Kent and Medway Mental Health NHS Trust

On this page

• 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
• Environmental sustainability – sustainable development

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The trust needed to strengthen its culture and user engagement. There was a clear vision and strategy and the trust had strong relationships with some of its external stakeholders. 

Leaders were working hard to embed a consistent organisational culture. Cultural variation was evident across the trust and had been identified in the recent independent review of quality and safety governance, which was published in January 2026. Staff confidence in local leadership, middle management capability, psychological safety and the meaningful involvement of patients, families and carers required further strengthening.

Staff reported limited confidence that leaders would consistently act upon concerns raised. Many staff described being fatigued by organisational change and senior leaders reported that they were working hard to improve the consistency of the trust’s middle management capability.

Concerns regarding psychological safety were also apparent. Increasing numbers of staff were choosing to raise concerns through the Freedom to Speak Up Guardian rather than through local management channels because they feared detriment if concerns were raised directly. This suggested cultural improvements had not yet been consistently embedded across all services and leadership levels.

There was evidence that some services continued to experience significant cultural challenges. The trust acknowledged that further work was required to embed positive cultures, particularly within community services,  where the trust’s cultural competency work had not yet been rolled out and staff reported feeling despondent following the community transformation programme. Leaders recognised the need to strengthen cultural competence and ensure local leaders had the skills and support necessary to create inclusive and psychologically safe working environments.

However, the trust had articulated a clear set of organisational values: Caring, Inclusive, Curious and Confident. These values were embedded within the Culture, Identity and Staff Experience (CISE) programme and supported by the trust's Equality, Diversity and Inclusion strategy, which was aligned to the organisational ambition of creating a great place to work.

There were positive initiatives designed to strengthen culture across the organisation. The trust had introduced the "Doing Well Together Improvement Programme" in early 2026 to provide a consistent approach to quality improvement, transformation and audit activity. Staff achievements were recognised through monthly "Values in Practice" awards across directorates.

The trust also had strong working relationships with some of its stakeholders including third sector organisations and education institutions. They worked closely together to tackle significant challenges such as patient flow and in collaborating on research initiatives. 

Co-production and family involvement were not yet consistently embedded across the organisation. The experiences of patients, carers and families were not yet central to local governance discussions. This posed a risk that patient and carer feedback would not always translate into clear improvement actions. 

There was also evidence that family involvement in frontline care remained inconsistent. Leaders acknowledged that staff did not always involve families during risk assessments and care planning, creating a risk that important contextual information, protective factors and lived experiences might be overlooked.

An Independent Rapid Review of Incidents found that family and carer involvement was not consistently embedded within safety-critical pathways. The review highlighted examples where engagement with families appeared procedural rather than meaningful and identified instances where communication and support following patient safety incidents had been insufficient. 

The trust's current three-year strategy (2023-2026) was built around three core themes: the people it cares for, the people who work for the organisation, and the partners it works with. Trust had developed its new five-year strategy, ‘Doing Well Together’, which was due to launch in April 2026. The Trust had also introduced the aligned ‘Doing Well Together Improvement Programme’, providing a coordinated approach to quality improvement, transformation and audit activity. 

Development of the strategy involved extensive engagement over a two-year period, drawing on staff survey feedback, engagement events, stakeholder discussions, complaints data, operational performance information, risk intelligence and business data. Engagement activity included an online survey and 13 face-to-face events involving approximately 300 staff and 150 patients, carers and family members. This engagement identified five consistent priorities:

• Keeping people safe while in the trust's care.
• Providing a positive experience of services.
• Reducing waiting times.
• Using resources effectively.
• Delivering care closer to home and avoiding unnecessary inpatient stays.

However, when we spoke with Allied Health Professionals, they expressed that they had not had enough opportunities to contribute to discussions about the trust’s strategy. 

There were also examples of robust strategic planning at service level. The pharmacy department had developed a Medicines Optimisation Plan for 2025/26 to 2029/30 through a collaborative process involving the whole pharmacy team. The strategy was aligned with the wider trust strategy and had been approved through the Quality Committee. 

Similarly, the forthcoming transfer of Child and Adolescent Mental Health Services (CAMHS) and the all-age eating disorder service had been carefully planned. The Finance Business and Investment Committee had considered the financial implications in detail and there was a shared understanding amongst executive and non-executive directors regarding associated risks and resource requirements.

Leaders also demonstrated learning from previous strategic challenges. The adult community mental health transformation programme had encountered significant difficulties, including a failure to fully anticipate foreseeable pressures within community services. However, leaders described how lessons learnt from this programme had informed the ongoing Community Refinement Programme, which was reported to be progressing more effectively.

