Chief Medical Officer

11 May 2000

Dear Colleague

NATIONAL AUDIT OF ECT IN SCOTLAND

For a number of years CRAG funded a national audit of ECT in Scotland. The results of this work have now been reported and a copy of the Final Report of the project is enclosed with this letter. The report was highly rated by external reviewers and favourably received by the Clinical Effectiveness Programmes Subgroup (a subcommittee of CRAG and the body which funded the project). We congratulate those involved in the audit and in particular welcome the plans of the Scottish ECT Audit Network (SEAN) to continue the audit into the future. Details of how the audit will be operated are set out the papers from SEAN enclosed with this letter.

The National Audit of ECT was an impressive project which successfully engaged all ECT centres in Scotland. Notable features of the audit included: the active involvement and support of staff in every ECT centre in Scotland; improvements in equipment and resulting patient safety, (including the closure of one unsatisfactory ECT suite); the development of written clinical protocols; enhanced awareness of the 'ECT Team' and greater recognition of the role of dedicated nursing staff; changes in practice in dealing with Mental Health Act and patient consent issues; and the collation of comprehensive, accurate data on ECT use in Scotland.

However, the audit also identified a number of problems which remain to be tackled: very few ECT co-ordinators have allocated sessions for their ECT work; the standard of supervision of junior medical staff is generally poor; and the standard of the premises could be improved. In light of these findings Trust Chief Executives will wish to review the allocation of consultant sessions to supervise the ECT service; Medical Directors will wish to ensure that junior medical staff are supervised adequately; and Directors of Nursing will wish to ensure that care standards are being applied (and may wish to refer back to CNO(98)9 - "Nurses working with people with a mental disorder - standards of clinical knowledge" - which was issued in November 1998). In addition, efforts should continue to be made to improve the physical environment in which ECT is given.

We consider that the maintenance and improvement of standards of ECT will be best served by all ECT centres continuing to participate in the national audit of ECT. This will facilitate the collation and feedback of data to allow inter-centre comparisons and support the continuation of SEAN as a professional supervisory body.

Yours sincerely,