Health has always been high on the local political agenda. It is crucial in local strategic partnership development, and links in well with local authority social inclusion initiatives. The professional library literature of recent years records a steep rise in interest in health, with more and better informed users wanting to take greater responsibility for their own health. This in turn coincides with the NHS aim of greater patient empowerment. All agree – health is a ‘good thing’.
The development of health information and promotion in libraries, though, has (with a few notable exceptions) progressed cautiously. The reasons for this are fairly obvious: as non-specialists, librarians may not have the knowledge to be able to assess the value of one information source over another, and cannot risk providing anything that might be construed as a medical opinion. In the face of an increasingly litigious culture, health initiatives in many authorities have until recently been aspirational – recognising many of the advantages of libraries and information staff, in terms of accessibility, information management expertise and service delivery infrastructure, but unsure how best to proceed.
A project earlier this year on health partnerships provided an opportunity to look at different types of health information delivery outside a hospital environment. The sample was largely self-selected (those who responded to a message posted on lis-publibs) but did illustrate different models for delivering health information, or information combined with specialist advice and support, into the heart of communities. All share the wish to be inclusive and accessible, but the way they are evolving is different.
This article looks at four models of practice – though the divisions between them are by no means watertight:
- The branded health information service
- The ‘department store franchise’
- The medical prescription service
- The supermarket concession.
The branded health information service
This is a library-based information service, with a clear individual identity, which provides health information or signposting on to other health services, but does not itself provide advice or formal counselling by a health practitioner. One of the longest established of these is Healthpoint, based at Poole Central Library, which has been running for 15 years and serves the population of three local authorities. It is currently funded by NHS Direct, with which there is a formal contract, and there is also a formal service level agreement with Social Services.
Over the years, good relationships have been built up with local voluntary sector bodies and the nearby Poole hospital service. Vivienne Grier, Healthpoint’s manager, comments: ‘Healthpoint is successful because it’s run professionally, with informed staff, up-to-date materials, and a lot of experience. It’s much more difficult to develop a service if you have to start on a shoestring with a couple of volunteers – you really need sustained investment from the start.’
A more recent service, based in East Renfrewshire, is a healthy living initiative called Health Connect, where money from the New Opportunities Fund (NOF) has enabled it to appoint a Health Information Development Worker and set up two permanent health information displays. Health Connect felt that libraries were an excellent base from which to reach the public. Much of the health worker’s efforts are directed to contacting groups which already meet regularly (e.g. the elderly, parents, teenagers) with a view to providing health information sessions, and encouraging them to contact the health worker with health queries.
Another strand of work is regular attendance at exhibitions and open days on health issues. Marie Hedges, the Project Co-ordinator, has identified critical success factors for the project (which has been successful both statistically and in the perception of local communities) as including good leadership (to ensure partnerships are motivated) and good communication.
The importance of senior-level involvement is underlined by Manchester, where the city’s Health Matters partnership is chaired by Annette Walters, the Head of Information Services, and includes other people who are influencing policy and direction. So far, one Health Matters information point (offering print material, internet sites and partner leaflets) has been set up (in Withington Library) and funding has just been obtained to roll them out across the city. There are plans to extend the service to include specialist nurse drop-ins, and to explore how the mobile service can be brought in.
The partnership recognises the need for strong branding and marketing (including building contacts with health-care professionals), and Health Matters has a clear, bold logo which appears on the shelf labelling as well as the publicity material. Another important factor is appropriate training, and Manchester has received funding for a member of staff to put together a vocational training package for library staff dealing with health enquiries.
The ‘department store franchise’
The information services in this model also work closely in partnership with their host libraries. What differentiates them from model 1 is that these branded services are linked to specific medical conditions, and include advice and support from health professionals or others (e.g. volunteers) who have some personal experience of that condition. Typically, the library will provide space, basic overheads and ‘in kind’ contributions such as professional input into service development via project steering groups, but otherwise the initiative is externally funded.
One well-established example is the Birmingham Arthritis Resource Centre (Barc), based in Birmingham’s Science Library but is registered as a charity attached to Birmingham University’s Rheumatology Department. Both the Head of the Science Library and the Head of the Central Library sit on the steering group. The aim is to provide a non-clinical environment, accessible to all. In addition to the paid posts of Manager and Volunteer Co-ordinator, there are 15 volunteers from various ethnic communities.
