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Bowel Management Patient Safety Alert (SPINE 01/19)

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Dear Tavistock and Portman NHS Foundation Trust,

MY COLLEAGUES AND MYSELF ARE SENDING A DISCRETE AND SEPARATE FOI REQUEST TO EVERY NHS TRUST (BUT ARE ENSURING THAT NO DUPLICATE REQUEST IS MADE TO ANY ONE TRUST).

WE WOULD REQUEST THAT FOI OFFICERS SEND (VIA THE WHATDOTHEYKNOW WEBSITE PORTAL) A SIMILARLY DISCRETE AND SEPARATE RESPONSE FOR EACH INDIVIDUAL TRUST.

I work for the Spinal Injuries Association (SIA), the leading national user-led charity supporting spinal cord injured people and their families. Being a user led organisation SIA understand the challenges of living with a spinal cord injury (SCI). We strive to support all people living with SCI to access the services and support they need to stay healthy and live full, fulfilling and active lives.

Part of my role is to assist the Head of Public Affairs with FOI requests, such as the one that follows. As a request under the Freedom of Information Act, please provide the following information about the recent NHS Improvement (NHSI) Patient Safety Alert “Resources to support safer bowel care for patients at risk of autonomic dysreflexia 25 July 2018”, Alert reference number: NHS/PSA/RE/2018/005

Q1. Does the Trust have a formal written policy for digital rectal examination, digital rectal stimulation and the digital removal of faeces in spinal cord injured and other patients with neurogenic bowel dysfunction?

(a) Yes
(b) No

Q2. Following recommendation of this patient safety alert, did the Trust “review your local clinical policy and guidance relating to bowel assessment and management”?

(a) Yes – produced a new policy
(b) Yes - revised an existing policy
(c) Yes – retained existing policy
(d) No – did not review an existing policy
(e) No – no bowel assessment and management policy in place

Q3. Is your policy based on the policy template that the Spinal Injuries Association circulated to your trust in August 2018?

(a) Yes
(b) No
(c) No bowel assessment and management policy in place

Q4. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention – Digital removal faeces?

(a) Yes
(b) No

Q5. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention –Digital rectal stimulation?

(a) Yes
(b) No

Q6. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention –Trans anal irrigation?

(a) Yes
(b) No

Q7. Are staff available seven days a week to undertake these bowel care interventions?

(a) Yes
(b) No

Q8. Has the Trust “reviewed your local education and training provision for interventional bowel management” as recommended in the Patient Safety Alert?

(a) Yes
(b) No

Q9. As requested by the Patient Safety Alert, has the trust developed “an action plan to ensure patients have adequate and timely access to staff who are trained appropriately to carry out these procedures, including in the evening and at weekends”?

(a) Yes
(b) No

Q10. Has the Trust “shared your reviewed local guidance, advice on how to identify staff who can provide Digital Removal of Faeces, and the key messages in this alert with medical, nursing and other relevant clinical staff”?

(a) Yes
(b) No

Q11. Does the Trust have a policy that allows for the personal care assistants/carers of spinal cord injured patients to assist with this element of the patient's care?

(a) Yes
(b) No

Q12. As recommended in the Patient Safety Alert, have you identified “an appropriate clinical leader to co-ordinate implementation of this alert”?

(a) Yes (please answer Q13, but ignore Q14)
(b) No (please answer Q14, but ignore Q13)

Q13. What are the contact details for the “appropriate clinical leader”(ie name, position, telephone and email)?

Q14. Why has your Trust not appointed an “appropriate clinical leader”?

(a) Alert implemented without appointment of a clinical leader
(b) Took no action following Patient Safety Alert, as policy already in place
(c) Took no action. No existing policy in place
(d) Other

Q15. Are your newly registered nurses able to demonstrate the nursing procedures as required in Annexe B, section 6.5 of the Nursing and Midwifery Council’s document ‘Future Nurse: Standards of Proficiency for Registered Nurses’?

