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....

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!

Sunday, 27 June 2010

I like Google but honestly....

After a good start I ended last week feeling a bit like the Katherine Hepburn character from 'Desk Set'. You know, the 1960s film about the reference desk of a large corporation managed by the luminous Hepburn being taken over by a machine called EMMERAC who can apparently answer all the questions thrown at it, rendering the reference desk redundant? (and if you are a librarian and haven't seen this film go out now and find it - it's hilarious and every self-respecting information professional should see it!).

My manager had a telephone conversation last thing on Friday with one of our external funders (who I shall not name as the following is not common knowledge yet) who told him they won't be able to give us the same level of funding this year and may cut us off altogether. Essentially they don't see the value of information skills training - the person in charge of education and development in this organisation claimed she could hire somebody one day a week "to show staff Athens resources" as she put it. Well I would like to see her try squeezing my job into one day a week - I trained nearly 30 people from this organisation in the last 3 months, meaning this person would have to run three training sessions in their one day a week plus all the advertising, planning and follow-up, Athens administration, random queries, people popping by ad hoc, literature search requests...they would be dead after one day on such a job. She also claims that somebody on the board there saw 'information skills training' on the budget and queried it, asking "what do we need this for, we've got Google haven't we?"

Obviously this made me feel really valued and appreciated and it's nice to see those in charge with such a progressive, enlightened view of information literacy! I was (and still am) pretty hurt and angry actually which didn't make for a very nice Friday evening but then I decided no - I am not going to let these people get to me. They are representative of all the work that still needs to be done regarding information literacy. I am the one out there on the ground meeting people every day who need help finding information and I know how much my training is valued. It is just depressing that these people (who unfortunately happen to hold the purse strings) do not and are completely out of touch with what their staff need. Instead of letting their attitudes discourage me I am going to take them in hand and challenge them through the work I do. I am an information professional - cross me at your peril!

Other than that the week went well and I had a very good training session with a lovely midwife on Thursday on staying up-to-date. She was very on the ball and wanted to find out more about RSS feeds and discussion lists. I do tend to cram quite a lot into my staying up-to-date course, but there is a lot out there!

I also had a good chat on the telephone with my colleague at the other hospital in our Trust and we have decided to organise a joint critical appraisal session covering both quantitative and qualitative research for anyone in the whole Trust. We were also talking of maybe trying to run training sessions first thing in the morning - "Early Bird Specials" if you will - with coffee and donuts!

I am also planning on sending out an evaluation form to all my one-to-one trainees from last year til now to find out if they are using the training they undertook and found it useful. Fingers crossed I get lots of positive responses!

Monday, 21 June 2010

"A medical degree is not required for this job...but it wouldn't hurt!"

I had a very interesting clinical query last week which took me completely out of my comfort zone and made me think afterwards "I must blog about this!" We had a call from a registrar on the wards on Tuesday asking if we could track down the lowest ever recorded sodium level (in a human) in the literature. He had a patient with a sodium level of 100 and he wanted to see if there had been any recorded lower. "Well that shouldn't be too difficult" thought I, but having sat myself down in front of Medline it took me ages to think how to approach the question in a standard database query sort of way. I started out very basically entering "low sodium", "lowest sodium" or "sodium requirements" as a title search but just got loads of articles about dietary sodium levels and things to do with animals. I then branched out to a thesaurus search for SODIUM and HUMANS and "low*" but again, too broad. I had to take a break then to do a one-to-one session with an OT but I asked the library assistant and senior library assistant to have a think as well.

An hour or so later I was back on the case. The library assistant had found a wonderful site on medical world records but unfortunately sodium levels were not exactly exciting enough to merit an entry. The senior library assistant suggested I consult some books on fluids and electrolytes which proved to be an excellent move because from these books ("Fluids and Electrolytes Made Incredibly Easy" and "Fluids and Electrolytes: A 2-in-1 Reference for Nurses") I discovered that a low sodium (or serum sodium) level was known medically as hyponatremia and it is measured in terms of MeQ/L. A serum sodium level of 100 is dangerously low (low is considered to be between 120 and 135) which made me hope our registrar was treating this patient and not sitting around waiting for my answer!

