CANDI 2021

Camden and Islington NHS Foundation Trust

3rd Floor, Room 3/25, West Wing

St Pancras Hospital

4 St Pancras Way

London NW1 0PE

E-mail: Freedom.Information@Candi.nhs.uk

Online: www.candi.nhs.uk Telephone: +44(0)20 3317 7100

Reference number: FOI 2022-38

Wendy Micklewright

wmicklewright@yahoo.co.uk

15 June 2022

Dear Wendy Micklewright

Freedom of Information Request

Thank you for your information request which we received on 5^th May 2022.

Please accept our apology for the delay. The response has been delayed due to the complexity of this request and the need for input from several teams across the Trust.

We hope that we have been able to fulfil your request and we appreciate your patience in your receiving this response.

In line with the Freedom of Information Act 2000 (FOIA), Camden and Islington NHS Foundation Trust (C&I NHS FT) is pleased to respond as below.

Your request and our response:

Please provide ECT information under the FOI act to the following questions:

Please supply patient’s information ECT leaflet.

Please see attached folder “ECT information” which contains information regarding ECT for both patients and professionals. We also have information regarding ECT treatment on our website:

https://www.candi.nhs.uk/service -users -and -carers/mental -health -act/being -sectioned

Please supply patient ECT consent form
Please see response to question 1, this form is contained in the ECT Information folder.

Please supply any ECT reports/investigations

There have been no ECT reports or investigations from 1^st January to 31^st December 2021.

How many ECT in 2021?

There were 152 sessions of ECT in 2021

What proportion of patients were men/women?

Men:	27%
Women:	73%

How old were they?

Please see table below.

Please note that the Trust considers that disclosure of some of the requested information risks identifying individuals. The reason for this is that the number of individuals for which this applies is very low (five or less).

The Trust’s view is that s.40(2) is applicable because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act.

Therefore, numbers of five or less will appear as *

Age	10 - 17	18-24	25-34	35-44	45-54	55-64	65-74	75+
The number of patients receiving ECT treatments for each of these years.	0	0	0	0	*	*	6	*

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

Due to the small number of patients involved, we cannot disclose this information about ethnicity as it may be used to identify individuals. This information is therefore exempt under Section 40 of the Freedom of Information Act.

The Trust considers that disclosure of some of the requested information risks identifying individuals.

The Trust’s view is that s.40(2) is applicable because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act.

How many were receiving ECT for the first time?

8 patients in 2021 were having ECT for the first time.

How many patients consented to ECT?

6 patients consented to ECT.

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

No ECT complaints were investigated outside the NHS and CCG.

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

No patients died within 1 month after having ECT.

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

No patients died within six months after receiving ECT.

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

No patients died by suicide within 6 months after receiving ECT.

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

There have been no reports of significant complications from ECT that have been suffered by patients.

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

There have been no formal complaints from patients of ECT or their relatives.

If so, what was their concerns?

N/A – please see above

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

Short term memory loss around the time of ECT is a common side effect. None of the reported side effects of short-term memory loss persisted beyond the ECT course itself.

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

A standardised Mini-mental State Examination (MMSE) is used to evaluate cognitive impairment/memory loss.
Have MRI or CT scans been used before and after ECT?
MRI/CT scans are not a requirement for ECT however some patients may have these as part of their overall treatment

If so, what was the conclusion?

N/A

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

There are no current plans for the Trust to prevent ECT in future.

Please provide SERIOUS INCIDENT information under the FOI act to the following questions:

Please supply any serious incident reports/investigations?

Serious incident reports/investigations regarding individual patients would not be shared under FOIA as these reports would be considered to be personal information under Section 40 of the FOIA as they would contain personal information about patients.

We can however advise that summary updates for serious incidents are provided to the C&I Trust Board and are published on our website.

Please find the link for the most recently quarterly report summary for serious incidents below:

4.1 Serious Incidents Management Report.pdf (candi.nhs.uk)
How many SERIOUS INCIDENT REPORTS in 2021?

There have been 26 serious incident reports conducted in 2021.

What proportion of patients were men/women?

Men:	54%
Women:	46%

How old were they?

The service user age range is from 22-66 years old, the average age of patient is 44 years.

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

Of the 26 serious incident investigations conducted, 6 service users were confirmed “POC/BAME”

How many SERIOUS INCIDENT REPORTS were investigated outside the NHS and CCG?

No serious incident reports were investigated outside the NHS and CCG.

How many patients died during or 1 month after SERIOUS INCIDENT REPORTS and what was the cause (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?
No patients died within one month after a serious incident investigation

How many patients died within 6 months after SERIOUS INCIDENT REPORTS and what was the cause (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?

No patients died within 6 months after a serious incident investigation

How many patients died by suicide within 6 months of receiving SERIOUS INCIDENT REPORTS (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?

