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 and promoted a good quality of life, based on best available evidence.

Key Question Score: 13 (54%)

Key Question Rating: Requires Improvement

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

Requires improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The integration of staff who had previously worked in age-specific teams was not fully embedded, which prevented them from being fully effective as a new team. People’s needs were not always assessed in a consistent or timely manner within Mental Health Together (MHT). However, the service provided a range of care and treatment options, alongside signposting, to support people’s health and wellbeing. The service took a holistic approach to supporting people and worked with partners to support people’s housing and employment opportunities.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs regularly.

Staff did not always understand people’s current needs or update care plans when necessary. The time between some people’s assessments and starting treatment meant their needs might have changed since assessment. The trust’s risk assessment policy stated that care plans and risk assessments should be updated after someone was admitted to hospital or had a crisis intervention. However, the trust’s internal audits showed this was not always happening. In Thanet MHT+ in January 2025, only 33% of care plans and 25% of risk assessments had been updated since a hospital admission or crisis intervention. Medway MHT+ was internally audited from 30 January 2025 – 7 February 2025 and only 50% of risk assessments had been updated since a hospital admission or crisis intervention. This was not in line with the organisation’s risk assessment policy.

Healthwatch Kent and Healthwatch Medway shared the feedback they had received from people who used services and carers, with the trust. They had received a lot of negative feedback about waiting lists and times for Mental Health Together (MHT). People reported long waits for assessment and treatment, during which time their mental health declined and despite calls to the service, they still had to wait a considerable time for appointments. One person who uses services told Healthwatch that despite numerous hospitalisations, they had still not started their initial intervention and had to wait for 6 months for a medication review. Despite their changing needs and risks, the adult community mental health service did not re-assess them to ensure timely treatment.

Some staff seemed confused about which assessments or processes should be followed for assessing people’s needs. Staff told us, and we observed in meetings, some confusion about whether some people needed the dedicated patient-rated scale assessment tool assessment, CPA (care plan approach), or personal safety plans.

The adult community mental health service had a clear referral and triage process to initially assess people’s needs and place them in the appropriate service. Care navigators triaged routine referrals for MHT and clinical pathway leads triaged urgent referrals, or those where risk had been identified by a care navigator, for MHT+. People who needed an urgent response within 4 hours were triaged to the rapid response team. Staff we spoke with all understood the referral and triage process and how any risk concerns should be escalated.

People’s needs were assessed at various points in their treatment. The adult community mental health service used a dedicated patient-rated scale assessment tool to work with people who used services to help them identify how they felt about different aspects of their life, and what they would like help with. The service had added two extra questions to their assessments about risk and substance misuse so they could have a clear overview of people’s needs.

The service used patient-rated scale assessments for all people who used the service after both referral and intervention. People could request an assessment at any point. Trusted assessments were carried out for people who needed a more in-depth assessment of their needs and risks, before being stepped up to MHT+. Trusted assessments were carried out with the aim that this would reduce the need for multiple other assessments in the future. Staff used the initial meeting and assessment tool to discuss any reasonable adjustments people might need as part of their care and treatment.

The early intervention in psychosis (EIP) service used the care programme approach (CPA) and part of the patient-rated scale assessment tool to assess people’s needs and inform their care plans. Staff told us they would be using the whole patient-rated scale assessment tool in future, in line with other teams.

The adult community mental health service recognised the needs of families and carers and provided support. Some of the carers we spoke to told us they had been referred for a carer’s assessment and had been provided with information about their loved one’s condition.

Although there were waiting lists to start treatment, people did not generally have to wait long from referral to have an initial contact to have their needs assessed. We reviewed data that showed the average number of days between referral and initial contact from the service between September 2024 and February 2025. For EIP, people waited an average of 10.7 days. For MHT, people waited an average of 24.2 days. For MHT+, people waited an average of 30.7 days. The service had recently employed additional, fixed term assistant psychologists to help with conducting patient-rated scale assessments soon after referral.

The adult community mental health service assessed people’s needs holistically. The service was able to signpost people to other services, including their partner organisations, to provide support with housing, employment and finances. This meant people could get support for issues that may affect their mental health and wellbeing.

People’s communication needs were assessed and met to maximise their involvement and enhance the effectiveness of their care and treatment. For example, the adult community mental health service had access to translators for people whose first language was not English.

The trust was a ‘2 star’ Triangle of Care accredited organisation. The Triangle of Care is a therapeutic alliance between carers, service users and health professionals. It aims to promote safety and recovery and to sustain mental wellbeing by including and supporting carers. Organisations achieve 2-star accreditation through a self-assessment process, demonstrating they have met specific standards for carer inclusion and support.The adult community mental health service supported carers to understand how they could support their loved ones. For example, 1 carer told us that through the EIP service, they had attended an online carers’ programme to learn about psychosis and living with someone with that condition.

The service planned and delivered people’s care and treatment with them. Their care and treatment included what was important and mattered to them and was in line with legislation and current evidence-based good practice and standards.

