NCEPOD
  • How does the method of the Clinical Outcome Review Programmes run by NCEPOD differ from the National Clinical Audits?
    • NCEPOD uses case note review in a sample of cases to assess the quality of care provided whereas national audits use quantitative data collected on sequential cases.
  • How can the work of NCEPOD complement / add to the national clinical audits?
    • Data items can be included in national (and local) clinical audit to reflect the recommendations from an NCEPOD report. Alternatively, the findings from a national clinical audit may benefit from the case note review aspect of NCEPOD to allow a greater depth of understanding, to perhaps alter the audit measurement for future cycles.
  • Can I find out who my Local Reporter / Ambassador is?
    • Yes. Give us a call or an email and we can let you know.
  • PARTICIPATION
  • Is participation mandatory?
    • Yes. In England and Wales and in Northern Ireland, Scotland and the Offshore Islands participation is requested by the Governments who are providing funds to the work programme. The Association of Independent Healthcare Organisations mandates it for the private sector hospitals wishing to register with them.
  • Does participation count towards Quality Accounts?
    • Yes in England.
  • How do you ensure high levels of returns / completion rates?
    • We provide regular updates on participation to Medical Directors, but generally we find that clinicians are engaged in completing questionnaires; and the NCEPOD Local Reporters are marvellous at identifying the cases and assembling the case notes.
  • Do the hospitals choose which cases you review?
    • No. They provide us with all cases during a defined time period and we randomly or semi-randomly select cases.
  • Could you have spotted the concerns at Mid Staffs?
    • No, as we only take small sample of cases from all hospitals it is impossible to see trends at a local level.
  • What happens if a hospital never returns data?
    • The Chief Executive of NCEPOD would contact the Medical Director at the hospital, and if no action taken then contacts the Chief Executive of the Trust/Board.
  • How will a transfer to the electronic patient record affect your data returns?
    • It will cause the NCEPOD Local Reporter to have to look in different places, but may make it easier and more secure to transfer where it is fully implemented.
  • Have you thought about going paperless?
    • Yes. With regard to questionnaires and we are exploring different methods of doing this. With regard to case note return there will still be an element of paper for a long time yet.
  • TOPIC SELECTION
  • Who can suggest topics to NCEPOD?
    • Anyone – if there is an issue in quality of care that you are concerned about then submit the topic.
  • Are the topics selected to align with Government agendas?
    • Ultimately this might be considered by the commissioners, but the process prior to the final selection of topics ensures that all topics have a clinical relevance regardless of any political agenda.
  • INVOLVEMENT
  • Is there patient or public involvement with the studies? If so, what is their role?
    • Yes. NCEPOD involves patients on each of the Study Advisory Groups and also has a panel or four Lay Representatives who cover many of our studies, supporting the patient representatives and advising the NCEPOD clinical and non-clinical team. In addition we have Lay Representatives on the NCEPOD Steering Group and Board of Trustees.
  • How do you select Study Advisory Group members?
    • Members are selected based on their clinical experience to represent a multi-disciplinary group from across the UK. Members may also be nominated by a representative organisation.
  • Can I apply to join a Study Advisory Group?
    • Yes. If you would like to be involved in any study please contact us and we will be delighted to talk through options with you.
  • How do you manage the individual agendas of Study Advisory Group members?
    • The meetings are chaired by an NCEPOD Clinical Co-ordinator who ensures that everyone has their say and that issues raised are discussed and agreement is reached.
  • Can I apply to be a case reviewer?
    • Yes. If you would like to be involved in any study please contact us and we will be delighted to talk through options with you.
  • Can I apply to be a Clinical Co-ordinator?
    • Yes. We open up vacancies for these roles as they become available – you can always express your interest though http://www.ncepod.org.uk/vacancies.html
  • METHOD
  • Why don’t you use controls to determine if care was better in a different group?
    • NCEPOD is not seeking to undertake that model of research, rather it facilitates peer group assessment performed by practitioners active in the field.
  • Why don’t you use power calculations to determine your sample size?
    • Because we are not undertaking a case-control study.
  • Why do you not use statistical tests?
    • The method is not research and therefore the studies are not designed to use them. We focus on the narrative.
