Report on an audit of two decades' activities of a clinical ethics committee: the Newcastle upon Tyne Hospitals NHS Foundation Trust Clinical Ethics Advisory Group (CEAG).

Background: 'The Clinical Ethics Advisory Group' (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG's way of working occurred over the past 5 years as a result of Court decisions, increasing public expectations and an increase in CEAG's paediatric case flow.

Purpose: Review historical data: (a) as a useful benchmark to look for the early impact of significant service changes and (b) to seek possible reference ('sentinel') cases for use with a posited practical (casuistic) case-based reasoning model.

Methods: Audit of the minutes of the first 22 years' meetings was undertaken by the two chairs of CEAG over that period of time.

Results: 223 matters discussed: 86 Trust policy issues; 117 clinical cases (84 adult (32 urgent), 33 child (8 urgent)); 12 CEAG procedural issues and 8 UK Clinical Ethics Network 'round robin' cases. The range of topic areas was wide. A broad range of ethical structures were deployed, principlism predominated. Quality was subjectively assessed by each reviewer, but different methods were used. This proved highly concordant between the two reviewers. 47% (105/223) of discussions were 'excellent' (*A4C4-A4C4) and 70% (156.5/223) 'good' or better (*A4C4-A3C3). By meeting the criteria of 'excellent' and 'prospective', 92/223 (41%) of matters were deemed potentially suitable as sentinel cases.

Conclusions: The audit provides a rich vein of information. There is demand for CEAG's services, workload is becoming more complex. Formal funding for such services seems justified.