HUMBER 2021

Freedom of Information Request 22 112

Our Reference: FOI 22 112 / SH / AA / HG

Name: Wendy Micklewright

Date: 29 June 2022

Address: wmicklewright@yahoo.co.uk

Dear Requester,

Further to your Freedom of Information Request, please find the Trust’s response below:

Humber Teaching NHS Foundation Trust (“the Trust”) can provide the following information.

Kindly note that in order to adhere to best practice in maintaining confidentiality, the Trust does not publish numbers lower than 5 as this could lead to the identity being revealed. Exemption – Section 40(2) of the Freedom of Information Act is applied. To disclose the information requested would be in breach of the Data Protection Act (2018).

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

1.Please supply patient’s information ECT leaflet.

Please see attached document entitled “Patient info for ECT”.

2.Please supply patient ECT consent form

Please see attached document entitled “Consent form ECT”

3.Please supply any ECT reports/investigations

None completed

4.How many ECT in 2021?

The number of sessions carried out is 229 however, this does not necessarily equate to the number of patients as patients may have more than one session.

5.What proportion of patients were men/women?

65% - Women, 35% Men

6.How old were they? Ages 31 to 82

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

4.3%

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 not ECT was considered the cause)? <5

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

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

The Trust is unable to provide a response to this question as death by suicide can only be determined in a Coronial setting.

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

15.Have there been any formal complaints from patients/relatives about ECT? No

16.If so, what was their concerns?

N/A

17.How many patients report memory loss/loss of cognitive function? <5

18.What tests are used to assess memory loss/loss of cognitive function? Addenbrookes and Abbreviated Mini Mental

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

Not as a routine requirement for ECT. There have been instances where CT scans have been done during a course of ECT to rule out underlying causes of cognitive impairment.

20.If so, what was the conclusion? N/A

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

The future may bring the development of more affective anti-depressant treatments with less side effects which could see a decrease in ECT treatment however certain patients may always respond better to specific treatments including ECT.

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

1.Please supply any serious incident reports/investigations?

The Trust is unable to provide the information requested as releasing the reports would likely breach the Data Protection Principals of the Data Protection Act 2018 and is therefore exempt under section 40(2) of the Freedom of Information Act 2000.

2.How many SERIOUS INCIDENT REPORTS in 2021?

3.What proportion of patients were men/women? Men = 5 Women = 8

4.How old were they?

The Trust is unable to provide a response to this question as providing the age of the patients

(a patient identifier) would likely breach the Data Protection Principals of the Data Protection Act 2018 and is therefore exempt under section 40(2) of the Freedom of Information Act 2000.

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

The Trust is unable to provide the information requested as it is not held in a reportable format. To go through each report and check the patient record to identify their ethnicity would exceed the statutory appropriate limit. Section 12(1) of the Freedom of Information Act 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 in Regulation 3(2) of The Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004 and states that in the case of a public authority, the appropriate limit is £600.

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

None that we are aware of.

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)?

None that we are aware of.

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)?

None that we are aware of.

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)?

The Trust is unable to provide a response to this question as death by suicide can only be determined in a Coronial setting.

10.How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications? None that we are aware of.

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

12.If so, what was their concerns? N/A

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

Robust patient safety governance arrangements, learning the lesson events, monitoring of action plans and monitoring of embedding revised or new practices, audit, peer review, daily safety huddles, divisional safety huddles, Clinical risk management group

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

1.Please supply any Restraints/investigations?

The Trust is unable to provide the information requested as the time taken to review and redact the reports to remove any patient identifiers, to ensure we do not breach the Data Protection Principals of the Data Protection Act 2018, would exceed the statutory appropriate limit. Section 12(1) of the Freedom of Information Act 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 in Regulation 3(2) of The Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004 and states that in the case of a public authority, the appropriate limit is £600.

2.How many RESTRAINTS in 2021?

745 incidents

3.What proportion of patients were men/women?

Female 52.08%

Male 42.28%

Not stated 5.64%

4.How old were they?

