Kent and Medway Mental Health NHS Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

Key Question Score: 16 (57%)

Key Question Rating: Requires improvement

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

Requires improvement: This meant people’s needs were not always met. The service was aware it had incomplete demographic information about people who used its services, which limited its ability to proactively reduce health inequalities. However, the trust had started to make improvements to better understand and remove any barriers experienced by people who used services and carers. The service included people who used services and carers to help shape service improvements. Staff tried to make reasonable adjustments to support people to access services.

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 service made sure people were at the centre of their care and treatment choices.

The adult community mental health service operated in a person-centred way and staff and leaders spoke of the importance of ensuring they delivered person-centred care. The service used a patient-rated scale tool to support the creation of care plans that focused on providing support in aspects of the person’s life that they wanted to work on.

Where communication might have caused challenges, the adult community mental health service put support in place. For example, the service made sure they had a British Sign Language interpreter available for deaf people.

The trust offered training in the use of Talking Mats, a visual communication tool so that people who struggle to communicate verbally could still express themselves and their thoughts and feelings.

Care plans we reviewed were person-centred and individualised, reflecting people’s individual recovery goals. One person who used services told us staff supported their individual needs. They gave an example that they can use fidget toys in meetings, which meant they felt more relaxed and reduced their anxiety during appointments.

However, the group setting and online delivery of some treatment pathways did not suit individuals’ preferences. Several staff told us that many people who used services preferred one to one, in person treatment which was not how the interventions were designed, and meant some people chose to opt out of their treatment.

The service generally understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice. However, it did not always provide continuity.

People who used services did not always experience continuity of care. The early intervention in psychosis (EIP) service had individual staff caseloads. However, in Mental Health Together (MHT) and Mental Health Together Plus (MHT+), they used a shared team caseload approach so people would not always see the same staff member throughout their care and treatment. Staff told us this meant it was sometimes difficult to get to know people including their preferences, risks, and their usual presentation. Staff had to review people’s care records to see their care plans and colleagues’ previous notes, prior to appointments as there was no quick way for staff to review necessary information before meeting someone for the first time.

Healthwatch Kent and Healthwatch Medway received feedback from people who used services and carers. Between October 2024 and December 2024, Healthwatch received mainly negative feedback about co-ordination and continuity of care. There were 81 negative, 17 positive and 18 mixed pieces of feedback in relation to co-ordination and continuity of care. The adult community mental health service received feedback from people who used services and their carers through the friends and family test. One person who used MHT fed back in December 2024 that the service could improve its continuity. They reported they had seen 20 different people, with only a couple of staff visiting more than once. They highlighted in their feedback that this meant it was difficult for staff to see if someone was getting better or worse.

Healthwatch Kent and Healthwatch Medway shared the feedback they had received from people and their carers, with the trust. Between July 2024 and September 2024, 69% of feedback they received about co-ordination and continuity of care was negative.

The service did not always provide appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The adult community mental health service complied with the Accessible Information Standard which ensures that people with disabilities or sensory impairments receive information and communications from the NHS and adult social care services in a way they can easily understand and use. Staff had mandatory training in the Accessible Information Standard with all teams in the service achieving at least an 86% compliance rate, though most teams had 100% compliance rate.

Staff ensured that people who used services could obtain information on treatments, local services and how to complain. This included information on notice boards and information that could be taken about other services such as leaflets.

The trust had an Overarching Information Governance Policy. The policy referenced guidance and training staff could access to ensure they were maintaining the confidentiality of people’s sensitive personal information, along with the trust’s legal duties to share such information in specific situations.

We noted that information was not always easily available in different languages spoken by people who used services. For example, the patient reported experience measures (PREMs) survey was only available in English at Laurel House. This meant that if English was not someone’s first language, they might be unable to easily provide their feedback to the service on their experience of care.

The service made it easy for people to share feedback and ideas or raise complaints about their care, treatment and support. They involved them in decisions about their care and told them what had changed as a result.

The adult community mental health service had an open culture of seeking and acting on people’s feedback. Staff proactively sought feedback from people who used services. For example, managers attended local mental health networks and spoke with Healthwatch to gain feedback, which helped them respond to issues people did not raise directly with the service.