As well as providing support for patients with arthritis or rheumatism, Barc provides support for informal carers of these patients (such as partners and family) and health-care professionals from all backgrounds. Helping under-served groups, especially people of non-Caucasian origin and/or people with literacy problems, is one of Barc’s key aims.
A lot of outreach work is done in the smaller community libraries, and Barc also arranges for groups to come in for talks – some by minibus from some distance away. These are often not library users, and they can then be sold the benefits of library membership. Training in finding the best websites is given to those who are not computer literate, and a six-language website is under development.
As a mutually enthusiastic partnership, it clearly works well, and has been so successful they are now discussing extending the concept to other medical conditions.
Wirral Libraries hosts one of the increasing number of specialist library-based information services provided by Macmillan Cancer Relief and its NHS partners. As with other similar projects, it arose from a recognition of the community access capability of libraries – in this case, by Paul Mackenzie, the Primary Care Service Improvement Facilitator, who contacted the Head of Libraries. The project developed from there, building on Wirral’s existing good record in health promotion. A key feature was the input provided by the active Patient/Carer Group which was very clear what it wanted the service to provide.
Launched in April 2004, it offers a specialist book collection, free leaflets, and is developing for the larger libraries a drop-in advice service by a Macmillan Information Facilitator. As well as plans to involve 64 GP practices and to collaborate with other health professionals such as the Healthy Schools Initiative Co-ordinator, it is hoped to develop a library ‘buddy’ service whereby enquirers can talk one to one to trained volunteers who have been affected by cancer themselves.
The medical prescription service
One of the defining features of this model (which does include ‘ordinary’ health information services as well) is the concept of having a prescription, prepared by a health professional, for further information on conditions or procedures. This prescription (which could be for print or electronic information sources) is then fulfilled with the help of an information professional.
One example of this is the Monkfield Medical Practice at Great Cambourne, in Cambridgeshire, a new town where it was envisaged from the start that the library and the health centre would be accommodated together in a purpose-built community building. It was decided to explore the contribution of an information professional to the provision of a primary health-care service by establishing the role of Community Health Information Development Officer within the new health-care team. The goal was to enable every patient to achieve a better understanding of their health issues and an improved ability to manage their concerns themselves. The Information Officer’s activities cover a wide range of liaison functions with local bodies, marketing and promotion, creating and maintaining a Health Information Point, and providing an information service to patients and clinicians.
The role has included the development of an Information Prescriptions concept, whereby physicians prescribe further information which can be delivered in the form of a pre-prepared pack on a common issue, or more individual assistance in searching for print or electronic sources of information. Additionally, professionals within the practice are encouraged to seek information prior to a patient consultation or following a media story. Appointments with the Information Officer can be arranged by the clinicians or directly by the patients themselves. With three years’ experience under her belt, Diane Wilson, the Information Officer (who spends 50 per cent of her time working for the practice, and 50 per cent for the library) believes that one officer could act as a prescriptions resource for a much larger population of clinicians and patients, perhaps across several practices. She has no doubt about the value of the experiment: ‘The concept of a shared role across libraries and health is very interesting and productive. Why aren’t other people doing it?’
The new Book Prescription Scheme in Plymouth is one of several health-related projects that the Central Library is involved in. This one arose partly from an approach by the University of Plymouth – to see if the library was interested in setting up a book prescription service similar to the Cardiff Book Prescription Scheme.1 It now includes partners from Torbay and Devon library services. One initial worry was the funding of the bookstock to support the project. However, when the suggested titles were looked at, the library realised that a lot of the material was already part of the mainstream stock, and that it would just need to buy multiple copies of about 35 titles for the main libraries, which can be transferred to smaller libraries on demand. The library funds the book purchase, the Primary Care Trust funds the prescription leaflets which will be issued at selected GP practices. Ann Henderson, the Information Services Manager, is very optimistic about the benefits of this project, and its sustainability, since no external funding has been sought. A particular concern of hers has been the need for good communication. This will include an external communication plan for the public, and also ensuring that front-line staff are aware of what’s going on and trained to deliver to a vulnerable client group.
The supermarket concession
Yes, you really can get health information at Asda! The Bournemouth Health Information Shop is a concession unit based within an Asda supermarket in the town centre. This is not a library initiative (though it does have professional library input on its steering group, and is just beginning to discuss a possible partnership with the local library service) but was set up by Bournemouth Teaching Primary Care Trust (the PCT) to provide an access point for the public within a community setting. It arose from the Department of Health report Shifting the Balance of Power,2 which advocated delivering public health and preventative work within the community. The aim of the shop (which is staffed by administrators not health professionals) is to deliver comprehensive health information to meet the needs of the local population and to promote partnership working. In 2003 it was highly commended in the Dorset and Somerset NHS Modernisation Awards.
