The Confidential Enquiries Louise Parker Associate Director, Research & Development (Confidential Enquiries)

The National Confidential Enquiries CEMACH - Maternal and Child Health

The National Confidential Enquiries CEMACH - Maternal and Child Health CISH - Suicides and Homicides by those in contact with the mental health services

The National Confidential Enquiries CEMACH - Maternal and Child Health CISH - Suicides and Homicides by those in contact with the mental health services NCEPOD - PeriOperative Deaths (Patient Outcomes and Deaths)

CE : Historical Objective To identify areas of substandard clinical care contributing to adverse patient outcome

CE : Historical Objective To identify areas of substandard clinical care contributing to adverse patient outcome To make recommendations for change

Some Examples CEMACH - Management of amniotic fluid emboli post caesarean section - Back to sleep

Some Examples CEMACH - Management of amniotic fluid embolis post caesarean section - Back to sleep CISH - Removal of ligature points from acute wards and joined-up transition to the community

Some Examples CEMACH - Management of amniotic fluid embolis post caesarean section - Back to sleep CISH - Removal of ligature points from acute wards and joined-up transition to the community NCEPOD - Provision of emergency theatres and supervision of junior doctors

Historical approach Largely observational studies involving scrutiny of case notes by expert panel

Current and Future Challenges Extended Remit Context Health and Social Care Act Robust Methodologies

Extended Remit Each CE has been asked to widen its scope - CEMACH - to include children - NCEPOD - to include adverse outcomes in live patients - CISH - to look at violent behaviour in addition to homicide

Extended Remit Each CE has been asked to widen its scope - CEMACH - to include children - NCEPOD - to include adverse outcomes in live patients - CISH - to look at violent behaviour in addition to homicide Each brings challenges of accessing high quality information

Context : finding the niche In 1999 NICE gained responsibility for funding the CE Other organisations - partners and stakeholders - Royal colleges - National Patient Safety Agency - CHI (CHAI) - NSF - ONS, NHS, Coronial System, review of child death, review of homicide

Health and Social Care Act Issues of access to patient data and patient consent

Methodologies Moving from qualitative to quantitative study methods

The Challenge Identifying the unique place for the CE within the current NHS structures

The Challenge Identifying the unique place for the CE within the current NHS structures Complimenting the role if NICE in producing authoritative guidance

The Challenge Identifying the unique place for the CE within the current NHS structures Complimenting the role if NICE in producing authoritative guidance Working in areas which will have the biggest potential for impact on patient outcome

The Strategy Working with together and with NICE - Associate Director for R&D - CE Advisory Committee - chaired by Professor Catherine Peckham - CE Working Group

Working with NICE Sharing expertise and developing common strategies

Working with NICE Sharing expertise and developing common strategies Exploring common data capture pathways with other agencies (eg NPSA an ONS)

Working with NICE Sharing expertise and developing common strategies Exploring common data capture pathways with other agencies (eg NPSA an ONS) Developing transparent and inclusive mechanisms for topic selection

In Summary New strategy to include recommendations for - Topic selection - Methodologies - Dissemination of findings - Recommendations