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, fair culture.

Key Question Score: 17 (61%)

Key Question Rating: Requires Improvement

At our last inspection we rated well led as requires improvement. At this inspection the rating has remained as requires improvement.We identified 1 breach of legal regulation in relation to governance.

Requires improvement: This meant the adult community mental health service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service’s governance processes still required significant improvement. The trust’s governance structure had changed in 2024, along with a change of service model through their transformation. Their processes did not always operate effectively, and there were inconsistencies across the service’s locations.

However, the trust had made improvements in how senior leadership worked with teams. There was a shared vision for the service and how staff were able to explain the vision confidently. There remained some disconnect between senior leadership and local teams regarding the strategic implementation of the vision, with most staff expressing concerns about risk. The service had developed excellent working relationships with partners and communities, which had benefitted people who used services to get more timely access to other services and support. Freedom to Speak Up arrangements allowed staff to express concerns and have them taken seriously.

This service scored 61 (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 had a shared vision that was based on diversity and inclusion, engagement, and understanding and meeting the needs of people and their communities. However, there was not a shared belief amongst staff in the effectiveness of the trust’s strategy to achieve this vision.

Staff knew and understood the trust’s vision and values and how they were applied in the work of their team. Staff told us about the adult community mental health service transformation and its aims. Some staff told us the transformation allowed them to make sure people who used services were supported more holistically and could quickly be seen by the right teams to support not only their mental health, but any aspect of their life that may be affecting their wellbeing.

The adult community mental health services and the trust’s senior leadership teams had successfully communicated their vision and values to the frontline staff in the service. Staff and leaders told us about their trust’s aspirations to provide holistic healthcare. They aimed to provide multi-agency joined up approaches to supporting people, with the person who uses services always at the centre of any decision making.

The trust sought staff feedback on the transformation throughout its implementation. Directors and staff from the Improvement Team carried out a series of listen and learn events to gain staff feedback so they could address any concerns quickly. This helped to ensure trust and service staff at all levels were collaborating to refine the tools and processes used in the transformation.

Some staff and leaders told us that the trust and service were trying to change from a blame culture into a learning culture. We were told that culture was the theme of a leadership away day at the beginning of 2025. Some staff told us that the transformation had been chaotic due to poor communication from trust leadership. They felt this had led to undefined practice that negatively impacted the care of people who used services.

However, some staff told us they felt that the transformation and other business decisions had been made by senior leadership without proper consultation with those who worked in the services who might better understand the impact. Although the vision was shared, there were sometimes differences of opinion between staff and senior leaders on the strategy needed to achieve this.

The service had leaders at all levels who had the skills, knowledge, experience and credibility to lead effectively. However, not all teams felt they operated with openness and honesty or embodied the culture and values of their workforce and organisation.

We spoke to senior leaders and managers who had considerable experience in the roles they were managing. Managers and leaders were trained in the same topics as their staff, even though they did not have a clinical caseload.

We spoke with senior leaders and directors. They demonstrated a good understanding of the services they managed, including their challenges and their achievements. They could explain clearly how the teams were working to provide high quality care. Leaders spoke to the inspection team with openness and an ability to reflect on where parts of the adult community mental health service needed to improve, or how they would have done things differently if implementing the transformation again. For example, directors told us that if they were to start again, they would ensure staffing and recruitment was fully sorted before starting the transformation.

Leadership development opportunities were available, including opportunities for staff. Staff told us about the range of personal and professional development opportunities and training courses they had access to. For example, we spoke with staff who were undertaking workplace apprenticeships that would provide them with the qualification and experience to progress their career. Staff spoke positively about the range of development opportunities available and about how managers supported them to develop.

Managers and senior leaders were visible to staff, with many based in the same offices at the different locations. Trust senior leadership visited the services, for example when carrying out listen and learn exercises with staff to learn about their experiences of the adult community mental health transformation.

The trust had paused its implementation of the adult community mental health transformation for early intervention in psychosis (EIP) and at-risk mental state services in response to staff feedback. Trust senior leadership were trying to work with staff to transform their services collaboratively.

However, there had been an increase in staff experiencing harassment, bullying or abuse at work. The trust’s Workforce Disability Equality Standard (WDES) – 2023/2024 data showed that 13.3% of disabled staff and 6.5% of non-disabled staff reported having experienced harassment, bullying or abuse from managers in the past 12 months. In 2022/2023 it had been 11.3% and 6.0% respectively.

