FOI 13173
Thank you or your recent Freedom of Information request. We have completed our search for information and the details are as follows:
Please provide Electro Convulsive Treatment (ECT) information under the FOI act to the following questions: -
1.Please supply patient’s information ECT leaflet? Please see attached
2.Please supply patient ECT consent form? Please see attached
3.Please supply any ECT reports/investigations? There has not been any investigations.
4.How many ECT in 2024? 42 patients received ECT including maintenance patients.
5.What proportion of patients were men/women? 18 male 24 female
6.How old were they? They ranged from 30 – 81yrs
7.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")? 6 patients
8.How many people covered by the equality act - specific protected characteristics - excluding age + gender - received ECT ? 7
9.How many people were offered talking therapy prior to ECT ? We do not capture this information – its recorded as psychology which covers everything.
10.How many were receiving ECT for the first time? 14
11.How many patients consented to ECT? 22
12.How many ECT complaints were investigated outside the NHS ? 0
13.How many patients died during or 1 month after ECT and what was the cause (whether or not ECT was considered the cause)? *<5 patients – please note that any death(s) recorded during this period were due to physical ill health
14.How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)? *<5 patients
15.How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)? *<5 patients
16.How many patients have suffered complications during and after ECT and what were those complications? Non recorded
17.Have there been any formal complaints from patients/relatives about ECT? 0
18.If so, what was their concerns? 0
19.How many patients report memory loss/loss of cognitive function? 24
20.What tests are used to assess memory loss/loss of cognitive function? Mini Ace, Subjective patient experience, Subjective test of memory before every ECT using the Comprehensive Psychological Rating Scale (CPRS).
21.Have MRI or CT scans been used before and after ECT? If it is identified that this is clinically indicated then these could be used.
22.If so, what was the conclusion? The use of MRI or CT Scans would be recorded within individual patient records, the conclusion to these are not stored within a central database therefore we would have to review all patient records who have had ECT to identify if scans were completed and the conclusion to these, this would take an excessive amount of time which we have calculated to be outside of the acceptable time limits of FOI Act 2000.
Section 12 (Cost Exemption), cost breakdown:
Access to records: 30mins
Minimum Time to review each record to identify data: 5mins
Clinical review of each case to confirm valid information in relation to the conclusion: 20mins per record
Total Time: 18hours
23.How does the Trust plan to prevent ECT in the future? There are no plans to discontinue ECT as this continues to be a necessary treatment which can be lifesaving treatment.
Please provide restraints information under the FOI act to the following questions: -
1.Please supply any Restraints/investigations? Investigation reports are not completed for restraints therefore data not available? Investigation reports are not completed for restraints therefore data not available.
2.How many RESTRAINTS in 2024? 2548 restraints
3.What proportion of patients were men/women? 40% male, 60% female
4.How old were they?
|
Age Band |
Count |
|
18-25 |
461 |
|
26-35 |
760 |
|
36-45 |
263 |
|
46-55 |
103 |
|
56-65 |
371 |
|
66-75 |
263 |
|
76-85 |
303 |
|
86+ |
24 |
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")? 20%
6.How many people covered by the equality act - specific protected characteristics - excluding age + gender - were restrained? We do not routinely record patient demographics for restraints besides patient age and gender and are therefore unable to supply this data, without reviewing individual records. We have concluded that this would this would take an excessive amount of time which we have calculated to be outside of the acceptable time limits of FOI Act 2000.
*Section 12 (1) Cost/Time exceeds 18.5 hours - Exemption Applied
The Trust anticipates that to retrieve the information it would take a minimum of 124 hours. The Trust would need to manually go through each death in the year and check whether each patient had been previously restrained, either by checking incident logs or patient notes.
There were 2548 restraints in 2024, if we assume a conservative estimate of 5 mins spent each record linked to a restraint.
2548 x 5 minutes = 212hours
7.How many RESTRAINTS were investigated outside the NHS? 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 is not centrally recorded therefore we would have to review individual patient records to retrieve the data; this would this would take an excessive amount of time which we have calculated to be outside of the acceptable time limits of FOI Act 2000.
