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.
In 1987 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.
NCEPOD covers all specialties
How do NCEPOD studies work?
Typically there are not always agreed standards with which NCEPOD can compare current practice. If there were an agreed standard 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.
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, ethical research approval is not required for its studies. For each study it undertakes NCEPOD will 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 Health Research Authority (HRA) before proceeding. HRA have agreed the above approach.
(To read more about the work programme we submit to the Health Research Authority (HRA) and ethical approval please click
here.)
How is NCEPOD governed and funded?
NCEPOD is independent of Government bodies and the professional associations. NCEPOD 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 Trustees page.
In addition, we also have the NCEPOD Steering Group. Members are nominated representatives of medical Royal Colleges and Associations and lay representation. There are also observers on the group from HQIP, the Coroners Society, the Royal College of Surgeons of Edinburgh, and the Royal College of Physicians of Edinburgh. 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 additional funding by independent sector hospitals.
Can an individual refer a case to NCEPOD?
The organisation exists to alert clinicians and hospital management to practice which may not have been of the best quality and to recommend improvements. It does not audit individual clinician's performance and it 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?
Under the National Clinical Audit and Patient Outcome Programme (NCAPOP) participation in the Clinical Outcome Review Programme into Medical and Surgical Care, and Child Health Review is mandated. The GMC states that clinicians should take part: Good Medical Practice states "You must take part in systems of quality assurance and quality improvement to promote patient safety". In particular Item (a) states "To help keep patients safe you must contribute to confidential inquiries". (Para 23 Good Medical Practice 2013). Additional guidance from the GMC on confidentiality also states that "There are circumstances in which you should disclose relevant information about a patient who has died" Para 137 states that this should be disclosed "when it is necessary to support the reporting or investigation of adverse incidents, or complaints, for local clinical audit, or for clinical outcome review programmes." The documents cover clinicians working in both the NHS and the independent sector.
The NHS Quality Accounts in England have classified participation in our work as a requirement.
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.
Trusts/Health Boards 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/Board are to be or not to be implemented, with reasons.
- Support those clinicians who are appointed as case reviewers or study advisory group members to participate in NCEPOD studies.
