This year more than most, the role of knowledge in the NHS has come to the fore. As the world has responded to the most significant health crisis of modern times, the dissemination, interpretation and application of evidence, knowledge and insight has led the fight against Covid-19. Sue Lacey Bryant, National Lead for NHS Knowledge and Library Services, talks to CILIP Chief Executive Nick Poole about how NHS Library information teams have supported services throughout the crisis.

It’s no surprise that the role that NHS knowledge and library services play in shaping the decisions of frontline teams is coming into sharp focus. (Celebrated between 14 and 18 June during the first ever NHS Knowledge and Library Services Awareness Week.) However, it isn’t just clinical responses for which England’s network of NHS library teams provide the evidence.

An information scientist and librarian by profession, Sue Lacey Bryant is a vocal champion of the role that knowledge plays in the success of the NHS – in every regard. As the national lead for NHS Knowledge and Library Services, Sue leads a pioneering strategy to deliver Knowledge for Healthcare, placing knowledge at the core of NHS decision-making, equipping colleagues with valuable evidence and enabling teams to share their learning from experience. Building on the first five years of work, Knowledge for Healthcare 2021-2026 was launched earlier this year.

Expertise in action

“Applying knowledge into action is the currency of a successful healthcare organisation. But we know that evidence does not speak for itself – it needs to be mobilised at the right time and through the right people to make a difference in decision-making,” explains Sue.

“Helping NHS bodies, staff, learners, patients and the public to access and use the right knowledge at the right time, in the right place to inform decision making and drive delivery of excellent healthcare and health improvement, is at the core of our work.

“It’s the expertise of our library teams that actively mobilises knowledge. Above and beyond enabling staff and trainees to pull down the evidence they need, and pushing out targeted and tailored information about research to health professionals, increasingly knowledge specialists are aligned to multidisciplinary teams. They enable NHS organisations to make an asset of the knowledge and experience of their staff. They find, synthesise and summarise evidence; saving staff time, placing evidence at the fingertips of health professionals, and at the heart of healthcare

“Knowledge services are an essential part of the decision-making infrastructure of the NHS, as well as of its education and training infrastructure. I am tremendously proud to work for the NHS and it’s a real privilege to be leading the work to ensure that the value that our incredible library services can bring to healthcare is fully realised.”

Equal benefit

The Knowledge for Healthcare strategy sets direction, providing a common development framework across the country.

“Knowledge for Healthcare is a change programme, at a really fundamental level. The ambition is to enable all NHS staff and learners to benefit equally from high-quality knowledge services, and to optimise the expertise of knowledge service teams to inform decision-making from board to bedside, and in community and primary care settings,” explains Sue.

The NHS employs 1,200 library staff across 183 services in England. And it is their work that has delivered the significant progress made through Knowledge for Healthcare. There is a raised profile and respect for these services across the NHS and this is absolutely at the door of the work that library teams do, day in day out, to support their colleagues on the frontline. “It is about taking library services that are highly respected and trusted by frontline teams, through decades of work focused on education and on clinicians, and moving that forward in a way that establishes knowledge services as a business-critical basis of decision making. It’s an evolution of our services, ensuring that we maximise the return on investment in knowledge.” Sue’s team recently developed a value proposition for NHS knowledge and library services – ‘The Gift of Time’ – work designed to help healthcare professionals understand the tangible impact the service can have on their practise.

Demonstrating value

Undertaken by an independent health economist, the study homes in on the real impact of knowledge and library services, producing a value proposition that captures the unique benefits of knowledge and library services to the NHS. The report focuses on two key strands: meeting the duty that the NHS has – under the Health and Social Care Act 2012 – to use evidence from research; and understanding how clinical librarian roles, and other embedded roles within clinical practise – impact on outcomes.

“Well, it’s the Holy Grail. Having a value proposition that really captures the difference we’re making to healthcare,” says Sue.

