Mersey Care NHS Foundation Trust 2024

FOI@merseycare.nhs.uk

FOI 25-257 – Appendix 1

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

1. Please supply patient’s information ECT leaflet.

Please see below the following leaflets: -

FAQs on ECT

Electroconvulsive Therapy (ECT)

Royal College of Psychiatrists ECT

2. Please supply patient ECT consent form.

Please see Your Rights To Say Yes or No to ECT Treatment below.

3. Please supply any ECT reports/investigations

None

4. How many ECT in 2024?

32 patients were treated in 2024.

5. What proportion of patients were men/women?

17 women and 15 men.

6. How old were they?

The youngest patient was 24 and the oldest was 83. The mean average age was 63 years.

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

One

8. How many people covered by the equality act received ECT?

Whilst the Trust may hold this information, it would require detailed review of each individual patient’s record to locate, retrieve and extract all this the information. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

9. How many people were offered talking therapy prior to ECT?

Whilst the Trust may hold this information, it would currently require detailed review of each individual patient’s record to locate, retrieve and extract all this the information. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

The referral paperwork is being updated to consider new ECTAS standards.

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

11. How many patients consented to ECT?

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

None

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

One patient died four weeks after receiving ECT. The patient developed a chest infection and treatment was paused. The patient subsequently died in hospital.

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

None.

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

None.

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

One patient with a background of pulmonary hypertension had ECT discontinued due to desaturation of blood oxygen in recovery. Respiratory opinion was sought, and the anaesthetist made the final decision to stop ECT.

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

18. If so, what was their concerns?

Not applicable

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

Of the 32 patients treated four scored worse on the Six Item Cognitive Impairment Test (6-CIT) following a course of ECT. Most respondents scored better on the 6-CIT after ECT as their overall mental health improved.

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

Comprehensive Psychopathological Rating Scale (CPRS)

Cognitive Impairment Test (6CIT)

Montreal Cognitive Assessment (MoCA)

Clinical Global Impression scale (CGI)

· Used to assess severity of illness (CGI-S) and change (CGI-I)

· CGI–S completed by referrer before treatment starts

· CGI–I completed before each treatment session within the department’s Patient Health Questionnaire (PHQ-9)

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

Yes, however this is the responsibility of the referring clinician and based on the clinical need of the service user.

22. If so what was the conclusion?

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

Freedom of Information is about the provision of fact (recorded information) not opinion.

The Trust can advise that:

ECT is a scientifically evaluated and effective treatment for severe depression and other conditions. It is approved by NICE, the Royal College of Psychiatrists and is available in most Mental Health Trusts throughout the UK. It is internationally available in most countries and is recognised as a standard intervention in severe and treatment resistant depression.

ECT continues to be scientifically researched with research papers published in all major international psychiatric journals as well as in the specialist international journal for ECT.

ECT forms part of a range of treatments for the more severe types of depression and Mersey Care NHS Foundation Trust is committed to developing its service for severe and resistant depression as part of its commitment to Perfect Care. The option of patients receiving ECT forms a key part of this service. Following a successful 2-year pilot, Mersey care now also offer TMS (Transcranial Magnetic Stimulation) as a treatment option. Many patients with treatment resistant depression who would have previously been referred for ECT have now been offered and treated with rTMS as an alternative.

Although most patients with depression will not require ECT it remains an important part of standard psychiatric practice.

The ECT service at Mersey Care is accredited with the Royal College of Psychiatrists Elective Convulsive Therapy Accreditation Service (ECTAS), which provides independent external evaluation of ECT services, and has been so for more than ten years, since the ECTAS service has existed.

FOI 25-257 – Appendix 5

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

1. Please supply any Restraints/investigations

Whilst the Trust holds this information, it is not held centrally and would require detailed review of each individual patient’s record (for all 4,612 restraints) to locate, retrieve and extract all this the information. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

Wards are required to undertake a de-briefing for staff and service users following incidents of physical intervention. Debriefs are a helpful mechanism to support teams at times where there have been injuries or significant concerns in relation to the acuity of the incident and they also support learning to reduce and prevent future incidents.

