Dear Mrs Micklewright,
Thank you for your request for information under the Freedom of Information Act 2000.
I can confirm that our response is:
Request:
ECT INFORMATION
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 2021?
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 racialisedcommunities ("POC / BAME")?
8 - How many were receiving ECT for the first time?
9 - How many patients consented to ECT?
10 - How many 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 notECT was considered the cause)?
12 - How many patients died within 6 months after ECT and what was the cause (whether or not ECTwas considered the cause)?
13 - How many patients died by suicide within 6 months of receiving ECT (whether or not ECT wasconsidered the cause)?
14 - How many patients have suffered complications during and after ECT and what were thosecomplications?
15 - Have there been any formal complaints from patients/relatives about ECT?
16 - If so, what was their concerns?
17 - How many patients report memory loss/loss of cognitive function?
18 - What tests are used to assess memory loss/loss of cognitive function?
19 - Have MRI or CT scans been used before and after ECT?
20 - If so, what was the conclusion?
21 - How does the Trust plan to prevent ECT in the future?
SERIOUS INCIDENT INFORMATION
22 - Please supply any serious incident reports/investigations?
23 - How many SERIOUS INCIDENT REPORTS in 2021?
24 - What proportion of patients were men/women?
25 - How old were they?
26 - What proportion of patients were classified people of the global majority or racialisedcommunities ("POC / BAME")?
27 - How many SERIOUS INCIDENT REPORTS were investigated outside the NHS and CCG?
28 - How many patients died during or 1 month after SERIOUS INCIDENT REPORTS and what wasthe cause (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?
29 - How many patients died within 6 months after SERIOUS INCIDENT REPORTS and what was thecause (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?
30 - How many patients died by suicide within 6 months of receiving SERIOUS INCIDENT REPORTS(whether or not SERIOUS INCIDENT REPORTS was considered the cause)?
31 - How many patients have suffered complications during and after SERIOUS INCIDENT REPORTSand what were those complications?
32 - Have there been any formal complaints from patients/relatives about SERIOUS INCIDENTREPORTS?
33 - If so, what was their concerns?
34 - How does the Trust plan to prevent SERIOUS INCIDENTS in the future?
RESTRAINT INFORMATION
35 - Please supply any Restraints/investigations?
36 - How many RESTRAINTS in 2021?
37 - What proportion of patients were men/women?
38 - How old were they?
39 - What proportion of patients were classified people of the global majority or racialisedcommunities ("POC / BAME")?
40 - How many RESTRAINTS were investigated outside the NHS and CCG?
41 - How many patients died during or 1 month after RESTRAINTS and what was the cause (whetheror not RESTRAINTS was considered the cause)?
42 - How many patients died within 6 months after RESTRAINTS and what was the cause (whether ornot RESTRAINTS was considered the cause)?
43 - How many patients died by suicide within 6 months of receiving RESTRAINTS (whether or notRESTRAINTS was considered the cause)?
44 - How many patients have suffered complications during and after RESTRAINTS and what werethose complications?
45 - Have there been any formal complaints from patients/relatives about RESTRAINTS?
46 - If so, what was their concerns?
47 - Are counts of forced injections available?
48 - How does the Trust plan to reduce restraints in the future?
Response:
The Trust has now had the opportunity to fully consider your request and responds as follows:
ECT INFORMATION
1 - Please see attached. 2 - Please see attached.
3 - Under Section 40 (2) of the Freedom of Information Act 2000 we are applying an exemption toyour request. In accordance with the General Data Protection Regulation (GDPR) 2018 Dorset Healthcare University NHS Foundation Trust is unable to release any ECT reports/investigations into the public domain to avoid the potential risk of individual identification and disclosure of highly sensitive personal information (special category personal data). Furthermore local reports from the ECT Accreditation Service (ECTAS) are provided in confidence in line with their confidentiality statement (please see below), therefore we are also applying exemption 41 to your request. It is ECTAS's expectation that the obligation to maintain confidentiality will be complied with, as this is an important part of the process working effectively to help improve the quality of services and patient care.
ECT Accreditation Service Confidentiality Statement:
The data contained within this booklet are confidential and not to be disseminated to anyone outside the host team or peer review team named inside this booklet without the permission of the host team or ECTAS. Any copies, electronic or paper, of this booklet retained by members of the review team after the service has received accreditation, should be destroyed. There is a publication strategy allowing ECTAS to publish the anonymous aggregated data in national reports, on its website and in appropriate scientific journals.
4 - There were ninety one clinics in 2021.
5 - Nineteen females and seven males.
6 - The age group ranges from being born in 1996 to 1937.
