New libraries for old

Back in September 1998, the SHINE Committee was invited to send three delegates to this conference which looked at how library and information services and information and communication technology can work together to deliver the key objectives and priorities of the recent white papers "The New NHS" and "Our Healthier Nation". Dorothy McGinley, Alison McIntosh and I attended.

The day consisted of a series of very short (15-20 minutes) presentations from a wide ranging groups of speakers with as much time as possible allowed for discussion and questions from the floor. I have to hand it to the chairs of the respective sessions who kept everyone remarkably to time.

The proceedings were introduced by Veronica Fraser, NHS Library Adviser. The first speaker was Andrew Holt, Head of Information Services Division, Department of Health. Andrew rattled through forthcoming changes in the way that government will work ("joined up government"), the new focus on citizen access to information by new routes such as the Internet and digital TV, and the ability to interact with information providers. He estimated that around 25% of government transactions would be electronic by 2002; there would be an exponential growth in Internet/NHSnet material and an electronic library for health, also by 2002. All this has had, and will continue to have, an impact on libraries. There are new sources of information appearing all the time. Librarians have rivals in a more anarchic world who will do their own thing uncontrolled and unmanaged. He stressed the need for more proactive information management and suggested that demand for information services will increase if supply is well fronted and organised. It has been recognised within the DoH that there is a major reskilling task for LIS professionals in this scenario. In recent years, fewer staff have been employed in the DoH Library in "traditional" library work and more on projects such as COIN and POINT. After this, Andrew had to rush off for a meeting with the Minister to explain why the DoH server had crashed the previous afternoon!!

John Farendon, Director of SECTA, then spoke about the new NHS information strategy paper "Information for Health". This represented a top level commitment to information strategy which would be implemented over a seven year period. The strategy focussed on what the patient wants, what NHS professionals and managers want, and what the general public wants in relation to information for health. The specific targets can be found in the paper itself and John did not go into these, but he did consider the implementation principles: that there was a national consensus on objectives, that there would be an effective and continuing dialogue; there would be centrally mandated deliverables; and local implementation would be integrated with national policy. He also mentioned that a Local Health Information Service draft circular was in preparation, although this would apply to England only.

Dr Muir Gray went on to speak about the National Electronic Library for Health (NeLH), a key element of the Information for Health document. In his usual enthusiastic fashion, Muir pointed out that basically it is people who will make the NeLH work - the technology and the culture are there but how will it be managed? The mission of the NeLH will be to provide easy access to best current knowledge and to improve health and health care, clinical practice and patient choice. The NeLH will operate under several basic principles: it will be obsessed with the quality of knowledge (basically acting as an assay service); it will provide both "knowledge" and "know-how"; it will be open equally to patients and clinicians; and it will be based on hypertext.

The Library will be organised in four main sections or floors: know-how i.e. guidelines and audit to provide a more systematic approach to care; knowledge, largely supplied by R&D; information for patients, managed by the Centre for Health Information Quality; and knowledge management skills and resources. There will also be decentralised services such as a NeLH for Mental Health, Coronary Heart Disease, etc. The first target will be to provide access to best current knowledge for clinicians within 15 seconds.

Five strategic priorities have been identified:

• providing easy access to knowledge;
• integration with other strategies and the development of the electronic patient record;
• development of knowledge management skills and resources;
• international partnerships e.g. with the National Library of Medicine;
• business management.

Muir suggested that some funding for these developments could be found by selling services to other countries. He estimated that an initial "building site" would be available by the end of November showing what progress is being made but it was aimed to launch NeLH in the spring of 1999 as part of a five year development programme.

Next up was Brian Hunt, Assistant Director, NHS Telecommunications Branch. His aim is to provide telecomms that give the users what they need without them having to understand how it works. Would that it were so simple! Brian admitted that there have been barriers which are being addressed, not least of which is finance. However, other issues such as the Security Code of Connection and supply contracts for access to the NHSnet have been seen as overly bureaucratic and steps are being taken to simplify these. The vision is to set up invisible technology with users getting the applications they want, when they want them, quicker, slicker and easier. He outlined what seemed to be very ambitious aims of integrated telecomms to support the clinical agenda, national directories, simplified E-mail systems for all, transparent data transfer between systems, one national voice system, audio/video conferencing from the desktop, and web-based information for both staff and the public.

Brian then went on to talk about the NHS Information Zone which was launched earlier in 1998 and aims to provide an easy and quick method of accessing valuable sites from a single starting point. In recent months, news items have been added and the site now offers a daily digest of health related news from a variety of sources including Reuters and the BBC.

