KENT 2020

Kent and Medway NHS and Social Care Partnership Trust

INFOACCESS (KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST) <kmpt.infoaccess@nhs.net>

FOI ID 25647 - Response

07/06/2021

Good Morning Wendy

I write further to your request FOI ID 25647 under the Freedom of Information Act 2000 regarding:-

ECT Treatment, Serious Incidents, Restraints, Seclusion & Medication Errors

Following an investigation and search of our records I can confirm the following Kent and Medway NHS and Social Care Partnership Trust (KMPT) information:-

Please provide ECT information under the FOI act to the following questions for the Year 2020:

Please supply patient’s information ECT leaflet.

Please find attached ECT Leaflet

Please supply patient ECT consent form.

Please find attached ECT Consent form

Please supply any ECT reports/investigations

All information requested is not routinely collected outside normal medical record keeping. The requested information is not held centrally and is contained within the individual medical records and archive systems which can not be extracted as a stand alone piece of data. In order to extract the requested information and collate the results would require a manual exercise to identify and review medical records and would exceed the appropriate time limits, as per the Freedom of Information Act 2000 section 12(1) which 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.

How many ECT in 2020?

287 Treatments in total in relation to 29 Patients

What proportion of patients were men/women?

Gender	Total
Male	10
Female	19

How old were they?

29 patients between ages 27 - 85

What were the diagnoses and in what proportions?

What proportions of patients were classified BAME?

Due to the low numbers involved in the response to your request I would like to confirm that we are unable to release the information. We are not obliged, under section 40 (2) FOIA to provide information that is personal information of another person if releasing would contravene any of the provisions of the Data Protection Act 2018. In this instance we believe that the figures are significantly low enough that identification of those involved could be made, and would therefore contravene the first Data Protection principle, therefore section 40 (2) is engaged.
The terms of this exemption in the freedom of information act mean that we do not have to consider whether or not it would be in the public interest for you to have the information

How many were receiving ECT for the first time?

Gender	Total
Male	14
Female	16

How many patients consented to ECT?

Gender	Total
Male	Fewer than 10
Female	Fewer than 10

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

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

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

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

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

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

If so, what was their concerns?

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

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

Adenbrookes cognitive examination (ACE III)

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

Head scans (CT/MRI) are not routinely requested before or after ECT unless there is a specific clinical indication.

If so what was the conclusion?

N/A

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

ECT is only ever used as a last resort. In line with NICE and RCPsych guidelines the wishes of the patient is of paramount importance and all attempts are made to obtain valid and informed consent

Please provide SERIOUS INCIDENT information under the FOI act to the following questions for the Year 2020:

Please supply any serious incident reports/investigations

All information requested is not routinely collected outside normal record keeping of an incident investigation. The requested information is not held centrally and is contained within the individual investigation records and archive systems which can not be extracted as a stand alone piece of data. In order to extract the requested information and collate the results would require a manual exercise to identify and review investigation records and would exceed the appropriate time limits, as per the Freedom of Information Act 2000 section 12(1) which 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.

How many SERIOUS INCIDENT REPORTS in 2020?

160

What proportion of patients were men/women?

Gender	Total
Male	96
Female	67

Please note KMPT have SI's where there is more than one patient and some where there are no patients

How old were they?

Age	Total
80 - 100	Fewer than 10
70 to 79	19
60 to 69	14
50 to 59	27
40 to 49	30
30 to 39	31
20 to 29	29
16 to 19	Fewer than 10

What proportion of patients were classified BAME?

Ethnicity	Total
Black African	Fewer than 10
Indian	Fewer than 10
Mixed white and Asian	Fewer than 10
Mixed white and black African	Fewer than 10
Mixed white and black Caribbean	Fewer than 10
Not stated	Fewer than 10
White - British	142
White - Irish	Fewer than 10
White - Other White	Fewer than 10

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

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

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

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

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

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

If so, what was their concerns?

