Regional health library service in Northern Ireland* By David S. Crawford, B.A., Dip. Lib. Stud., Associate L.A. Senior Librarian and Assistant Life Sciences Area Librarian
McGill University Health Sciences Library 3655 Drummond Street Montreal, Quebec H3G 1Y6 Canada
The regional medical library service provided to physicians, hospitals, nurses, social workers, and health care administrators throughout Northern Ireland by the Queen's University of Belfast is described. A brief outline of the National Health Service in the United Kingdom is given, and the library service is described in terms of collections, cataloging, interlibrary loan, and reference.
INTRODUCTION The level and type of library service provided to health care professionals depends, to a large extent, upon the health care and library environments in which they are offered. Therefore, library services are not always offered in a standard way, but the end resultthe provision of accurate, timely, and complete information-should be essentially the same. Though the United Kingdom of Great Britain and Northern Ireland (U.K.) is normally thought of as a unified state, there are variations in the government organization in each of its four component countries: England, Wales, Scotland, and Northern Ireland. This paper looks at the organization of health library service in the smallest of these, Northern Ireland (N.I.), and compares its organization to that in other parts of the U.K. NATIONAL HEALTH SERVICE ORGANIZATION
[1-2] In the U.K., the National Health Service (NHS)which is almost completely funded by general tax revenues-is responsible for providing primary health care, hospital care, dental care, and pharmaceutical products to all citizens. Coverage is universal, and all * The research necessary to produce this paper was supported in part by the World Health Organization and the British Council and could not have been undertaken without the help and cooperation of the staff of the Northern Ireland Health and Social Services Library/Queen's University Medical Library, Belfast.
364
citizens are entitled to the same level of care, though the older, the younger, and the chronically ill are exempt from some of the charges made for dental and pharmaceutical services. Private hospitals (both forprofit and not-for-profit) and private physicians do exist, but they are a small part of the total health care community.
In the U.K., the National Health Service is responsible for providing primary health care, hospital care, dental care, and pharmaceutical products to all citizens. Coverage is universal, and all citizens are entitled to the same level of care. NHS is a national service, but it is organized in a slightly different way in each of the four countries. In England the secretary of state for health is the government minister responsible for NHS. In Scotland, Wales, and Northern Ireland, responsibility rests with the secretary of state for that country. In England, much the largest component of the U.K., the secretary of state for health exercises his/her authority through fourteen regional health authorities. These regional health authorities are subdivided into 190 district health authorities; there are also twenty special health authorities responsible for specialized services such as training, health education, and postgraduate teaching hospitals. Primary medical, dental, and optical care is organized through family practitioner committees, which hold service contracts with family practitioners (family physicians), dentists, opBull Med Libr Assoc 78(4) October 1990
Library service in N. Ireland
ticians, and pharmacists and maintain registers of patients in their areas. In Wales the organization of NHS is similar to the English pattern, though there is only one health authority. In Scotland there are health boards, which have most of the responsibilities of the English and Welsh health authorities and also perform the functions of the family practitioner committees. In N.I., which is unique in that social services are a central government responsibility, there are four health and social services boards, and there are neither districts nor family practitioner committees. Though the organization of NHS is different in each of the four countries, the service provided is the same in all parts of the U.K.
CHARACTERISTICS OF NORTHERN IRELAND N.I. is relatively sparsely populated and has a total population of approximately 1.5 million with a population density of 112 per square kilometer. Since over half of the population is concentrated in the Belfast area, this average gives a rather false impression; most of the country has a much lower density than these figures suggest. The shape of N.I. means that no part of it is more than about 130 kilometers (80 miles) from Belfast. An excellent road network has been built, in part with development aid from the European Economic Community, which makes communication by road very fast. There are two universities in N.I. Queen's University, founded in the midnineteenth century, provides medical and dental training, while the University of Ulster, founded in the 1960s, is responsible for a number of paramedical courses. The National Board for Nursing, Midwifery and Health Visiting for Northern Ireland, one of four such boards in the U.K., is responsible for all nurses' training and, as of April 1990, supports five colleges of nursing and one of midwifery. Nurses' training is presently hospitalbased, but the aim (by the year 2000) is to have nursing education based in one of the universities [3]. The National Board is funded by the Department of Health and Social Services (DHSS [N.I.]), while the universities are funded by the Department of Education (N.I.). The Belfast Medical School, now the Faculty of Medicine of Queen's University, was founded in 1836 and has historically provided most of the medical practitioners for the area that is now N.I. As is common elsewhere, the medical school has a tradition of supporting its graduates throughout their careers. When a separate medical library was opened in 1954, it was natural for graduates to look to this library to fill their information needs. This library was built on the university campus at the Royal Victoria Hospital, at that time the main site for clinical training, and served from the start as the hospital library. Though Bull Med Libr Assoc 78(4) October 1990
Queen's University met most of the costs for this library, a small contribution toward this nonuniversity service was made by the Northern Ireland Hospitals Authority, which was at that time, responsible for all NHS hospitals in N.I.