We analyse all incident data weekly, which is fed back to clinical areas. This enables us to identify areas that require additional support and keeps our teams constantly engaged in the process of improvement. In addition to this, all incidents of PI are collated and monitored monthly by our divisional Reducing Restrictive Practice Monitoring Groups.

All restraint episodes are reviewed and audited monthly by a ward manager not attached to that area. All restraint episodes are also monitored for appropriateness and proportionality via the Reducing Restrictive Practice Monitoring Group.

2. How many RESTRAINTS in 2024?

4,612

3. What proportion of patients were men/women?

Gender	Episodes
Female	2052
Male	2079
No Gender indicated	481

4. How old were they?

Age Bands	Episodes
19 and under	89
20-29	1520
30-39	1292
40-49	369
50-59	612
60-69	172
70-79	53
80-89	18
90-99	6
No age indicated	481

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

13.72% BAME / 82.18% White / 3.31% not stated. 11.62% of restraints had no details recorded.

6. How many people covered by the equality act were restrained?

Whilst the Trust holds this information, it would require detailed review of each individual patient’s record to locate, retrieve and extract all this the information. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

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

Whilst the Trust may hold this information, it is not held centrally and would require detailed review of each individual patient’s record to locate, retrieve and extract all this the information. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

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

Number of patients died within 1 month of restraint	Reason
5	Possible suicide	2
	Unexpected natural cause death	2
	Expected natural causes	1

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

Number of patients died within 6 months of restraint	Reason
5	Possible suicide	4
5	Unexpected natural cause death	1

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

Six

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

Wards are required to seek a medical review following all incidents of physical intervention and seclusion by medical staff as per policy SD18. Whilst the Trust holds this information, it is not held centrally and would require detailed review of each individual patient’s record to locate, retrieve and extract all this the information. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

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

One

13. If so, what was their concerns?

The patient complained that the handcuffs had caused an injury.

14. Are counts of forced injections available?

The Trust does not currently monitor the number of injections given without consent so are unable to provide this information.

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

Freedom of Information is about the provision of fact (recorded information) not opinion.

The Trust can advise that:

· As part of our drive towards striving for Perfect Care, Mersey Care NHS Foundation Trust launched the ‘No Force First’ initiative, with the aim of eliminating restrictive interventions in our inpatient services, unless necessary.

· The Trust believes people in our care who present with behaviours of concern should be supported through methods other than physical and medication-led restraint. We remain committed both to the ‘No Force First’ initiative in our inpatient services, a model of working that focuses on reducing restrictive practices and improving patient outcomes.

· Mersey Care NHS Foundation Trust is leading research. We work very closely with service users on pre-agreed care plans and on co-produced positive behavioural support, in line with the national best practice and government policy documents and practice guidance to break the cycle of restriction and use positive early interventions.

· Mersey Care NHS Foundation Trust treats the safety of its staff, patients and visitors very seriously and when incidents happen there are rigorous procedures in place, together with a review of the events so we may learn from them. It is necessary to point out that multiple levels of scrutiny are in place and staff are highly trained to deal with violent or aggressive situations.

· Mersey Care NHS Foundation Trust clinicians and service users continue to share national award platforms which have recognised the joint working in reducing restrictive practice together.

Appendix 6:

FOI 25-257 – Appendix 6

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

1. Please supply any SECLUSION reports/investigations

Whilst the Trust holds this information, it is not held centrally and would require detailed review of each individual patient’s record (for all 808 seclusions) to locate, retrieve and extract all this the information. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

All seclusion episodes are reviewed and audited monthly by a ward manager not attached to that area. All seclusion episodes are also monitored for appropriateness and proportionality via the Reducing Restrictive Practice Monitoring Group.

2. How many SECLUSIONS in 2024?

808

3. What proportion of patients were men/women?

Gender	Episodes
Female	138
Male	670

4. How old were they?

Age Bands	Episodes
19 and under	9
20-29	199
30-39	258
40-49	167
50-59	144
60-69	26
70-79	5

This data is based on the patient’s age at the start of the seclusion episode and therefore a patient could be reported in multiple age bands if multiple seclusions occurred.