However, we identified that there had been significant delays in the review of clinical staffing models and target dates for this review had been missed. Leaders explained that this was because work had slowed because of the launch of the new trust strategy.

The trust's mission was to deliver brilliant care through brilliant people, supported by a vision to provide outstanding care and work in partnership to deliver care in the right place, for every service user, every time. This vision was underpinned by six strategic objectives focused on delivering outstanding person-centred care, creating a great place to work, reducing health inequalities through partnership working, transforming care through technology and data, maximising resources, and creating environments that benefit service users and staff.

Not all leaders understood the context in which services delivered care, treatment and support. They did not consistently model the culture and values of the workforce or the wider organisation. In some areas, leaders lacked the skills, knowledge, experience or credibility required to lead effectively, and leadership was not always characterised by integrity, openness or honesty.

The trust recognised the need to strengthen the capability and responsiveness of its middle‑leaders. Senior leaders were developing plans to improve support for middle leaders, ensuring staff felt able to raise concerns without fear of reprisal and that local leaders were confident in addressing issues within their services. Work to improve cultural competency had already begun within the acute and rehabilitation directorate and was due to be rolled out across the other operational directorates. Senior leaders acknowledged the importance of improving psychological safety so staff could speak openly about concerns and receive timely feedback on actions taken. Twenty-six percent of all speak up cases had been reported because the individual feared there would be consequences for them if they raised their concerns with local leaders.

The Executive Team comprised eight members, five of whom were voting Board members: the Chief Executive Officer, Chief Medical Officer, Chief Operating Officer and Deputy Chief Executive Officer, Acting Chief Nurse, and Chief Finance and Resources Officer. The remaining three were the Director of Partnerships and Transformation, Director of Strategy and Engagement, and Chief People Officer, who were non‑voting members.

From October 2025, the Chief Medical Officer also took on the role of Interim Chief Medical Officer at Kent Community Health Foundation Trust, creating opportunities for closer partnership working across the two organisations. The acting Chief Nurse had been acting in the role since January 2026 due to the substantive post‑holder undertaking a secondment with the local Integrated Care Board. The Chief People Officer was due to leave their post, and recruitment for an interim replacement was underway at the time of inspection.

Executive leaders were supportive of senior leadership teams across the trust. The Chief Executive Officer, in post since November 2023 and previously the trust’s Chief Finance and Resources Officer, continued to play an active role in the wider health system as its finance lead.

The Chief Executive Officer had effectively provided direct and individual leadership to tackle longstanding and current cultural challenges within the organisation and was working hard to spread this responsibility and accountability across the trust’s senior leadership team. The positive work of the Chief Executive Officer in addressing culture was raised by staff at different levels in the organisation, as well as executive and non-executive colleagues. 

Operational directorates followed a tripartite leadership model, with each directorate led by a Director of Operations, Director of Nursing and Medical Director, all reporting to their executive counterparts. This structure supported balanced clinical and operational leadership across the trust. Stakeholders spoke positively about the openness and collaborative approach of trust leaders, noting their commitment to improving outcomes for the wider population.

The trust chair was due to leave in June 2026, with recruitment for a successor underway. The remaining Board members were Non‑Executive Directors.

There was significant under‑representation of global majority staff at Board level. KMPT’s 2024/25 Workforce Race Equality Standard report highlighted that while global majority representation had grown to 30% of the workforce, representation remained limited in senior non‑clinical and leadership roles. Disparities persisted in recruitment outcomes, disciplinary processes and experiences of harassment and discrimination. Although improvements had been made in perceptions of fairness and reductions in discrimination gaps, under‑representation at Board level remained a concern. The trust’s Race Equality Action Plan (2025–27) set out actions to strengthen progression pathways, improve recruitment equity, enhance conflict resolution processes and increase leadership diversity.

New leaders received an appropriate induction, and all directors had undergone Fit and Proper Person Requirement checks. Senior leaders routinely considered succession planning to ensure continuity and minimise gaps in leadership.

Some staff reported fearing reprisal if they spoke up about concerns to their local leaders. Twenty-six percent of people who had contacted the Freedom To Speak Up Guardian (FTSUG) cited fear of reprisal as their main reason for using the FTSUG process. The trust had made improvements to the ways in which people could speak up and their voice be heard. 

During the last well-led inspection in November 2021 we identified that the trust needed to improve its Speak Up culture. At this inspection improvements had been made to the speak up process and staff now knew how to raise their concerns with the FTSUG and felt confident to do so. 

