It has been a very busy few weeks here in the Healthcare Library and I thought I would take a bit of time to reflect on a few things that have happened in the past weeks. My colleague and I did a session at another site hospital last week on critical appraisal, covering both quantitative and qualitative research (she did quan, I did qual) and it went really well! All the participants turned up, which is very unusual, and there was a good mix of doctors, nurses and allied health professionals.
I piloted an exercise found on the ever helpful CATNiP wiki called the “Qualitytative Street exercise” which basically used Quality Street chocolates to explain some of the concepts of qualitative research. Basically everyone had to choose their favourite, eat it then describe what they liked about the chocolate. These terms were written up on the whiteboard and then we put them into categories such as ‘taste’, ‘texture’ or ‘appearance’. We then had a discussion on such issues as focus group recruitment (e.g. nobody asked what the study was about before agreeing to participate!), why people might choose not to take part, how the data were “collected”, data saturation, how the data were analysed and the role of the researcher (how might their answers have differed if they knew I was employed by Nestle...or Cadbury’s?!) We got very positive feedback on the session overall and a few people mentioned they found the qualitative session particularly useful as they do not encounter much in their day-to-day work. I personally found listening to the quantitative session very helpful as it gave me ideas for what to add to my training course.
Our journal survey finished at the beginning of October but between one thing and another I didn’t get a chance to look through the results properly until Friday, when I had to send the results to my manager and the manager on our other site for a meeting on Tuesday about journal selection for the coming year. We had 151 responses in the end and it was very interesting going through the results. We received a lot of useful suggestions for how we could improve the service as well as a huge list of recommended journal titles. I do not envy the managers trying to decide which ones to take and which ones to discard! One very positive result was seeing how well the NHS resources are used – the majority of respondents said they used library.nhs.uk, HILO or MyAthens to access e-journals. The next favourite access point is Google which is not surprising really. Another interesting result was that only half of the respondents prefer electronic access to journals over print. 18% prefer print and 27% have no preference. The respondents seemed fairly satisfied with the provision of e-journals and print journals, ease of access and promotion and the top titles read at the Trust are BMJ, New England Journal of Medicine, Lancet, Nursing Standard, British Journal of Midwifery and Stroke. Some of the suggestions for improvement were a bit outrageous, such as having print copies of all journals at all three sites (exactly what we are trying to avoid!) and “electronic access via British Library services” (which if left to the devices of our users would wipe out our entire budget in a week) but others were very helpful such as targeted email services for specific subjects and coming to speak at team meetings and inductions. The survey certainly identified areas where further training is needed.
Finally I have been working away on my very first book review! An email went round a few weeks ago asking for volunteers to review a couple of books for the HLG newsletter. My manager forwarded it on to me and one of the books “Technology Training in Libraries” caught my attention so I got in touch with the person offering and volunteered to do the review. The book is part of the Facet ‘Tech Set’ series and was a very interesting read. I enjoyed the experience of writing up about it and will put the link to my review when it is published in the newsletter, hopefully next month.
I have been very busy with one-to-one sessions, especially as degree courses are starting up again. I had an Orthopaedics registrar in the other morning who wanted a very comprehensive literature search for his dissertation and I was grateful once again that a Masters degree is required for becoming a qualified librarian as the first thing he asked was whether I had experience in carrying out research. If I hadn’t done a Masters and gone through the experience of carrying out my research project I probably would have felt quite intimidated but as it was I could answer in the affirmative and he seemed quite impressed that a postgrad qualification was required for being a librarian!
Saturday, 30 October 2010
Sunday, 24 October 2010
An Information Revolution...without libraries?
The Department of Health’s Liberating the NHS: An Information Revolution consultation document was published on Monday this week (18 Oct 2010) and lays out a strategy for the way the NHS should manage information in the future. As Andrew Lansley quite rightly states in the Foreward of the document, “we must not lose sight of the primary purpose of information in the health and care system: to ensure that every patient and service user receives high quality care” (p3). All well and good but the term “information” in this document is somewhat nebulous, used as an umbrella term for everything from patient records to health websites to audit to evidence. Furthermore there is no mention of libraries or library services anywhere in the document apart from a reference to the “Indicators for Quality Improvement library” (p36) which I for one have never heard of.
