NHS libraries and e-library initiatives

It is important by way of background to provide some account of initiatives to provide NHS clinical staff with online resources for evidence-based practice and decision-making, as problems were frequently encountered with using these.

The provision of library and information services within NHS organisations was managed and

supported at a strategic level by Health Education England (HEE) (Health Education England, 2014). A development framework for library services, Knowledge for healthcare, was issued in late 2014 (Health Education England, 2014), according to which “Healthcare library and knowledge services underpin all aspects of the NHS - supplying the evidence base to the service to make decisions on treatment options, patient care and safety, commissioning and policy, and to support lifelong learning, undertake research and drive innovation” (p. 6). The provision of services was coordinated by library leads from each of the 13 HEE Local Education and Training Boards (LETBs), and subject to a national quality assurance framework. Library and information services within NHS organisations could vary greatly in form and means of delivery; they could be provided as standalone services, or

via outsourcing or partnership arrangements with institutions of higher education or with other NHS Trusts. Funding for libraries was complex and often historically based on educational funding

streams, with marked inequities between regions, and between the acute and other sectors (Ebenezer, 2000; Robert Huggins Associates, 2005; Hill, 2008; Stewart, 1992). This bore on the level of staff support available for service development and information literacy training, as well as the provision to end-users of subscription-based information resources.

It was common in the later 1990s for NHS libraries to purchase subscriptions to web-based versions of bibliographic databases locally, although a number of regional library services were experimenting with consortial purchasing (Pye & Ball, 1999). The 1998 NHS IT strategy Information for health (NHS Executive, 1998) included among its strategic objectives a plan to establish a National electronic Library for Health (NeLH) : “a National Electronic Library for Health including accredited clinical reference material will be established” (NHS Executive, 1999, p. 60). This was intended to provide easy access for clinicians to best current knowledge, and thereby to improve health and health care, patient choice, and clinical practice (Toth, Muir Gray, Fraser, & Ward, 2000), the assumption being that “health professionals have information needs that they themselves recognise and that they will access such information if provided with the means to do so” (Randell, Mitchell, Thompson,

McCaughan, & Dowding, 2009). The plans envisaged that NHS librarians would play a pivotal role in the development and delivery of the NeLH's aims and objectives. Included in the proposals was the creation of a series of so-called Virtual Branch Libraries covering specialised areas; these were intended to function as communities of practice (Brice, 2003). The pilot NeLH went live in 2000; it was launched as a full service in the spring of 2003. Available resources included a selection of evidence-based sources authenticated via the Athens system (now OpenAthens), including the Cochrane Library; the range of these increased over time. A subsequent IT strategy document, Building the information core (Department of Health, 2001) set NHS Trust IT departments a target for clinical and support staff to be provided with basic email and web browsing services by March 2002, and other staff to have them by March 2003. The NeLH aimed to work in partnership with NHS libraries (Turner, 2004).

The DH’s response to the report of the inquiry into paediatric cardiac surgery at the Bristol Royal Infirmary (Department of Health, 2002a), gave impetus to the establishment of a unified, hybrid National Library for Health (NLH) that included a greater amount of centrally-purchased electronic content (Ebenezer, 2005; Herman & Ward, 2004; Isetta, 2008), procurements for which were carried out via the National Core Content project (NCC)(Glover, 2008). A new common interface for

bibliographic databases integrated within the NLH website was implemented in April 2008, initially called Search 2.0, later renamed Health Databases Advanced Search (HDAS) (“Journals and

databases,” 2008). The deployment of an NHS-wide link resolver enabled library leads and Trust library managers to purchase additional content to supplement the “core” e-journal and e-book purchases, which could thereby be made available to staff within the relevant Trust(s). However, problems with HDAS (originally known as Search 2.0) had been frequently reported by librarians via the LIS-MEDICAL JISCmail list and elsewhere ever since its launch, including slow response times, non-availability of the service, crashes, anomalous search results, or problems with exporting search results. Even following a major upgrade in June 2012 which had been intended to address the main technical problems, these reports had continued.¹³ For the benefit of library staff reporting service issues, a summary of reported problems with HDAS had been published on the NICE website.¹⁴ As an measure to minimise their impact, access was made available for library staff and end-users to the relevant aggregators’ “native” interfaces as an alternative. In response to the ongoing problems, another major upgrade of HDAS was initiated in 2015 and launched in October 2016.¹⁵