  • Do you need such a large sample size?
    • Yes. Whilst the themes of a study often emerge after review of around 100 cases, it is important that cases are included from all relevant hospitals across the UK. This results in around 500 set of case notes.
  • Do you look at death only as an end point?
    • No. Case inclusion into a study will vary based on the topic of review, but our remit is to look at all outcomes, not just death.
  • CASE REVIEW
  • When using death or a severe outcome as inclusion criteria, aren’t you just looking at the sickest cases?
    • Yes. We are and it is on purpose. By highlighting remediable factors in the quality of care of the sickest group (and we do) then we know that this represents only the tip of the iceberg.
  • What do you do with unexpected findings? Could they just be chance?
    • Yes they could, so they have to be handled with care. Any substantial finding is checked with the Study Advisory Group and the case Reviewers for a consensus opinion.
  • Isn’t it easier to comment on a case when the outcome is known? And won’t that encourage the reviewer to find criticism?
    • Case reviewers are sympathetic critics of the cases, however the random sampling means that cases have not been selected because they are ‘good’ or ‘bad’ so it levels the review process.
  • How do you adjust for the fact that some case reviewers will be ‘hawks’ and some will be ‘doves’?
    • By ensuring a large enough group of reviewers are involved, it means that no one voice can affect the overall messages. We also train case reviewers at the start of the study. The reviewers review cases in small groups with the support of a clinical co-ordinator and if any reviewers opinion appears to be overly critical or non critical that would be discussed and resolved.
  • Why do you only look for poor aspects of care?
    • We don’t. The primary focus is poor care, as the study has been suggested because it is thought that the quality of care is not as it should be. However, we do ask that good aspects of care are raised too.
  • RECOMMENDATIONS & IMPACT
  • How are recommendations formed?
    • They are derived from the key findings and then honed using an iterative process with the case reviewers and Study Advisory Group.
  • How soon should the recommendations be acted upon?
    • As soon as possible. It may take 3-5 years to see a national effect of the recommendations and that will only occur due to local implementation, so the sooner it starts the better as this will drive up quality of care nationally.
  • How do you encourage implementation of the recommendations?
    • We provide gap analysis tools, organisational benchmarking data and audit toolkits for local use. We travel around presenting at hospitals and are very happy to promote successful local quality improvement initiatives.
  • How do you expect recommendations to be implemented in a cash strapped NHS?
    • Many recommendations have no financial cost; and better organisation of care would often lead to greater efficiency which may actually reduce costs. Ineffectual or sub-optimal care of course carries a financial cost as well as being detrimental to the patient and so a case can often be made that any recommendations may save not cost money.
  • Could you have not just written the report anyway?
    • No. the value of the investigation is that it provides an evidence base for any change proposed and having been identified by clinicians that evidence is more readily accepted and may thus be easier to implement.
  • How do you affect outcome?
    • We affect the outcome of future patients by making recommendations to improve the quality of care they receive. Some of our reports have led to a re-design of national protocols and most have resulted in changes to local protocols.
  • Who monitors the impact of your reports?
    • Every six months we undertake an impact assessment, and every two years a stakeholder review. In addition, participation and action may be picked up by the CQC in England.
  • Do you have a formal link with the CQC/NHS Improvement/Health Inspectorate Wales/Healthcare Improvement Scotland/Regulation and Quality Improvement Authority Northern Ireland?
    • No, but we do know that participation in NCEPOD studies is often asked about by those bodies and many Trust/Boards are keen to demonstrate implementation of our recommendations.
  • INFORMATION GOVERNANCE
  • How does NCEPOD comply with information governance requirements?
    • NCEPOD complies with all requirements as required by the relevant organisations in the four nations. More information can be found here: http://www.ncepod.org.uk/informationsecurity.html
  • Why do you not have ethics approval?
    • Ethics Committee approval is not required in accordance with the HRA decision tool, the work programme is not classified as research.
  • Do you share identifiable data with anyone else?
    • No identifiable data are ever shared. Occasionally interested parties may ask to access the final aggregated dataset for additional analysis once the report has been published. At this stage all links to individuals, hospitals or healthcare professionals has been removed.