While the bulk of An Information Revolution is concerned with patient records and the flow of medical data there are certainly a number of areas where libraries are involved or could be involved. Section 4.6 states “in order to grasp the opportunities offered by the information revolution, clinicians and care professionals need to be able to access the best evidence (including international evidence) of outcomes, interventions and risks. Evidence needs to be user-friendly, up-to-date and available at the point of care, to inform discussions with patients and service users…Individual professionals, teams and organisations need to be supported to access information of this kind, which can make all the difference in ensuring safety and effective outcomes” (p36) Ummm, yes – do they not realise that this information is already being provided by hundreds of NHS medical libraries across the country every day? There is a short paragraph dedicated to NHS Evidence, described as a service which “is an important addition to commercially provided data services (which are often subscription-based and aimed at particular specialist audiences)” again ignoring the fact that such subscriptions are usually paid for by NHS library services on behalf of their users.
The document strongly supports better access to medical information for patients, which of course is laudable, but takes a rather simplistic view of what is a very complex subject. The emphasis on the internet as a channel for medical information is very obvious but is fairly silent on the subject of information literacy and evidence-based medicine. The three criteria for effective information is that it should be:
- informing, so that they know it is comprehensive and can be trusted;
- engaging, so that they are willing and able to use it; and
- empowering, so that they know how it can make a difference (p11)
How about authoritative, evidence-based, reliable?
The document states that “for some time now, people have been using the internet to explore a diagnosis after (or before) they visit their doctor” (p10) quoting a study of patient use of the internet which showed 11% of patients for neurology outpatients at the Walton Centre for Neurology and Neurosurgery in Liverpool in 2001-5 accessing the internet prior to clinic attendance. 11%?! It’s hardly statistically significant is it? The document also mentions “the role of websites such as ‘Mumsnet’ in generating new ways of sharing insights and information – including health information – is having a lasting effect on our society. Carers, patients, service users, care workers and clinicians are increasingly able to access forums to discuss the issues that matter to them, and offer support from others with experience of their condition” (p10) and exhorts that “the NHS, local authorities and care providers should be responding to and supporting these new approaches” (p11). Now I have been on a few of these forums in my time and have found them pretty useless to be honest, mainly involving somebody complaining they have a strange rash, followed by a slew of respondents all saying they have something similar but nobody knowing exactly what it is or how it should be treated.
Libraries, both medical and public, are extremely well-placed to provide authoritative, reliable information to patients. Many libraries already do and even more would be willing to do so. Why is this not mentioned in An Information Revolution? It may well be that “information cannot be seen as something that is the sole responsibility of the specialist” (p39) but why not harness the knowledge and experience of information specialists such as librarians and avoid reinventing the proverbial wheel?
Finally, I did have to laugh at the statement on page 14: “Whilst any associated costs will need to be met within the Department of Health’s Spending Review settlement, there will be no additional central funding to pay for the information revolution…Whilst there will inevitably be costs, which could fall centrally and/or locally, the information revolution should, ultimately, pay for itself.” Not surprising really that the government thinks good quality information can be produced on the cheap, but it makes the whole document ring rather hollow.
I shall definitely be responding to this consultation document and hope many other medical librarians will as well. After all, there is not going to be an Information Revolution in the NHS without us!
While the bulk of An Information Revolution is concerned with patient records and the flow of medical data there are certainly a number of areas where libraries are involved or could be involved. Section 4.6 states “in order to grasp the opportunities offered by the information revolution, clinicians and care professionals need to be able to access the best evidence (including international evidence) of outcomes, interventions and risks. Evidence needs to be user-friendly, up-to-date and available at the point of care, to inform discussions with patients and service users…Individual professionals, teams and organisations need to be supported to access information of this kind, which can make all the difference in ensuring safety and effective outcomes” (p36) Ummm, yes – do they not realise that this information is already being provided by hundreds of NHS medical libraries across the country every day? There is a short paragraph dedicated to NHS Evidence, described as a service which “is an important addition to commercially provided data services (which are often subscription-based and aimed at particular specialist audiences)” again ignoring the fact that such subscriptions are usually paid for by NHS library services on behalf of their users.