7 - None.
8 - There were eight patient that were receiving ECT for the first time in 2021.
9 - Fourteen of the patients were deemed to have capacity and consented to treatment, howeverthe other patients were deemed to lack capacity to make this decision however were consenting to treatment.
10 - None.
11 - Under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying anexemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 (this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information.
12 - Under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying anexemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 (this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information.
13 - Suicide is a conclusion determined by HM Coroner. With the information available to the Trustwe have not identified any patients with this conclusion in 2021 within 6 months of ECT.
14 - There were no patients that were deemed to have had complications.
15 - None in 2021.
16 - N/A.
17 - Under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying anexemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 (this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information.
18 - Addenbrooke's Cognitive Exam (ACE III).
19 - MRI's and CT scans are not part of the standard investigations for ECT procedure and thus,unless there are prior concerns, not requested.
20 - N/A.
21 - ECT is used in line with NICE guidance N90 to gain fast and short-term improvement of severesymptoms of a depressive illness, a prolonged or severe episode of mania, or catatonia after all other treatment options have failed, or when the situation is thought to be life-threatening.
SERIOUS INCIDENT INFORMATION
22 - We have had no incidents identified as a serious incident for 2021 relating to ECT.
23 - Fifty-four serious incidents reported in 2021, none of these relate to ECT.
24 - Female 33%
Male 67%
These are not related to ECT.
25 - 18-24 9%
25-34 19%
35-44 7%
45-54 20%
55-64 15%
Over 65 30%
These do not relate to ECT.
26 - This would involve review of each clinical record and exceed time allowed. Consequently underSection 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information.
27 - The Trust only investigates incidents within Trust services; we are unable to answer for otherproviders.
28 - There were less than 5 deaths of patients within one month. This excludes any incidents thatwere reported as a serious incident due to the death of the patient. This only includes incidents where the serious incident was not fatal, but the patient died up to one month after the incident. This includes patients who were current patients at the time of the incident and any patients seen within the six months prior to the incident. We cannot provide the cause of death as this is determined by the HM Coroner.
Under Section 40 (2) of the Freedom of Information Act 2000 we are applying an exemption to your request. In accordance with the General Data Protection Regulation (GDPR) 2018 Dorset Healthcare University NHS Foundation Trust does not release statistics below 5, or those which could result in the calculation of statistics below 5, in order to avoid the potential risk of individual identification.
29 - There were less than 5 deaths of patients within six months. This excludes any incidents thatwere reported as a serious incident due to the death of the patient. This only includes incidents where the serious incident was not fatal, but the patient died up to six months after the incident. This includes patients who were current patients at the time of the incident and any patients seen within the six months prior to the incident. We cannot provide the cause of death as this is determined by the HM Coroner.
Under Section 40 (2) of the Freedom of Information Act 2000 we are applying an exemption to your request. In accordance with the General Data Protection Regulation (GDPR) 2018 Dorset Healthcare University NHS Foundation Trust does not release statistics below 5, or those which could result in the calculation of statistics below 5, in order to avoid the potential risk of individual identification. 30 - Suicide is a conclusion determined by HM Coroner. There were no suicides so far recorded of Trust patients after the patient was involved in a serious incident. This includes patients who were current patients at the time of the incident and any patients seen within the six months prior to the incident. Not all deaths occurring in 2021 will have received a Coroner’s conclusion yet.
31 - You have requested data for any type of complication after the incident, including any financialimpact on the patient. To obtain this information, this would involve review of each clinical record and exceed time allowed. Consequently under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information. We also do not have access to health and financial data held by other organisations, so would not be able to answer this question accurately.
32 - None in 2021.
33 - N/A.
34 - The Trust follows NHS England Serious Incident Framework, 2015. This sets out the process tofollow to ensure that when investigating a serious incident any problems that occurred during a patients care are clearly identified. This often results in recommendations to improve practice also learning to cascade across the Trust. All serious incidents are reviewed to gather learning and any trends or themes, and follow governance pathways for action and sharing.
RESTRAINT INFORMATION
35 - Some restraints will be subject to post-incident review, however this would involve review ofeach clinical record and exceed time allowed. Consequently under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information.
36 - There were 2,183 restraints reported across 1,692 incidents in 2021.
37 - Female 69%
Male 31%
38 - Under 18 12%
18-24 25%
25-34 8%
35-44 4%
45-54 6%
55-64 14%
Over 65 31%
All above restraint data excludes incidents where seclusion and rapid tranquilisation was used.
39 - This would involve review of each clinical record and exceed time allowed. Consequently underSection 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information.
