With this issue, the relationship between John Wiley Publications and the International Journal of Evidence-Based Healthcare (IJEBH) comes to an end. Since 2003, IJEBH has published reviews of strengths, limitations and gaps in the evidence for a wide range of healthcare interventions. The papers published in this issue draw to a close a decade-long process for disseminating information about what works best when seeking optimal healthcare outcomes. IJEBH has benefitted from the software developed by the Joanna Briggs Institute, which has greatly expanded capacity for conducting reviews of evidence in Australia and overseas. As a result, IJEBH has become an authoritative source of information for healthcare professionals as the number of contributors has grown. The material published has demonstrated increasing sophistication in the use of the tools and techniques for creating and presenting reviews of evidence. In addition, the cause of evidence-based healthcare policy has been served by the IJEBH policy of encouraging debate as well as consensus.

However, it is in the nature of evidence-based practice that the individual person drops out of sight as evidence is aggregated, evaluated and disseminated. Some of the best evidence is taken up in practice, but more is ignored because of resistance and organisational barriers. The aims of improving the experience and outcomes of healthcare are not always stated explicitly in reviews of evidence, but there is always an unstated assumption. Healthcare professionals, especially clinicians, have a moral obligation to apply the principles of evidence-based practice whenever and wherever the required knowledge and resources are available. If something like this obligation is binding on healthcare professionals, it seems reasonable to ask why evidence-based practice is not more evident in those practice settings that have a sufficient number of well-educated clinicians; adequate buildings and equipment; and stated commitments to patient safety, patient-centred care and optimal patient outcomes. Could it be that evidence-based practice is an optional extra in healthcare?

Readers familiar with the National Health Service will know of the furore that followed the unnecessary deaths and appalling neglect of patients at the Mid Staffordshire NHS Foundation Trust. There have been inquiries into what went wrong1 and why they went wrong.2 Patients were left in their own excrement for lengthy periods, staff failed to provide assistance for patients who could not eat without help, and some patients were treated with callous indifference by, for example, staff leaving water out of reach and ignoring repeated requests for assistance with toileting.1 These institutionalised practices were due to failures in governance and leadership at all levels of the NHS bureaucracy.2 Failure in clinical leadership, breakdowns in trust authorisation and oversight, and malfunction of agencies with monitoring responsibilities contributed to a culture in which the patient became invisible as inconvenient truths were ignored in the quest to achieve the wrong priorities. The system failures that occurred were not considered particularly noteworthy by those responsible because they were aware that similar occurs elsewhere in the NHS.2 At a broader level, patient care failed as an unintended consequence of narrow interpretations of government policies compounded by deep-seated problems in the culture of the NHS. The personhood of the patient was forgotten as ever more attention was paid to doing the business of a system in which positive information was valued over taking seriously concerns about patient care that it was far too easy to brush aside.2 Compliance with standards that did not affect services to patients was celebrated, whereas the agencies responsible for oversight left performance monitoring to someone else.2 In short, too many bureau chiefs, NHS managers and clinicians had responsibilities for which they were not held accountable despite the concerns of relatives about untimely deaths and institutionalised neglect of parents and other family members.

For most purposes, the evidence for the positive effects of optimum hydration, proper nutrition and cleanliness on health does not need the support of meta-analyses. Personal experience and common knowledge are usually enough to rely on. So, staff at the Mid Staffordshire NHS Trust cannot claim that they did not know that patients need to drink, eat and be kept clean. What then explains why they were so callous? Surely, system failures are not totally to blame. Is there no sense in which healthcare professionals and the healthcare workers who support them have a moral obligation to apply their personal knowledge within the limits of patient safety? If there is not, there seems little point to evidence-based practice because nothing compels us to put our knowledge into practice. However, if each of us sense an irresistible impetus for using rather than only having information, whether or not we regard it as a moral commitment, we can gain a lot by reading the final contributions to IJEBH in its current from as well as from its decade of achievement as a John Wiley publication. The success that has been achieved can then be built on as IJEBH is published electronically by Lippincott Williams and Wilkins from the first issue in 2014.

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