Freedom of Information Request

Reference Number:EPUT.FOI.22.2488

Date Received: 05.05.2022

Information Requested:

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

 Please supply patient’s information ECT leaflet. Please find attached.
Please supply patient ECT consent form               Please find attached.
Please supply any ECT reports/investigations
              The Trust can confirm that there are no report/investigations.
 
How many ECT in 2021?
               668 Sessions
This figure does not represent the number of patients, individual patients can receive multiple sessions of ECT
 
What proportion of patients were men/women?

	Male	Female
Gender	30%	70%

              
How old were they?

	0-17	18-65	65+
Age	N/A	43	30

 
What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
3%
 
How many were receiving ECT for the first time?
               34
 
How many patients consented to ECT?
               32
Please note, that in some circumstances, it is necessary to treat patients in the absence of consent if their condition is deemed to be life threatening or that the patient lacks capacity at the time to make an informed decision. In these circumstances the patient is assessed by two medical consultants independently to confirm if treatment is necessary and the decision is therefore taken in the best interests of the patient.
 
 
How many ECT complaints were investigated outside the NHS and CCG?
               There are no (zero) complaints investigated outside of 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)?
               There are no (zero) patients deaths during or 1 month after ECT.
 
How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)?
               There are no (zero) patients deaths within 6 months after ECT
 
How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)?
               There are no (zero) patients deaths by suicide within 6 months of receiving ECT.
 
How many patients have suffered complications during and after ECT and what were those complications?
4 patients had complications, these were associated with low blood pressure which were clinically managed.
 
Have there been any formal complaints from patients/relatives about ECT?
               No
 
If so, what was their concerns?
               N/A
 
 
How many patients report memory loss/loss of cognitive function?
               6
 
What tests are used to assess memory loss/loss of cognitive function?
              Mini-Ace,
CPRS,
MADRS
Moca
 
Please note that either the Mini- Ace or Moca can be used for cognitive assessment  
 
Have MRI or CT scans been used before and after ECT?
               No
 
If so, what was the conclusion?
               Not applicable.
 
How does the Trust plan to prevent ECT in the future?
The Neuromodulation treatment service, which includes Esketamine, Repetitive Transcranial Magnetic Stimulation and Vagus Nerve Stimulation. ECT is only considered as a last resort modality.

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

 Please supply any serious incident reports/investigations?
The Trust is unable to provide this information. This is because the information Provided in these reports could potentially make the individuals identifiable. The Trust is therefore applying Section 41 (Information Provided in Confidence).
              
How many SERIOUS INCIDENT REPORTS in 2021?
In 2021, the Trust implemented the Patient Safety Incident Response Framework (PSIRF) as an early adopter which has replaced the Serious Incident Framework.
 
Therefore, we have provided the number of serious incidents and those incidents               reported under the new framework.
              
1st January 2021 – 30th April 2021 (Serious Incidents Framework) = 34
 
1st May 2021 – 31st December 2021 (Patient Safety Incident Response Framework) = 62
 
What proportion of patients were men/women?
              

	Male	Female	Transgender
Gender	55%	44%	1%

 
 
How old were they?
 

	0-17	18-65	65+
Age	1	77	18

 
 
What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
               7%
 
How many SERIOUS INCIDENT REPORTS were investigated outside the NHS and CCG?
There are no (zero) complaints investigated outside of 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)?
               The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual serious incident reports and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
 
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)?
               The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual serious incident reports and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
How many patients died by suicide within 6 months of receiving SERIOUS INCIDENT REPORTS (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?
               The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual serious incident reports and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications?
               The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual serious incident reports and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS?
               Yes
 
If so, what was their concerns?
               Details of the areas of concerns that were raised are as follows:
Concern about level of communication from Patient Safety Investigator/Team
Concern about information sharing
Concerns about content of Patient Safety Investigation report
Concerns regarding staff involved with the PSI investigation
Time taken to complete Patient Safety Investigation (PSI)
 
How does the Trust plan to prevent SERIOUS INCIDENTS in the future?
Essex Partnership University NHS Foundation Trust has focussed on putting safety at the heart of everything we do - establishing a three year safety strategy "Safety First, Safety Always". We're now in the second year of this strategy and have focussed on a huge range of activities, including reducing ligature risk on our sites, creating more therapeutic and safe environments for our patients, an emphasis on supportive engagement and observations, a recruitment drive so that we have the right staff with the right skills, early adopter of Patient Safety Incident Response Framework, enhanced training and investment in technology.
 
