Kent and Medway NHS and Social Care Partnership Trust

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• 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

We assessed two quality statements from this key question in relation to the concerns that had been raised prior to the assessment. Our rating of this key question was good. Staff on the wards were suitably trained and supported to perform their roles. Supervision was an area that required improvement but the local management of the service already had a plan to improve this which was under continuous review. Quality improvement projects and improvement plans were in place and the direction of change was improving the care and treatment on the wards.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Leaders and managers supported staff, and staff were clear on their individual roles and responsibilities. Managers met with staff on an ad hoc basis and through staff meetings regularly. Issues of concern around arrangements for patients to leave the ward were being followed and staff were aware of the processes and felt they were suitable for the safety of the patient group. Team meetings were happening regularly and governance messages from the organisation were being filtered down to the ward staff.

All staff were required to have supervision once within a 6-week window, however, as discussed above, staff did not always receive regular supervisions. The trust informed us that the Directorate has recently faced challenges in conducting supervisions within the designated timelines. This has been particularly evident in many wards undergoing transitions, including the integration of new ward managers and an uptick in staff illness, with Amberwood and Cherrywood notably experiencing a significant impact due to the acuity on the wards. These changes have led to supervisions being deprioritized. To address this issue, the acute directorate were in the process of implementing a new one-to-one supervision initiative. This innovative approach aimed to ensure that supervisions occurred every six weeks, offering a more flexible framework than the current fixed schedule. This initiative was in the final stages of planning and was expected to be implemented shortly, significantly enhancing the trust’s supervision strategy and ensuring ongoing support for staff. Additionally, the trust informed us that they will be focusing their support specifically on the wards that are performing poorly. This targeted approach will enable them to provide more intensive assistance where it is most needed, aiming to elevate the standards of care and operational efficiency across all areas . 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. The trust had a number of clinical audits and service evaluation projects which the wards in the acute directorate were involved with.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Ward managers shared feedback from complaints with staff and learning was used to improve the wards. The service used compliments to learn, celebrate success and improve the quality of care. We saw "you said we did" boards on the wards showing that locally the wards were attempting to move local concerns up to the acute directorate governance team. The trust shared lessons learned bulletins with the wards and the managers discussed these in their ward staff meetings. In February 2024, absence without leave was discussed in the lessons learned shared bulletins. As a result of this, the wards had already implemented systems to ensure rapid tranquilisation was monitored prior to patients taking leave as this had been an outcome of a trust wide lessons learned bulletin. There were regular monthly acute governance team learning bulletins available for staff to review and these were addressed in the staff meetings.

A quality improvement plan had been developed in order to address the areas of concern identified from serious incidents that had occurred on Amberwood and Cherrywood ward since January 2024. This is evidence that the provider has taken action following the serious incidents on the wards we inspected, to embed learning and make improvements. The trust conducted annual staff surveys to gather staff views for continuous improvement. They had set up a multi-agency interface and collaborative working group in January 2024 to improve better working relationships with staff in response to the staff survey results for 2023. Local staff teams were also involved in identifying areas of improvement and corresponding action plans. The trust gathered the views of patients at ward level and managers were able to review comments and share the positive feedback with staff, and formulated actions to respond to comments which indicated that the patient experience could have been better. The trust told us that friends and family test data posters and ‘You Said We Did’ actions were displayed on notice boards on the wards so that patients can see how their concerns were being taken forward and changes made. Data showed that 51 responses were received for Amberwood ward between April 2023 to February 2024, and 41 of these indicated that patients had received very good or good care. For Cherrywood ward, data showed that 133 responses were received between April 2023 to February 2024, and 93 of these indicated that patients had received very good or good care. The trust had a number of quality improvement projects which the wards in the acute directorate were involved with, such as reducing violence and aggression on the acute inpatient wards by 15% over three years, and a therapeutic interventions project on Amberwood ward aiming to test changes on the implementation of more therapeutic interventions in the evenings and at weekends.