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

Each Serious Incident is investigated using root cause analysis methodology. This enables recommendations to be produced and actions to be developed. The actions are monitored until they are closed. KMPT has recently developed a Central Investigation Team which enables a consistent investigation and shared learning to be discussed. This team meets weekly to discuss cases which allows for trends and themes to be identified. Additionally, the Trust has also recently set up an action plan meeting for Serious Incident investigations. This enables a more cohesive approach to developing actions, including Trust-wide actions. On occasions there are aggregated investigations to allow theme and trend analysis from investigations. The Trust involves families and patients in the investigations to also learn further. The investigations and sometimes cross-organisational and so joint learning is also developed that way. The Trust also has Trust-wide action plans from external Serious Incidents that have been nationally reviewed. There is learning from experience group which enables further learning to be developed and also themes come from other areas such as complaints in this meeting. Additionally, the investigations are sent to the commissioners who also follow up when deemed required. Care groups take individual learning to their governance meetings for sharing of learning.

Please provide restraints information under the FOI Act to the following questions for the year 2020

Please supply any Restraints/Investigations

How many RESTRAINTS in 2020?

1593

What proportion of patients were men/women?

Gender	Total
Male	246
Female	234
Note stated	Fewer than 10

Please note some patients are involved in multiple incidents and there are some incidents where the patient was not identified.

How old were they?

Age Range	Total
90 - 100+	Fewer than 10
80-89	21
70 to 79	29
60 to 69	42
50 to 59	76
40 to 49	79
30 to 39	85
20 to 29	120
10 to 19	25

What proportion of patients were classified BAME?

Ethnicity	Total
Bangladeshi	Fewer than 10
Black African	16
Black Caribbean	Fewer than 10
Chinese	Fewer than 10
Indian	Fewer than 10
Mixed white and Asian	Fewer than 10
Mixed white and black African	Fewer than 10
Mixed white and black Caribbean	Fewer than 10
Not stated	34
Other Asian	Fewer than 10
Other ethnic category	Fewer than 10
White - British	375
White - Irish	Fewer than 10
White - Other White	21

How many RESTRAINTS were investigated outside 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)?

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

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

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

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

If so, what was their concerns?

All information requested is not routinely collected outside normal record keeping. The requested information is not held centrally and is contained within the individual records and archive systems which can not be extracted as a stand alone piece of data. In order to extract the requested information and collate the results would require a manual exercise to identify and review medical records and would exceed the appropriate time limits, as per the Freedom of Information Act 2000 section 12(1) which 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.

Are counts of forced injections available

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

KMPT has the Promoting Safe Services Strategy in place that is aimed at reducing both the use of restrictive practices as well as incidents of aggression. The strategy focusses on primary prevention, addressing the root cause, and many evidenced-based reduction initiatives and practices are already common place within services, e.g. Positive Behaviour Support plans, Safety Huddles and Safe wards.
All uses of restraint are reported and reviewed by manager level and above to identify lessons learnt and to share good practices. Staff receive Physical Intervention training that is based on a Human Rights framework that continually emphasises the least restrictive intervention at all times.

Please provide SECLUSION information under the FOI act to the following questions for the Year 2020:

Please supply any SECLUSION reports/investigations

How many SECLUSION in 2020?

357

What proportion of patients were men/women?

Male	95
Female	34
Not Stated	Fewer than 10

Please note some patients are involved in multiple incidents and there are some incidents where the patient was not identified.

How old were they?

Age	Total
100+	Fewer than 10
90-99	Fewer than 10
80-89	Fewer than 10
70 to 79	Fewer than 10
60 to 69	Fewer than 10
50 to 59	15
40 to 49	27
30 to 39	31
20 to 29	42
10 to 19	Fewer than 10

What proportion of patients were classified BAME?

Ethnicity	Total
Black African	Fewer than 10
Black Caribbean	Fewer than 10
Chinese	Fewer than 10
Mixed white and Asian	Fewer than 10
Mixed white and black African	Fewer than 10
Mixed white and black Caribbean	Fewer than 10
Not stated	Fewer than 10
Other ethnic category	Fewer than 10
Pakistani	Fewer than 10
White - British	93
White - Irish	Fewer than 10
White - Other White	Fewer than 10

How many SECLUSIONS were investigated outside the NHS and CCG ?