The document strongly supports better access to medical information for patients, which of course is laudable, but takes a rather simplistic view of what is a very complex subject. The emphasis on the internet as a channel for medical information is very obvious but is fairly silent on the subject of information literacy and evidence-based medicine. The three criteria for effective information is that it should be:
- informing, so that they know it is comprehensive and can be trusted;
- engaging, so that they are willing and able to use it; and
- empowering, so that they know how it can make a difference (p11)
How about authoritative, evidence-based, reliable?
The document states that “for some time now, people have been using the internet to explore a diagnosis after (or before) they visit their doctor” (p10) quoting a study of patient use of the internet which showed 11% of patients for neurology outpatients at the Walton Centre for Neurology and Neurosurgery in Liverpool in 2001-5 accessing the internet prior to clinic attendance. 11%?! It’s hardly statistically significant is it? The document also mentions “the role of websites such as ‘Mumsnet’ in generating new ways of sharing insights and information – including health information – is having a lasting effect on our society. Carers, patients, service users, care workers and clinicians are increasingly able to access forums to discuss the issues that matter to them, and offer support from others with experience of their condition” (p10) and exhorts that “the NHS, local authorities and care providers should be responding to and supporting these new approaches” (p11). Now I have been on a few of these forums in my time and have found them pretty useless to be honest, mainly involving somebody complaining they have a strange rash, followed by a slew of respondents all saying they have something similar but nobody knowing exactly what it is or how it should be treated.
Libraries, both medical and public, are extremely well-placed to provide authoritative, reliable information to patients. Many libraries already do and even more would be willing to do so. Why is this not mentioned in An Information Revolution? It may well be that “information cannot be seen as something that is the sole responsibility of the specialist” (p39) but why not harness the knowledge and experience of information specialists such as librarians and avoid reinventing the proverbial wheel?
Finally, I did have to laugh at the statement on page 14: “Whilst any associated costs will need to be met within the Department of Health’s Spending Review settlement, there will be no additional central funding to pay for the information revolution…Whilst there will inevitably be costs, which could fall centrally and/or locally, the information revolution should, ultimately, pay for itself.” Not surprising really that the government thinks good quality information can be produced on the cheap, but it makes the whole document ring rather hollow.
I shall definitely be responding to this consultation document and hope many other medical librarians will as well. After all, there is not going to be an Information Revolution in the NHS without us!
Monday, 27 September 2010
Clinical Governance: doing the right thing
I attended a workshop on clinical governance on 23 September, hosted by CLIST and held at the Bloomsbury Healthcare Library. I decided to go more out of duty than interest as clinical governance is one of those things I find it very hard to get excited about. I was pleasantly surprised by what I heard however and found the session much more interesting than expected. Our speaker, Nada Schiavone, who is currently the Patient Safety Lead at NHS London, was a very engaging speaker with much experience in both clinical and managerial work. Her presentation was peppered with real examples of situations she has faced and she was very candid about her concerns regarding the changes currently planned for the NHS and how they will affect patient safety and clinical governance.
The course consisted of a presentation about clinical governance itself (very simply put, clinical governance is about doing the right thing, at the right time, in the right way, in the right place for the right patient) and how it fits in with the aims and objectives of the NHS. This was followed by her thoughts on how NHS library services could have a positive impact on clinical governance. Finally we split into groups and worked through some scenarios. As part of the presentation Nada asked us to guess the average cost of litigation claims against the NHS costs the average acute Trust and it turned out to be £21 million a year – that is £21 million per Trust, per year! So, very important to get things right, obviously.
As far as library involvement in clinical governance, Nada proposed the following questions:
- Are you on the right committees for supporting evidence-based practice?
- Are you visible?
- What evidence base can the library produce to support integrated governance (a fancier word for clinical governance, which includes governance other than just clinical)
- What information does the service provide for patients?
- How do you demonstrate support for audit/research projects?
- Can you help with presenting data? Writing a report? Publishing a piece of work?
She also stressed the importance of being aware of service redesigns and aligning library resources to Trust strategies and staff needs, all of which sounded very familiar! I went away with a lot to think about and will possibly now be able to summon a little more excitement about clinical governance…
The course consisted of a presentation about clinical governance itself (very simply put, clinical governance is about doing the right thing, at the right time, in the right way, in the right place for the right patient) and how it fits in with the aims and objectives of the NHS. This was followed by her thoughts on how NHS library services could have a positive impact on clinical governance. Finally we split into groups and worked through some scenarios. As part of the presentation Nada asked us to guess the average cost of litigation claims against the NHS costs the average acute Trust and it turned out to be £21 million a year – that is £21 million per Trust, per year! So, very important to get things right, obviously.