The adult community mental health service provided a range of care and treatment interventions suitable for the people who used their services. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. Within MHT, there were 6 clinical pathways and 1 social intervention pathway. This meant there was a range of interventions to suit individual needs. Within MHT+, there were 6 clinical pathways and an urgent duty function. The urgent duty function provided an immediate duty response and support for family or carers.

Staff participated in a range of clinical audits. The trust undertook several Prescribing Observatory for Mental Health (POMH) audits. The trust’s audit for improving the quality of clozapine prescribing was used as a case study of good practice in POMH’s April 2024 Sharing Best Practice report. The audits led to recommendations at local and trust level. For example, an audit on medical devices across the trust led to the development of e-learning about medical devices for community mental health service staff. Participation in clinical audits meant staff could improve practice and raise the quality of care and treatment delivered to people who used services.

The adult community mental health service encouraged staff to develop any ideas they had to improve services. Leaders told us they supported staff to do this through quality improvement projects. We were told about a quality improvement project that was near completion, which had created a standardised way for the service to use their risk evaluation and decision boards. This aimed to provide a consistent and robust approach to its risk escalation and decision processes across teams.

The adult community mental health service had taken part in a university led trial for a different approach to mental health crisis and organising care provision. The approach focused on a person’s social network working collaboratively with clinicians, support staff and the person who used services themselves. All staff in MHT+ had been trained to deliver this approach and the service was planning to formally implement the model in 2025.

The adult community mental health service included a range of specialists. Teams included consultant psychiatrists, speciality doctors, physical health nurses, mental health nurses, pharmacists, occupational therapists, psychologists, assistant psychologists, psychotherapists, healthcare assistants, social workers, peer support workers and support, time and recovery (STR) workers. The service could signpost people to other agencies as needed, and its partner organisations provided additional specialist support.

Staff attended regular team meetings and biweekly business meetings. These meetings enabled clinical and non-clinical staff of all grades to be kept informed of any news or changes within their service and to be kept informed of best practice. Any learning from safety incidents and complaints was shared along with health and safety updates. Minutes from the meetings were uploaded to shared drives for all staff to access. Managers attended integrated quality and performance review meetings for their directorate. In these meetings, managers would look at what their data showed for their quality position, before the information was shared with senior leaders.

Staff in the community mental health service for working age adults received training in the Mental Health Act in line with the responsibilities of their role. The service had high rates of compliance for Mental Health Act training, with most teams at 100% compliance.

The trust’s Mental Health Act team monitored when people who used services under Community Treatment Orders were due to have their Section 132 rights read to them. The Mental Health Act team sent reminders to staff to make sure people had their rights read to them when this was due.

Staff told us that they found the trust’s Mental Health Act office helpful if they had any queries.

The transformation of community mental health services had not been implemented successfully across all sites and teams. The merging of ‘older adults’ and ‘younger adults’ was implemented inconsistently across teams.

Staff and teams did not always work together effectively. The 2024 transformation of adult community mental health services changed the service from being age-specific (working age adults and older adults) into an “ageless” service for adults 18 years upwards (from 14 years upwards for EIP). This meant that staff who had previously worked in age-related specialisms were now asked to work across all ages. Staff and leaders told us that some staff had expressed concerns that the merging of the two services may detract from the older adults service.

The integration of the working age adults and older adults’ teams was at various stages of implementation across the adult community mental health service. The Thanet team and the Dover and Deal team, for example, had the flexibility to rota staff to cover need without having to consider if staff worked with “younger adults” or “older adults”. At other sites, however, there was still a clear distinction between the previously separate teams and some staff did not feel comfortable working across both teams. Leaders told us they did not currently have any formal plans to upskill staff to effectively work across both age groups and any upskilling was up to individual staff members taking a proactive interest.

Feedback about meetings across the adult community mental health service was mixed. In some teams, we were told that attendance at risk evaluation and decision meetings was mainly by MHT+ staff. We observed several risk evaluation and decision meetings, flow meetings and multi-disciplinary team meetings across the service. A risk evaluation and decision meeting we observed at Britton House was well attended and discussions, though brief, led to action plans allocated to named members of staff. However, we also observed some meetings in which staff gave limited input and discussions were not in depth.

MHT teams had general managers who oversaw the service and were employed by a partner organisation. Staff told us there were some challenges in working effectively in this way as some of the partner organisations staff did not have access to all the trust’s human resource systems, which made it difficult to effectively line manage and supervise trust staff.

Both MHT and MHT+ had shared team caseloads. This meant that it was important that all staff kept accurate and up to date care records so that information on people’s progress, care plans and risks was easily accessible. We reviewed 25 care records with staff from the service and observed that staff found it difficult to find the information they were looking for.

Leaders were aware that the combining of teams had caused concern for some staff. They were making efforts to address staff’s concerns and to create a cohesive team and adult community mental health service. For example, in some teams, they had introduced flexible workstation arrangements in the offices to encourage collaboration and engagement between colleagues.

