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

The service did not always make sure people who used services could access care and treatment in a timely way. It did not always meet national standards for assessment of emergency crisis referrals and calls to the 24-hour mental health helpline were not always answered quickly.

However, staff supported people who used services to access activities outside the service, such as work, education and family relationships. The service met the needs of people who used services with a protected characteristic. Staff helped people who use services with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

This service scored 62 (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 and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The rapid response and home treatment teams service met the needs of all people who used their service, including those with a protected characteristic. A protected characteristic, is one that is protected by law against unfair treatment or discrimination. We spoke to 8 people and patients and those that had protected characteristics felt the services had incorporated these into their care. All people and patients we spoke to said that staff understood their individual needs including cultural and religious needs. Staff helped patients with communication and their social issues, such as homelessness and access to services.

Staff discussed people who used their services’ specific needs in daily morning planning meetings. Staff made sure people could access information on treatment, local services, and how to complain. In the morning planning meetings staff discussed the individual language needs of patients and how best to communicate with them including booking an interpreter. The teams had a diverse caseload with several people who needed an interpreter.

Staff from the rapid response and home treatment teams were able to record in the people who used this service care records their individual needs and preferences, and whether they had any communication or accessibility needs.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up and flexible. The home treatment and rapid response team service ensured that families and carers had opportunities to be involved in the care and treatment of the people who used their services, with their consent. Families and carers were usually present during home visits by the team. Staff told us that they knew it was important to involve carers and families as they were able to provide contextual information on a person that would benefit formulating their care plan. The service had created a booklet with information for carers and families. Staff in the service could access support from dedicated carers leads to ensure carers were provided with information about support services and their rights. Staff applied the Triangle of Care to formulate care plans. The service were completing self assessments which were due the week after our inspection. Senior leaders told us managers will then use the results to improve care. The Triangle of Care is an improvement tool based on 6 principles to ensure providers include and support unpaid carers.

The service did not always have information available in all languages spoken by people who used their services. However the service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Staff across the home treatment and rapid response service ensured that people who used services could obtain information on treatments, local services, rights and how to complain. There were notice boards and leaflets in service user-areas and people were given information about other services as part of their assessments. Staff communicated with people who used services so that they understood their care and treatment, including finding effective ways to communicate with people with communication difficulties. People we spoke to told us the service made an effort to meet their communication needs. Staff at the service made notifications to external bodies where relevant. Managers told us that they made all necessary notifications to external bodies, for example, to the police when managing a high intensity user of the service. However, we noted that information was not always easily available in languages spoken by people who use services. For example, the patient reported experience measures (PREMs) survey was only available in English. 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 people in decisions about their care and told them what had changed as a result. The service had a clear structure in place to manage complaints. The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and wider service. Complaints were managed jointly by the Patient Advice and Liaison Service (PALS) and the trust complaints team. Complaints were investigated and the complainant was contacted for their input. The PALS team had developed training for staff to help them manage informal complaints. Managers attended local mental health networks and spoke with Healthwatch to gain feedback. 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. People we spoke to said they either knew how to make a complaint or would contact the service to find out how if needed. Across the home treatment and rapid response service and rapid response team there had been 8 formal complaints between March 2024 and February 2025. These were investigated jointly by the PALS and the complaints team. The complainant would be contacted in each case. The service would address informal complaints to prevent them escalating to a formal complaint. Managers told us staff would offer to meet any person that used their service that had a complaint. The trust did not track informal complaints, however it was recorded if the complaint had been escalated from an informal complaint. The themes from these complaints were mainly people and carers disagreeing with staff input or decisions, and staff attitudes towards people who used the service. Poor communication with people that used the service was also identified by the trust as a reoccurring theme. Managers shared feedback from complaints with staff and learning was used to improve the service. Complaint themes and learning were shared in governance meetings. Feedback and learning from complaints was shared with staff at team meetings. Feedback from compliments was also shared at these meetings. The clinical governance team monitored all complaints and compliments 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. Patients, relatives and carers knew how to complain or raise concerns. There were multiple channels for people who used services and carers to provide feedback on their care. The service had feedback forms, the friends and family test, patient reported experience measures (PREMs) and carer reported experience measures (CREMs). The trust held forums called Trust Wide Patient Experience Groups (TWPEGs) and Trust Wide Carer Experience Groups (TWCEGs). The Trust Wide Patient and Carer Experience Groups are bi-monthly forums dedicated to understanding and improving the experiences of those using services. One of the home treatment teams had a carers lead who would take the lead on identifying carers in need. The team would then send out 2 staff to a home visit so that a staff member could sit with the carer or family member.

