National electronic Library for Health

The National electronic Library for Health (NeLH) was a digital library service provided by the NHS for healthcare professionals and the public between 1998 and 2006. It briefly became the National Library for Health and continues to this day as NHS Evidence, managed by the National Institute for Health and Care Excellence.

Policy origins

Looking back from the mid 1990s the NHS Library Adviser Margaret Haines observed that during the 1980s NHS libraries had failed to capitalise on opportunities becoming available to them to advance their services and demonstrate their value.^[1] The main issues she saw were 'duplication and lack of co-ordination' arising from complex funding and a lack of integration with host organisations. Her concerns echoed those voiced by other senior NHS librarians. Judy Palmer, head librarian for the Oxfordshire region found that 'libraries were becoming increasingly marginalised, librarians were facing competition from other providers, that there were no recognisable national strategies, that there was massive duplication, fragmentation and information hoarding'^[2] In response to such concerns the British Library organised a seminar on NHS libraries, which came to be known known as the Cumberlege Seminar.^[3] This was followed a year later by a second seminar held at the Kings Fund in London.^[4] As a result, the role of NHS Library Adviser was established (Margaret Haines being the first incumbent, followed by Veronica Fraser). A Health Service Guideline on NHS libraries was published in 1997, and a number of local initiatives took place, among them the establishment of an innovative project in Oxford to increase the use of the World Wide Web in NHS libraries.^[5] The idea of an open access digital library of high quality health related information was suggested by JA Muir Gray to Frank Burns CBE, at the time Chief Executive of Wirral NHS Trust Warrington and leading the development of Information for Health, an IT strategy for the NHS 1998-2005.^[6] The strategy stated:

A National Electronic Library for Health including accredited clinical reference material will be established.^[7]

Creating The National Electronic Library for Health

Implementation of the NeLH began in October 1998.^[8] Robert Ward, a senior civil servant at the Department of Health, convened a meeting of interested parties in Leeds. Following from that meeting an implementation plan was developed by Ben Toth and Muir Gray and signed off by the Department of Health. A programme board was established; members included the NHS Library Adviser Veronica Fraser, a senior regional IMT Adviser Jeremy Thorp, and Bob Gann who was leading the development of NHS Direct online. The NeLH programme was included in the first portfolio of the NHS Information Authority; work began on implementation in January 1999, with the appointment of a project manager, Peter Bladen, and a project assistant Carol Shanley, based in the NHSIA's temporary offices in Calthorpe Road, Birmingham. The NeLH office later transferred to Aqueous II, Birmingham. Implementation began with the development of a business case and a pilot service to test the concept of the NeLH and provide evidence for the business case.

The Pilot NeLH was launched in November 2000, based around a central website (the core collection) with links to commissioned websites (specialist resources). Resources included a selection of evidence-based resources, some of which were restricted to (Cochrane Library and Clinical Evidence) NHSnet users only, a limitation which would be rectified in later years, and several Specialist (or Virtual Branch) Libraries covering primary care, infectious diseases, and emergency medicine, managed by Anne Brice. Over time the number of services increased, including a specialist medicines library and a federated search engine. Core staff numbered around 6 in the early days of the library, including recruits and secondees from NHS libraries. An early goal was the establishment of a network of librarians across the NHS to promote the library, led by Alison Turner. Nick Rosen joined the team to promote the library, and Ian McKinnell joined later as technical lead. ^[9] The pilot website was run from NHSIA servers, first in Bury St Edmunds and later in Exeter. The business case was developed by staff seconded to the NHSIA from the Department of Health and HM Treasury and went on to be commended by the Blair Government's Public Sector Productivity Panel^[10] as a notable use of the Treasury 5 Case model. The business case also became the subject of a chapter in Making Sense of Public Sector Investments.^[11] Following approval of the Full Business Case, procurement began, with the full service live in 2003.

From NeLH to NLH to NHS Evidence

As part of its response to the Report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary the Department of Health established the National Knowledge Service in 2003, tasking it with closer integration of digital and physical library services. A programme to establish a National Library for Health was established, which included a review from TFPL,^[12] a cost analysis by Robert Huggins Associates,^[13] and steps towards several NHS wide shared services, including: a business case for a unified NHS document delivery service developed by Bertha Man Low and colleagues; a question answering service; an NHS resolver and underlying enterprise architecture. With the demise of the NHSIA in 2005 the NeLH transferred its staff and operations to Connecting for Health, the body responsible for implementing the NHS National Programme for IT. The operational base remained in Birmingham but increasingly staff worked in the CFH main office in Leeds and also in London, first in Victoria and later at the CFH office in BMA House and a Department of Health office in Sea Containers House overlooking the River Thames. In 2008, with the National Programme for IT in decline, arrangements began to transfer the NeLH to NICE, where it continues to operate, as NHS Evidence.

Successes and failures of the NeLH

The record of the NeLH shows a mixture of success, failure, and worthy experiment.

Successes include: the business case was recognized by HM Treasury as a model of its kind; the project was delivered to time and budget and became a valued service; funding was obtained to make the Cochrane Library available across the UK on a simple open basis; extra funding for Clinical Evidence was secured from the Modernisation Fund; a care pathways database was introduced; obstacles were overcome to make the Athens Access Management System available to the NHS as part of the NLH enterprise architecture; Health Language, a terminology service, was procured as a framework contract; the Children's BNF was introduced, funded by the Department of Health; Hitting the Headlines and Zetoc were procured; the fee paid by the NHS to the Copyright Licensing Agency was halved; co-operation with JISC increased; the PRODIGY programme was cancelled and replaced by Clinical Knowledge Summaries. Funding was found to support for the regional pharmacy information services; an online directory of library service points was funded; an NHS link resolver was implemented.

Among the failures: a z39.50 federated search supplied by Fretwell Downing could not be made to work; attempts to base the CLA license on actual usage foundered; work with JISC to reduce double-dipping by academic publishers across HE-NHS made little progress; reform of the NHS libraries regional structure was only partly successful and the vision of a unified networked library for the NHS didn't survive; integration with CFH products and services was less than anticipated; a strategic partnership with Map of Medicine fell foul of the CFH commercial directorate; a planned partnership with ISABEL didn't survive the CFH procurement process. Plans to implement an NHS wide deal with Biomed Central were initiated but didn't progress.

Experiments included: a pilot of LibQual; the development of an XML standard for representing clinical guidelines; a DSpace implementation hosted by Hewlett Packard Laboratories; an RSS feed manager developed by Microsoft as part of its NHS Common User Interface project; and a browser based calendar and communication tool known as MyWorkPlace - a great idea but technically ahead of the technology available to the NHS at the time.

Legacy

Seventeen years on from its conception the main service offered by NeLH is still in place, albeit under a different name. Some elements of the NeLH infrastructure are still visible, notably OpenAthens, once threatened by Shibboleth but now flourishing alongside it. The vision of a unified, seamless NHS library service for all staff and service users has disappeared. NHS libraries, organised as before the NeLH but now led from Health Education England, appear to be confronting the same issues as the 1980s - including: complexity of funding (with associated uncertainty of service offer, duplication and inefficiency); and a lack of integration with the wider NHS. However, formal library services are arguably less important in 2016 than they were in the period leading up to the Cumberlege seminars, because the means available to deliver and receive information are radically different now compared to the 1980s when ironically NHS libraries were early adopters of online information services. Meanwhile, the NHS is embracing a digital future, seemingly without any connection to the services NHS libraries could offer.

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