Select Committee on Science and Technology Written Evidence


APPENDIX 97

Memorandum from the Knowledge Services Group, NHS Education for Scotland

1.  BACKGROUND

  1.1  NHS Scotland Library and Knowledge Services are currently undergoing a technological and cultural sea-change as a result of the ongoing transition from print to electronic delivery of knowledge support. NHS Education's new strategy for NHS Scotland Knowledge Services—"Exploiting the Power of Knowledge in NHS Scotland"[322]— highlights the need for a coordinated, system-wide approach to manage this rapidly changing human and technological context. The vision is of NHS Scotland Knowledge Services transformed and modernised by improved application of technology, and facilitated by the skills of information practitioners and managers.

2.  CURRENT SITUATION

  2.1  Recent surveys of NHS Scotland Library Services[323] show that, on average, approximately 70% of library non-staff revenue budgets is expended on journal subscriptions, predominantly in print format. Total journal spend for individual library units is low, ranging from £1,800 to £60,000 per annum. Our current data on total spend are incomplete, but we estimate that of the order of £1 million is currently spent on local print journals by NHS Scotland Library Services, with purchase of journals by departments and journals over and above this. Budgets for NHS Scotland Library Services are, of course, experiencing reductions in the same way as other NHS services. Combined with the new pressures on NHS Library budgets as a consequence of the electronic age, and steep increases in journal costs above rate of inflation, (7-8% increases year on year since 1999 in health sciences title costs), the picture is one of already underfunded journal subscriptions being unavoidably subjected to further reduction as a result of subscription cancellations throughout the NHS Scotland system. The consequence is poorer support at local level for the practice and research needs of NHS Scotland staff.

  2.2  In contrast to this decline in local service capacity, NHS Education for Scotland currently funds access to over 3,000 electronic journals via the NHS Scotland e-Library, an Internet resource which is available to all NHS Scotland staff. Economies of scale mean that national purchasing of electronic content is considerably more cost-effective than local purchasing in print or electronic format. There seems little doubt that this is the way of the future, offering highest value-for-money access to a wealth of information resources on an equitable basis throughout NHS Scotland . However, the fact that the NHS Scotland e-Library currently operates only on a pilot basis, with no guarantee of future sustainability on the present scale, is resulting in duplication of spending within the NHS. Local systems currently feel unable to cancel subscriptions to the full extent possible because of the uncertainty over the permanent future of the national electronic system.

3.  IMPACT OF "BIG DEAL" PACKAGES

  3.1  The budget currently available for national journal provision via the NHS Scotland e-Library creates a dependency on "Big Deal" packages, where titles of major interest can only be purchased in combination with titles of minor relevance. We estimate that at least 30% of current print subscriptions across NHS Scotland, including a number of key titles for priority clinical areas (eg, "Cancer", "Cerebrovascular Diseases", "British Journal of Radiology") are not available via package deals that are affordable within the budget for the NHS Scotland e-Library. Such titles may, for example, only be available direct from publisher, with national pricing models yet to be devised, or may only be offered via a "Big Deal" arrangement with a high proportion of largely irrelevant material which makes the package economically unjustifiable from an NHS perspective.

  3.2  Admittedly, the "Big Deal" approach has, to date, offered some short term advantages in extending access to an unprecedented range of information resources across the NHS Scotland system. The danger is that the pressures on local budgets may mean that NHS Scotland becomes over-dependent upon national purchasing from a restricted, insecure budget of predefined journal packages which exclude these key titles vital for the maintenance of first quality healthcare knowledge support.

4.  ADDRESSING THE RISKS

  4.1  In brief, in order to address the risks inherent in this situation, adequate funding has to be secured to support equitable access for the long term to journal literature keyed to the research, education and practice needs of the full range of NHS Scotland staff. This needs to be accompanied by the negotiating power to "unpack" the "Big Deal" conditional sales which are reducing our capacity to tailor knowledge support to NHS Scotland need, and ultimately to meet the demands of patient care.

5.  CROSS-SECTORAL PURCHASING

  5.1  There may be scope in the longer term for a degree of economic cross-sectoral management of journal purchasing, particularly where there is overlap of interest at the NHS/Higher Education interface. However, we would stress that this can only be achieved on a basis of sound understanding of the full range of knowledge needs of the NHS, and with the reassurance that a cross-sectoral approach will not further diminish our ability to shape knowledge provision in accordance with specific NHS need.

6.  IMPACT OF OPEN ACCESS PUBLISHING

  6.1  Currently, NHS Scotland is required to pay, in the form of institutional journal subscriptions, in order to access information on the progress and outcomes of research which is itself subsidised by NHS finance. The advent of Open Access Publishing seems to offer some promise in addressing this paradox of double payment. We advocate further investigation of the "pre-print" model offered by Harnad[324], whereby NHS Scotland staff would electronic copies of their peer-reviewed research papers freely available to the NHS community via an Internet gateway. We would approve also exploration within NHS Scotland of the "author payment" model which can incorporate the cost of publication in research funding arrangements. These new publishing models emerging from the transformative power of the electronic medium seem to us to have the potential to democratise information access, and to improve the transparency of the peer review process, as well as to foster collaborative enquiry and development of a research and knowledge management ethos within the NHS.

  6.2  Problems which may be anticipated in the process of this transition include: management of information overload; assignation of intellectual property rights to original material interspersed with comments or amendments by multiple reviewers, and definition of credit ratings to correspond to a new peer review system. From the NHS perspective, it is essential to realise that the prima facie savings afforded by the electronic medium in communicating research information need to be weighed against the consequent need for investment in connectivity and information skills training for the NHS community as a whole.

7.  CONCLUSION

  7.1  To conclude, the present transition in scientific publishing creates significant opportunities for improved access to knowledge to support the work of the health service in Scotland. However, the element of threat involved in the "Big Deal" approach must be addressed. Above all, the path to the new future depends essentially on provision of adequate, long term funding to meet the knowledge needs of NHS Scotland.

February 2004




322    Exploiting the power of knowledge in NHS Scotland: a national strategy. NHS Education for Scotland, 2004. Back

323    Survey of UK NHS Library Service activity and funding 2002-2003 (unpublished data). Library and Knowledge Services Development Network. Back

324    Harnad, S. (1995) Electronic Scholarly Publication: Quo Vadis? Serials Review 21(1) 70-72. Back


 
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