KENT Ambulance NHS is lacking in systems to ensure good quality patient care, according to a report published by the independent Commission for Health Improvement.

The CHI says the former NHS regional office's embargo on the trust recruiting to senior positions until September last year put pressure on the organisation's management capacity.

The management had also focused on achieving national targets rather than developing the systems to ensure the continual improvement of patient care.

The CHI says that systems for managing risks need to be improved. It has specific concerns about the trust's lack of robust infection control procedures, which need to be revised and monitored as a matter of urgency.

The inspection found staff were concerned that they do not always have time to clean ambulances thoroughly and not all clinical waste was properly disposed of in the ambulance stations visited by CHI.

The report says staff feel distant from the decision-making process and internal communication is poor. Furthermore not all staff feel they work in a just and fair culture.

However, the report, which follows a detailed inspection, says trust staff are committed to providing the best possible care for patients.

It says staff treat patients with respect, explain what is happening to them and move them in a caring and supportive way.

The CHI also found examples of good practice, notably the support services offered to its staff which include a dedicated chaplaincy service. The trust also provides occupational health, fast access to physiotherapy, chiropractor and osteopathy services and a counselling service.

Peter Homa, the chief executive of CHI, said: "The senior management of Kent Ambulance NHS trust has been under strain over the past few years, but its new executive team is committed to clinical governance and improving their services."

He added: "Kent Ambulance NHS Trust already provides good pastoral support to its staff, but it needs to match their dedication to patient care with a commitment to involving them in the decision-making process. The trust is producing an action plan in response to this report and the strategic health authority will monitor its progress."

The trust's chief executive Hayden Newton said: "We enjoyed the CHI process. The timing could not have been better in terms of the service now getting a full executive team in post. We found the report provided by CHI to be honest, helpful and constructive."