Patient Homicide Data 2018-23

Dear FoI department,

This is a Freedom of Information request for statistics about patient homicides.

Please can you tell me the number of your patients that have committed, or who are suspected of committing, a homicide by date, for each of the years 2018 – 2023 inclusive?

By Homicide I mean murder, manslaughter, infanticide, or causing death by dangerous driving.

By Patients I mean both community and in-patients of mental health services who are either current patients or who have had contact with the trust within six months of the offence.

By suspected of committing a homicide I mean charged by the Police or found unfit to plead where legal proceedings have not yet been completed, or, where a patient has taken their own life after apparently killing someone else.

Just to be clear I am NOT requesting any personal data. I am interested in the statistics over time and at different times of the year.

As I understand, these incidents would normally trigger a Trust Serious Incident investigation, and there would presumably be correspondence with the National Confidential Inquiry into Suicide and Homicide by people with mental illness (NCISH), I trust this information will be relatively easy to collate.

I understand you will acknowledge my request and reply within twenty working days, which by my reckoning is by 30 October 2024.

I hope this request is clear, but please do not hesitate to contact me should you need any further information.

Thank you for your consideration.

The Trust confirms that it does not hold complete data on the information you have requested. This is because data about a patient’s past criminal activity is not routinely recorded on the patient’s electronic patient record, and only noted within clinical notes, where relevant to the treatment being received.

We estimate that to confirm the number of patients on whom we hold the information requested for the years 2018-2023 would exceed the appropriate limit under Section 12 of FOIA. This is because our electronic patient records system does not have a dedicated field for this type of data, and so we cannot extract this by simply running a report. We would need to examine thousands records to locate and, where held, extract this information. We estimate it would take around 10 minutes to search one record, thereby totalling circa 166 hours per thousand records to be searched.

The resources provisioned under FOIA are limited to £450 per request, which equates to 18 hours of officer time at a notional rate of £25 per hour. Accordingly, the Trust is not obliged to respond to this request and so we will not be processing it further.

Should you wish to narrow the scope of your request, then the Trust would treat any reformulated request we receive as a fresh FOI request and we may be able to help you.

Please note that information provided under FOIA relates to information held by this Trust at the date on which the request was made.

We trust that you are satisfied with this response. If you are dissatisfied then please write to us at FOI@tavi-port.nhs.uk within 40 working days, quoting the reference details in the header of this email, and explaining the reason for your dissatisfaction. The Trust would then appoint a senior manager, not previously involved in this case, to conduct an internal review of our original response and advise you of their findings, within 20 working days, which would include either a revised response, or a rationale for upholding the original response.

Thank you for your reply to my recent request, but I’m not sure it can be correct.

As I mentioned in my original application:

As I understand these incidents would normally trigger a Trust Serious Incident investigation, and there would presumably be correspondence with the National Confidential Inquiry into Suicide and Homicide by people with mental illness (NCISH), I trust this information will be relatively easy to collate.

So I would not expect you to have to consult individual patient records.

I made similar requests to your Trust before in 2013, 2016, and 2019, all of which were answered without mentioning this exemption or having to consult patient records.

Could I ask you please to reconsider my application, and if necessary organise a review of the decision.

Thanks very much for your help,

Best wishes

Job Title: Adult Unit Lead Clinician, Consultant Psychotherapist and Social Worker.

Having triangulated the information request with our patient safety and governance team I can confirm that due to there being less than six cases of this nature we are unable to disclose details due to the risks of identifying individual/s from the results.

It is the NHSE/ONS standard not to provide data where there are low numbers, equal to or less than five, as it may be possible to identify individuals from the incident and year.  Any homicide history of our patients constitutes personal data, and cannot be released.  Although the year alone is not personal data, we also have to consider other information that is already available, or may become available, which could be combined with the data requested.  This is not a just a question of considering the means reasonably likely to be used by general public, but also the means likely to be used by a determined person with a particular reason to want to identify individuals from data in the public domain or elsewhere, now or in the future, and/or gained from other sources.

We are, therefore, withholding this information in accordance with Section 40(2) and Section 40(3a) and Section 41(1) of the Freedom of Information Act 2000.

The disclosure of personal data or easily identifiable data would be unfair, thus breaching UK GDPR Principle (a): Lawfulness, fairness and transparency. As this is an absolute exemption, we do not have to apply the Public Interest Test when applying this exemption.

Our trust read your latest request as asking for information about all patients we have treated and whether any of them had committed homicide at any point during their lives, either before or during their spell as a patient under our care. Your request for an internal review has clarified that this request was solely concerned with the period in which a patient was under our care and not before that time.

Having now clarified the parameters of your criteria for this FOI, I have made a new request for data within the trust with the outcomes outlined above.

I note that information related to Serious Incidents, including Homicide is not always related to this trust by patients or other agencies and where this information is relayed it may be some time after the event.

Further to the FOI statement Question “As I understand these incidents would normally trigger a Trust Serious Untoward Incident investigation, and there would presumably be correspondence with the National Confidential Inquiry into Suicide and Homicide by people with mental illness (NCISH), I trust this information will be relatively easy to collate.” The answer is yes, sometimes this could happen but not necessarily, depending on the nature and details of each individual case and whether we are made aware of the case history by other agencies.

All Freedom of Information requests apply to data held at the time of the request, I am therefore unable to comment on FOI responses previously sent to you.

In compiling this response I have consulted with our FOI lead, Governance and patient safety team and reviewed the structures of standard patient risk assessment formats to consider whether we could have missed any data relevant to this FOI. When I consulted these trust-wide services I found, as stated in the summary above, that the low number of relevant incidents should not be reported for data protection reasons.

