Responding to COVID-19 in the National Health Service in England: positive changes and learning for Knowledge for Healthcare

Introduction In response to needs identified during the initial weeks of the COVID-19 pandemic Health Education England (HEE) library and knowledge services team has led a series of initiatives. These focus on enabling the system to work smarter and on fostering greater collaboration between libraries, and with partners and stakeholders. At the same time, they continue to deliver on the strategic direction of Knowledge for Healthcare (1) in England.


Introduction
In response to needs identified during the initial weeks of the COVID-19 pandemic Health Education England (HEE) library and knowledge services team has led a series of initiatives. These focus on enabling the system to work smarter and on fostering greater collaboration between libraries, and with partners and stakeholders. At the same time, they continue to deliver on the strategic direction of Knowledge for Healthcare (1) in England.

Background
Healthcare in United Kingdom is devolved to homecountry administrations in Scotland, Wales and Northern Ireland. HEE is the steward of investment in library and knowledge services on behalf of the National Health Service (NHS) in England. Knowledge for Healthcare (1) provides a strategic development framework for NHS-funded library and knowledge services. It sets out an ambitious vision to ensure the use of the right knowledge and evidence at the right time (2). The HEE library and knowledge services team leads the strategic approach to the delivery of Knowledge for Healthcare and the development of NHS library and knowledge services across England. The team incorporates a knowledge management (KM) function that works internally to mobilise evidence and manage and share organisational knowledge within HEE. The NHS in England is a complex system, comprising a wide range of different organisations with different roles, responsibilities and specialities (3). Across England 184 library and knowledge services are funded by the NHS to provide services to 223 NHS provider trusts.

Clare Edwards, Lucy Reid and Sue Lacey Bryant
In May 2019 HEE also carried out a snap-shot survey to ascertain the status of the library and knowledge services. The survey demonstrated that all NHS library and knowledge services have continued to deliver services throughout, ranging from "virtual only" through to fully opened and staffed ( Figure 1). The survey highlighted which services were being restricted or not offered; this information also helped to inform the plan and development of initiatives.

Outcomes achieved in delivering COVID-19 initiatives
McLaren (4) provides a detailed overview of the initiatives developed by the HEE team, often in partnership and collaboration with local NHS service managers. This review of these initiatives is structured around five primary drivers, or underpinning goals, which we believe will "drive" the delivery of our vision for Knowledge for Healthcare.

Staff and learners make optimal use of high-quality knowledge resources and evidence at the point of need
A key driver has been to optimise the evidence base for the NHS workforce. Trusted sources of information on COVID-19 have been collated into a single place. The HEE team has worked with suppliers to ensure new content and COVID-19 offers are discoverable via the routes most typically used by the NHS workforce. A priority has been to work with BMJ Best Practice to promote this as our national clinical decision support tool for England, including the COVID-19 related patient information, and to work towards integrating this within electronic patient records. Access is also promoted through e-Learning for Healthcare, HEE's e-learning repository for the NHS. The HEE LKS team worked with suppliers including publishers, Eduserv for OpenAthens authentication and the British Library for document supply services to ensure business resilience, the continued on-and off-site access to administrative systems for library staff and the evidence base for the healthcare workforce.
A key strand has been to optimise the expertise of the NHS library and knowledge specialist workforce by coordinating resources and capability through collaboration. This resulted in the development of both a Search Strategy Bank and Current Awareness sharing bank (5). As of 31st July, 171 searches on COVID-19 related topics have been added, Figure 2 shows the visitors to the COVID-19 search bank and other areas of the blog. The work to support COVID-19 has further demonstrated the benefits of working collaboratively. Library and knowledge specialists have requested that this type of collaborative initiative is extended to cover evidence searches on a wider range of topics. The experience has also reinforced a growing appetite for centralised content procurement and for a national discovery system. This is something that we want to continue to foster and enable smarter working practice so we can maximise both the expertise of our small specialist workforce and the resources available. Access to evidence services and resources has also been extended. Across England seven temporary hospitals, named Nightingales, were set up to provide extra beds in case needed to cope with the COVID-19 pandemic. The HEE team played a role in enabling access to evidence and knowledge services for the Nightingale hospitals by supporting NHS library service managers to shape the offer. The team also facilitated a community of practice amongst the library service managers involved who have particularly valued this opportunity to share learning, ideas and approaches to problem-solving as they worked with the new hospitals. The pandemic has, however, also highlighted the information needs of workforce groups who are illserved by current library and knowledge provision, such as primary care pharmacists, something that needs to be addressed as we move forward.

Healthcare organisations, staff and learners received quality assured, business-critical knowledge and library services
In the crisis, librarians and knowledge specialists stepped forward to demonstrate their business-critical roles. The specialist workforce used their KM skills to support decision making, enhancing awareness amongst senior managers, including knowledge support for the Board and senior decision making, supporting gold/silver command and synthesising and summarising complex evidence to deliver rapid evidence reviews. Figure 3 is a social media card from the Chief Executive of Buckinghamshire Healthcare NHS Trust explaining the impact of the library and knowledge service team during COVID-19. As more services have been delivered virtually the library and knowledge workforce has demonstrated a capability for rapid and agile development and there is an opportunity to make greater use of technology to deliver knowledge services. Meanwhile, the extension of digital knowledge service delivery has highlighted that physical library space is also valued by the NHS workforce. Through COVID-19 it has been welcomed as a health and wellbeing space of sanctuary as well as a learning space (Figure 4).
Within HEE the KM team is contributing to the development and structure of "e-learning for Healthcare", working with colleagues on the HEE Technology Enhanced Learning COVID-19 programme for the health and care workforce.

