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Appendix A11

Example terms of reference

A: Draft Terms of reference, membership and Modus Operandi for the Sheffield Teaching Hospitals NHS Trust, Clinical Ethics Group

Click here to download this section of Appendix A11 as a pdf document.

The meeting will be called the STH Clinical Ethics Group (CEG)

1) Purpose

The purpose of the CEG is to:

  • Provide a forum for discussion on clinical ethical issues within STH
  • Raise the general awareness of clinical ethical problems within STH
  • Provide advice and guidance to the STH Trust Board, CMB and Directorates on ethical issues to facilitate the development of standards and policies, and improve the quality of care.
  • Provide ‘real time support to individual clinicians / practitioners.
  • To assist the education of STHT staff (including Group members) in Ethical matters

The CEG will not:

  • Provide legal advice
  • Undertake risk management
  • Provide advice on research matters
  • Consider any issue not primarily of an ethical nature

The CEG will be advisory and not executive.

Collaboration with others in Sheffield (notably the Sheffield Children’s Hospital) is essential.

2) Membership principles

The Chair will be appointed by the Group and serve for a term of three years at the end of which the filling of the position will be reviewed. There will be a Vice Chair appointed by the group, who will serve as above.

Members will serve for a period of three years. which may be renewable. Places shall be made available to new members where members retire from the group. Where no new members are ready to join the group, periods of service may be renewed. NB: care will be taken to ensure that periods of service are staggered to avoid significant problems of retirement from the group.

The CEG will be quorate, when either the Chair or Vice Chair and 5 members are present

  • Membership of the CEG. Membership will be limited to 12 – 15 individuals. There is a requirement to cross-reference with the Patients Council. CEG membership should be broadly acceptable to clinicians/practitioners.
  • Members should be ‘recruited’ on the basis of reputation, performance, skill and knowledge.
  • Lay representation is necessary, but specific pressure group representation should be avoided.
  • Members should be clear that they are present for their personal attributes (see second bullet point above) and not as representatives of any given body, group, profession or organisation.
  • Co-option of members in addition to a core membership for specific issues will take place as required.
  • Members will be willing to participate in ethical educational activities, including links with other Ethics Groups and the UK Clinical Ethics Network

3) Place within the Trust infrastructure

CEG is a formally constituted group, ratified by the Clinical Management Board and Trust Board.

The CEG will prepare a summary report on the activities of the Group on an annual basis and will submit the report to the Clinical management Board.

4) Meetings

  • There will be a formal agenda, issued not later than seven working days before each meeting. Agenda items / papers to be submitted to the Chair net less than ten working days before each meeting. Items of urgent business arising after this time will be accommodated with the agreement of the meeting.
  • Notes of the meeting will be taken, recording key discussion points, actions agreed and any advice / guidance agreed by the group. Notes will be issued to members not later than 14 working days following meetings.
  • Meetings will take place initially at a frequency of every six weeks (to be reviewed in the light of experience).

These Terms of Reference to be reviewed at least every three years.

Copyright of this terms of reference is held by Sheffield Teaching Hospital NHS Trust

Paul Gerrish
Sheffield Teaching Hospitals NHS Trust, Clinical Ethics Group

B: Great Ormond Street Hospital for Children NHS Trust Clinical Ethics Committee (formerly Clinical Ethics Forum) Terms of Reference

Click here to download this section of Appendix A11 as a pdf document.

Authority

The Committee will operate under the authority of the Trust Board.

Membership

The membership of the Committee is multidisciplinary. Initially members will be invited or canvassed. The balance of membership will be reviewed by the Committee.

The Committee includes at least one representative from medical, surgical, academic, nursing, social work and other paramedical specialties. It also includes representatives from Chaplaincy and a general practitioner. Lay members have been recommended and elected by the Committee and include those with specific ethical expertise and a representative of the local health authority. Academic representation is provided by a representative of the Institute of Child Health. It is hoped that the Committee will include a lawyer, though the latter will not be acting in a professional capacity.

The Chair and Committee have powers to co-opt individuals with expertise necessary for the discussion of particular issues.

From the experience of other groups, it would seem that membership should be limited to approximately 20. A quorum would consist of at least one representative from each professional group. plus at least two lay members and Chair or Vice-chair. The membership should generally be for three years, reviewable after that time.

Chair

The Chair should serve for a period not less than three years. The post should be open to all health care professionals or lay representatives.