The trust’s Workforce Race Equality Standard (WRES) data for 2023/2024 showed that incidence of experiencing harassment, bullying or abuse from staff had increased for both Black, Asian and Minority Ethnic staff and white staff. In the 2022 survey, 19.8% of Black, Asian and Minority Ethnic staff and 16.2% of white staff reported bullying, abuse or harassment from staff, compared with 20.6% and 19.0% respectively in 2023. The trust’s KMPT Combined Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) Action Plan 2024-2026 acknowledged that it needed to address this issue and demonstrate a strong commitment to tackling harassment and bullying.

There remained a disconnect between staff and senior leadership. Some staff told us that senior leadership did not listen to their feedback on the adult community mental health transformation. Some staff and managers told us that senior leadership were too far removed from the detail to make decisions that affected services without properly involving staff in the decision-making process.

The service created a positive culture where people feel that they can speak up and that their voice would be heard.

Managers and staff had access to the feedback from people who used services, carers and staff, and used it to make improvements. The team in the Beacon Centre told us that Wednesdays had previously been a day full of meetings, which staff had found to be too much. Therefore, the manager had introduced protected time and continuing professional development (CPD) hour on Wednesdays. This meant staff meetings were more focused and productive and gave staff time to carry out other important aspects of their roles.

The trust had a Freedom to Speak Up Guardian. In the March 2025 Board report, it was noted that the trust had received 61 cases in the previous 6 months. Data was not available in relation to the community services for working age adults, however action from a cluster of cases in the Dover area included the introduction of a robust engagement process between management and staff, as well as peer to peer support opportunities. The trust recognised that managers needed to become more confident in having difficult conversations with staff so that improvements that were learned from cases could be embedded. It was noted that in the Sevenoaks area, staff did not feel supported in their concerns. The report showed a commitment from the trust senior leadership team and Board members to better understand and address staff concerns.

The service valued diversity in their workforce and was keen to make the workforce more inclusive and representative of the populations they worked in.

Staff were able to apply to work flexibly. Staff and leaders gave us examples of flexible working arrangements that supported people’s personal circumstances such as caring responsibilities and health issues.

The trust undertook equality monitoring of staff within the adult community mental health service to ensure it was diverse in its make-up and representative of the people it supported. We reviewed the trust’s Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) data for 2023/2024. The trust’s representation of Black, Asian and Minority Ethnic staff across the trust had increased to 28.0% in 2023/2024. In comparison, Black, Asian and Minority Ethnic staff representation in the NHS across the South East and across England nationally was 26.4%. The trust target for Black, Asian and Minority Ethnic staff representation had been 22%, so its higher actual figure showed successful implementation of their action plan to support this and see improvements in Black, Asian and Minority Ethnic representation.

During 2024, the trust’s WRES data showed an increase in Black, Asian and Minority Ethnic staff at all bandings. Black, Asian and Minority Ethnic applicants were less likely to be appointed to roles, but there had been an increase in both Black, Asian and Minority Ethnic and white applicants being shortlisted. The trust was working to address any barriers for Black, Asian and Minority Ethnic applicants within the recruitment process, for example with the introduction of a new recruitment policy.

Lessons had been learned from previous WRES data that had shown Black, Asian and Minority Ethnic staff had a much higher likelihood of entering formal disciplinary processes than white staff. As a result, a new Central Investigations Team had been put in place, and the trust had introduced the Restorative Just and Learning Culture question to support decision making when investigating any concerns raised.

The trust’s WDES data showed the representation of disabled staff across the trust had increased to 7.69%, which was higher than the national average of disability representation across the NHS of 4.9%. The trust was planning to launch a campaign to encourage staff to add their disability information to their staff records, as the staff survey results indicated that around 30% of trust staff were disabled.

Disabled applicants were less likely to be appointed to roles than non-disabled applicants. Non-disabled staff were 1.15 times more likely to be appointed from shortlisting than those staff with disabilities. The trust’s recruitment team was planning to develop guidance for recruiting managers to write inclusive job adverts that included information about reasonable adjustments to encourage applications from disabled people. Disabled staff reported experiencing bullying, harassment or abuse from colleagues, people who used services and managers at higher levels than the national average. However, disabled staff were not more likely than non-disabled staff to enter the disciplinary process.