The knowledge and library services workforce has increased capability, confidence and capacity to meet the evolving knowledge and information needs of the healthcare system
Supporting NHS library and knowledge staff in England has been an important aspect during the pandemic. Ways of working have changed, teams have needed to adapt the workplace and support for wellbeing has been crucial. The HEE team has kept in regular contact with their colleagues in NHS libraries throughout the pandemic to listen and enable learning and sharing.
As services moved more to online and digital provision there has been a need to support digital skills development. Training workshops for the library workforce in facilitating virtual meetings and online training proved extremely popular. A small group has benefited from "train the online trainer" skills development ready to cascade training to the wider healthcare workforce. The wellbeing and resilience of staff is critical to ensure a motivated and effective workforce. The team has offered training on personal resilience and on how to lead a team in a pandemic. With changes in government advice since May 2020 more services are starting to reopen the physical library space, a cause of anxiety for some staff members. The collated resources for adapting the workplace has been one of the most accessed sections of the "For LKS Staff" (5) resource on the COVID-19 blog. Continuing to develop our national training and leadership programmes in this context will be vital to increasing the confidence and capability of staff and to developing and sustaining new ways of working.

Staff, learners, patients an the public are better equipped to use evidence-based patient, health and wellbeing information
A priority work strand in Knowledge for Healthcare is health literacy and evidenced based patient information. The team identified that it was difficult to find trusted information resources for the public about coronavirus. A website (6) has been developed to bring together existing online resources. The site includes content in Accessible formats and for Children and Young People, Older People, Cancer and Coronavirus, Long Term Conditions, Mental Wellbeing, Carers and Looking After Yourself.
Health literacy e-learning (7) was launched in April 2020, developed in partnership with National Education Scotland (NES). This was a planned initiative which is now being promoted as part of the COVID-19 response to enable the healthcare workforce to more effectively communicate health information to patients and the public. The health literacy and patient information resources have been used well since their launch during the pandemic. Figure 6 shows the reach and impact of these resources.

Healthcare organisations, services and systems effectively mobilise evidence, learning, knowledge and know-how to enable evidence-based policy and practice
Knowledge for Healthcare advocates for the transformation of the role of the librarians and knowledge specialist to become business critical in mobilising evidence and organisational knowledge across the NHS in England (8).

Clare Edwards, Lucy Reid and Sue Lacey Bryant
The pandemic generated a need for rapid distillation of lessons learned, and clarification of unanswered questions, both by managers and in clinical practice to expedite the adoption of changed ways of working. The HEE team has actively promoted the NHS Knowledge Mobilisation Framework (9) which introduces a suite of tools such as After-Action Review and Retrospect. This has been supported by the launch of a new video (10) demonstrating the tools and also incorporates the questions used as the Nightingale Hospital in London was set up. NHS librarian and knowledge specialists have been crucial in promoting these resources and facilitating the lessons learned. The team will continue to support health librarians "on the ground" to expand the effective use of KM tools. Organisations also want to build knowledge assets to inform best practice and management of any subsequent phases of the pandemic.

Partnership working
Partnership working enabled NHS library and knowledge staff to support the healthcare workforce and patients effectively during this time. In England, HEE has worked closely with the Department for Digital, Culture, Media and Sport, Public Health England, National Institute for Health and Care Excellence, NHS England and Innovation and the Chartered Institute of Library and Information Professionals resulting in shared guidance, improved business continuity and disseminated good practice. There have been many discussions amongst peers right across the United Kingdom, with NHS leads in Wales, Scotland, Northern Ireland and with colleagues in the Republic of Ireland focussed on disseminating information, widening access to published sources of evidence resource and technology.

Learning and next steps
NHS librarians and knowledge specialists have continued to adapt to a changing and challenging environment. However, developments and new ways of working have continued to deliver against the five Knowledge for Healthcare drivers including identifying and implementing service transformation and innovation. The work achieved demonstrates an acceleration of beneficial changes in ways of working that need to be implemented for the future and which we look to build upon as part of the refresh of the Knowledge for Healthcare strategy. We plan to continue these developments, harnessing the appetite for collaborative working to implement further advances, for instance building on digital and health literacy skills, ensuring equitable access to resources, and mobilising evidence to support shared learning. With uncertain times ahead we will be using KM tools such as After Action Review amongst the HEE library and knowledge services team to reflect and gather our learning ahead of the English winter. More broadly, NHS teams in England are aware of the risk that we fail to act on the learning generated during the pandemic meaning that the positive outcomes are lost. There is a significant role for library and knowledge specialist to help the NHS build resilience, by supporting the workforce to access evidence, capture and share the learning and build knowledge assets to inform management and practice in any future phase of COVID-19 or, indeed, any future pandemic.

Submitted on invitation.
Accepted on 10 August 2020.