“We were able to see very clearly, the expert skills that knowledge specialists have in finding and presenting evidence and synthesised information and the real impact of this. The health economist reported that the service provides healthcare professional staff with time saving, accelerated access to better quality evidence which in turn allows the NHS to meet its statutory obligations to utilise evidence from research. There is, of course, enormous value in this.

“It found that our fantastic knowledge and library teams help healthcare professionals use their time more effectively to drive improvements against the quadruple aim of the health service - improving the health of populations, enhancing the experience of care for patients, reducing the per capita cost of healthcare and improving the staff experience of providing care. The study reported that NHS library services deliver a net economic benefit of £77m per annum, and were the staff ratio for qualified librarians improved in line with Health Education England’s recommendations, that number could be rather greater.

“It is an incredible demonstration of the value of the work of knowledge specialists, knowledge managers, everyone who works in our NHS libraries. I see their impact. I see the difference our service makes, but to have an objective view on that – and to see it played back so clearly through the ways in which these Services inform decisions – whether on clinical guidelines or treatment options for an individual patient, or service design, is really something. These are decisions that should be based on the very best evidence – and library services staff in Trusts can bring that together, taking a wealth of evidence from research and across a range of experience and specific insight - or ‘know-how’ for short – enabling NHS professionals to use that knowledge effectively.”

The right decisions

Under Sue’s watch, NHS knowledge and library services staff have been able to bring to life the diversity of their work and their real impact. Much of this is thanks to the #AMillionDecisions campaign, a partnership between Health Education England and CILIP Health Libraries Group. Recognising the enormous number of decisions taken across the NHS every single day, this initiative spotlights the significant role that knowledge and library specialists can play in ensuring these are evidence-informed.

“The #AMillionDecisions campaign really helps to shine a light on the importance of knowledge for decision-making and the valuable work of information professionals in nurturing the NHS as the learning organisation that the health service strives to be.

“It has given a platform to recruit wonderful champions to tell their story of working with librarians and for knowledge and library specialists to articulate the difference they make. #AMillionDecisions gives teams a stage on which to showcase the impact that evidence brings to bear, and how their skills in searching for evidence, and managing knowledge help health professionals improve patient safety, reduce costs, lead effective change management programmes, and redesign the workforce. Yes, the knowledge service helps clinicians keep up to date with key information in their world – but it is so much more than that, supporting roles in research, quality improvement, management, finance, procurement and more.”

Sue adds: “The ambition now is to continue to use our Knowledge for Healthcare framework as a change agent – a tool to drive innovation and improvement, to ensure that the work and expertise of library teams underpins decision-making across the system.”

And, as the first NHS Knowledge and Library Services Awareness Week rolls out, Sue expects that the enhancements that knowledge services are making to assist NHS staff and learners will come into sharper focus. There are five key themes driving the work.

“We’re looking at a new digital infrastructure to streamline access to knowledge and library resources. That’s a huge programme of work that will see us invest in a national resource discovery system that will connect in with local library systems and improve our digital offer to the workforce. Currently we have 91 library management systems across the 183 services operating in England. Working in partnership with local teams, we will be consolidating these to less than 10, simplifying access to knowledge resources.

“Mobilising evidence from research is not only about ensuring that it is discoverable but also about disseminating information effectively, and sharing it in formats that can be used easily. Equally, it is about us tapping into staff know-how, and promoting tools and techniques that help staff mobilise knowledge. We are here, in a digital age, and there is a tremendous need to accelerate the spread and adoption of innovation across the NHS. That’s one of the outcomes we’re aiming to achieve through Knowledge for Healthcare.” “Knowledge services are business critical. The national team in Health Education England assures the quality of health library services on behalf of the NHS, helping NHS organisations understand what good looks like, using a maturity framework. We help teams to refine their services to add even greater value.

