Kent and Medway Mental Health NHS Trust

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

Key Question Score: 11 (55%)

Key Question Rating: Requires improvement

We last rated caring at this service in 2018, when we rated it good. At this inspection the rating has changed to requires improvement.

Requires improvement: This meant people did not always feel well-supported. Some of the adult community mental health service’s interventions were not easily tailored to individuals’ preferences and the lack of waiting list monitoring meant that people’s needs were not always responded to quickly. Not all staff were routinely supported through supervision. However, staff and leaders shared a compassionate approach to supporting people in their care to have an improved quality of life. People who used services and carers told us, and we observed, that staff were kind, respectful and helpful in their interactions. People were treated as individuals and not as their diagnoses. The service valued and supported its staff to carry out their roles well and celebrated their achievements.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were treated with kindness, empathy and compassion and their privacy and dignity were respected. Colleagues from other organisations were also treated with kindness and respect.

Staff in the adult community mental health service showed care and compassion towards people who used services and their carers. The service had moved towards an approach in which they focused on people’s symptoms rather than diagnosis. Leaders told us this was to help remove any prejudice or bias people might have about certain diagnoses and protect people from any harm they might have experienced because of this. However, some people told Healthwatch Kent and Healthwatch Medway that the lack of a diagnosis caused them confusion and meant they were unsure whether they were receiving the appropriate treatment.

Staff supported people to understand and manage their care, treatment or condition. The adult community mental health service model included education for people and their carers, for example, there was an understanding and managing recovery intervention for people on the Bipolar Needs pathway.

Staff spoke respectfully and with compassion about people who used services. In meetings and in interviews with staff and leaders, we observed staff speaking with empathy and kindness about the people in their care. We reviewed the care records of 25 people and observed respectful and appropriate language used within the care notes.

People and their carers found the staff kind and respectful. We spoke with 22 people and 7 carers. Most people described staff as being knowledgeable, caring, respectful, patient, understanding and considerate. People described staff as making them feel at ease and treating them “as a person, not a number”.

Staff helped people feel comfortable at appointments. For example, at Britton House, people were offered hot drinks during assessments and meetings and had access to water.

Healthwatch Kent and Healthwatch Medway received feedback from people who used services and carers. Between October 2024 and December 2024, feedback about the care given by staff was mainly positive, with 114 pieces of feedback that were positive, 33 that were mixed and 56 that were negative.

The service did not always treat people as individuals and make sure their care, support and treatment met their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The adult community mental health service recognised that it had limited knowledge of its patient population as some information, such as religion and ethnicity, had not always been routinely recorded on people’s care records. Therefore, it was difficult for the service to always be responsive to people’s individual needs. Work had begun to improve demographic and protected characteristic data collection and staff were reminded of the need to record such information.

Some of the treatment interventions had high rates of people not attending. A North Kent governance meeting in November 2024 noted that they had seen an increase in ‘did not attend’ (DNA) for follow ups and first appointments in Mental Health Together. In September 2024, 10.5% of first appointments resulted in DNAs, which increased to 11.6% in October 2024. Follow up appointments had a DNA rate of 11.4% in September 2024, which increased to 12.2% in October 2024. They noted the DNA rate for groups was quite high as people would prefer a one to one and face to face appointment. They planned to look at the difference in DNA rates between telephone appointments and face to face appointments. Some staff told us that DNA rates for some online treatments were high, which was a concern to them and highlighted the loss of personal contact that staff felt was possibly also felt by people who used services. Healthwatch Kent and Healthwatch Medway shared feedback from 1 September 2024 to 28 February 2025 from people who used services and their carers. Many people said they had found group sessions (both online and in person) unhelpful and would have preferred one to one support. Some people said they found the care pathways unhelpful, as they were told they had to complete certain aspects of it before they could access the part they felt might help them. Some people said that despite making the adult community mental health service aware of their past trauma history with the opposite sex, they were put in mixed group interventions or had appointments with staff of the opposite sex, which meant they were unable to engage in their treatment. Some people told Healthwatch that adult community mental health services did not take neurodivergence into account and were unable to properly support autistic people.