However, there continued to be a concern amongst some members of staff that it would be detrimental to voice their concerns to local leaders. Twenty-six percent of all speak up cases had been reported because the individual feared there would be consequences for them if they raised their concerns with local leaders.

The Trust commissioned The Guardian Service Ltd (GSL) to provide an independent Freedom to Speak Up Guardian service. GSL had provided this service to the Trust since June 2022. A dedicated FTSU Guardian acted as the lead Guardian for the Trust, with arrangements in place through GSL to provide alternative cover, including outside normal working hours and during periods of leave. GSL worked with the National Guardian's Office and supported the Trust in meeting national Freedom to Speak Up reporting requirements.

The FTSUG was visible and worked hard to reach out to staff to let them know how to raise concerns. They attended the corporate staff induction, team away days, held face-to-face and virtual drop-in sessions and wrote blogs and intranet articles. The purpose of this was to improve staff understanding of the trust’s speak up process and encourage them to raise concerns. The FTSUG had also held sessions to discuss the value for managers in encouraging staff to speak up and in emphasising the importance of feedback loops and embedding learning in practice.

The FTSUG direct reported to and had easy access to the Chief Executive Officer, allowing for timely escalation of matters. 

A Freedom to Speak Up report was scrutinised by the people committee every six months and an annual report was presented to the Board. The FTSUG also completed reports each month for the Chief People and Chief Executive Officers, as well as a non-executive director and met with them to discuss this. 

The trust had continued to see a recent reduction in the number of staff reporting that they were unsafe at work because of managing incidents of violence and aggression due to patients becoming distressed. Another prevalent theme in speak up reports was some staff having issues with their local managers, particularly in community teams. 

The trust had recently taken action to reduce timeframes for formal HR processes following feedback from staff. They had also taken action to now prioritise early informal resolution for cases where this was appropriate. 

Senior leaders were developing a triangulation approach which aimed to capture feedback received via the trust’s speak up, complaints and staff survey. The aim was to strengthen leaders’ understanding of themes and trends in staff sentiment.

A new escalation pathway was currently being developed. The aim of this was to strengthen local ownership and accountability for concerns, with escalation determined by risk. This involved patient safety concerns being rated as red and handled and escalated within 12 hours. Any cases of staff bullying and harassment were rated as amber and handled within 48 hours, and other concerns were rated green with a timescale of 72 hours for escalation. 

The trust was behind with its implementation of the Patient Carer Race Equality Framework (PCREF). Work was also needed to address disparities in recruitment outcomes, disciplinary processes and experiences of harassment and discrimination amongst staff from the global majority. 

The latest Equality, Diversity and Inclusion (EDI) report was published in 2025 and covered the time period April 2024 to June 2025. This report provided a detailed examination of Gender Pay Gap, performance against Workforce Equality Standards, and progress in line with NHS England’s EDI High Impact Actions (HIA). Alongside these were a variety of initiatives linked to the trust’s six strategic priorities from the Equality, Diversity and Inclusion Plan, aimed at strengthening inclusivity across the trust.

The trust had identified six key focus areas to address between 2024 and 2029 to advance EDI across the organisation. The focus areas were reducing incidents related to racism, violence and aggression on inpatient wards; improving leadership accountability through cultural competence; enhancing the EDI strategy through workforce engagement and data; to review and enhance all people policies to make sure they reflect the needs of the workforce; to improve staff health equities and wellbeing and building effective workforce communications and engagement and improvement of the incident logging system and process.

The trust had begun taking action to improve the experience of staff from the global majority, including reducing bullying and harassment and strengthening career progression opportunities for staff from the global majority. However, it was still at an early stage of implementing the mandatory Patient and Carer Race Equality Framework (PCREF), which aims to ensure mental health services are racially inclusive and culturally appropriate. The trust was also in the early phases of embedding health‑inequality monitoring across core datasets, including ethnicity, and had not yet established local measures such as the ethnicity profile of people assessed for dementia. A steering group had been established to drive this work forward over the coming year.

During the last well-led inspection in November 2021 we identified that the Workforce Race Equality Standard (WRES) data showed work was needed to decrease instances of bullying and harassment experienced by staff from the global majority. The Workforce Race Equality Standard (WRES) was introduced by the NHS in 2015 to focus on the experiences of staff from the global majority compared to white staff. At this inspection we identified that the trust had taken actions to help reduce instances of bullying and harassment in staff from the global majority. This involved training managers in restorative practice, encouraging early local resolutions when problems were reported, improving the trust’s minimising violence and aggression initiatives and enhancing safe reporting routes such as the improved Freedom to Speak Up pathway. However, there continued to be disparities in recruitment outcomes, disciplinary processes and experiences of harassment and discrimination. White applicants were 1.18 times more likely to be appointed from shortlisting compared to applicants from the global majority. The relative likelihood of staff from the global majority entering a formal disciplinary process compared to white staff was 2.62. 