Evolution of the regional library service By the mid-1960s, it was apparent that these rather ad hoc arrangements should be examined. At the same time, the Northern Ireland Hospitals Authority and the General Health Services Board, which had a statutory duty to provide postgraduate training for doctors and dentists, joined with Queen's University to create the Northern Ireland Postgraduate Medical Education Board. This board was charged with the responsibility of formulating policies and providing administrative facilities for the development of postgraduate medical and dental education in N.I. The board decided to provide this training through postgraduate medical centers that were to be attached to the larger district hospitals throughout N.I. The first of five postgraduate medical centers was opened in 1967, and the other four opened between 1968 and 1971. Each offered postgraduate training courses, had a permanent administrative staff, and was supervised by a clinical tutor appointed by the board. The funding for the postgraduate medical centers was provided by DHSS (N.I.). A five-year grant of £15,000 (U.S. $36,000)t was received from the Nuffield Provincial Hospitals Trust; this allowed each center to have a small reference library and made it possible for Queen's University to hire an additional librarian. This was the first university-based regional medical librarian post established in the U.K. The librarian's responsibilities included selecting and organizing books and journals for each center, training the centers' administrative staff to look after the collections, and serving as a contact person for library users based outside the Queen's University/Royal Victoria Hospital complex. Though collections of books had previously existed in some of these hospitals, it is fair to say that these were the first real medical libraries in N.I. outside Belfast. By providing a point of contact, these libraries allowed the Queen's University Medical Library to reach a far larger number of potential users. In the early 1970s, just as the Nuffield grant expired, local government in N.I. was reorganized, and at about the same time, NHS was reorganized throughout the U.K. As a result, the four health and social services boards were created in N.I. The NHS reorganization gave greater powers to DHSS (N.I.), and they cont Currency conversions are based on the rate at the time mentioned.
365
Crawford
vened a working party to examine the provision of library and information services. The working party had representatives from DHSS (N.I.), the Department of Education (N.I.), the Northern Ireland Council for Nurses and Midwives (the predecessor of the National Board for Nursing, Midwifery and Health Visiting), the Northern Ireland Council for Postgraduate Medical Education (previously called the Postgraduate Medical Education Board), and Queen's University. Partly because the Queen's University Medical Library was already providing library service to all Queen's University staff (students and graduates), to staff of the Royal Victoria Hospital in Belfast, and to anyone taking a course at one of the postgraduate medical centers, it was recommended that DHSS (N.I.) should fund the establishment of a provincial medical library and that this should be based at the Queen's University Medical Library. In the summer of 1974, DHSS (N.I.) accepted the report. It was implemented, following an exchange of letters between the permanent secretary (the senior civil servant) of DHSS (N.I.) and the vice-chancellor of Queen's University in late 1974.
Professional library staff should be concentrated at the central library, similar to the manner in which the librarian responsible for the postgraduate medical centers had functioned since 1968, and locally based staff should remain the financial responsibility of the hospital, nursing college, or social services center where they were based. Essentially, the report recommended that the Northern Ireland Health and Social Services Library/ Queen's University Medical Library should be created to incorporate formally the existing functions of acting as the university's medical and dental library and supporting the libraries in the postgraduate medical centers [4]. In addition, it should extend service to all NHS staff in N.I., to social workers employed by the health and social services boards, and to nurses in training. Furthermore, it should act as the health administration (health care management) library for N.I. This was a sizable increase in the library's responsibilities and involved a considerable expansion in both staff and collection needs. While the expansion envisaged was large, the working party recommended that funding for the service should come from only two sources. Queen's University should support the teaching needs, and DHSS (N.I.) should support the needs of all the other components. In practice, DHSS (N.I.) takes "a slice off the top" of the budgets of the four health and social services boards; 366
the National Board for Nursing, Midwifery and Health Visiting; and the Council for Postgraduate Medical Education and allocates these funds to the library service in a global manner. The working party recommended that the professional library staff should be concentrated at the central library, similar to the manner in which the librarian responsible for the postgraduate medical centers had functioned since 1968, and that locally based staff should remain the financial responsibility of the hospital, nursing college, or social services center where they were based.