The Trust is unable to provide a response to this question as providing the age of the patients

(a patient identifier) would likely breach the Data Protection Principals of the Data Protection Act 2018 and is therefore exempt under section 40(2) of the Freedom of Information Act 2000.

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

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

None as far as the Trust is aware.

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

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

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

The Trust is unable to provide a response to this question as death by suicide can only be determined in a Coronial setting.

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

The Trust is unable to provide the information requested as it is not held in a reportable format. In order to locate this information, we would be required to read through each incident description and identify any complications recorded. Section 12(1) of the Freedom of Information Act 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 in Regulation 3(2) of The Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004 and states that in the case of a public authority, the appropriate limit is £600.

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

13.Are counts of forced injections available?

Yes, and as per the clarity you have provided, we can confirm that in 2021, Rapid Tranquilisation was undertaken on 44 occasions.

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

Please see document called ‘Prevention of restraint and seclusion’ as well as the below response:

The Trust has a workplan to further strengthen the Reducing Restrictive Intervention agenda. This work plan was produced and presented at the Mental Health Act Legislation committee. The below is an update of this work plan.

Update and oversee the implementation of “safe wards” within the Trust and using a positive behaviour support framework and encourage staff and services to use these approaches

All wards have now updated their safe wards pledges

Consideration of the current risk management plans for advance planning of restrictive interventions.

Areas now take an individualised risk approach rather than blanket restrictions.

Continue the current training used to manage violence and aggression

The Positive Engagement Team (PET) continue to deliver bespoke sessions to a number of wards and to support the development of clinical plans for a number of complex patients, the PET team have been happy to advise when individual service users have complex needs and have extended this offer to Multidisciplinary Teams (MDTs) with the aim of reducing risks to patients and staff. The security lead from secure services has now been fully trained to deliver De-escalation Management and Intervention sessions and can offer more bespoke sessions if needed to the more complex patients.

The security lead from secure services now delivers bespoke secure training for the Secure Escort Vehicle and has arranged a number of sessions.

The security lead from secure services now delivers bespoke handcuff training and has arranged a number of sessions within secure services.

Review of restrictive interventions in use across the Trust, including the use of seclusion, types of restraint specifically focusing on prone restraint, rapid tranquilisation, defacto seclusion and time out.

Work is undertaken in all clinical areas around this, and all clinical areas present their data at the monthly RRI group

Review of post incident restrictions and lessons learnt

All divisions have plans in place to review incidents and look at lessons learnt.

Consider chemical restraint in more detail and how medication is utilised to sedate and calm outside of the parameters currently described by rapid tranquilisation, including how this is discussed and managed within care plans.

The episodes of RT are also discussed in monthly RRI group, as well as in clinical meetings within the divisions

Production of quarterly reports for the MHA legislation committee Reports all written and tabled at committee

Production of an annual report for the MHS legislation committee Reports all written and tabled at committee

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

1.Please supply any SECLUSION reports/investigations

The Trust is unable to provide the information requested as the time taken to review and redact the reports to remove any patient identifiers to ensure we do not breach the Data Protection Principals of the Data Protection Act 2018, would exceed the statutory appropriate limit. Section 12(1) of the Freedom of Information Act 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 in Regulation 3(2) of The Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004 and states that in the case of a public authority, the appropriate limit is £600.

However, by way of assistance we can tell you that in the period requested, there has been a total of 270 incidents. Of these incidents, 209 were categorised as no harm, 57 were low harm and 4 were moderate harm.

2.How many SECLUSIONS in 2021? See response above.

3.What proportion of patients were men/women?

Female 19.63%

Male 73.70%

Not stated 6.67%

4.How old were they?

The Trust is unable to provide a response to this question as providing the age of the patients

(a patient identifier) would likely breach the Data Protection Principals of the Data Protection Act 2018 and is therefore exempt under section 40(2) of the Freedom of Information Act 2000.

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? None as far as we are aware.

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

0 incidents

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)?

The Trust is unable to provide a response to this question as death by suicide can only be determined in a Coronial setting.

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?

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

Please see document called ‘Prevention of restraint and seclusion’ and the response above for Q14 under the heading of restraint.