As far as library involvement in clinical governance, Nada proposed the following questions:
- Are you on the right committees for supporting evidence-based practice?
- Are you visible?
- What evidence base can the library produce to support integrated governance (a fancier word for clinical governance, which includes governance other than just clinical)
- What information does the service provide for patients?
- How do you demonstrate support for audit/research projects?
- Can you help with presenting data? Writing a report? Publishing a piece of work?
She also stressed the importance of being aware of service redesigns and aligning library resources to Trust strategies and staff needs, all of which sounded very familiar! I went away with a lot to think about and will possibly now be able to summon a little more excitement about clinical governance…
Feast or Famine...
Having just complained last week that it was a bit quiet it has suddenly gone busy again here in the Healthcare Library. Staff inductions have started up again and we also had a new intake of student doctors which can only mean library tours and presentations for all. We are also running a journal survey across all three sites and have had over 100 responses so far – much better than expected. I spent much time the week before last played about with our LMS so we could send out an email to all our users (who have email addresses). This will serve a dual purpose: catching people who are library members but not Athens users and seeing just how comprehensive (or not) our records are on the LMS. It will also test the capabilities of the LMS itself which is quite good at ingesting data but not so admirable at spitting it out again. Spent a while with the Senior Library Assistant experimenting and we eventually got it to run a report as a text document which I opened in Access, refined some of the data, saved as a text document again then opened in Word to insert the required semicolons needed for Outlook.
Of course when I sent my marvellous instructions to the Library Manager at our other site he sent back an email with a much easier way but the nice thing about my way is that we get all the bounced back emails, which the poor Library Assistant (and myself!) spent a few hours amending last week. It gave us a chance to clear out some old records as well so I think the experiment worked quite well...
I have attended a few meetings and training sessions the last few weeks including a CLIST meeting, a clinical governance training session (which I will talk about in a separate blog post) and the R&D Committee meeting. CLIST, held at the Bloomsbury Healthcare Library, is always a good chance to catch up with what has been going on with the other information skills trainers in London and my counterpart at another site library met afterwards to plan our critical appraisal session in October. We sent the communication out last week and already have about 8 takers! I have also recently joined the Trust R&D Committee and attended my first meeting last Friday where new proposals for research in the Trust were heard and matters around research were discussed. I found it very interesting, informative and highly professional, even though I didn’t understand everything discussed it gave me a sense of how the library could get involved in research at the Trust.
And finally, we have been in the news again – even hitting the BBC headlines last week! I have a feeling it's going to be a tough winter...
- Patients ‘at grave risk’ from poorly trained doctors (Independent on Sunday, 19 Sep 2010)
- Sidcup hospital to close A&E and maternity over the winter (BBC News, 22 Sep 2010)
Of course when I sent my marvellous instructions to the Library Manager at our other site he sent back an email with a much easier way but the nice thing about my way is that we get all the bounced back emails, which the poor Library Assistant (and myself!) spent a few hours amending last week. It gave us a chance to clear out some old records as well so I think the experiment worked quite well...
I have attended a few meetings and training sessions the last few weeks including a CLIST meeting, a clinical governance training session (which I will talk about in a separate blog post) and the R&D Committee meeting. CLIST, held at the Bloomsbury Healthcare Library, is always a good chance to catch up with what has been going on with the other information skills trainers in London and my counterpart at another site library met afterwards to plan our critical appraisal session in October. We sent the communication out last week and already have about 8 takers! I have also recently joined the Trust R&D Committee and attended my first meeting last Friday where new proposals for research in the Trust were heard and matters around research were discussed. I found it very interesting, informative and highly professional, even though I didn’t understand everything discussed it gave me a sense of how the library could get involved in research at the Trust.
And finally, we have been in the news again – even hitting the BBC headlines last week! I have a feeling it's going to be a tough winter...
