Health Department
Human Resources Directorate
CRAG
Chief Scientist Office

NHS HDL (2000) 01

Dear Colleague

1. Learning Together, the Education, Training and Lifelong Learning Strategy for the NHS in Scotland, emphasises the importance of access to a sound knowledge base as part of the resources.of information, skills and facilities needed to support learning.

2. Clinical effectiveness and research require similar resources, as reflected in MEL(1999)76 on goals for clinical effectiveness and the Research Strategy for the NHS in Scotland. Such resources are also needed to meet the standards being set by the Clinical Standards Board for Scotland.

3. This joint circular recognises our shared interests in a sound knowledge base and shows the steps we axe taking to link our activities in this area. We encourage you to approach the issue in the same spirit.

4. This circular covers:

• corporate membership of the Scottish Library and Information Council (SLIC), funded by CRAG
• the formation of a project group under Learning Together to take forward the improvement of learning resources and the wider knowledge base for healthcare
• the initial work of the project group

5 . MEL (2000) 11 asked General Managers and Chief Executives to act to lift restrictions on access to study facilities under their control by the end of 2000. This is a first step towards the objective for Health Boards and Trusts that within five years all staff groups have ready access to comprehensive and improved library and information services designed and resourced to meet their learning needs (Learning Together paragraph 3.2 1).

7^th August 2000
______________________________

Managers of NHS library and  
information resources in Scotland

Tel: 0131-244 5088 or 5089
Fax: 0131-244 2837
e-mail: catherine.hewit@scotland.gov.uk
_______________________

6. As the next step towards that objective, each General Manager and Chief Executive is asked to ensure the following actions are taken:

• include clear plans for improving library and information services as an explicit and integral part of strategies for clinical effectiveness, information management and technology and research and development; and
• assist the Learning Resources Project Group with information when requested, and consider how they can assist the Group by offering or developing good practice.

7. The Learning Resources Project Group will develop a checklist of local actions to improve library and information services to assist you to define the task for your organisation. This will be available soon.

8. Health Boards and NHS Trusts are accountable on these matters in their reporting on clinical effectiveness and clinical governance. As part of the implementation of Learning Together the Strategy Implementation Group will be monitoring the action taken by Health Boards and Trusts on these points.

9. Further detail on the matters in this letter is given in the attached Annex.

10. Please arrange to copy this circular for information to your local Partnership Forum and to all contractors to your organisation who provide health services in your area, including GPs and GDPs. This circular has been sent to NHS Librarians, but please also copy it to any other managers in your organisation responsible for library and information resources.

11. This circular will be placed on the Scottish Executive web site at www.scotland.gov.uk/learningtogether/ and will also be accessible through the SHOW site.

Yours sincerely

ROBIN NAYSMITH
Acting Director of Human Resources

SIR DAVID CARTER
Chief Medical Officer, Chairman of CRAG

PROFESSOR GRAEME CATTO
Chief Scientist

Previous circular in the Learning Together series:
MEL (2000) 11 : Learning Together; Initial Actions

ANNEX

LEARNING TOGETHER AND CRAG:
LEARNING RESOURCES AND THE KNOWLEDGE BASE FOR HEALTHCARE

1. The Knowledge Base for Healthcare

1.1 It is essential that staff in a modern NHS have access to a knowledge base that supports their work. This is recognised in policies of the Scottish Executive Health Department including Learning Together, and policies on clinical effectiveness, clinical governance and research. It should also be recognised in the policies of all Health Boards and NHS Trusts.

2. "Enabling Access to the Knowledge Base of Healthcare" : the SLIC Report

2.1 In 1998 the Scottish Library and Information Council (SLIC) published a report entitled "Enabling Access to the Knowledge Base of Healthcare" (available from the Scottish Council for Postgraduate Medical and Dental Education). It showed that the knowledge base of healthcare supports a number of different purposes, of which the main ones are:

• the evidence to support clinical effectiveness
• the information to support research
• the knowledge base which supports learning.

Taken together, these purposes make a powerful contribution to clinical governance.

2.2 The report showed that information was in many instances not available to those who need it for these purposes and that the practical arrangements for storing and accessing the information were uneven and fragmented. It made recommendations for the policy, management, funding and staffing of library and information services.

2.3 The report's findings are given in Appendix A to this Annex and an information leaflet on SLIC was enclosed with the print version of this letter.

