Information Governance Office
Maudsley Hospital
Denmark Hill
London
SE5 8AZ
Email: foi@slam.nhs.uk
26 May 2020
Dear Ms Micklewright,
RE: Your Information Request
Thank you for your request for information received on 16th April 2020 under the terms of the Freedom of Information Act (2000).
You requested the following information:
ECT Information
Please supply patient’s information ECT leaflet.
Please see this information attached
Please supply patient ECT consent form.
Please see this information attached.
Please supply any ECT reports/investigations
Please be advised that this information is withheld under s.40 of the FOIA (Personal Information) as it contains personal data other than personal data of the requester, and where disclosure under the Act would breach one of the data protection principles in the General Data Protection Regulation (GDPR) or Data Protection Act 2018 (DPA). It is our view that disclosing this information would breach the fair processing provisions of the first data protection principle, in that it would not be the reasonable expectation of these individuals that their personal data would be disclosed in this way. The exemption at section 40 is an absolute exemption, and does not require consideration of the public interest test.
Please supply any ECT reports/investigations.
All patients require an ECG, Full blood count & U&Es & urea, full physical history, Vital signs to be done before each treatment prior to leaving the ward BP, T, R, Oxygen levels, BM. All test results are kept in the patients ECT file, I do not keep the files at the clinic.
How many ECT in 2019/2020
437 ECT
What proportion of patients were men/women.
Men -19
Women - 30
How old were they
Men age range between 34 & 82
Women age range between 22 & 74
What were the diagnosis and in what proportions.
Men
Recurrent depressive disorder - 11
Schizoaffective disorder – Less than 5
Schizophrenia – Less than 5
BPAD – Less than 5
Women
Recurrent depressive disorder - 14
Schizoaffective disorder - 7
Schizophrenia – Less than 5
BPAD - 6
What proportion of patients were classified BAME
Female - 8
Male - 7
How many were receiving ECT for the first time.
Men - 12
Women - 14
How many patients consented to ECT.
Men - 6 consented
Women - 8 consented
How many patients died during or soon after ECT and what was the cause (whether or not ECT was considered the cause).
None
How many patients died a few months after ECT and what was the cause a(whether or not ECT was considered the cause).
None
How many patients died by suicide within a few 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
How many patients report memory loss/loss of cognitive function.
About half of the patients complain about memory loss/cognitive function, but this is very mild and sometimes does not last.
What tests are used to assess memory loss/loss of cognitive function.
Cognitive and memory tests are completed on the ward MMSE is used.
Have MRI or CT scans been used before and after ECT.
No
If so what was the conclusion.
N/A
How does the trust plan to prevent ECT in the future.
Electroconvulsive therapy (ECT) is the most efficacious treatment available for individuals with severe affective disorders
Although electroconvulsive therapy (ECT) is considered the most efficacious treatment available for individuals with severe affective disorders, ECT’s availability is limited and declining, suggesting that information about the population-level effects of ECT is needed. Question 21 confirmed that even in the trust we need to improve information about efficacy, safety and not prevent but increase the offer to this treatment to the Treatment Resistant Depressive and Bipolar patients
In the short-term treatment of the major depressive episode, the combination of ECT and pharmacotherapy as continuation treatment is more potent than either intervention alone. Unfortunately, ECT has been used in the UK mainly when antidepressants haven’t worked, and the depression is severe.
The rate of use in the UK is a sixth that in the US. Many people who haven’t responded to antidepressants or psychotherapy could benefit from ECT, but do not get it.
Electroconvulsive therapy may be associated with reduced short-term psychiatric inpatient readmissions among psychiatric with severe affective disorders. This potential population health effect may be overlooked regarding the availability of ECT.
Meaning electroconvulsive therapy may be an effective and cost-effective treatment for treatment-resistant depression and should be considered after failure of 2 or more lines of pharmacotherapy and/or psychotherapy.
Offering ECT after 2 failed lines of pharmacotherapy/psychotherapy is most likely to maximise its health-economic value and is concordant with recommendations from some national guidelines and ECT specialists. The increasing use of ECT by offering it earlier in the course of treatmentresistant depression could significantly improve outcomes for this difficult-to-treat patient population.
Serious Incident Information
Please supply SERIOUS INCIDENT REPORTS patient’s information leaflet. (Leaflet to be attached).
The Trust does not have a serious incident patient information leaflet.
Please supply patient SERIOUS INCIDENT REPORTS consent form. (Form to be attached).
The Trust does not have a serious incident consent form.
Please supply any serious incident reports/investigations
Independent investigation reports are confidential until published by NHS England and these can be accessed from their website https://www.england.nhs.uk/publications/reviewsandreports/invest-reports/
In addition, anonymised “lessons learned” reports are cascaded to relevant parties to ensure that improvements are delivered.
