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

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

At our last assessment we rated this key question as requires improvement. At this assessment the rating remains requires improvement.

This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

Staff completed comprehensive assessments of patients’ needs and delivered a range of evidence-based interventions to support rehabilitation, independence and recovery. Patients had access to occupational therapy, psychological support, physical healthcare and meaningful activities tailored to their individual needs and preferences.

Staff worked collaboratively across multidisciplinary teams and with external partners to support continuity of care, discharge planning and transitions into the community. Patients were supported to develop practical living skills, greater independence and community engagement.

Patients generally received compassionate and person-centred care from staff who understood their individual communication and support needs.

However, the Person-Led Care Planning Model and rehabilitation model were not consistently understood or embedded across the service. Local leaders were not consistently able to explain the rehabilitation model, how patients progress was evaluated or how the effectiveness of interventions was measured. This created inconsistency in how care and treatment approaches were understood and delivered across the service.

The service used a range of individual outcome measures. However, outcome monitoring systems were not sufficiently robust or consistently embedded to demonstrate that patients were achieving positive and sustained rehabilitation outcomes. Leaders could not consistently evidence how patients progress towards greater independence, recovery and discharge was being monitored and evaluated. Occupational therapy staff acknowledged that outcome measures were not completed consistently, and staff told us that progress was not always evident within patient records.

Length of stay information and patient records showed some patients had experienced significantly prolonged admissions. Although staff continued to support patients to work towards greater independence and community living, leaders could not consistently demonstrate how rehabilitation interventions were supporting progression, reducing the risks associated with long-term admission or achieving meaningful rehabilitation outcomes. This meant the service could not always demonstrate that care and treatment was effective, person-centred and focused on supporting patients to achieve their individual goals and aspirations

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.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed care records during the assessment. Staff completed comprehensive mental health assessments for patients in a timely manner at, or soon after, admission. Staff also assessed patients’ physical health needs following admission, and physical health oversight was supported by weekly General Practitioner (GP) attendance.

Staff used structured clinical tools, including the Historical Clinical Risk Management 20 Version 3 (HCR-20 V3) and the Risk for Sexual Violence Protocol (RSVP), to assess and review risks and inform care planning. These assessments were reviewed during six-monthly Care Programme Approach (CPA) meetings.

Staff developed care plans that reflected patients’ identified needs, including communication needs, sensory preferences, physical health and rehabilitation goals. The service had introduced a Person-Led Care Planning Model focused on identifying what mattered to patients and aligning care and treatment to their goals. Although some staff described the model inconsistently, records reviewed during the assessment showed assessment information was used to guide personalised support.

Care plans were personalised, holistic and recovery-oriented. Staff updated care plans and risk information following reviews, incidents and changes in presentation where required. Accessible support plans using symbols, photographs and plain language were available where appropriate for patients with learning disabilities and autistic patients.

Capacity assessments were completed and reviewed when required. Patients received care and treatment based on comprehensive and regularly reviewed assessments of need.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important to them. Care and treatment were delivered in line with legislation and evidence-based practice. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these appropriately.

Staff provided a range of care and treatment interventions suitable for the patient group. Interventions included psychological therapies, occupational therapy input, positive behaviour support approaches and rehabilitation-focused activities intended to support patients to develop independence and daily living skills.

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. Mental Health Act training compliance was 100%.

Staff had access to administrative support and guidance regarding the implementation of the Mental Health Act and its Code of Practice. Staff knew how to access local Mental Health Act policies and procedures and understood their responsibilities under the Act.

Patients had access to information about Independent Mental Health Advocacy (IMHA) support. Patients told us they had regular access to advocacy services and staff supported patients to understand and exercise their rights under the Mental Health Act.

Staff explained patients’ rights under the Mental Health Act in ways they could understand and repeated this where required. Records reviewed during the assessment showed staff recorded discussions relating to patients’ rights appropriately.