The adult community mental health service made adjustments for people who used services. For example, staff made face to face appointments with someone who had a learning disability and poor hearing that made telephone calls difficult for them.

We spoke with 22 people and 7 carers. Several of them told us that the adult community mental health service understood their or their loved one’s needs. One person who used services told us they felt staff were very responsive and would listen to them.

The service promoted people’s independence, so they knew their rights and had choice and control over their own care, treatment and wellbeing.

One of the aims of the adult community mental health service’s transformation was to provide greater choice and independence to people who used services. The draft standard operating procedure for Mental Health Together (MHT) and Mental Health Together Plus (MHT+) stated that one of their 5 guiding principles was “no care or treatment decision without me”. The service used a patient-rated scale tool to create person-centred care plans that were based on what they wanted support with.

People who used services were given information to make decisions about their medication. Consultants, pharmacists and non-medical prescribers spoke with people about medication choices, side effects, monitoring and benefits. We saw evidence in care records that people’s requests to have medication reviews led to medication review appointments. We observed an appointment in which a pharmacy technician explained to one person who took clozapine about the importance of letting them know if their smoking habits changed.

The adult community mental health service linked in with the child and adolescent mental health service (CAMHS). The adult service involved children in decisions about their care when they transitioned from young people’s services to adult services. The trust had developed a ‘Child and Young People Transition New Ways of Working Protocol’ for 2025.

The service generally listened to and understood people’s needs, views and wishes. However, whilst people were waiting for treatment, their needs were not always responded to in that moment to minimise any discomfort, concern or distress.

The adult community mental health service had long waiting lists for some interventions. The service’s ‘waiting well’ approach meant they did not routinely monitor people’s needs, including any risks they had, in MHT. Some staff told us that there were many people that were on pathways waiting for a long time to start treatment, some of whom no longer needed that treatment by the time their intervention started. They felt that many people did not receive the contact they needed whilst waiting.

Some staff told us they had received feedback from people who were struggling to get through to the service on the phone. The service had introduced a new telephone system in response to previous feedback about calls not being answered. Several staff told us that calls were now more frequently answered, but as they could be answered by staff at any of the locations, this sometimes led to people feeling they were being passed from one person to another.

The service used a risk evaluation and decision process for reviewing risk. We observed risk evaluation and decision meetings and minutes in which the risk evaluation and decision process was effective for supporting people who did not attend clinic appointments and were at risk, or showing signs of significant deterioration to their mental state. We observed, and leaders told us, that MHT staff did not always attend these meetings. People on waiting lists were not routinely monitored, therefore their risks were only known to the provider if they had any contact with services when they were in a crisis.

However, for some people who used services, assessments were carried out regularly. People could request an assessment, so that care plans could be amended in line with current need.

Staff showed concern for people’s wellbeing in a caring and meaningful way. During an observation of an assessment, we saw staff took time to observe, communicate and engage the person in discussion about their immediate needs.

Staff supported people who used services when their needs changed. For example, staff within the early intervention in psychosis service (EIP) told us about someone who developed an urgent physical health condition which needed an operation. Staff made sure they gave the person information about the treatment and procedure. The person had limited family support, so staff liaised between the hospital and the person to ensure everything went well.

The trust considered how to safely discharge people. A revised ‘did not attend’ (DNA) policy had been written and was due to be presented for approval in March 2025. The revised policy supported MHT to safely discharge people with low-risk profiles who did not attend appointments. This meant that space could be made available for people who did require care and treatment.

The service did not effectively promote the wellbeing of its staff, and support and enable them to always deliver person-centred care.