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

1.Please supply any MEDICATION ERRORS reports/investigations

However, by way of assistance, we can tell you that for the period requested, there were a total of 362 medication errors. Of those 362 incidents, 309 were categorised as no harm, 52 as low harm and 1 as moderate harm.

2.How many MEDICATION ERRORS in 2021? See response above

3.What proportion of patients were men/women?

Female 34.25%

Male 37.29%

No Details 28.45%

4.How old were they?

The Trust is unable to provide a response to this question as providing the age of the patients

(a patient identifier) would likely breach the Data Protection Principals of the Data Protection

Act 2018 and is therefore exempt under section 40(2) of the Freedom of Information Act 2000.

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

6.How many MEDICATION ERRORS were investigated outside the NHS and CCG? The Trust can confirm that for the period requested, a total of 20 medication errors were investigated outside of the NHS & CCG.

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)?

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)?

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

The Trust is unable to provide a response to this question as death by suicide can only be determined in a Coronial setting.

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

The Trust is unable to provide the information requested as it is not held in a reportable format. In order to locate this information we would be required to read through each incident description and identify any complications recorded. Section 12(1) of the Freedom of Information Act 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 in Regulation 3(2) of The Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004 and states that in the case of a public authority, the appropriate limit is £600.

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

12.If so, what was their concerns? N/A

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

Request staff report any medication errors/incidents via our reporting system – Datix, including near misses to ensure we capture learning proactively to prevent future errors.
Each medication incident reported is processed by a member of the Medicines Safety team, led by the Medicines Safety Officer. Investigation takes place regarding how the error occurred.
Each medication incident is discussed in the Patient Safety huddle which occurs every weekday. Any learning outcomes/actions are fed back to the team, resulting in working collaboratively with the Medicines Safety team to implement any change to process/practice to ensure we are preventing the error occurring again in the future.
If the medication error/incident is categorised as causing harm to a patient, this is escalated to an Initial incident Review which is completed by a clinical lead/service manager/Matron within the team.
Initial Incident Reviews are discussed weekly at the Critical Risk Management Group meeting attended by a multidisciplinary clinical lead for each Division/Medical Director/Chief Pharmacist/Medicines Safety Officer in the Trust. Implementation of actions and learning outcomes are discussed, actioned, and monitored within the group.
If required due to the seriousness of the medication error, this may then be escalated from an Initial incident Review to a Significant Event Audit, following on to a Serious Incident Review.
Actions from these reviews may result in change to Trust procedures, which goes to the Drugs & Therapeutics Committee for approval. A Practice Note would be issued to all staff to inform them of the change in practice and the learning incorporated in this to ensure we are preventing these errors occurring in the future.
Monthly Medication error/Incident reports are produced for each Divisions in the Trust, and these are sent to all Medication related groups/committees/meetings/clinical networks to ensure they are cascaded to all staff. Learning outcomes are shared from all divisions to promote learning and proactively identify near misses to prevent future errors occurring.
Medicine Safety Team produce learning outcome information in an ‘Learning the Lessons’ format if any themes/trends are identified which is shared within the Trust via our Trust Global communication.
Each ward/unit/community team has an allocated Pharmacists and Pharmacy Technician who work as Medicines Safety Champions ensuring medication is used as safely as possible across our Trust. Medication audits are carried out to ensure we are monitoring practices and that they are safe and adhered to.
Medication related training is regularly updated to incorporate any learning outcomes or procedural changes – if themes/trends are identified in a particular area, bespoke face to face training is facilitated by the Medicines Safety team to ensure we have put everything in place possible to ensure future we prevent future errors occurring

Medicines Safety Officer attends regional Medicines Safety meetings and multi organisational meetings to ensure our learning outcomes are shared to other Trusts and also that our Trust is proactively implementing/sharing outcomes from other Trusts to all our staff to try and prevent future medication errors.

Kind regards,

Freedom of Information Team

Humber Teaching NHS Foundation Trust

Mary Seacole Building

Willerby Hill

Willerby

HU10 6ED

https://www.humber.nhs.uk/about -our -trust/freedom -of -information -enquiry -form.htm