Community adult mental health services in Kent and Medway rated as Requires Improvement

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Adult mental health services in the community run by the Kent and Medway NHS and Social Care Partnership Trust have been rated as requires improvement following an inspection.

The Care Quality Commission (CQC) has also rated the service as Requires Improvement in relation to whether it was safe and well-led. It was previously rated Good.

This does not impact the overall rating of the trust, which remains Good overall.

CQC carried out an unannounced focused inspection of the community-based mental health services in November, after receiving concerns about the quality of the service, which could result in a risk to patient safety.

Inspectors visited four of the trust’s community services teams: South West Kent; Dartford, Gravesend and Swanley; South Kent Coast and Medway.

These teams provide specialist community based mental health services and work with people at the team base, in satellite locations and in patients’ homes. They support patients with complex mental health needs and provide recovery focused treatment, including psychological therapy.

Karen Bennet-Wilson, CQC’s head of hospital inspection for mental health, said: “Although the teams worked well at a local level, and staff morale and culture was positive and supportive, we told Kent and Medway NHS and Social Care Partnership Trust that it must improve the overall governance of its service in order to deliver better care to people.

“Specifically, it must ensure it has the right number of staff in each team to enable them to provide safe and effective care to patients. It must also ensure that patients’ risk assessments are updated and that all patients have risk management plans in place.

“This includes patients having a crisis plan that has been developed with them and, where relevant, their carer, so that staff know how to respond quickly in a crisis situation. The trust must also ensure that patients are assessed and receive the treatment they need without extended delay, and within the agreed target times.

“We told the trust that it must send CQC a report saying what action it will take to make these improvements and we will continue to monitor the service to ensure that these are implemented and fully embedded.”

The rating changed for the following reasons:

Trust governance processes did not always ensure that key issues in the teams were picked up and addressed in a timely manner.

Across all the teams, staff did not manage risk well. Risk management plans were basic and crisis plans were not always completed or lacked detail.

Some types of treatment were not available because there were not enough staff to learn how to provide the treatment and then deliver it. This meant that people with complex mental health needs were left waiting to receive the care they needed.

Only 75% of patients received an initial assessment within the agreed four-week timeframe, when the trust target is 95%.

Patients who did not need urgent care had to wait for some time for their treatment to start. Some patients on the trust’s ‘Active Review List’ were waiting for over six, or even 12 months.

However, inspectors reported that patients who required urgent care were treated promptly and that staff were monitoring waiting lists well to ensure that those who required urgent care were seen as soon as possible.

Helen Greatorex, KMPT Chief Executive said, “We will be reviewing the CQC report on the inspection of our community mental health teams (CMHTs) in detail over the coming weeks and will address the issues and concerns raised to ensure we implement the improvements identified.

“We fully acknowledge we have more work to do, however our ongoing improvement plans are already starting to address the key points raised in the report. For example, we are nearing the end of a programme to enhance the therapies our CMHTs provide, which will in turn help to address waiting times for treatment.

“In addition, we regularly and routinely audit patient records and risk management plans to identify areas for improvement. We have systems in place to monitor staffing levels and staff workloads so issues can be quickly addressed.

“I would also like to take this opportunity to thank our staff for their ongoing hard work and commitment.

“I assure all those who rely on our services that we will continue to work to provide them with the best possible care. Our primary concern is always to provide safe, high quality and compassionate care to our patients, and this remains our key priority.”

Kent and Medway NHS and Social Care Partnership Trust has 10 community mental health teams (CMHT) for adults and runs sites including The Beacon off Manston Road, which was not one of the areas inspected. Multidisciplinary teams of health care professionals at the trust include psychiatrists, psychiatric nurses, psychologists, occupational therapists and support workers.

CQC is also currently running a campaign called ‘Because we all care’ and is particularly keen to hear the experiences of unpaid carers who provide care and support to people. This could be in care homes, hospitals or at home. You can read more about the campaign here.