40 - The Trust only investigates restraint which occur within Trust patients.
41 - 7.
This excludes incidents where seclusion and rapid tranquilisation was used.
The Trust does not hold the cause of death for all patients the exception being when a death on Trust premises as a serious incident.
42 - 13.
This excludes incidents where seclusion and rapid tranquilisation was used.
The Trust does not hold the cause of death for all patients the exception being when a death on Trust premises as a serious incident.
43 - Suicide is a conclusion determined by HM Coroner. There were 0 suicides recorded for patientswho were restrained in 2021 where suicide has been determined by HM Coroner. Not all deaths occurring in 2021 will have received a Coroner’s conclusion yet.
44 - You have requested data for any type of complication after the incident, including any financialimpact on the patient. To obtain this information, this would involve review of each clinical record and exceed time allowed. Consequently under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information. We also do not have access to health and financial data held by other organisations, so would not be able to answer this question accurately 45 - None in 2021.
46 - N/A.
47 - There were 220 rapid tranquilisation incidents in 2021.
48 - The Trust holds a strategic meting to review all use of force events. We a developing a reducingrestrictive practice strategy that will underpin our plans going forward. Additionally all incidents are reviewed by the PMVA team who link with the ward manager to identify any trend / patterns / learning. All incidents of restraint are reviewed by the team and a debrief is held with the team and the patient. patients have wellbeing plans and behavioural support plans to look at supporting acutely unwell patients and strategies to minimise the use of restraint.
The information supplied to you in this communication, continues to be protected by the Copyright, Designs and Patents Act 1988. You are free to use it for your own purposes, including any noncommercial research you are doing and for the purposes of news reporting.
As advised previously, your request has been split over two FOI Request references. Additional responses for FOI 4298 will be released to you in due course.
If you wish to re-use the information supplied, in whole or in part, for any other purpose e.g. commercial publications, please write to me stating what information you wish to re-use, the purpose(s) you wish to re-use the information for. We will respond within 20 working days of receiving your request with any conditions and charges that relate to the re-use of the information in accordance with the Re-use of Public Section Information Regulations 2005.
If you wish to discuss any of the above, please contact me, quoting the reference above.
If you are unhappy with the way in which we have handled your request, please contact myself in the first instance. If you wish to make a formal complaint, you should write to our Complaints Manager at Dorset HealthCare University NHS Foundation Trust, Trust HQ, Sentinel House, 4-6
Nuffield Road, Poole, Dorset BH17 0RB
If you are not content with the outcome of your complaint or the internal review, you may apply directly to the Information Commissioner for a decision. Generally, the Information Commissioner will only make a decision once you have exhausted the complaints and/or internal review process provided by us. The Information Commissioner can be contacted at: The Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF.
Yours faithfully
Freedom of Information Coordinator http://www.dorsethealthcare.nhs.uk/
Email: dhc.foi.enquiries@nhs.net
Additional information Sent 20 June 2022
Dear Mrs Micklewright,
Thank you for your request for information under the Freedom of Information Act 2000.
I can confirm that our response is:
Request:
SECLUSION INFORMATION
1 - Please supply any SECLUSION reports/investigations
2 - How many SECLUSIONS in 2021?
3 - What proportion of patients were men/women?
4 - How old were they?
5 - What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
6 - How many SECLUSIONS were investigated outside the NHS and CCG?
7 - How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
8 - How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
9 - How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
10 - How many patients have suffered complications during and after SECLUSION and what were those complications?
11 - Have there been any formal complaints from patients/relatives about SECLUSION?
12 - If so, what was their concerns?
13 - How does the Trust plan to reduce SECLUSIONS in the future?
MEDICATION ERROR INFORMATION
14 - Please supply any MEDICATION ERRORS reports/investigations
15 - How many MEDICATION ERRORS in 2021?
16 - What proportion of patients were men/women?
17 - How old were they?
18 - What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
19 - How many MEDICATION ERRORS were investigated outside the NHS and CCG?
20 - 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)?
21 - How many patients died within 6 months after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)?
22 - How many patients died by suicide within 6 months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)?
23 - How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?
24 - Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
25 - If so, what was their concerns?
26 - How does the Trust plan to prevent MEDICATION ERRORS in the future?
Response:
The Trust has now had the opportunity to fully consider your request and responds as follows:
1 - Some seclusion events will be subject to post-incident review; however, this would involve review of each clinical record and exceed time allowed. Consequently, under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information).
2 - There were 106 seclusion incidents reported in 2021.
