Dear Wendy
Freedom of Information Request 029
Thank you for your request for information which we received on 15th April 2024. We contacted you on 29 April 2024 where we asked the following:
With regards to FOI requests, the Trust endeavours to provide as much information that it holds, within the appropriate time limit of 18 hours set for NHS organisations under Section 12 of the FOI Act.
The Trust may be able to provide advice and assistance to requesters on how the scope of a request can be narrowed down in these instances, and I note the questions you have asked this year are identical to those that you requested in 2023 (reference FOI 035) - with the additional questions:
Electro Convulsive Treatment (ECT):
8.How many people covered by the equality act received ECT ?
9.How many people were offered talking therapy prior to ECT ?
10.How many were receiving ECT for the first time?
Restraints :
6.How many people covered by the equality act were restrained?
SECLUSION:
6.How many people covered by the Equality Act were secluded ?
We believe we can provide the answers to the same questions we responded to in 2023 within the time limit set under Section 12 of the FOI Act.
However, we would like to offer you the opportunity to specify the information included within your request which is of the most importance to you to receive.
Would you please specify the information that is of most importance for you to receive from your original request, outlined in your email below.
We note that you did not respond to our requests for you to specify the information included within your request which is of the most importance. Therefore, we have answered your questions below to the best of our ability within the time exemption outlined in Section 12(1) of the Freedom of Information Act.
Our answer to your questions is as follows:
ECT:
1. Please supply patient’s information ECT leaflet
2. Please supply patient ECT consent form
3. Please supply any ECT reports/investigations
4. How many ECT in 2023?
5. What proportion of patients were men/women?
6. How old were they?
7. What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
8. How many people covered by the equality act received ECT ?
9. How many people were offered talking therapy prior to ECT ?
10. How many were receiving ECT for the first time?
11. How many patients consented to ECT?
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?
19. How many patients report memory loss/loss of cognitive function?
20. What tests are used to assess memory loss/loss of cognitive function?
21. Have MRI or CT scans been used before and after ECT?
22. If so, what was the conclusion?
23. How does the Trust plan to prevent ECT in the future?
Restraints:
24. Please supply any Restraints/investigations How many RESTRAINTS in 2023?
25. What proportion of patients were men/women?
26. How old were they?
27. What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
28. How many people covered by the equality act were restrained?
29. How many RESTRAINTS were investigated outside the NHS and CCG?
30. How many patients died during or 1 month after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?
31. How many patients died within 6 months after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?
32. How many patients died by suicide within 6 months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)?
33. How many patients have suffered complications during and after RESTRAINTS and what were those complications?
34. Have there been any formal complaints from patients/relatives about RESTRAINTS?
35. If so, what was their concerns?
36. Are counts of forced injections available?
37. How does the Trust plan to reduce restraints in the future?
Seclusion:
38. Please supply any SECLUSION reports/investigations. How many SECLUSIONS in 2023?
39. What proportion of patients were men/women?
40. How old were they?
41. What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
42. How many people covered by the Equality Act were secluded ?
43. How many SECLUSIONS were investigated outside the NHS and CCG?
44. How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
45. How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
46. How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
47. How many patients have suffered complications during and after SECLUSION and what were those complications?
48. Have there been any formal complaints from patients/relatives about SECLUSION?
49. If so, what was their concerns?
50. How does the Trust plan to reduce SECLUSIONS in the future?
Medication Errors:
51. Please supply any MEDICATION ERRORS reports/investigations How many MEDICATION ERRORS in 2023?
52. What proportion of patients were men/women?
53. How old were they?
54. What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
55. How many people covered by the equality act endured medication errors ?
56. How many MEDICATION ERRORS were investigated outside the NHS and CCG?
57. 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)?