How many SERIOUS INCIDENT REPORTS in 2019?
100
What proportion of patients were men/women?
58 male 42 female
How old were they?
Unfortunately, the provision of the requested information would exceed the appropriate cost limit under Section 12, which is currently £450. This equates to 18 hours of staff time at £25 an hour. This is because the information requested is not easily retrievable as we do not hold this information in a readily accessible format. To locate and retrieve this information would require a manual search of all individual records. Under the FOIA, an authority is allowed to refuse a request where to comply with the request would exceed the appropriate cost limit.
What were the diagnoses and in what proportions?
Please refer to the response at Q6 above.
What proportion of patients were classified BAME? Ask SI to provide
Please refer to the response at Q6 above.
How many were receiving SERIOUS INCIDENT REPORTS for the first time? See enclosed response
Please refer to the response at Q6 above.
How many patients consented to SERIOUS INCIDENT REPORTS?
We do not seek consent to complete a serious incident investigation.
How many SERIUOS INCIDENT REPORTS were investigated outside the NHS and CCG?
All Serious incidents are investigated by the NHS and CCGs. NHSE may commission an independent organisation for independent homicide reviews (but the investigation comes from NHSE).
How many patients died during or soon after SERIOUS INCIDENT REPORTS and what was the cause (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?
Please refer to the response at Q6 above.
How many patients died a few months after SERIOUS INCIDENT REPORTS and what was the cause (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?
Please refer to the response at Q6 above.
How many patients died by suicide within a few months of receiving SERIOUS
INCIDENT REPORTS (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?
Please refer to the response at Q6 above.
How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications?
Please refer to the response at Q6 above.
Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS?
None
If so, what was their concerns?
n/a
How many patients report memory loss/loss of cognitive function?
Please refer to the response at Q6 above.
What tests are used to assess memory loss/loss of cognitive function?
Please refer to the response at Q6 above.
Have MRI or CT scans been used before and after SERIOUS INCIDENT REPORTS?
Not Applicable
If so what was the conclusion?
Not applicable
How does the Trust plan to prevent SERIOUS INCIDENTS in the future?
The purpose of the Serious Incident Investigation is to identify learning and therefore make improvements in clinical care and practice. The Trust has a number of committees in place review and make recommendation and areas of good practice arising from Investigations are acted upon and disseminated across the Trust.
Restraints information
Please supply RESTRAINTS patient’s information leaflet.
Not applicable
Please supply patient RESTRAINTS consent form.
Not applicable
Please supply any Restraints/investigations You can use the response to item 3 in the ECT request
Please be advised that this information is withheld under s.40 of the FOIA (Personal Information) as it contains personal data other than personal data of the requester, and where disclosure under the Act would breach one of the data protection principles in the General Data Protection Regulation (GDPR) or Data Protection Act 2018 (DPA). It is our view that disclosing this information would breach the fair processing provisions of the first data protection principle, in that it would not be the reasonable expectation of these individuals that their personal data would be disclosed in this way. The exemption at section 40 is an absolute exemption, and does not require consideration of the public interest test.
How many RESTRAINTS in 2019?
Please refer to the response at Q7 above.
What proportion of patients were men/women?
Please refer to the response at Q7 above.
How old were they?
Please refer to the response at Q7 above.
What were the diagnoses and in what proportions?
Please be advised that,the provision of the requested information would exceed the appropriate cost limit under Section 12, which is currently £450. This equates to 18 hours of staff time at £25 an hour. This is because the information requested is not easily retrievable as we do not hold this information in a readily accessible format. To locate and retrieve this information would require a manual search of all individual records. Under the FOIA, an authority is allowed to refuse a request where to comply with the request would exceed the appropriate cost limit.
What proportion of patients were classified BAME?
Please refer to the response at Q7 above.
How many were receiving RESTRAINTS for the first time?
Please refer to the response at Q7 above.
How many patients consented to RESTRAINTS?
Not applicable
How many RESTRAINTS were investigated outside the NHS and CCG ?
Please refer to the response at Q7 above.
How many patients died during or soon after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?
Please refer to the response at Q7 above.
How many patients died a few months after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?
Please refer to the response at Q7 above.
How many patients died by suicide within a few months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)? 15. How many patients have suffered complications during and after RESTRAINTS and what were those complications?
Please refer to the response at Q7 above.
Have there been any formal complaints from patients/relatives about RESTRAINTS? Ask Complaints to provide response.
Between 01.04.2019 – 31.03.2020 there were less than 5 complaints regarding completed restraints, less than 5 complaints about a discussed complaints (which never took place)
If so, what was their concerns? Ask Complaints to provide a response
Less than 5 complaints were made regarding what the complainant perceived as excessive force, less than 5 related to verbal aggression, less than 5 related to privacy and dignity. The less than 5 complaints regarding restraint that did not take place:- patients were told if they did not comply with certain treatment then restraint may be required (coercion).
