Kent and Medway Mental Health NHS Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

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.