Collections and staffing [5-61 Prior to 1974, the collections of the Queen's University Medical Library had been almost completely provided with university funds and had covered only medicine and dentistry. Since 1974 the collections have been provided with a mixture of university and DHSS (N.I.) funding, and now cover all aspects of health sciences and health care administration. Though the growth of the collection has been substantial, and despite a working party recommendation for a new jointly funded library building, the space allocated to the library has not increased. Both readers and staff must operate in very cramped quarters, and much of the collection is in closed-access stacks. DHSS (N.I.) provided a one-time grant of £100,000 (U.S. $240,000) to develop the central collection; DHSS (N.I.) also provides an annual grant to cover staffing in the central library and services and collections in both the central and the outlier libraries. By 1989 this annual grant had grown to approximately £500,000 (U.S. $850,000). To operate this greatly expanded service, twelve new posts were created in 1974. These included four professional posts directly responsible for providing regional service. As recommended by the working party, these librarians were based at the central library and were each responsible for a subject area/ group of clients throughout N.I. One librarian was responsible for the provision of service to nurses, the role of the existing postgraduate medical education librarian was expanded to include the approximately thirty libraries in larger general hospitals, and a social services librarian was appointed to establish libraries and provide services for practicing social workers. Though it had been decided not to establish health administration collections in each of the health and social services boards, an additional librarian was appointed in the library with responsibility for collection development and services to health care managers throughout N.I. These four regional service librarians are responsible for service to their own user groups and are assisted by the other staff of the library, who order, Bull Med Libr Assoc 78(4) October 1990
Library service in N. Ireland
catalog, process, and photocopy material for both the central and the outlier libraries. Almost all material ordered for an outlier library is duplicated in the central library; outlier material is cataloged to exactly the same level as material added to the central library. The central library is one of four branches of the Queen's University library system and thus experiences the benefits and the drawbacks inherent in being part of a large library system. Queen's University recently became a member of the Birmingham Cooperative Library Mechanisation Project (BCLMP) library automation system. This has provided an online public access catalog (OPAC) and a systemwide computer output microform (COM) catalog, but has resulted in cards and printed lists no longer being available to the outlier libraries. As outlier libraries are really small working collections with comparatively inexperienced users, cards or printed lists are the preferred form of catalog until funds can be allocated to mount their own catalogs on local microcomputers, using the BCLMP database to provide the machinereadable records.
The central library is one of four branches of the Queen's University library system and thus experiences the benefits and the drawbacks inherent in being part of a large library system. Queen's University recently became a member of the Birmingham Cooperative Library Mechanisation Project (BCLMP) library automation system. In addition to being responsible for the training of staff in their outlier libraries and for collection development in their specialties, the regional librarians are also responsible for reference services to their respective client groups. These reference questions can be referred by the public services staff in the central library, can come directly by telephone and letter, or can be sent by the staff in charge of the outlier libraries. Since DHSS (N.I.) funding is given to provide for the information needs of the users covered by the 1974 agreement, all reference work including online searches and interlibrary loan-and photocopies of articles are provided to these designated patrons without charge. This arrangement, though reducing administrative costs considerably, results in a certain amount of conflict between students (who must pay for these services) and DHSS (N.I.)/NHS staff (who receive them free).
