Review of the national Confidential Enquiries

1
Review of the national Confidential Enquiries

• Peter Littlejohns
• Clinical Director

2
CE review key issues

• Purpose in the new NHS
• Methodology
• Confidentiality
• Quality of data
• Extension to other topics
• Funding disparities
• Cost effectiveness

3
Options for change

• Single flexible organisation with consolidated
  budget, accountable to NICE
  
• Time-limited studies, with controls where
  possible?
  
• Near misses, avoidable incidents, preventable
  morbidity (examples of good care?)
  
• Confidential feedback without attribution of
  blame?
  
• Extension to primary care?

4
Progress since last year (1)

• External review received by NICE board, (June
  2000)
  
• Implementation group established, (Sept 2000)
• Comparison of methodologies, (Oct-Nov 2000)
• Audit of resources, (Jan-Mar 2001)

5
Progress since last year (2)

• Workshops, (May-June 2001)
• Paper on proposals for change approved by NICE
  Board, (June 2001)
  
• Proposals out for consultation (end Oct
  2001)
  
• Modifications agreed by NICE Board, (21 Nov 2001)

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Definition

• National Confidential Enquiries are tools for
  identifying patterns of practice, or service
  provision, that may be causally related to
  unexpected serious adverse outcomes (death or, in
  the future, near misses).

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Aims of proposed changes(1)

• To enable recommendations arising from Enquiry
  reports to have similar status to other NICE
  guidance
  
• To secure the effective management of resources

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Aims of proposed changes(2)

• To provide a framework for the Enquiries so that
  projects can be planned and implemented over
  several years, in a stable contractual
  environment
• To contribute to the wider clinical governance
  agenda, and complement the work of other
  organisations such as the Commission for Health
  Improvement and National Patient Safety Agency.

9
Proposals for change

• 3 new Confidential enquiries
• Maternal Child Health
• Mental Health
• Medical Surgical Care
• Each with own multi-professional steering group
  organisation
  
• Topic selection proposals
• Project Methodology
• Consideration of outcomes
• Report production

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Confidential Enquiry Advisory Committee (1)

• Membership
• Independent chair
• 2 members from each CE
• 2 from NICE
• Members from CHI and NPSA
• Other independent members
• clinical lay
• Observers from Scotland and N Ireland.

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Confidential Enquiry Advisory Committee (2)

• Responsible for
• Overall strategy
• Liaison with national bodies
• New initiatives
• Joint working
• Quality assurance of reports

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Structural relationships
Ministers Department of Health National Assem
bly for Wales
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Methodology

• Rolling programme of time-limited studies
• Denominator data case control studies
• Confidentiality essential, full anonymisation to
  be kept under review
  
• Standardised assessment at national level
• Extension to primary care near misses
• Full report, produced by Confidential Enquiry,
  short form version with recommendations, produced
  by NICE.

14
CESDI structure

• Clear separation of national functions
  responsibilities from any regional or local
  priorities, including implementation
  
• Significant streamlining standardisation of
  structures use of resources, to produce new
  organisation with CEMD capable of taking on new
  role
• All staff accountable to centre
• No payment to trusts for data

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Finance Contracts

• All savings to be ploughed back into developing
  Confidential Enquiries
  
• CEs need to demonstrate cost effectiveness
• 3 new Confidential Enquiries to have 3-year
  rolling contracts with NICE, subject to annual
  review and tight financial monitoring

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Timetable for change

• Target was to have changes implemented by April
  2002
  
• CESDI situation complicated by changes in wider
  NHS- major HR implications
  
• CEMD triennia finishes end 2002
• NICE will work with individual enquiries on
  detailed timetable, alongside business planning
  process, and present details to Board, January
  2002