The history of NCEPOD
- The principal precursor to NCEPOD was a confidential and anonymous
pilot study of mortality associated with anaesthesia (Lunn and Mushin,
1982). This covered inpatients from five regions in England, Wales
and Scotland. Its aims were to assess perioperative information in
order that the clinical practice of anaesthesia might be improved
and to provide comparative figures between regions to facilitate
this. A further important objective was to establish an index of
contemporary standards of care to permit future comparisons. It had
hoped that this study might be a combined surgical and anaesthetic
enterprise but this proved impossible.
In 1982 a joint venture between surgical and anaesthetic specialties named the
Confidential Enquiry into Perioperative Deaths (CEPOD) was initiated. This reviewed
surgical and anaesthetic practice over one year in three regions. In 1988 the
National Confidential Enquiry into Perioperative Deaths (NCEPOD) was then established
supported by government funding, and its first report was published in 1990.
Since its inception NCEPOD has moved from reviewing the care of surgical patients and now covers all specialties. This is reflected in the wide range of studies we are currently undertaking. We also look at near misses rather than just death and have increased the number of reports we publish each year.
The remit of NCEPOD
- NCEPOD's purpose is to assist in maintaining and improving standards
of medical and surgical care for the benefit of the public by reviewing
the management of patients, by undertaking confidential surveys and
research, and by maintaining and improving the quality of patient care
and by publishing and generally making available the results of such
How do NCEPOD studies work?
- Typically there are not always agreed standards with which NCEPOD
can compare current practice. If there were then all our work could
be defined as audit where the question to be answered would be "Does
this service reach a predetermined standard?". Usually
we are asking a question more akin to "What standard does
this service achieve?". In order to assess the standard,
NCEPOD initially uses a technique to identify the key components
of a service and their importance. It does this by a modified nominal
group technique, designed for us by our Scientific Advisors, Professor
Steve Gallivan and Dr Martin Utley, who both work at the Clinical
Operational Research Unit at University College, London.
NCEPOD can therefore state that its work:
Does not involve new treatments
Does not involve additional therapies or investigations
Does not involve allocation to treatment groups
Does not involve randomisation.
In general, therefore, research ethical approval is not required for its studies.
However, NCEPOD will for each study it undertakes ask the following questions
to ensure that this remains the case:
- Does this study involve a new treatment?
- Does this study involve an additional therapy or investigation(s)?
- Does this study involve allocating patients to different groups not chosen
by the healthcare practitioner/patient?
- Does this study involve randomisation?
- Is there any other reason why the Steering Group think advice should be
If any of the answers to these questions are 'yes', then advice will be sought
from the National Research Ethics Service (NRES) before proceeding.
NRES have agreed the above approach.
How does NCEPOD select studies?
- Each year, NCEPOD invites organisations or individuals to submit
original study proposals for consideration as possible forthcoming
studies. Proposals should be relevant to the current clinical
environment and have the potential to contribute original work
to the subject. Organisations or individuals wishing to submit
a study proposal are required to complete a Study Proposal
Form, which will be available to download from this website
at the time the call for proposals is announced.
How do we disseminate our findings and recommendations?
- To date we have circulated in the order of 6500 full reports and about 20000 summaries per annum. Our reports are published mainly in hardcopy but some in electronic CD format (2004-2006) with an extended summary. All recent reports are also available in a pdf format to download. Multiple copies of these reports and summaries are sent to Local Reporters for onward dissemination to consultants within their hospitals. Copies of the full report are also sent to the Chief Executive, Local Reporter and Medical Library within each Trust.
In addition, NCEPOD, on the day of publication host a presentation of the findings
of the report. This is usually held at one of the clinical Royal Colleges.
During the year NCEPOD staff visit hospitals (by invitation) and give presentations
as part of multidisciplinary meetings such as audit days. This provides an excellent
opportunity to discuss the ways in which clinicians participate in morbidity
and mortality audit and to examine the ways in which recommendations made by
NCEPOD should be addressed within the local setting.
What happens if we find a case that gives us cause for concern?
- Cases that cause NCEPOD concern are referred back to the Medical
Director of the Trust concerned in order that appropriate action
may be taken. Consultants involved with the case are also notified.