58. How many patients died within 6 months after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)?
59. How many patients died by suicide within 6 months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)?
60. How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?
61. Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
62. If so, what was their concerns?
63. How does the Trust plan to prevent MEDICATION ERRORS in the future?
Below we have listed how much time we have taken to respond to your request:
Team Time spent (hours & mins) Total in minutes
Freedom of Information 6 hours 360
Executive Office 3 hours 180
Specialist Risk Information Analyst 30 mins 30
Datix Support and Risk Information 4hrs 30 mins 270
Complaints 30 mins 30
ECT 2hrs 120
Pharmacy 1 hour 60
Mental Health Inpatients 30 mins 30
Total time spent 1080
We have outlined below the estimation from our team on how this time is broken up:
Team Determine if they hold the information Find the information Retrieve the information Extract the information Total time
Freedom of Information 0 minutes 1.5 hours 2 hours 2.5 hours 6 hours
Executive Office 0 minutes 1 hour 1 hour 1 hour 3 hours
Datix Support and Risk Information 30 minutes 120 minutes 90 minutes 60 minutes 5 hours
ECT 30 minutes 15 minutes 45 minutes 30 minutes 2 hours
Pharmacy 5 minutes 15 minutes 20 minutes 20 minutes 60 minutes
Complaints 5 minutes 5 minutes 10 minutes 10 minutes 30 minutes
Mental Health Inpatients 0 minutes 5 minutes 5 minutes 20 minutes 30 minutes
To answer the remainder of your questions, we have outlined below the additional hours this would require:
Seclusions
The Trust recorded a total of 158 seclusions reported in 2023. Therefore, to answer the questions relating to seclusion, our team would need to manually review each incident report and locate the corresponding patient within our patient record system, Rio. They would need to review the notes in detail to be able to locate information on the patients’ gender, age, ethnicity (where the incident report is listed as ‘other’ or ‘not stated’, or not recorded at all), whether the patient had died following the incident report and protected characteristics in relation to the equality act. We estimate it would take 5 minutes per topic, meaning it would take a minimum of 40 minutes per set of notes to review, making a total of 6,320 minutes or 105 hours and 20 minutes.
The breakdown of time would be as follows:
• 105.33333 (approx.) hours @ £25 = £2,633.33
Restraints
The Trust recorded a total of 773 restraints reported in 2023. Therefore, to answer the questions relating to restraints, our team would need to manually review each incident report and locate the corresponding patient within our patient record system, Rio. They would need to review the notes in detail to be able to locate information on the patients’ gender, age, ethnicity (where the incident report is listed as ‘other’ or ‘not stated’, or not recorded at all), whether the patient had died following the incident report and protected characteristics in relation to the equality act. We estimate it would take 6 minutes per topic, meaning it would take a minimum of 42 minutes per set of notes to review, making a total of 32,466 minutes, or 541 hours and 6 minutes.
The breakdown of time would be as follows:
• 541.1(approx.) hours @ £25 = £13,527.50
Medication Errors
The Trust recorded a total of 89 medication errors in 2023. Therefore, to answer the questions relating to medication errors effecting patients, our team would need to manually review each incident report and locate the corresponding patient within our patient record system, Rio. They would need to review the notes in detail to be able to locate information on the patients’ gender and ethnicity (where the incident report is listed as ‘other’ or ‘not stated’, or not recorded at all), whether the patient had died following the incident report and any protected characteristics in relation to the equality act. We estimate it would take 7 minutes per topic, meaning it would take a minimum of 30 minutes per set of notes to review, making a total of 2,670 minutes, or 44 hours and 30 minutes.
The breakdown of time would be as follows:
• 44.5 (approx.) hours @ £25 = £1,112.50
ECT
The Trust recorded a total of 297 ECT sessions in 2023. Therefore, to answer the questions relating to ECT effecting patients, our team would need to manually review each incident report and locate the corresponding patient within our patient record system, Rio. They would need to review the notes in detail to be able to locate information on had the patient been offered talking therapies prior to ECT and any protected characteristics in relation to the equality act We estimate it would take 5 minutes per topic, meaning it would take a minimum of 10 minutes per set of notes to review, making a total of 2,970 minutes, or 49 hours and 30 minutes.
The breakdown of time would be as follows:
• 49.5 (approx.) hours @ £25 = £1,237.50
Therefore with 158 seclusions, 773 restraints and 89 medication errors and 297 ECT sessions, the breakdown to fully answer this FOI request is listed below:
• Seclusions: 97.16667(approx.) hours @ £25 = £2,633.33
• Restraints: 450.91667 (approx.) hours @ £25 = £13,527.50
• Medication errors: 44.5 (approx.) hours @ £25 = £1,112.50
• ECT: 49.5 (approx.) hours @ £25 = £1,237.50
This means we would require an additional 740 hours and 26 minutes or £18,510.83, to fully answer the questions outline within your FOI request and this significantly exceeds the parameters set out in Section 12(1).
