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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