Asked by: Lord Freyberg (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, further to the Written Answer by Lord O’Shaughnessy on 27 March (HL6013), whether ad hoc analysis has been undertaken over the last five years to match claims or injury codes to particular diseases or broader activities, either by the NHS Litigation Authority or by third parties such as academics or consultants with access to their data; for which diseases those analyses have been undertaken, when and by whom; whether summary results from those analyses are available, and if so, where; and how many claims were associated with each of those diseases at the time of the analysis.
Answered by Lord O'Shaughnessy
The National Health Service Litigation Authority (NHS LA) has not undertaken any ad hoc analysis over the last five years to match claims or injury codes to particular diseases or broader activities.
Due to the large amount of data in relation to the cause and injury codes used in the NHS LA claims management system to identify five claims or more, this information is attached.
It is not possible to provide data on cause and injury codes with between two and four claims associated and with only one claim associated, as this could lead to the re-identification of an individual.
The following table shows the number of claims by primary cause codes with 0 claims associated for 2015 – 16.
Number of clinical negligence claims received 2015/16 by primary cause with total claim value as at 31 March 2016 | |
Primary Cause | Number of claims |
Electro convulsive therapy treatment | 0 |
Fail/Delay Avail Of SCBU Beds | 0 |
Fail/Delay Obtain Cord PH | 0 |
Incident In Community By absconding/discharge patients | 0 |
In hospital Maternal Death Post Partum Haemorrhage Caesarean Section | 0 |
Injury To Others By Patient | 0 |
Inpatient Suicide- Non Collapsible Rails | 0 |
Intravenous Administration of Misselec Concentrate Potassium Chloride | 0 |
Mendelsohn's Syndrome | 0 |
Unlawful Detention – mental Health | 0 |
Wrong Application Of Electrode | 0 |
Source : NHS LA
The following table shows the number of claims by primary injury code with 0 claims associated for 2015-16.
Number of clinical negligence claims received 2015/16 by primary injury with total claim value as at 31 March 2016 | |
Primary Injury | Number of claims |
Foetal Anti-Convulsant Syndrome. | 0 |
ISO Immunisation | 0 |
Klumpke's Paralysis | 0 |
Liver Transplant | 0 |
Pierced Ear Drum | 0 |
Stunted Growth | 0 |
Swine Flu | 0 |
Source: NHS LA
Asked by: Baroness Tyler of Enfield (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what assessment they have made of the increase in unexpected patient deaths reported by England’s mental health trusts; and what steps they are taking to reduce the number of such deaths.
Answered by Lord O'Shaughnessy
The Government wants to make the National Health Service the safest, most transparent healthcare system in the world - the first step towards this ambition is to collect safety data more reliably. The level of reported harm has increased as a result of our very deliberate improvements in the way such events are recorded and investigated.
The Government has introduced requirements for the reliable reporting of any safety incidents, all of which should be investigated fully at a local level then reported to NHS England.
From April 2017, all NHS trusts and foundation trusts will be required to publish numbers of avoidable deaths and how they are improving care.
Asked by: Baroness Berger (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 27 January 2017 to Question 61518, what the recorded causes of death were of the 11 children who died in in-patient mental health units since 2013.
Answered by Baroness Blackwood of North Oxford
I refer the hon. Member to the answer I gave on 27 January 2017 to Question 61518. It is not departmental policy to publish data on individuals, in line with law and patient confidentiality. With such a small cohort, the risk of patients becoming identifiable is increased.
Asked by: Dan Jarvis (Labour - Barnsley North)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 19 April 2016 to Question 33552, if the National Clinical Audit and Patient Outcomes Programme will audit the number of avoidable deaths from epilepsy in adults.
Answered by Jane Ellison
The Epilepsy Society paper presents the findings of the National General Practice Study of Epilepsy (NGPSE), a 25-year cohort analysis of 558 people having recurring unprovoked seizures, and also considers more widely the issue of premature mortality and death in epilepsy. The NGPSE study found that 189 (34%) of the cohort died during the 25 year follow-up period, and six people in this group (3%) had died directly due to their epilepsy. The NGPSE also found a frequent link between co-morbidity in epilepsy and death.