Section 12 of the FOIA states that a public authority is not obliged to comply with a request for information if the authority estimates that the costs of complying with the request would exceed the appropriate limit – 18 hours for a public authority such as the Trust.
When considering whether section 12(1) applies, the authority can only take into account certain costs as set out in the Freedom of Information and Data Protection (Appropriate Limits and Fees) Regulations 2004 (‘the Regulations’). These are set out at Regulation 4(3) and are:
a) determining whether it holds the information,
b) locating the information, or a document which may contain the information,
c) retrieving the information, or a document which may contain the information, and
d) extracting the information from a document containing it.
We hope this response fulfils your request.
Should you not be satisfied with our response, you have a right to complain and request an internal review. You should forward your request tofoi.bht@berkshire.nhs.uk.
In the meantime, if you have any queries then please contact us at the above address.
Yours sincerely
Julie Hill
Company Secretary
ECT
1. Please supply patient’s information ECT leaflet.
We also have access to other language information from the Electroconvulsive Therapy Accreditation Service (ECTAS). The CQC information leaflet is only given to detained patients.
2. Please supply patient ECT consent form
3. Please supply any ECT reports/investigations
Please be advised the Trust does not release details where patients can be identified in line with UK GDPR, and we are withholding this information under Section 40 (1) (Personal Data) of the Act. Section 40(1) is an Absolute Exemption and is therefore not subject to the public interest test.
4. How many ECT in 2023?
There were 297 ECT sessions.
5. What proportion of patients were men/women?
• 40.91% Male
• 59.9% Female
6. How old were they?
• 14.47% aged 19-50 years
• 18.22% aged 51-64 years
• 67.21% aged over 65
7. What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
• BAME: 18%
• White: 77%
• Other: <5
8. How many people covered by the equality act received ECT ?
As we do not have this information readily available in a format you have requested, for us to manually search our files would be in excess of the appropriate limit set for NHS organisations of £450 under Section 12 of the Act. This represents the estimated cost of one person spending 18 hours locating, retrieving, and extracting and collating the information (where it exists). Section 12(1) is an Absolute Exemption and is therefore not subject to the public interest test.
9. How many people were offered talking therapy prior to ECT ?
As we do not have this information readily available in a format you have requested, for us to manually search our files would be in excess of the appropriate limit set for NHS organisations of £450 under Section 12 of the Act. This represents the estimated cost of one person spending 18 hours locating, retrieving and extracting and collating the information (where it exists). Section 12(1) is an Absolute Exemption and is therefore not subject to the public interest test.
10. How many were receiving ECT for the first time?
There were 12 patients who received ECT for the first time.
11. How many patients consented to ECT?
100% of patients with capacity
12. How many ECT complaints were investigated outside the NHS and CCG?
None
13. How many patients died during or 1 month after ECT and what was the cause (whether or not CT was considered the cause)?
0 recorded deaths within in 1 month of last ECT Treatment.
14. How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)?
One patient died 8 weeks after ECT – cause of death recorded as suicide.
One patient died 10 weeks after ECT – cause of death recorded as sepsis.
15. How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)?
As noted in Question 14 there was 1 patient death by suicide.
16. How many patients have suffered complications during and after ECT and what were those complications?
0
17. Have there been any formal complaints from patients/relatives about ECT?
No complaints received.
18. If so, what was their concerns?
Not applicable
19. How many patients report memory loss/loss of cognitive function?
This is addressed individually and would require a manual search through individual patient records.
As we do not have this information readily available in a format you have requested, for us to manually search our files would be in excess of the appropriate limit set for NHS organisations of £450 under Section 12 of the Act. This represents the estimated cost of one person spending 18 hours locating, retrieving and extracting and collating the information (where it exists). Section 12(1) is an Absolute Exemption and is therefore not subject to the public interest test.
20. What tests are used to assess memory loss/loss of cognitive function?
Six Item Cognitive Impairment Test (6CIT).
21. Have MRI or CT scans been used before and after ECT?
No
22. If so, what was the conclusion?
Not applicable
23. How does the Trust plan to prevent ECT in the future?
Not applicable
Medication Errors
1. Please supply any MEDICATION ERRORS reports/investigations
Please be advised the Trust does not release details where patients can be identified in line with UK GDPR, and we are withholding this information under Section 40 (1) (Personal Data) of the Act. Section 40(1) is an Absolute Exemption and is therefore not subject to the public interest test.
