Kent and Medway NHS and Social Care Partnership Trust has retained its overall rating of good overall, following a recent Care Quality Commission (CQC) inspection.
In November, CQC carried out an unannounced comprehensive inspection of three of the core mental health services provided by the trust, as part of its continual checks on the safety and quality of healthcare services. These were:
- acute wards for adults of working age and psychiatric intensive care units (PICU)
- forensic inpatient/secure wards
- wards for older people with mental health problems
Following the inspection, the overall rating for the trust remains as good. The rating for well-led also remains as good, caring remains outstanding, effective improved from good to outstanding, but safe dropped from good to requires improvement.
All three core services have now been rated good overall. Previously the forensic inpatient/secure wards were rated outstanding, the acute wards for working age adults and psychiatric intensive care units were rated requires improvement, and the wards for older people with mental health problems were rated good.
Karen Bennett-Wilson, CQC’s head of hospital inspection, said:
“When we inspected Kent and Medway NHS and Social Care Partnership Trust, we found a professional, strong and capable leadership team, focused on ensuring the people who use the service, and their families, receive the best care and treatment as possible. It was clear that leaders understood the priorities and challenges faced by the trust and they were focused on addressing these.
“We saw several examples of notable practice, such as a trust-wide commitment to become an anti-racist organisation, although more still needs to be done to ensure that black, Asian and minority ethnic staff don’t experience bullying and harassment from patients, carers and the public.
“Throughout the trust, staff demonstrated a passion for delivering high quality care to patients and most staff said they felt proud to work for the trust. However, some staff said they felt there were issues that had not been addressed by the senior team, but they didn’t feel comfortable to raise these concerns with leaders.
“Overall, this is a well-run trust, and maintaining a good quality of care especially set against the backdrop of a pandemic is impressive, however, we did point out some areas where improvements need to be made, including repairs and maintenance needed on some of the wards. We will continue to monitor the service to ensure that these are made.”
Across the trust, inspectors found the following during this inspection:
- Since the last inspection the trust had appointed a new chair and five new non-executive directors, plus a new executive director of nursing, due to start in 2022. The directors provided high quality, effective leadership and showed a high level of awareness of the priorities and challenges facing the trust and how these were being addressed. They also demonstrated an ability to adapt at fast pace during the COVID-19 pandemic and they had responded positively to previous inspection findings
- There were a range of mechanisms in place for identifying, recording and managing risks and issues, and mitigating actions. Individual services maintained their risk registers which were submitted to the trust’s electronic risk management system. All staff had access to the risk register and were able to escalate concerns when required. Staff concerns matched those on the risk register
- Patients told us that staff treated them with compassion and kindness. They said that staff respected patients’ privacy and dignity. Patients said staff were attentive, non-judgemental and caring.
Inspectors also found the following example of outstanding practice:
- The trust was in the process of setting up a new engagement council which would enable people who use the service, their carers and members of the public to have their say on how the service is run
- The acute wards for adults and PICU was part of the armed forces network. As part of this, they had looked at things to consider if a veteran was in a mental health setting. They used specially trained staff with the appropriate skills to support veterans and local NHS teams when the veteran was in crisis or was admitted to a mental health inpatient ward. They were also rolling out a training video across the trust
- On the wards for older people with mental health problems, staff used several innovative tools designed to improve the quality of life, care and treatment for patients living with dementia. For example, they used lifelike dolls or soft toy animals to promote feelings of relaxation and pleasure to help people who are withdrawn, distressed or anxious. They also gave patients a playlist of personal music which assisted people living with dementia to connect with the past through songs which held meaning for them. During manual handling training, staff also used an age simulation suit to help increase their awareness of the impairments experienced by older people
- On the forensic inpatient and secure wards, the low secure services were piloting the implementation of the trust’s anti-racism strategy. A number of working groups had been set up to create and embed a culture which would reduce the frequency of black, Asian and minority ethnic staff experiencing racist bullying and harassment from patients and carers.
However:
- Some staff said they were reluctant to raise concerns with senior leadership because of fears of reprisals, or because they felt that their concerns would not receive a response from the senior team
- Although the trust had a workforce strategy and had recruited some international nurses, trust-wide there were a high number of vacancies with an overall staff vacancy rate of 15% against a target of 11.85%. Staff retention rates had declined across 2021 reaching 81.8% against a target of 87.3%
- The trust had an explicit commitment to equality and inclusion however, workforce racial equality data showed an increasing amount of racial bullying and harassment was experienced by black, Asian and minority ethnic staff. This had increased from 35.6% in 2017 to 42.9%
- Some essential maintenance, refurbishment and repair work was needed across several core services. However, the trust leaders were aware of this and were taking action
- On Jasmine ward, some patients said that they did not always feel stimulated or engaged. Intermittent patient observations were not always carried out in line with the trust policy, and there was no clear evidence that patients were involved in their care planning
- Some patients were happy with the food provided, however others said food portions were small and not of good quality. Food preparation was carried out by ward nursing staff which had a significant impact on their clinical time.
Full details of the inspection are given in the report published on our website.
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