For the number of qualified library and knowledge specialists per member of NHS workforce

The NHS requires proactive knowledge services as business-critical instruments of informed decision-making. These services call for a blend of expertise, encompassing:

  • embedded roles in clinical and management teams providing decision-ready information
  • knowledge managers who mobilise corporate knowledge and staff ‘know-how’ to underpin strategy and operations,

There is significant variation in the ratio of qualified librarians and knowledge specialists to healthcare staff, leading to inequitable service provision across England.

There is insufficient capacity to maximise the benefit of these roles to inform evidence-based improvement in care, the spread of innovation, improved productivity and cost savings.

This means that the service is not uniformly able to deliver evidence for #AMillionDecisions. The introduction of a recommended staff ratio is a key action by Health Education England to enable individual organisations to identify and address that risk.


1. To optimise the benefits for the NHS of the emerging new roles for librarians and knowledge specialists, HEE recommends that all NHS organisations:

(i) review regular reports of the positive impact of the library and knowledge service on outcomes

(ii) work with the local library service manager to prioritise allocation of clinical librarian, knowledge manager and other embedded roles to specialities

(iii) take incremental steps to improve the staff ratio between qualified librarians and knowledge managers per member of the NHS workforce, through role redesign and by expanding this specialist workforce

2. HEE recommends that over time, all NHS organisations aspire to achieving a muchimproved staffing ratio

3. HEE recommends that those NHS organisations with a staffing ratio in the region of the current average of 1 qualified librarian to 1,730 or more healthcare staff, strive to achieve a ratio of at least 1 qualified librarian or knowledge specialist per 1,250 WTE NHS staff.

4. HEE commits to monitoring the staff ratios annually and to reviewing the recommended ratio in three years' time.


Prepared at the request of the Health Education England Executive in August 2018 and approved by HEE Executive on 5 November 2019, HEE has adopted as policy a recommendation to improve the staff ratio for the number of qualified library and knowledge specialists per member of the NHS workforce.

This policy recommendation underlines the opportunity for NHS organisations to drive improvements in both the quality of care and productivity with the assistance of clinical librarian and knowledge manager roles.

This policy supplements HEE’s Policy on NHS Library and Knowledge Services in England published in 2016.1


To determine this recommendation for improving the staff ratio HEE has:

  • analysed performance data derived from the HEE Library Quality Assurance Framework (LQAF) in relation to workforce data
  • identified services from which staff have shared examples of the positive impact of the library service
  • identified services with clinical librarian and knowledge manager roles
  • looked for correlations between all these facets.