The trust expected staff to be supported with regular supervision and annual appraisals. Most staff who had received supervision spoke positively about their experiences of it. However, supervision compliance rates across the adult community mental health service were low in the following teams:

• Thanet Psychology 67%,
• Medical East Kent 50%,
• EIP and ARMS Medical East Kent 50%,
• Canterbury Coastal CMHT 0%,
• Thanet CMHT 42%,
• EIP Thanet 50%,
• Ashford and Canterbury MHT 75%,
• Ashford and Canterbury CMHT 69%,
• South Kent Coastal CMHT 57%,
• EIP Shepway 58%,
• South Kent Coastal CMHT Admin 53%,
• South Kent Coastal Psychology 70%,
• North Kent Medical 50%,
• Dartford, Gravesham and Swanley Psychology 56%,
• Dartford, Gravesham and Swanley CMHT 31%,
• Swale CMHT 75%,
• EIP and ARMS Medical North Kent 67%,
• Medway CMHT 70%,
• Medway CMHT Admin 57%,
• West Kent CMHT 47%,
• South West Kent CMHT 61%,
• Maidstone MHT 64%,
• Maidstone Psychology 56%,
• EIP ARMS Medical West Kent 25%,
• EIP West Kent Psychology 75%.

Staff received annual appraisals to assess their performance and identify their key skills and career progression opportunities. The overall trust target was 95%. EIP Admin East Kent achieved only 67% compliance, and EIP East Kent Psychology achieved only 50% compliance in 2024.

The trust’s Disability and Wellness Network (DAWN) members highlighted that some of the trust’s buildings presented challenges for people who use wheelchairs due to the lack of ramps and width of doors in some places. DAWN’s December 2024 meeting minutes noted that the trust was making ongoing efforts to improve Disability Discrimination Act (DDA) compliance for fire evacuation routes and wheelchair accessibility, although no deadline for the work was noted. Other staff found some of the lighting triggered migraines, which affected their health and wellbeing as well as their productivity. At Coleman House, some staff were unable to access their personal belongings in March 2025, after the asbestos ceiling had collapsed in offices in July 2024.

The trust’s Workforce Race Equality Standard (WRES) data for 2023/2024 showed that incidence of staff experiencing discrimination at work from managers, team leaders or other colleagues had increased for all staff. In the 2022 survey, 10.8% of Black, Asian and Minority Ethnic staff and 5.7% of white staff reported having personally experienced discrimination at work in the last 12 months, compared with 13.7% and 7.4% respectively in 2023.

Staff and teams were recognised for their achievements. We saw evidence of this in the minutes of team meetings, and the service also had values in practice (VIP) awards. The VIP awards were based on the trust values and awarded an employee and team of the month. The adult community mental health service was trying to encourage more sharing of compliments, and some teams had introduced “appreciation stations” for staff to give praise to each other.

Sickness absence within the adult community mental health service was consistently lower than sickness absence levels across the trust. The trust’s full time equivalent sickness absence from March 2024 to January 2025 averaged 4.64%. In comparison, the service’s full time equivalent sickness absence from February 2024 to January 2025 averaged 3.6%.

The trust and managers provided support to staff to enable them to carry out their roles. There was a flexible working policy, and flexible working arrangements were reviewed on a regular basis. Caring responsibilities were considered within the flexible work process. We were told an example in which the adult community mental health service accommodated a particularly complicated flexible working request for staff. Staff had access to occupational health assessments and advice. We observed staff using adjustable standing desks. In addition to health passports (confidential documents for staff who may require workplace adjustments), and supportive equipment and software, staff could also have their workloads adapted as needed.

Staff told us they felt respected, supported and valued by their immediate teams and were proud to work in their teams. Staff feedback was mixed about how supported they felt by, and how proud they were to work for, the trust. Some staff were critical of how the adult community mental health service transformation had been communicated and implemented, stating that changes had been made without consultation with staff. However, other staff felt the trust and senior leaders had worked well with staff to identify and action improvements as they arose.

Some staff said they had been supported to develop their career through work-based apprenticeships, and the trust was able to benefit from the staff’s increased skill set and experience.