Health Care Evaluation: Confidential enquiry processes

The purpose of a confidential enquiry is to detect areas of deficiency in clinical practice and devise recommendations to resolve them. Enquiries can also make suggestions for future research programmes.

Most confidential enquiries to date (at both national and local level) are related to investigating deaths, to establish whether anything could have been done to prevent the deaths through better clinical care.

The confidential enquiry process goes beyond that of audit, in that the details of each death or incident are critically reviewed by a team of experts to establish whether clinical standards met (similar to the audit process) and also that the right clinical decisions were made in the circumstances (audit is unlikely to include this aspect).

Confidential enquiries are “confidential” in that details of the patients/cases remain anonymous, though reports of overall findings are published.

National confidential enquiries

Recent national level confidential enquiries include:

• Confidential Enquiry into Maternal and Child Health (CEMACH)- aims to improve the health of mothers, babies and children through maternal and perinatal mortality surveillance (to investigate the circumstances of maternal deaths, stillbirths, neonatal and post-neonatal deaths and to identify avoidable factors and seek their remedy) as well as undertaking national and local clinical audits.
• Suicide and homicide by people with mental illness.
• National Confidential Enquiry into Perioperative Deaths (NCEPOD)- to assess perioperative information to improve anaesthesia practice, establish an index of contemporary standards of care for future comparisons, as well as providing comparative figures between regions to facilitate this.

The process of conducting a national confidential enquiry process usually includes a National Advisory Body (NAB) appointed by ministers, guiding, overseeing and co-ordinating the Enquiry, as well as receiving, reporting and disseminating the findings along with recommendations for action. The Board would also make an annual report to ministers. Medical directors of local healthcare Trusts are charged with providing details of every death / incident relevant to the enquiry to the coordinating statistical analysis group who prepare summary reports for the NAB. The NAB agree criteria by which some of the cases will be investigated in more detail by a panel of experts. Public Health Directors have responsibility to ensure confidential enquiry processes are followed and supported by all contributors, that relevant documentation is submitted, and that recommendations from the enquiries are acted upon. Some health authorities may be chosen to lead on certain aspects of the confidential enquiry process and it is the Director of Public Health’s responsibility to ensure that appropriate expert panels are formed and adequately resourced to undertake the task in hand.

Local Confidential enquiries:

Confidential enquiries can also be conducted at a local level in a similar way- whereby a panel of locally appointed experts review clinical practice to ascertain whether any deaths or adverse events were avoidable. Recommendations for action are then made and implemented. Some examples of local confidential enquiries include:

• Drug related deaths
• Deaths from suicide

© Rosalind Blackwood 2009