The trust had an action plan to address the inequalities reported by their Black, Asian and Minority Ethnic and disabled staff. The action plan focused on staff experience, recruitment and learning and development. Leaders told us about the trust’s aspiration to have a workforce that represented the diverse communities it served. The trust had started to work on implementing their Equality, Diversity and Inclusion Plan as part of their Cultural Transformation Programme. The trust had a range of groups staff could join that provided support and advocacy and campaigned for equality, such as the Black, Asian, Minority Ethnic (Global Majority) Staff Network, Disability and Wellness Network, Faith Network, LGBTQ+ Network, Menopause Network and Neurodiversity Network. The trust had Culture Inclusion Ambassadors and Equality, Diversity and Inclusion Leads and Champions.

The service did not have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. Therefore, they could not always act on the best information about risk, performance and outcomes.

We found multiple areas of concern within governance. The trust had introduced a new governance structure in April 2024, after moving from care groups to directorates. The service did not have policies for all the interventions or tools they used with people, such as their patient-rated scale assessments. The service had implemented its transformation of community services with the introduction of MHT and MHT+ without a final standard operating procedure. The draft standard operating procedure we saw had several incomplete sections, so staff did not have clear processes to follow for MHT or MHT+.

The trust shared records with us about incidents of self-harm whilst waiting for treatment, and audit data from its clinics. However, the trust later informed us that the data they sent had not been accurate. They explained that their recording and auditing of physical health checks had changed, and some audits had been carried out by people who were unfamiliar with the process. This has increased our concerns about the effectiveness and robustness of their governance processes.

Some of the trust policies and standard operating procedures were out of date, such as the Development, Approval and Management of Formal Trust Documents Policy and Procedures, which had a review date of November 2024 and had not been done. The Risk Evaluation and Decision - The multidisciplinary approach to managing risk in Community Mental Health Services document had a review date of November 2024 but had not been done. Within the document was a template for risk evaluation and decision meetings, but we observed that different teams used different templates. The Policy and Procedure for Managing Patients Who Did Not Attend (DNA) and/or Are Unable to be Contacted was due to be reviewed in February 2024 but had not been done. The trust told us that their revised policy was due to be signed off after we inspected in March 2025. The adult community mental health service’s Peer Supported Open Dialogue Service Standard Operating Procedure had a review date of April 2023 but had not been done. Although some staff and leaders told us there was a plan to fully implement the Open Dialogue care model, it was not clear if this had already occurred as in the East Kent directorate, there were ‘Open Dialogue’ Peer Support Workers. There was no crisis plan policy or procedure to inform staff of the required standards of crisis plans, though the lack of tailored crisis plans had been highlighted in our previous inspection of the service in 2020. The Early Intervention in Psychosis (EIP) Services Operational Policy had been due for review in January 2025 but had not been done. The staff consultation regarding changes to EIP had been paused, meaning the out-of-date policy remained operational.

The adult community mental health service’s monitoring of supervision showed low rates of compliance. The service did not audit supervision or training. Although training was spoken about at governance meetings, and there was a process in which reminders were sent to staff, the compliance rates remained low in some teams.

The adult community mental health service was not always monitoring and recording when appointments were cancelled due to lack of staff.

Some staff told us they felt decisions were made in senior leadership meetings that did not involve the right level of staff who would understand the potential impact of decisions made within those meetings.

There was confusion about ligature risks within adult community mental health services. The trust told us that ligature risk assessments were only conducted in inpatient areas and health-based places of safety. However, internal audits for adult community mental health services showed staff were required to check that ligature cutters were present at community services locations. Although they were aware of the risk to some people, they were not taking all reasonable steps possible to reduce the risk of people tying ligatures when in their buildings.

Care records were not easy to navigate. Staff struggled to find information in people’s care records during our inspection. Different teams told us they had rules about not being allowed to write someone’s prescription details in their progress notes. This meant staff were not always able to quickly find information about people who used services, which could impact the effectiveness and safety of the care they delivered.

Some staff were unsure of the governance structure. For example, there were 3 consultants in EIP services in a locality structure, but there was some confusion about who the overall head was, which led to a lack of clarity about who was responsible for budgets and spending.

The trust’s Audit and Risk Committee noted in its March 2025 Board Report paper that changes were needed to governance processes. For example, they stated that there was limited assurance regarding the reporting processes for risks and several risks required redrafting to improve their accuracy.