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

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

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

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

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

If so, what was their concerns?

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

KMPT has recently reviewed and updated it’s Seclusion Policy; it is based on a Human Rights and values framework and compliant with the MHA Code of Practice (2015). The policy includes primary preventative strategies including trauma informed awareness to ensure that seclusion as always a last resort. All uses of Seclusion are directly reported to a senior management team, ranging from Directors, Matrons and Promoting Safe Services Specialists every 24 hour period which is in addition to the ‘live’ reports via the Trust’s online reporting system. Every seclusion use is reviewed for lessons learnt and sharing. The Promoting Safe Services team provide clinical advice and support to reduce incidents of seclusion use as well as the duration of use. All inpatient clinical staff receives comprehensive training in the use of seclusion, this includes alternatives to seclusion, for example, collaborative Positive Behaviour Care plans and is based on a human rights and ethical framework. The Trust also has the Promoting Safe Services Strategy 2020-2022 is aimed at reducing both uses of restrictive practices and incidents of aggression by implementing evidenced based preventative initiatives and innovations.

Please provide MEDICATION ERRORS information under the FOI act to the following questions for the year 2020:

Please supply any MEDICATION ERRORS reports/investigations

How many MEDICATION ERRORS in 2020?

538

What proportion of patients were men/women?

Gender	Total
Male	223
Female	165
Not stated	Fewer than 10

Please note some patients are involved in multiple incidents and there are some incidents where the patient was not identified.

How old were they?

Age Band
90 - 100	Fewer than 10
80-89	14
70 to 79	39
60 to 69	60
50 to 59	70
40 to 49	63
30 to 39	64
20 to 29	68
10 to 19	Fewer than 10
Not known	Fewer than 10

What proportion of patients were classified BAME?

Ethnicity	Total
Black African	Fewer than 10
Black Caribbean	Fewer than 10
Chinese	Fewer than 10
Indian	Fewer than 10
Mixed white and black African	Fewer than 10
Mixed white and black Caribbean	Fewer than 10
Not stated	30
Other Asian	Fewer than 10
Other Black	Fewer than 10
White - British	329
White - Irish	Fewer than 10
White - Other White	Fewer than 10

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

How many patients died during or one month after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)?

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

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

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

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

Fewer than 5

If so, what was their concerns?

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

KMPT have a medicine safety officer working in our Trust, who’s focus is medicines safety and promoting shared learning not only within the Trust but also networks across organisations so learning is shared across the wider system. KMPT ensure learning from medication incidents is shared through Medicines Management Newsletters and Medication Incidents Learning Bulletin.
KMPT have set up a medicine incident group which meets bimonthly and is chaired by the medicine safety officer. In these meetings we will:

Analyse incidents to identify, prioritise and address medication risks to minimise harm to patients
Improving understanding of, reporting of and learning from medication error incidents in the organisation
Identifying, developing and promoting best practice for medication safety.
Identifying learning from incidents and sharing throughout the Trust
Coordinating education and training to improve the quality of medication error incident reports and safe medication practices
Assisting in development and review of medication-use policies and procedures

I confirm that the information above/attached completes your request under the Freedom of Information Act 2000. I am also pleased to confirm that no charge will be made for this request.

If you have any queries about this response please contact me. Please remember to quote the reference number above in any future communication.

I confirm that the information above/attached completes your request under the Freedom of Information Act 2000. I am also pleased to confirm that no charge will be made for this request.

If you have any questions or concerns or are unhappy with the response provided or the service you have received you can write to the Head of Information Governance at the address on top of this letter. If you are not content with the outcome of your complaint, you may apply directly to the Information Commissioner for a decision.

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Kind Regards

Anna Planck PC.dp (GDPR)
Deputy Head of Information Governance & Records Management

Kent and Medway NHS and Social Care Partnership Trust
Information Governance Department
St Michaels House
St Michaels Road
Sittingbourne
Kent, ME10 3DW

01795 514531
07468 741605

anna.planck@nhs.net

www.kmpt.nhs.uk

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