I returned to my Medline search and search hyponatremia in the title and the thesaurus, combined these searches with OR then searched "100 MEQ/L" OR "less than 100 MEQ/L" and added these searches to the hyponatremia search. I got 6 results, which were not bad but still not quite what I was after. I started working down from 100 MEQ/L to 90, then 80, 70 and 60 but that didn't work very well so I then tried combining the hyponatremia searches with "severe" and "serum sodium level" which, while not giving me the answer, helped me to gain a better knowledge about what I was looking for. In the end I found the combination of hyponatremia (title and thesaurus) AND "serum sodium.ti,ab" AND "MEQ/L" AND "severe.ti.ab" gave me a good range of low sodium levels, both case studies and research on groups of patients and I could be reasonably sure that the lowest serum sodium level ever recorded in the literature is 99 MEQ/L.

It was a very interesting search, not least of which the way it illustrated the different ways humans and computers "think". Funnily enough, the library assistant told her friend about the search a few days later and he promptly put in "lowest sodium level recorded" into Google and came up with a relevant article mentioning 99 MEQ/L as the lowest ever but without having done the search myself on a database I couldn't have been certain that this was the right answer. I certainly now know more about sodium levels than I ever wanted to know!

Friday, 11 June 2010

Information Literacy

Well I've only been back at work for two days as I was on holiday in lovely Wales for most of the week but I thought I would still blog about them as the first day back especially was quite interesting. It was our bi-monthly CLIST (Clinical Library and Information Skills Trainers) group meeting on Thursday and there were quite a few lively discussions which got going over information literacy skills in healthcare professionals today. Two points which I thought would be useful to mention was the fact that nurses are now being expected to do Masters levels qualifications in order to progress in their careers but many are not getting the support they need to carry out this level of education. One of the librarians at the meeting (who has been in the job for a long time) was saying that some of the nurses she has been seeing recently barely have basic literacy skills, much less information literacy. They are brilliant nurses but just don't have the academic background and processing skills necessary to carry out Masters level work. The universities offer very little support and they are having to manage their very stressful day-to-day nursing work on top of the education - it is unfair on them and must be so demoralising. And we health librarians have to pick up the pieces!

Another point was about information literacy in general among staff and a CLIST member made an interesting point that the style of internet searching has changed in recent years. People using the internet in a personal capacity at home do not tend to 'surf' or explore the internet like they did when the World Wide Web first became popular. She was saying that people now tend to concentrate on two or three sites (Facebook, Google, Yahoo email account etc) to find what they need rather than roving through lots of different sites and as a result have become much less certain about the internet 'terrain'. This then translates over to the work situation where people prefer to have one site to find everything they need. But in health and medicine this is just not possible.

Our afternoon session quite coincidentally was on information literacy as well and we had the ever-enthusiastic Susie Andretta of the FILE course leading the session. There were three presentations - one from Richard Thorne of NHS Nottingham City who is leading on public health intelligence course for public health professionals in the East Midlands area, another from Sue Jennings of Lancashire Care Trust who has a very exciting approach to blogging and current awareness bulletins and the last presentation came from Susie herself which asked about whether evaluation of training sessions should focus on the trainer, the user or the organisation. I found the session from Sue the most interesting - she has been using a blog in conjunction with a monthly one page current awareness bulletin with very successful results. The blog (which uses Wordpress) is very impressive - almost like a website on it's own. The most exciting thing is the complexity of the statistics available on Wordpress - you can literally see who is reading what on nearly every part of the blog and the stats are truly amazing. I was inspired but unsure how well it would work in an acute trust - Lancashire Care Trust is a mental health trust so most of the material is concentrated on mental health. I do think it might be an idea to switch our work blog over to Wordpress though (no offense Blogger....)

Today I have been back in the office catching up with my emails and getting back up to speed again. Have a busy week training-wise next week with quite a few one-to-ones. On Monday I am going into town to find out more about the Ovid link resolver and whether it will be the answer to all our link resolving problems. Hmmm, chance would be a fine thing....!