*Section 12 (1) Cost/Time exceeds 18.5 hours - Exemption Applied
The Trust anticipates that to retrieve the information it would take a minimum of 124 hours. The Trust would need to manually go through each death in the year and check whether each patient had been previously restrained, either by checking incident logs or patient notes.
There were 1490 deaths in 2024, if we assume a conservative estimate of 5 mins per record.
1490 deaths x 5 minutes = 7450 minutes = 124 hours
9.How many patients died within 6 months after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)? Please see response to Q8
10.How many patients died by suicide within 6 months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)? Please see response to Q8
11.How many patients have suffered complications during and after RESTRAINTS and what were those complications? 0 patients
12.Have there been any formal complaints from patients/relatives about RESTRAINTS? 0
13.If so, what was their concerns? N/A
14.Are counts of forced injections available? if so how many people were forcible injected ? Where clinically necessary patients may require intramuscular injection of medication. We recorded 861 instances of intramuscular medication being administered during restraint
15.How does the Trust plan to reduce restraints in the future? This is a multi-faceted issue with numerous variables at play, and while we strive to reduce the numbers, there are no guarantees as it largely depends on individual admissions and the severity of their conditions, which can fluctuate despite our best efforts. The effectiveness of restraint reduction also varies based on how it is measured, whether it's total numbers, restraint hours or duration, restraints per day/week, or restraints per admission, etc. However, there are several general principles and strategies we follow to attempt to reduce restraints:
Firstly, our in-patient staff are well-trained using “Safety Interventions” provided by CPI, a global training provider that is Restraint Reduction Network compliant. The guiding principles taught include using restraint as a last resort, ensuring it is the least restrictive, proportionate and reasonable, employing verbal interventions and de-escalation skills, and the practice of “let go to calm”.
Secondly, all reported restraint incidents are meticulously analysed by various roles including clinical governance staff, health and safety personnel, and clinical staff. These analyses are reported to the board through various mechanisms and committees, which helps in providing trust assurance, monitoring spikes, and targeting interventions where necessary.
Thirdly, effective debriefing is an integral part of our approach. Our inpatient staff are trained in conducting debriefs for both patients and staff as part of their “Safety Interventions” training. This ensures that dual learning from incidents takes place, particularly in recognizing future triggers and developing effective personal de-escalation techniques specific to individual patients.
Additionally, we have effective leadership with a robust policy detailing the Trust's expectations around the contentious field of restraint. This policy encompasses international and national guidance and emphasizes best practices, which is reflected in training and staff supervision, as well as future learning from senior staff and managers.
Finally, effective risk assessment and care plans are crucial. All our patients undergo risk assessments and have effective care plans as a result. Any patient subjected to physical holding skills will have an award-winning Person-Centred Physical Intervention Protocol (PCPIP) in place, which includes a restraint care plan and a positive behavioural support management plan, with a great emphasis on co-production.
16.How many of these restraints were face down restraints? 106
Please provide SECLUSION information under the FOI act to the following questions: -
1.Please supply any SECLUSION reports/investigations? Investigation reports are not completed for restraints therefore data not available
2.How many SECLUSIONS in 2024? 69 seclusions
3.What proportion of patients were men/women? 100% male
4.How old were they?
|
Age Band |
Count |
|
18-25 |
13 |
|
26-35 |
23 |
|
36-45 |
22 |
|
46-55 |
6 |
|
56-65 |
*<5 |
|
66-75 |
0 |
|
76-85 |
0 |
|
86+ |
0 |
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")? 45%
6.How many people covered by the equality act - specific protected characteristics - excluding age + gender - were secluded ? We do not routinely record patient demographics for seclusions besides patient age and gender and are therefore unable to supply this data without reviewing individual records. To do so would add to previous time taken in relation to this request and therefore we have calculated to be outside of the acceptable time limits of FOI Act 2000; please see earlier calculation estimations in relation to how we calculate this.