The shop provides health promotion leaflets, organises ‘themed’ days and provides a monthly drop-in service when a nurse carries out blood pressure sessions. The PCT’s PALS (Patient Advice and Liaison Service) service is also based here. Staff handle telephone enquiries as well as personal visits, and can carry out information searches using websites approved by the PCT. Situated where it is, it has high visibility, and the number of enquiries is rising.
Key issues
More and more public library authorities are looking to get involved in health-related projects and, as the examples above indicate, there is an increasing amount of useful and varied experience to draw on. Speaking to staff around the country involved in delivering health information to the public, the same key points kept coming up, namely:
The quality of partnership working
- Multi-agency partnerships take time to reach the stage where there is good mutual trust and confidence, where each partner understands the others’ organisational objectives, what they want from the relationship and what they can bring to it
- Initial buy-in must be at a senior level
Project management
- Done properly, these projects can take substantial planning and investment – don’t underestimate the resources required
- Steering groups must represent all stakeholders
- Projects need to have clear leadership and good communication. It is worth taking time to build an effective project team which understands team dynamics and can take corrective action when required
- Identify and celebrate milestones
- Have a system in place for monitoring and evaluating what you are achieving
- Sustainability may be a key issue: think ahead to what might happen at the end of the project and be clear what the possible options are, instead of just hoping for the best
Contractual and staffing issues
- Most current projects operate on a rather informal basis, but the trend is towards establishing more formal arrangements. Consider whether this would be useful for your project
- Make sure that the project is complying with current legislation (e.g. data protection) and has taken account of any liability issues
- Shared line management of the information staff delivering the service can be a hazard – make responsibilities and reporting lines absolutely clear
- Volunteers can play a valuable role in providing support to patients and carers in library environments, but the service must be managed by someone who can take proper responsibility for it
Marketing
- Marketing needs to be sustained (not just a ‘big bang’ at launch) – make sure adequate resource is built into the budget
- Develop a strong, identifiable brand
- Don’t ignore internal marketing to library staff: they have to own the project too
Training
- Make sure front-line staff know what’s going on, and are adequately trained to deal with target groups
- Identify the training needs for those delivering the new service. Are there local health librarians who can help? Formal courses?
Increasingly, projects such as these are demonstrating the value for library services of developing health-related partnerships. The growth potential for innovative service development using ICT or outreach activities is huge. They can bring new users into libraries, and extend librarians’ skills and knowledge. Best of all, they are making a genuine contribution to improving the health of communities.
Contacts
Birmingham:
Brian Gambles, Head of Central Library (0121 303 3372; Brian_Gambles@birmingham.gov.uk) and Chandrika Gordhan, Manager, Birmingham Arthritis Resource Centre (0121 464 2708; c.gordhan@bham.ac.uk).
Bournemouth:
Belinda Pearson, Manager, Health Information Shop, Asda, Bournemouth (01202 318954; healthinfoshop@btconnect.com).
Cambourne:
Diane Wilson, Community Health Information Development Officer, Monkfield Medical Practice, Cambourne (01954 282164; Diane.Wilson@gp-D81637.nhs.uk).
East Renfewshire:
Marie Hedges, Project Co-ordinator, Health Connect, Barrhead (0141 577 8435; marie.hedges@renfrewshire.gov.uk).
Manchester:
Annette Walters, Head of Information Services, Manchester Libraries and Theatres (0161 234 1994; a.walters@notes.manchester.gov.uk).
Plymouth:
Ann Henderson, Information Services
Manager, Plymouth Libraries (01752 306795; ann.henderson@plymouth.gov.uk).
Poole:
Vivienne Grier, Health Information Librarian, Poole Libraries (01202 675377; v.grier@poole.gov.uk).
Wirral:
Peter Aspinall, Project Officer, Wirral Libraries (0151 643 7228; peteraspinall@wirral-libraries.net).
References
1 Wales Mental Health in Primary Care website (www.wales.nhs.uk/sites/home.cfm?orgid=405).
2 Shifting the Balance of Power: the next steps. Department of Health, 2001. Available to download from www.dh.gov.uk Publications and Statistics site.
Diana Grimwood-Jones is an independent consultant (diana@artemisconsult.demon.co.uk).