- Patients ‘at grave risk’ from poorly trained doctors (Independent on Sunday, 19 Sep 2010)
- Sidcup hospital to close A&E and maternity over the winter (BBC News, 22 Sep 2010)
Monday, 6 September 2010
Back on the Blog Wagon
I have inadvertently taken a break over the summer from my blog as things have been a bit quiet on the training front but as it is now September I have started to feel familiar twinges of guilt so it’s time to get back on the wagon and blog on a regular basis again. Not a great deal has happened since my last post on the White Paper and in fact the White Paper parade has all gone a bit quiet lately. However people are busy writing more papers in preparation for it becoming law and no doubt we’ll be hearing more when it comes out of consultation on the 11th Oct. For a good resource on all things White Paper I can recommend nothing better than the Health Management Specialist Collection’s White Paper page which not only has all the documentation for the Paper but all the responses from various organisations and media reports as well.
I attended the HLG Conference 2010 on the 19th-20th July which took place this year in Salford Quays near Manchester. The theme was ‘Keeping information centre stage amidst changing scenery’ and there were many interesting seminars and workshops to attend and the venue was really lovely (see attached photo which I took on my first day). My only problem was that there was no wireless access and as mobile signals interfered with the sound equipment in the main lecture theatre it meant I couldn’t tweet my experience as it happened – something I had been really looking forward to! However I did have a good time, met some interesting people and dutifully wrote up my report for the HLG Newsletter which you can read here.
I went on a systematic reviews training day at the end of July which was held at Guy’s campus and hosted by information specialist staff from Cochrane and CRD. They gave very in-depth and informative sessions on the work that goes into producing a systematic review and I found the presentation on searching at systematic review level especially helpful. It certainly gave me a lot to think about and aspects to include in my Systematic Reviews workshop.
I also paid a visit to the Royal College of Physicians library a few weeks ago which proved very dramatic as upon my arrival a BBC film crew were outside the building in Regent’s Park filming a TV drama! Once I navigated my way around the cameras, SWAT teams and semi-automatic rifles into the building we were given an excellent tour of the different bits of the library, which is spread across two sites. They have a very impressive collection of both old and new stock which is accessible to all members of the Royal College and have the largest collection of medical education books in the country. Unfortunately because of building regulations they are unable to put a sign outside the building directing people to the Medical Education Resource Centre so they rely very much on word-of-mouth recommendation. In the Heritage Centre library on the other site I was especially excited to catch site of books owned by John Dee which had been stolen sometime in the 16th century and somehow ended up in the hands of a Duke who contributed his collection to the RCP. Certainly none of our books have such an exciting progeny!
As far as training is concerned it has been quiet over the summer and I decided not to run group training in August to allow myself to catch up with other things. These included trying to convince health managers at the hospital to sign up for Athens accounts (which failed miserably), tracking down some book titles for Learning and Organisational Development to buy on our behalf and promoting the Medicine Collection journals. My new training schedule was advertised last week and I have had a few takers but not as many as I had hoped! Still I suppose people are still getting back from holiday mode etc so I have to hope I will get a few more in the weeks to come. My colleague in Bromley and I are running a joint session on critical appraisal at the Queen Mary’s site in mid-October. She will be doing quantitative (thank goodness!) and I will be doing qualitative and we will be trialling a new critical appraisal technique involving Quality Street chocolates...more on that when it happens!
Thursday, 15 July 2010
How will the new NHS White Paper affect NHS library and information services?
OK so looking back I realise my last posting was a little heated and 'of the moment'! I have now had a few days to reflect on the White Paper and even got a chance to read through most of it to try and work out what it may mean for NHS library and information service provision. Unfortunately it is far from clear but I will mention a few things I think are worth considering...
1. Referencing
The first thing I noticed skimming through the Paper is just how poorly referenced it is. There are many examples of broad sweeping statements like "information, combined with the right support, is the key to better care, better outcomes and reduced cost" (p13) and "there is compelling evidence that better information also creates a clear drive for improvement in providers" (p14) with no references to where this "evidence" can be found. Only 8 scholarly journal articles are referenced and only one of these is a systematic review. There are also no hypertext links to other documents mentioned in the Paper, even DH ones. Come on guys - this document puts even Wikipedia to shame!
