Making a Bigger Difference – Guide for Commissioners

In Health industry on July 14, 2008 by Library and Knowledge Service

The NHS Institute for Innovation and Improvement has recently published Commissioning to make a bigger difference.  I was quite optimistic about the blurb in the Commissioning Bulletin, which begins: “How do we know that what we plan to do will lead to a service innovation or make a bigger difference? These guides illustrate methods and tools to help NHS teams answer this question.”

I was hopeful that one of these methods and tools might be to begin with a search for high-quality research evidence.  And indeed, literature searches are mentioned on page 44: “If you do not know what typical best practice is in other contexts, find out. You can do this via a literature search or by simply asking colleagues and others who you think might have a broader perspective.” 

Better than nothing, I suppose, although the idea of “simply” asking colleagues rather goes against the basic premise of evidence-based practice, which is that the beliefs of individuals, even eminent ones, are often overturned by looking at large-scale, up-to-date research. 

Anyway, at least there is recognition of the place of literature searching, except that we then come on to who should be doing these searches.  In an example of how to use this framework, a provider/commissioner team decide to assess an innovative idea compared with traditional care and “the GP on the team suggests that she will do a literature search so that they can compare their work with best practices around the world in the hope that they might get further ideas for local innovation.”

There is no mention of the words “library”, “librarians” or “information specialists” in this 96 page document on evidence-based commissioning from the organisation that hosts the National Library for Health.  Why not?  Why should any PCT Chief Execs, commissioners, or GPs take the Hill Report seriously when it is not supported by the very organisation that published it? Why is it that NHS librarians have to be constantly knocking on doors to make their pressence known?  Not only are we likely to be more skilled at searching than most GPs, but our time costs massively less.  Strongly recommending the use of library professionals in commissioning decisions would be a win-win situation for PCTs and the NHS as a whole, and yet there is next to no official recognition of this from the top. 

I’m aware that as librarians we sometimes have a tendency to rail ineffectually at perceived injustices, but I really would like an answer to these questions from someone at the Institute.  I’ve posted this message on the Primary Health Libraries Group and am hoping that someone may direct it to the authors of the guide.  I’d also be interested to know whether anyone else sees this as a concern.


One Response to “Making a Bigger Difference – Guide for Commissioners”

  1. Hi Ben. Great to see your post; now we are three! It’s very interesting to hear about issues affecting health libraries, as while I’m not in the libary world, I am only just off to the side of it… I think that supporting commissioning decisions is potentially a huge role that health libraries could move into – a role that (in its current form at least) is perhaps relatively new and is only going to get bigger. It seems like madness, and is evidently very disappointing, that national documents still view “evidence-based” research as a non-specialist (and an expensive one at that) sitting down at a keyboard when they have five minutes and Googling and, if you’re lucky, PubMeding their way in a rather ad hoc fashion.

    It would be very interesting to hear if you get any response from the Primary Health Libraries Group, and in particular from the NHS Institute for Innovation and Improvement itself. I guess that commissioners ‘on the ground’ as it were are understandably struggling with all these new initatives as they’re rolled out, and I’m sure that if a really competent health librarian approached them with an attitude of a) understanding and b) having the potential to help solve their problem – you might well be able to talk your way into supporing the decision making process…

    One has to be optimistic…

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