The adult community mental health service had effective partnership working with other organisations and sought to encourage more partnerships. For example, in Thanet, leaders had started to invite social workers into the Beacon Centre to assist people with filling in forms. This meant social services could create links with people who used services and identify any other potential support needs they might have, as well as make links with staff in the service.

The adult community mental health service worked with partners involved in providing care and support to people who used services. They worked with police, social services, homelessness charities and the local university. This enabled them to identify people’s needs in a holistic way.

Staff and leaders spoke positively about the partnership working within MHT and MHT+. They told us that their partnership with other organisations allowed them to provide appropriate services to people without the need for multiple lengthy referrals to other parts of the health and social care system. Staff employed by the trust described staff employed by partner organisations as full members of the multi-disciplinary team. Several staff told us that being in the same buildings as partners enhanced their communication and aided collaboration. This meant people who used services were able to get access to the right service provision quickly, without being “bounced” between services.

We spoke with several staff who were employed by the adult community mental health service’s partner organisations, and they told us that they felt supported and valued by trust staff.

Staff supported people to manage their health and wellbeing and offered services to maximise their independence.

Staff and leaders told us the adult community mental health service was trying to increase the focus on improving the physical health of people who used services. Each directorate held regular Physical Health Forums to help improve the physical health of people who used services. The trust worked with their resuscitation service to develop protocol and policy for people who used services with increasingly complex physical health needs. The trust had a Physical Health and Examination Policy that emphasised the increased risk of poor physical health experienced by people who used services. It contained clear assessment tools and guidance for clinical staff to monitor physical health, and any side effects people may have from medication. The service had created a competency framework to support clinical staff to assess the deteriorating patient. The framework provided guidance and protocols for staff to follow in an emergency. This meant people who used services were more likely to get the support needed to address any physical emergencies or physical health concerns in a timely way.

Staff supported people who used services to live healthier lives. For example, they offered a drug and alcohol programme to people who required support with this as well as their mental health. Physical health checks were an established part of relevant intervention pathways.

People who used services had opportunities to take part in group physical activity. For example, occupational therapists offered walking groups, kickboxing and football groups.

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

MHT and MHT+ carried out assessments with people who used services before and after interventions. This enabled the service to see the effect treatment had on how people felt about various aspects of their life. The service had developed tools that allowed staff to review the effectiveness of interventions based on the changes in people’s assessment scores. March 2025’s Integrated Performance and Quality Report submitted to the trust’s Board, showed people whose referrals were closed within the past 12 months reported improvements in mental health, with 50.8% of people reporting improvements. 47.3% of people reported improvements in consultations (meetings with mental health professionals) and 46.8% reported improvements in leisure activities.

The adult community mental health service took part in trust and national audits that looked at different aspects of care and treatment. In March 2025, the trust’s clinical audit programme included 64 different audits, most of which involved community services. For example, the service was involved in the National Clinical Audit of Psychosis Early Intervention in Psychosis Service EIP 2024. Involvement in such clinical audits enabled the service to review where it needed to make improvements to the care and treatment it provided.

We saw learning and actions were identified to improve people’s care following audits. For example, we saw learning from a clinical audit of olanzapine use and monitoring among people accessing EIP which had identified low rates of compliance with National Institute for Health and Care Excellence guidelines. Learning from the audit identified potential causes of the low compliance, including the lack of a system to organise and book 3 monthly physical health checks and the lack of robust communication structures. We did not see any action plan to address these issues.

However, the adult community mental health service had recognised it did not always have up to date physical health or compliance checks of people prescribed regular oral mental health medicines. In January 2025, Thanet MHT+ had 63.1% compliance against physical health checks. In February 2025, Thanet MHT+ had 58.5% compliance against physical health checks, which reduced to 53.2% compliance in March 2025.

People’s mental health and any associated risks were not monitored whilst they waited to start interventions.

People were informed of their rights around consent, and these were respected when the service delivered person-centred care and treatment.

Staff took all practical steps to enable people who used services to make their own decisions. Consent to care and treatment and consent to share information were noted on people’s care records. We observed medication reviews, clinic appointments and assessments and each time, staff made sure consent was received.

People who were on Community Treatment Orders (CTOs) had their section 132 rights read to them annually. This was recorded in their care records.

The trust had a Consent to Treatment Policy. The policy showed clear expectations and responsibilities for staff regarding seeking and recording consent from people who used services.

Staff sought the consent of people who used services and their families when making referrals, as evidenced in the trust’s Safeguarding Overview Report March 2025. The service had made some Early Help referrals to social services when there were safeguarding concerns. Early Help referrals require consent to refer.

Staff in the community mental health service for working age adults received training in the Mental Capacity Act in line with the responsibilities of their role and 92% of staff had completed their 3 yearly Mental Capacity Act training and 90% of staff had completed their 3 yearly Mental Capacity Assessment Recording: Consent training. Staff told us capacity was discussed regularly as part of a multi-disciplinary team during meetings.