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

At our last assessment we rated well-led as good. At this assessment the rating has gone down to requires improvement. We found some concerns with the service. At the health-based places of safety (HBPoS) patients frequently were detained beyond the legal permitted period, and received treatment, without a legal framework to do this within. Staff at the HBPoS were not aware of the tools in place to support patients with communication needs. The rapid response and home treatment teams were not meeting the service standards for responding to people who used their services. The rapid response and home treatment teams had several vacancies across the teams, and there was high use of bank and agency staff However leaders had the skills, knowledge and experience to perform their roles. Teams had access to the information they needed to provide safe and effective care. Staff collected and analysed data about outcomes and performance. They used this to identify improvements.

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 had a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and their communities.

Staff knew and understood the trust’s vision and values and how they were applied in the work of their team. Staff told us they had been working on a year long project to update the trust values as part of the trust’s transformation. The trust told us they were creating digital spaces where staff could ask questions and the executive team would respond.

The services and the trust’s senior leadership teams had successfully communicated their vision and values to the frontline staff in the service. The trust sought staff feedback on the transformation throughout its implementation. Managers told us that since July 2024 they have felt more included in inter-departmental working, and that the trust had a shared direction. Staff told us the new values had more patient and staff involvement and was a collaborative project. Staff and leaders told us about their trust’s aspirations to provide holistic healthcare. Staff told us they welcomed the inclusion of professional curiosity to the values, as it was important for staff to reflect on their practice.

Managers told us that they worked to deliver high quality care within budgets available. Mangers told us this was focused on development of staff and their competencies. Managers and staff gave us multiple examples of staff undertaking further training and developing in their roles.

The service had inclusive leaders at all levels who understood the context in which they deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles. We spoke to senior leaders and managers who had considerable experience in the roles they were managing. Team and service managers had held their roles for at least a year, and most had developed into the role within the Trust.

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. Staff told us that leaders were visible and approachable. Leaders spoke to the inspection team with openness and an ability to reflect on where parts of the service needed to improve.

Managers and senior leaders were visible to staff, with many based in the same offices at the different locations. Service managers were based in the same offices as their home treatment teams. However, some managers told us that staff were still adjusting to new management structures, and they felt there was still room for improvement from senior managers around communication and visibility but they had felt empowered to share those concerns with senior managers.

The trust had a Freedom to Speak Up Guardian (FTSUG) and a FTSUG policy in place. Data provided by the trust from the FTSUG at the time of out inspection showed that in the 2024/2025 reporting period to date there had been 97 concerns reported across the trust. This was not broken down into directorate however the highest reported themes were with systems and processes, and concerns with management. Managers at the home treatment and rapid response service told us there had not been any recent whistleblowing’s in the service.

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. The trust had a flexible working policy in place to support conversations with staff. Staff and leaders gave us examples of flexible working arrangements that supported people’s personal circumstances such as caring responsibilities and religious commitments. The trust had a reasonable adjustments policy in place, and managers told us their teams felt empowered to speak up and ask for support. The trust undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the people it supported. The trust shared its Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) data for 2023/2024 with us. 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 into formal disciplinary process 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%, compared with NHS England’s WDES data showing the national average of disability representation across the NHS was 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 had not completed this. However there was no timeframe for this at the time of our inspection. Disabled applicants were less likely to be appointed to roles than non-disabled applicants. 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. However there was no timeframe for this at the time of our inspection. Disabled staff reported experiencing bullying, harassment or abuse from colleagues, service users and managers at higher levels than the national average. However, disabled staff were not more likely than non-disabled staff to enter into 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 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.