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

16.77% BAME / 81.71% White /1.52% not stated.

These percentages are based on 328 distinct patients.

6. How many people covered by the Equality Act were secluded?

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

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

None.

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

None.

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

None.

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

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

Three.

13. If so, what was their concerns?

· Patient complained that there was no access to toilet paper in seclusion.

· Patient complained they had been placed in seclusion for seven weeks. (Not upheld)

· Patient complained that their seclusion was unlawful, the toilet was broken and access to the garden was restricted.

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

Freedom of Information is about the provision of fact (recorded information) not opinion.

The Trust can advise that:

· The Trust has a preventative strategy through No Force First approach that is established and embedded in practice. There is a clear approach and interventions that are designed to support a reduction strategy for all restrictive practices including seclusion.

· Reducing restrictive practices is a key priority and a zero approach to segregation has been embedded. Consequently, robust governance and oversight processes are embedded to ensure that seclusion is used as a last resort and that patients are not in seclusion for longer than is necessary

· The Trust invests in staff training which focusses on preventative strategies and de-escalation. The training has been certified by Bild and is approved as meeting the standards set by the Restraint Reduction Network. Staff are equipped with clinical skills that harness positive relationships, human rights approaches and a compassionate culture

· Better clinical Environments. The Trust is investing in clinical environments, use of de-escalation and comfort room as well as quiet rooms to offer alternative spaces for patients on wards. There is greater focus on trauma informed care and interventions

· The HOPE(s) model has been developed within the Trust, has been applied, and shared both locally and nationally. The model aims to end long term segregation (LTS) and the harm associated with this. By reducing LTS the Trust will also focus on seclusion

· Seclusion is always a last resort.

Appendix 7:

FOI 24-198 – Appendix 7

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

1. Please supply any MEDICATION ERRORS reports/investigations

Whilst the Trust holds this information, it would require detailed review of each individual medication incident (3,556 such incidents) on the Trust’s incident reporting systems (Datix, Ulysses and Radar) to locate, retrieve and extract all this the information. It would also require review of each individual incident report to ensure they are individually checked to ensure any person confidential information is redacted. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

2. How many MEDICATION ERRORS in 2024?

3,556

3. What proportion of patients were men/women?

Whilst the Trust holds this information, it would require detailed review of each individual incident reported to locate, retrieve and extract all this the information. If the patient’s gender is not recorded, each individual patient’s record would then need to be reviewed. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

4. How old were they?

Whilst the Trust holds this information, it would require detailed review of each individual incident reported to locate, retrieve and extract all this the information. If the patient’s age is not recorded, each individual patient’s record would then need to be reviewed. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

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

6. How many people covered by the equality act endured medication errors?

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

The Trust does not hold this information as it is outside its remit.

8. 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)?

Cause of death is not routinely recorded on every patient care record. Whilst the Trust may hold this information, it would require detailed review of each individual patient’s record to locate, retrieve and extract all this the information. Therefore, this part of the Trust response is refused under S12(1) of the Freedom of Information Act.

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

As per response to Q7 above.

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

As per response to Q7 above.

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

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

Three.

12. If so, what was their concerns?

· Patient complained they had been given the incorrect medication.

· Patient complained that their medication is never given on time.

· Patient’s partner complained that incorrect doses of medication were given.

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

Freedom of Information is about the provision of fact (recorded information) not opinion.

The Trust can advise that:

· The Trust takes medication errors very seriously and after an incident has happened there are rigorous procedures in place, together with a review of the events so we may learn from them. Extra training is given if required.

· All medicines incidents are reviewed for emerging trends and themes through the Trust medicines management governance processes and ensures lessons are shared and learnt to prevent future incidents. The Trust has set ‘zero harm from medicines’ as a key perfect care goal in it’s Clinical Strategy to ensure that medicines safety remains front and centre, supports monitoring and quality improvement plans.

· The Trust invests in staff training which focusses on preventative strategies and de-escalation.

Regards

The FOI Team

Mersey Care NHS Foundation Trust

FOI@merseycare.nhs.uk