A learning review following the suicide of someone who used services highlighted that the trust did not have a policy regarding out of area referrals management for staff to follow. There was still no specific policy regarding out of area referrals, though the Mental Health Together and Mental Health Together Plus Draft Operating Policy did state that referrals received outside of the trust were to be directed to a single place within the locality team.

Not all staff had access to the equipment and information technology needed to do their work. The information technology infrastructure was not reliable in some locations. For example, the internet was unreliable at Britton House and Heathside Centre, which affected staff’s ability to carry out their duties and deliver care to people who used services.

In one team, some staff told us about processes that added unnecessary administrative tasks for clinical staff. Administration staff were not able to book appointments for people’s initial interventions. Assistant psychologists had to phone and book in their own initial interventions and administration staff would then send the appointment letter. Staff told us this caused delays and frustration for staff and for people who used services. They did not think managers were aware of the situation.

Not all team managers had access to information to support them with their management role. Some trust staff were line managed by staff from one of the partner organisations in the MHT service. However, partner organisation staff did not have access to all of the trust’s human resource systems and information within them. This meant it was more difficult to provide effective line management and supervision.

Staff maintained and had access to the risk register at team level. Staff could escalate concerns when required. The risk register was available on staff computer systems. However, some risks had been on risk registers for a long time without achieving the trust’s planned level of risk reduction. For example, in East Kent, the risk of long MHT waiting lists had been added to the directorate’s risk register in November 2021 and was above the trust’s target risk level at the time of inspection.

The service understood their duty to collaborate and work in partnership, so their services could work seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The adult community mental health service had established effective partnerships with the community. The Ashford and Canterbury team had strong links with the local university, from whom they received lots of referrals. They linked in with local homelessness organisations to arrange assessments and support when they knew where people would be staying in the area.

The adult community mental health service worked well with other providers. For example, staff referred people who used services to the Kent and Medway Complex Autism Services (KAMCAS) as needed. They also carried out joint assessments with drug and alcohol services, so people were supported in other aspects of their life that may have an impact on their mental health and wellbeing.

The trust had a research community. It had partnerships with over 350 local people and organisations from their communities who were actively contributing to their research studies and improvements. The trust had Community Partnership pledges from over 25 organisations ranging from domestic abuse charities, male mental health organisations, homeless charities and sports organisations. The research community had presented a suicide prevention conference in partnership with Kent County Council.

People who used services and staff could meet with managers to give feedback. For example, South West Kent offered ‘meet the manager’ sessions twice a month.

As part of the trust’s transformation of adult community mental health services, it had strong partnerships with external organisations. People who used services could access Individual Placement and Support from a partner organisation to develop work skills and gain paid or voluntary positions. They could work with another partner organisation to address their housing and accommodation needs. The service also held a contract with a local charity to co-run their service user network (SUN) model. This removed the need for additional referrals and potentially lengthy waiting times.

Some staff told us that the adult community mental health service was trying to shift the focus from being only about intervention when someone was in their care, to also considering how to reintegrate people into their community independently. The EIP service used social prescribing, which meant people were able to access activities that would offer them support after they had been discharged from the service.

There was a culture of continuous learning, innovation and improvement across the organisation and the local teams. Staff had opportunities, and were encouraged, to actively contribute to safe, effective practice and research.

Staff participated in national audits relevant to the service and learned from them. For example, they participated in a national audit which reviewed myocarditis monitoring during clozapine initiation, from which the trust created an updated protocol. This meant that people who used services could benefit from the learning of the service and receive better care.

The trust had a research community. There were opportunities for staff, people who used services, carers, community organisations and individuals in the community to participate in research. The trust had 6 Staff Research Champions and planned to have at least one staff research champion in each community of practice. The research community had taken part in investigating what was needed to involve people in research about dementia in coastal communities. They held focus groups and interviews within coastal towns to hear what carers and people living with dementia needed to be able to take part in research. The research community held events during which the team spoke to members of the public about opportunities to take part in research and join the research community.

The trust’s pharmacy team was active in national audit activity with the Prescribing Observatory for Mental Health (POMH), which ran clinical audit-based quality improvement programmes that focused on specific areas of prescribing practice.

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 5-year trial reported that the model’s approach of having far more open and transparent conversations with people who used services and whomever they identified as their support network, led to improved outcomes.