Information Governance Office
Maudsley Hospital
Denmark Hill
London
SE5 8AZ
 
Email: foi@slam.nhs.uk 
23 August 2021
 
Dear Ms Micklewright,
 
RE: Your Information Request
 
Thank you for your request for information received on 25 April 2021 regarding ECT, serious incidents, restraints, seclusions and medication errors, under the terms of the Freedom of Information Act (2000). 
 
You requested the following information:
 

 
      Please see attached pdf document titled ‘Patient Information Leaflet’.
 

 
      Please see attached pdf document titled ‘Patient Agreement to ECT - Consent Form 1’.
 

 
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.
 

 
The Trust carried out 341 ECT’s in 2020 / 2021.
 

 
      Please see table below:
 
 
                
         

 

 
      Please see table below:
 

 

 
       Please see table below:
                          

 

 
       Please see table below:
                                

 

 
      Please see table below:
                               

 

 
        None.
 

      
       None.
 

 
       None.
 

 
       None.
 

       
       None.
 

 
       Not applicable.
 

 
       About half of the patients complain about memory loss/cognitive function but this is very mild and sometimes does not last.
 

 
       Cognitive and memory tests are used to assess memory loss / cognitive function. 
 

 
       No. 

 
       Not applicable.
 

 
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. In the short-term treatment of a 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 have not worked and the depression is severe. The rate of use in the UK is a sixth that in the US.  Many people who have not 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 treatment-resistant depression could significantly improve outcomes for this difficult-to-treat patient population.
 

 
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.
 

 
      A total of 119 serious incident reports were recorded in 2020.
 

 
      Please see table below:
 

 

 
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.
 

 
      Please refer to the response to Q.4 above.
 

 
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)
 

 
      Please refer to the response to Q.4 above.
 

 
      Please refer to the response to Q.4 above
 

 
      Please refer to the response to Q.4 above.
 

 
      Please refer to the response to Q.4 above.
 

 
      Yes.
 

      
      The Trust is currently awaiting receipt of the report.
 

      
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 to review and make recommendations and areas of good practice arising from Investigations are acted upon and disseminated across the Trust.
 

 Please supply any Restraints / 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 refer to the response to Q.1 above.
 

 
     Please refer to the response to Q.1 above.
 

 
     Please refer to the response to Q.1 above.
 

 
     Please refer to the response to Q.1 above.
    

 
     Please refer to the response to Q.1 above.
 

 
     Please refer to the response to Q.1 above.
 

 
      Please refer to the response to Q.1 above.
 

 
      Please refer to the response to Q.1 above.
 

 
      Please refer to the response to Q.1 above.
 

 
      Between 01.04.2020 – 31.03.2021 there were 4 complaints regarding completed restraints
 

 
A total of three complaints were made regarding what the complainant perceived as excessive force. 
1 complaint was regarding restraint that did not take place: patients said they were not sure under what circumstances restraint would be used
 

      
      Please refer to the response at Q1 above    
 

    
The Trust has a multidisciplinary working group, including lived experience representative, which focuses on safety, including use of restraint and seclusion, in the Trust. The group employs a quality improvement methodology and other change methodologies to test, evaluate and then scale and spread improvement initiatives.
 

 
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.
 

 
     A total of 654 seclusions were recorded in 2020.
 

 
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. 
 

 
      Please refer to the response to Q.3 above.
 

 
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.
 

 
      Not applicable.
 

 
    Please refer to response to Q.5 above.
 

 
    Please refer to response to Q.5 above.
 

 
    Please refer to the response to Q.5 above.
 

 
      Please refer to the response to Q.5 above.
 

 
    Yes.
 

 
    The complaints were related to care, treatment, attitude and behaviour.
 

 
The Trust has a multidisciplinary working group, including lived experience representative, which focuses on safety, including use of restraint and seclusion, in the Trust. The group employs a quality improvement methodology and other change methodologies to test, evaluate and then scale and spread improvement initiatives.
 
 

 
      Please see the following enclosed documents:
 

 
      There was a total of 2,301 medication incidents reported in 2020.
 
It is important to note that the figures provided are reported medication incidents.  We are not able to provide information on errors only as it will require extensive resources to review all reported incidents to identify those that are solely medications errors.
 
Medication incidents include not only errors but other incidents such as loss of stationery (e.g. prescription charts, FP10 prescriptions), loss of drug cupboard keys, fridge breakdown and CD balance errors etc..  A significant part of the incidents may also be due to administration of medication under rapid tranquilisation where our policy states we have to document this as an incident.  
 

 
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.
 

 
      Please refer to the response to Q.3 above.
 

 
      Please refer to the response to Q.3 above.
 

 
      Please refer to the response to Q.3 above.
 

 
      Please refer to the response to Q.3 above.
 

 
      Please refer to the response to Q.3 above.
 

 
      Please refer to the response to Q.3 above
 

 
      Please refer to the response to Q.3 above.
 

 
      Please refer to the response to Q.3 above
 

 
     Not applicable.
 

 
     The overall aim or purpose of the Medicines Safety Committee is to ensure the safe use of medicines in the trust
 
     Key objectives:
 
▪    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 committee meets four times a year.
 
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,
 
Christopher Howarth
Christopher Howarth
Information Governance Assurance Manager