Dear Wendy Micklewright
Thank you for your email
Please see below as requested
RE: Freedom of Information Request
Thank you for your request for information received by the Trust on 15 May 2025 regarding Electro Convulsive Treatment (ECT), restraints, seclusion and medication errors under the terms of the Freedom of Information Act (2000).
You requested the following information:
Please provide Electro Convulsive Treatment (ECT) information under the FOI act to the following questions: -
1.Please supply patient’s information ECT leaflet
2.Please supply patient ECT consent form
3.Please supply any ECT reports/investigations
4.How many ECT in 2024?
5.What proportion of patients were men/women?
6.How old were they?
7.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
8.How many people covered by the equality act - specific protected characteristics - excluding age + gender - received ECT ?
9.How many people were offered talking therapy prior to ECT ?
10.How many were receiving ECT for the first time?
11.How many patients consented to ECT?
12.How many ECT complaints were investigated outside the NHS ?
13.How many patients died during or 1 month after ECT and what was the cause (whether or not ECT was considered the cause)?
14.How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)?
15.How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)?
16.How many patients have suffered complications during and after ECT and what were those complications?
17.Have there been any formal complaints from patients/relatives about ECT?
18.If so, what was their concerns?
19.How many patients report memory loss/loss of cognitive function?
20.What tests are used to assess memory loss/loss of cognitive function?
21.Have MRI or CT scans been used before and after ECT?
22.If so, what was the conclusion?
23.How does the Trust plan to prevent ECT in the future?
The Trust is unable to comply with the full scope of your request due to the substantial work required to retrieve the information. Many of the data points requested are not held in a centrally accessible format and would require a manual review of individual patient records and documentation. As such, the request exceeds the appropriate cost limit set out in Section 12 of the Freedom of Information Act 2000.
Under Section 12, public authorities are not required to comply with a request if the estimated cost of doing so exceeds £450, which equates to 18 hours (2.5 working days) of staff time at a standard rate of £25 per hour. Based on our assessment, fulfilling this request would exceed that limit.
We would also like to advise that some of the information you are seeking may already be available in the public domain. Specifically, the ECT Accreditation Service (ECTAS), managed by the Royal College of Psychiatrists, publishes comprehensive national datasets which include information such as patient demographics, diagnoses, consent, and outcomes. These datasets cover services across England, Wales, and Northern Ireland. For services in Scotland, similar data is available via SEAN (Scottish ECT Accreditation Network). These resources may help to answer some of your questions, particularly in relation to sex, age, number of patients treated without consent, and clinical outcomes.
In response to one part of your request:
-
No complaints have been received from patients or relatives regarding ECT.
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).
2.How many RESTRAINTS in 2024?
A total of 2494 restraint incidents were reported from Jan-Dec 2024.
3.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.
4.How old were they?
Please refer to the answer for question three
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please refer to the answer for question three
6.How many people covered by the equality act - specific protected characteristics - excluding age + gender - were restrained?
This information is exempt under section 12 of the Freedom of Information Act 2000 (cost limit) as the Trust estimates that the cost of complying with your request would exceed the appropriate limit. The reason for this exemption is because an audit would be required to extract this information which falls outside the scope of the FOIA.
7.How many RESTRAINTS were investigated outside the NHS?
Not applicable
8.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
9.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
10.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
11.How many patients have suffered complications during and after RESTRAINTS and what were those complications?
Please refer to the answer for question one
12.Have there been any formal complaints from patients/relatives about RESTRAINTS?
Yes
13.If so, what was their concerns?
This information is withheld due to the risk of an Information Governance breach. Disclosing specific details could potentially identify individuals and is therefore exempt under Section 40(2) of the Freedom of Information Act 2000 (personal data).
Not applicable
14.Are counts of forced injections available? if so how many people were forcible injected ?
A total of 868 Rapid Tranquillisation (RT) incidents were reported from Jan-Dec 2024. It is important to note that the reported figures include RT administered to manage violent or challenging behaviour, as well as medication used for enforced treatment. While enforced medication does not meet the clinical indications for RT, it is still recorded under this category for patient safety purposes, to ensure appropriate physical health monitoring.
15.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. As part of our ongoing reducing restrictive practices work, the five key patient safety interventions are being implemented on our wards which either have international evidence, national evidence or locally generated evidence supporting their use. These interventions are: Safe Wards, SafetyPods and Deltoid Intramuscular injection, Safety Huddle, Dynamic Appraisal of Situational Aggression (DASA) and mobile phone charging facilities. The inpatient Seni Lewis Training Programme, launched in February 2023, continues to be implemented. Seni Lewis Training Programme has received positive feedback from staff since its implementation. Our staff have reported being more confident in utilising de-escalation skills, understanding trauma informed care, human rights approach and using least restrictive practices.