Increasing numbers of people have multiple long term conditions (LTCs), not just single diseases, and that the management of comorbidity and multimorbidity presents a significant challenge to the National Health Service. It is an issue highlighted in the Five Year Forward View and defined as a central task of the NHS. Improving the support and choice provided to people with LTCs and enabling them to live healthy independent lives remains a key ambition for this Government. NHS England is responding with specific actions to improve the delivery of personalised care planning, self-management support and personal health budgets, as well as helping to support the development of new service models that deliver care that is more proactive and less reactive in the management of patients with LTCs. More information can be found in NHS England’s Business Plan for 2016-17, available at the following link:
www.england.nhs.uk/wp-content/uploads/2016/03/bus-plan-16.pdf
Guidance from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of epilepsy covers the issue of comorbidity, including polypharmacy. However, in recognition of this increasing problem, NICE is also working to produce a new clinical guideline on the management of multimorbidity in a range of common conditions which is scheduled for publication in September 2016.
Regarding the matter of variation in epilepsy mortality, the Neurology Intelligence Network (NIN), a partnership programme between Public Health England (PHE) and NHS England, has produced a detailed epilepsy profile presenting data at clinical commissioning group (CGG) level against 20 separate indicators, including mortality. CGGs should consider mortality rates alongside other indicators such as prevalence and unplanned admission rates, and in the wider socioeconomic context of their local area to understand the challenges and consider what improvement activity may be appropriate. NHS England is also taking specific action to target unwarranted variation in treatment and outcomes across range of conditions, including epilepsy, through the Rightcare Programme, which is being rolled out to all CCGs in 2016-17. The NIN profiles can be found at the following link:
http://fingertips.phe.org.uk/profile-group/mental-health/profile/neurology
Finally, as previously set out, the Healthcare Quality Improvement Partnership commissions, develops and manages the National Clinical Audit and Patient Outcomes Programme on behalf of NHS England, Wales and other devolved administration. There are no specific plans for an audit to cover all cases of avoidable deaths from epilepsy at this time.
Asked by: Dan Jarvis (Labour - Barnsley North)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 19 April 2016 to Question 33552, what assessment he has made of the implications for his Department's policy of the Epilepsy Society's longitudinal study on epilepsy mortality.
Answered by Jane Ellison
The Epilepsy Society paper presents the findings of the National General Practice Study of Epilepsy (NGPSE), a 25-year cohort analysis of 558 people having recurring unprovoked seizures, and also considers more widely the issue of premature mortality and death in epilepsy. The NGPSE study found that 189 (34%) of the cohort died during the 25 year follow-up period, and six people in this group (3%) had died directly due to their epilepsy. The NGPSE also found a frequent link between co-morbidity in epilepsy and death.
Increasing numbers of people have multiple long term conditions (LTCs), not just single diseases, and that the management of comorbidity and multimorbidity presents a significant challenge to the National Health Service. It is an issue highlighted in the Five Year Forward View and defined as a central task of the NHS. Improving the support and choice provided to people with LTCs and enabling them to live healthy independent lives remains a key ambition for this Government. NHS England is responding with specific actions to improve the delivery of personalised care planning, self-management support and personal health budgets, as well as helping to support the development of new service models that deliver care that is more proactive and less reactive in the management of patients with LTCs. More information can be found in NHS England’s Business Plan for 2016-17, available at the following link:
www.england.nhs.uk/wp-content/uploads/2016/03/bus-plan-16.pdf
Guidance from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of epilepsy covers the issue of comorbidity, including polypharmacy. However, in recognition of this increasing problem, NICE is also working to produce a new clinical guideline on the management of multimorbidity in a range of common conditions which is scheduled for publication in September 2016.
Regarding the matter of variation in epilepsy mortality, the Neurology Intelligence Network (NIN), a partnership programme between Public Health England (PHE) and NHS England, has produced a detailed epilepsy profile presenting data at clinical commissioning group (CGG) level against 20 separate indicators, including mortality. CGGs should consider mortality rates alongside other indicators such as prevalence and unplanned admission rates, and in the wider socioeconomic context of their local area to understand the challenges and consider what improvement activity may be appropriate. NHS England is also taking specific action to target unwarranted variation in treatment and outcomes across range of conditions, including epilepsy, through the Rightcare Programme, which is being rolled out to all CCGs in 2016-17. The NIN profiles can be found at the following link:
http://fingertips.phe.org.uk/profile-group/mental-health/profile/neurology
Finally, as previously set out, the Healthcare Quality Improvement Partnership commissions, develops and manages the National Clinical Audit and Patient Outcomes Programme on behalf of NHS England, Wales and other devolved administration. There are no specific plans for an audit to cover all cases of avoidable deaths from epilepsy at this time.
