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

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 and fair culture.

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

This meant leadership, management and governance systems did not always support the delivery of high-quality, person-centred care.

Governance systems and oversight processes were not effective in identifying and addressing concerns promptly. During the assessment, we identified environmental concerns including damaged fencing, debris and exposed wires within the second garden area, kitchen hygiene concerns and an unsecured medicines cupboard. Although these concerns were addressed following the assessment, governance systems had not identified and resolved them effectively prior to the assessment.

The Person-Led Care Planning Model and rehabilitation model were not consistently understood or embedded across the service, which created inconsistency in understanding and delivery across the staff team. Outcome measurement systems also required further strengthening to consistently demonstrate patients’ progress and rehabilitation outcomes.

Some staff reported inconsistent senior leadership visibility and said they felt disconnected from wider organisational priorities.

We found the service was in breach of Regulation 17. The provider did not have effective systems and processes in place to assess, monitor and improve the quality and safety of the service.

However, staff described a positive and supportive culture within the ward team and told us they felt respected and valued by local managers. Staff told us they felt able to raise concerns and described a culture that promoted reflection, learning and person-centred care.

Leaders had introduced improvements since the previous assessment, including improved mandatory training compliance, reflective practice initiatives and increased focus on personalised and accessible care planning approaches for patients with learning disabilities and autistic patients.

This service scored 57 (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 some shortfalls. The service did not always have a clear shared vision, strategy and culture based on transparency, equality, diversity, inclusion and engagement. Leaders did not always understand the challenges and needs of people using the service.

Staff described the rehabilitation model inconsistently and the Person-Led Care Planning Model was not fully embedded across the service. Some staff were unclear about how the model should be applied in practice, which created inconsistency in understanding and delivery.

During the assessment, local leaders were not able to clearly describe the service’s Statement of Purpose or consistently explain the rehabilitation model being delivered within the service. This indicated the operational model and strategic direction were not fully embedded across the leadership team.

Staff had opportunities to contribute to discussions about the service and changes within the ward. However, some staff told us they felt disconnected from wider organisational priorities and reported inconsistent visibility from senior leaders.

However, staff told us they understood the provider’s values and described positive and supportive working relationships within the ward team. During the assessment, we observed positive and respectful interactions between staff and patients, and staff demonstrated a good understanding of patients’ individual communication and support needs.

Staff could describe how they worked to provide person-centred care and support patients’ progress towards greater independence within the resources available.

The evidence showed some shortfalls. Leaders did not always demonstrate the skills, knowledge and experience needed to lead the service effectively or consistently embed the service model across the team.

During the assessment, local leaders were not always able to clearly explain the service’s Statement of Purpose or consistently describe how the rehabilitation model was being delivered in practice. This limited leaders ability to demonstrate how rehabilitation interventions were supporting patients progress and recovery. Length of stay data showed that patients often experienced lengthy and complex rehabilitation pathways, making it particulary important that rehabilitation outcomes were clearly defined, monitored and evidenced. However, rehabilitation outcomes were not always consistently evidenced through outcome monitoring.

Some staff told us senior leadership visibility was inconsistent and said they felt disconnected from wider organisational priorities and developments.

However, staff spoke positively about the ward manager and described them as supportive, approachable and responsive to concerns raised within the ward. Staff described positive working relationships within the immediate team and said they felt psychologically safe to raise concerns.

Local leaders understood patients’ individual needs and promoted person-centred care and support. During the assessment, we observed positive interactions between leaders, staff and patients within the ward environment.

Leadership development opportunities and reflective practice initiatives were available for staff, including programmes focused on reflective learning and interpersonal relationships within teams.

The evidence showed a good standard. The service fostered a positive culture where people felt able to speak up and believed their views would be heard.

Patients and carers had opportunities to give feedback about the service through community meetings, feedback processes and Friends and Family Test surveys. Friends and Family Test feedback from January 2026 was largely positive, and staff told us feedback had resulted in changes within the service, including improvements to ward information and cooking activities.

Staff told us they felt able to raise concerns and were confident they would be listened to. They described a supportive team culture where issues could be discussed openly, and staff felt psychologically safe within the immediate team.