16.How many of these restraints were face down restraints?
28
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).
2.How many SECLUSIONS in 2024?
A total of 272 seclusions were reported in Jan-Dec 2024.
3.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
4.How old were they?
Please see the answer to question three.
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please see the answer to question three.
6.How many people covered by the equality act - specific protected characteristics - excluding age + gender - were secluded ?
This information is exempt under section 12 of the Freedom of Information Act 2000 (cost limit) as the Trust estimates that the cost of complying with your request would exceed the appropriate limit. The reason for this exemption is because an audit would be required to extract this information which falls outside the scope of the FOIA.
7.How many SECLUSIONS were investigated outside the NHS?
Not applicable
8.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.
9.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.
10.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.
11.How many patients have suffered complications during and after SECLUSION and what were those complications?
Please refer to the answer for question one.
12.Have there been any formal complaints from patients/relatives about SECLUSION?
Yes
13.If so, what was their concerns?
This information is withheld due to the risk of an Information Governance breach. Disclosing specific details could potentially identify individuals and is therefore exempt under Section 40(2) of the Freedom of Information Act 2000 (personal data).
14.How does the Trust plan to reduce SECLUSIONS 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. As part of our ongoing reducing restrictive practices work, the five key patient safety interventions are being implemented on our wards which either have international evidence, national evidence or locally generated evidence supporting their use. These interventions are: Safe Wards, SafetyPods and Deltoid Intramuscular injection, Safety Huddle, Dynamic Appraisal of Situational Aggression (DASA) and mobile phone charging facilities. The inpatient Seni Lewis Training Programme, launched in February 2023, continues to be implemented. Seni Lewis Training Programme has received positive feedback from staff since its implementation. Our staff have reported being more confident in utilising de-escalation skills, understanding trauma informed care, human rights approach and using least restrictive practices. The Trust seclusion policy is also focused on prevention of seclusion.
Please provide MEDICATION ERRORS information under the FOI act to the following questions: -
1. Please supply any reports or investigations relating to medication errors.
We are unable to share this information, as investigations are not recorded in a format that allows for easy extraction specific to medication errors.
2. How many medication errors have occurred in 2024?
Incidents relating to medication errors are reported through the Datix Cloud IQ (DCIQ) system. These reports cover a range of categories relating to incidents.
3. What proportion of patients involved in medication errors were men or women?
Gender data may be recorded in incident reports; however, this information may be incomplete or inaccurate and should be treated with caution.
4. What were the ages of the patients involved in medication errors?
We are currently unable to extract this data.
5. What proportion of patients were from the global majority or racialised communities ("POC/BAME")?
Ethnicity data may be present in some incident reports, but its accuracy cannot be guaranteed. Any response based on this information should note its limitations.
6. How many people with protected characteristics under the Equality Act (excluding age and gender) were affected by medication errors?
The Trust is unable to provide accurate data on this. Although some equality characteristics (e.g. religion or disability) may be recorded in the system, this data is potentially unreliable.
7. How many medication errors were investigated outside of the NHS?
The Trust does not hold this information. It is unknown to us whether any medication errors were investigated externally.
8. How many patients died during or within one month after a medication error, and what was the cause of death (whether or not the medication error was the cause)?
DCIQ does not provide this specific data. Furthermore, the Trust does not determine cause of death.
9. How many patients died within six months after a medication error, and what was the cause of death (whether or not the medication error was the cause)?
DCIQ does not provide data in this format. Cause of death is not determined or held by the Trust.
10. How many patients died by suicide within six months of a medication error (whether or not the medication error was the cause)?
DCIQ does not capture this data in a way that enables this specific question to be answered. We are exploring whether another data source could assist.
11. How many patients have suffered complications during or after medication errors, and what were those complications?
Harm data is included in incident reporting; however, it does not comprehensively describe all complications or directly answer this question.
12. Have there been any formal complaints from patients or relatives about medication errors?
No
13. If so, what were the concerns raised in those complaints?
Not applicable
14. 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
Clement Olusoji
Corporate Information Governance Officer
South London and Maudsley NHS Foundation Trust
Maudsley Hospital | Denmark Hill | London | SE5 8AZ