Friendship group affiliated to HVN

7 June 2023 

 

Dear Wendy Micklewright

 

RE: Freedom of Information Request 

 

Thank you for your request for information received by the Trust on 27 April 2023 regarding 

ECT, Seclusion, Serious Incidents, and other Trust services under the terms of the Freedom of Information Act (FOIA) (2000).  We provided an initial response on 24 May 2023 and as indicated we are now providing an updated response for questions regarding seclusion, restraints, and complaints.

 

You requested the following information: 

 

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

1. Please supply patient’s information ECT leaflet.

See attached patient ECT information leaflet “patient information leaflet.pdf”

1. Please supply patient ECT consent form

See the attached patient ECT consent form “Patient agreement to ECT – consent form 1.pdf”

1. Please supply any ECT reports/investigations

Please note, ECT reports, and investigations are exempt under section 40(2) (personal information) of the Freedom of Information Act (2000) as these contain documents contain confidential information regarding patients and staff. revealing this personal information contravenes the principles of confidentiality within the Data Protection Act (2018).

1. How many ECT in 2022?

The trust carried out 519 ECT treatments in 2022

1. What proportion of patients were men/women?

Please see the below table showing the proportion of patients by gender

 

Gender	Proportion of patients that were men/women
Male	9
Female	35

 

1. How old were they?

The male age range was between 24 and 86 years old

The female age range was between 19 and 81 years old

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

Please see in the below table, the proportion classified as being in POC / BAME communities

Gender	Number in POC / BAME communities
Male	<5*
Female	18

 

Please note where there are low numbers in answer to the request, this is indicated as

<5 (less than five). This information is exempted for disclosure under Section 40 (2) of

the FOIA as disclosure of the information may increase the likelihood of identifying an

individual which would contravene the principles of confidentiality within the Data

Protection Act (2018).

 

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

Please see in the below table, the proportion classified as receiving ECT for the first time

 

Gender	Number receiving ECT for the first time
Male	5
Female	22

1. How many patients consented to ECT?

Please see in the below table, the proportion of patients that consented to ECT

 

Gender	How many patients consented to ECT
Male	7
Female	17

 

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

There were 3 Complaints received in 2022/23 which were investigated outside of the Trust.

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

None

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

None

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

None

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

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

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

One complaint

1. If so, what was their concerns?

The complaint was related to the ECT team’s coordination of treatment.

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

Please refer to the answer for question fourteen

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

Cognitive and memory tests are completed on the ward MMSE is used.

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

No

1. If so, what was the conclusion?

N/A

1. 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 treatment-resistant depression could significantly improve outcomes for this difficult-to-treat patient population.

 

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

1. 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/reviews-andreports/invest-reports/. In addition, anonymised “lessons learned” reports are cascaded to relevant parties to ensure that improvements are delivered.

1. How many SERIOUS INCIDENT REPORTS in 2022?

779

1. What proportion of patients were men/women?

Please see the below table showing the proportion of patients by gender

Gender	Number of serious incident reports
Males	464
Females	305
Not specified	5
Blanks	5

1. How old were they?

The age range was from 0 – 97

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

Please see the below table showing the proportion of patients in POC / BAME communities.

Ethnicity	Number of serious incident reports
Black African	48
Black Caribbean	53
Chinese	4
Indian	9
Pakistani	7
Mixed White and Asian	3
Mixed White and Black African	4
Mixed White and Black Caribbean	3
Not Stated	155
Other Asian	21
Other Black	11
Other Ethnic Category	166
Other Mixed	5

 

1. How many SERIOUS 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.

1. 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)?

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.

1. 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)?

Please see the answer for question seven.

1. How many patients died by suicide within 6 months of receiving SERIOUS INCIDENT REPORTS (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?

Please see the answer for question seven.

1. How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications?

Please see the answer for question seven.

1. Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS?

Please see the answer for question seven.

1. If so, what was their concerns?

Please see the answer for question seven.

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

 

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

1. Please supply any Restraints/investigations?

Please note, restraint reports, and investigations are exempt under section 40(2) (personal information) of the Freedom of Information Act (2000) as these contain documents contain confidential information regarding patients and staff. Revealing this personal information contravenes the principles of confidentiality within the Data Protection Act (2018).

1. How many RESTRAINTS in 2022?

There were 2548 in 2022. This figure includes all forms of restraint for example; physical, chemical, mechanical, seclusion, long term, segregation and others.

1. What proportion of patients were men/women?

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.

1. How old were they?

Please refer to the answer for question three.

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

Please refer to the answer for question three.

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

N/A

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

Please refer to the answer for question one.

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

Please refer to the answer for question one.

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

Please refer to the answer for question one.

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

Please refer to the answer for question one.

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

There were 7 complaints regarding restraints

1. If so, what was their concerns?

Please see the below table showing the reasons for concerns in the complaints data:

Reason	Number of complaints
Patient being restrained or restricted	4
Appeal Against Detention	1
Behaviour	1
Reason For Detention	1

 

1. Are counts of forced injections available?

Please refer to the answer for question one.

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

The Trust has a multidisciplinary working group, including lived experience representatives, 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 provide SECLUSION information under the FOI act to the following questions:

1. Please supply any SECLUSION reports/investigations

Please note, seclusion reports and investigations are exempt under section 40(2) (personal information) of the Freedom of Information Act (2000) as these contain documents contain confidential information regarding patients and staff. revealing this personal information contravenes the principles of confidentiality within the Data Protection Act (2018).

1. How many SECLUSIONS in 2022?

There were 410 seclusions in 2022

1. What proportion of patients were men/women?

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.

 

1. How old were they?

Please refer to the answer for question three.

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

Please refer to the answer for question three.

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

N/A

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

Please refer to the answer for question one.

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

Please refer to the answer for question one.

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

Please refer to the answer for question one.

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

Please refer to the answer for question one.

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

There have been three complaints regarding seclusion.

1. If so, what was their concerns?

Please see the below table showing the number of concerns and reasons:

 

Reason	Number of complaints
Problems with medication	2
Alleged assault	1

 

1. How does the Trust plan to reduce SECLUSIONS in the future?

The Trust has established a patient safety improvement programme which has in its first 12-18 months focused on reducing violence and restrictive practice in patient services. The programme provides an organisational structure and support and expertise. Directorate safety leads are responsible for developing improvement plans and testing change ideas in 3 monthly cycles before learning is shared across the Trust at a shared learning collaborative event.

The Trust seclusion policy is also focused on prevention of seclusion. There is a separate work stream looking at implementation of the policy. This is in the diagnostic phases and requires data work before it can progress.

 

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

1. Please supply any MEDICATION ERRORS reports/investigations

Please note, medication error reports and investigations are exempt under section 40(2) (personal information) of the Freedom of Information Act (2000) as these contain documents contain confidential information regarding patients and staff. Revealing this personal information contravenes the principles of confidentiality within the Data Protection Act (2018).

 

1. How many MEDICATION ERRORS in 2022?

659

1. What proportion of patients were men/women?

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.

1. How old were they?

Refer to question three

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

Refer to question three

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

Refer to question three

1. 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)?

Refer to question three

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

Refer to question three

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

Refer to question three

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

Refer to question three

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

No

1. If so, what was their concerns?

N/A

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

 

The Trust encourages reporting. We examine themes of errors and devise Quality Improvement Projects (QIPs) where necessary. In addition, 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, 

 

 

Antani Blake  

Corporate Information Governance Officer