In May 2021, the Trust implemented the Patient Safety Incident Response
Framework (PSIRF) as an early adopter. The Trust has a Patient Safety Incident Response plan however whilst this is not currently published it will be in the near future. The Trust is therefore applying exemption Section 22 of the Freedom of Information act, this exemptions is for information that is intended to be published in the future.

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

 

Please supply any Restraints/investigations?
               The Trust does not hold this data centrally, to determine this would require a     manual trawl of each individual restraint incident and relating patient records,              therefore the Trust is unable to provide all of the information requested as this    would exceed the time and cost limits, as set out in the Act. The Trust is therefore                 applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
How many RESTRAINTS in 2021?
               2365
 
What proportion of patients were men/women?
              

	Male	Female	Other	Not Stated
Gender	28%	70%	1%	1%

               *Other is an available option on the internal form that can be chosen
 
 
How old were they?
               Of those where ages were recorded please see below table

	0-17	18-65	65+
Age	823	1334	208

 
 
What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
18%
               4% incidents do not have ethnicity stated.
 
How many RESTRAINTS were investigated outside the NHS and CCG?
There are no (zero) complaints investigated outside of the NHS and CCG.
 
How many patients died during or 1 month after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?
 
The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual restraint incident and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
How many patients died within 6 months after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?
 
The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual restraint incident and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
How many patients died by suicide within 6 months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)?
The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual restraint incident and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
How many patients have suffered complications during and after RESTRAINTS and what were those complications?
The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual restraint incident and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
Have there been any formal complaints from patients/relatives about RESTRAINTS?
               Yes
 
If so, what was their concerns?
Details of the areas of concerns that were raised are as follows:   Inappropriate use restraints
               Staff professionalism
 
Are counts of forced injections available?
Counts of Rapid Tranquillisation are kept.
 
How does the Trust plan to reduce restraints in the future?
The Trust has a Reducing Restrictive Practice Strategy which is overseen by the Reducing Restrictive Practice Steering Group.

This Group also monitors restraint incidents and advises wards on appropriate actions..

The Trust are engaged in the National Quality Improvement Collaborative with NHS England/ Improvement and University College London partners with an ambition to reduce restraints / seclusions by 25% over the following 12 months.
 

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

 

Please supply any SECLUSION reports/investigations
The Trust does not hold this data centrally, to determine this would require a     manual trawl of each individual seclusion incident and relating patient records,     therefore the Trust is unable to provide all of the information requested as this            would exceed the time and cost limits, as set out in the Act. The Trust is therefore   applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
How many SECLUSIONS in 2021?
289
 
What proportion of patients were men/women?
 

	Male	Female	Other	Not Stated
Gender	43%	56%	0.50%	0.50%

*Other is an available option on the internal form that can be chosen
 
How old were they?
              Of those where ages were recorded please see below table

	0-17	18-65	65+
Age	74	207	8

 
              
What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
30%
2% incidents do not have ethnicity stated.
 
How many SECLUSIONS were investigated outside the NHS and CCG?
There are no (zero) complaints investigated outside of the NHS and CCG.
 
How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual Seclusion/LTS incident and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
              
How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual Seclusion/LTS incident and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
 
How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual Seclusion/LTS incident and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
How many patients have suffered complications during and after SECLUSION and what were those complications?
The Trust does not hold this data centrally, to determine this would require a manual trawl of each individual Seclusion/LTS incident and relating patient records, therefore the Trust is unable to provide all of the information requested as this would exceed the time and cost limits, as set out in the Act. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit.
 
Have there been any formal complaints from patients/relatives about SECLUSION?
               Yes
 
If so, what was their concerns?
               Staff attitude and behaviour  
 
How does the Trust plan to reduce SECLUSIONS in the future?
              The Trust has a Reducing Restrictive Practice Strategy which is overseen by the                                  
Reducing Restrictive Practice Steering Group. This Group also monitors seclusion incidents and advises wards on appropriate actions. The Trust are engaged in the National Quality Improvement Collaborative with NHS England/ Improvement and
University College London partners with an ambition to reduce restraints /seclusions by 25% over the following 12 months
 

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

 

1             Please supply any MEDICATION ERRORS reports/investigations
The Trust does not hold this data centrally, to determine this would require a manual trawl of individual records for every patient who had a reported medication error of any type. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit).
 
How many MEDICATION ERRORS in 2021?
               1,101
 
 
 
What proportion of patients were men/women?

	Male	Female
Gender	39%	61%

 
 
How old were they?

	0-17	18-65	65+
Age	30	442	297

* Please be advised not all medication errors are involving patients
 
What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
               10%
 
How many MEDICATION ERRORS were investigated outside the NHS and CCG? There are no (zero) complaints investigated outside of the NHS and CCG.
 