No patient died of any cause after a serious incident investigation

How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications?

No reports of patients having suffered complications during or after a serious incident investigation

Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS?

Yes, Camden and Islington NHS FT can confirm that formal complaints have been received from patients/relatives regarding serious incident reports.

If so, what was their concerns?

This information would not be shared under the FOIA as the complaint information would contain personal information. The Trust’s view is that s.40(2) is applicable because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act.

How does the Trust plan to prevent SERIOUS INCIDENTS in the future?

The Trust is committed to reducing and prevention of serious incidents across the organisation.

We are working to the National Patient Safety Strategy that you can find on the NHS website.

The Trust has a Weekly serious incident review group to look at all serious incidents and all incidents resulting in deaths.
There is also a monthly Mortality Review Group which reviews the learning from case reviews of mortalities, and homicides reviews (when applicable), and other national publication of suicides for learning and dissemination across the organisation.
Lessons learnt from incidents and complaints are shared across the Trust through multiple channels including lessons learnt bulletins.
We continue to engage with patients and families to understand their views and opinions via a variety of channels
We have integrated quality improvement into our daily practices to ensure we are working as effectively, efficiently and safely as possible.
We engage other local and national organisations and networks to ensure we are up to date with important patient safety information.

We will also be implementing the new patient safety strategy across Trust when it is published by NHS England.

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

Please supply any Restraints/investigations?

Reports/investigations regarding restraints/investigations would not be shared under FOIA as these reports would be considered to be personal information under Section 40 of the FOIA as they would contain personal individuals about patients.

How many RESTRAINTS in 2021?

There were 727 restrictive interventions undertaken at C&I in 2021

What proportion of patients were men/women?

Female	46%
Male	50%

How old were they?

Age	10 - 17	18-24	25-34	35-44	45-54	55-64	65-74	75+	Not recorded
The number of patients restrained	0	156	229	131	97	81	9	17	7

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

Please see below table. Please note that BAME includes the below categories:

Asian or Asian British - Any other Asian background
Asian or Asian British - Bangladeshi
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Black or Black British - African
Black or Black British - Any other Black background
Black or Black British - Caribbean
Chinese
Mixed - Any other mixed background
Mixed - white and Asian
Mixed - white and black African
Mixed - white and black Caribbean
Other Ethnic Groups - Any other ethnic group

Ethnicity Category	Proportion of Patients
BAME	55%
White - British	25%
White - Other	15%
White - Irish	2%
Not stated/blank	3%

How many RESTRAINTS were investigated outside the NHS and CCG?

None

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

None

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

This information is held by Camden and Islington NHS FT however it has been withheld due to low numbers. The Trust considers that disclosure of some of the requested information risks identifying individuals. The reason for this is that the number of individuals for which this applies is very low (five or less).

The Trust’s view is that s.40(2) is applicable because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act.

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

None

How many patients have suffered complications during and after RESTRAINTS and what were those complications?

None

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

Yes

If so, what was their concerns?

Details of complaints made regarding restraints would not be shared under FOIA as these reports would be considered to be personal information under Section 40 of the FOIA as they would contain personal individuals about patients.

Please note that the Trust does not have an automated approach to recording this information from complaints and the data is therefore drawn manually. Complaints may be worded in a way that is not consistent with the terms of seclusion and restraint. We therefore believe the data shared to be reasonable accurate but wish to caveat that it may not provide a complete data set.

Are counts of forced injections available?

Yes

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

The Trust has employed a Reducing Restrictive Intervention Specialist Lead who is leading the implementation of the Trust strategy on violence and restrictive intervention reduction. The overall aim of the strategy is to implement interventions that are geared towards reducing conflict and the use of unnecessary restrictive interventions, including but not limited to restraint and seclusion.

The specialist lead is also working together with the executive lead for use of force in implementing the requirements of the Mental Health Unit (use of force) Act 2018 which is aimed at reducing the use of restraint and restrictive interventions.

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

Please supply any SECLUSION reports/investigations

Reports/investigations regarding restraints/investigations would not be shared under FOIA as these reports would be considered to be personal information under Section 40 of the FOIA as they would contain personal individuals about patients.

How many SECLUSIONS in 2021?

112

What proportion of patients were men/women?

Female	37%
Male	63%

How old were they?

Please note that the Trust considers that disclosure of some of the requested information risks identifying individuals. The reason for this is that the number of individuals for which this applies is very low (five or less).

The Trust’s view is that s.40(2) is applicable because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act.

Therefore, numbers of five or less will appear as *

Age

Oct-17

18-24

25-34

35-44

45-54

55-64

65-74

75+

Age not recorded

The number

of patients

Ethnicity Category	Proportion of Patients
BAME	63%
White British	20%
White - Other	16%
Not Stated	1%

How many SECLUSIONS were investigated outside the NHS and CCG?