3. Scottish Executive support for improving the knowledge base of healthcare

3.1 The principles set out in the SLIC report have been reflected in a number of policy developments.

3.2 The Education, Training and Lifelong Learning Strategy, Learning Together (available at www.scotland.gov.uk/leamingtogether/), includes a commitment to support learning by improving access to the knowledge base through:

• removing organisational barriers to the use of educational facilities including library and information facilities (para. 3.20)
• maximising the benefits of IT in giving access to such facilities and to new learning methods and developmental opportunities (para. 3.16)
• developing a national information network as a framework for all Health Boards and Trusts to give all staff groups ready access to comprehensive and improved library and information services designed and resourced to meet their learning needs (para. 3.21).

3.3 The goals for clinical effectiveness set out by the Clinical Research and Audit Group (CRAG) in MEL(1999)76 (available at www.show.scot.nhs.uk/crag) state that "Trusts should have an appropriate infrastructure to support clinical audit and clinical effectiveness and be able to provide evidence of: ........ (c) systems to disseminate relevant information; and (d) an IM&T strategy which supports clinical effectiveness". As set out in MEL(2000)29 (available at www.show.scot.nhs.uk/crag) , Health Boards and Trusts are required to report progress against these goals. Effective library and information services are also essential to delivering the standards being set by the Clinical Standards Board for Scotland. ,

3.4 The Research Strategy for the NHS in Scotland produced by the Chief Scientist Office in 1998 recognised the importance of the SLIC Report and strongly supported the part that library and information services play in ensuring access to research results. It stated "We will be working to ensure that Library and Information Services are able to make a fully effective contribution. This will need co-ordination and development. Within CSO, mechanisms will be sought to ensure that the scale of Support Funding devoted to this area is appropriate, and is used cost effectively to deliver more than local benefit."

3.5 Harnessing the potential of information and communication technologies to make learning opportunities and information widely available is very much in line with the message of the Digital Scotland Task Force report (available for comment on www.scotland.gov.uk/digitalscotland/report.htm) and with current work on lifelong learning. Appropriate use of technology provides access to a very wide range of information and to means of organising and using it.

3.6 Health Boards and NHS Trusts should have local strategies to improve the knowledge base of healthcare and maximise its contribution to learning, clinical effectiveness and research.

4. Corporate Membership of SLIC

4.1 To support the principle that clinical effectiveness needs a sound knowledge base, CRAG has funded corporate membership of SLIC for the financial years 2000/01 and 2001/02. This allows all NHS libraries in Scotland to have the benefits of SLIC membership. The benefits are detailed in the leaflet on SLIC. These arrangements will be reviewed towards the end of the two-year period.

4.2 In particular, SLIC membership provides access to project funding of around £10,000 p.a. for which bids will be invited by the Learning Resources Project Group (see 6.10 below) for awards in November. It also provides consultancy services which will be used by that group (see 5.3 below).

4.3 Health Boards and NHS Trusts are asked to examine and use the potential of SLIC membership to develop their library and information services.

5. The Learning Resources Project Group

5.1 As part of the implementation of Learning Together, a Learning Resources Project Group has been established under the chairmanship of Dr. Graham Buckley. Its work will cover:

• Library and information services
• Open and distance learning
• Learning materials
• Use of IT for learning.

5.2 The membership of the Project Group includes expertise in clinical effectiveness and research as well as library, information and educational expertise. The Project Group will establish sub-groups to deal with specific areas. Its reporting relationships will include liaison with CRAG and the Clinical Standards Board as well as the accountability structures for Learning Together set out in MEL(2000)/11 (available at www.scotland.gov.uk/leamingtogether/)

5.3 Mary Lakie, a consultant who was involved in the production of the SLIC report, will be a member of the Project Group and will act as its secretary and researcher. Her services are being provided by SLIC as part of the arrangement for corporate membership funded by CRAG.

6. Work of the Learning Resources Project Group

6.1 The Project Group will work from the SLIC recommendations and examine current practice with a remit to:

• identify and disseminate good practice
• make specific recommendations to ensure equity of access to high quality services
• establish criteria for monitoring the quality of these services
• define the training needs for staff to make use of new learning resources.

Its initial work will include the following aspects.

a) Mapping library and information services
6.2 Mary Lakie will co-ordinate a study of the current position on library and information services available for NHS staff, building on the information obtained in the SLIC study. This will identify good practice and the existence of barriers and the need and scope for improvement. The aim is to complete this study by October 2000.

