CANDI 2022

Dear Wendy Micklewright,

Thank you for your request which we received on 17^th May 2023. Your request has been considered and processed in accordance with the requirements of the Freedom of Information (FOI) Act 2000. Please find our response(s) below.

Your request and our response:

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

1.Please supply patient’s information ECT leaflet.

Please see information previously supplied to you in FOI 2022-38. For reference, these leaflets are also available on our website:
20120821_mha_ect_booklet_final.pdf (cqc.org.uk)
electroconvulsive-therapy-information-resource---3-march-2022.pdf (rcpsych.ac.uk)

2.Please supply patient ECT consent form

As above this information has been supplied in a previous FOI response.

3.Please supply any ECT reports/investigations

There have been no ECT reports or investigations from 1st January to 31st December 2022.

4.How many ECT in 2022?

There were 169 sessions of ECT in 2022.

5.What proportion of patients were men/women?

Men: 9
Women: 11

6.How old were they?

The age range of patients receiving ECT treatment in 2022 was between 18 and 75+ years of age.

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

We do not record this information with regards to patients receiving ECT treatment.

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

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.

In order to retrieve this information we would have to manually extract and retrieve the information from the patient records for each patient who had ECT and determine whether they were receiving ECT for the first time as this information is not held in a central location and can only be determined from examination of historic records. We have estimated it would take a minimum of 60 minutes to locate this information, therefore, 169 sessions recorded of ECT x 60 minutes = 10,140 minutes (169 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: 169 hours x £25 £4,225.

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.

Section 16 – Advice and Assistance

Under Section 16 of the FOIA, public authorities are obliged to provide advice and assistance, so far as it would be reasonable to expect the authority to do so, to persons who propose to make, or have made, requests for information to it. We would therefore like to invite you to narrow your request.

9.How many patients consented to ECT?

4 patients consented to ECT.

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

No ECT complaints were investigated outside the NHS and CCG.

11.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.

12.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 6 month after having ECT.

13.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.

14.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.

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

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

16.If so, what was their concerns?

N/A

17.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.

18.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.

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

A standardised Mini-mental State Examination (MMSE) is used to evaluate cognitive impairment/memory loss.

20.If so, what was the conclusion?

N/A

21.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: -

1.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 SI Mangt report Q2, 2022-23.pdf (candi.nhs.uk)

2.How many SERIOUS INCIDENT REPORTS in 2022?

There have been 9 serious incident reports conducted in 2022.

3.What proportion of patients were men/women?

Men: 4
Women: 5

4.How old were they?

The service user age range is from 21-81 years old, the average age of patient is 47 years.

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

Of the 9 serious incident investigations conducted, 2 service users were confirmed “POC/BAME”.

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

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

7.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.

8.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.

9.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/by suicide after a serious incident investigation.

10.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.

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

Camden and Islington NHS FT can confirm that 1 formal complaint has been received from patients/relatives regarding serious incident reports.

12.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.

13.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 two serious incident review group to look at all serious incidents and all incidents resulting in deaths.
There is also a bi-monthly Mortality Review Group which reviews the learning from 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: NHS England » The NHS Patient Safety Strategy

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

1.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.

2.How many RESTRAINTS in 2022?

There were 961 Physical Restraints undertaken at C&I in 2022

3.What proportion of patients were men/women?

Female                                   42%
Male                                     55%
Not stated/Unknown             3%

4.How old were they?

age bands - restraints
<16	0	0%
16 – 24	204	21%
25 – 34	334	35%
35 – 44	174	18%
45 – 54	115	12%
55 – 64	68	7%
65 – 74	11	1%
75+	41	4%
Not stated	14	1%
	961

The average age of patient is 49 years.

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

62%

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

None

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

None

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

None

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

None

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

None

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

Yes

12.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.

13.Are counts of forced injections available?

Yes

14.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

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

1.Please supply any SECLUSION reports/investigations

2.How many SECLUSIONS in 2022?

There were 168 seclusions in 2022

3.What proportion of patients were men/women?

Female 45%
Male 55%

4.How old were they?

Age bands - seclusion
<16	0	0%
16 – 24	34	20%
25 – 34	76	45%
35 – 44	33	20%
45 – 54	15	9%
55 – 64	10	6%
65 – 74	0	0%
75+	0	0%
Not stated	0	0%
	168	100%

The average age of patient is 38 years.

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

64%

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

None

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

None

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

None

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

None

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

None

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

12.If so, what was their concerns?

N/A

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

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: -

1.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.

2.How many MEDICATION ERRORS in 2022?

There were 290 medication errors recorded in 2022

3.What proportion of patients were men/women?

Female 37%

Male 43%

4.How old were they?

Age Range

O-17

18-24

25-34

35-44

45-54

55-64

65-74

75+

Age not Recorded

Total

Number

of patients

290

5.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	41%
White British	27%
White Irish	1%
White Other	8%
Not Stated	4%
Unknown	19%

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

None

7.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)?

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:

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
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.
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 a minimum 5 minutes per patient, therefore: 5 minutes per patient x 290 patient files = 1,450 minutes (24 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: 24 hours x £25 = £600

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/enduringstandards/standards-that-remain-valid/medication-safety

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:

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
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.
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 a minimum of 7 minutes per patient, therefore: 7 minutes per patient x 290 patient files = 2,030 minutes (34 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: 34 hours x £25 = £850

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:
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
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.
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 2022 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 2022 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 a minimum of 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 290 patient files = 1,450 minutes (24 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.

Section 16 – Advice and Assistance

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.

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:

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
Determine whether or not a complication arose from this error
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 a minimum of 5 minutes per patient, therefore: 5 minutes per patient x 290 patient files = 1,450 minutes (24 hours)

Section 16 – Advice and Assistance

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

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

Yes

12.If so, what was their concerns?

13.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 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 Process

If you are dissatisfied with this response, you may request an internal review by emailing freedom.information@candi.nhs.uk.

Requests for an internal review should be made within 40 working days from the date of this response, 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:

Information Commissioners Office

Wycliffe House

Water Lane

Wilmslow

Cheshire SK9 5AF

Kind regards,

Information Governance Team

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

Online: www.candi.nhs.uk

Telephone: +44(0)20 3317 7100