Information Governance Office
Maudsley Hospital
Denmark Hill
London
SE5 8AZ
Email: foi@slam.nhs.uk
6th June 2022
Dear Wendy Micklewright
RE: Freedom of Information Request
Thank you for your request for information received by the Trust on the 5th of May 2022 regarding ECT, serious incidents, restraints and seclusions under the terms of the Freedom of Information Act (2000).
You requested the following information:
Please provide ECT information under the FOI act to the following questions:
Please note the below is data on the Trust’s ECT service for the financial year 20/21. We endeavour to provide 21/22 data by Friday 17 June.
1.Please supply patient’s information ECT leaflet.
Please see attached pdf document titled ‘Patient Information Leaflet’.
2.Please supply patient ECT consent form
Please see attached pdf document titled ‘Patient Agreement to ECT - Consent Form 1’.
3.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.
4.How many ECT in 2021?
The Trust carried out 341 ECT’s in 20/21.
5.What proportion of patients were men/women?
Gender Total
Male 22
Female 32
6.How old were they?
|
Gender |
Age Range |
|
Male |
22 - 84 |
|
Female |
20 - 79 |
7.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
.
Gender
Male 7
Female 13
8.How many were receiving ECT for the first time?
|
Gender |
Total |
|
Male |
13 |
|
Female |
14 |
9.How many patients consented to ECT?
Gender Total
Male 5
Female 7
10.How many ECT complaints were investigated outside the NHS and CCG?
No complaints reported
11.How many patients died during or 1 month after ECT and what was the cause (whether or not ECT was considered the cause)?
None
12.How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)?
None
13.How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)?
None
14.How many patients have suffered complications during and after ECT and what were those complications?
None
15.Have there been any formal complaints from patients/relatives about ECT?
None
16.If so, what was their concerns?
N/A
17.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.
18.What tests are used to assess memory loss/loss of cognitive function?
Cognitive and memory tests are used to assess memory loss / cognitive function.
19.Have MRI or CT scans been used before and after ECT?
No
20.If so, what was the conclusion?
N/A
21.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. 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 re-admissions among psychiatric patients 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 treatmentresistant depression and should be considered after failure of two or more lines of pharmacotherapy and/or psychotherapy. Offering ECT after two 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/reviewsandreports/invest-reports/ 4 . In addition, anonymised “lessons learned” reports are cascaded to relevant parties to ensure that improvements are delivered.
2.How many SERIOUS INCIDENT REPORTS in 2021?
133
3.What proportion of patients were men/women?
42 female
83 male
3 not specified (new)
5 incidents not related to patients
4.How old were they?
Please see the below table:
|
Age range |
Total |
|
6-17 |
4 |
|
18-25 |
15 |
|
26-55 |
75 |
|
56-64 |
15 |
|
65-74 |
9 |
|
75 and over |
5 |
|
Not stated |
5 |
|
Not patient incident |
5 |
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please see ethnicity information in the below table:
|
Ethnicity |
Number of patients |
|
African |
7 |
|
Any other Asian background |
<5 |
|
Any other Black background |
18 |
|
Any other ethnic group |
7 |
|
Any other mixed background |
<5 |
|
Any other White background |
12 |
|
Black British |
<5 |
|
British (A) |
38 |
|
Caribbean |
5 |
|
Indian or British Indian |
6 |
|
Irish |
<5 |
|
Mixed Black |
<5 |
|
Not Known (99) |
5 |
|
Not stated |
7 |
|
Other white, white unspecified |
<5 |
|
Pakistani or British Pakistani |
<5 |
|
Vietnamese |
<5 |
|
Welsh |
<5 |
|
White and Asian |
<5 |
|
White and Black Caribbean |
<5 |
|
White - other white |
<5 |
|
Black Carribbean |
<5 |
|
White - British |
<5 |
|
Black African |
<5 |
|
Other ethnic category |
<5 |
|
Grand Total |
128 |
Please note under section 40 of the FOIA (personal information), low numbers of patients are exempted to protect patient confidentiality. The Trust can confirm however, that this number is less than five patients.
6.How many SERIOUS INCIDENT REPORTS were investigated outside the NHS and CCG?
All SIs are investigated by the NHS and CCGs. NHSE may commission an independent organisation for independent homicide reviews, but the investigation comes from NHSE.
7.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.
8.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.
9.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.
10.How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications?
Please see the answer for question seven.
11.Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS?
Please see the answer for question seven.
12.If so, what was their concerns?