6.3 The input of Health Boards and Trusts is vital to this study and they are asked to work with Ms. Lakie to identify issues and opportunities locally, and then to build action on those matters into their local planning.

b) Electronic databases of health journals
6.4 There are several providers in the market for electronic access to health journals. Such access would support learning, clinical effectiveness and research and should be available as widely as possible in the NHS in Scotland. The potential for arranging this on a national basis is being explored with a view to establishing a national contract if that is feasible and economic.

6.5 The Project Group will take over this work and assess, for example:

• the type of service needed (bibliographies, full text journals etc.)
• co-ordination with the information needs of other sectors including Higher Education
• suppliers
• local variations and the fact that some Trusts already have local contracts.

in the context of the principles proposed by the Digital Scotland Task Force. The Project Group's aim is to formulate by November 2000 a specification for electronic database provision capable of implementation at national, regional and local levels.

c) Learning materials
6.6 There is a substantial body of learning materials and programmes which has been developed by health organisations in-house, by consultants, by Universities, by bodies such as COLEG, etc. The Project Group will work with these groups to assess what is available and what is good practice and how to improve access to suitable material. The aim is to make most effective use of what has already been achieved, to focus future efforts and to bring consistency where appropriate.

6.7 This work will link closely with that of a separate Project Group being established under Learning Together to cover qualifications including the use of National Occupational Standards and SVQs.

d) The remote and rural dimension
6.8 Access to information and learning materials can be very difficult in remote and rural areas. This is a particular issue for the NHS in Scotland. IT offers an unprecedented opportunity to overcome some of those difficulties. It will not, however, solve all the difficulties, especially in a service which is fundamentally about personal contact.

6.9 The Project Group will work with the Remote and Rural Areas Resource Initiative (RARARI) and expects to establish joint projects.

e) Identifying and promoting good practice
6.10 In the course of her work Ms. Lakie will help the Project Group to identify and assess existing and potential good practice for the NHS in Scotland. Existing examples will be considered for dissemination. Potential good practice will be considered for the funding of demonstration projects and the Project Group will be inviting bids through the Learning Together lead contact identified by each Board and Trust.

6.11 Health Boards and NHS Trusts are asked to consider what good practice they can offer or
develop in the work areas of the Project Group. The Learning Together lead contact should be
involved in any good practice proposal or bid and will be given information on bidding processes.

7. Further Information

7.1 The contacts for further information are:

and the Scottish Health on the Web site at http://www.show.scot.nhs.uk/

Human Resources Directorate
CRAG
Chief Scientist Office

Scottish Executive Health Department

APPENDIX A

Enabling Access to the Knowledge Base of Healthcare
Library and Information Provision for the NHS in Scotland

CONTEXT

The Scottish Library and Information Council established a working group to review library and information provision for the NHS in Scotland in 1996. The group was established in response to concerns relating to the fragmentation of existing library and information services, and uncertainties over funding.

The Council took the view that giving NHS staff better access to the knowledge base of health care was essential to support more effective clinical care based on evidence of best practice.

The multidisciplinary membership of the working group under the chairmanship of Dr Graham Buckley reflected the interests of all health care professionals, healthcare policy and management and library and information personnel.

The review group undertook its work during a year of great political and policy change culminating, for the health sector in Scotland, with publication in December 1997 of the White Paper on the future of the National Health Service in Scotland Designed to Care: renewing the National Health Service in Scotland.

The changing relationships, patterns of provision and working practices highlighted in the White Paper provide an appropriate environment for the recommendations contained in the Review of Library and Information Services in the National Health Service in Scotland.

BACKGROUND

Stimuli for review:

• need for healthcare delivery to be based on evidence of best practice;
  
  
• developments in electronic information resources and substantial growth in availability of text-based information relevant to improving healthcare;
  
  
• increasing need for access to this information resulting from emphasis on quality, audit and research;
  
  
• changing content and structure of nurse education;
  
  
• problem and resource-based learning methods in medical training;
  
  
• commitment to continuing education and access to up-to-date information for their members by professional bodies;
  
  
• a change of government and its underpinning philosophies;
  
  
• a growing body of evidence that effective library and information services have a positive, cost-effective impact on healthcare decision-making as well as a role in lifelong learning.

