About the strategic drivers for this policy
HEE is the strategic lead for NHS funded library and knowledge services in England.
As the centre for analysis and expertise, we support changes the NHS already plans to make (1-5 years) by:
- supporting local delivery of new roles and skills at scale and pace and anticipate future changes over the next 5+ years
- providing national leadership on the opportunities and choices for the wider system so that we can futureproof the service and take advantage of the latest science and technology
As a system partner, working collaboratively to align our levers, investments and plans to ensure we have the workforce to deliver 21st century care for patients, with a unique responsibility for taking a longer view, committed to ensuring that the right knowledge and evidence is used at the right time at the Board and the bedside, at the clinic and in the community.
HEE’s policy is to ensure equitable access to knowledge services and evidence resources and to develop the knowledge specialist workforce with the right skills to deliver business-critical services.1
Knowledge for Healthcare, HEE’s strategic framework, highlights that ‘increasingly the NHS will see knowledge specialists embedded within clinical, commissioning and management teams’ (p.26). 2
The Topol Review identified a need to increase the numbers of knowledge specialists in the NHS (recommendations AIR5/DM4).7
As the NHS gears up for the digital future, there is a window of opportunity in which to ensure that the right numbers of qualified librarians and knowledge specialists are in place to inform an evidence-based NHS and to support a digitally-enabled workforce.
Staff ratios: current position
The ratio of qualified librarians and knowledge specialists to the NHS workforce in England is 1:1,730. This figure conceals significant variation between regions, with regional averages varying from 1:1,180 in London to 1:2,255 in the North. See Appendix 1.
Meeting quality standards
The Learning Development Agreement held between HEE and each provider organisation requires that Library and Knowledge Services must meet nationally agreed quality standards set out in LQAF.
The impact of low staffing levels in library and knowledge services
Analysis shows that knowledge services with fewer qualified staff per workforce headcount are challenged to meet the 90% minimum compliance threshold defined in LQAF.
Insufficient capacity to deliver the full range of knowledge services required by the NHS, including the roles of clinical librarian and knowledge manager, is a key factor in failing to meet the minimum standard.
HEE is implementing a new Quality and Improvement Outcomes Framework for library and knowledge services from April 2020. Replacing LQAF, the new framework emphasises the importance of improving outcomes to meet the needs of a modern health service.
Making a positive impact
The #AMillionDecisions advocacy campaign has given local health libraries a voice through which to promote their positive impact.
Correlating case studies submitted to our Impact databank from those services with high LQAF scores, we looked at the staff ratios within which these services are operating. Examples are given in Appendix 2.
These case studies report on how library and knowledge services make a positive impact on:
- Improving patient care: Evidence supplied led to a low-cost cure for unrelenting chest symptoms and has changed international practice.
- Cost effectiveness: The clinical librarian provided input essential to achieve £1.9 million in savings
- Releasing time: Evidence supplied lead to updates to midwifery policies and guidelines and released 302.5 hours of the midwife’s time, equivalent to a saving of £12,397.
- Improving productivity: Identifying interventions to deliver health benefits and contribute to quality and efficiency savings for system-wide transformation.
- Knowledge management: using a KM tool the Head of Library Services and KM helped a Medical Division Board introduce a robust approach for developing clinical guidelines.
The staffing levels at the services which report the case studies above range between 1:614 and 1:932 qualified librarians/knowledge specialists per WTE healthcare staff.
As clinical librarian roles become established the challenge is one of capacity and of reach. Where trusts invest in clinical librarian posts these are ‘rationed’, able to work with but a handful of designated teams.
This is inequitable and there is an implicit risk to high quality patient care and safety. Meanwhile, few organisations have yet to realise the benefits of a dedicated knowledge management (KM) function.
Of course, health library and knowledge services with less capacity also make a positive impact on patient care through their daily work.
To illustrate, at Buckinghamshire Healthcare NHS Trust, which operates at around the average staff ratio of 1:1,704, the clinical librarian provided evidence on patient safety which informed a decision to upskill Healthcare Assistant Roles.
In the context of difficulties in recruiting to band 5 posts this contributed to a cost-saving of £100,000.