How many patients report memory loss/loss of cognitive function?
Please refer to the response to Q7 above
What tests are used to assess memory loss/loss of cognitive function?
Please refer to the response at Q7 above.
Have MRI or CT scans been used before and after RESTRAINTS?
Please refer to the response at Q7 above.
If so what was the conclusion?
Please refer to the response at Q7 above.
How does the Trust plan to reduce restraints in the future?
The Trust has drawn up a strategy to reduce the use of restrictive practices. The framework to achieve this over a three-year period (2017 to 2020) is outlined in the enclosed document.
Seclusion Information
Please supply patient’s information SECLUSION leaflet.
Please see information attached
Please supply patient SECLUSION consent form.
Please see information attached
Please supply any SECLUSION reports/investigations see enclosed
Please be advised that this information is withheld under s.40 of the FOIA (Personal Information) as it contains personal data other than personal data of the requester, and where disclosure under the Act would breach one of the data protection principles in the General Data Protection Regulation (GDPR) or Data Protection Act 2018 (DPA). It is our view that disclosing this information would breach the fair processing provisions of the first data protection principle, in that it would not be the reasonable expectation of these individuals that their personal data would be disclosed in this way. The exemption at section 40 is an absolute exemption, and does not require consideration of the public interest test.
How many SECLUSION in 2019?
3395 incidents of restraint, affecting 785 patients.
What proportion of patients were men/women?
|
Gender |
Incident Count |
Individual Count |
|
Female |
2098 |
367 |
|
Male |
1226 |
416 |
|
Not specified (new) |
69 |
Less than 5 |
|
Transgender |
Less than 5 |
Less than 5 |
|
Grand Total |
3395 |
785 |
How old were they?
|
Age Group |
Incident Count |
Individual Count |
|
Under 18 |
812 |
67 |
|
18-25 |
1132 |
160 |
|
26-35 |
526 |
202 |
|
36-45 |
389 |
150 |
|
46-55 |
318 |
105 |
|
56-65 |
128 |
41 |
|
65+ |
66 |
37 |
|
Missing |
24 |
23 |
|
Grand Total |
3395 |
785 |
704 incidents of seclusion, affecting 258 patients.
|
Gender |
Incident Count |
Individual Count |
|
Female |
306 |
96 |
|
Male |
398 |
162 |
|
Grand Total |
704 |
258 |
|
Age Group |
Incident Count |
Individual Count |
|
Under 18 |
217 |
32 |
|
18-25 |
170 |
66 |
|
26-35 |
194 |
81 |
|
36-45 |
71 |
45 |
|
46-55 |
40 |
24 |
|
56-65 |
6 |
Less than 5 |
|
Missing |
6 |
6 |
|
Grand Total |
704 |
258 |
What were the diagnoses and in what proportions?
Please be advised that, the provision of the requested information would exceed the appropriate cost limit under Section 12, which is currently £450. This equates to 18 hours of staff time at £25 an hour. This is because the information requested is not easily retrievable as we do not hold this information in a readily accessible format. To locate and retrieve this information would require a manual search of all individual records. Under the FOIA, an authority is allowed to refuse a request where to comply with the request would exceed the appropriate cost limit.
What proportion of patients were classified BAME? Ask LB to provide
Please refer to the response to question 7 above.
How many were receiving SECLUSION for the first time?
Please refer to the response to question 7 above.
How many patients consented to SECLUSION? See enclosed response
Not applicable
How many SECLUSIONS were investigated outside the NHS and CCG ?
Not applicable
How many patients died during or soon after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
Please refer to the response to question 7 above.
How many patients died a few months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
Please refer to the response to question 7 above.
How many patients died by suicide within a few months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
Please refer to the response to question 7 above.
How many patients have suffered complications during and after SECLUSION and what were those complications?
Please refer to the response to question 7 above.
Have there been any formal complaints from patients/relatives about SECLUSION?
There were 5 complaints
If so, what was their concerns?
The fact that they were taken into seclusion
How many patients report memory loss/loss of cognitive function?
Please refer to the response to question 7 above.
What tests are used to assess memory loss/loss of cognitive function?
Please refer to the response to question 7 above.
Have MRI or CT scans been used before and after SECLUSION?
Please refer to the response to question 7 above.
If so what was the conclusion? See enclosed response
Please refer to the response to question 7 above.
How does the Trust plan to prevent SECLUSION in the future?
The Trust has drawn up a strategy to reduce the use of restrictive practices. The framework to achieve this over a three years period (2017 to 2020) is outlined in the enclosed document.