Staff ensured patients were able to access Section 17 leave when this had been authorised. Leave arrangements were reviewed regularly through ward rounds and daily multidisciplinary huddles. Decisions relating to leave and restrictions were discussed with patients so they understood the rationale for any changes.

Staff stored copies of detention papers and associated Mental Health Act documentation appropriately so these were accessible when required. Care records reviewed during the assessment showed consideration of Section 117 aftercare planning where relevant.

The service had systems in place to monitor the application of the Mental Health Act through care record reviews, multidisciplinary oversight and governance processes.

The evidence showed a good standard. The service worked well across teams and services to support patients. Staff shared information appropriately when patients moved between services to support continuity of care.

Staff held regular and effective multidisciplinary meetings to review patients’ care, risks and progress. These included daily multidisciplinary huddles, weekly ward rounds, six-monthly Care Programme Approach (CPA) reviews and fortnightly transition meetings involving community providers and learning disability teams.

Staff shared information about patients through handovers and multidisciplinary discussions. During the assessment, we observed staff working collaboratively across disciplines to review risk, leave arrangements and discharge planning. Community teams and external partners were involved in transition planning to support continuity of care and safe discharge arrangements.

The teams had effective working relationships with services both within and outside the organisation. Staff worked collaboratively with community learning disability teams, commissioners, General Practitioners (GPs) and external providers to support patients preparing for discharge and community reintegration.

However, some nursing staff told us they relied on verbal handovers following ward rounds rather than routinely reviewing written documentation on RiO. This created a risk that staff would not always have a consistent understanding of clinical decisions and care plans.

Meeting observations and staff feedback showed staff understood their roles and responsibilities in supporting patients consistently. Staff and teams worked collaboratively to support patients’ care and treatment.

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

Staff supported patients to manage their physical health and wellbeing. Patients had regular access to a General Practitioner (GP), and staff completed physical health monitoring to support patients’ ongoing health needs. Easy-read physical health information was displayed throughout the ward environment to support patients’ understanding of their health and wellbeing.

Ward activities promoted healthier lifestyles and greater independence. Staff supported patients to develop cooking skills and healthy eating habits through whole-ward cooking sessions held every second Saturday, where patients were encouraged to take active roles in planning and preparing meals.

Staff also supported patients to access education, volunteering opportunities and community activities that promoted physical and emotional wellbeing. Two patients attended college and 1 patient volunteered within the on-site canteen. Patients also participated in activities including shopping, badminton and community outings.

During the assessment, we observed patients being supported to access activities, develop independence and make choices about how they spent their time. Staff reinforced daily living skills and supported patients to build confidence and prepare for greater independence within the community.

The Quality of Life Tool supported these findings and showed staff promoted patients’ independence, choice and control through meaningful and personalised opportunities.

The evidence showed significant shortfalls. The service did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The service used a range of individual outcome measures. However, outcome measurement systems were not consistently embedded across the service. Staff supported patients to work towards greater independence and community living, however the service could not consistently demonstrate the effectiveness of rehabilitation interventions or evidence patients progress through measurable outcomes.

Length of stay information and patients’ records showed some patients had experienced significantly prolonged admissions. Staff told us that progress was not always evident within patient records and occupational therapy staff acknowledged that outcome measures were not completed consistently. This meant leaders could not always demonstrate how patients were progressing towards greater independence, recovery and discharge.

Although patients accessed meaningful activities, education, volunteering opportunities and therapeutic interventions, systems for evidencing progress and measuring rehabilitation outcomes were not sufficiently robust. This reduced assurance that care and treatment was consistently achieving positive and sustained rehabilitation outcomes for patients.

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 practical steps to support patients to make their own decisions and used accessible communication approaches to support patients’ understanding and involvement in care and treatment decisions.

Patients had access to advocacy services, including Independent Mental Health Advocate (IMHA) support. Staff shared information with families and carers only with the patient’s consent and involved patients in decisions relating to their care, leave and future plans.

Staff used personalised and accessible communication approaches to support patients’ understanding and involvement in decision-making. Some patients were supported using symbols, easy-read information and personalised communication tools.