Health librarians have been at the forefront of responding to the Covid-19 pandemic. Catherine McLaren, on behalf of the Health Education England (HEE) Library and Knowledge Services Team, looks at what that has meant over the last three months – and what it means for the sector as it moves forward.
Although we are all still amid change, the national Library and Knowledge Services team within Health Education England (HEE) has recently taken stock of our activities through the pandemic to date. We are keen to understand the learning
that we can take from the experience and are sharing our reflections at this point in the hope that this may be helpful to others.
Implementing Knowledge for Healthcare, the team leads a strategic approach to the development of NHS library
and knowledge services. Now, as in normal times, we provide professional advice to the system and to health librarians. The team procures and ensures that the NHS has 24/7 access to evidence and knowledge resources, supports the development
and assures the quality of NHS library and knowledge services in England. During the Covid-19 pandemic we have also undertaken some direct service provision where we have identified a single, central approach as the most effective
response to the need.
On 30 January 2020 the first laboratory confirmed case by specimen data of Covid-19 in England. The next day another one followed, and throughout February cases slowly picked up. At the same
time people were placed in quarantine as they came back from Wuhan China. Information professionals were quickly on the case. On 18 February #ukmedlibs held a twitter chat on Questions for coronavirus, and other public health emergencies: the librarian’s role.
The chat was hosted by Caroline De Brún of Public Health England (PHE) and highlighted the work of libraries during health emergencies. By the end of the chat5 that evening, a lot of material had been gathered and ideas on the best way forward had been shared. The HEE Library and Knowledge Services team immediately decided to create an online resource to bring information and ideas together in response to the developing
crisis. We chose to host the new resources on the Knowledge for Healthcare blog, as a site with which NHS librarians were already familiar.
Scope of the response
By the beginning of March there were over 80 lab-confirmed cases and, on the 6 March, sadly the first death. It was clear that health services across the UK were going to be affected in an unprecedented way due to Covid-19.
We wanted to facilitate knowledge sharing by NHS library staff in England so that they could better support the wider health system. Information products needed to be quickly developed and shared. We committed to developing resources
that would directly meet the needs of health librarians and save them time. Out of this came the Covid-19 blog site pages which went live on the 13 March
2020. We saw that work was being repeated across the system. Recognising that some knowledge services were under pressure, and that health librarians offer unique specialist skills into the system, we wanted to assist and encourage
colleagues to share their work and avoid duplication, releasing their time to focus on priorities.
We wanted to bring all the evidence sources linked to Covid-19 into one place and highlight what information was freely available. Doing it
in this way means that as things change, we update one national page rather than several regional or local pages. This applies both to sources in the wider system and to sources for library and knowledge specialists. HEE’s
Knowledge Management team compiled and updates resources for the international Coronavirus section on e-Learning for Healthcare, notably compiling essential guidance.
Database and e-resource providers opened a lot of resources relevant to Covid-19 for free, in a short period of time. The HEE Library and Knowledge Services team saw the need to collate information into one place. Additionally, publishers have also opened e-resources that are not directly linked to Covid-19
for a limited time. We focused on selecting those resources that NHS librarians could make readily discoverable for healthcare staff via the discovery platforms they already use. In this way we can enable and disable access
quickly and easily as publishers change their position.
The evidence sources page went live on the 24 March. By then it had already become clear, as NHS staff across the system began posing questions, that there was duplication of requests for literature searches and evidence summaries
on different aspects of managing Covid-19. The HEE team responded by forming a working group of expert searchers from across England with members of the HEE Library and Knowledges Services team. They worked together to plan
and deliver a service, inviting colleagues to share their work to assist library and knowledge services staff and better meet the needs of NHS staff in England.
Searches are received through a central email; they are then distributed to the expert group for assessment against the inclusion criteria before being added to the search bank [n=138 at 12 June 2020].
The page went live at the end of March, and continues to be refined. It also links users to several ready-made search strategies.
Naturally, other nations and organisations have similarly come together to streamline procedures around how their library and knowledge services teams are working to provide evidence and support librarians and knowledge specialists
through the pandemic. We signpost work undertaken by Scotland and Ireland and other countries. At a strategic level, the national lead is in regular liaison with the NHS leads in the home countries, with Ireland, and across Europe through the European Association for Health Information and Libraries.
One area where NHS library and knowledge service staff were struggling to support the healthcare workforce effectively at the start of the pandemic was information overload. In a time of pressure and change when getting the right
information to the right people is even more important, we wanted to highlight to NHS library and knowledge service staff the work that had already been happening around current awareness.
Recognising that some services might be struggling to maintain current awareness services, or needing to set something up in a hurry, we signpost to Current Awareness Service for Health (CASH) and KnowledgeShare, the two dominant services in this field on a page on the Covid-19 blog.
We are encouraging a collaborative approach, linking to bulletins that library and knowledge services are happy to share, providing details on who to contact and when each is updated.
With an impressive track-record of cooperation and networking, the experience of working through Covid-19 has only strengthened the level of collaboration between NHS library and knowledge services. They are willing to share the
work they are doing with other services in the NHS and recognising that in many cases this only needs to happen once.
Adapting the workplace
HEE has successfully ensured maintenance of 24/7 access to evidence-based digital knowledge resources for the whole NHS workforce throughout the pandemic and focused on business resilience to achieve this. Sixty per cent of NHS
libraries remained physically open throughout the pandemic, most staffed but with reduced staffing and 21 per cent accessible to healthcare staff but not staffed. In a further five per cent of cases, service delivery has been
When needed we have highlighted information to library and knowledge services staff so they could make changes, which keeps themselves and their users safe. This included the guidance from the Covid-19 Guidance Cell of Public Health
England’s National Infection Service, as advised to the Department of Digital, Culture, Media and Sport at the end of March:
- The risk from books covered in a plastic cover handled by someone who is a possible Covid-19 case is negligible after 72 hours.