Staff said they knew how to escalate concerns and felt comfortable doing so. Staff demonstrated awareness of Freedom to Speak Up processes and how to access the Freedom to Speak Up Guardian. Freedom to Speak Up training compliance was 97%.

Managers and staff had access to feedback from patients, carers and staff and used it to support improvements within the service.

However, some staff told us they felt less connected to wider organisational priorities due to inconsistent senior leadership visibility.

The evidence showed a good standard. The service valued diversity within the workforce and worked towards an inclusive and fair culture by promoting equality and inclusion for staff.

Staff described the team as diverse, supportive and welcoming. Staff told us they felt respected by colleagues and described positive working relationships across the multidisciplinary team.

Staff were trained in equality, diversity, inclusion and human rights, with 100% of staff completing the training.

The provider delivered allyship and reflective practice training to support inclusive practice and psychologically safe teams. Staff wellbeing initiatives and inclusive events, including Diwali celebrations, staff recognition events and team wellbeing activities, helped promote an inclusive and supportive culture within the service.

Managers put reasonable adjustments in place for staff where required, and staff told us they felt supported by local managers.

During the assessment, we observed respectful and collaborative interactions between staff members from different professional backgrounds and roles. Staff spoke positively about the ward environment and said they felt valued and supported within the team.

The evidence showed significant shortfalls. The service did not always have effective governance processes or systems of accountability to ensure the quality and safety of the service.

Governance systems and oversight processes had not identified or addressed concerns promptly. During the assessment, we identified environmental concerns including damaged fencing and debris within the second garden area, kitchen hygiene concerns and an unsecured medicines cupboard. These issues had not been identified and resolved through existing governance and oversight systems prior to the assessment.

Although staff undertook local audits and governance processes were in place, these had not consistently identified concerns relating to environmental oversight, safety checks and outcome monitoring. Outcome measurement systems also required further strengthening to consistently demonstrate patients’ progress and rehabilitation outcomes.

The Person-Led Care Planning Model and rehabilitation model were not consistently understood or embedded across the service, which created inconsistency in understanding and delivery across the staff team.

Staff understood arrangements for working with external teams and community services to support patients’ care, transition planning and discharge pathways. However, some staff reported inconsistent senior leadership visibility and said they felt disconnected from wider organisational priorities.

Governance and oversight systems were not effective in identifying concerns promptly or providing leaders with assurance regarding the quality, safety and effectiveness of the service. Environmental concerns, medicines safety issues and kitchen hygiene concerns had not been identified or resolved through existing governance processes prior to assessment. In addition, leaders could not consistently demonstrate how rehabilitation interventions were supporting patients progress and recovery and discharge outcomes. Outcome monitoring systems were not sufficiently robust and local leaders were not consistently able to explain how rehabilitation outcomes were evaluated or how the effectiveness of interventions was measured. This meant leaders did not have effective oversight of whether patients were achieiving positive and sustained rehabilitation outcomes or progressing towards greater independence. These significant governance failings limited leaders ability to identify risks, evaluate the effectiveness of care and treatment, evidence positive outcomes and drive improvement across the service.

The evidence showed a good standard. The service understood the importance of collaborative working and partnership arrangements to support patients’ care and discharge planning.

Staff worked collaboratively with community teams, commissioners and learning disability services to support patients’ care, transition planning and discharge pathways. Fortnightly transition meetings were used to coordinate care and review progress towards discharge.

The multidisciplinary team worked with learning disability community teams and external providers to support safe transitions into the community. Psychology staff led on the“risk on a page” document and providedbespoke training to community providers.

Staff described positive working relationships with external teams and partner organisations involved in patients’ care and support.

However, external commissioning delays and limited specialist placement availability affected the pace of some discharge pathways despite collaborative working between agencies.

The evidence showed some shortfalls. The service did not always focus consistently on learning, improvement and innovation. Systems for embedding and sustaining improvement were not always effective.

There was evidence of learning and improvement within the service. Staff had recently completed ligature refresher training, and psychology staff adapted communication and outcome tools to meet individual needs, including personalised visual emotion scales. Staff also used reflective practice to review incidents and update behaviour support plans.

Staff supported patients to develop practical skills, independence and confidence through personalised and rehabilitative approaches. Staff spoke positively about opportunities for reflection and learning within the ward team.