Preliminary 'health warning'
This report summarises a mapping exercise made predominantly through the use of questionnaires, although there are some additional documents which can be found on the accompanying database in which all the questionnaire data is entered. Mapping is complemented by the Good Practice Compendium. It is not a piece of scientific research but is meant as a tool which can serve as the foundation for further, more sophisticated enquiry.
We have data from 23 of 25 EU countries (regarding United Kingdom, see note p.5) and approximately 80% of these responses are already independently validated. The missing countries are Latvia and Malta. To clarify what is meant by validation; Belgium, Lithuania, Luxembourg, Slovenia and the Slovak republic have so far provided uncorroborated data, albeit some from Health Ministries. Of the remaining 18 countries, data has been obtained from two or more sources in 12 cases, but in the other six (Cyprus, France, Greece, Ireland, Netherlands and Sweden) some effort had been made to validate the original data using a consensus approach rather than simply providing an alternative set of responses (hence, in the database, only results from a ‘Master’ questionnaire will be entered for these six).
It is a given that this exercise represents a ‘first cut’. That is, the best approximation of the data available working within the resource constraints of the present project. As a result there will inevitably be some inconsistencies, resulting particularly from: lack of adequate validation; disagreements between respondents; difficulties with voca-
bulary; and the fact that this is a ‘snapshot’ of what is a continuously evolving picture. Where possible, in the text that follows, inconsistencies and possible explanations for them will be identified. Inevitably not every inconsistency will be dealt with. Nevertheless, we are satisfied that the main objective, to obtain a crude but useable overview of patient safety activity in Europe as of December 31st. 2006, has been achieved.
To acknowledge the above factors, the text will normally present results in the form “the country reports that…” as a short hand for “the available data from one or more respondents (including data from the Best Practice Compendium) allows us to summarise the position in this country as…”. In other words, some assumptions are being made, for the sake of practicality, although those interested in exploring responses in more depth can pull out the individual items from the database and draw their own conclusions.
A note on legislation
Legislation was not dealt with by a specific question in the final version of the questionnaire, the development of which is described below. However, we have sufficient data to provide a brief, although not necessarily complete, summary. The report for WHO (Europe) on national quality systems by Charles Shaw and Isuf Kalo (2002) assisted in this regard.
As far as formal legislation on health quality is concerned, current data indicates that Denmark has unique although fairly recent legislation on Patient Safety (June 2003) but a few other countries have specific legislation on health-
care quality. Czech Republic (resolution N458/2000), Lithuania (Law on patients rights & compensation for damage to health 1996), Netherlands (Individual Health Care Professions Act 1997), and Sweden (Health & Medical Services Act 1997) have what appear to be legislation directed at a comprehensive national approach to health quality, while Austria, France, Germany, Hungary, Italy, Spain and England and Wales have legislation but perhaps with a less comprehensive scope.
A note on the United Kingdom contribution
England and Wales comprises a population of approximately 54 million of the total UK population (approx. 60.6 M). The term NHS, commonly used as a synonym for ‘National Health Service’ in reality relates primarily to England and Wales (NHS Wales partly devolved). Northern Ireland & Scotland have their own systems (NHS: disambiguation).
Sir Liam Donaldson, Chief Medical Officer for the NHS is indeed the UK government’s principal medical advisor and represents the UK in European meetings, but is professional head of all medical staff in England only and there are separate CMO’s for Scotland, Wales and Northern Ireland. The National Patient Safety Agency (of the NHS) only deals with England and Wales. For this study, to try to minimize confusion, data was only collected from England and Wales, as Scotland and Northern Ireland have different patient safety arrangements (and in Scotland, a separate legal system), but are not separate European entities.