Medication Errors Information
Please supply patient’s information MEDICATION ERRORS leaflet.
Please refer to Appendix 20 of the Medicines Policy attached.
Please supply patient MEDICATION ERRORS consent form.
Consent is not necessary
Please supply any MEDICATION ERRORS reports/investigations
Please see the attached Medicines Safety Committee Minutes and Error Presentations.
Please be advised that parts of this information is withheld under s.40 of the FOIA (Personal Information) as it contains personal data other than personal data of the requester, and where disclosure under the Act would breach one of the data protection principles in the General Data Protection Regulation (GDPR) or Data Protection Act 2018 (DPA). It is our view that disclosing this information would breach the fair processing provisions of the first data protection principle, in that it would not be the reasonable expectation of these individuals that their personal data would be disclosed in this way. The exemption at section 40 is an absolute exemption, and does not require consideration of the public interest test.
How many MEDICATION ERRORS in 2019?
Please be advised that, the provision of the requested information would exceed the appropriate cost limit under Section 12, which is currently £450. This equates to 18 hours of staff time at £25 an hour. This is because the information requested is not easily retrievable as we do not hold this information in a readily accessible format. To locate and retrieve this information would require a manual search of all individual records. Under the FOIA, an authority is allowed to refuse a request where to comply with the request would exceed the appropriate cost limit.
What proportion of patients were men/women?
Please refer to the response to question 4 above.
How old were they?
Please refer to the response to question 4 above.
What were the diagnoses and in what proportions?
Please refer to the response to question 4 above.
What proportion of patients were classified BAME?
Please refer to the response to question 4 above.
How many were receiving MEDICATION ERRORS for the first time?
Please refer to the response to question 4 above.
How many patients consented to MEDICATION ERRORS?
Please refer to the response to question 4 above.
How many MEDICATION ERRORS S were investigated outside the NHS and CCG?
Please refer to the response to question 4 above.
How many patients died during or soon after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)?
Please refer to the response to question 4 above.
How many patients died a few months after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)?
Please refer to the response to question 4 above.
How many patients died by suicide within a few months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)?
Please refer to the response to question 4 above.
How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?
Please refer to the response to question 4 above.
Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
There were less than 5 complaints
If so, what was their concerns?
They were related to prescribing errors and the possible effects this may have had on the patients
How many patients report memory loss/loss of cognitive function?
Please refer to the response provided at question 4 above.
What tests are used to assess memory loss/loss of cognitive function?
Please refer to the response provided at question 4 above.
Have MRI or CT scans been used before and after MEDICATION ERRORS?
Please be advised that the Trust does not hold this information
If so what was the conclusion?
Please refer to the response provided at 20 above.
How does the Trust plan to prevent MEDICATION ERRORS in the future?
We have a Medicines safety committee whose overall aim or purpose is to ensure the safe use of medicines in the trust
Their key objectives are:
▪ To review the medication section of the trust incident reporting policy
▪ To agree a process for improving the rate and quality of medication incident reporting in the trust
▪ To agree a system for follow-up of medication incidents
▪ To agree a system for disseminating learning points from commonly reported and serious medication incidents
▪ To recommend changes to medicines procedures where necessary
▪ To develop medicines procedures where necessary
▪ To inform the trust and other relevant stakeholders of risks identified from medication errors.
▪ To recommend ways of reducing the likelihood of serious errors recurring and developing ways of minimising risk from medication errors.
▪ To provide a summary of incidents in the annual medicines report to the trust board. This will include assurance to the trust board that medicines incidents are appropriately reported and that follow-up includes learning and a change in practice where necessary.
▪ To review the medication risks on the trust assurance log (risk register).
▪ To liaise with KHP partners when necessary in order to standardise practice and share learning across the trusts and CCGs.
▪ To advise on any changes in the medicines policy following complaints about medicines from patients and carers.
The information supplied to you continues to be protected by the Copyright, Designs and Patents Act 1988. You are free to use it for your own purposes, including any non-commercial research you are doing and for the purposes of news reporting. Any other reuse, for example commercial publication, would require the permission of the Trust. This may be done by writing to the Information Governance Office at the above address.
If you have any queries about this letter or if you are unhappy with the service you have received in relation to your request and wish to make a complaint or request a review of our decision, please do not hesitate to contact the Information Governance Office via foi@slam.nhs.uk
If you are not content with the outcome of your complaint, you may apply to the Information Commissioner for a decision. Generally, the ICO cannot make a decision unless you have exhausted the complaints procedure provided by South London and Maudsley NHS Foundation Trust. The Information Commissioner can be contacted at:
The Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire SK9 5AF
Yours sincerely,
Wayne Elliott
IG Assurance Manager