Please see the answer for question seven.
13.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 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.
2.How many RESTRAINTS in 2021?
We endeavour provide a response by Friday 17 June
3.What proportion of patients were men/women?
Please refer to the answer for question two
4.How old were they?
Please refer to the answer for question two
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please refer to the answer for question one
6.How many RESTRAINTS were investigated outside the NHS and CCG?
Please refer to the answer for question one
7.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
8.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
9.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
10.How many patients have suffered complications during and after RESTRAINTS and what were those complications?
Please refer to the answer for question one
11.Have there been any formal complaints from patients/relatives about RESTRAINTS?
We endeavour to provide a response to this question by Friday 17 June
12.If so, what was their concerns?
Please refer to the answer for question eleven
13.Are counts of forced injections available?
Please refer to the answer for question one
14.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 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.
2.How many SECLUSIONS in 2021?
We endeavour to provide a response to this question by Friday 17 June.
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 for question three.
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please see the answer for question three.
6.How many SECLUSIONS were investigated outside the NHS and CCG?
None
7.How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
Please see the answer for question three.
8.How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
Please see the answer for question three.
9.How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
Please see the answer for question three.
10.How many patients have suffered complications during and after SECLUSION and what were those complications?
Please see the answer for question three.
11.Have there been any formal complaints from patients/relatives about SECLUSION?
Please refer to the answer for question two 12.If so, what was their concerns?
Please refer to the answer for question two
13.How does the Trust plan to reduce SECLUSIONS in the future? Please refer to the answer for question two
Please provide MEDICATION ERRORS information under the FOI act to the following questions:
1.Please supply any MEDICATION ERRORS 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.
2.How many MEDICATION ERRORS in 2021?
645
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 for question three.
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please see the answer for question three.
6.How many MEDICATION ERRORS were investigated outside the NHS and CCG? Please see the answer for question three.
7.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)?
Please see the answer for question three.
8.How many patients died within 6 months after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)?
Please see the answer for question three.
9.How many patients died by suicide within 6 months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)?
Please see the answer for question three.
10.How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?
Please see the answer for question three.
11.Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
No formal complaints were made to the pharmacy team regarding medication errors.
12.If so, what was their concerns?
N/A
13.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 noncommercial 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
ADDITIONAL EMAIL
29 June 2022
Dear Wendy Micklewright
RE: Freedom of Information Request
Thank you for your request for information received by the Trust on the 5 of May 2022 regarding ECT, serious incidents, restraints and seclusions under the terms of the Freedom of Information Act (2000). We sent a response letter on 6 June 2022, and as indicated in our letter please see the below update to your request.
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.
Please see attached pdf document titled ‘Patient Information Leaflet’.
2.Please supply patient ECT consent form
Please see attached pdf document titled ‘Patient Agreement to ECT - Consent Form 1’.
3.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.
4.How many ECT in 2021?
The trust carried out 499 ECT treatments in 2021/2022.
5.What proportion of patients were men/women?
Gender Total
Male 22
Female 55
6.How old were they?
|
Gender |
Age Range |
|
Male |
24 - 85 |
|
Female |
22 - 81 |
7.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
|
Gender |
|
|
Male |
5 |
|
Female |
26 |
8.How many were receiving ECT for the first time?
|
Gender |
Total |
|
Male |
13 |
|
Female |
28 |
9.How many patients consented to ECT?
Gender Total
Male 7
Female 21
10.How many ECT complaints were investigated outside the NHS and CCG?
No complaints reported.
11.How many patients died during or 1 month after ECT and what was the cause (whether or not ECT was considered the cause)?
None
12.How many patients died within 6 months after ECT and what was the cause (whether or not ECT was considered the cause)?
None
13.How many patients died by suicide within 6 months of receiving ECT (whether or not ECT was considered the cause)?
None
14.How many patients have suffered complications during and after ECT and what were those complications?
None
15.Have there been any formal complaints from patients/relatives about ECT?
None
16.If so, what was their concerns?
N/A
17.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.
18.What tests are used to assess memory loss/loss of cognitive function?
Cognitive and memory tests are used to assess memory loss / cognitive function.
19.Have MRI or CT scans been used before and after ECT?
No
20.If so, what was the conclusion?
N/A
21.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. 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 re-admissions among psychiatric patients 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 treatmentresistant depression and should be considered after failure of two or more lines of pharmacotherapy and/or psychotherapy. Offering ECT after two 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/reviewshttps://www.england.nhs.uk/publications/reviews-andreports/invest-reports/andreports/invest-reports/. In addition, anonymised “lessons learned” reports are cascaded to relevant parties to ensure that improvements are delivered.