There were high numbers of calls to the urgent mental health helpline (111 service) that were abandoned. This meant some people who used services requiring urgent help may not have been able to get through to a staff member. The rapid response team did not always meet the national standard for assessments within 4-hours of an emergency referral. At this inspection we found capacity in the 111 service did not meet the demand the service had identified. Between April 2024 and January 2025 the average rate of abandonment of calls to the crisis line was 26.8%. However, this had improved as in February 2024 the rate was 39.5% and in January 2025 the rate was 26.8%. This placed people who used services at risk of harm as they may not be able to access the service at a time when their needs were considerably heightened. At our last inspection, we found the service did not always meet the national standard for 4-hours from emergency referral to assessment. However, data provided by the trust showed that there had been improvement from February 2024 until January 2025. From February 2024 that rate of urgent assessments seen within 4 hours across all rapid response and home treatment teams was 76% and in January 2025 the rate was 90.9%. There was not much variance between teams. This meant the service did not always act in a timely manner to assess and respond to the risks associated with people who used services experiencing deterioration in their mental health. However the mental health home treatment and rapid response service was available 24-hours a day and was accessed through a single point of access that was a centralised dedicated crisis telephone line. There were no waiting lists for the home treatment teams. Staff mostly saw patients referred urgently for a face-to-face assessment within four hours, and non-urgent referrals within 24 hours. One home treatment team had a person with physical health needs that was refusing treatment. The team worked with the person and identified their anxiety around attending the appointments. The team was able to take extra steps to manage this for the person to access their treatment. The service had a mobile assessment vehicle to provide a rapid response to people that used their service that needed to be seen urgently. Managers told us this vehicle could be deployed to meet people anywhere in public, including to meet with and assess people who were homeless.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. Managers and staff we spoke with across the home treatment and rapid response services were aware of inequalities faced by the population they provided a service to. They had a good understanding of socioeconomic status of people who used their services. Managers told us people who used the service were at a higher risk of homelessness and financial stress. Managers and leaders told us that as part of their 3 year strategy the trust was making an effort to gain a greater understanding of the health inequalities the people who used their services faced. One aspect of this was increasing the quality of physical health checks and reducing obesity that was due to medicines people were taking. The physical health nurse in teams would take the lead on this. Staff would refer people into physical activity programmes as part of their care plan. Social workers in teams were also able to help people with social issues such as access to food banks and homelessness, as well as refer to voluntary agencies for community engagement. Social workers could also go with people to community engagement events. Healthwatch Kent and Healthwatch Medway shared the feedback they had received from people who use services and carers, with the trust. Between April 2024 and July 2024, feedback from people and patients showed an increase in feedback where health inequalities were mentioned. Between July 2024 and December 2024, there was a significant increase in the proportion of negative sentiment in the feedback given by people recorded as being of Black/African/Caribbean/Black British ethnicity, compared to positive feedback. However, 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 and this was due to be presented in March 2025 so an action plan could be created from the findings. The trust’s policies and procedures outlined how to apply equality impact assessments to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. The Medway and Swale home treatment team won a values in practice award around extra care they provided to improve the home environment of one of the people who used their service.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported people who used services to make informed choices about their care and plan their future care and treatment. Staff created personalised care and safety plans for people who used services, and accounted for their needs, wishes and feelings. Care plans we reviewed showed this and were recovery focused.

People told us the service helped them plan what to do if their condition deteriorated and ensured they had contact details to use if this happened.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. Staff were able to refer to other teams and services if appropriate, such as autism services.