2. How many MEDICATION ERRORS in 2023?
There were 89 medication errors reported across the Trust.
3. What proportion of patients were men/women?
• Female: 40
• Male: 36
Please note, there are some incident reports which do not have the patients gender listed. Therefore, we are not able to provide a breakdown for these patients without completing a manual search through individual patient records.
4. How old were they?
• 13-17 years <5
• 18-20 years <5
• 21-25 years <5
• 26-30 years <5
• 31-35 years <5
• 36-40 years <5
• 41-50 years <5
• 51-60 years 7
• 61-70 years 16
• 71 and over years 25
With very small numbers of cases (<5) and we believe that providing this information could lead to the identification of individuals as patients of our service and so we are withholding this information under Section 40(2) of the FOI Act.
5. What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
• White: 58
• BAME: 13
• Not stated/ unknown: 5
Please note, there are some incident reports which do not have the patients ethnicity listed. Therefore, we are not able to provide a breakdown for these patients without completing a manual search through individual patient records.
6. How many people covered by the equality act endured medication errors ?
As we do not have this information readily available in a format you have requested, for us to manually search our files would be in excess of the appropriate limit set for NHS organisations of £450 under Section 12 of the Act. This represents the estimated cost of one person spending 18 hours locating, retrieving and extracting and collating the information (where it exists). Section 12(1) is an Absolute Exemption and is therefore not subject to the public interest test.
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)?
This information would require a manual search through individual patient records.
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)?
This information would require a manual search through individual patient records.
10. How many patients died by suicide within 6 months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)?
This information would require a manual search through individual patient records.
11. How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?
0.
12. Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
0.
13. If so, what was their concerns?
N/A.
14. How does the Trust plan to prevent MEDICATION ERRORS in the future?
The Trust will continue to reduce medication errors by:
• Encourage more reporting of errors and more importantly near misses.
• Promote a just culture.
• Continue to invest in multidisciplinary Medication Safety Officers who review reported errors and disseminate relevant learning from local, national and international sources.
• Continue to support the Medication Safety Group who monitor for trends and patterns and review action plans from reported medication errors.
• Continue to promote local learning from using learning from medication errors and associated learning materials.
• Continue to promote standardisation and simplification of medication processes.
• Contribute to 2 ICS medication safety groups to share learning and work together to reduce errors.
Restraints
1. Please supply any Restraints/investigations?
Please be advised the Trust does not release details where patients can be identified in line with UK GDPR, and we are withholding this information under Section 40 (1) (Personal Data) of the Act. Section 40(1) is an Absolute Exemption and is therefore not subject to the public interest test.
2. How many RESTRAINTS in 2023?
Within our mental health inpatient division, we recorded 773 restraints. This includes mental health inpatients and learning disabilities inpatients. Please note this data includes a range of interventions ranging from guiding a patient using minimal force to another area of a ward, to full restraint.
3. What proportion of patients were men/women?
Mental health inpatients Learning disability inpatients
Female: 399 Female: 26
Male: 269 Male: 31
Please note, the figures above are for the total number of restraints rather than the number of individual patients. There are some incident reports which do not have the patients gender listed. Therefore, we are not able to provide a breakdown for these patients without completing a manual search through individual patient records. The figures are based on the number of people who have experienced a restraint.
4. How old were they?
Mental health inpatients Learning disability inpatients
• 13-17 years 9
• 18-20 years 26
• 21-25 years 110
• 26-30 years 74
• 31-35 years 57
• 36-40 years 68
• 41-50 years 107
• 51-60 years 48
• 61-70 years 95
• 71 and over years 68 • 21-25 years 10
• 26-30 years 11
• 31-35 years 21
• 36-40 years 9
• 41-50 years 5
Please note, the figures above are for the total number of restraints rather than the number of individual patients. There are some incident reports which do not have the patients age listed. Therefore, we are not able to provide a breakdown for these patients without completing a manual search through individual patient records. The figures are based on the number of people who have experienced a restraint.
5. What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Mental health inpatients Learning disability inpatients
• White: 433
• BAME: 207
• Not stated/ unknown: 27 • White: 38
• BAME: 18
Please note, the figures above are for the total number of restraints rather than the number of individual patients. There are some incident reports which do not have the patients ethnicity listed. Therefore, we are not able to provide a breakdown for these patients without completing a manual search through individual patient records.
