BARNET, ENFIELD AND HARINGEY MENTAL HEALTH NHS TRUST 2023

St Ann’s Hospital

St Ann’s Road

London, N15 3TH

Tel: 020 8702 3000

FOI Ref. No: 614
12 November 2024

Re: Your request under Freedom of Information Act 2000

Dear Requestor,

I am writing in respect of your recent request for information to Barnet, Enfield and Haringey Mental Health NHS Trust under the provisions of the Freedom of Information Act (FOIA) 2000.

We have considered your request under section 1(1) of the FOIA which entitles you to be provided with any information held by a public authority, unless an appropriate exemption applies. Accordingly, we have answered your request in the order raised.

Please find below your request followed by our response

Please provide Electro Convulsive Treatment (ECT) information under the FOI act to the following questions: -

We collect data on ethnicity in line with NHS Digital protocols here https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/submit-data/data-quality-of-protected-characteristics-and-other-vulnerable-groups/ethnicity. Ethnicity data for employees is self-reported on our ESR and recruitment systems, from the national presets which are in line with Census groups here 2021 census results: Ethnic groups in your constituency (parliament.uk).

Our grouping of ethnicities for reporting depends on the collection framework we are using. For example, in the NHS Workforce Race Equality Standard, we use NHS England reporting requirements which are already in the public domain here https://www.england.nhs.uk/wp-content/uploads/2017/03/wres-technical-guidance-2019-v2.pdf (S.7).

1.Please supply patient’s information ECT leaflet

2.Please supply patient ECT consent form

3.Please supply any ECT reports/investigations

The Trust are withholding this information under Section 40(1) (Personal Data) of the Act because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act and s.40(2) FOIA.

4.How many ECT in 2023?

2022-2023 – 369

2023-2024 – 311

5.What proportion of patients were men/women?

Gender	Total
Female	237
Male	100
Grand Total	337

6.How old were they?

Age	Total
18-25	4
26-35	62
36-45	41
46-55	49
56-65	52
65+	129
Grand Total	337

7.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?

BAME	Total
BAME	126
Unknown	10
White	201
Grand Total	337

8.How many people covered by the equality act received ECT ?

None

9.How many people were offered talking therapy prior to ECT ?

We do not keep track of this information.

10.How many were receiving ECT for the first time?

11.How many patients consented to ECT?

A further exemption is applicable where the processing of confidential patient records engages exemption section 40(3)(a) a contravention of any of the data protection principles. In this situation the Trust would need to access individual patient records to establish whether the patient had received ECT treatment for the first time this contravenes the principle of fair & lawful processing of patient records (which are maintained and held for the purpose of direct patient care).

12.How many ECT complaints were investigated outside the NHS and CCG?

13.How many patients died during or 1 month after ECT and what was the cause (whether or not ECT was considered the cause)?

14.How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)?

15.How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)?

16.How many patients have suffered complications during and after ECT and what were those complications?

17.Have there been any formal complaints from patients/relatives about ECT?

18.If so, what was their concerns?

N/A

19.How many patients report memory loss/loss of cognitive function?

20.What tests are used to assess memory loss/loss of cognitive function?

We would be using the ACE III if ever this is any issue is raised.

21.Have MRI or CT scans been used before and after ECT?

N/A

22.If so, what was the conclusion?

N/A

23.How does the Trust plan to prevent ECT in the future?

N/A

Please provide restraints information under the FOI act to the following questions: -

1.Please supply any Restraints/investigations

2.How many RESTRAINTS in 2023?

823

3.What proportion of patients were men/women?

Female = 105 (33.55%)

Male = 208 (66.45%)

4.How old were they?

*Under 18 Years*	23
*18-29 Years*	*115*
*30-39 Years*	75
*40-49 Years*	49
*50-59 Years*	29
*60-69 Years*	18
*70-79 Years*	2
*80-89 Years*	2

5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?

181 (57.82%)

6.How many people covered by the equality act were restrained?

313

7.How many RESTRAINTS were investigated outside the NHS and CCG? 0

8.How many patients died during or 1 month after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)? 0

9.How many patients died within 6 months after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)? 0

10.How many patients died by suicide within 6 months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)? 1

11.How many patients have suffered complications during and after RESTRAINTS and what were those complications? 8 instances of patient injury during restraint were reported.

12.Have there been any formal complaints from patients/relatives about RESTRAINTS?

13.If so, what was their concerns?

N/A

14.Are counts of forced injections available?

Yes

15.How does the Trust plan to reduce restraints in the future?

The Trust have robust governance processes in place to ensure that incidents of restraint and Seclusion are reviewed at a divisional and organisational level, this is to ensure that when used they are necessary and proportionate and are within the legal frameworks set put in our PMVA and Seclusion policies. Any changes in trends are reviewed and actions put in place.

A weekly Safety Huddle occurs across the Partnership/Trust chaired by the Chief nurse or nominated deputy where senior staff present data for example: complaints, mandatory training, incidents and identify an patterns or themes arising alongside an action plan.

We have experts by experience working in each division to ensure that the patient voice is at the centre of our work to reduce restrictive practices across the organisation.