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)? The Trust does not hold this data centrally, to determine this would require a manual trawl of individual records for every patient who had a reported medication error of any type. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit).
              
How many patients died within 6 months after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)? The Trust does not hold this data centrally, to determine this would require a manual trawl of individual records for every patient who had a reported medication error of any type. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit).
 
How many patients died by suicide within 6 months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)? The Trust does not hold this data centrally, to determine this would require a manual trawl of individual records for every patient who had a reported medication error of any type. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit).
 
How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?
The Trust does not hold this data centrally, to determine this would require a manual trawl of individual records for every patient who had a reported medication error of any type. The Trust is therefore applying Section 12 of the Act (where cost of compliance exceeds appropriate limit).
 
Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
               Yes
 
If so, what was their concerns?
               Prescribing error
Overprescribing
Administration
              
How does the Trust plan to prevent MEDICATION ERRORS in the future?
               Medication incidents reported via the Trust adverse event reporting system (DATIX) are analysed regularly to identify lessons learned to inform clinical practice improvements.

These are discussed at the Medication Management Group and Medication Safety Group.
 

Applied Exemptions

Section 41 (Information provided in confidence):

(1)            Information is exempt information if—

(a)            it was obtained by the public authority from any other person (including another public authority), and

(b)           the disclosure of the information to the public (otherwise than under this Act) by the public authority holding it would constitute a breach of confidence actionable by that or any other person.

(2)            The duty to confirm or deny does not arise if, or to the extent that, the confirmation or denial that would have to be given to comply with section 1(1)(a) would (apart from this Act) constitute an actionable breach of confidence.

 

Section 12 (Exemption where cost of compliance exceeds appropriate limit):

(1)            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.

(2)            Subsection (1) does not exempt the public authority from its obligation to comply with paragraph (a) of section 1(1) unless the estimated cost of complying with that paragraph alone would exceed the appropriate limit.

(3)            In subsections (1) and (2) “the appropriate limit” means such amount as may be prescribed, and different amounts may be prescribed in relation to different cases.

(4)            The Secretary of State may by regulations provide that, in such circumstances as may be prescribed, where two or more requests for information are made to a public authority—

(a)            by one person, or

(b)           by different persons who appear to the public authority to be acting in concert or in pursuance of a campaign, the estimated cost of complying with any of the requests is to be taken to be the estimated total cost of complying with all of them.

 

(5)       The Secretary of State may by regulations make provision for the purposes of this section as to the costs to be estimated and as to the manner in which they are to be estimated

 

Section 12 (Exemption where cost of compliance exceeds appropriate limit):

 

(1)                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.

(2)                Subsection (1) does not exempt the public authority from its obligation to comply with paragraph (a) of section 1(1) unless the estimated cost of complying with that paragraph alone would exceed the appropriate limit.

(3)                In subsections (1) and (2) “the appropriate limit” means such amount as may be prescribed, and different amounts may be prescribed in relation to different cases.

(4)                The Secretary of State may by regulations provide that, in such circumstances as may be prescribed, where two or more requests for information are made to a public authority—

(a)                by one person, or

(b)                by different persons who appear to the public authority to be acting in concert or in pursuance of a campaign, the estimated cost of complying with any of the requests is to be taken to be the estimated total cost of complying with all of them.

 

(5)           The Secretary of State may by regulations make provision for the purposes of this section as to the costs to be estimated and as to the manner in which they are to be estimated

 

Section 22 (provides an exemption for information that is intended to be published in the future.)

 

               (1) Information is exempt information if—

(a)                the information is held by the public authority with a view to its publication, by the authority or any other person, at some future date (whether determined or not),

 

(b)                the information was already held with a view to such publication at the time when the request for information was made, and

 

(c)                 it is reasonable in all the circumstances that the information should be withheld from disclosure until the date referred to in paragraph

(a).

 

(2)  The duty to confirm or deny does not arise if, or to the extent that, compliance with section 1(1)(a) would involve the disclosure of any information (whether or not already recorded) which falls within subsection (1).

 

(3)  Future publication

(a)                For the exemption in section 22 to apply, the public authority must, at the time of the request, hold the information and intend that it or ‘any other person’ will publish it in future. This means that it must have a settled expectation that the information will be published at some future date

 

(b)                In this exemption ‘any other person’ means an individual or a body corporate; a public authority or a private organisation.

 

 

Publication Scheme:

 

As part of the Freedom of Information Act all public organisations are required to proactively publish certain classes of information on a Publication Scheme. A publication scheme is a guide to the information that is held by the organisation. EPUT’s Publication Scheme is located on its Website at the following link https://eput.nhs.uk