance, risk and quality of care being delivered to patients because staff were not updating the patient record system in the right way.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for patients. They share information and learning with partners and collaborate for improvement.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. Patients with autism had care, education and treatment reviews.

Directorate leaders engaged with external stakeholders, such as commissioners.

Staff displayed information about advocacy in communal areas.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for patients. They actively contribute to safe, effective practice and research.

The trust had been actively involved in a working group put together by the National Forum of Mental Health and Learning Disability Nurse Directors (the Forum) to explore best practice regarding therapeutic observations and use of enhanced observation within inpatient mental health, learning disability and autism care. At the time of our assessment, the trust was reviewing the guiding principles that had been recently published to inform policy reviews.

Staff participated in national audits relevant to the service and learned from them. The trust had conducted audits internally for their own learning. This included an Audit of the Sensory Aspects of Inpatient Environments and a Clinical Audit on PRN (when required) Psychotropic medication in acute inpatient wards. The trust was also conducting various other audits which were in progress at the time of the assessment.