Serious incidents and deaths of patients with a learning disability

George Julian made this Freedom of Information request to Oxford University Hospitals NHS Foundation Trust

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The request was partially successful.

Dear Oxford University Hospitals NHS Trust,

Please could you provide the following information:

1a) total number of deaths that have occurred at the Trust in each of the the last five years (please provide data broken down by year)
1b) the number of these deaths that were classified as unexpected

2a) total number of deaths that have been referred to the Coroner by the Trust in each of the last five years
2b) of these, the number of deaths of patients with a learning disability referred to the Coroner

3a) total number of deaths of patients with a learning disability that have occurred at the Trust in each of the last five years (please provide total number and indicate whether they were inpatients at the time of their deaths)
3b) of these, the number of these deaths of patients with a learning disability that were classified as unexpected

4a) total number of deaths at the Trust reported as an incident on the National Reporting and Learning System (NRLS) in each of the last five years
4b) total number of deaths at the Trust reported on Strategic Executive Information System (STEIS) in each of the last five years
4c) if possible, please indicate the number of these that relate to patients with a learning disability

5a) total number of initial 72-hour reviews into deaths (as defined by the NHS Serious Incident Framework) in each of the last five years
5b) total number of investigations into deaths (as defined by the NHS SI Framework) in each of the last five years - please provide data broken down by severity, Level 1 internal investigations, Level 2 comprehensive internal investigations, Level 3 independent investigations. Please also indicate whether the numbers refer to investigations opened or completed.

Many thanks for your time.

Yours faithfully,
Dr George Julian

FOIA (RTH) OUH,

Dear Sir/Madam

 

Thank you for your request in which you asked for information the trust
may hold.

 

Your request is being considered and Oxford University Hospitals NHS
Foundation Trust will respond within 20 working days in compliance with
the Freedom of Information Act 2000.

 

There may be a fee payable for this information. You will be informed if
this is the case and you can decide if you wish to proceed with your
request.

 

If appropriate, the information requested can be made available in
alternative formats, including other languages, Braille, large print, and

CD’s. If you require any of these formats then please let me know.

 

Please contact me if you have any further enquiries about your request. I
would be grateful if you could quote the reference number given at the top
of this email. 

 

Regards,

 

Valerie Gray

 

Freedom of Information Officer

Planning & Information

Oxford University Hospitals NHS Foundation Trust

The John Radcliffe Hospital

Headley Way | Headington | Oxford | OX3 9DU

 

Tel: 01865 572470

Email: [email address]

 

Recipients should be aware that all emails received or sent by this Trust
are subject to the Freedom of Information Act 2000 and therefore
information within them may be disclosed to a third party. Please note
that under our obligations to the Data Protection Act 1998, we will not
disclose any personal information without your consent.

 

 

 

show quoted sections

FOIA (RTH) OUH,

Dear Sir/Madam

 

Thank you for your request sent on the 31^st January 2017. Please find
your response below.

 

1a) total number of deaths that have occurred at the Trust in each of the
the last five years (please provide data broken down by year)

  2012 2013 2014 2015 2016
Total number of inpatient deaths 2395 2506 2422 2329 2481

 

 

1b) the number of these deaths that were classified as unexpected

The Trust does not classify deaths as expected/unexpected. Numbers of
deaths that were investigated as Serious Incidents.

  2012 2013 2014 2015 2016
Deaths investigated as a Serious Small numbers 11 14 11 11
Incident suppression

 

 

2a) total number of deaths that have been referred to the Coroner by the
Trust in each of the last five years

  2012 2013 2014 2015 2016
Referrals accepted by Coroner 285 326 277 259 248
Coroner’s inquests
                                         (The 6 91 137 178 167
electronic recording system provides data from
December 2012)
Total 291 417 414 437 415

 

 

2b) of these, the number of deaths of patients with a learning disability
referred to the Coroner

  2012 2013 2014 2015 2016
Not recorded (Learning
Coroner referrals for deaths of disability patients 8 7
patients with a learning disability database is collated from
2015)
Coroner’s inquests for deaths of Not recorded on the electronic
patients with a learning disability recording system
Total Not recorded 8 7

 

 

3a) total number of deaths of patients with a learning disability that
have occurred at the Trust in each of the last five years (please provide
total number and indicate whether they were inpatients at the time of
their deaths)

  2012 2013 2014 2015 2016
Total number of inpatient deaths of patients with 9 9 14 19 14
a learning disability

 

 

3b) of these, the number of these deaths of patients with a learning
disability that were classified as unexpected

The Trust does not classify deaths as expected/unexpected, investigated
deaths of patients with a learning disability as Serious Incidents.

  2012 2013 2014 2015 2016
Deaths of patients with a
learning disability Not recorded on the electronic Small numbers
investigated as a Serious recording system suppression
Incident

 

 

4a) total number of deaths at the Trust reported as an incident on the
National Reporting and Learning System (NRLS) in each of the last five
years

  2012 2013 2014 2015 2016
Total number of inpatient deaths reported on NRLS 8 13 19 13 11

 

 

4b) total number of deaths at the Trust reported on Strategic Executive
Information System (STEIS) in each of the last five years

  2012 2013 2014 2015 2016
Total number of inpatient deaths reported Small
on STEIS numbers 12 14 11 11
suppression

 

4c) if possible, please indicate the number of these that relate to
patients with a learning disability

  2012 2013 2014 2015 2016
Total number of inpatient deaths of Not recorded on the Small
patients with a learning disability electronic recording 0 numbers
reported on NRLS system suppression
Total number of inpatient deaths of Small
patients with a learning disability Not recorded numbers
reported on STEIS suppression

 

 

5a) total number of initial 72-hour reviews into deaths (as defined by the
NHS Serious Incident Framework) in each of the last five years

Electronic records of initial 72-hour reviews have been held since 2015
and numbers are provided in the table below.  Previous to this date paper
records are held.  Accessing the paper records for the date period 2012 to
2014 would require increased staff and time allocation, under s12 FOIA
potentially exceed the cost limit £450.

  2012 2013 2014 2015 2016
Total number of initial 72-hour reviews into - - - 6 18
deaths

 

5b) total number of investigations into deaths (as defined by the NHS SI
Framework) in each of the last five years - please provide data broken
down by severity, Level 1 internal investigations, Level 2 comprehensive
internal investigations, Level 3 independent investigations. Please also
indicate whether the numbers refer to investigations opened or completed.

STEIS does not request the outcome and a search of investigations cannot
be completed based on ‘death’.  Between 2012 and 2016 the manner in which
STEIS has described the levels of investigations has differed.  The
Independent investigations have remained the same and therefore can be
sourced and numbers provided in the table below.

  2012 2013 2014 2015 2016
Level 3 independent investigations 0 0 0 0 Small numbers
suppression

 

Regards,

 

Valerie Gray

 

Freedom of Information Officer

Planning & Information

Oxford University Hospitals NHS Foundation Trust

The John Radcliffe Hospital

Headley Way | Headington | Oxford | OX3 9DU

 

Tel: 01865 572470

Email: [1][email address]

 

Recipients should be aware that all emails received or sent by this Trust
are subject to the Freedom of Information Act 2000 and therefore
information within them may be disclosed to a third party. Please note
that under our obligations to the Data Protection Act 1998, we will not
disclose any personal information without your consent.

 

References

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Dear Valerie,

Thank you for taking the time to respond to my FOI request,

Best wishes
Dr George Julian