Vice-Chair

The Vice-Chair should serve for a period of not less than three years. The post should be open to all disciplines. Either the Chair or Vice-Chair should be a lay member. The Committee should be a sub-committee of the Trust Board.

Aims and Objectives

  • To provide a forum for the confidential, multidisciplinary discussion and analysis of matters of ethical concern arising from clinical practice at the GOS Trust and to provide, where appropriate, an informed, reasoned and justifiable opinion on such matters.
  • To contribute to the integrated development of standards, guidelines and policies directed at enhancing good ethical practice and improving, patient care.
  • To advise on and develop institutional ethics policies and to evaluate their outcome, and to contribute to other policies which have a significant ethical impact.
  • To educate health care professionals in all disciplines in the principles required for good ethical practice and develop methods for the evaluation of the process.
  • To initiate and support research, in collaboration with the Research Ethics Committee and Institute of Child Health, in the health care ethics field.
  • To contribute an informed, reasoned view on matters of ethical concern arising from paediatric practice to the wider national and international communities and to provide a paediatric perspective on ethical issues of national importance.
  • Although discussion on the ethical principles which individual cases might raise is important, it is not to be regarded as the key focus of the Committee.
  • The role of the Committee is advisory and educational, rather than prescriptive, and there would be no compulsion for individual cases to be discussed by it. However, the Committee would be responsive to the need to discuss particular issues as they arose.

Teaching and Training

To be effective, members of the Committee will need to develop ethical expertise in a comparable fashion to members of the Research Ethics Committee by:

  • Becoming more familiar with principles, concepts and theory.
  • Studying relevant cases, legislation and policies.
  • Having, input from invited individuals with appropriate expertise.
  • Attending conferences etc. on health care ethics.
  • Having access to and discussing relevant literature.

There is sufficient expertise within the currently proposed membership of the Committee to oversee this process.

The Committee would have an important wider role in teaching and training on ethical issues within the Hospital and the Institute. It is envisaged that close co-operation with the Research Ethics Committee, in the areas of teaching and training and research and development would take place. It would support and develop the long-term strategy of linking research ethics and clinical ethics by an integrated Department of Ethics.

Evaluation

The Committee will seek to audit its activities and develop a technique for assessment of its function. The Committee will submit an annual report to the Trust Board which will include aspects of audit and performance evaluation.

Frequency of Meetings

The Committee will meet monthly, or as required.

Administration

Administrative support for the Committee is provided by the Research & Development Office.

Copyright of this terms of reference is held by Great Ormond Street Hospital for Children NHS Trust

Dr Richard Trompeter
Great Ormond Street Hospital for Children NHS Trust CEC

C: Royal United Hospital NHS Trust, Bath Clinical Ethics Committee Terms of Reference

Click here to download this section of Appendix A11 as a pdf document.

This is an informal group committed to helping to advise on problems of an ethical nature arising in a hospital setting. The members include ethicists from an academic institution, clinicians (doctors and nurses), a psychologist, solicitor and a cleric. Membership will lapse if a member fails to attend three consecutive meetings of the Committee.

Members of the group, who will be known within the hospital, can be contacted at any time by staff who feel that the opinion of group members may help to resolve particular difficulties. We would hope to receive enquiries relating to clinical ethical problems rather than to clinical competence, professional discipline or resource allocation. Enquiries outside our remit will, with the enquirers permission, be referred to the relevant person or group.

Once a member is contacted and the nature of the problem established, further members will be contacted as thought necessary. Members’ views will be summarised by the Chair before issue.

The enquirer and patient involved will normally remain anonymous during discussions and when records are kept. It is accepted that this will not always be possible particularly if a meeting with the patient or relatives is thought to be of benefit. But no such meetings will take place without the explicit consent of the patient (or the relative if the patient is not competent). No identifying details will be kept in the records of the ethics committee. However, with the consent of those involved, a note about the consultation may be put in the patient’s hospital records.

Records of all discussions will be kept on a pro-forma.

A regular audit of our work will be produced.

The group will meet quarterly. Some of these meetings will be open to members of the hospital staff. The group will be chaired by one of its members elected by the group for two years in the first instance. No person will act as Chair for longer than four consecutive years.

The group will consider a wider educational role, and there may be occasions on which it feels that written guidelines should be produced.

Copyright of this terms of reference is held by Royal United Hospital NHS Trust Clinical Ethics Committee.

Peter Rudd
Royal United Hospital NHS Trust CEC