Dear FoI department,

This is a Freedom of Information request for statistics about patient homicides.

Please can you tell me the number of your patients that have committed, or who are suspected of committing, a homicide by date, for each of the years 2018 – 2023 inclusive?

By Homicide I mean murder, manslaughter, infanticide, or causing death by dangerous driving.

By Patients I mean both community and in-patients of mental health services who are either current patients or who have had contact with the trust within six months of the offence.

By suspected of committing a homicide I mean charged by the Police or found unfit to plead where legal proceedings have not yet been completed, or, where a patient has taken their own life after apparently killing someone else.

Just to be clear I am NOT requesting any personal data. I am interested in the statistics over time and at different times of the year.

As I understand, these incidents would normally trigger a Trust Serious Incident investigation, and there would presumably be correspondence with the National Confidential Inquiry into Suicide and Homicide by people with mental illness (NCISH), I trust this information will be relatively easy to collate.

I understand you will acknowledge my request and reply within twenty working days, which by my reckoning is by 30 October 2024.

I hope this request is clear, but please do not hesitate to contact me should you need any further information.

Thank you for your consideration.

The Trust confirms that it does not hold complete data on the information you have requested. This is because data about a patient’s past criminal activity is not routinely recorded on the patient’s electronic patient record, and only noted within clinical notes, where relevant to the treatment being received.

We estimate that to confirm the number of patients on whom we hold the information requested for the years 2018-2023 would exceed the appropriate limit under Section 12 of FOIA. This is because our electronic patient records system does not have a dedicated field for this type of data, and so we cannot extract this by simply running a report. We would need to examine thousands records to locate and, where held, extract this information. We estimate it would take around 10 minutes to search one record, thereby totalling circa 166 hours per thousand records to be searched.

The resources provisioned under FOIA are limited to £450 per request, which equates to 18 hours of officer time at a notional rate of £25 per hour. Accordingly, the Trust is not obliged to respond to this request and so we will not be processing it further.

Should you wish to narrow the scope of your request, then the Trust would treat any reformulated request we receive as a fresh FOI request and we may be able to help you.

Please note that information provided under FOIA relates to information held by this Trust at the date on which the request was made.

We trust that you are satisfied with this response. If you are dissatisfied then please write to us at FOI@tavi-port.nhs.uk within 40 working days, quoting the reference details in the header of this email, and explaining the reason for your dissatisfaction. The Trust would then appoint a senior manager, not previously involved in this case, to conduct an internal review of our original response and advise you of their findings, within 20 working days, which would include either a revised response, or a rationale for upholding the original response.

Thank you for your reply to my recent request, but I’m not sure it can be correct.

As I mentioned in my original application:

As I understand these incidents would normally trigger a Trust Serious Incident investigation, and there would presumably be correspondence with the National Confidential Inquiry into Suicide and Homicide by people with mental illness (NCISH), I trust this information will be relatively easy to collate.

So I would not expect you to have to consult individual patient records.

I made similar requests to your Trust before in 2013, 2016, and 2019, all of which were answered without mentioning this exemption or having to consult patient records.

Could I ask you please to reconsider my application, and if necessary organise a review of the decision.

Thanks very much for your help,

Best wishes

Job Title: Adult Unit Lead Clinician, Consultant Psychotherapist and Social Worker.

Having triangulated the information request with our patient safety and governance team I can confirm that due to there being less than six cases of this nature we are unable to disclose details due to the risks of identifying individual/s from the results.

It is the NHSE/ONS standard not to provide data where there are low numbers, equal to or less than five, as it may be possible to identify individuals from the incident and year.  Any homicide history of our patients constitutes personal data, and cannot be released.  Although the year alone is not personal data, we also have to consider other information that is already available, or may become available, which could be combined with the data requested.  This is not a just a question of considering the means reasonably likely to be used by general public, but also the means likely to be used by a determined person with a particular reason to want to identify individuals from data in the public domain or elsewhere, now or in the future, and/or gained from other sources.

We are, therefore, withholding this information in accordance with Section 40(2) and Section 40(3a) and Section 41(1) of the Freedom of Information Act 2000.

The disclosure of personal data or easily identifiable data would be unfair, thus breaching UK GDPR Principle (a): Lawfulness, fairness and transparency. As this is an absolute exemption, we do not have to apply the Public Interest Test when applying this exemption.

Our trust read your latest request as asking for information about all patients we have treated and whether any of them had committed homicide at any point during their lives, either before or during their spell as a patient under our care. Your request for an internal review has clarified that this request was solely concerned with the period in which a patient was under our care and not before that time.

Having now clarified the parameters of your criteria for this FOI, I have made a new request for data within the trust with the outcomes outlined above.

I note that information related to Serious Incidents, including Homicide is not always related to this trust by patients or other agencies and where this information is relayed it may be some time after the event.

Further to the FOI statement Question “As I understand these incidents would normally trigger a Trust Serious Untoward Incident investigation, and there would presumably be correspondence with the National Confidential Inquiry into Suicide and Homicide by people with mental illness (NCISH), I trust this information will be relatively easy to collate.” The answer is yes, sometimes this could happen but not necessarily, depending on the nature and details of each individual case and whether we are made aware of the case history by other agencies.

All Freedom of Information requests apply to data held at the time of the request, I am therefore unable to comment on FOI responses previously sent to you.

In compiling this response I have consulted with our FOI lead, Governance and patient safety team and reviewed the structures of standard patient risk assessment formats to consider whether we could have missed any data relevant to this FOI. When I consulted these trust-wide services I found, as stated in the summary above, that the low number of relevant incidents should not be reported for data protection reasons.