- The risk from books with a cardboard/paper cover is negligible after 24 hours.
As services assess and plan the changes they need to make over the medium term the Adapting the Workplace pages enable
library service managers to share information, including approved plans and resources, around what they are doing to fully reopen the physical space. We include some of the work that has happened elsewhere, including in this
area from NHS Wales and it enables those libraries who have been continuing their physical services throughout the pandemic to share their learning.
Knowledge for Healthcare Blog Usage
Mostly the blog site is being accessed from the United Kingdom, but it has also been accessed from Australia, Canada, Finland, France, Germany, Ireland, Netherlands, Spain, and the United States. The three pages within the Covid-19
resources with the highest unique page views up until 7 June, are the evidence sources (4,450), literature searching (3,085) and adapting the workplace (983). Across all the Covid-19 pages there has been over 14,000-page views.
Patient and Public Information
Early on we started a Covid-19 page for patients and the public which signposted to the NHS coronavirus hub, NHS 111, the WHO information
network and highlighted myth-busting links.
We were very aware that in many cases this was not enough. Lots of organisations and charities were providing information specific to their clients’ needs around Covid-19. Healthcare staff had no one place to go to find this information.
We wanted to assist NHS library and knowledge service colleagues bringing information together to save them time. At the same time, we wanted to support NHS and social care organisations to meet the Accessible Information Standard.
Liaising with NHS England, Public Health, NHS for Scotland and the Patient Information Forum, we confirmed that it would be helpful for the HEE national team to take on the role of curating this information and that other NHS organisations
would then signpost to the pages we built. While the national Library and Knowledge Service team does not usually undertake direct service provision, we were delighted to capitalise on our own team’s expertise and experience
to collate a central collection of Coronavirus Resources for the Public as part of HEE’s response to the pandemic.
Launched on 26 May 2020 the library. nhs.uk resource of Coronavirus Resources for the Public initially focused on three areas: Children and Young People,
Older People, and Accessible Formats. The latter has attracted the most
use to date. By 11 June there had been over 11,018 unique visits to the site. Further areas are in development; we are collating Corona- virus information resources on Cancer, Wellbeing, Long Term Conditions and Carers.
Liaising with NHS library services that stepped up to support the information and evidence needs of staff at the new Nightingale hospitals has been an important area of work during the pandemic. The London site opened in early
April. Barts Health NHS Trust Knowledge and Library Services were able to offer knowledge services and resources. The team was quickly able to promote resources that had already been gathered by HEE on the Covid-19 blog pages.
Nightingale Hospital London,
As other Nightingale hospitals were planned the HEE team set up a com- munity of practice for the library and knowledge services staff involved, so that they could collaborate, learn, and support each other. As part of this, clinical
decision-making tools like BMJ Best Practice have been embedded into the patient record.
Representatives from the library and knowledge services supporting the seven Nightingale hospitals in Birmingham, Bristol, Exeter, Harrogate, London, Manchester and Washington participate in this community of practice which is facilitated
by the HEE team. To begin with they met weekly and the learning from the London team was shared with the group.
Meeting training needs
NHS librarians have an impressive record of networking as a means of mutual support as well as knowledge exchange. The HEE regional teams have ensured regular contact with trust library service
managers throughout. We moved fast to commission programmes to support virtual working – facilitating virtual meetings, developing skills to deliver training online. These were fully booked within 30 minutes of being advertised and
are being repeated to enable maximum participation across the country. Equally we have been concerned to support individuals through a challenging time and have offered sessions on wellbeing and resilience.
Learning to date
We will continue to reflect on an ongoing basis, but there are some initial themes. Covid-19 has raised the profile of NHS library and knowledge services in many trusts. It has the potential to influence the design and delivery of
services going forward. The delivery of health library and knowledge services through the pandemic reinforces guiding principles and values articulated in the Knowledge for Healthcare strategy,
- Collaboration: we observe greater collaborative working between NHS library services
- Digital-by-default: accelerating approaches that optimise digital and virtual delivery
- Collective purchasing: centralised procurement to reduce inequities in access to evidence sources
- It also speaks to the importance of mobilising knowledge to support evidence usage from Board to bedside.
Teams are supporting each other not simply by knowledge sharing and through networks but by sharing and repurposing information outputs.
Looking ahead to the ‘new normal’ in which health and care staff will be working we see a greater role for health library and knowledge service teams in supporting digital skills, digital and health literacy and patient information.
At the same time, the pandemic experience has surfaced that health librarians will want to consider whether there are further areas where it is most productive to create a single resource, or lead delivery of a single service once,
All these themes will be reflected in the refresh of HEE’s strategic development framework, Knowledge for Healthcare. As a member of the HEE Library and Knowledge Service team this time has been equally challenging and rewarding. There
have been the personal challenges faced by all of us of seeing society, work and family life change overnight. There has been the challenge and delight of virtual working, of virtual friends and virtual family. Gardens and public
green spaces have become more important. It has been rewarding to engage my critical thinking and assessment skills of information while contributing to the direct service provision provided to the public through the Coronavirus
resources on library.nhs.uk. Working as part of a diverse and skilled national team during this time has allowed me to develop my skills further in different areas including curating information, responding to training needs and
web development all at speed.
The dedication of NHS librarians through these difficult times is striking. For our part, the HEE Library and Knowledge Services team is focused on understanding how we can assist and support our colleagues to deliver knowledge services
to the NHS during the pandemic. We are committed to supporting library and knowledge services staff in the NHS, and to deliver what is of most help to them, as they continue their work to bring evidence to the ward and the Board,
to underpin patient care.
Details of access to library and knowledge services for Health Education England staff can be found