(a) Yes
(b) No

Technical Note – Relevant annexe reads:-

“Annexe B
6: Use evidenced based, best practice approaches for meeting needs for care and support with bladder and bowel health
6.5: Administer enema, suppositories and undertake manual evacuation when appropriate.”

If you have any queries or require clarification on any of these questions, please contact the Spinal Injuries Association at [email address]

Yours faithfully,

Lauren Theodosi

Freedom of Information Requests, Tavistock and Portman NHS Foundation Trust

 

 

Dear Ms Theodosi

 

FREEDOM OF INFORMATION ACT 2000 - INFORMATION REQUEST

 

Your request for information, as detailed in your email below, has now
been considered in line with the requirements of the FOI Act 2000, and the
information requested is considered to be not applicable to this Trust.

 

The Tavistock and Portman NHS Foundation Trust is a specialist mental
health Trust which provides outpatient psychotherapy services only.   The
Trust has no bowel management departments and does not provide acute
services.    Your enquiry is therefore considered as not applicable to
this Trust.

 

Information about the Trust can be found on
[1]www.tavistockandportman.nhs.uk

 

If you wish to discuss any of the above please contact me, quoting the
reference details in the header of this email.

 

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,
you should write to:  Ndumbe Shu, Information Governance and Information
Security Manager, The Tavistock and Portman NHS Foundation Trust, 120
Belsize Lane, NW3 5BA, or via email to: [2][email address]

 

If you are not content with the outcome of your complaint or review, you
may apply directly to the Information Commissioner for a decision.
Generally, the ICO cannot make a decision unless you have exhausted the
complaints procedure provided by the Council. The Information Commissioner
can be contacted at:  The Information Commissioner's Office, Wycliffe
House, Water Lane, Wilmslow, Cheshire, SK9 5AF.  Telephone: 08456 30 60 60
or 01625 54 57 45.  Website address:  [3]www.ico.gov.uk

 

Yours sincerely,

 

Sandy Benson

Freedom of Information Officer

Tavistock and Portman 
NHS Foundation Trust
Tavistock Centre 
120 Belsize Lane
London NW3 5BA
[4]www.tavi-port.org
P Please consider the environment before printing this e-mail

 

From: Lauren Theodosi [mailto:[FOI #555765 email]]
Sent: 25 February 2019 11:59
To: Freedom of Information Requests <[Tavistock and Portman NHS Foundation Trust request email]>
Subject: Freedom of Information request - Bowel Management Patient Safety
Alert (SPINE 01/19)

 

Dear Tavistock and Portman NHS Foundation Trust,

MY COLLEAGUES AND MYSELF ARE SENDING A DISCRETE AND SEPARATE FOI REQUEST
TO EVERY NHS TRUST (BUT ARE ENSURING THAT NO DUPLICATE REQUEST IS MADE TO
ANY ONE TRUST).

WE WOULD REQUEST THAT FOI OFFICERS SEND (VIA THE WHATDOTHEYKNOW WEBSITE
PORTAL) A SIMILARLY DISCRETE AND SEPARATE RESPONSE FOR EACH INDIVIDUAL
TRUST.

I work for the Spinal Injuries Association (SIA), the leading national
user-led charity supporting spinal cord injured people and their families.
Being a user led organisation SIA understand the challenges of living with
a spinal cord injury (SCI). We strive to support all people living with
SCI to access the services and support they need to stay healthy and live
full, fulfilling and active lives.

Part of my role is to assist the Head of Public Affairs with FOI requests,
such as the one that follows. As a request under the Freedom of
Information Act, please provide the following information about the recent
NHS Improvement (NHSI) Patient Safety Alert “Resources to support safer
bowel care for patients at risk of autonomic dysreflexia 25 July 2018”,
Alert reference number: NHS/PSA/RE/2018/005

Q1. Does the Trust have a formal written policy for digital rectal
examination, digital rectal stimulation and the digital removal of faeces
in spinal cord injured and other patients with neurogenic bowel
dysfunction?