VISION

Library and information services in the NHS in Scotland are a key resource for improving the quality of healthcare when they enable all NHS staff who required information in the course of their work to have access to and help in making effective use of the knowledge base of healthcare.

Role of skilled LIS Staff includes:

• providing leadership by identifying the range and nature of the user community, advising on the mix of services and sources appropriate to the needs of that community and monitoring LIS performance to satisfy those needs
  
  
• selecting, organising and disseminating information to support high quality evidence-based clinical practice and management decision making
  
  
• supporting education, training and professional development for all NHS staff
  
  
• supporting research and development undertaken by NHS staff and the dissemination of research findings
  
  
• assisting quality assurance and medical audit to provide health promotion and other information for patients

EXPECTATIONS of LIBRARY & INFORMATION SERVICES

The report describes the LIS facilities and services which all staff working and training in the NHS should reasonably expect to be available to them.

User needs, which will vary over time and according to professional group, will usually include:

• provision of information resources of all kinds whether on-site or through physical or electronic networks which support all the levels of professional training - basic, further professional qualifications, specialist skills, continuing professional education and development
  
  
• enabling best practice and evidence-based healthcare through access to specialist resources - guidelines, outcome measures and audit tools and evidence-based resources. Subject coverage would include service development and change issues as well as clinical material.
  
  
• support for access to and use of information through training in information retrieval and critical appraisal to ensure effective use of time by NHS staff
  
  
• access to information resources to support research activity as this becomes more of a priority within the NHS
  

ISSUES

There is no integrated, policy framework for library and information services in the NIIS at national, area and local levels.

Complexity and variation in funding streams have generated uncertainty about responsibilities for the organisation and resourcing of services, and uneven and fragmented provision which have created barriers to the use of library and information services by different groups of staff.

There is a need to develop and improve electronic access to the knowledge base.

There is a major training requirement if NHS staff are to acquire the skills necessary for making efficient use of electronic access.

There is no clear, consistent management framework for library and information staff. Coherent organisational and career structures are needed.

RECOMMENDATIONS

The purpose of the recommendations, collectively, is to the realise the vision and meet expectations of practice.

STRATEGY

The Scottish Executive Health Department should develop a policy framework identifying responsibility for provision of LIS to NHS staff. This would identify clear links with functions such as Clinical Effectiveness, Information Management and Technology (IM&T), R&D, Education and Training, and Human Resources.

The Scottish Executive Health Department should establish clear terms of reference for the management of library services, recognising their multidisciplinary nature and guaranteeing access and appropriate provisions for all NHS staff.

The Scottish Executive Health Department needs to clarify funding streams appropriate to support provision of LIS to NHS staff, to support the development of costings in this area and develop means e.g. weighted capitation, of ensuring equity of provision.

SERVICE DEVELOPMENT

Within the context of a national LIS policy, Trusts and Boards should develop clear LIS strategies covering the needs of all staff groups, demonstrating how access to information resources will be ensured via direct provision of service or via contracts and service level agreements. These strategies would benefit from integration with strategies in other areas e.g. IM&T, R&D and Continuing Education.

QUALITY

A framework for specifying user needs, service provision, benchmarking and performance management of LIS should be developed by building on existing accreditation tools and models and improving collection and analysis of usage data and other management information.

CO-ORDINATION

LIS planning should be co-ordinated at a logical geographic and/or organisational level to enable development of strategies for LIS, co-ordinate funding streams, establish arrangements for performance management and ensure economies of scale through resource sharing, joint purchasing and training activities. Partnerships should be encouraged between NHS libraries and those of higher education LIS providers and professional organisations to develop flexible and innovative services.

LIS and IM&T managers need to work closely together to ensure that access to the knowledge base of health care is given the same degree of technical consideration and support as management and patient information systems.

To enable implementation of these recommendations the Scottish Executive Health Department will need, in the short term, to assign staffing and resources with strategic management and change management capabilities, facilitation skills and the ability to provide professional advice, to support the development of LIS specifications, facilitate change and resolve strategic issues. This function will need to be sufficiently staffed and resourced to provide consistent and widespread support and to enable progress to be made.

The Report of a Working Group of the Scottish Library & Information Council
© May 1998, The Scottish Library & Information Council

Full report available on request from:

Scottish Council for Postgraduate Medical and Dental Education
Hobart House
80 Hanover Street
Edinburgh EH2 I EL

Tel 0131-225-4365 (Attn: Mrs S Macaloney)