This approach was given support by the GMC in 1998 and 1999 and was
ratified by the NCEPOD Steering Group in March 2001 and more recently
in April 2005. This approach is in line with the proposal within
the Making Amends consultation document and it also meets the requirements
laid down by the GMC in Good Medical Practice.
How are we governed and funded?
NCEPOD is independent of the Department of Health and the professional associations. It is both a charity and a company limited by guarantee.
NCEPOD has a board of directors that are referred to as the NCEPOD Trustees. This board oversees the charitable and corporate governance of the organisation. The members can be seen on the Contacts page.
In addition we also have the NCEPOD Steering Group. Members are nominated representatives of the various medical Royal Colleges and Associations and lay representation. There are also observers on the group from HQIP, the Coroners Society, the Institute of Healthcare Management, the Scottish Audit of Surgical Mortality and The Institute for Health and Clinical Excellence. This board ensures the clinical integrity of the work that NCEPOD undertakes.
The work is commissioned by the Healthcare Quality Improvement Partnership on behalf of the funding bodies listed below and additionally funded by the independent sector hospitals.
Funding bodies include;
CPD Accreditation for completing NCEPOD Questionnaires
- Consultants who complete NCEPOD questionnaires make a valuable contribution
to the investigation of patient care. Completion of questionnaires
also provides an opportunity for consultants to review their clinical
management and undertake a period of personal reflection. These activities
have a continuing medical and professional development value for
individual consultants. Consequently, NCEPOD recommends that consultants
who complete NCEPOD questionnaires keep a record of this activity
which can be included as evidence of internal/self directed Continuous
Professional Development in their appraisal portfolio.
Can an individual refer a case to NCEPOD?
- NCEPOD is an organisation in which currently practising clinicians
review the management of patients undergoing medical and surgical
Undertaking confidential surveys; and
Reviewing care provision and resources in the units carrying
out the care.
The surveys cover all units which provide the care being considered
and the results are promulgated in regular reports in which comments
and recommendations are made to suggest ways in which healthcare
practice can be improved to the public benefit.
Primarily therefore the organisation exists to alert clinicians and hospital
management to practice which may not have been of the best quality and to recommend
improvements. However, it does not audit individual clinician's performance and
it therefore has no direct involvement in individual patient care and is not
able to provide medical opinions or to recommend specialists. If you require
help in these matters please contact your general practitioner who will be able
to direct you appropriately.
The requirement to participate in the work of NCEPOD?
- The DH in their guidance on Clinical Governance state that Trusts must take part (Clinical Governance Reporting Processes - 14th November 2002) and the DH paper 'A First Class Service: Quality in the New NHS (1998) also states this. Additionally the GMC states that clinicians should take part: Good Medical Practice states "You must work with colleagues and patients to maintain and improve the quality of your work and promote patient safety". In particular Item (g) states "contribute to confidential enquiries and adverse event recognition and reporting, to help reduce risk to patients". (Para 14 Good Medical Practice 2006). Additional guidance from the GMC on confidentiality also states "There are circumstances in which you should disclose relevant information about a patient who has died" Item (c) states "for National Confidential Enquiries or for local clinical audit". The DH documents cover NHS Trusts and the GMC document covers clinicians working in both the NHS and the Independent sector. More recently the NHS Quality Accounts have classified participation in the National Confidential Enquiries as a requirement and the NHS LA have also reworked section 5 of their 'Risk Management Standards' to outline participation in the Confidential Enquiries.
Guidelines on Compliance with NCEPOD
NCEPOD regards compliance for individual clinicians as: completing NCEPOD questionnaires when requested to do so, and taking cognisance of recommendations arising out of our reports which are relevant to their practice. Clinicians may also wish to use our audit tools in order to facilitate local audits. This activity should be considered during their annual appraisal.
Acute NHS Trusts should:
- Provide support for the NCEPOD Local Reporters and individual clinicians in order to permit them to contribute to NCEPOD studies.
- Appoint an NCEPOD Ambassador to support the Local Reporter where necessary.
- Consider all NCEPOD recommendations, and record an action plan detailing how those recommendations of relevance to their Trust are to be or not to be implemented, with reasons.
- Support those clinicians who are appointed as advisors or experts to participate in NCEPOD studies.
NCEPOD believes this level of compliance would be appropriate to meet the requirements set out by the GMC, NHSLA and the NHS Quality Accounts.
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