All staff groups, including staff from the global majority, had experienced a recent increase in bullying and harassment from patients, relatives or the public. For staff from the global majority, this had risen from 35% in 2023 to 43% in 2025. 

White individuals made up 85% of voting Board members, while constituting 67% of the overall workforce. White individuals were overrepresented on the voting Board, which may reinforce perceptions of inequality in access to leadership roles. 

The trust was planning to implement a shadow Board made up of staff from the global majority, using reverse mentoring so senior staff could better understand the experiences of staff from the global majority, and was considering how to build a career succession pipeline targeted at staff from the global majority. 

Although improvements had been made in perceptions of fairness and reductions in discrimination gaps, under-representation at Board level remained a concern.

The trust had collaborated with an external partner on its focus area around improving leadership accountability through cultural competence. This had helped ensure staff and leaders in the acute and rehab directorate were culturally competent. Staff reported this had been beneficial in calling out incidents of racism, violence and aggression toward staff, which is another of the trust’s EDI focus areas. There were plans to roll out the cultural competency work to the remaining service directorates. 

The Global Majority Network had brought people together from different backgrounds and was committed to valuing individuality, supporting inclusion and promoting diversity. The network had helped highlight the impact of racism in the workplace, helped review recruitment processes to identify and challenge bias and barriers, and provided monthly staff drop-ins to provide peer support and safe space discussions. 

Of all staff employed by the trust, 7.8% reported that they lived with a disability, which is above the national NHS average of 4.9%. The trust had a Disability And Wellness Network for staff, which helped raise awareness of the needs of disabled staff in the organisation and provided a safe space for disabled staff to provide peer support. 

The trust had recently established a centralised reasonable adjustments process and had launched a health and wellbeing passport to support conversations between staff and managers about their disabilities.

The Workforce Disability Equality Standard (WDES) was launched in March 2019 and required NHS trusts to measure disabled staff outcomes against a set of ten specific measures (metrics) in comparison to the experiences of non-disabled staff. The most recent WDES was published in 2025 and highlighted that disabled staff consistently report higher levels of harassment, bullying or abuse from patients, relatives or the public compared to their non-disabled colleagues. All staff groups, including disabled staff, reported an increase in cases of bullying and harassment from patients, relatives or the public. For disabled staff, this had increased from 31% in 2023 to 33% in 2024. 

Eleven percent of disabled staff reported experiences of harassment, bullying or abuse by their manager in 2024, compared with 7% of all staff. This was a reduction on the previous year. Nineteen percent of disabled staff experienced harassment, bullying or abuse by a colleague in 2024, compared with 12% of all staff.

The trust’s mean gender pay gap stood at 13.5% for the year 2023-24. This was a reduction from 15.4% the previous year. Although the trust’s gender pay gap was slightly above the national NHS average of 13.1%, the trust was making measurable progress towards pay equity.

Aside from the Global Majority and Disability And Wellness Network, the trust also provided LGBTQ+, Faith, Menopause and Neurodiversity networks. These networks all aimed to raise the profile and share experiences of staff with protected characteristics and provided a safe space for staff to provide peer support and flag issues to senior leaders. 

LGBTQ+ networks at all healthcare providers in the Kent system had recently collaborated to mark LGBTQ+ history month in February 2026. 

The trust had a dedicated Involvement and Engagement (IE) team which supported patients, carers and communities to have a meaningful voice in shaping services and wider trust decisions. The team coordinated engagement activity across the trust, supported co-creation and worked with voluntary, community and social enterprise (VCSE) partners to broaden participation, including reaching people whose voices were less often heard. However, the trust needed to improve the way it involved patients, family and carers. Leaders reported that this was a priority for them and it had also been raised in the recent independent quality governance review. Leaders spoke about the need to use the voice of patients, families and carers by making experience insights and outcomes a standing requirement in governance forums and learning from incidents and patient safety reviews. This had not yet been embedded. 

Significant concerns were identified in relation to the trust’s governance processes. The trust did not always operate with clear responsibilities, effective systems of accountability, or robust governance arrangements. Staff did not consistently act on the best available information about risk, performance and outcomes, or ensure this information was effectively shared and used to support safe, high-quality care.