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 home treatment and rapid response service had recently undergone a transformation and leadership restructure. The teams now worked in geographical directorates as a home treatment and rapid response service. This included the rapid response, home treatment teams and psychiatric liaison. At the health-based places of safety (HBPoS) patients frequently were detained beyond the legal permitted period, and received treatment, without a legal framework to do this within. Staff did not always carry out their duties under the Duty of Candour to inform and apologise to patients when their detention had lapsed. The service had a policy to manage this but this was not always followed. 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, however there had been an overall improvement to this over the year prior to our inspection. The rapid response and home treatment teams had several vacancies across the teams. There was high use of bank and agency staff. Staff supervision was not always being completed. The trust and service had translator services in place for staff to use for people who used the service and patients, however staff at the HBPoS were unaware of this and told us they used google translate for patients. The service had a framework of what must be discussed at a team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. However, some staff told us that some sharing of incidents and information was more difficult after moving to geographical directorates. They said there were extra steps to take to share information with home treatment and rapid response teams in a different directorate, when this was shared at service level previously. However staff and managers were able to articulate clearly how information flowed up through the structures but also down to staff at daily meetings. We observed daily morning team meetings and reviewed minutes from team and clinical governance meetings. We saw those risks and immediate concerns were shared and escalated to the appropriate staff. Managers and staff attended a range of clinical governance meetings. This included quality and patient safety meetings, lessons learnt meetings, physical health and clinical risk forums. We reviewed minutes from these meetings from November 2024 to February 2025. They covered reviewing the risk register, sharing learning from incidents and complaints, and actions escalated from directorate teams. Managers and senior leaders were aware of the risks to their service. They maintained and had access to the risk register. Staff concerns matched those on the risk register and issues we found during the inspection were also reflected on the risk register. For example, risks related to staffing vacancies across the whole of the home treatment and rapid response service were recorded on the risk register. The lack of substantive consultant cover was also on the risk register. The register included controls in place, any gaps, actions to mitigate risk and a risk owner. Staff had access to the equipment and information technology needed to do their work. The trust was moving to completing all work on electronic devices. They used hybrid devices they could take on home visits with them. Staff told us this had been very helpful in reducing the amount of time it took for them to complete their notes. The trust had business continuity service plans for emergencies which were particular to each service. They included plans for loss of staff, utilities and information technology and telecommunications and gave staff clear processes to follow in such an event. The business continuity plans were reviewed and updated regularly. Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. Staff undertook audits, which were recorded using an online system. For example, managers carried out audits of care records for people who used the service. Learning and opportunities for quality improvement from these were shared with the team.

The service understood their duty to collaborate and work in partnership, so their services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The service had established strong links and partnerships with the community. This included a mobile assessment vehicle to see people quickly. Another example is that one of the rapid response teams had a person who was homeless. The area did not have a rough sleepers service so the team contacted an equivalent agency in London for advice. This agency sent an outreach worker to support this person with their social issues. The service worked well with other providers. The home treatment and rapid response service met with police and attended meetings to discuss high intensity users. Staff were able to refer people to substance misuse services and autism services as needed. Staff did this through their established relationship with the community mental health teams. This meant people were supported in other aspects of their life that may have an impact on their mental health. Managers and senior leaders from the health-based places of safety (HBPoS) met at quarterly inter-agency meetings to monitor the performance and issues with the HBPoS. These were attended by trust managers, integrated care board members, police, local authority and other trusts. The service received relevant information of concern from Multi-Agency Public Protection Arrangements (MAPPA) meetings, a UK framework for managing the risks posed by serious sexual and violent offenders. Minutes from these meetings were shared with service and supported to identify risks for the teams. The service was part of the Kent integrated care system. This also included local authorities, the integrated care board, primary care, and other organisations. As part of their immediate management review process of serious incidents, a nominated staff member would inform other agencies as required including commissioners and NHSE.

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 were given the time and support to consider opportunities for improvements and innovation and this led to changes. Managers and staff told us about current quality improvement initiatives taking place across the service. Examples included projects to improve the quality of handovers. One home treatment team had a person with physical health needs that was refusing treatment. The team worked with the person and were able to take extra steps to manage this for the person to access their treatment. 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. The trust’s chief pharmacist had worked closely with the executive team and commissioners to secure funding for both a pharmacist and a pharmacy technician for every team in the service. This was in place at the time of inspection. This was to improve the quality of input from the pharmacy team. The Dartford home treatment team were undertaking a quality improvement project as they had identified a lack of confidence in the team in supporting autistic people. They created a new care plan protocol to support the understanding of the needs of autistic people. 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 use services could benefit from the learning of the service and receive better care. People who used services and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to the feedback from people who use services, carers and staff and used it to make improvements. People who use services and carers were involved in decision-making about changes to the service. The service used Patient Reported Experience Measures (PREMs) and Carers Reported Experience Measures (CREMs) to obtain feedback on the service. For example, the service introduced peer practitioners to provide support for carers of people with substance misuse. Their contact details are shared in the initial letter to carers from the service. People who used services and carers were welcome to meet senior leadership to provide feedback. Managers told us that a reason the number of formal complaints for the teams were low was because they were proactive in contacting people when concerns were raised, so that issues could be addressed quickly. The service had a head of allied health professionals that was also the carers forum lead, and fed back concerns and issues raised at these forums.