7.How many SECLUSIONS were investigated outside the NHS? 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)? Please see response to Q8 in restraints section
9.How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)? Please see response to Q8 in restraints section
10.How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)? Please see response to Q8 in restraints section
11.How many patients have suffered complications during and after SECLUSION and what were those complications? Please see response to Q8 in restraints section
12.Have there been any formal complaints from patients/relatives about SECLUSION? 0
13.If so, what was their concerns? N/A
14.How does the Trust plan to reduce SECLUSIONS in the future? Yes
Please provide MEDICATION ERRORS information under the FOI act to the following questions: -
1.Please supply any MEDICATION ERRORS reports/investigations? Investigation reports are not completed for medication errors therefore data not available without reviewing individual records. To do so would add to previous time taken in relation to this request and therefore we have calculated to be outside of the acceptable time limits of FOI Act 2000; please see earlier calculation estimations in relation to how we calculate this.
2.How many MEDICATION ERRORS in 2024? 361
3.What proportion of patients were men/women? 53% male, 47% female
4.How old were they?
|
Age Band |
Count |
|
18-25 |
32 |
|
26-35 |
51 |
|
36-45 |
37 |
|
46-55 |
36 |
|
56-65 |
30 |
|
66-75 |
49 |
|
76-85 |
42 |
|
86+ |
*<5 |
*note, this does not total 361 as not all medication errors impacted a patient. Some occurred prior to administering a drug, but had potential to cause harm
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")? 24%
6.How many people covered by the equality act - specific protected characteristics - excluding age + gender - endured medication errors ? We do not routinely record patient demographics for medication errors besides patient age and gender and are therefore unable to supply this data without reviewing individual records. To do so would add to previous time taken in relation to this request and therefore we have calculated to be outside of the acceptable time limits of FOI Act 2000; please see earlier calculation estimations in relation to how we calculate this.
7.How many MEDICATION ERRORS were investigated outside the NHS ? 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)? Please see response to Q8 in restraints section
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)? Please see response to Q8 in restraints section
10.How many patients died by suicide within 6 months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)? Please see response to Q8 in restraints section
11.How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications? *Section 12 (1) Cost/Time Exceeds 18.5hours exemption applied. This information is not centrally recorded therefore we are unable to provide this information without reviewing individual records. To do so would add to previous time taken in relation to this request and therefore we have calculated to be outside of the acceptable time limits of FOI Act 2000.
Cost/Time Exceeds 18.5hours exemption applied.
The Pharmacy team would need to manually go through each medication error case in the year and check whether each patient had any potential complications that could be attributable to the medication error from the patient notes and liaison with any other health service provider involved in their care.
There were 361 medication errors in 2024, if we assume a conservative estimate of 15 mins per record.
361 x 15mins = 5415minutes = 90.25hours
12.Have there been any formal complaints from patients/relatives about MEDICATION ERRORS? *<5
13.If so, what was their concerns? Patients would have preferred a different method of medication then ones given.
14.How does the Trust plan to prevent MEDICATION ERRORS in the future? Medication errors or the reporting of near misses is encouraged to enable lessons to be learned or mitigations to be put in place to avoid/reduce in future. A new electronic prescribing and medication administration is being piloted and rolled out currently to further support safer use of medicines.
Exemption Applied
*<5 - Section 40 (2) Personal Data exemption - Due to small numbers involved within these responses we have indicated a value ‘less than’ 5 this is to ensure that individuals are not identified as other information that could be within the public domain may aid the identification of the individuals.
*Section 12 (1) Cost/Time Exceeds 18.5hours - The request is estimated to take longer than the provision of 18.5 per request.
The full Freedom of Information Act 2000 is available on the legislation website via the following link: http://www.legislation.gov.uk/ukpga/2000/36/contents. The Trust is regarding this response as a full and complete discharge of its responsibilities under the Freedom of Information Act 2000 in relation to this request. I trust it fulfils your requirements but should you have any concerns please do not hesitate to contact us and we will attempt to resolve your issues.
If you are unhappy with the outcome of your request our complaints process is available on our internet site; www.blackcountryhealthcare.nhs.uk. If you are not satisfied with the outcome of your complaint you can raise your concerns directly with the Information Commissioner, please be aware that the ICO cannot make a decision unless you have exhausted the complaints process provided by the Trust. The Information Commissioner can be contacted at: The Information Commissioners Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF or via their website www.ico.org.uk.
Yours sincerely,
Information Governance Team
Email: bchft.foi1@nhs.net
Tel: 01922 607000