“Health literacy is another vital aspect of the work. We know people face challenges as they connect to the health service, and look to find, interpret and respond to health information. We want to help people make better decisions about their health. We are working to ensure that staff, learners, patients and the public are all better equipped to use evidence-based patient, health and wellbeing information both for shared decision making and self-care. So, a priority for us is to work alongside other information providers on building the health literacy skills of the community.

“And, as a key pillar of work – Knowledge for Healthcare has a strong focus on workforce planning and development to support the transforming nature of knowledge and library services. Library teams contribute to everything from policy change, clinical protocols, cost savings, staffing and patient safety. Therefore, we are focused on ensuring that our knowledge and library services workforce has the capability, confidence and capacity to meet the evolving needs of the healthcare system.

“As the technology advances, and the needs of the NHS change, the healthcare workforce needs to gain new skills and adapt. And all of that, remembering that 50 per cent of today’s NHS workforce will still be in post in 10 years’ time. Keeping up to date and continuing to learn is really key for everyone. Libraries have an important part to play in that agenda, and indeed, our own specialist workforce must similarly continue to evolve and adapt to support that journey too.”

Visible, valued, embedded

Some of the projects the team has taken forward – particularly around digital resources – are designed to place knowledge at the fingertips of health professionals, and that’s a vital workstream, according to Sue. Purchasing BMJ Best Practice as a Clinical Decision Support tool for the NHS in England has been a major step forward in terms of provision. Knowing when our loved ones are in hospital, that the staff caring for them can go to this app and look up high-quality evidence at any time of day or night is something I am very proud we have been able to achieve in the last few years. This is an expensive piece of kit to purchase for a country and we need to make sure it is visible and promoted, and delivers value, but it’s hugely important and is helping to embed this evidence-led approach in practice. The BMJ Best Practice app is a hugely valuable resource.

“And of course, we have seen a huge driver for change during the pandemic too.

“Like our colleagues on the frontline, knowledge and library service teams have also adapted quickly to respond to the pandemic, something that has created a whole new appetite for skills around knowledge. The way in which local services have adapted their services, and their commitment to collaboration has been staggering. In turn, keen to avoid duplication of effort, the national team has mobilised to coordinate some of this work, for example initiating a shared Covid-19 Search Bank. And we have built a gateway to information about Covid for patient groups with specific information needs.

“As we come through the crisis, we’re seeing many changes in healthcare: the growth in virtual consultations, the way in which people can use wearables and sensors to gather clinical data – I think these are just some innovations that will be extraordinarily impactful over time. Knowledge specialists will be playing a role in helping healthcare professionals to draw on insights from the pandemic and gain new skills as services transform.”

“In essence, knowledge specialists have and will continue to make an extraordinary contribution to the health service that I believe the nation has never valued more,” Sue adds. “We are committed to ensuring the right knowledge is used at the right time, and in the right places – and in this way library and knowledge specialists effectively empower people to make the right decisions.”

Talk to your librarian

So what would Sue say to anyone seeing the NHS Knowledge and Library Services National Awareness Week campaign and wondering how it might assist them in their role?

“I would say ‘talk to your librarian. Invite them to be a part of your multidisciplinary team. The breadth of their work means that you can be absolutely certain that they offer services that can help you and your team. Knowledge and library specialists prepare evidence summaries, keep teams up to date, teach information skills, assist learners and researchers, and provide expertise in knowledge management. This pivotal service is absolutely shaping the work of the incredible NHS.”

Check out NHS Knowledge and Library Services's website for coverage of NHS Knowledge and Library Services Awareness Week and Twitter at #KLSNAW.

Read Knowledge for Healthcare: A strategic framework for NHS Knowledge and Library Services in England 2021-2026

Read NHS Library and Knowledge Services Value Proposition: The Gift of Time.

Read Recommendations to improve the staff ratio for the number of qualified library and knowledge specialists per member of NHS workforce (pdf).

Knowledge for Healthcare Covid-19 Search Bank.