• Information technology
• evidence-based medicine
• healthcare quality improvement
• patient safety
• decision support
• computerised
• clinical practice guidelines
• adverse events
• epidemiology and detection
• mortality (standardised mortality ratios)

Angelow and Black1 mount a series of scathing criticisms of the national confidential enquiries (NCEs). They suggest ‘nesting’ NCEs within prospective National Clinical Audits. The competing interest declared by one of the authors is that he chairs the National Clinical Audit Advisory Group. He was also a member of the group convened by the National Patient Safety Agency (NPSA) that advised on the future of the NCEs.

The criticisms are without merit, and I deal with them in turn.

First, it is alleged that the research evidence of the impact of the recommendations is poor, with no time series analysis or experimental studies and is restricted to considering their impact on the structure and process rather than the outcome of care.

The role of the NCE is to enable the profession to describe the gap between what is happening to selected groups of patients and what it believes should happen, to suggest improvements and to propagate those suggestions. The undoubted value of audit does not denigrate the value of detailed observational studies. Neither time series analyses nor experimental studies are relevant to assess the impact of what is best seen as a …