An independent quality governance review commissioned by the trust and reported to the Board in January 2026 found that the organisation's overall quality governance maturity was developing, with significant lagging features identified in safety-critical controls, governance discipline, assurance confidence, risk management, regulatory readiness and organisational culture. The review identified weaknesses in the reliability of core safety controls, particularly in relation to risk formulation, care planning and compliance with the Mental Health Act. This review was proactively commissioned by the Chief Executive Officer to independently assess and strengthen quality governance.

During the inspection, we found weaknesses in the trust's approach to risk management at both operational and strategic levels. Although risks were recorded within the Board Assurance Framework (BAF) and Trust Risk Register (TRR), these documents were not always being used effectively as dynamic risk management tools. Significant risks were not always captured on the corporate risk register, and where risks were recorded, mitigating actions often lacked sufficient detail. Risk entries did not consistently identify clear ownership, accountability, timescales or measurable actions required to reduce risk.

Some Board committees required strengthening, particularly in relation to the quality of information received and the level of scrutiny applied. We found that reporting to both the Audit and Risk Committee and the Finance, Business and Investment Committee relied heavily on exception reporting and concise summary papers. While Board members described robust discussion and challenge during committee meetings, this was not consistently evidenced in committee minutes, making it difficult to determine how assurance had been gained or how concerns had been escalated to the Board. Committee workplans were not routinely reviewed, escalation processes were inconsistent and important issues were not always clearly reported through governance structures. Poor data quality further reduced the effectiveness of oversight arrangements.

The Quality Committee in particular required strengthening to improve its effectiveness. We identified quality issues that were not fed up to the Quality committee for discussion. For example, we identified concerns regarding the skills and experience of the agency staff working in the trust’s inpatient services. Some agency workers did not always possess the same Patient Safety Syllabus (PSS)/restrictive intervention restraint training competencies as substantive staff. Although leaders had introduced mitigating actions, including supporting agency staff to complete trust training programmes and exploring alternative agency arrangements, the associated workforce competency risks were not clearly articulated within strategic risk reporting and the Quality Committee did not have robust oversight of this issue. 

Senior leaders acknowledged shortcomings in the trust's risk management processes and described plans to introduce clearer escalation thresholds and improve accountability for risks at local level. However, these arrangements had not yet been fully implemented or embedded at the time of inspection.

The Chair of the Audit and Risk Committee told us that the BAF and Trust Risk Register were reviewed at every Audit and Risk Committee meeting and that the BAF was presented to every Board meeting. Despite this, committee members recognised that risk registers were not always reviewed with sufficient frequency or responsiveness. They described existing processes as overly focused on describing risks and documenting controls, rather than critically assessing whether controls were effective, identifying gaps in assurance, or ensuring timely implementation of mitigating actions. Board members acknowledged that risk reporting processes remained cumbersome and lacked maturity.

The independent governance review also highlighted weaknesses in the trust's assurance arrangements. Assurance processes were described as fragmented and heavily reliant on narrative reporting and individual knowledge rather than systematic, closed-loop assurance mechanisms. The review found that governance processes did not consistently provide confidence that risks were being effectively controlled, mitigated and monitored.

We identified examples where governance arrangements lacked clear oversight. Some governance groups did not appear to have clearly defined reporting lines or effective mechanisms for ensuring actions were completed. Concerns were also raised regarding the effectiveness of scrutiny of Quality Impact Assessments (QIAs) and Equality Impact Assessments (EQIAs), with variable quality of assessments and insufficient governance oversight of their completion and review.

Data quality issues further undermined the trust's ability to gain assurance. The independent governance review identified weaknesses in the quality and consistency of data used across governance systems, limiting the trust's ability to triangulate performance, safety and quality information effectively. This reduced the reliability of the Integrated Quality Performance Report and other assurance mechanisms.

Leaders told us they were committed to strengthening governance discipline through more standardised reporting, clearer assurance grading, rationalisation of governance forums and stronger accountability where actions were delayed. However, these improvements remained largely at the planning stage and had not yet resulted in demonstrable improvements in governance effectiveness.

The trust had processes in place for assessing the quality and equality impacts of service changes, including involvement from senior clinical leaders. However, these processes were not consistently visible within committee papers and Board members were unable to clearly describe a consistent approach to reviewing Quality Impact Assessments and Equality Impact Assessments. As a result, we were not assured that all efficiency programmes and service changes had been subject to sufficiently robust assessment prior to implementation.

This was particularly important given NHS England's Quality Impact Assessment Framework, published in June 2025, which requires providers to integrate Quality and Equality Impact Assessments into financial and operational decision-making processes and service redesign programmes.