2. An 'information revolution'
The Paper goes into a fair amount of detail about providing sufficient information to patients to enable them to make decisions about their healthcare (section 2). This will apparently be in the form of a 'information revolution' which is partly to do with providing patients with access to "comprehensive, trustworthy and easy to understand information from a range of sources on conditions, treatments, lifestyle choices and how to look after their own and their family’s health" (p.13) but also giving them greater access to their health records and more effective outcome measures for better accountability. "Patients and carers will be able to access the information they want through a range of means" but it is not clear what these "means" are and I will be interested to see the information strategy the government is planning on publishing sometime in the autumn. I am not sure the government realises the complexities and expense involved in organising and distributing health information to patients and the extra burden this will have on healthcare providers.
3. Education and training
The other area of greatest relevance to library and information services is of course education and training. This is mentioned very briefly towards the end of the Paper (section 4.32) and it seems that moneys intended for the purpose of education and training (MPET) will be gradually put into the hands of providers, rather than the DH, allowing them to make local decisions about training and education for staff. In theory this is a good idea but unless the finance is properly ring-fenced it has a habit of 'disappearing' and being used to fund other things. It remains to be seen whether the GP consortia and the Centre for Workforce Intelligence (whoever they are?!) will have enough clout and interest to see this does not happen.
So, overall still not very impressed! I guess we library and information professionals will just have to wait and see what the real impact of this White Paper will be on our services to users....
1. Referencing
The first thing I noticed skimming through the Paper is just how poorly referenced it is. There are many examples of broad sweeping statements like "information, combined with the right support, is the key to better care, better outcomes and reduced cost" (p13) and "there is compelling evidence that better information also creates a clear drive for improvement in providers" (p14) with no references to where this "evidence" can be found. Only 8 scholarly journal articles are referenced and only one of these is a systematic review. There are also no hypertext links to other documents mentioned in the Paper, even DH ones. Come on guys - this document puts even Wikipedia to shame!
2. An 'information revolution'
The Paper goes into a fair amount of detail about providing sufficient information to patients to enable them to make decisions about their healthcare (section 2). This will apparently be in the form of a 'information revolution' which is partly to do with providing patients with access to "comprehensive, trustworthy and easy to understand information from a range of sources on conditions, treatments, lifestyle choices and how to look after their own and their family’s health" (p.13) but also giving them greater access to their health records and more effective outcome measures for better accountability. "Patients and carers will be able to access the information they want through a range of means" but it is not clear what these "means" are and I will be interested to see the information strategy the government is planning on publishing sometime in the autumn. I am not sure the government realises the complexities and expense involved in organising and distributing health information to patients and the extra burden this will have on healthcare providers.
3. Education and training
The other area of greatest relevance to library and information services is of course education and training. This is mentioned very briefly towards the end of the Paper (section 4.32) and it seems that moneys intended for the purpose of education and training (MPET) will be gradually put into the hands of providers, rather than the DH, allowing them to make local decisions about training and education for staff. In theory this is a good idea but unless the finance is properly ring-fenced it has a habit of 'disappearing' and being used to fund other things. It remains to be seen whether the GP consortia and the Centre for Workforce Intelligence (whoever they are?!) will have enough clout and interest to see this does not happen.
So, overall still not very impressed! I guess we library and information professionals will just have to wait and see what the real impact of this White Paper will be on our services to users....
Tuesday, 13 July 2010
Hey! Who took my NHS?!
The coalition government published a White Paper on the NHS yesterday (12/7/10) called Equity and Excellence: Liberating the NHS, which promises a “bottom up” approach to NHS funding, a dismantling of unnecessary administration, targets and bureaucracy and (the usual) improvements in health outcomes, better care for patients etc. It will accomplish this by putting the majority of NHS funds (about 80%) in the hands of GPs, giving all NHS Trusts foundation status, granting the responsibility of public health to local authorities and getting rid of all primary care trusts (PCTs) and strategic health authorities (SHAs).
The White Paper is couched in cleverly worded language so that those outside the NHS and not privy to its organisational structure will not at first realise that what is actually being proposed is the effective dismantling of the NHS as an organisation and a move to privatising a public service. GP surgeries already operate as mini enterprises separate from the NHS. Trusts that gain foundation status are given power to operate outside the structures and targets of the NHS. The only other bodies existing as NHS organisations (PCTs and SHAs) are to be abolished. Put this all together and one is left begging the question: just what is the NHS anymore?
