SWLSTG 2022

Dear Mrs Micklewright,

Thank you for your enquiry. I am writing in response to your freedom of information request sent on 25/04/2023.

For ease of reference, your request is set out below in bold and our response is in italics.

1.Please supply patient’s information ECT leaflet

Please see attached information.

2.Please supply patient ECT consent form

Please see attached information.

3.Please supply any ECT reports/investigations

No such investigations were undertaken.

4.How many ECT in 2022?

17 cases and 209 sessions

5.What proportion of patients were men/women?

12 males, 5 females

6.How old were they?

Between 19 and 85 yrs

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

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

9.How many patients consented to ECT?

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

There have been no complaints.

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

The Trust does not collate mortality data.

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

The Trust does not collate mortality data.

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

The Trust does not collate mortality data.

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

The term complications is to be understood as something over and above expected side effects. By

analogy,pain and constipation are expected side effects of abdominal surgery, but a perforated bowel would,

be a complication.

There have been none.

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

16.If so, what was their concerns?

N/A

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

The Trust does not collate this data.

Obtaining this data would require accessing all these assessment for all patients undergoing ECT and would,

amount to a level of work comparable to a piece of research rather than a response to an FOI request.

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

Subjective test of memory before every ECT using the Comprehensive Psychopathological Rating Scale

(CPRS)

Montreal Cognitive Assessment (MoCA) at baseline after first ECT and weekly thereafter.

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

No. There would be no clinical indication to perform CT or MRI scans before and after ECT.

20.If so, what was the conclusion?

N/A

21.How does the Trust plan to prevent ECT in the future?

The Trust has no plans to prevent ECT, which is a treatment approved by NICE under specific

circumstances that include ECT as a lifesaving intervention.

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

1.Please supply any serious incident reports/investigations?

The cost of complying with this component of your request would exceed the limit set by section 12(1) of the Freedom of Information Act. So, on this occasion we will not be taking this component of your request further. The law allows us to decline to answer FOI requests when we estimate it would cost us more than £450 (18 hours, calculated at £25 per hour) to identify, locate, extract, and then provide the information that has been asked for. This would entail reviewing details of 2094 incidents (see the response below). To complete this work in under 18 hours would require over 116 incidents an hour to be processed to be below the maximum, and that would exclude the time taken to respond to the other components of your request. I do not believe that this is possible and have therefore concluded that the position is more than the limit prescribed in the act. Although the Trust cannot answer this component of your request now, we might be able to answer a refined request within the cost limit. Please be aware that we cannot guarantee at this stage that a refined request will fall within the FOIA cost limit. You can find out more about Section 12(1) by reading the full text of the Act, available at http://www.legislation.gov.uk/ukpga/2000/36/section/12. I am sorry that on this occasion I have not been able to answer this aspect your request. You have the right to appeal our decision if you think it is incorrect. Details can be found at the end of this letter Due to the volume of work to print and copy this information to send this number of incident forms this would fall outside of the time allowed within section 12 of the Freedom of Information Act

2.How many SERIOUS INCIDENT REPORTS in 2022?

3.What proportion of patients were men/women?

Female	52
Male	43

4.How old were they?

*Row Labels*	*Count of Incident Number*
14	1
15	2
17	3
18	3
20	1
23	1
25	1
26	2
27	2
28	2
29	2
30	3
31	1
32	2
34	3
36	3
37	2
38	1
39	6
40	1
41	2
42	1
43	2
44	3
45	1
46	3
47	2
48	1
49	1
51	1
52	1
53	2
56	1
58	4
59	4
60	3
61	1
63	1
64	4
66	1
68	2
71	1
72	1
75	2
76	1
78	1
79	1
80	2
81	1
87	1
88	1
*Grand Total*	95

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

34%

6.How many SERIOUS INCIDENT REPORTS were investigated outside the NHS and CCG?

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)? 59

SI	Count of Incident Number
Unexpected Death (Cause Unknown)	24
Suspected Suicide (Awaiting Confirmation from Coroner)	35

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)?

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)?

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

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

12.If so, what was their concerns?

N/A

13.How does the Trust plan to prevent SERIOUS INCIDENTS in the future?

The Trust is working to implement the new NHS Patient Safety Incident Response Framework which brings around significant change to the management of Serious Incidents previously under the SI Framework 2015. With the emphasis being on improvement and focusing on systems and processes. The Trust will use the Fundamental Standards of Care to drive this improvement.

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

1.Please supply any Restraints/investigations?

Please see attached RCA

2.How many RESTRAINTS in 2022?

The figures for gender/age/BAME do not add up to the overall number of restraints as the same patient may have been restrained multiple times.

1492

3.What proportion of patients were men/women?

Female: 160

Male: 165

Not specified: 1

4.How old were they?

