Asked by: Dan Jarvis (Labour - Barnsley Central)
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 Central)
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: Luciana Berger (Liberal Democrat - Liverpool, Wavertree)
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: Luciana Berger (Liberal Democrat - Liverpool, Wavertree)
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: Luciana Berger (Liberal Democrat - Liverpool, Wavertree)
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.
Asked by: Jamie Reed (Labour - Copeland)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, how many (a) young people under 18 and (b) children under five have been admitted to hospital after ingesting methadone or buprenorphine in the last five years; and how many such ingestions were fatal.
Answered by Jane Ellison
The following table provides data on finished admission episodes (FAEs), finished discharge episodes (FDEs) and FDEs where the patient died, where there is a primary or secondary diagnosis of methadone poisoning, by the requested age groups for the last five years for which data is available.
Please note that:
- data for buprenorphine ingestion has not been given as it is not possible to identify buprenorphine ingestion from the ICD10 diagnosis scheme available in the Hospital Episode Statistic s (HES) database,
- both FAE and FDE are given as the question asks about both admissions and the outcome of the admissions,
- admissions, discharges and discharges ending in death are not directly comparable because FAEs and FDEs do not represent the number of patients; as it is possible for an individual to have one or more episodes of care in any given period, while a death record can appear only once,
- hospital stays can span year-end so that the numbers of FAEs and FDEs do not necessarily match within any given year,
- any person who died without being admitted to hospital would not be counted, and
- the ICD-10 codes were used to define 'methadone poisoning' is T40.3 Poisoning by narcotic and psychodysleptics [hallucinogens], methadone
Count of (a) finished admission episodes (FAEs)1, (b) finished discharge episodes (FDEs)2 and (c) FDEs where the patient died3, with a primary or secondary diagnosis4 of methadone poisoning5, by the age groups (i) 0-4 and (ii) 0-17 years, 2008-09 to 2012-136
| 0-4 year olds | 0-17 year olds | ||||
FAEs | FDEs | FDEs – Discharged Dead | FAEs | FDEs | FDEs – Discharged Dead | |
2008-09 | 21 | 21 | 0 | 40 | 40 | 0 |
2009-10 | 22 | 22 | 0 | 68 | 68 | 0 |
2010-11 | 23 | 23 | 0 | 83 | 86 | 0 |
2011-12 | 21 | 20 | 0 | 48 | 47 | 1 |
2012-13 | 13 | 14 | 0 | 31 | 32 | 0 |
Source: Hospital Episode Statistics (HES), Health and Social Care Information Centre
The following table provides data on the number of deaths due to ingesting methadone or buprenorphine in persons aged (a) under 5 and (b) under 18 for the last five years for which data is available. The data has been divided into deaths in hospital and all deaths so as to capture those persons who were admitted to hospital due to ingesting methadone or buprenorphine, but later died at home.
All deaths and deaths that occurred in a hospital where the underlying cause was poisoning by methadone or buprenorphine, for persons aged (a) under 5 and (b) under 18, England and Wales, deaths registered between 2009-2013 1,2,3
| Year | Hospital deaths, under 5 | Hospital deaths, under 18 | All deaths, under 5 | All deaths, under 18 |
Methadone | 2009 | 0 | 0 | 0 | 1 |
| 2010 | 0 | 1 | 0 | 3 |
| 2011 | 0 | 1 | 0 | 8 |
| 2012 | 0 | 1 | 0 | 1 |
| 2013 | 0 | 1 | 1 | 3 |
|
|
|
|
|
|
Buprenorphine | 2009 | 0 | 0 | 0 | 0 |
| 2010 | 0 | 0 | 0 | 0 |
| 2011 | 0 | 1 | 0 | 2 |
| 2012 | 0 | 0 | 0 | 0 |
| 2013 | 0 | 0 | 0 | 0 |
Source: Office for National Statistics (ONS)
Notes:
1. Cause of death was defined using the following International Classification of Diseases, Tenth Revision (ICD-10) codes:
F11–F16, F18–F19: Mental and behavioural disorders due to drug use (excluding alcohol and tobacco),
X40–X44: Accidental poisoning by drugs, medicaments and biological substances, X60–X64: Intentional self-poisoning by drugs, medicaments and biological substances,
X85: Assault by drugs, medicaments and biological substances, and
Y10–Y14: Poisoning by drugs, medicaments and biological substances, undetermined intent
Deaths were included where the underlying cause was due to drug poisoning and where buprenorphine or methadone was mentioned on the death certificate.
2. Figures for England and Wales include deaths of non-residents.
3. Figures are for deaths registered, rather than deaths occurring in each calendar year. Due to the length of time it takes to complete a coroner’s inquest, it can take months or even years for a drug-related death to be registered. More details can be found in the 'deaths related to drug poisoning' statistical bulletin: www.ons.gov.uk/ons/rel/subnational-health3/deaths-related-to-drug-poisoning/england-and-wales---2013/stb---deaths-related-to-drug-poisoning-in-england-and-wales--2013.html#tab-Impact-of-Registration-Delays-on-Drug-Related-Deaths
Asked by: Seema Malhotra (Labour (Co-op) - Feltham and Heston)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what systems are in place for recording and publication of children's deaths in psychiatric hospitals who had been either forcefully detained or voluntary in-patients; and to which authority such deaths are reported.
Answered by Norman Lamb
From 1 April 2008, all Local Safeguarding Children Boards (LSCBs) have had a statutory responsibility to review the deaths of all children from birth (excluding still born babies) up to 18 years, who are normally resident within their area. This is known as the Child Death Review Process. Their responsibilities include setting up a Child Death Overview Panel which reviews child deaths on behalf of the LSCB. This would include deaths in psychiatric in-patient settings. The following link presents data collected from LSCBs in England to the year ending 31 March 2013.
www.gov.uk/government/publications/child-death-reviews-year-ending-31-march-2013
The Care Quality Commission (CQC) is currently developing a system of Intelligent Monitoring for Mental Health services; it is considering which indicators, including those that relate to Serious Untoward Incidents to include in it. This will include children and young people.
The CQC is the official source of information on deaths of patients subject to the Mental Health Act. A link to the CQC's Monitoring the Mental Health Act 2012/13 is:
www.cqc.org.uk/sites/default/files/media/documents/cqc_mentalhealth_2012_13_07_update.pdf
Further information can be obtained from:
The Care Quality Commission (CQC)
public.affairs@cqc.org.uk
Asked by: Seema Malhotra (Labour (Co-op) - Feltham and Heston)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, how many children of each (a) age and (b) gender have died while in-patients (i) at psychiatric hospitals in total as either forcefully detained or voluntary in-patients and (ii) in each institution in each year since 2000.
Answered by Norman Lamb
Since April 2008 all Local Safeguarding Children Boards have had a statutory duty to review the death of all children from birth to age 18. Statistics on these Child Death Reviews are collated and published by the Care Quality Commission (CQC) and are available on the CQC's website:
www.gov.uk/government/collections/statistics-child-death-reviews.
Statistics on the location of child deaths are available from 2010 onward and show that in this time, no child has died in an inpatient mental health unit.
According to data from the Mental Health Act Commission, six females and one male under 18 died between 2003 and 2008. Owing to patient confidentiality these figures cannot broken down to each institution.