Published in September, the plan builds on more than 200 improvements already made over the past year, including addressing issues behind CQC warning notices.

‘What we're trying to do, or we are doing very differently, is have an improvement plan that is actually going to make sure what we're embedding is truly embedded and that it's making a difference that lasts,' Kirby stressed.

‘It's not something that is going to come back around in six months or a year and we say, "Oh, we had that problem a while ago".'

Based on feedback from patients and families, alongside independent reviews and regulatory inspections, the plan is focused on four key themes: safety and clinical risk; access and waiting; environment and experiences; and leadership and governance.

Safety and clinical risk

‘We've come away from risk stratification and are going into more risk formulations,' Kirby commented. ‘That's been quite a deliberate move by the organisation. It was making sure that we were monitoring not just the compliance because we've seen that go up, but really monitoring the quality of those risk assessments.'

The plan also focuses on improving physical health monitoring, particularly for people coming to depot clinics.

‘That wasn't quite where we wanted it wanted that to be,' Kirby acknowledged.

‘We're almost at 80% of patients receiving full physical health checks, so that's been really significant.'

Reducing self-harm, particularly for women in in-patient wards, is another focus area.

‘We knew that some of our rates of self-harm were quite high in those areas,' Kirby commented.

The trust has looked at improving trauma-informed care and developed its own multi-award winning Minimal Risk Activity Packs, which have reduced self-harm incidents by 64% for female inpatients.

‘This was an idea that was brought to us by one of our OT apprentices who took this to our innovation den which is run by our improvement team,' Kirby explained.

‘It's quite a simple idea. It's a pack that people are given on the ward that has got certain items to offer support. Staff work with them through the pack to minimise the risk of self-harm.'

In addition, the trust's Psychiatric Liaison led Start Afresh project works with people who repeatedly come into A&E departments who self-harm. The team helps ensure people are seen within four hours of attending.

‘We've wanted to really move towards a place that is proactive rather than reactive,' Kirby explained.

‘We don't want to be in a position where we're picking up learning because an incident's happened, or because a regulator has come out or a complaint has come in, we're moving to a place where actually we're starting to notice things ourselves or staff are telling us.'

Access and waiting

‘This was a really significant area for us, partly because we went through a period of time where we saw we saw quite a significant increase in demand,' Kirby noted.

The trust has achieved a 47% reduction in its over 38-week community services waiting list.

As of September, 74% of patients had commenced treatment within 18 weeks of referral.

‘We want that to be 100%,' Kirby added. ‘That's where we're aiming for.'

Kent and Medway Mental Health NHS Trust is also close to eliminating its over 52 week waits in adult services.

‘We're moving to a place when referrals come in, where we're looking at them collectively with our partners in the room as well,' Kirby noted.

‘When they come in, rather than us looking at them and saying, "Oh, I think they might be better served over here," everyone's in the same room and it stops that delay.'

The trust offers a number of support services for mental health patients presenting at A&E, including a mental health helpline, safe haven partnerships run by voluntary organisations and rapid response teams who go out and see people within four hours where necessary.

‘It's also about making sure with our community teams that we know our patients really well, so they can reach out and they can get help and support from the community teams during the day, as and when they need to,' Kirby added.

Environment and experiences

CQC inspection feedback has revealed patients and staff have found the trust's ward environments unwelcoming.

As a result, a decorating programme for all inpatient wards has been completed at Coleman House in Dover. 

‘Our estates teams now work closely with our clinical teams through escalation routes and weekly meetings,' Kirby highlighted.

Leadership and governance

The need for improvements in leadership and governance was highlighted in the CQC's March inspection report which found a culture where some staff didn't feel safe enough to raise issues with management.

‘We're now very visible as an exec team and leadership team,' the acting chief nurse said.

‘We don't have a head office anymore. We hot desk among the teams. We're making deliberate moves to be very approachable, so that we can start to pick up some of these things.

‘One of our trust values is about being curious, and I really encourage that with staff because there's something about if you're in a service, be curious about it.

‘Obviously, there will be learning from patient safety incidents, for example. We will get learning when things don't quite go right, and there's complaints. But we also want to pick up things ahead of time and move to a much more proactive place.'

In addition, Kent and Medway has introduced its Your Experience Matters online survey to regularly gather feedback from patients and carers.

In terms of recruitment and workforce support, the trust has boosted community health team capacity and launched its Doing Well Together improvement programme.

Kirby said the mental health trust had a very close relationship with its universities on nursing and ‘was oversubscribed for newly qualified nurses'.

‘We're about ensuring that when people look to come and work for us, they're looking and they're seeing this is something or somewhere aligned to their values and where they want to work,' the acting chief nurse explained.

‘I came back to the organisation after several years and I feel so aligned and so passionate about the direction we're going.

‘It's a great place to work and we're seeing that because our vacancy rates are going down.'

Summing up the plan, Kirby concluded: ‘It's for every single person in the organisation and about making our services and experiences for our patients, carers and families  the best we can make them.'