Divisions have Quality Improvement projects to reduce the use of Restrictive practice e.g Coral Ward have structured Seclusion debriefs led by ward psychologist to support patients to process what has happened to them, they also meet with staff to understand what has lead to the Seclusion. This supports the teams to understand what drives seclusion practice.

The new Nurse Consultant for patient safety will regularly review patients who are subject to seclusion or high levels of restraint, they are also commencing Seclusion Review Group work across the divisions to support teams to understand their own seclusion practice, to put in change ideas that improve patient experience with a long-term goal to reduce the use.

All inpatient staff attend PMVA training which focuses on Trauma informed approach, verbal de-escalation as well as teaching prescribed holds to be used as a last resort.

There is good oversite of Restrictive practice use in the positive and safe meeting, we have just reviewed our Seclusion and Restraint policy to ensure it reflects the current practices across the organisation.

There is continued collaboration between teams to reduce Restrictive practice, alongside the Brilliant Basic work: safety as standard

Please provide SECLUSION information under the FOI act to the following questions: -

1.Please supply any SECLUSION reports/investigations

2.How many SECLUSIONS in 2023?

357

3.What proportion of patients were men/women?

Female = 56 (25.34%)

Male = 165 (74.66%)

4.How old were they?

Under 18 Years	3
18-29 Years	91
30-39 Years	63
40-49 Years	41
50-59 Years	15
60-69 Years	8

5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?

137 (61.99%)

6.How many people covered by the Equality Act were secluded ?

221

7.How many SECLUSIONS were investigated outside the NHS and CCG? 0

8.How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)? 0

9.How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)? 0

10.How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)? 0

11.How many patients have suffered complications during and after SECLUSION and what were those complications? 0

12.Have there been any formal complaints from patients/relatives about SECLUSION?

13.If so, what was their concerns?

n/a

14.How does the Trust plan to reduce SECLUSIONS in the future?

We have experts by experience working in each division to ensure that the patient voice is at the centre of our work to reduce restrictive practices across the organisation.

All inpatient staff attend PMVA training which focuses on Trauma informed approach, verbal de-escalation as well as teaching prescribed holds to be used as a last resort.

There is continued collaboration between teams to reduce Restrictive practice, alongside the Brilliant Basic work: safety as standard

Please provide MEDICATION ERRORS information under the FOI act to the following questions: - Please supply any MEDICATION ERRORS reports/investigations

2.How many MEDICATION ERRORS in 2023?

126

3.What proportion of patients were men/women?

Female = 38 (33.93%)

Male = 74 (66.07%)

4.How old were they?

Under 18 Years	4
18-29 Years	12
30-39 Years	24
40-49 Years	14
50-59 Years	28
60-69 Years	20
70-79 Years	6
80-89 Years	3
90-99 Years	1

5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?

54 (48.21%)

6.How many people covered by the equality act endured medication errors ?

112

7.How many MEDICATION ERRORS were investigated outside the NHS and CCG? 0

8.How many patients died during or 1 month after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)? 0

9.How many patients died within 6 months after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)? 0

10.How many patients died by suicide within 6 months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)? 0

11.How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications? 6 instances reported. Complications reported include pain at site on injection, worsening withdrawal symptoms, self harm attempt, adverse reaction at site of injection, medication titration required, seizure.

12.Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?

13.If so, what was their concerns?

N/A

14.How does the Trust plan to prevent MEDICATION ERRORS in the future?

We are completing our roll out of an electronic prescription and medicine administration solution (ePMA)- this system is proven to reduce the number and severity of medicine administration and prescribing related incidents.

Further work and integration of the medicine safety systems to improve consistency in medicine incidents management across the Trust.
Further collaborative work in improving medicine and patient safety across NCL ICB and wider nationally.
Further collaborative work with the ePMA team to ensure mitigation of medicine safety risks identified.
Continuing collaborative work across the partnership and NCL regarding safe valproate management.
Work with the CD-LIN - (controlled drugs local intelligence network) to ensure that controlled drugs are used safely in the Trust
Further work and integration of the medicine safety systems to improve consistency in medicine incidents management across the Trust and SLA partners

Partnership Medicines Safety Group bi- monthly; medication incidents and thematic reviews highlighted and actions required discussed; Medication incident themes shared within Medicines Safety Notices/ Medicines newsletter trust wide

Conditions of use

Any information supplied to you is free to use for your own purposes, including any non-commercial research you are doing and for the purposes of news reporting. Any other re-use, for example commercial publication and subscription charge, would require the permission of the Trust.

Our copyright and database right material is licensed for use and re-use under the Open Government Licence (OGL). You can view the licence online, or write to: Information Policy Team, The National Archives, Kew, Richmond, Surrey TW9 4DU

We hope you are satisfied with the way in which your request was handled, if not you may request an internal review by writing to the Information Governance Team at the address shown at the top of this letter or by email to: beh-tr.foi@nhs.net within 40 days of this letter. When contacting the Trust please quote the above reference that is unique to your request.

Requests for an internal review should be made within 40 working days from the date of this response to beh-tr.foi@nhs.net, please note we are not obligated to accept internal reviews after this date.

If you remain dissatisfied with the Trust’s response you may write to:

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Kind regards,

Information Governance Team