WORCESTERSHIRE 2023

Dear Mrs Wendy Micklewright,

 

 

Trust response:

 

 

WORCESTER ECT

 

  1.      Please supply patient’s information ECT leaflet.

 

Please see below a list of current leaflets supplied by the Worcester ECT service.  

 

  •           Royal College of psychiatrists ECT leaflet (most up to date version) attached
  •             Grafton Worcester - ECT "Making your Decision" attached
  •             Grafton Worcester - ECT "your guide to treatment" attached
  •             Grafton Worcester - ECT "Information for relatives and carers" attached
  •             Grafton Worcester - The ECT Suite, a visual guide.  attached
  •             CQC - ECT Your guide about Consent to Treatment - external leaflet given to Worcester ECT patients
  •             Onside Advocacy services - external leaflet given to Worcester ECT patients.

 

  1.      Please supply patient ECT consent form

 

Please see attached ECT consent forms 1 and 4 as used by both ECT services

 

  1.      Please supply any ECT reports/investigations

 

There have been no reports or investigations within the Worcester ECT service

 

  1.      How many ECT in 2023?

 

17 Patients received ECT in Worcester in 2023.   This totalled 229 ECT treatments.

 

  1.      What proportion of patients were men/women?

 

In Worcester there were:    Male = 5 patients.   Female = 12 patients.

 

  1.      How old were they?

 

Ranging from 20-89

 

 

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

 

None

 

  1. How many people were covered by the Equality Act?

All patients were covered by the equality act

  1. How many people were offered talking therapy prior to ECT?

Offered: 15 patients

Not offered: 3 patients due to being too unwell.

 

 

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

 

7 patients in Worcester received ECT for the first time

 

  1.      How many patients consented to ECT?

 

All 17 patients had a valid consent form 1 or 4 for ECT, depending on their capacity to consent to treatment.

 

10 Patients were deemed to have capacity to consent to ECT treatment .  7 patients did not have capacity to consent to ECT.

 

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

 

None

 

  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?

 

None

 

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

 

No

 

  1.  If so, what was their concerns?

 

N/A

 

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

 

1 – due to pre-existing frontotemporal dementia

 

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

 

  •            Montreal Cognitive Assessment (MoCA) - at baseline, then every 4 treatments and at end of course.
  •            Comprehensive Psychopathological Rating Scale (CPRS) - before every single ECT treatment
  •            Autobiographical Questions - at baseline, then every 4 treatments and at end of course
  •            Mental Capacity Assessments (MCA) before each ECT treatment
  •            Mental state examinations during weekly ward reviews including cognition / memory
  •            Consultation with family members to assess changes in functioning / cognition
  •            Occupational therapy assessments to assess cognition
  •            Direct patient questioning about their memory and any changes they may perceive
  •             Post ECT follow up for 3 months after ECT which includes further MoCA testing at 2 months

 

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

 

Yes, where clinically indicated

 

  1.  If so, what was the conclusion?

 

MRI/CT scan have been used to rule out any organic causes for mental health issues/ injuries of the brain whilst having ECT.

 

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

 

N/A

 

 

HEREFORD ECT

 

1.Please supply patient’s information ECT leaflet

Please see attached

 

2.Please supply patient ECT consent form

Please see attached

 

3.Please supply any ECT reports/investigations

N/A

 

4.How many ECT in 2023?

147

 

5.What proportion of patients were men/women?

3 Males,   4 Females.

 

6.How old were they?

Ranging from 24 – 85

 

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

0

 

8.How many people covered by the equality act received ECT ?

All

 

9.How many people were offered talking therapy prior to ECT ?

Unknown

 

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

2

 

11.How many patients consented to ECT?

1

 

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

Unknown

 

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

None

 

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

None

 

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

None

 

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

None

 

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

None

 

18.If so, what was their concerns?

N/A

 

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

None

 

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

ABMQ, MOCA, CPRS, ECT time to orientation questionnaire.

 

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

Yes for some patients. 