During its ten-year life span, responsibility for the former National electronic Library for Health / National Library for Health transferred between organisations four times: from the NHS information Authority (NHSIA), to Connecting for Health when the NHSIA was abolished, then to the NHS

Institute for Innovation and Improvement before, following publication of the Darzi review (Darzi, 2008), finally transferring to the National Institute for Health and Care Excellence (NICE ), albeit in a considerably altered form — i.e. minus its strategy, its Virtual Branch Libraries and its development remit for NHS library services — as NHS Evidence (National Library for Hesalth, 2009). This

institutional instability, and the resulting separation of e-library initiatives from other aspects of NHS IT, is of importance culturally and politically, and is discussed further in Section 11.5.

13 They are referred to in the minutes of the LKSL Information Management and Technology Group for November 2012:

http://www.libraryservices.nhs.uk/document_uploads/SIMTG/SIMTG_minutes_14_Nov_2012.pdf.

The researcher has been unable to locate the report which was circulated to members of the group.

14 http://www.nice.org.uk/about/nice-communities/library-and-knowledge-services-staff/nice-evidence-services-issues.

15 http://labs.nice.org.uk/331-2/.

From the outset, the third-party authentication service Eduserv Athens (later OpenAthens) was used to authenticate access for NHS staff to e-resources.¹⁶ Eligible staff needed to register individually for OpenAthens accounts using an NHS email address or from a computer within the N3 network.

Accounts were issued for a period of two years initially. They could be retained when staff moved to another NHS organisation; users were required to change their account details online to do this.

Users frequently contacted library services requiring help with lost usernames or passwords (although an automated password reminder facility was available), with expired accounts, and with problems transferring their accounts. They were also likely to encounter problems with individual resources (see Section 5.3, below). A relatively small proportion of NHS clinical staff registered for OpenAthens accounts; the percentage of an organisation’s staff who were active Athens account users was at one stage proposed as a national key performance indicator (Royal Berkshire NHS Foundation Trust, 2014). In the interests of information literacy support, some universities also issued their health sciences students with university OpenAthens accounts; these provided access not to locally purchased material, but solely to the national core content e-resources (University Health and Medical Librarians Group, 2014). Students on placement within the NHS were also eligible to register for local NHS OpenAthens accounts on the same basis as staff, and an individual student was able to hold both types of account; this was another fertile source of confusion.

Individuals who were not eligible for a personal NHS OpenAthens account could be offered an access account, enabling them to access NHS e-resources within an NHS library on a walk-in basis.

End-users’ difficulties with Athens or OpenAthens authentication were referred to a major library strategy document: “There always seems [sic] to be problems logging into Athens … and accessing the article is quite confusing.” (Health Education England, 2015b, p. 14) This relates to Brennan et al.'s finding (2014) that NHS staff and student users perceived the need for usernames and passwords to be a major barrier to accessing information.

At the time of the study, social workers within the UK had available to them an information portal developed by the Social Care Institute for Excellence (SCIE): ¹⁷ those employed by local authorities who were working within the NHS had access online to a range of professional journals in social work, authenticated via Athens, as well as to local and national NHS information resources.

16 Eduserv OpenAthens: http://openathens.org/

17 SCIE: http://www.scie.org.uk [retrieved 01/05/2013];

In relation to access to information resources, one of the agreed follow-up actions from the TDAG survey (described below in Section 2.7.3.4.2) (TDAG, 2009b), was the setting-up of a national whitelist of “domains not to be blocked” within the NHS. This whitelist was updated at the group’s meetings, where candidate sites for addition to the list which had put forward by librarians within the members’ geographical areas were discussed and decided upon. The list was maintained as an MS Excel spreadsheet; it was available to download at the (LKSL) website.¹⁸ The successor to the group ceased to exist in March 2015 when LKSG’s subgroups were reorganised to align with the core themes of the Knowledge for Healthcare library strategy (Health Education England, 2014); its papers were archived on the site. Subsequently, arrangements were made for the list to be

maintained by one of the local OpenAthens administrators. The intention was that library managers should send updated versions of the whitelist to their Trust IT departments as soon as they were published, for the required configuration changes to be made.