Please provide ECT information under the FOI act to the following questions: -
1 Please supply patient's information ECT leaflet.
Please see Appendices 2 and 3 attached
2 Please supply patient ECT consent form.
Please see Appendix 4 attached.
3 Please supply any ECT reports/investigations
None
4 How many ECT in 2022?
Seventeen
5 What proportion of patients were men/women?
Six men and eleven women
6 How old were they?
Between 34 and 88 years
7 What proportion of patients were classified people of the global majority or racialised communities (“POC/BAME”)?
None
8 How many were receiving ECT for the first time?
Nine
9 How many patients consented to ECT?
Ten (Four of these started without capacity and regained capacity during treatment,consent was gained and reaffirmed at each appointment)
10 How many ECT complaints were investigated outside the NHS and CCG?
None
11 How many patients died during or 1 month after ECT and what was the cause (whether or not ECT was considered the cause)? None
12 How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)?
None
13 How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)?
None
14 How many patients have suffered complications during and after ECT and what were those complications?
One patient was slower to wake from anaesthetic than we would expect
15 Have there been any formal complaints from patients/relatives about ECT?
No
16 If so, what was their concerns?
Not applicable
17 How many patients report memory loss/loss of cognitive function?
Ten (Four of which reported memory had improved during ECT)
18 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-l)
CGI — S completed by referrer before treatment starts
CGI — | completed before each treatment session within the department
Patient Health Questionnaire (PHQ-9)
19 Have MRI or CT scans been used before and after ECT?
No
20 If so what was the conclusion?
Not applicable
Please provide SERIOUS INCIDENT information under the FOI act to the following questions:-
1 Please supply any serious incident reports/investigations
Whilst the Trust holds this information, it would require detailed review of each individual serious incident (394 such incidents) on the Trust's incident reporting system Datix 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 SERIOUS INCIDENT REPORTS in 2021? (Possible error should read 2022 ?)
394
This figure may include incidents in relation to staff and visitors as well as patients.
3 What proportion of patients were men/women?
Whilst the Trust holds this information, it would require detailed review of each individual serious incident on Datix to locate, retrieve and extract all this the information.
If the patient's gender is not recorded on Datix, 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 serious incident on Datix to locate, retrieve and extract all this the information.
If the patient's age is not recorded on Datix, 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")?
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
6 How many SERIOUS INCIDENT REPORTS were investigated outside the NHS and CCG?
The Trust does not hold this information as it is outside its remit.
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)?
Cause of death is not routinely recorded, but some causes may be noted within thepatient care records.
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.
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)?
As per response to Q7 above
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)?
As per response to Q7 above
10 How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications?
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
11 Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS?
Yes
12 If so, what was their concerns?
10 complaints were made
Six related to care and treatment
One was regarding confidentially
One was a fall resulting in a broken pelvis.
One was medication (not an error).
One was an allegation against staff purchasing items on behalf of a patient and financial discrepancies
13 How does the Trust plan to prevent SERIOUS INCIDENTS in the future?
Freedom of Information is about the provision of fact (recorded information) not opinion
The Trust can advise that:
The Trust takes any incidents 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 require
The Trust invests in staff training which focusses on preventative strategies and de-escalation
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 5,477 restraints) to locate, retrieve and extract all this the information.
Therefore, this part of the Trust response is refused under S$12(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 in order 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 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 RESTRAINTS in 2022?
5,477
Unfortunately, due to the impact of the COVID-19 pandemic successive lockdowns and isolating measures were put in place.
There was noted to be a large rise in the number of restraints over this period.
3 What proportion of patients were men/women?
42% of restraints were recorded as female and 30% as male.
Gender Episodes
Female 2283
Male 1637
Transgender 4
No Gender indicated 1553
4 How old were they?
Age Bands Episodes
19 and under 138
20-29 1141
30-39 839
40-49 738
50-59 203
60-69 191
70-79 126
80-89 133
90-99 7
No age indicated 1961
5 What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
21%
6 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.
7 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 3
Unexpected natural cause death 2
Natural cause death with no concerns 1
8 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 6
Expected natural cause death with no concerns 3
Unexpected natural cause death 2
Natural cause death with no concerns 1
9 How many patients died by suicide within 6 months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)?
None
10 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
11 Have there been any formal complaints from patients/relatives about RESTRAINTS?
No
12 If so, what was their concerns?
Not applicable
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 837 seclusions) to locate, retrieve and extract all this the information.
Therefore, this part of the Trust response is refused under S$12(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 2022?
837
3 What proportion of patients were men/women?
34% female and 54% male
12% of seclusions were recorded with no gender indicated
4 How old were they?
Age Bands Episodes
19 and under 13
20-29 149
30-39 134
40-49 122
50-59 49
60-69 23
70-79 3
No age was indicated for 344 patients
5 What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
4.5% BAME and 95.5% White
6 How many SECLUSIONS were investigated outside the NHS and CCG?
None
7 How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
None
8 How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
None
9 How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
One
10 How many patients have suffered complications during and after SECLUSION 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.
11 Have there been any formal complaints from patients/relatives about SECLUSION?
There have been seven complaints from patients regarding seclusion
12 If so, what was their concerns?
Three patients felt that seclusion was inappropriate, and three patients related to the length of time in seclusion, and one was from a relative who was unhappy about thereason for the seclusion
13 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
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 (2,661 such incidents) on the Trust's incident reporting system Datix 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 2022?
2,661
3 What proportion of patients were men/women?
Whilst the Trust holds this information, it would require detailed review of each individual incident on Datix to locate, retrieve and extract all this the information.
If the patient's gender is not recorded on Datix, 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 on Datix to locate, retrieve and extract all this the information. If the patient's age is not recorded on Datix, each individual patient's record would then need to be
reviewed.
Therefore, this part of the Trust response is refused under S12(1) of theFreedom of Information Act
5 What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
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.
6 How many MEDICATION ERRORS were investigated outside the NHS and CCG?
The Trust does not hold this information as it is outside its remit
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)?
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
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)?
As per response to Q7 above
9 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
10 How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?
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
11 Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
No
12 If so, what was their concerns?
Not applicable
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