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Confidential Enquiry into Maternal and Child Health

Improving the health of mothers, babies and children


About Us

 

Overview

Confidential Enquiry into Maternal and Child Health (CEMACH) commenced in April 2003.  We aim to improve the health of mothers, babies and children by carrying out confidential enquiries on a nationwide basis and by widely disseminating our findings and recommendations.

Our work on maternal, perinatal and child health programmes consisted of a number of elements, for example;

  • Maternal and perinatal mortality surveillance
  • National clinical audits 
  • Local clinical audits 
  • Conferences, seminars and interactive workshops
  • Research and other projects

The maternal and perinatal mortality surveillance and national clinical audits are commissioned by the National Patient Safety Agency (NPSA) as part of their responsibility for the national confidential enquiry programme. The Department of Health, Social Services and Public Safety (DHSSPS) through the Health Promotion Agency for Northern Ireland, and NHS Quality Improvement Scotland (NHSQIS) also contribute to this programme. Our other work is commissioned by a variety of funding bodies including national charities, pharmaceutical and NHS bodies (including NHS Trusts). 

For further details on the individual projects within our programmes, please see the programmes page.

 

 

How We Are Organised

CEMACH has a central office in Baker Street in London which also houses the regional office activity for London and the South East. There are a further five regional offices in England, and affiliated offices in Wales, Northern Ireland and Scotland. The Channel Islands and the Isle of Man also participate in the enquiry programme.
 
CEMACH is an independent body managed by a consortium of eight Royal Colleges each of which nominate a board member –
 
        Royal College of Obstetricians & Gynaecologists (RCOG)
        Faculty of Public Health (FPH)
        Royal College of Anaesthetists (RCA)
        Royal College of General Practitioners (RCGP)
        Royal College of Midwives (RCM)
        Royal College of Paediatrics & Child Health (RCPCH)
        Royal College of Pathologists (RCPath)
        Royal College of Psychiatrists (RCPsych)

There are three lay members on the Board.
 
There is a national professional advisory committee for our programmes – the National Advisory Committee for Enquiries into Maternal Health (NACEMH), and the National Advisory Committee for Enquiries in Child Health (NACECH).

 

 

Thank you to clinicians

CEMACH depends on the voluntary support of the many clinicians across the UK who help us in different ways to deliver our programmes. Every unit has a unit coordinator who provides us with perinatal mortality data and there are many people who take the trouble to ensure that we are notified of maternal deaths. Every project depends on a network of clinicians who provide notification data.

Confidential enquiry panels involve the participation of multidisciplinary groups of clinicians providing their expertise so that lessons can be learned and shared from individual adverse outcomes.  Our board and working groups involve senior clinicians who shape and inform our programmes. The enquiry would not be possible without the sustained support of large numbers of practising clinicians with a wide variety of experience.

We would like to thank everyone who helps us. We endeavour to ensure that our work will contribute to the goal we share of improving outcomes for mothers, babies and children.

 

Our Approach to National Confidential Enquiry

In respect of our “core” national confidential enquiry work, which currently represents some 80% of our overall activity, the Enquiry carries out ongoing mortality surveillance alongside “task and finish” topics on issues arising from the surveillance work. This amalgam of ongoing surveillance and task and finish topics is distinctive to CEMACH and is not the same as the approach used by other national confidential enquiries. Our firm belief is that this integration of surveillance and topic work is an ideal model for a national confidential enquiry into maternal and child health where both clinical practice and wider demographic factors are important in improving outcomes.
 
The maternal and perinatal mortality surveillance work has a long pedigree and was inherited from the Enquiry’s predecessor bodies, CESDI and CEMD. Our intention is to collect a standard dataset of all maternal and perinatal deaths and to report annually on mortality trends. There is also a triennial report on maternal deaths giving the results of our case studies into those deaths. Changes in rates, causes of death and risk factors are monitored. Local health services, including individual health providers, receive information to support the monitoring of their mortality rates compared to other providers. Discussions are in hand to develop this system with other national agencies for providing early warning of unexpected mortality clusters. A further key purpose of the surveillance work is to identify topics that require more in-depth enquiry through carrying out a time-limited project. There is, as yet, no funding to provide a similar mortality surveillance system for children, though CEMACH has undertaken a one year study (2006) of child mortality in 5 areas of the UK, the results of which will be reported early in 2008.   
 
Our “task and finish” topics cover children as well as mothers and babies. For our “task and finish” work we use a national clinical audit methodology to help us to identify avoidable factors associated with adverse outcomes. This requires there to be clear, authoritative, evidence-based standards against which the actual clinical care provided in individual cases can be assessed. Topics where there are existing clinical guidelines promulgated by NICE or other authoritative sources are particularly appropriate, though we will use consensus based standards where we are satisfied that there is a sufficient evidence base to do this.
 
These standards are used as the basis of the development of an audit questionnaire (or “pro forma”) for the topic. This is used to assess the care provided in the individual case and as the basis for the subsequent aggregation of findings to develop recommendations for national application. When linked with a case control approach, this can be used to identify those standards where adherence or non-adherence makes a difference to the clinical outcome. However case control studies tend to be larger, more complex and more resource-intensive than the more straightforward clinical audits and it is not possible for us to achieve the range of topics we need if we always use a case control approach.
 
The methodology also requires that clinical case notes provide sufficient information on which to base the assessment. The Enquiry’s most distinctive contribution is in areas where other large scale review mechanisms might encounter medico-legal inhibitions on the release of documentation.