I was asked to contribute a personal reflection of the role of clinical librarian over the last 20 years, with a nod towards possible future developments, and whilst it’s true I have been working as a health librarian in the NHS for two decades, clinical librarianship was not a feature of my early NHS career. I don’t pretend to be a historian of all matter clinical librarian-y, so instead I’ll comment on the things which made an impression on me during the first decade, led me towards taking up a clinical librarian role myself in the second, and what I hope will happen in the future.
After spending the early part of my library career running information services for people with disabilities in the voluntary sector, I joined the NHS as an Information & Library Officer in 1999, working in the East Midlands for Trent Healthline. This Freephone health information service soon merged with the juggernaut that was NHS Direct. The nurse triage side of the service got all the publicity, but I worked for NHS Direct East Midlands’s Health Information Service, supporting call centre based health information advisors by providing search skills training, resource selection and literature searching for complex patient enquiries, alongside librarians and knowledge officers based all across the country. I spent a very happy and fulfilling 10 years with NHS Direct, taking on a succession of roles, but as the saying goes “when the fun stops, stop” and I left about a year before the whole enterprise got re-organised out of existence; all the remaining health information staff were made redundant, and all the health information expertise we’d developed over the previous decade was scattered to the four winds (waves at Dave A, Gill F, and Sarah H, fellow NHSD-ers in the north).
During my time with NHD Direct I tried to keep abreast of developments in health librarianship. I attended the first Evidence Based Librarianship conference in Sheffield in 2001, which has grown into an international evidence based library and information practice (EBLIP) movement. While at NHS Direct East Midlands I’d heard about Linda Ward and the clinical librarian project at Leicester as I was working close by in Nottingham at the time. They were doing fascinating work in the early 2000’s after trialling it a couple of years before that, working directly with clinicians, on ward rounds and in clinical meetings, and evaluating their impact. It sounded exotic, thrilling, rewarding, downright scary, but oh, so interesting.
In the mid-2000s I read Clinical librarianship in the UK: temporary trend or permanent profession? an article in two parts (Sargeant & Harrison 2004). After examining job adverts, job descriptions and surveying librarians via the fledgling CLIN-LIB mailing list, they concluded part two by saying
“The role of the CL is expert and complex, demanding a combination of skills and knowledge. It can be viewed as a cross between detective and barrister. In the case of a clinical enquiry, the facts of the case need to be found and the resulting information synthesized and retold to the jury. This combination of skills and a forceful pro‐active approach is not one that has usually been associated with the library and information profession.”
In that paragraph, I can see the seeds of my future career direction being sown. I left NHS Direct in 2009 to work as an Outreach Librarian & Library and Knowledge Skills Trainer in an acute Trust in the East Midlands to develop the skills I’d need to make the jump into clinical librarianship. The Hill report (Hill 2008) and the idea of a National Knowledge Service were still shiny and new then, and it felt that library services had been really “seen” for what they could offer, perhaps for the first time. The National Library for Health was replaced by NHS Evidence, complete with its sinister Orwellian eyeball, and tensions arose when their marketing strategy included the assertion that NHS Evidence was no longer just for librarians, the implication being that we had been an annoying bottleneck in the mission to equip clinicians with evidence. I remember my librarian colleagues feeling somewhat aggrieved, since we felt that we were the most valuable marketing tool NHS Evidence had, and ticking us off for getting in the way was a rather short sighted move.
In my role as Outreach Librarian I was finding that being a library service “evangelist” was the easy part, and I already had the requisite training and search skills, but what I needed to acquire was tacit knowledge. How evidence is used in secondary care, how to gain the trust of doctors, how not to be intimidated by consultants, how to deal with rejection / indifference / scepticism from clinical teams, how to establish credibility and become valuable rather than a novelty item or a nuisance. University Hospitals Leicester Clinical Librarian team had been running a steady stream of conferences and study days since 2002, and in 2010 I attended their “Starting out and Moving Forward” event which filled in many gaps and gave me the confidence to “take it to the next level”. I wangled an invitation to my first ward round for diabetes & endocrinology soon afterwards, and it turns out I was right, clinical librarianship was thrilling, rewarding, scary and so, so interesting.
Fast forward to 2014, the Knowledge for Healthcare framework came out and it looked like finally, clinical librarianship was getting its moment in the sun. So much looked possible from that point onwards. I jumped regions in 2015 and got a job with Clinical in the job title to become Clinical / Outreach Librarian with Doncaster & Bassetlaw. It’s hard to properly quantify the deluge of CPD opportunities and tools that were made available in my new role and my new region. Gradually with the change in emphasis from “local” region to Northern Region, David Stewart became a “household name”, and the Knowledge for Healthcare work stream he led on workforce planning & development underpinned the development of health library staff everywhere.
The #Amilliondecisions campaign was a brilliant way to capture the breadth and depth of health libraries’ contribution to patient care and shine more light on what we had to offer as clinical librarians. The recognition by HEE in late 2019 that the number of professionally qualified staff available to take forward the massive Knowledge for Healthcare agenda varied widely across the country was another huge step forwards. For services like my own for which the current average of 1 qualified librarian to 1,730 healthcare staff is still highly aspirational, the enhanced ratio of 1: 1250 feels breathtakingly distant. However, I believe help is on the way in the form of the new Value Proposition: The Gift of Time and the inspiration and data provided by the Wirral clinical librarian study (Hartfiel et al 2020).
I don’t know how long it will take before every Trust has an adequate number clinical librarians but I do know that we need more high quality research into our own impact to help every service get the funding and staffing complement they need to have maximum impact in their Trusts. Research as an enabler for Knowledge for Healthcare is our way forward - evidence based library and information practice is the rising tide that lifts all boats.
Clinical / Outreach Librarian
Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust
Harrison J., Sargeant S. Clinical librarianship in the UK: temporary trend or permanent profession? Part II: present challenges and future opportunities. Health Information & Libraries Journal Vol 21(4) pp220 - 226
Hill, P. Report of a National Review of NHS Health Library Services in England: From knowledge to health in the 21st century. 2008. Accessible at: https://www.libraryservices.nhs.uk/document_uploads/NHS_Evidence/national_library_review_final_report_4feb_081.pdf
Hartfiel N., Sadera G., Treadway V,. et al. A clinical librarian in a hospital critical care unit may generate a positive return on investment. Health Information & Libraries Journal Dec 2020 https://doi.org/10.1111/hir.12332