Achieving an improved staffing ratio

The NHS requires proactive knowledge services as business-critical instruments of informed decision-making. Currently there is significant variation in the ratio of qualified librarians and knowledge specialists to healthcare staff, leading to inequitable service provision across England. This means that the Service is not uniformly able to draw on evidence for #MillionDecisions. 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.


For the first time this policy, agreed by the Health Education England Executive in November 2019, provides a set of recommendations from which trusts and arm’s length bodies may look to ensure, and where necessary continuously build, improved staffing levels.

Recommendations:

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 much-improved 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.

Organisations are invited to contact their local HEE Library and Knowledge service lead for support in progressing these recommendations.  

Sue Lacey Bryant
National Lead for NHS Library and Knowledge Services

Impact Case Studies:

Advice around obtaining figures for cost savings

There are currently over 250 impact case studies on the Knowledge for Healthcare listing. Many of these mention savings in terms of clinical and managerial staff time, and financial savings.  Very few of these, however, provide actual figures in terms of financial savings.

Such figures are, however, invaluable in adding to the weight of the impact case when used for national advocacy purposes.  It was decided to investigate the services who had successfully obtained financial figures for their case studies to determine whether there are any useful lessons or advice which can be shared for others trying to replicate their success.

Responses

Eight services were identifies as having submitted one or more case studies providing details of cost savings achieved.  These services were approached for details of any techniques, learning, and/or advice for colleagues wishing to replicate the success.

Seven services responded to this enquiry:

  • Blackpool Teaching Hospitals NHS Foundation Trust (Michael Reid)
  • Brighton & Sussex University Hospitals NHS Trust (Ben Skinner)
  • Buckinghamshire Healthcare NHS Trust (Sarah Lewis)
  • Chelsea and Westminster Hospital NHS Foundation Trust (Uma Devalapalli)
  • Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (Sarah Gardner)
  • George Elliot Hospital NHS Trust (Stephen Ayre)
  • Warrington and Halton Hospitals NHS Trust (Alex Williams)

Their notes, advice and reflections have been collated into a short report.

Summary

Key points from the above:

  • Those who have received services from the library are often keen to help.  Maximise this opportunity if you can.
  • Involvement with projects supported by a search from the start can provide greater insights into the impact of the work.  Make the most of such involvement.
  • Using and analysing a questionnaire can provide signposts to those cases worthy of further investigation.
  • Allow time for financial savings to have been realised before following up
  • Use the personal approach where possible and interview colleagues to allow for focused probing with regard to details of financial savings.
  • Be flexible with the questions you ask and tailor the interview to the situation for best results.  This includes the language chosen.

While recognising that collecting data on financial savings can often be complex and challenging, we would encourage you to make use of the advice and learning included in the report when tackling impact in your own organisation.

You may also be interested to watch out for the latest paper on the NHS Clinical Librarianship study which is due to be published soon.   

Digital knowledge resources: rethinking NHS investment

Digital knowledge resources are high on the agenda. We know that NHS library services across England will recently have spent time finalising subscriptions for 2020. Those with April-March subscriptions will be gearing up for a similar round of activity in the Spring, involving publishers and local procurement and finance departments. Next there is all the associated work of updating holdings in catalogues and link resolvers to be done.

Elsewhere in the UK healthcare library staff now spend very little time on activity relating to e-resources. In Scotland, Wales and Ireland, the vast majority of NHS-funded digital knowledge resources are purchased and managed centrally, freeing up time for local library staff to focus their expertise on delivering knowledge services to users.

In England only 25% of total NHS spend on e-resources is invested nationally, and all the work associated with 75% of investment has to take place locally. Given the commonality of the resources we see being purchased locally for acute, mental health and community staff, and in the context of the principles of Knowledge for Healthcare principles relating to equity, efficiency and economy of scale, these proportions should surely be the other way around.

Open access publishing is advancing. The transition from payment for access to payment for publication is gathering pace. In our knowledge-based industry embracing the administration involved in article processing fees hardly seems a good use of the time and expertise of already-stretched NHS library staff. A nationally coordinated approach makes even more sense.

With the majority of HEE library funding distributed to trusts within education tariff, we can currently only take small steps towards this. We continue to engage with suppliers about the need for fair and transparent pricing which incentivises collaborative procurement, uses appropriate workforce numbers rather than bed numbers, recognise the value of content over platform-specific ‘bells and whistles’, and will support cost-neutral transition to open access, and some have responded very positively. HEE has commissioned NICE to procure a new Framework Agreement to replace the one which expires in September 2020 and we expect it to reflect all these principles.

We’re working hard to seek the introduction of a separate LKS Tariff which may provide a mechanism for pooling funded, but re-stacking public investment in digital collections will continue to rely on the willingness of library teams and host trusts to share costs and combine effort. The signs are promising: our 2018 survey of managers indicated that 86% would definitely or possibly be willing to pool e-resource funding nationally. We see lots of potential to scale up successful local collaborative procurement schemes. Greater central and national procurement will avoid replication of effort, freeing up staff time that local service managers can choose to direct resource into services to staff and learners, in the best interest of patients.

As we go into a new decade, the future lies in your hands. We are gearing up for the challenge of the new decade! Are we ready?

Season’s Greetings from the HEE Library Leads Resource Discovery Team
Helen Bingham, Richard Bridgen, Dominic Gilroy, Helene Gorring, Lucy Reid and Jenny Toller