2.How many SERIOUS INCIDENT REPORTS in 2021?
133
3.What proportion of patients were men/women?
42 female
83 male
3 not specified (new)
5 incidents not related to patients
4.How old were they?
Please see the below table:
|
Age range |
Total |
|
6-17 |
<5 |
|
18-25 |
15 |
|
26-55 |
75 |
|
56-64 |
15 |
|
65-74 |
9 |
|
75 and over |
5 |
|
Not stated |
5 |
|
Not patient incident |
5 |
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please see ethnicity information in the below table:
|
Ethnicity |
Number of patients |
|
African |
7 |
|
Any other Asian background |
<5 |
|
Any other Black background |
18 |
|
Any other ethnic group |
7 |
|
Any other mixed background |
<5 |
|
Any other White background |
12 |
|
Black British |
<5 |
|
British (A) |
38 |
|
Caribbean |
5 |
|
Indian or British Indian |
6 |
|
Irish |
<5 |
|
Mixed Black |
<5 |
|
Not Known (99) |
5 |
|
Not stated |
7 |
|
Other white, white unspecified |
<5 |
|
Pakistani or British Pakistani |
<5 |
|
Vietnamese |
<5 |
|
Welsh |
<5 |
|
White and Asian |
<5 |
|
White and Black Caribbean |
<5 |
|
White - other white |
<5 |
|
Black Carribbean |
<5 |
|
White - British |
<5 |
|
Black African |
<5 |
|
Other ethnic category |
<5 |
|
Grand Total |
128 |
Please note under section 40 of the FOIA (personal information), low numbers of patients are exempted to protect patient confidentiality. The Trust can confirm however, that this number is less than five patients.
6.How many SERIOUS INCIDENT REPORTS were investigated outside the NHS and CCG?
All SIs are investigated by the NHS and CCGs. NHSE may commission an independent organisation for independent homicide reviews, but the investigation comes from NHSE.
7.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.
8.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.
9.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.
10.How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications?
Please see the answer for question seven.
11.Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS?
Please see the answer for question seven.
12.If so, what was their concerns?
Please see the answer for question seven.
13.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 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.
2.How many RESTRAINTS in 2021?
In 2021 there were 2995 restraints. This figure includes all forms of restraint for example; physical, chemical, mechanical, seclusion, long term, segregation and others.
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 one.
6.How many RESTRAINTS were investigated outside the NHS and CCG?
Please refer to the answer for question one.
7.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.
8.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.
9.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.
10.How many patients have suffered complications during and after RESTRAINTS and what were those complications?
Please refer to the answer for question one.
11.Have there been any formal complaints from patients/relatives about RESTRAINTS?
Four complaints regarding restraints.
12.If so, what was their concerns?
The complaints are regarding concerns of disproportionate force.
13.Are counts of forced injections available?
Please refer to the answer for question one.
14.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 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.
2.How many SECLUSIONS in 2021?
There were 478 incidents of seclusion in 2021
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 for question three.
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please see the answer for question three.
6.How many SECLUSIONS were investigated outside the NHS and CCG?
None
7.How many patients died during or 1 month after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
Please see the answer for question three.
8.How many patients died within 6 months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?
Please see the answer for question three.
9.How many patients died by suicide within 6 months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?
Please see the answer for question three.
10.How many patients have suffered complications during and after SECLUSION and what were those complications?
Please see the answer for question three.
11.Have there been any formal complaints from patients/relatives about SECLUSION?
None specifically about seclusions, but there were four regarding restraints (see answers in the restraints section).
12.If so, what was their concerns?
N/A
13.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 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.
2.How many MEDICATION ERRORS in 2021?
645
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 for question three.
5.What proportion of patients were classified people of the global majority or racialised communities ("POC / BAME")?
Please see the answer for question three.
6.How many MEDICATION ERRORS were investigated outside the NHS and CCG? Please see the answer for question three.
7.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)?
Please see the answer for question three.
8.How many patients died within 6 months after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)?
Please see the answer for question three.
9.How many patients died by suicide within 6 months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)?
Please see the answer for question three.
10.How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?
Please see the answer for question three.
11.Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
No formal complaints were made to the pharmacy team regarding medication errors.
12.If so, what was their concerns?
N/A
13.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 noncommercial 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