(a) Yes
(b) No

Q2. Following recommendation of this patient safety alert, did the Trust
“review your local clinical policy and guidance relating to bowel
assessment and management”?

(a) Yes – produced a new policy
(b) Yes - revised an existing policy
(c) Yes – retained existing policy
(d) No – did not review an existing policy
(e) No – no bowel assessment and management policy in place

Q3. Is your policy based on the policy template that the Spinal Injuries
Association circulated to your trust in August 2018?

(a) Yes
(b) No
(c) No bowel assessment and management policy in place

Q4. If admitted to the Trust will a person with neurogenic bowel
dysfunction receive the following bowel care intervention – Digital
removal faeces?

(a) Yes
(b) No

Q5. If admitted to the Trust will a person with neurogenic bowel
dysfunction receive the following bowel care intervention –Digital rectal
stimulation?

(a) Yes
(b) No

Q6. If admitted to the Trust will a person with neurogenic bowel
dysfunction receive the following bowel care intervention –Trans anal
irrigation?

(a) Yes
(b) No

Q7. Are staff available seven days a week to undertake these bowel care
interventions?

(a) Yes
(b) No

Q8. Has the Trust “reviewed your local education and training provision
for interventional bowel management” as recommended in the Patient Safety
Alert?

(a) Yes
(b) No

Q9. As requested by the Patient Safety Alert, has the trust developed “an
action plan to ensure patients have adequate and timely access to staff
who are trained appropriately to carry out these procedures, including in
the evening and at weekends”?

(a) Yes
(b) No

Q10. Has the Trust “shared your reviewed local guidance, advice on how to
identify staff who can provide Digital Removal of Faeces, and the key
messages in this alert with medical, nursing and other relevant clinical
staff”?

(a) Yes
(b) No

Q11. Does the Trust have a policy that allows for the personal care
assistants/carers of spinal cord injured patients to assist with this
element of the patient's care?

(a) Yes
(b) No

Q12. As recommended in the Patient Safety Alert, have you identified “an
appropriate clinical leader to co-ordinate implementation of this alert”?

(a) Yes (please answer Q13, but ignore Q14)
(b) No (please answer Q14, but ignore Q13)

Q13. What are the contact details for the “appropriate clinical leader”(ie
name, position, telephone and email)?

Q14. Why has your Trust not appointed an “appropriate clinical leader”?

(a) Alert implemented without appointment of a clinical leader
(b) Took no action following Patient Safety Alert, as policy already in
place
(c) Took no action. No existing policy in place
(d) Other

Q15. Are your newly registered nurses able to demonstrate the nursing
procedures as required in Annexe B, section 6.5 of the Nursing and
Midwifery Council’s document ‘Future Nurse: Standards of Proficiency for
Registered Nurses’?

(a) Yes
(b) No

Technical Note – Relevant annexe reads:-

“Annexe B
6: Use evidenced based, best practice approaches for meeting needs for
care and support with bladder and bowel health
6.5: Administer enema, suppositories and undertake manual evacuation when
appropriate.”

If you have any queries or require clarification on any of these
questions, please contact the Spinal Injuries Association at
[5][email address]

Yours faithfully,

Lauren Theodosi

-------------------------------------------------------------------

Please use this email address for all replies to this request:
[6][FOI #555765 email]

Is [7][Tavistock and Portman NHS Foundation Trust request email] the wrong address for Freedom of Information
requests to Tavistock and Portman NHS Foundation Trust? If so, please
contact us using this form:
[8]https://www.whatdotheyknow.com/change_re...

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show quoted sections

Lauren Theodosi

Dear Freedom of Information Requests,

Spinal cord injured people may need in-patient or community care at any time in their lives.
Indeed, such care may be required many, many years after their original injury (and rehabilitation). Also, the primary reason why care is required might well be unrelated directly to the spinal cord injury.
For example, a spinal cord injured person may: have serious mental health issues which require in-patient treatment; be admitted to hospital following an accident or severe infection; or require ongoing care in the community.
Despite the above, you have advised that our bowel management freedom of information request is not applicable to your trust.
Please explain precisely why you believe that a spinal cord injured person could never require services from your trust in their lifetime.
It would be greatly appreciated if you could copy your WhatDoTheyKnow response to [email address]

Yours sincerely,

Lauren Theodosi

Freedom of Information Requests, Tavistock and Portman NHS Foundation Trust

Dear Ms Theodosi

Thank you for submitting a further enquiry on the above subject regarding
bowel management services – which we have already  advised you is not a
service offered by this Trust,  and that we do not provide inpatient nor
acute services.

