A personal view of the development of health libraries over the last twenty years? As it happens, I joined the NHS in spring 2000, so the development of health libraries and my career have travelled in parallel. Let me say now, I came into health libraries by accident; only moving across from business support because the DTI decided to close the Business Link network, and I needed a job. What that meant was that I came in as an experienced manager, but with no knowledge of or experience in health, and equally no baggage or preconceptions.

The healthcare library system, if it can be called a system, that I joined in 2000 was very different from today. In my own Trust, we had libraries at five sites, each with its own librarian, and operating in its own idiosyncratic way. Those five libraries defined their own user communities ranging from a multi-disciplinary cross-organisational open-door library which most would recognise as normal today, to a doctors-only reference-only offering which, even then, was elitist and divisive in the extreme. Print was the norm, e-journals in their infancy and subscription policies as diverse as the whims of publishers could make them (some would say “no change there, then”), no e-books, and very limited access to databases run from more-or-less networked CD-ROMs.

What was also evident twenty years ago, in Leeds and elsewhere, was that partnership was important, and that working together was going to build stronger local services. That was music to the ears of somebody who had been doing that as a business librarian since qualification in the early 1980s. Back in 2000, the driver for partnership was something called Information for Health (NHS Executive, 1998), and more specifically the Full Local Implementation Plan (FLIS) for that. In Leeds, the FLIS (Leeds FLIS Editorial Board, 2000) had money attached, and enabled us to do things that otherwise would not have been possible, and gave us freedom test out some ideas. These included a pilot service for an unserved group (Practice Nurses), and an internet café at St James’s Hospital to open access to e-resources for both staff and public.

The partnership also gave us the impetus to implement a shared library management system, hosted by LTHT but operated across all partners, a consortium arrangement that is still in existence twenty years later. Disparate library systems, or lack thereof, was another feature of the health libraries I inherited twenty years ago. Today it is almost inconceivable that any library, let alone a multi-site service could run without a publicly accessible catalogue and no means beyond hand written cards of managing circulation of stock.

If that was then, how have we moved to now? From my standpoint, there have been two main threads. The first has been technology. The growth of electronic resources – books, journals databases – and the way that these moved information out from the confines of the library into the end-users’ space, or even into their pocket via smartphones and apps, has meant a gradual reshaping of our role. From the introduction of the national core content and the development of the National Electronic Library for Health, to a national Point of Care decision support tool on an app, and soon a national discovery platform, the end user has been given more control over when and how they accessed evidence in the 24x7 NHS. If users became the people who accessed for themselves the information that we, the expert gatekeepers, once found and delivered to them, where did we fit?
This led to the second thread, that of widening access and reshaping our role. Twenty years ago many hospital libraries, mine included, were content to tell people what they had, and wait for them to come along and use it. Selling features not benefits may have worked for that one specific staff group who had regular exams on their career pathway towards Consultant, but it did nothing to encourage the majority who couldn’t see what was in it for them. Over the course of the last twenty years we have embraced benefits rather than features, and found a way to encompass all clinical groups, non-clinical colleagues, organisational projects, and patients, carers and the public.

We have been helped in this by work at national level. The Hill Review (Hill, 2008) recommended, among other things, that “NHS library, knowledge and information services”(Hill, 2008 p24), and note the words he used there, should be formally regarded as essential in supporting clinical, policy and commissioning decisions, and seen as part of the core business of the NHS. Knowledge for Healthcare (Health Education England, 2014), our first national strategy, set out clear objectives to develop a cohesive and consistent offering across the country, and the Topol Review (Topol, 2019) brought to the fore the use of technology in embedding knowledge into frontline decision making.

As a result, we have developed embedded librarians, outreach librarians, librarians supporting quality improvement, librarians supporting Trust Boards. Services are devised around end users, in discussion with users, and increasingly delivered in the users’ space on users’ terms. If not, their feedback in surveys is forthright. Not every service can do everything, and much still depends on organisational priorities, but this offering is now widespread enough for us to see it as normal.

Perhaps an even greater change, especially in the last few years, has been the way services have looked at users as individuals as well as being part of a defined staff group, so have taken more focus on resources and activity to support wellbeing, on reading clubs, on knitting groups, on working to address issues around equality and diversity. At a cross-sector workshop in Leeds in 2019, health and public librarians came together to look at how we each support the health of the people of Leeds. At the end of the workshop, having heard what each other does, we realised that we all do very similar things; only the scale and priorities differed.

Over the years, service quality and demonstrating value for money has become more important. We had HeLICON (Fowler and Trinder, 2002) - well you have to start somewhere! Then we had LQAF (Health Education England, 2004), giving us a common standard to work to. It may have been a painful process assessing against this, but I found the process of finding and justifying evidence against the standard helpful in highlighting areas for development. Now we have the maturity model of QIOF (Health Education England, 2019), moving away from simply meeting a standard, towards showing how well developed the organisation is in terms of embedding knowledge and evidence into everyday business. That’s quite a journey.

I could talk about impact case studies, consortium purchasing deals, shared search strategy databases, coordinated leadership development programmes, none of which existed twenty years ago, but suffice it to say that the library landscape of today is definitely not the same landscape as that I first trod on 2000

So what of the future? Anybody looking ahead is necessarily putting their head on the block of history. I recently came across slides from a presentation I gave at a seminar some years ago. Yes, as a good librarian, everything is filed carefully way for future reference! At the time, possibly 2006/7, I was looking at provision last year, today, next year, and in ten years’ time. How wrong I was! So let’s set myself up to be wrong again.

Space will be even more at a premium going forward than it is now, and will need to be justified to be retained. There will always need to be a focus to people to come to ask for help, not everybody wants the remote touch, but it may well be shared and multi-professional (see local authority enquiry hubs). Flexible working and remote delivery developed over the pandemic will stay in place, and provide opportunities to be more responsive to users’ needs, to deliver at their convenience, and to focus on adding value. Teams may or may not increase in size, but specialisms within teams will develop as demands from different interests within organisations discover the value of using knowledge and evidence.

It’s a safe bet to say that in twenty years’ time health library services will look and feel as different from those of today, as today’s services do from those of the day David and I took up our respective posts, but in twenty years’ time they will still be here, and still supporting their many and varied users.

Recently one of my users sent an email to thank the team for their support over recent months. In it she talked about us “believing in her”. My take on the future of health libraries is that whatever they look like, they won’t have gone far wrong if a user can still say that they believed in her.

Paul Twiddy
Library & Information Service Manager
The Leeds Teaching Hospitals NHS Trust



Fowler, C. and Trinder, V. (2002) Accreditation of Library and Information Services in the Health Sector. A Checklist to Support Assessment. Health Libraries and Information Confederation (HeLICon) Working Group. Health Libraries and Information Confederation.
Health Education England (2004) Library quality assurance framework (LQAF) England. Health Education England.
Health Education England (2014) Knowledge for healthcare: a development framework for NHS library and knowledge services in England 2015-2020. Health Education England.
Health Education England (2019) Quality and Improvement Outcomes Framework for NHS Funded Library and Knowledge Services in England. Health Education England.
Hill, P. (2008) Report of a national review of NHS health library services in England: from knowledge to health in the 21st century. National Library for Health.
Leeds FLIS Editorial Board (2000) Leeds full implementation plan (FLIS). Leeds: Leeds Health Authority.
NHS Executive (1998) Information for health: an information strategy for the modern NHS 1998-2005: a national strategy for local implementation. London: NHS Executive.
Topol, E. (2019) The Topol Review: preparing the healthcare workforce to deliver the digital future: an independent report on behalf of the Secretary of State for Health and Social Care. Health Education England.