None

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

None

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

None

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

None

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

None

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

Yes

If so, what was their concerns?

Camden and Islington NHS FT can confirm that formal complaints have been received from patients/relatives regarding seclusions. However, due to low numbers this information is exempt from disclosure under Section 40 of the FOIA.

The Trust’s view is that s.40(2) is applicable because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act.

Please note that the Trust does not have an automated approach to recording this information from complaints and the data is therefore drawn manually. Complaints may be worded in a way that is not consistent with the terms of seclusion and restraint. We therefore believe the data shared to be reasonable accurate but wish to caveat that it may not provide a complete data set.

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

The Trust has employed a Reducing Restrictive Intervention Specialist Lead who is leading the implementation of the Trust strategy on violence and restrictive intervention reduction. The overall aim of the strategy is to implement interventions that are geared towards reducing conflict and the use of unnecessary restrictive interventions, including but not limited to restraint and seclusion.

The specialist lead is also working together with the executive lead for use of force in implementing the requirements of the Mental Health Unit (use of force) Act 2018 which is aimed at reducing the use of restraint and restrictive interventions.

Please provide MEDICATION ERRORS information under the FOI act to the following questions:

Please supply any MEDICATION ERRORS reports/investigations

Medication Error reports/investigations would not be shared under FOIA as these reports would be considered to be personal information under Section 40 of the FOIA as they would contain personal individuals about patients.

How many MEDICATION ERRORS in 2021?

There were 385 medication errors recorded in 2021

What proportion of patients were men/women?

Female	46%
Male	50%

How old were they?

Age Range

Oct-17

18-24

25-34

35-44

45-54

55-64

65-74

75+

Age not Recorded

Total

Number

of patients

307

Ethnicity Category	Proportion of Patients
BAME	39%
White British	36%
White Irish	1%
White Other	13%
Not Stated	5%
Unknown	6%

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

None

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)?

I can confirm Camden and Islington NHS Foundation Trust hold the information requested although it is not in a format from which this information can be easily retrieved. Therefore, the information you have requested is being withheld under the following exemption.

Section 12 - Exemption where cost of compliance exceeds appropriate limit

Section 1(1) does not oblige a public authority to comply with a request for information if the authority estimates that the cost of complying with the request would exceed the appropriate limit. The 'appropriate limit' is defined as £450 or 18 hours.

In determining whether to invoke the Section 12 exemption, (exemption where the cost of compliance exceeds appropriate limit), Camden and Islington NHS Foundation Trust is entitled to take into account the costs it reasonably expects to incur in determining whether it holds the information, locating the information or a document containing the information and extracting the information.

The Trust has determined that to produce the information you request would take over the appropriate limit, and therefore the exemption described in S.12 is applicable in this case.

In order for the Trust to provide this information we would need to undertake the following steps:

1) Extracting and examining the patient records of every patient that had died, and examining the patient history to ascertain if at any point a medication error occurred whilst they were under the care of C&I

2) This information would then have to be matched with the date of the patients’ death to establish if the death occurred within 1 month of the medication error.

3) The cause of death would have to be determined from the patient file. This is information may be incomplete as an inquest and or investigation could still be awaiting completion.

We have estimated this would take 5 minutes per patient:

5 minutes per patient x 518 patient files = 2,590 minutes (43 hours)

Additionally, as providing this information would take over 18 hours, this would exceed the cost limit stipulated by the FOIA which is set at £450 or £25 per hour. Therefore:

43 hours x £25 = £1,075

Section 16 – Advice and Assistance

In order for us to provide advice and assistance to you in line with Section 16 of the FOIA, you may wish to know that if a medication error occurs within the Trust, it is reported and investigated, with outcomes and any consequences reported on. All staff are aware of the importance of medicine safety and training is provided to staff.

NHS Resolution and NHS England have provided information regarding medication errors which you may find useful:

https://resolution.nhs.uk/2022/03/31/learning -from -medication -errors

https://www.england.nhs.uk/patient -safety/patient -safety -alerts/enduring -standards/standards that -remain -valid/medication -safety

Under section 16 of the FOIA, public authorities are required to provide the requester with advice and assistance while processing their request. This is especially important where a request for information exceeds the appropriate cost limit. C&I NHS FT would like to advise you to narrow down your request, however the total time taken to review and respond to all the questions within this FOI request have exceeded 18 hours working with multiple teams.

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

Section 12 - Exemption where cost of compliance exceeds appropriate limit

The Trust has determined that to produce the information you request would take over the appropriate limit, and therefore the exemption described in S.12 is applicable in this case.

