The inspection in March, which rated leadership requires improvement, found a culture where some staff don't feel safe enough to raise issues to management and ethnic minority groups and disabled staff experienced disparities in recruitment, disciplinary processes and workplace discrimination.

Serena Coleman, CQC's deputy director of mental health in the South, said: ‘When we inspected Kent and Medway Mental Health NHS Trust, we found leaders and staff were committed to improving the care they provided, but we found significant concerns about the trust's management arrangements which meant people weren't always protected from the risk of poor care.'

A quarter of staff who contacted a Freedom to Speak up Guardian did so out of a fear of reprisals and the CQC found staff remained significantly overrepresented at board level compared with the wider workforce.

The report also found ‘family and carers weren't always involved in a meaningful way'.

Sheila Stenson, chief executive, said: ‘A lot has improved since the CQC visited us in March; progress has been made. But I'm not complacent and know there is more to do to strengthen our culture, so colleagues feel safe and supported to speak up, and to ensure patients, families and loved ones are more consistently involved in their care and in how we improve services. What matters now is making sure those improvements are embedded and are felt consistently by our patients, families and colleagues.

‘The CQC report recognises that we understand our challenges, that we're making progress and that there are many strengths across our trust, from excellent partnership working to strong innovation and research. That gives me confidence that we know what needs to change and that we are moving in the right direction.'