We found examples where significant operational risks were not clearly reflected in strategic risk reporting. For example, adult community mental health services continued to experience significant waiting times, creating risks for patients awaiting assessment and treatment. Although local improvements to patient risk management processes were underway, including the introduction of revised risk assessment templates, mitigating actions for patients waiting extended periods for care were not always clearly articulated within strategic risk reporting.

Significant environmental challenges within the medium secure forensic estate were well recognised by leaders but were not always clearly reflected within corporate risk reporting. The estate was described as not fully fit for purpose, with challenges relating to lack of en-suite facilities, seclusion provision, split-site layouts and operational complexities associated with patient movement around the site. Long-term solutions were expected to take several years to deliver.

We identified delays in responding to complaints and concerns regarding the timeliness of some investigations and after-action reviews. The trust also recognised ongoing difficulties in monitoring the progress of safety investigations and ensuring delays were minimised. Progress implementing the Patient and Carer Race Equality Framework (PCREF) had also been affected by workforce challenges, including delays following the loss of a key lead role and difficulties in collecting and analysing data relating to protected characteristics and patient outcomes.

Leaders demonstrated awareness of many of the governance weaknesses identified and had taken positive steps, including commissioning both an external well-led review and an independent quality governance review. The trust had developed plans to address the seven areas identified by the independent governance review, including:

• Strengthening safety-critical controls and escalation processes.
• Improving governance discipline and assurance standards.
• Building leadership accountability, capability and psychological safety.
• Improving data quality and insight.
• Embedding patient, family and carer involvement in assurance processes.
• Strengthening regulatory readiness.
• Improving the translation of quality priorities into operational delivery.

At the time of inspection, the trust had identified a number of the areas requiring improvement and some actions were already underway or reflected in existing plans and initiatives. However, further work was required to embed these changes and demonstrate their sustained impact on governance, risk management and organisational assurance.

Despite the governance concerns identified, there were examples of some improvement. The trust had made progress in developing its patient safety systems and implementing the Patient Safety Incident Response Framework (PSIRF). The independent governance review found evidence of improved thematic analysis of patient safety incidents and a more system-focused approach to learning.

The trust had also made significant progress in reducing waiting times within memory assessment services. Leaders reported that the proportion of patients waiting more than 52 weeks for assessment had reduced substantially over a 12 month period, resulting in significant improvement in performance.

The trust collaborated and worked in partnership with other organisations providing health and care services to the local population with the aim of providing services that could operate seamlessly for the people who used them. Staff shared information and learning with partner organisations and worked collectively to drive improvement across pathways and communities, such as its work to address challenges with patient flow by working closely together with charity organisations to develop the Clarendon Royal Community. 

The trust had well‑established joint working arrangements with Kent Community Health Foundation Trust (KCHFT) in particular. From October 2025, the Chief Medical Officer took on a joint interim role across both organisations, strengthening clinical alignment and enabling closer partnership working. 

Leaders described positive partnership working across the local system, including improved engagement with police and transport police following the trust’s rebrand, which aimed to strengthen stakeholder confidence and rebuild relationships. Collaborative work with the Integrated Care Board (ICB), primary care, social care and third‑sector partners had significantly improved the long‑standing challenges within memory assessment services. Together, partners developed new community‑based rapid assessments, including level‑one frailty‑aligned pathways and care‑home‑based diagnostic approaches, ensuring people who were bedbound or unable to travel could still access timely support and advance care planning.

However, leaders expressed that they were continuing to work hard to strengthen the trust’s relationship with the local authority. The relationship with the local authority was particularly important. One of the root causes of pressure on the acute mental health care pathway was that there were problems in identifying a suitable social care placement for patients who were clinically ready for discharge, which meant that beds were not available in hospital for patients who needed them. Social care placements are funded by the local authority.  

Flow remained one of the trust’s most significant priorities. The trust had some of the highest numbers nationally of patients clinically ready for discharge but unable to leave hospital. At the end of February 2026, 67 patients were ready for discharge, 19 were waiting for admission (including in emergency departments), and 11 were placed out of area. The Board held a dedicated seminar to address flow challenges and reviewed progress on initiatives such as improved police pathways, reduced ambulance conveyances, and new crisis alternatives including “safe havens” co‑located with acute hospitals. The trust was also exploring additional models for people requiring short‑term intervention without full admission.

Innovative partnership working was evident through the Clarendon Royal Community initiative in Gravesend, providing hotel‑based accommodation for patients ready for discharge but awaiting social care placements. Delivered with the charity Age UK, the model had saved 1,300 bed days and £600,000, while supporting reintegration into the community. The Board planned to consider county‑wide expansion in March 2026.