6. How many people covered by the equality act were restrained?
As we do not have this information readily available in a format you have requested, for us to manually search our files would be in excess of the appropriate limit set for NHS organisations of £450 under Section 12 of the Act. This represents the estimated cost of one person spending 18 hours locating, retrieving and extracting and collating the information (where it exists). Section 12(1) is an Absolute Exemption and is therefore not subject to the public interest test.
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)?
This information would require a manual search through individual patient records.
9. How many patients died within 6 months after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?
This information would require a manual search through individual patient records.
10. How many patients died by suicide within 6 months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)?
This information would require a manual search through individual patient records.
11. How many patients have suffered complications during and after RESTRAINTS and what were those complications?
This information would require a manual search through individual patient records.
12. Have there been any formal complaints from patients/relatives about RESTRAINTS?
1 complaint received.
13. If so, what was their concerns?
Allegation of unreasonable force during restraint
14. Are counts of forced injections available?
There were 288 intramuscular (IM) injections reported. Please note, this does not mean they were all forced injections, as some patients prefer IM or even request IM.
15. How does the Trust plan to reduce restraints in the future?
We have a dedicated oversight and operational group; this is also a breakthrough objective for the Trust monitored by the board. We have a programme of quality improvement work with dedicated leads focussing on data analysis to inform our work. Patient and advocacy feedback informs the focus. Overall, we have seen a reduction.
Seclusion
16. Please supply any SECLUSION reports/investigations
Please be advised the Trust does not release details where patients can be identified in line with UK GDPR, and we are withholding this information under Section 40 (1) (Personal Data) of the Act. Section 40(1) is an Absolute Exemption and is therefore not subject to the public interest test.
17. How many SECLUSIONS in 2023?
Within our mental health inpatient division (including learning disabilities inpatients), we recorded 158 seclusions.
18. What proportion of patients were men/women?
• Female: 26
• Male: 109
Please note, there are some incident reports which do not have the patients gender listed. Therefore, we are not able to provide a breakdown for these patients without completing a manual search through individual patient records.
19. How old were they?
Mental Health Learning Disabilities
13-17 years <5
18-20 years <5
21-25 years 25
26-30 years 17
31-35 years 15
36-40 years <5
41-50 years 17
51-60 years 14
61-70 years 6
71 and over 10
21-25 years 7
26-30 years <5
31-35 years 7
36-40 years <5
We are unable to provide all of this information as we are dealing with very small numbers of cases (<5) and we believe that providing this information could lead to the identification of individuals as patients of our service and so we are withholding this information under Section 40(2) of the FOI Act.
Please note, there are some incident reports which do not have the patients age listed. Therefore, we are not able to provide a breakdown for these patients without completing a manual search through individual patient records.
20. What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Mental Health Learning Disabilities
• White 47
• BAME 63
• Not stated 8 • White 15
• BAME <5
Please note, there are some incident reports which do not have the patients ethnicity listed. Therefore, we are not able to provide a breakdown for these patients without completing a manual search through individual patient records.
21. .How many people covered by the Equality Act were secluded ?
As we do not have this information readily available in a format you have requested, for us to manually search our files would be in excess of the appropriate limit set for NHS organisations of £450 under Section 12 of the Act. This represents the estimated cost of one person spending 18 hours locating, retrieving and extracting and collating the information (where it exists). Section 12(1) is an Absolute Exemption and is therefore not subject to the public interest test.
22. How many SECLUSIONS were investigated outside the NHS and CCG?
0.
23. How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
This information would require a manual search through individual patient records.
24. How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
This information would require a manual search through individual patient records.
25. How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
This information would require a manual search through individual patient records.
26. How many patients have suffered complications during and after SECLUSION and what were those complications?
This information would require a manual search through individual patient records.
27. Have there been any formal complaints from patients/relatives about SECLUSION?
0
28. If so, what was their concerns?
Not applicable
29. How does the Trust plan to reduce SECLUSIONS in the future?
This is part of the work to reduce all restrictive interventions, our use of seclusion has reduced. We are working on post incident reviews and ensuring safety plans reflect preventative measures. Our focus is on utilising information from patient, carer advocacy to intervene early.
Regards
Angela Ewins
Freedom of Information Officer/ Executive Business Assistant
Corporate HQ Administration Team
London House, London Road, Bracknell, Berkshire, RG12 2UT