Please provide ECT information under the FOI act to the following questions: -
Please supply patient’s information ECT leaflet.
Please see Appendices 2 and 3 attached.
Please supply patient ECT consent form.
Please see Appendix 3 attached.
Please supply any ECT reports/investigations
None.
How many ECT in 2021?
177 (across 20 patients treated).
What proportion of patients were men/women?
50% male, 50% female.
How old were they?
From 23 Years to 78 years.
What proportion of patients were classified people of the global majority or racialised communities (“POC/BAME”)?
5%
How many were receiving ECT for the first time?
Eight.
How many patients consented to ECT?
Four.
How many ECT complaints were investigated outside the NHS and CCG?
None.
How many patients died during or 1 month after ECT and what was the cause (whether or not ECT was considered the cause)?
None.
How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)?
None.
How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)?
None.
How many patients have suffered complications during and after ECT and what were those complications?
None.
Have there been any formal complaints from patients/relatives about ECT?
No.
If so, what was their concerns?
Not applicable.
How many patients report memory loss/loss of cognitive function?
None.
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
Patient Health Questionnaire (PHQ-9)
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?
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
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 10 years, since the ECTAS service has existed.
Please provide SERIOUS INCIDENT information under the FOI act to the following questions:-
Please supply any serious incident reports/investigations
Whilst the Trust holds this information, it would require detailed review of each individual serious incident (314 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.
How many SERIOUS INCIDENT REPORTS in 2021?
314
This figure may include incidents in relation to staff and visitors as well as patients.
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.
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.
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.
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.
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 the patient 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.
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.
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.
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.
Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS?
No.
If so, what was their concerns?
Not applicable.
How does the Trust plan to prevent SERIOUS INCIDENTS in the future?
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 required.
The Trust invests in staff training which focusses on preventative strategies and deescalation.
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 4,777 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 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.
How many RESTRAINTS in 2021?
4,777
Unfortunately there was a large rise in 2021 due to the impact of the COVID-19 pandemic, successive lockdowns and isolating measures that were put in place.
What proportion of patients were men/women?
62% Male, 38% Female.
Please note that 7% of all restraints were recorded with no gender stated.
How old were they?
|
Age Bands |
Episodes |
|
19 and under |
123 |
|
20-29 |
906 |
|
30-39 |
885 |
|
40-49 |
624 |
|
50-59 |
118 |
|
60-69 |
160 |
|
70-79 |
162 |
|
80-89 |
106 |
|
90-99 |
3 |
Please note that 35% of all restraints were recorded with no age stated.
What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
BAME 2%, White 98%
Please note that 56% of restraints were recorded with no ethnicity details included.
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.
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 |
6 |
Unexpected natural cause death |
1 |
|
Expected natural cause death with no concerns |
1 |
||
|
COVID-19 Related Death |
2 |
||
|
Awaiting Coroners Report |
1 |
||
|
Natural cause death with no concerns |
1 |
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 |
14 |
Unexpected natural cause death |
3 |
|
Expected natural cause death with no concerns |
2 |
||
|
COVID-19 Related Death |
1 |
||
|
Awaiting Coroners Report |
3 |
||
|
Natural cause death with no concerns |
3 |
||
|
Accidental death |
1 |
||
|
Natural Causes/Expected |
1 |
How many patients died by suicide within 6 months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)?
Two.
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.
Have there been any formal complaints from patients/relatives about RESTRAINTS?
Two complaints from patients.
If so, what was their concerns?
Both patients were not happy being on a mental health ward. Both complaints were not upheld due to the nature and degree of the patient and their mental health illness/capacity at the time of the incident.
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.
How does the Trust plan to reduce restraints in the future?
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 absolutely 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 ‘No Force First’ and the ‘Safewards’ initiative in our specialist learning disability division, a new 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.
Please provide SECLUSION information under the FOI act to the following questions: -
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 470 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.
How many SECLUSIONS in 2021?
470
What proportion of patients were men/women?
71% Male, 29% Female.
How old were they?
|
Age Bands |
Episodes |
|
19 and under |
3 |
|
20-29 |
162 |
|
30-39 |
136 |
|
40-49 |
135 |
|
50-59 |
27 |
|
60-69 |
6 |
|
70-79 |
1 |
What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
7% BAME, 93% White.
How many SECLUSIONS were investigated outside the NHS and CCG?
None.
How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
None.
How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
None.
How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
None.
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.
Have there been any formal complaints from patients/relatives about SECLUSION?
Two complaints from patients.
If so, what was their concerns?
Both patients felt that seclusion and the length of time was inappropriate. Both complaints were not upheld.
How does the Trust plan to prevent SECLUSION in the future?
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 deescalation. 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 deescalation 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: -
Please supply any MEDICATION ERRORS reports/investigations
Whilst the Trust holds this information, it would require detailed review of each individual medication incident (2,749 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.
How many MEDICATION ERRORS in 2021?
2,041 incidents categorised as ‘medication errors’ or ‘incident involving medication’ on Mersey Care’s instance of Datix, plus a further 708 incidents categorised as
‘medication incidents’ on Mid-Mersey’s (formerly North West Borough Healthcare NHS
Foundation Trust) instance of Datix
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.
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 the Freedom of Information Act.
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.
How many MEDICATION ERRORS were investigated outside the NHS and CCG?
The Trust does not hold this information as it is outside its remit.
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, but some causes may be noted within the patient 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.
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.
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.
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.
Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
No.
.
If so, what was their concerns?
Not applicable.
How does the Trust plan to prevent MEDICATION ERRORS in the future?
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.
The Trust invests in staff training which focusses on preventative strategies and deescalation.