 

I believe that in your response below, you are now enquiring about forms
of trauma-induced psychotherapy support.    

We  treat patients who present with histories of trauma, and would adapt
the approach to individual client needs using a traditional psychodynamic
approach within our generic psychotherapy service.  We have a specialist
trauma unit within adult complex needs which provides a range of
interventions including psychodynamic psychotherapy, EMDR, yoga and art
therapy.

 

Please note that, having reviewed our  reply below, we must advise that
your interpretation  “that a spinal cord injured person could never
require services from your trust in their lifetime” was not indicated in
our response.

 

Please note that the information provided under FOI is information held at
the date on which the request was made.  If you wish to discuss any of the
above please contact me, quoting the reference details in the subject
header of this email.

 

Re-use of Information

The information provided above is given in response to a request received
under the Freedom of Information Act 2000, and is Trust copyright.  You
may re-use this Tavistock and Portman NHS Foundation Trust copyright
information in accordance with the Open Government Licence:
[1]http://www.nationalarchives.gov.uk/doc/o...
(Please note that re-use of personal data is not allowed under this
license.)

 

For information which is not Tavistock and Portman NHS Foundation Trust
copyright, e.g. external websites, please contact the named party
directly.

 

Should you be 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, you should write to:  Ndumbe Shu, Information Governance and
Information Security Manager, The Tavistock and Portman NHS Foundation
Trust, 120 Belsize Lane, NW3 5BA, or email: [2][email address]

 

If you are not content with the outcome of your complaint or review, you
may apply directly to the Information Commissioner for a decision.
Generally, the ICO cannot make a decision unless you have exhausted the
complaints procedure provided by the Trust.  The Information Commissioner
can be contacted at: Information Commissioner's Office, Wycliffe House,
Water Lane, Wilmslow, Cheshire, SK9 5AF.  Telephone: 08456 30 60 60 or
01625 54 57 45 .  The ICO website can be reached at [3]www.ico.org.uk.

 

Yours sincerely,

 

 

Sandy Benson

Freedom of Information Officer

Tavistock and Portman 
NHS Foundation Trust
Tavistock Centre 
120 Belsize Lane
London NW3 5BA
[4]www.tavi-port.org
P Please consider the environment before printing this e-mail

 

 

From: Lauren Theodosi
[[5]mailto:[FOI #555765 email]]
Sent: 07 May 2019 13:36
To: Freedom of Information Requests <[6][Tavistock and Portman NHS Foundation Trust request email]>
Subject: Re: RESPONSE TO FOI Request -18-19400 Bowel Management - Lauren
Theodosi - Whatdotheyknow

 

Dear Freedom of Information Requests,

Spinal cord injured people may need in-patient or community care at any
time in their lives.
Indeed, such care may be required many, many years after their original
injury (and rehabilitation). Also, the primary reason why care is required
might well be unrelated directly to the spinal cord injury.
For example, a spinal cord injured person may: have serious mental health
issues which require in-patient treatment; be admitted to hospital
following an accident or severe infection; or require ongoing care in the
community.
Despite the above, you have advised that our bowel management freedom of
information request is not applicable to your trust.
Please explain precisely why you believe that a spinal cord injured person
could never require services from your trust in their lifetime.
It would be greatly appreciated if you could copy your WhatDoTheyKnow
response to [7][email address]

Yours sincerely,

Lauren Theodosi

show quoted sections

We don't know whether the most recent response to this request contains information or not – if you are Lauren Theodosi please sign in and let everyone know.