National Confidential Enquiry into Patient Outcome and Death

Last updated

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) is a registered charity based in London. Dr Marisa Mason is the Chief Executive and Ian Martin is the Chair of the Trustees. [1] [2] The organisation started from a pilot study of mortality associated with anaesthesia in five regions in England, Wales and Scotland published in 1982. A joint venture was established between surgery and anaesthesia named the Confidential Enquiry into Perioperative Deaths. It became the National Confidential Enquiry into Perioperative Deaths (NCEPOD) in 1988 and published its first report in 1990. It now covers all specialities and covers all outcomes as well as deaths. [3]

Contents

It is a condition of registration with the General Medical Council as a doctor that registered medical practitioners in the UK must participate in the work of confidential enquiries. [4] All NHS Trusts in England are required to participate in NCEPOD studies as part of Quality Accounts. [5] The Department of Health and the Scottish Government require NHS Trusts and health boards to participate. [6] It is commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England, Northern Ireland, Scotland, Wales and the Channel Islands to undertake the Medical & Surgical Clinical Outcome Review Programme. [7]

Published reports

Its 2015 report on gastrointestinal bleed services demonstrated major deficiencies in the diagnosis and subsequent treatment of the condition and called for 24 hour access to specialists. [8]

Its report "Mental Health in General Hospitals: Treat as One" was published on 26 January 2017. It identified factors affecting the quality of care of patients aged 18 years or older with a significant mental disorder who are admitted to a general hospital. [9]

In July 2017 it published a study which found that many patients who needed non-invasive ventilation for acute respiratory failure had problems in the quality of their care. [10] There was a high mortality rate - over a third of patients treated with NIV. The British Thoracic Society supported the recommendation for NIV to be administered in a dedicated clinical area in every hospital. [11] Lack of ventilators in hospitals was a common problem, even though a basic machine costs less than £2,000. [12]

Each and Every Need, published in March 2018, looked at the care provided to children, young people and young adults with cerebral palsy and included national data analysis provided by Cardiff University.

Since then, NCEPOD has published numerous reports such as Acute Heart Failure: Failure to Function (2018), [13] Cancer in Children, Teens and Young Adults: On the Right Course? (2018), [14] Perioperative Diabetes: High and Lows (2018), [15] Mental Healthcare in Young People and Young Adults (2019), [16] Pulmonary Embolism: Know the Score (2019), [17] Acute Bowel Obstruction: Delay in Transit (2020), Long Term Ventilation: Balancing the Pressures (2020), [18] In Hospital Care of Out-of-Hospital Cardiac Arrests: Time Matters (2021) [19] and Dysphagia in Parkinson’s Disease (2021). [20]

Their latest report to be published is How data captured by NCEPOD supports the identification of healthcare inequalities - A Review, published in early 2022. [21]

Related Research Articles

<span class="mw-page-title-main">Respiratory failure</span> Inadequate gas exchange by the respiratory system

Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia. Respiratory failure is classified as either Type 1 or Type 2, based on whether there is a high carbon dioxide level, and can be acute or chronic. In clinical trials, the definition of respiratory failure usually includes increased respiratory rate, abnormal blood gases, and evidence of increased work of breathing. Respiratory failure causes an altered mental status due to ischemia in the brain.

<span class="mw-page-title-main">Northwick Park Hospital</span> Hospital in London, England

Northwick Park Hospital (NWPH) is a major National Health Service hospital situated in the town of Harrow, North West London, managed by the London North West University Healthcare NHS Trust. It is located off Watford Road in the London Borough of Brent; closely bordering the London Borough of Harrow.

Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. Anesthesiologists and surgeons employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available. ASA score is the most well known of these.

Clinical governance is a systematic approach to maintaining and improving the quality of patient care within the National Health Service (NHS) and private sector health care. Clinical governance became important in health care after the Bristol heart scandal in 1995, during which an anaesthetist, Dr Stephen Bolsin, exposed the high mortality rate for paediatric cardiac surgery at the Bristol Royal Infirmary. It was originally elaborated within the United Kingdom National Health Service (NHS), and its most widely cited formal definition describes it as:

A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

<span class="mw-page-title-main">Non-invasive ventilation</span> Breathing support administered through a face mask

Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask, nasal mask, or a helmet. Air, usually with added oxygen, is given through the mask under positive pressure; generally the amount of pressure is alternated depending on whether someone is breathing in or out. It is termed "non-invasive" because it is delivered with a mask that is tightly fitted to the face or around the head, but without a need for tracheal intubation. While there are similarities with regard to the interface, NIV is not the same as continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle; CPAP does not deliver ventilation but is occasionally used in conditions also treated with NIV.