 

22.If so, what was the conclusion?

Unknown

 

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

N/A

 

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

1.Please supply any Restraints/investigations

2.How many RESTRAINTS in 2023?

 

1084 Restraints

 

3.What proportion of patients were men/women?

Female

Male

Not Specified

756 (69.7%)

326 (30.1%)

2 (0.2%)

 

4.How old were they?

0-18

19-30

31-40

41-50

51-60

61-70

71-80

81-90

91-100

Not Specified

18

681

90

57

51

74

87

24

1

1

 

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

5.6%

 

6.How many people covered by the equality act were restrained?

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

0

 

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

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

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

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

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

13.If so, what was their concerns?

14.Are counts of forced injections available?

Yes, 33% (367 of the 1094) restraints involved the administration of rapid tranquilisation.

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

 

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

1.Please supply any SECLUSION reports/investigations

2.How many SECLUSIONS in 2023?

 

Herefordshire & Worcestershire Health and Care NHS Trust has no seclusion rooms

 

3.What proportion of patients were men/women?

4.How old were they?

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

6.How many people covered by the Equality Act were secluded ?

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

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

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

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

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

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

13.If so, what was their concerns?

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

 

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

1.Please supply any MEDICATION ERRORS reports/investigations

2.How many MEDICATION ERRORS in 2023?

666 Medication Incidents

 

3.What proportion of patients were men/women?

Female

Male

Not Specified

349 (52.4%)

280 (42.0%)

37 (5.6%)

 

4.How old were they?

0-18

19-30

31-40

41-50

51-60

61-70

71-80

81-90

91-100

Not Specified

22

42

68

47

65

93

126

125

37

41

 

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

4.1%

 

6.How many people covered by the equality act endured medication errors ?

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

0

 

8.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)?

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

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

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

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

13.If so, what was their concerns?

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

The Trust aims to prevent medication errors in the future by focusing on the following workstreams  :

 

  1. Medicines Safety PSIRF Improvement Group: The Medicines Safety Improvement Group (MSIG) has been established to optimize all aspects of medicines safety across HWHCT. MSIG will be a collaborative interprofessional improvement working group. The Group will aligns its aims and objectives to the National Patient Safety strategy and with the Service Delivery Units priorities. As a multidisciplinary group, it will generate themes and improvement actions to reduce the risk of patients deteriorating, facilitate learning and psychological safety through medicine safety optimisation. In addition, it will identify methods to measure impact of actions on care, to identify if a change has resulted in an improvement in care and safety of patients. The group is focusing on four areas of improvement: Documentation, Technology & Tools, Staff Communication and Education.
  2. Review mandatory training for nurses to address issues highlighted by incident reports.
  3. Changes to Ulysses categories to refine the data we obtain from the medicine incident reports and target our medicines safety interventions
  4. Medicines Management Clinical Audit plan:  The audits planned explore opportunities for improved reporting and intelligence-gathering using the BetterMeds ePMA system.

 

 

Complaints –

Section 21 - Information accessible to applicant by other means. This information is already published on our website and is considered exempt from disclosure under section 21(1) of the Freedom of Information Act, as it is reasonably accessible to you by other means.

 

This information can be located in our Board Papers in the Workforce reports, Quality & Safety Reports

 

Patient deaths within x months –

This information cannot be extracted electronically and a manual search of individual patient records would be required. This would exceed the appropriate cost limit under section 12(1) of the Freedom of Information Act 2000.

 

Section 12 – Exemption where cost of compliance exceeds appropriate limit.  Section 12 of the Act makes provision for public authorities to refuse requests for information where the cost of dealing with them would exceed the appropriate limit, which for local authorities is set at 18 Hours. We estimate that it will take us in excess of 18 hours to determine appropriate material and locate, retrieve and extract the information in reference to your request.

 

 

 

Yours sincerely

 

FOI Officer

2 Kings Court, Charles Hastings Way, Worcester WR5 1JR

WHCNHS.FOIrequest@nhs.net