The Francis Inquiry and an international picture of safety

For the World Health Organization (WHO), the Francis Inquiry report into very poor standards of care in a hospital in the NHS represents, at one level, a domestic response to a domestic issue in one of the Organization’s ‘member states’. At another level, however, it represents a major milestone in the global fight to reduce unsafe care that was, in many ways, started in the UK. What it says, and does not say, therefore, will have a major impact on healthcare safety efforts internationally.

It was in 2004 that the then Chief Medical Officer Sir Liam Donaldson was the UK Government’s head of delegation to the WHO. Working with other member states, he proposed and had accepted a resolution on patient safety to the World Health Assembly. This established the World Alliance for Patient Safety. The UK, like the US, Canada and many European countries, was in the midst of responding to the first ever safety ‘scandals’ of the day and the World Alliance was a new and exciting effort to create awareness and change in healthcare systems.

The WHO established three major pillars to support its work:

• the Global Patient Safety Challenges to ‘challenge’ ministers and practitioners in key areas of patient harm
• a research programme to fill our knowledge gaps on adverse events
• a patient engagement programme, Patients for Patient Safety.

Over the past eight years, the WHO has engaged over 160 countries, over 15,000 hospitals and hundreds of thousands of healthcare practitioners and patients around the world, all seeking to create safer healthcare environments.

What then are we to make of the fact that in the birthplace of the global healthcare safety movement, the problem of error and patient neglect are still endemic? How can we react with anything but despair to the accounts of mismanagement and attempts to bypass decision systems that were designed to make care safe?

In fact, there are two levels of concern if you are looking from the outside in to the UK healthcare system. The first is the worry that, after a decade of investment in safety efforts, a scandal such as that which bore the Francis Inquiry could still happen at the scale and depth which it did.

The second, more important worry is the lack of concerted response to the issue. Where has the outrage gone that greeted reports such as To Err is Human from the US Institute of Medicine and An Organisation with a Memory from the Chief Medical Officer in the UK?

At the WHO, we have noted that the world’s developed economies are in the midst of two responses to safety concerns these days. The first is that of countries such as the UK and the Netherlands, where national efforts at safety are being scaled back in the midst of financial cutbacks or new policy focus areas focused on health are access. This leaves countries vulnerable to issues like those described in the Francis report. The WHO’s patient safety programme is in a vibrant phase establishing its new forward programme led by myself and supported by Sir Liam Donaldson, who is now the WHO’s Envoy for Patient Safety.

The second response is one seen in countries like Ghana, South Africa, Argentina, the US and Canada, where safety is still being raised by leading experts as a top priority for action, with funding from private and public sources to continue the fight.

Which set of countries will be proven right as we head into the ‘post-Millennium Development Goal’ world? Of course, those of us deep in the effort to improve safety believe that providing safe, quality healthcare must be a priority for governments, as well as healthcare organisations and professionals. 

The issues surfaced in the Francis Inquiry are not just policy questions for the UK. More effort must be made to sift through the many recommendations of the report to see what can be learned for other hospitals and other countries.

In the meantime, the UK would do well to learn from the countries it originally led in the fight to improve healthcare safety and refocus on what is important – keeping patients safe from harm.

Edward Kelley works on the World Health Organization’s Patient Safety Programme