Professor Sir Bruce Edward Keogh, KBE, FMedSci, FRCS, FRCP is a Rhodesian-born British surgeon who specialises in cardiac surgery. He was medical director of the National Health Service in England from 2007 and national medical director of the NHS Commissioning Board from 2013 until his retirement early in 2018. He is chair of Birmingham Women's and Children's NHS Foundation Trust.

<span class="mw-page-title-main">Fulbourn Hospital</span> Hospital in Cambridge

Fulbourn Hospital is a mental health facility located between the Cambridgeshire village of Fulbourn and the Cambridge city boundary at Cherry Hinton, about 5 miles (8 km) south-east of the city centre. It is managed by the Cambridgeshire and Peterborough NHS Foundation Trust. The Ida Darwin Hospital site is situated behind Fulbourn Hospital. It is run and managed by the same trust, with both hospitals sharing the same facilities and staff pool.

<span class="mw-page-title-main">Queen Elizabeth Hospital, London</span> Hospital in London, England

Queen Elizabeth Hospital is a hospital in Woolwich in the Royal Borough of Greenwich. It was opened in March 2001 and serves patients from the Royal Borough of Greenwich and the London Borough of Bexley. The hospital was built to accommodate the services previously provided at Greenwich District Hospital and Brook General Hospital, and is a Private Finance Initiative hospital. It is managed by the Lewisham and Greenwich NHS Trust.

<span class="mw-page-title-main">NHS Scotland</span> Publicly-funded healthcare system in Scotland

NHS Scotland, sometimes styled NHSScotland, is the publicly funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland, supported by seven special non-geographic health boards, and Public Health Scotland.

In the United Kingdom, operating department practitioners (ODPs) are allied healthcare professionals who are involved in the planning and delivery of perioperative care. As the name suggests, they are primarily employed in surgical operating departments, but they may also work directly within a variety of acute clinical settings, including pre-hospital emergency care, emergency departments, intensive care units (ICUs), endoscopy suites, interventional radiology, cardiac catheter suites, obstetric theatres and reproductive medicine.

County Durham and Darlington NHS Foundation Trust is an NHS Foundation Trust based in North East England. It runs two acute hospitals in University Hospital of North Durham and Darlington Memorial Hospital as well as further non-acute centres at Shotley Bridge Hospital, Sedgefield Community Hospital, Richardson Community Hospital, Weardale Community Hospital, Bishop Auckland Hospital and Chester-le-Street Hospital. The Chief Executive is Sue Jacques. The most recent review of the Trust by the Care Quality Commission in 2019 provided an "Overall: Good" rating.

<span class="mw-page-title-main">National Health Service (England)</span> Publicly-funded healthcare system in England

The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde. Primarily funded by the government from general taxation, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal English residents and residents from other regions of the UK, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).

<span class="mw-page-title-main">National Health Service</span> Publicly-funded healthcare systems in the United Kingdom

The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom, comprising the National Health Service in England, NHS Scotland and NHS Wales. Health and Social Care in Northern Ireland was created separately and is often locally referred to as "the NHS". The original three systems were established in 1948 as part of major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay. Each service provides a comprehensive range of health services, provided without charge for people ordinarily resident in the United Kingdom apart from dental treatment and optical care. In England, NHS patients have to pay prescription charges; some, such as those aged over 60, or those on certain state benefits, are exempt.

The Healthcare Quality Improvement Partnership (HQIP) was established in April 2008 to promote improvement in health services, by increasing the impact that clinical audit has on healthcare quality in England and Wales and, in some cases other devolved nations. It is led by a consortium of the Academy of Medical Royal Colleges, Royal College of Nursing and National Voices.

<span class="mw-page-title-main">Spire Healthcare</span> British private healthcare company

Spire Healthcare Group plc is the second-largest provider of private healthcare in the United Kingdom. It is listed on the London Stock Exchange and is a constituent of the FTSE 250 Index.