The trust had collaborated with partners to deliver the Mental Health Together (MHT) community mental health offer. This was introduced in early 2024 and was designed to transform how people with complex mental health needs were supported in the community. By bringing together all services and agencies into one cohesive model, patients accessed faster, more personalised care without having to engage with multiple organisations. This reduces the need to navigate separate services or undergo repeated assessments, ensuring a more streamlined and joined-up approach to care. 

System pressures remained significant. The local system spent 1.5% less on mental health than neighbouring systems, equating to around £60 million per year. The local system also faced ongoing strain on urgent and emergency care pathways. The ICB led a transformation programme focused on delivering timely, evidence‑based crisis support in the least restrictive setting. The trust contributed actively to this work and also prepared well with local partners for the transfer of community Child and Adolescent Mental Health Services and the all‑age eating disorder service from another trust. Leaders had clear oversight of risks, particularly medical staffing gaps, and had developed robust digital and operational plans to ensure a safe transition. Progress was monitored closely by the Board through detailed risk registers and milestone tracking.

The trust continued to develop new facilities to improve pathways, including a female psychiatric intensive care unit (PICU) and a centralised Section 136 health‑based place of safety (HBPoS) in Maidstone. These developments aimed to improve flow, reduce out‑of‑area placements and support smoother transitions between teams. Positive system working was evident, with the CEO providing system leadership for finance, alongside strong collaboration with organisations providing emergency departments and with KCHFT’s learning disability teams.

The Board reviewed a new tiered, risk‑based partnership model in October 2025, designed to classify partnerships at system, place and neighbourhood levels. Work was underway to develop a partnership register, maturity matrix and principles for working with voluntary and community sector organisations.

The trust had strengthened its approach to HBPoS following previous regulatory concerns. Staff were now more responsive when patients required inpatient admission, improving capacity and reducing delays. A centralised Maidstone HBPoS model was in development to further support flow.

Partnerships also extended to clinical governance and statutory responsibilities. The expansion of service‑level agreements with acute trusts ensured that patients detained under the Mental Health Act in non‑mental‑health settings continued to receive statutory protections.

Pharmacy teams worked closely with ICB partners through Integrated Medicines Optimisation networks, developing system-wide guidance on dementia prescribing, lithium, melatonin pathways, antipsychotic use, community clozapine and depot management. Joint work with acute partners produced rapid tranquilisation guidance to support consistent practice across the system.

The trust engaged extensively with partners in developing its new strategy. Contributors included voluntary, community and social enterprise organisations, grassroots groups, GPs, Primary Care Networks, NHS partners, local authorities, councillors, statutory committees, community interest companies and Healthwatch. Partners reported improved organisational culture, more open engagement and values‑led collaboration, and strong alignment with the trust’s strategic priorities.

The trust focused on continuous learning, innovation and improvement and considered how it could benefit local populations. Staff encouraged creative ways of delivering equality of patient experience, outcomes and quality of life for people. Staff actively contributed to safe, effective practice and research. However, the fact the trust’s internal governance processes needed to be strengthened potentially limited opportunities for staff to identify and act on areas of performance that needed to be improved. 

The trust’s approach to research had developed significantly since the last well-led inspection in November 2021. There was a clear focus on involving staff from all professions in research and linking in with local education and research institutions and ensuring published research was now done via credible journals. 

A Director of Research reported to the Chief Medical Officer. The trust had a three-year strategy for research and innovation which contained planned projects. Researchers worked closely with partners in other education and healthcare institutions to deliver research projects, including local medical schools. They also worked hard to secure funding to support research. For example, the ‘Mental Health Together’ initiative, which involved utilising virtual technology to support people receiving treatment for mental health conditions, had been part-funded by a grant secured from the Engineering and Physical Sciences Research Council. 

A research project utilising low-field scanners for speedy dementia diagnoses had helped reduce the length of time patients waited to receive a dementia diagnosis. Dementia diagnosis waits reduced from 27.1 to 12.6 weeks. This involved transporting mobile scanners to different locations where memory assessment clinics took place, which helped ensure patients received a timely diagnosis and weren’t waiting longer than necessary for brain scans. 

There were no restrictions on which staff could take part in research projects and research was not limited to doctors. For example, some pharmacy staff were taking part in research projects at the trust as part of PhD qualifications. A medical administrator was working jointly with a perinatal psychiatrist on a project aiming to improve mental health support to people who experience miscarriage. 