3 - Proportion of Incidents:
Female 49%
Male 51%
4 - Under 18 and 18-24 26
25-34 28
35-44 15
45-54 16
55-64 11
Over 65 10
5 - Information regarding numbers and types is recorded using the incident reporting system; this does not provide ethnicity data. This would involve review of each clinical record and exceed time allowed. Consequently, under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information).
6 - The Trust records only seclusion which occurs on Trust premises and for Trust patients.
7 - 0. 8 - 0.
9 - Suicide is a conclusion reached by HM Coroner, not by the Trust. There were 0 conclusions of suicide in Trust patients secluded in 2021. Not all deaths occurring in 2021 will have received a Coroner’s conclusion yet.
10 - You have requested data for any type of complication after the incident, including any financial impact on the patient. To obtain this information, this would involve review of each clinical record and exceed time allowed. Consequently, under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request.
11 - None in 2021.
12 - N/A.
13 - The Trust holds a strategic meeting to review all use of force events. We a developing a reducing restrictive practice strategy that will underpin our plans going forward. Additionally, all incidents are reviewed at a local level with the ward manager to identify any trend / patterns / learning.
All incidents of seclusion are reviewed by the team and a debrief is held with the team and the patient. Patients have wellbeing plans and behavioural support plans to look at supporting acutely unwell patients and strategies to ensure seclusion is only ever the last resort.
14 - Data held by the Trust is for errors for the whole organisation, rather than for seclusion specifically. To provide the requested information would exceed the permitted time for FOIs.
Consequently, under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information).
15 - There were 573 medication incidents in 2021.
16 - Female 47%
Male 43%
Sex Not Recorded 10%
17 - Under 18 5%
18-24 4%
25-34 8%
35-44 7%
45-54 6%
55-64 13%
Over 65 57%
18 - Information on types and numbers of medication errors is recorded within the Trust incident reporting system which does not provide ethnicity data. This would involve review of each clinical record and exceed time allowed. Consequently, under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending
2.5 working days locating, retrieving and extracting the required information).
19 - Medication errors are only captured and investigated by the Trust for Trust patients.
20 - 35.
21 - 69. The cause of death is not available for all these patients within Trust databases. This would involve review of external records held by other providers and exceed time allowed. Consequently, under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information).
22 - Suicide is a conclusion made by HM Coroner. There were 0 suicides recorded for patients involved in medication error incidents in 2021. Not all deaths occurring in 2021 will have received a Coroner’s conclusion yet.
23 - You have requested data for any type of complication after the incident, including any financial impact on the patient. To obtain this information, this would involve review of each clinical record and exceed time allowed. Consequently, under Section 12 (cost limit) of the Freedom of Information Act 2000 we are applying an exemption to your request. The information requested is not centrally recorded to the level of detail specified in your request. To collate this data would exceed the permitted cost limit of £450 this represents the estimated cost of one person spending 2.5 working days locating, retrieving and extracting the required information). We also do not have access to health and financial data held by other organisations, so would not be able to answer this question accurately.
24 - None in 2021.
25 - N/A.
26 - The Trust’s Medicines Safety Officer, with support from the Medicines Safety Group continues to work to improve reporting and to share learning from medication incidents. Learning is shared Trust wide and across the system via the Dorset Medicines Safety Group. The roll out of EPMA has begun which will prevent some medication errors and medicines management training, including training relating to medicines safety, is currently being reviewed and updated.
The information supplied to you in this communication, continues to be protected by the Copyright, Designs and Patents Act 1988. You are free to use it for your own purposes, including any non-commercial research you are doing and for the purposes of news reporting.
If you wish to re-use the information supplied, in whole or in part, for any other purpose e.g. commercial publications, please write to me stating what information you wish to re-use, the purpose(s) you wish to re-use the information for. We will respond within 20 working days of receiving your request with any conditions and charges that relate to the re-use of the information in accordance with the Re-use of Public Section Information Regulations 2005.
If you wish to discuss any of the above, please contact me, quoting the reference above.
If you are unhappy with the way in which we have handled your request, please contact myself in the first instance. If you wish to make a formal complaint, you should write to our Complaints Manager at Dorset HealthCare University NHS Foundation Trust, Trust HQ, Sentinel House, 4-6
Nuffield Road, Poole, Dorset BH17 0RB
If you are not content with the outcome of your complaint or the internal review, you may apply directly to the Information Commissioner for a decision. Generally, the Information Commissioner will only make a decision once you have exhausted the complaints and/or internal review process provided by us. The Information Commissioner can be contacted at: The Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF.
Yours faithfully
Freedom of Information Coordinator http://www.dorsethealthcare.nhs.uk/
Email: dhc.foi.enquiries@nhs.net