About

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 activities.

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 sought?

If any of the answers to these questions are 'yes', then advice will be sought from the Central Office for Research Ethics Committees (COREC) before proceeding. COREC 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 five observers on the group from the National Patient Safety Agency (NPSA), 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.

NCEPOD is mainly funded by the Department of Health via NPSA (~90% of funding in 2005/06) and the remainder of funds are provided by the Health and Social Service Executive Northern Ireland, the offshore islands and the Independent sector.

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 care by: Undertaking confidential surveys; and
Researching 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.

How does NCEPOD's work affect patients?

The National Institute for Clinical Excellence (NICE) has produced an information poster that explains the work of the Confidential Enquiries to patients. This is part of the work that we and the other Enquiries are doing to promote public awareness of our work.

The poster should have been sent to all Trusts to display in hospitals and GP surgeries so you may have seen it already. Click here for a copy of the poster. The Adobe Acrobat reader is required which is free to download here.

What are NCEPOD's views on operating at night?

NCEPOD considers that all the appropriate resources and appropriately trained personnel should be available in order for surgery to take place whatever the time. It is acknowledged that patterns of work will vary, dependent upon local arrangements, available resources and in particular consultant availability and appropriate job planning.

It is important to recognise however, that the competence level of staff in both surgery and anaesthesia must be appropriate not only for the complexity of the surgery, but also for the general health in terms of co-morbidities of the individual patient.

It must also be recognised, that trainees should only perform duties under appropriate levels of supervision, and that consultant trainers should also be sufficiently fresh and well rested to be able to perform their supervisory role.

Is it mandatory to participate in the work of NCEPOD?

Yes it is. 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 must take part: Good Medical Practice states 'You must... take part in confidential enquiries and adverse event recognition and reporting to help reduce risk to patients' (Para 12 Good Medical Practice 2001). The DH documents cover NHS Trusts and the GMC document cover clinicians working in both the NHS and the Independent sector.

Who's Who at NCEPOD?

For a list of NCEPOD staff and their associated roles, please click here.

Company Number 3019382

Registered Charity Number 1075588

A company limited by guarantee

Registered in England and Wales.