Trust staff had worked closely with partners including the charity sector to develop the Clarendon Royal Community. This involved acquiring local hotel accommodation to provide a step-down service for patients who were ready to be discharged from inpatient mental health settings, but who did not yet have a social care placement identified for them to be discharged to. This helped improve patient flow and saved money that would otherwise be spent on inappropriately long inpatient stays. 

Staff took part in Quality Improvement (QI) initiatives. The trust provided a QI framework for staff within services to find solutions to problems locally. For example, improvements to the way medicines were stored and administered had been made at the Allington Centre, which is a forensic mental health hospital. By introducing a new medicine storage system, staff had improved the timeliness of medicine rounds and enhanced stock visibility which led to cost reductions. The new approach to medicines storage was now being rolled out across all services. 

Improvements needed to be made to the timeliness with which the trust investigated incidents and complaints. This would help ensure any learning would be shared and embedded promptly to prevent similar incidents reoccurring. 

The trust commissioned thematic reviews when themes or trends in incidents were identified, to help identify actions that would address the root causes. In November 2025, a cluster of patient safety incidents resulting in self-harm or death in the trust’s adult community mental health services occurred over a few days. An independent rapid review was commissioned by the Chief Executive Officer to undertake an objective assessment of the incidents. The rapid review found governance and safety concerns including poor quality investigation documentation, inconsistent risk assessment and safety planning practice, insufficient communication and support for families and an overreliance on telephone consultations. 

The trust was about to launch a new patient experience measure called ‘your experience matters’ in April 2026. This aimed to be a more effective, standardised way of collecting data about patient experience.

The trust had recently launched its ‘Doing Well Together’ programme. The programme provided staff with frameworks to develop system-wide improvements to clinical issues and grouped together audit, transformation and QI programmes for a more systemic, coordinated approach to improvement. 

The trust had a good understanding of any negative impact of its activities on the environment and made a positive contribution to reducing it and supporting people to do the same.

The trust had a Green Plan which was produced in response to a statutory requirement for all NHS trusts to refresh existing Green Plans with renewed targets and ambitions for 2025-2028. This refreshed Green Plan continued to build on the trust’s commitment and progress made towards achieving Net Zero by 2040 and therefore aligning the trust with NHS statutory requirements and the Long-Term Plan.

The refreshed plan had fifteen focus areas for 2025-2028. The trust was aiming to embed sustainability, reduce direct emissions, review its travel and transport, and to work closely with partners to achieve its sustainability aims. 

The estates and facilities action plan contained projects aimed at improving the environmental sustainability of the trust. Leaders were reviewing the trust’s carbon emission trajectory. Heat decarbonisation plans were in place for 20 main buildings. However, further work was needed to improve the trust’s estate to help ensure it met its 2040 net-zero carbon target. There were also programmes to replace all lighting in the trust with more sustainable Light Emitting Diode (LED) bulbs, to increase solar panel coverage, and to improve insulation in buildings to reduce energy needed to heat and cool buildings. 

The trust was considering travel and transport in relation to its own fleet of vehicles and how to encourage its patients, staff and visitors to use greener alternative transport options. A current programme to eliminate the use of trust-owned diesel vehicles was underway, with plans to replace these with electric and petrol alternatives. The carbon emissions caused by newly purchased vehicles that consumed petrol was being offset by tree planting on trust premises. 

A green space and biodiversity action plan formed part of the trust’s green plan. The trust was aiming to improve the quality of green spaces to benefit people’s physical and mental health whilst also providing cleaner air, noise reduction and supporting biodiversity. Staff and patients had been involved in developing the new canopy garden on Ruby ward at Priority House in Maidstone and were working closely with Natural England to get the most from the space in terms of biodiversity and therapeutic benefit to patients. Four hundred and thirty trees had been planted on trust property during 2024-25 and a further 100 during 2025-26. 

The trust had saved £135K by recycling old furniture. Rather than discarding used furniture that was no longer needed, unused items were put in a catalogue for other NHS trusts who could then purchase the furniture second-hand. 

Environmental sustainability was regarded as an important responsibility by the pharmacy team. Initiatives included eliminating the use of nitrous oxide, promoting the use of Ch on the inpatient wards. Sustainability considerations were also incorporated into service and pathway planning.

The trust was working closely with partners to deliver its ambitions under the Green Plan. For example, supply chain and procurement processes focused on working with partners to embed circular purchasing solutions that were sustainable and cost saving. Leaders worked with partners to deliver capital projects that met the requirements of the trust’s green plan and to provide low carbon, high quality healthy food options for all, and reduce food waste.