Kent and Medway NHS and Social Care Partnership Trust

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed three quality statements in the safe key question. We found an open culture where concerns related to patients accessing the community were being managed and patients felt safe on the wards. There was good evidence of clinical governance happening and lessons learned being shared with the staff in a timely manner. Patients and staff felt there were suitable numbers of staff and that they were able to manage the patients safely within the numbers allocated by the trust. However improvements were required to ensure that patients were fully informed of their right to raise concerns and complaints.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients felt that staff were interested in their care but did not routinely explain what their care plans meant to them. The wards participated in the provider’s restrictive interventions reduction programme, which met best practice standards, this meant that the patients did not feel they were exposed to unnecessary restrictions. Levels of restrictive interventions were reported by patients to be low and reducing. Patients told us that staff avoided using restraint by using de-escalation techniques and restrained patients only when these failed and when necessary to keep the patient or others safe. People felt supported to raise concerns and felt staff treated them with compassion and understanding.

Staff understood the Mental Capacity Act definition of restraint and worked within it. Staff followed NICE guidance when using rapid tranquilisation Staff followed best practice, including guidance in the Mental Health Act Code of Practice, if a patient was put in long-term segregation. Learning was becoming embedded in relation to the use of section 17 leave at Littlebrook. We found good systems in place to record section 17 leave arrangements for patients leaving the ward and for informal patients there were good systems in place to ensure that nurses had a discussion with them prior to them leaving the ward. This meant that time off the ward for patients was being managed safely. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues. Staff felt there was an open culture, and that safety was a priority.

Quality improvement plans had been developed in order to address the areas of concern identified from serious incidents that have occurred on Amberwood and Cherrywood ward since January 2024. There was evidence that the provider had taken action following the serious incidents on the wards we inspected, to embed learning and make improvements. The wards had Clinical Risk Assessment and Suicide Prevention Training which showed that there was training to support evidence of learning from incidents and that this was being discussed at ward level. We found examples of how learning was being shared following investigations of safety events, these also demonstrated cross-organisational learning. Acute directorate learning bulletins were being disseminated to all wards to share with staff. There were examples of identified early learning being reviewed weekly from reviewing incidents on an IT system called InPhase that were discussed at the trust wide serious incident and mortality panel.

Overall patients told us they were confident in the staff team and the ward managers and the team’s ability to keep them safe. Patients told us they were not always getting information on admission to help orientate them to the ward environment. When we looked, the patient handbook was out of date. We were told this is something which is in the process of being updated. Although the wards had a board that identified who was on shift, patients were not aware who to go to on a daily basis to express their thoughts and concerns which meant that sometimes they felt unsupported. We found inconsistent information on how to complain about care on the ward. We found little information on how to contact advocacy services on the wards, there were some details on Cherrywood but none on Amberwood. The organisation had the information available for patients, however a recent patient on Amberwood had removed the board and this was in the process of being refitted.

Although most clinical notes were stored electronically, the wards used a combination of electronic and paper records to record daily observations, community access forms and physical healthcare monitoring, staff made sure they were up-to-date and complete but said this was sometimes a struggle. Records were stored securely on the wards and remained in the office or the clinic room.

There was evidence of safe systems in place. Staff handover meetings covered a range of information related to patients’ care. The trust had ward specific regularly reviewed risk registers, which covered high risk areas and described mitigations to manage the risks. The trust informed us that at the time of the inspection the trust’s acute directorate were reviewing their generic Health and Safety risks, to determine whether these needed to be held at individual ward level, or directorate level, and some risks, such as staffing levels, had already been categorised for directorate oversight. Multidisciplinary team meetings and clinical governance meetings were taking place at directorate and ward level, however, they were not always held regularly . However there were a range of meetings taking place, such as quality, transformation and risk meetings. The trust had recently undergone a restructure and as a result a new governance meeting structure was put in place as a framework for each directorate to implement. The trust informed us that the acute directorate have been reviewing their meeting structures and as a result some of the meetings have not been occurring as frequently as planned. This was something the organisation had committed to improving following the restructure of the governance meetings. We saw examples of acute directorate ‘safe’ meetings which were held on a monthly basis, demonstrated that the trust maintained safe systems of care and how safety and risks were monitored and assured.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients felt that staff were always there when they needed them and they had been treated positively with dignity and respect. Patients felt they were able to contact their doctor once a week at ward round and also in between ward rounds if they felt they needed to.

The hospital had enough nursing and support staff to keep patients safe. Staff worked 12 hour shifts and the number of staff was calculated using a staffing ladder which factored in the needs of the patients. Managers told us that sometimes, staffing numbers were affected due to staff sickness, injury or bank staff cancelling shifts. They told us that they would always try and get cover from overtime or bank staff and the wards would always be supported by the ward manager and members of the multidisciplinary team working on the wards when needed. Staffing levels were reviewed by the senior managers daily at the hospital wide senior management meeting, and where wards had additional staff, they could be used to support wards who needed help. This supported patients to use their leave from the wards when required. The hospital had taken significant steps to fill nursing vacancies using overseas nurses and carried out an offsite induction and on site induction to support their transition. The ward managers could adjust staffing levels according to the needs of the patients. The hospital had enough staff on each shift to carry out any physical interventions safely. In addition, each ward had an allocated response member of staff who remained on the ward and was identified as a responder in the event of an emergency on another ward.

We observed sufficient numbers of staff across both wards. Patients were being spoken with in a dignified manner and it was clear that the staff knew the patients needs well.

Data provided by the Trust suggested that the two wards had enough nursing and support staff to keep patients safe. For Amberwood ward, there were not any vacancies for registered nurses, and there were low vacancies for healthcare assistants. For Cherrywood ward, there were low vacancies for registered nurses, and they were slightly over-recruited with healthcare assistants above the establishment levels to compensate. The staff turnover percentage for Amberwood ward and Cherrywood ward was lower than the overall staff turnover percentage for the trust. There was evidence that the mandatory training programme was comprehensive. Most of staff had completed and kept up to date with their mandatory training. All areas of mandatory training had a 90% target for compliance. Cherrywood Ward had an overall 92% compliance and Amberwood Ward 88%, however, compliance was over 80% for the vast majority of the 44 mandatory training courses. Managers monitored mandatory training and alerted staff when they needed to update their training. There were arrangements for medical cover for each ward and arrangements in place to cover any vacancies. All staff were required to have supervision once within a 6-week window, however, staff did not always receive regular supervisions. Data shows that during the last two 6-week windows (22 December 2023 – 02 February 2024 & 03 February 2024 – 16 March 2024) only 8.33% and 33.33% of staff received supervisions in Amberwood Ward, and 12.5% and 20.83% of staff received supervisions in Cherrywood Ward.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.