There were multiple channels for people who used services and their carers to provide feedback on their care. The adult community mental health service had feedback forms, the friends and family test, patient reported experience measures (PREMs), and carer reported experience measures (CREMs). Leaders told us they were looking at how they could increase the response rate to PREMs and CREMs to gain insight into people’s experiences of care. People were told how their feedback had changed things, for example through ‘you said, we did’ notice boards in waiting areas, although the board in Laurel House waiting room appeared out of date and referenced COVID-19.

The trust provided numerous engagement opportunities for people who used services and carers to share their feedback and help shape services. There was a trust-wide Patient Experience Group which included representation from partners such as Healthwatch, advocacy groups and peer support workers. There was a Carer Experience Group and a Transforming Neurodiversity Support (TNS) Programme Board. The TNS Board aimed to empower people with a learning disability and autistic people to become leaders and help guide and shape the direction of services. The trust had an Engagement Pool, which was a diverse network of people who used services and their carers who used their expertise to help shape service improvements. The adult community mental health service encouraged managers to speak to people who had raised concerns to quickly resolve the issue or prevent the issue from worsening. Staff gave an example of a complaint they had received from someone about the adult community mental health service transformation. They were invited to speak with managers and discuss the changes, so they understood them.

Staff were trained in how to manage and investigate complaints. The trust’s patient advice and liaison service (PALS) team had developed training for staff. Complaint investigations were allocated across the adult community mental health service to allow for objectivity. Staff told us the complaints training emphasised the need to provide complainants with a sincere apology and to inform them of what the service had learnt from the complaint.

The adult community mental health service supported staff wellbeing when complaints were raised about them. Staff who were the subject of complaints were given tailored support to ensure they were ok and could manage the situation well. Managers were open with them and would share the complaint to look at what happened. Staff did not receive a punitive approach to complaints and were supported to identify what may have gone wrong, to help improve future practice.

Staff knew how to handle complaints appropriately. They were aware of the complaints process and how to support people who used services to raise concerns or make a complaint. We spoke with 22 people and 7 carers. They all said they either knew how to make a complaint or would contact the service to find out how, if needed. One carer told us they felt very confident any complaint would be responded to positively. One person told Healthwatch they had a positive experience with the PALS team and the complaint process when they made a complaint about their community mental health team.

Complaints were reviewed thematically and learning shared across the adult community mental health service. Complaint themes and learning were shared in governance meetings. Complaints received across all community services between March 2024 and February 2025 totalled 295. The number of compliments received during the same period was 757. Across the trust, 807 complaints were closed between March 2024 and February 2025, of which 8% were upheld, 16% were partially upheld, 26% were not upheld and 50% were resolved. The top 3 complaint themes were poor/lack of communication with patient, attitude of nurse, and lack of treatment/therapy.

Between March 2024 and February 2025, the trust had 5 complaints referred to the Parliamentary and Health Service Ombudsman. Four of those cases were accepted for investigation. One case was closed with no aspects of the complaint upheld, and no recommendations for the trust, and the others remain open.

People had access to advocacy services, which supported them to understand their rights and share their concerns and opinions with the service.

However, people’s requests to be discharged were not always listened to and acted on. We observed 2 sets of notes that showed people had told the adult community mental health service that they no longer felt they needed the service’s support and felt much better, ahead of their trusted or initial assessment. In both cases, assessment appointments were booked after the person had said they did not want or need the service’s support.

The service did not always make sure that everyone could access the care, support and treatment they needed when they needed it.

The adult community mental health service had incomplete information about the protected characteristics of people who used its services. There was inequity in access for some minority groups. Although there was limited protected characteristic data available, a Health Inequalities Data Visualisation Update in March 2025 showed that ‘White: Gypsy or Irish Traveller, Roma’ had the highest rates of ‘did not attend’ and client cancellations. This meant they did not receive the care and treatment they needed. People from the most deprived areas were overrepresented in the MHT waiting list.