Initial reaction to the news has been cautious from professional bodies such as the BMA, the Royal College of Surgeons and the Care Quality Commission. The King’s Fund has been more vocal and the national press (Guardian, Independent) has had a field day. What has been most surprising about this White Paper is that it has seemingly come out of nowhere and how can we be sure that such radical changes will actually have a positive benefit on patient care? Are GPs really ready and equipped to take on such an enormous responsibility (on top of their already challenging work)? Do local authorities have the capacity to handle the public health remit? Who is going to make sure they are doing a good job? And most of all: Does the NHS really need another massive reorganisation?
All the pieces of this enormous jigsaw puzzle are not meant to be in place until 2013-14 at the latest but it is a blow to PCTs and SHAs, which are full of hard-working, knowledgeable and experienced managers and other staff who are committed to patient care and quality. As things stand now they will find it difficult to be taken seriously in the new world order and personally I think it is insulting to sub-title the document 'liberating the NHS' as if all managers and management structures are somehow holding the NHS back.
It remains to be seen in the immediate, medium and long-term how 'Equity and Excellence' will impact the NHS. I will be blogging later in the week on how I think these changes may affect medical library services. I have to agree with Andrew Burnham that the coalition government are taking an enormous gamble with the NHS as an organisation, with patients and with the lives of NHS staff at a critical time where none of us can afford to lose.
P.S. I also just want to point out for the record that Twitter was of enormous benefit when it came to the current awareness promotion of the White Paper to our library users. I was on alert all day waiting for the announcement to send the link out to managers, consultants and GPs as soon as it was published. Although we were able to watch the Parliament proceedings as they happened via BBC iPlayer (link) it was the Department of Health Twitter page which published the link first and I sent the publication out to our users a full 2 and a half hours before Andrew Lansley’s official email landed in our NHSNet accounts. Another example of why Twitter should not be a banned site in NHS Trusts!
The White Paper is couched in cleverly worded language so that those outside the NHS and not privy to its organisational structure will not at first realise that what is actually being proposed is the effective dismantling of the NHS as an organisation and a move to privatising a public service. GP surgeries already operate as mini enterprises separate from the NHS. Trusts that gain foundation status are given power to operate outside the structures and targets of the NHS. The only other bodies existing as NHS organisations (PCTs and SHAs) are to be abolished. Put this all together and one is left begging the question: just what is the NHS anymore?
Initial reaction to the news has been cautious from professional bodies such as the BMA, the Royal College of Surgeons and the Care Quality Commission. The King’s Fund has been more vocal and the national press (Guardian, Independent) has had a field day. What has been most surprising about this White Paper is that it has seemingly come out of nowhere and how can we be sure that such radical changes will actually have a positive benefit on patient care? Are GPs really ready and equipped to take on such an enormous responsibility (on top of their already challenging work)? Do local authorities have the capacity to handle the public health remit? Who is going to make sure they are doing a good job? And most of all: Does the NHS really need another massive reorganisation?
All the pieces of this enormous jigsaw puzzle are not meant to be in place until 2013-14 at the latest but it is a blow to PCTs and SHAs, which are full of hard-working, knowledgeable and experienced managers and other staff who are committed to patient care and quality. As things stand now they will find it difficult to be taken seriously in the new world order and personally I think it is insulting to sub-title the document 'liberating the NHS' as if all managers and management structures are somehow holding the NHS back.
It remains to be seen in the immediate, medium and long-term how 'Equity and Excellence' will impact the NHS. I will be blogging later in the week on how I think these changes may affect medical library services. I have to agree with Andrew Burnham that the coalition government are taking an enormous gamble with the NHS as an organisation, with patients and with the lives of NHS staff at a critical time where none of us can afford to lose.
P.S. I also just want to point out for the record that Twitter was of enormous benefit when it came to the current awareness promotion of the White Paper to our library users. I was on alert all day waiting for the announcement to send the link out to managers, consultants and GPs as soon as it was published. Although we were able to watch the Parliament proceedings as they happened via BBC iPlayer (link) it was the Department of Health Twitter page which published the link first and I sent the publication out to our users a full 2 and a half hours before Andrew Lansley’s official email landed in our NHSNet accounts. Another example of why Twitter should not be a banned site in NHS Trusts!
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