Asked by: Dan Jarvis (Labour - Barnsley North)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 19 April 2016 to Question 33552, if he will make an assessment of the extent of regional variation in premature death from epilepsy.
Answered by Jane Ellison
The Epilepsy Society paper presents the findings of the National General Practice Study of Epilepsy (NGPSE), a 25-year cohort analysis of 558 people having recurring unprovoked seizures, and also considers more widely the issue of premature mortality and death in epilepsy. The NGPSE study found that 189 (34%) of the cohort died during the 25 year follow-up period, and six people in this group (3%) had died directly due to their epilepsy. The NGPSE also found a frequent link between co-morbidity in epilepsy and death.
Increasing numbers of people have multiple long term conditions (LTCs), not just single diseases, and that the management of comorbidity and multimorbidity presents a significant challenge to the National Health Service. It is an issue highlighted in the Five Year Forward View and defined as a central task of the NHS. Improving the support and choice provided to people with LTCs and enabling them to live healthy independent lives remains a key ambition for this Government. NHS England is responding with specific actions to improve the delivery of personalised care planning, self-management support and personal health budgets, as well as helping to support the development of new service models that deliver care that is more proactive and less reactive in the management of patients with LTCs. More information can be found in NHS England’s Business Plan for 2016-17, available at the following link:
www.england.nhs.uk/wp-content/uploads/2016/03/bus-plan-16.pdf
Guidance from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of epilepsy covers the issue of comorbidity, including polypharmacy. However, in recognition of this increasing problem, NICE is also working to produce a new clinical guideline on the management of multimorbidity in a range of common conditions which is scheduled for publication in September 2016.
Regarding the matter of variation in epilepsy mortality, the Neurology Intelligence Network (NIN), a partnership programme between Public Health England (PHE) and NHS England, has produced a detailed epilepsy profile presenting data at clinical commissioning group (CGG) level against 20 separate indicators, including mortality. CGGs should consider mortality rates alongside other indicators such as prevalence and unplanned admission rates, and in the wider socioeconomic context of their local area to understand the challenges and consider what improvement activity may be appropriate. NHS England is also taking specific action to target unwarranted variation in treatment and outcomes across range of conditions, including epilepsy, through the Rightcare Programme, which is being rolled out to all CCGs in 2016-17. The NIN profiles can be found at the following link:
http://fingertips.phe.org.uk/profile-group/mental-health/profile/neurology
Finally, as previously set out, the Healthcare Quality Improvement Partnership commissions, develops and manages the National Clinical Audit and Patient Outcomes Programme on behalf of NHS England, Wales and other devolved administration. There are no specific plans for an audit to cover all cases of avoidable deaths from epilepsy at this time.
Asked by: Baroness Hollins (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether, in the light of Mazars' report investigating unexpected deaths at Southern Healthcare, they intend to establish a national review into premature deaths for people with mental illness, in addition to those with learning disabilities.
Answered by Lord Prior of Brampton
Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 requires registered mental health providers to notify the Care Quality Commission (CQC) about deaths of people detained or liable to be detained under the Mental Health Act 1983. In addition, the CQC monitors data provided by the Health and Social Care Information Centre through the Mental Health Minimum Data Set on deaths of mental health hospital patients.
The CQC will be undertaking a wider review into the investigation of deaths in a sample of all types of National Health Service trust (acute, mental health and community trusts) in different parts of the country. As part of this review, the CQC will assess whether opportunities for prevention of death have been missed, for example by late diagnosis of physical health problems.
There are currently no plans to establish a national review into premature deaths of people with mental illness.
Asked by: Baroness Berger (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, how many in-patients in child and adolescent psychiatric in-patient units have died in each year since 2010.
Answered by Alistair Burt
The number of inpatient deaths in child and adolescent mental health services is not collected centrally by the Department of Health.