In the question/discussion session, Muir Gray spoke of a GP he met who says he doesn't want to access Medline from his desktop. He wants to access the information he needs within 15 seconds and spend no more than another 15 seconds reading it during a consultation. He might be willing to spend a couple of minutes accessing and reading something over a cup of coffee but anything longer than that becomes "education".

One delegate asked how the culture could be changed to get people to work within this new co-operative set-up. She mentioned the need to bring on board human resources personnel as an example. Muir envisaged a NeLH for HR being developed since it was important that "management" activity should also be based on the best evidence. The possibility of the Librarian becoming the Chief Knowledge Officer in an organisation was also suggested.

Another delegate asked about the involvement of LIS personnel in the development of local information strategies. John Farendon mentioned that the forthcoming circular would probably put the onus on the chief executive in an area to pull together the relevant parties but it may be that librarians will have to push themselves forward. They cannot assume they will automatically be included. Where have we heard that one before?

Muir also mentioned what he called the "Family Silver" project. By this he meant that there was already a significant body of resources available which could be pulled together as an early priority. A delegate from Canada finally summed up what many of us were probably feeling at this point in the proceedings. She mentioned the need for careful staging of all this activity since, although it was an exciting prospect, it could also seem overwhelming to those who needed and wanted to get involved.

Lunch was followed by another quick-fire session. Mark Field, Professional Adviser at the Library Association, spoke rather vaguely about his interpretation of and experiences with Knowledge Management. John Kirriemuir, Project Manager at OMNI, spoke about JISC funded electronic library projects, especially OMNI. He mentioned that a Resource Discovery Network Centre was about to be set up which will control all these gateways but he stressed that resource recovery is not enough. There is no use being to locate information quickly if it takes an age to download. What is needed is a discovery and access system.

Betsy Anagnostelis from the Royal Free Hospital was then meant to speak about using the Internet but the bulk of her presentation was about joint purchasing arrangements for electronic databases. She mentioned a recently negotiated deal which was allowing cross-sectoral purchasing for the first time, with 41 Higher Education and 75 NHS Trusts taking out subscriptions. But she warned that licensing arrangements are not the most important aspect. It is the running/ownership costs which count:- support, training, search interfaces, registration, where is the data to be stored, maintained and by whom? What sort of network will it be on? What about speed of access?

Judy Palmer from Anglia and Oxford then spoke on the theme of "Libraries to Go". Her thesis was that we need to change libraries from being "rear view mirrors" to become centres of multimedia evidence; libraries without walls; gateways; centres of instruction; and quality filters with people who can: talk to users in their own language; critically appraise practice and service; understand and exploit IT; initiate and lead; manage people and resources; negotiate and influence; teach and facilitate learning. These people will be educators, designers of knowledge systems, problem solvers and synthesisers, net navigators and, last but not least, bloodhounds not golden retrievers! Can we do it? Well, it depends on how much the NHS is prepared to put into developing its LIS professionals. Judy suggested that projects are a good way of achieving results and developing new skills e.g. the PRISE project in her region, the peripatetic librarian project in the Highlands, and a clinical librarian trial in Oxford. We need to consider distributed models of service - thinking about how people need and use information on the hoof. She had spoken to a number of primary care staff who say that they can't, won't and don't use libraries because they are too far away or open at the wrong times, etc. These are issues which need to be tackled.

Gill Needham from the Open University spoke about the work she is doing in developing web-based services to students. The OU also provides students with information about local university libraries and what access arrangements, if any, exist. This raised some hackles in the audience during the discussion session. The OU is also looking at document delivery options but at the moment cannot offer this service to its many thousands of students. Gill also mentioned their Learner Support Team, their information management skills guides for each faculty and resource specific training materials. They have also produced a multi-media training pack for health professionals on Health Informatics in relation to evidence based health care.

Sally Hernando from the South and West Region spoke about education consortium based networks in her region. They had conducted a review in the region which highlighted very similar problems to those found in our own SLIC review. Two educational purchasing consortium projects have been set up so far. In Cornwall and Devon, a hub and spoke model involving a service level agreement with the local university has been established. This involves seamless access to resources in the consortium area; access to electronic resources 24 hours a day, seven days a week in user-defined locations. Sally outlined the role of the region and the library services in delivering the agenda. In the region, the role of the IT Coordinator was important as were partnerships between libraries, IM&T, Education and R&D. To deliver the agenda, libraries also had to liaise with IT professionals and users, train users, facilitate access and assist in the development of electronic information services.

Muir Gray who chaired this session mentioned the possibility of a "bring and buy" sale on the proposed NeLH building site where people could report on projects like these as an example of what could be achieved locally.

Unfortunately, travel arrangements meant that the Scottish contingent had to leave before the last session which centred on information for patients and the public.

Maureen Thom
The Development Group