The trust had implemented the NHS Patient and Carer Race Equality Framework (PCREF) to try to reduce racism and increase equity. This is a mandatory framework that all trusts across England must embed. Their action plan had a number of actions identified, and several completed, such as cultural competence training for 259 senior leaders, to increase their ability to tackle health inequalities and racism. They aimed to increase organisational competencies by introducing a Health Inequalities Hub on the staff intranet in summer 2025.

Staff made reasonable adjustments for some people who used services. For example, deaf people who used services had a British Sign Language interpreter for their talking therapies. However, they did not routinely have information available in languages other than English. We observed a meeting in which one person who used services was discussed. English was not their first language, so they needed a translator for their trusted assessment. All appointment letters to this person had been sent only in English and they had not attended 3 appointments they had been invited to.

The adult community mental health service considered how to accommodate the needs of people and their carers. One carer told us that despite their mobility difficulties, they were able to attend appointments with their loved one as they could use the building’s lift to access the meeting room floor.

The adult community mental health service had made improvements to their telephone systems for people who used services and staff. People had previously reported an inability to get through on the telephone. The service had introduced a new system in which the central MHT and MHT+ telephone number could be answered in any of their locations. However, some staff told us this had led to frustration from some people who felt they were now passed from one team to another before speaking to the right staff.

The service had not actively sought and listened to information about people who were most likely to experience inequality in experience or outcomes. Therefore, they were not always able to tailor the care, support and treatment in response to this.

The adult community mental health service did not have accurate demographic or protected characteristic information about all of the people who used its services. Governance meeting minutes and papers recorded that the service had incomplete information. Staff had not been routinely recording protected characteristics data for people who used services.

Healthwatch Kent and Healthwatch Medway shared the feedback they had received from people who used services and their carers, with the trust. In comments Healthwatch received between April 2024 and July 2024, there was an increase in feedback about health inequalities. Between July 2024 and December 2024, there was a significant increase in negative sentiment in the feedback given by people recorded as being of Black/African/Caribbean/Black British ethnicity. One person who used services and is of Asian, Asian British or Black, African, Caribbean or Black British ethnicity said they had found a nurse they had an appointment with to be dismissive in their response, and lacking in understanding of the challenges faced by menopausal women.

The trust had been carrying out work to identify and reduce health inequalities. The trust had worked with a health inequalities advisor to develop a data dashboard based on the trust’s priorities, to identify health equity areas. They planned to create an inequalities steering group that would lead a work plan after the analysis and dashboards were presented to the trust board in March 2025.

The trust’s policies and procedures referred to related equality impact assessments to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Staff were trained in equality, diversity, inclusion and human rights. They undertook 3 yearly equality training and compliance rates were consistently high, with most teams in the adult community mental health service having 100% compliance.

The service did not always support people to plan for important life changes, so they could have enough time to make informed decisions about their future.

We reviewed 25 care records. Evidence of planning for discharge was only seen in the records of people who were accessing the EIP service. People were on the EIP caseload for 3 years, after which they would be discharged to their GP, MHT or MHT+ as needed. The EIP service was trialling a discharge group in which people could speak about their anxieties or fears regarding discharge and plan to ensure they had a successful discharge.

People who used services were not always successfully discharged from the service. Adult community mental health service data showed that between March 2024 and February 2025, there were 5503 re-referrals for people to MHT, with the average time until re-referral of 100.6 days. During the same time period, there were 786 re-referrals for MHT+, with the average time until re-referral of 341.5 days. EIP received 65 re-referrals, with the average time until re-referral of 1445.9 days. Some staff told us that the adult community mental health service did not look at the reasons why people were re-referred, for example because they had been referred to a different team or service that did not accept their referral. This meant the service could not identify any learning that could lead to more successful long-term or permanent discharges.

Some staff told us it was sometimes difficult for them to get to know people who used services well enough to support them to make decisions about their future. Some staff told us that it could be hard to create a relationship with someone in their care because they worked with a shared team caseload, which meant they did not always get to know people well when working with them.

Staff supported people who used services to be referred for autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) assessments. The specialist services required people to remain on the MHT or MHT+ case load whilst waiting for their assessment. We requested information from the service regarding the number of people who were on waiting lists for other providers to assess their needs, but the service was unable to provide this information as they told us it was not reportable from their care record system.