However, deaths of all patients detained under the Mental Health Act 1983 are notified to the Care Quality Commission (CQC). There were no such deaths reported in 2010/11. They reported that in 2011/12 one person aged 19 or under had died of unnatural causes and none had died of natural causes. In 2012/13 the CQC reported no deaths from unnatural causes and one from natural causes in detained patients aged 19 or under. Their report for 2013/14 (the most recent in the public domain) did not provide a breakdown by age of the deaths of detained patients.[1]
The Department for Education collect and publish data on the number of child deaths reviewed each year, including those where the death occurred in a mental health inpatient unit. These can be found in table 6 of the Statistical First Release ‘Child Death Reviews – year ending 31 March 2015’, available at:
https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2015
However, it is possible that the year in which the review took place, was later than the year in which the death occurred.
The number of reviews of deaths occurring in a mental health inpatient unit have been suppressed in this table (shown with a ‘x’), indicating that there were 5 or fewer, and the actual figure is not shown in order to protect confidentiality. The number of reviews of deaths occurring in a mental health unit from 2010 to 2014 was nil.
[1] Care Quality Commission: Monitoring the Mental Health Act” (annual publications for 2012/13 and 2013/14)
Asked by: Baroness Berger (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what system is in place to record and publish statistics on child and adolescent deaths in psychiatric in-patient units.
Answered by Alistair Burt
The number of inpatient deaths in child and adolescent mental health services is not collected centrally by the Department of Health.
However, deaths of all patients detained under the Mental Health Act 1983 are notified to the Care Quality Commission (CQC). There were no such deaths reported in 2010/11. They reported that in 2011/12 one person aged 19 or under had died of unnatural causes and none had died of natural causes. In 2012/13 the CQC reported no deaths from unnatural causes and one from natural causes in detained patients aged 19 or under. Their report for 2013/14 (the most recent in the public domain) did not provide a breakdown by age of the deaths of detained patients.[1]
The Department for Education collect and publish data on the number of child deaths reviewed each year, including those where the death occurred in a mental health inpatient unit. These can be found in table 6 of the Statistical First Release ‘Child Death Reviews – year ending 31 March 2015’, available at:
https://www.gov.uk/government/statistics/child-death-reviews-year-ending-31-march-2015
However, it is possible that the year in which the review took place, was later than the year in which the death occurred.
The number of reviews of deaths occurring in a mental health inpatient unit have been suppressed in this table (shown with a ‘x’), indicating that there were 5 or fewer, and the actual figure is not shown in order to protect confidentiality. The number of reviews of deaths occurring in a mental health unit from 2010 to 2014 was nil.
[1] Care Quality Commission: Monitoring the Mental Health Act” (annual publications for 2012/13 and 2013/14)
Asked by: Baroness Berger (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, how many patients discharged from mental health in-patient care have taken their own life within (a) one week and (b) two weeks of that discharge in each year since 2010; and how many investigations have been undertaken into those deaths.
Answered by Norman Lamb
The first three months after discharge remain a time of particularly high suicide risk – this is especially true in the first 1-2 weeks. Between 2002 and 2012 there were 3,225 suicides in the United Kingdom by mental health patients in the post-discharge period, 18% of all patient suicides.
Post-discharge suicides were most frequent in the first week after leaving hospital when 380 deaths occurred, an average of 35 per year.
The number and proportion who died in the first week after discharge has not changed over the report period.
380 of the 3,225 people counted as post-discharge suicides between 2002-12 died in the first week after leaving hospital. 292 people died in the second week.
The total number of people who died within three months of in-patient discharge is, as follows:
2010: 202
2011: 220
2012: 177 (estimate)
We have reviewed the serious incident framework (due to be launched for April 2015) to support better recognition, reporting and investigation of serious incidents (which would include suicide/ self-inflicted death, but also other serious incidents affecting people with mental health needs). We are also exploring changes to the Serious Incident reporting system (STEIS) database to enable incidents, risks, trends and opportunities for learning to be more easily identified.
This Government is seeking to change the culture that suicide is inevitable for some people. In January this year the Deputy Prime Minister announced our ambition for ‘zero suicides’. This set out an aspiration for every part of the NHS to commit to a ‘zero suicide’ ambition. This ambition has already been adopted in some local areas and we are certain that this kind of approach can work to dramatically reduce suicides.
Pioneering work in Liverpool, the South-West and in the East of England means that health workers are already focusing on how they care for people with mental health conditions with a view to preventing suicide. The Deputy Prime Minister called on the health service to look at this work being done by these three pioneering areas.