Healthcare is a knowledge intensive industry. The Health and Social Care Act 2022 places duties in respect of research upon the Secretary of State (p45, S40) and therefore upon the health service as a whole, that organisations in the exercise of their functions: “must facilitate or otherwise promote –
(a) research on matters relevant to the health service, and
(b) the use in the health service of evidence obtained from research.”
As strategic lead for knowledge and library services on behalf of the system, Health Education England (HEE) is committed to working with organisations to ensure that knowledge and library services have the right resources to offer the right services.
It is through education, and sharing knowledge, research evidence and best practice, that the NHS inspires and informs the delivery of high-quality healthcare. NHS knowledge and library services are crucial to unlocking this value, informing decisions about patient care and safety, productivity, efficiency, service transformation and enhancing working lives. (Knowledge for Healthcare 2021-26).
All learners and staff need to be able to use the knowledge and library services they need, irrespective of their base. (NHS Library and Knowledge Services in England Policy) Investing in NHS knowledge and library services is a good example of investing to improve value.
An independent health economics study has shown that these services give the ‘Gift of Time’, delivering value for money and making a positive return on investment. Taking the ‘heavy lifting’ out of getting evidence into practice to improve the quality of care, they deliver a cost benefit ratio of 1:2.4 based on savings of clinicians’ time alone. This does not include the wider value of improved access to higher quality evidence and the resulting impact on patient outcomes, costs, productivity and the workforce.
The establishment of Integrated Care Boards in July 2022 generates new opportunities for system leaders to ensure appropriate provision of knowledge and library services to learners and the workforce, and to maximise the value of investment in knowledge resources across systems. HEE’s regional knowledge and library services leads are pleased to support these discussions.
Changes to education tariff in September 2022 will see the redistribution of education funding to create an increased clinical tariff price. Medical undergraduate tariff is extended to include placements in primary care and PIVO settings (private, independent and voluntary organisations).Moreover, changes to tariff do enable consideration of indicative arrangements.
It is timely, therefore, to revisit the basis on which 1) placement provider organisations with a knowledge and library service determine the allocation of funding to the service, and 2) on which placement provider organisations without their own knowledge and library service reach a service level agreement with another organisation. Accordingly, these recommendations are offered as indicative guidance.
Indicative funding levels
Placement providers receive a contribution to the cost of knowledge and library services from HEE as part of the placement fee. The NHS Education Contract specifies that the Placement Provider will ensure that there is:
- a proactive, high-quality knowledge and library service that is available to all staff and learners. (14.2)
- an appropriate level of funding, both from education tariff and matched employer contributions, to support delivery of proactive, high-quality knowledge services. (14.8)
As an indicative figure, it is recommended that a minimum of 2.4% of the placement fee paid by HEE is committed to knowledge and library services, to be matched by employer contributions. This applies to organisations with their own knowledge and library service, and to organisations which commission provision via a Service Level Agreement.
This percentage was identified through a review of funding provided by HEE for library services from tariff. The review was completed by HEE Finance in 2017 in response to an HEE commissioned, independent audit. It examined data from all regions over a three-year period. It identified the average funding to knowledge and library services from tariff as 2.4%.
Understanding the economic benefits of investing in knowledge and library services, and the value to patients and the workforce, many NHS organisations allocate funding well above the indicative minimum. This allows them to resource high quality proactive knowledge services with the right team and the right resources to maximise the benefits.
HEE’s regional knowledge and library services leads are pleased to work with Trusts on service development to help them realise the benefits of the Gift of Time.
Opportunities for collaborative procurement
Investing in more collaborative procurement is another good example of investing to improve value. The 2022/23 Guidance makes provision for this: “Where a provider hosts particular services, such as library services, HEE may agree the basis for any recharges that the host provider wishes to make. If all the organisations within a local area agree to a pooled support system, they may agree that HEE, or another named organisation manage a proportion of the placement fee on their behalf.” (DHSC Education and Tariff Guidance and Prices 2022 - 2023, Section 7.7)
There is a high degree of commonality of spend on digital knowledge resources by local NHS knowledge and library services. To achieve better value for money, there is the opportunity for placement providers to pool funding into central, regional or coordinated procurement of digital knowledge resources. This will significantly strengthen the ability to deliver system-wide savings. It will also widen access to resources for NHS learners and staff, and release staff time from procurement and resource management.
The following recommendations are offered as guidance. It is recommended that Placement Providers in every setting:
- facilitate and promote the use in the health service of evidence obtained from research, encouraging staff and learners to maximise the value of using the knowledge and library service to support learning and decision making.
- commit a minimum of 2.4% of the placement fee paid by HEE to the knowledge and library service
- ensure that, as a minimum, funding allocated to the knowledge and library service from the placement fee paid by HEE is matched by an employer contribution
- engage with the knowledge and library service manager to ensure that the service has the right resources to offer proactive, high-quality knowledge and library services to all learners and staff
- encourage the knowledge and library service to work with other services, and with the national NHS knowledge and library service team, to achieve better value through more collaborative procurement
6 July 2022
As approved by the Operational Delivery Group,11 July 2022
Page last reviewed: 30 September 2022