And most exciting of all - I have a new template for my blog! Thanks Blogger - now just get some analytics built in and I'll be well chuffed.

Tuesday, 1 June 2010

One year in post!

Well it is a momentous day - this day last year was my first day at my current job which means I have survived a whole year as a librarian! Praise be. As I sit here celebrating (rather modestly) with a limoncello and tonic and some Welsh cakes I thought it would be a good opportunity to reflect back on some of the things I've learned so far....

1. The only constant is change - so be flexible and adaptable
2. Be passionate about your work, but not precious
3. Use any opportunity to market services
4. Make the most of any contact with users and follow up potential leads
5. Don't rely solely on email
6. Always check the To: field when replying to an email, and delete any content below your message
7. Make training sessions relevant to users
8. Keep training presentations as short and engaging as possible
9. Be prepared for disappointment but hope for the best
10. Never assume anything!

Yes it has been a very interesting year and I have learned so much. I have been really blessed to be working with a great team and manager which makes all the difference and really hope the next year will be as good as the last. There are definitely challenging times ahead....

Had two sessions booked in today - one a critical appraisal: qualitative research and the other a session for specialist cardiac nurses, neither of which turned out quite as I planned! First of all nobody turned up for the critical appraisal session - I had 5 potentially booked and not a one arrived. A very apologetic doctor turned up an hour and a half later; he had been in a minor car accident and sorting out all the paperwork had taken longer than expected. I had an email from another potential trainee later on as well - she had got confused about the date. So I'll let them off but no idea what happened to the others!

The cardiac nurses session was a bit strange as well, although at least 4 turned up! I had been told to expect quite high-level nurses, familiar with libraries and database searching but none of my trainees matched this description. They were all lovely but I don't think any of them had ever seen a database in their life, which meant I had to adapt the session slightly. However at least we got them all registered and they know the library is here when they need it.

Well I am off on holiday to North Wales tomorrow so I won't be blogging again for a little while. As I am feeling a little de-mob happy I thought I would post this wonderful video a friend sent me on Facebook today: http://www.youtube.com/watch?v=a_uzUh1VT98.

Enjoy!!

Sunday, 23 May 2010

Graduation and All That Jazz

Well probably the high light of this week was our graduation ceremony at the Guildhall in London on Tues. Arrived bright and early at 8.30am to be robed in a very handsome black gown with a gold and burgundy sash (and cap, of course). Most of my friends off my course came (we were all full-timers) and it was a very nice ceremony with full faculty parade, brass band and all. The Library and Information Studies class came right near the end so we had to sit through a lot of names before it was our turn. I had never been to the Guildhall before and thought it was a lovely building, full of history.





Back to the grindstone on Wednesday with my first Systematic Reviews workshop and a Learning Awareness Week stand outside the hospital canteen. I had two doctors sign up for the Systematic Reviews course, but only one turned up. He was very keen though and interestingly he had already done a systematic review recently. He wanted to know more about tracking down articles and making sure he everything written on a particular subject. So I ran through my presentation and we sat down and did a little literature search later on. I'm not sure how useful the course was to him but I did try to encourage him to ask the library to help out with his literature searches! He is coming along to the Reference Management and Finding the Evidence Improvers this week (one after the other, phew!).

Learning Awareness Week went pretty well - the stand outside the canteen on Wednesday attracted a fair amount of attention (lots of freebies!) and we got people to fill in slips of paper with their name, job title and something they wanted to learn or something they had learned this week. We then made these into a long chain, which is now hanging proudly on our journals shelf! On Thursday we had a drop-in session for people to make the most of their Athens accounts but in the end only had 2 takers. Still it was worth doing and all-in-all a good chance to get out and interact with some potential users. The most interesting and rewarding part of the week for me was meeting a patient who came up to our stand and wanted to know more about where to find medical information. We had a really good chat and I pointed her in the direction of NHS Evidence and NHS Choices, both excellent, free sources of information for patients and carers.