In order for the Trust to provide this information we would need to undertake the following steps:

2) This information would then have to be matched with the date of the patients’ death to establish if the death occurred within 6 months of the medication error.

3) The cause of death would have to be determined from the patient file. This is information may be incomplete as an inquest and or investigation could still be awaiting completion.

We have estimated this would take 7 minutes per patient:

7 minutes per patient x 518 patient files = 3,626 minutes (60 hours)

Additionally, as providing this information would take over 18 hours, this would exceed the cost limit stipulated by the FOIA which is set at £450 or £25 per hour. Therefore:

60 hours x £25 = £1,500

Section 16 – Advice and Assistance

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

Section 12 - Exemption where cost of compliance exceeds appropriate limit

The Trust has determined that to produce the information you request would take over the appropriate limit, and therefore the exemption described in S.12 is applicable in this case.

In order for the Trust to provide this information we would need to undertake the following steps:

2) This information would then have to be matched with the date of the patients’ death to establish if the death occurred within 6 months of the medication error.

3) We would need to determine if this death was ruled to be a suicide. This is information may be incomplete as an inquest and or investigation could still be awaiting completion.

Please note that the number of patients who died from suicide for 2021 has not yet been finalised and any data provided would therefore not be a true reflection. This is due to difficulties in obtaining inquest conclusions from the Courts, and that not all inquests will have taken place for all deaths within the time period requested as some suicides may have occurred in 2021 which have not yet been investigated.

Additionally, as this data is not complete (total number of patients who died from suicide) it is therefore not possible to determine whether or not the patient experienced medication errors within 6 months before their death. As deaths may not have been determined to be a suicide, we are therefore unable to provide this information.

We are therefore unable to estimate the time it would take to determine how many patients died from suicides. Please note we have estimated it would take us 5 minutes to determine the patient history and whether the patient died within 6 months of a medication error, as outlined above.

Therefore: 5 minutes per patient x 518 patient files = 2,590 minutes (43 hours)

We would then have to factor in the additional time it would take to determine if the death was ruled a suicide for the reasons outlined above.

Additionally, as providing this information would take over 18 hours, this would exceed the cost limit stipulated by the FOIA which is set at £450 or £25 per hour. Therefore:

43 hours x £25 = £1,075

Section 16 – Advice and Assistance

10. How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?

Section 12 - Exemption where cost of compliance exceeds appropriate limit

The Trust has determined that to produce the information you request would take over the appropriate limit, and therefore the exemption described in S.12 is applicable in this case.

In order for the Trust to provide this information we would need to undertake the following steps:

2) Determine whether or not a complication arose from this error

3) Detail the complication and determine if this information could be released under the FOIA as to protect the identity of the individual patient concerned

We have estimated this would take 5 minutes per patient:

5 minutes per patient x 518 patient files = 2,590 minutes (43 hours)

Additionally, as providing this information would take over 18 hours, this would exceed the cost limit stipulated by the FOIA which is set at £450 or £25 per hour. Therefore:

43 hours x £25 = £1,075

Section 16 – Advice and Assistance

As detailed above, each medication error is investigated and where complications arise these are investigated and resolved.

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

Camden and Islington NHS FT can confirm that formal complaints have been received from patients/relatives regarding medication errors. However, due to low numbers (five or less) this information is exempt from disclosure under Section 40 of the FOIA.

The Trust’s view is that s.40(2) is applicable because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act.

If so, what was their concerns?

As above, this information would not be shared under the FOIA as the complaint information would contain personal information regarding parents. The Trust’s view is that s.40(2) is applicable because disclosure of this information could lead to individuals being identified which would be a breach of their rights under the Data Protection Act.

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

Improving medicines safety is one of the key priorities for the trust. The trust has got a medicines safety officer in post who chairs the Medicines Safety Group. The Medicines Safety Group provides a framework to enable safe use of medicines. The aims of the Group are to change the culture around incident reporting, identify the common themes of medicine incidents and take the learning forward to change practice. The Group reviews all the medicines incidents and produces thematic review each month. It also provides regular monthly feedback on medication incidents to the teams with the examples of incidents and learning lessons.

The medication safety officer works closely with quality and patient safety teams to review quality and risk management issues related to medicines use. They also work in collaboration with the wards and teams around the trust to build a culture of medicine safety and implement changes to prevent similar future incidents.

Review

We hope you are satisfied with the way in which your request was handled, if not you may request an internal review at the above email address within 28 days of this letter. When contacting the Trust please use the above reference that is unique to your request.

If you remain dissatisfied with the outcome of the internal review, you may seek further recourse by lodging an appeal with the Information Commissioner’s Office (ICO) at Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF or on the ICO’s website via the following link:

https://ico.org.uk/global/contact -us/

Yours sincerely,

Information Governance Team