*Age*	*Sum of Patients Restrained*
10-19	47
20-29	88
30-39	55
40-49	44
50-59	44
60-69	21
70-79	19
80-89	7
90-99	1
*Grand Total*	*326*

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

BMECategory	Patients Restrained
BME	163
Non-BME	157
Not Known	6

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

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

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

2 deaths by natural causes and 2 are not recorded as deceased on Ulysses.

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

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

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

12.If so, what was their concerns?

1	Bruising suffered following several episodes of restraints
2	Complaint about unreasonable force used during restraint
3	Body left stiff and sore following a restraint
4	Restraint left her feeling sore on her and intimidated
5	Suffered bruising following restraint
6	Complaint about unreasonable force used during restraint

13.Are counts of forced injections available?

Number of rapid tranquilisation under restraint: 261

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

Please see attached policy.

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

1.Please supply any SECLUSION reports/investigations

None that met criteria for SI Investigation

2.How many SECLUSIONS in 2022?

261

3.What proportion of patients were men/women?

GenderDesc	Patients Secluded
Female	29
Male	82

4.How old were they?

*Age*	*Sum of Patients Secluded*
10-19	17
20-29	37
30-39	16
40-49	21
50-59	12
60-69	8
*Grand Total*	*111*

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

BMECategory	Patients Secluded
BME	59
Non-BME	50
Not Known	2

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

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

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

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

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

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

12.If so, what was their concerns?

1	Patient was taken to seclusion numerous times

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

Our policy has been updated to reflect the use of force act 2018 statutory guidance which will support the reduction of restrictive practices of which seclusions is one.

Please see attached policy.

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

1.Please supply any MEDICATION ERRORS reports/investigations

None that met criteria for SI Investigation

2.How many MEDICATION ERRORS in 2022?

437

3.What proportion of patients were men/women?

*Gender*	*Count of Incident Number*
Female	174	40%
Male	155	35%
Unknown	2	1%
Not Recorded	106	24%

4.How old were they?

Age (Years)	Count of Incident Number
8	1
11	2
13	2
16	6
17	6
18	2
19	6
20	5
21	5
22	4
23	14
24	13
25	8
26	11
27	6
28	5
29	6
30	6
31	6
32	6
33	8
34	5
35	4
36	4
37	8
38	4
39	4
40	8
41	8
42	6
43	1
44	7
45	3
46	3
47	7
48	3
49	6
50	6
51	3
52	4
53	3
54	4
55	2
56	5
57	2
58	11
59	7
60	5
61	4
62	1
63	3
64	6
66	2
67	2
68	5
69	1
72	3
73	1
75	3
76	5
77	3
78	4
79	4
80	2
81	3
82	2
83	2
84	1
85	2
87	4
88	1
90	1
92	1
Not Recorded	110
Grand Total	437

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

39%

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

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)?

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)?

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

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

1 Patient experienced jerking in 1 hand.

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

12.If so, what was their concerns?

1	A medication error occurred where patient was given Take home medication when they had been placed on a Depot Injection
2	Incorrect Medication prescribed

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

The organisation has a Medicines Safety Officer that leads on reporting and learning from medicines incidents for the organisation. This is done through embedding the Patient Safety Incident Response framework and ensuring improvement and learning pathways are embedded across the organisation using systems approaches to learning for medicines incidents.
The Trust has a multidisciplinary Safe Medication Practice Group which leads monitoring and reviewing medicines incidents and alerts, identifying themes and systems approaches to learning and monitors implementation across the service lines.
Each team have a medicines safety champion to support embedding of learning and preventing incidents more locally.
Promoting a safety culture across the Trust with regards to medicines incidents
Utilising systems such as the electronic prescribing and medicines administration systems to force functions and set up alerts to reduce medicines incidents, using the prescription tracking system and scanners to reduce specific types of incidents, use of pharmacy automation to reduce specific types of medicines dispensing incidents.
Education and training sessions, monthly learning bulletin as a tool to spread learning and share incidents, updates of policies and procedures.
Co-produced quality improvement projects
Working with the ICB on various medicines safety initiatives

I trust that this response satisfies your request. However, if you are not satisfied you may request an internal review of our response by emailing us at foi@swlstg.nhs.uk setting out your reasons. Please ensure that the reference number appearing in the subject line above is quoted to make it easier for the team to deal with further correspondence. Requests for an internal review should be made within 40 working days of receipt of our response.

In the event that you remain dissatisfied with the outcome of any appeal, you have the right to appeal to the Information Commissioner’s Office (ICO), although they will expect you to exhaust the Trust internal complaints policy before they will consider a case. For further details see www.ico.gov.uk

Yours sincerely

Philip Murray

Director of Finance and Performance

Janet

Janet Porter

Executive Assistant/Project Coordinator

Janet Porter

South West London & St George’s Mental Health NHS Trust

Tolworth Hospital

Acacia East Wing

117-127 Red Lion Road

Tolworth

Surrey

KT6 7QR

Tel: 0203 513 5914

Email: janet.porter@swlstg.nhs.uk