Healthcare in London, which consumes about a fifth of the NHS budget in England, is in many respects distinct from that in the rest of the United Kingdom, or England.

The "Greater Manchester Model" of NHS health care was a system uniquely devolved within England, by way of close integration with the Greater Manchester Combined Authority and local authorities, led by the Mayor of Greater Manchester. In July 2022 the Greater Manchester integrated care system took over responsibility for health and social care in the conurbation. The financial plan for 2022–23 had an initial shortage of £187 million.

<span class="mw-page-title-main">Private healthcare in the United Kingdom</span>

Private healthcare in the UK, where universal state-funded healthcare is provided by the National Health Service, is a niche market.

Ramani Moonesinghe OBE MD(Res) FRCP FRCA FFICM SFFMLM is Professor of Perioperative Medicine at University College London (UCL) and a Consultant in Anaesthetics and Critical Care Medicine at UCL Hospitals. Moonesinghe was Director of the National Institute for Academic Anaesthesia (NIAA) Health Services Research Centre between 2016 and 2022, and between 2016 and 2019 was Associate National Clinical Director for Elective Care for NHS England. In 2020 on she took on the role of National Clinical Director for Critical and Perioperative care at NHS England and NHS Improvement.

Mike Grocott is professor of anaesthesia and critical care medicine at the University of Southampton and director of the National Institute for Health and Care Research's (NIHR) Southampton Biomedical Research Centre (2022-27). He is an NIHR Senior Investigator (2018-26) and was national specialty group lead for Anaesthesia Perioperative Medicine and Pain within the NIHR Clinical Research Network (2015-2021). He is a consultant in critical care medicine at University Hospital Southampton NHS Foundation Trust.

References

  1. ↑ "About >Trustees". www.ncepod.org.uk. Retrieved 19 February 2023.
  2. ↑ "NCEPOD - National Confidential Enquiry into Patient Outcome and Death".
  3. ↑ "NCEPOD". Association of Anaesthetists of Great Britain and Ireland. Retrieved 18 July 2017.
  4. ↑ General Medical Council (2013). Good Medical Practice, section 23a (PDF). p. 10. Retrieved 19 July 2017.{{cite book}}: |website= ignored (help)
  5. ↑ "NHS England".
  6. ↑ "The remit of NCEPOD". NCEPOD. Retrieved 18 July 2017.
  7. ↑ "NCEPOD Medical and surgical outcome review call for topics". HQIP. 9 August 2016. Retrieved 18 July 2017.
  8. ↑ "NCEPOD report shows major shortfall in the care of GI bleed patients". Royal College of Anaesthetists. 3 July 2015. Retrieved 18 July 2017.
  9. ↑ "Mental Health in General Hospitals: NCEPOD report". Health Care Conferences. 27 January 2017. Retrieved 18 July 2017.
  10. ↑ Juniper, M; Ellis, G; Smith, NCE; Protopata, KL; Mason, M (July 2017). "Non-Invasive Ventilation: Inspiring Change (2017)". NCEPOD. Retrieved 19 July 2017.
  11. ↑ "Lung Specialists welcome new report into non-invasive ventilation as a milestone to help improve patient care". British Thoracic Society. 13 July 2017. Retrieved 19 July 2017.
  12. ↑ Sick patients dying ‘unnecessarily’ in NHS because of poor care The Guardian
  13. ↑ "NCEPOD - Acute Heart Failure: Failure to Function (2018)".
  14. ↑ "NCEPOD - Cancer in Children, Teens and Young Adults (2018)".
  15. ↑ "NCEPOD - Perioperative Diabetes: High and Lows(2018)".
  16. ↑ "NCEPOD - Mental Healthcare in Young People and Young Adults (2019)".
  17. ↑ "NCEPOD - Pulmonary Embolism: (2019)".
  18. ↑ "NCEPOD - Long Term Ventilation: (2020)".
  19. ↑ "NCEPOD - Out of Hospital Cardiac Arrests: (2019)".
  20. ↑ "NCEPOD - Dysphagia in Parkinson's Disease:: (2021)".
  21. ↑ Healthcare Inequalities ncepod.org.uk
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.