The library and its services in the 1980s As of 1990, the regional medical library service in N.I. has been in operation in its present form for over Bull Med Libr Assoc 78(4) October 1990
fifteen years. It was reviewed in 1987 by the Efficiency Services Branch of DHSS (N.I.). Their report recommended, yet again, that a new library be built and that another working party be established by DHSS (N.I.) and Queen's University to review the funding base for the library and examine the long-term staffing needs of the service. This working party was set up in late 1988 and is due to report in 1990. In addition to DHSS (N.I.) and Queen's University representatives, the working party has, as an external assessor, a senior health care librarian from England. Despite the obvious problems caused by lack of suitable space and shortage of funds, the establishment of the Northern Ireland Health and Social Services Library/Queen's University Medical Library has made possible the expansion and rationalization of health and social services library resources in N.I. In addition to the five postgraduate medical center libraries established between 1968 and 1972, there are now libraries in all the colleges of nursing and midwifery-some with additional outlier collections in hospitals used for training, eight collections in social services training units, libraries in larger district general hospitals, and one multidisciplinary library. This multidisciplinary library, at Altnagelvin Hospital in Londonderry, provides service to hospital staff, to the college of nursing, to local health managers, and to the postgraduate medical center; its collection is also of use to practicing social workers and trainers. This was the first outlier library to employ a professional librarian, but the National Board for Nursing, Midwifery and Health Visiting has recently agreed that all colleges of nursing/midwifery in N.I. should appoint professional librarians who will work under the supervision of the regional nursing librarian. It is expected that these staff will be hired during 1990. In addition to these librarians in the outlier libraries (who are locally funded), a university-funded librarian is in charge of the sub-branch library serving the preclinical science departments and the Queen's University School of Pharmacy. Since this library is situated in the other main teaching hospital, the Belfast City Hospital, it also serves as the main contact point for all NHS staff working in this hospital. It is expected that its responsibilities in this area will increase since most of the collection from the library of the Belfast Postgraduate Medical Center will be moved into this library, and a number of the university's clinical departments will transfer to this site. In the U.K., interlibrary loan (ILL) services are highly developed. The British Library Document Supply Center (DSC) at Boston Spa has a mandate to provide ILLs both quickly and comprehensively. Though DSC was developed originally as a source of scientific material, its collections now cover all disciplines, and its retrospective collection is strong. The health sciences collection at DSC is particularly good 367
Crawford
and is supported by a network of resource libraries, such as those of the Royal Society of Medicine and the British Medical Association. DSC supplies loans or copies of material for a single price; payment is by prepaid coupon. These omnipresent coupons are used as "library currency" throughout the U.K.; DSC will redeem coupons from other net lenders. Since DSC can supply a very high proportion of the ILL requests required by the library (over 95%), and they do so very quickly, it is the library's practice to send all ILL requests to DSC in the first instance. Some may be referred by them to one of the resource libraries, but it is much easier to access only one initial source. The library is able to obtain almost 15,000 ILL requests each year using one nonprofessional staff member with limited professional supervision. As mentioned earlier, ILL requests are supplied free to all staff covered by the 1974 agreement. With fast ILL service and exceedingly cramped quarters, it is seen as a better investment to spend more of the budget on DSC coupons and, thus, less on collections. As outlier libraries get professional staff, the ILL requests for their patrons will be sent directly to them by DSC, but will still be ordered centrally so that titles can be identified for purchase. In general, the library is trying to get away from viewing collection size as a measure of success and is attempting to provide the most information at the lowest cost, no matter where the information comes from or who owns it. When the Northern Ireland Health and Social Services Library/Queen's University Medical Library was established in 1974, it was built upon the existing university medical library. In 1974 the DHSS (N.I.) grant allowed for an additional twelve posts to be added; in 1978 an additional five DHSS (N.I.)-funded and four university-funded posts were created. Furthermore, the collection profile of the library has been extended from a basic medical/dental library to an all-encompassing health sciences library. Though the 1974 working party recommended a simpler funding formula, it is still complex. The university provides and maintains the library building, all staff in the central library are employed by the universitythough many are funded by the DHSS (N.I.)-and all central collections belong to the university, though more and more are purchased with DHSS (N.I.) funds. Major expenditures, such as the much-discussed new library accommodation or the reclassification of DHSS (N.I.)-funded staff, require agreement from both funding bodies. Until recently the director of the library was advised by a subcomittee of the University Library Committee, which consisted of both university and DHSS (N.I.) members. Under a "rationalization" of the university committee structure, the branch library subcommittees of the university library committee have been abolished. It is expected that the current working party will address the lack 368
of a forum for ongoing dialog between the health care library and its patrons.
Some patron categories definitely demand and receive better service than others, since most of the district general hospital libraries are open only to medical staff. CONCLUSIONS There is no doubt that the library services provided to health and social services staff in N.I. have increased substantially since 1974. Not only have the college of nursing libraries been established to support the aim of a more academic nursing education, but the provision of professionally supervised collections in district hospitals and social services training centers has given most staff in these units access to current reference material and a point of contact with the greatly expanded resources of the central library. All staff employed by the health and social services boards and all general practitioners have a right to use all library services, and to do so without charge. Apart from the obvious need for a central library with open-access stacks, the system provides library service to a disparate group of patrons and does so in a nonbureaucratic and cost-effective manner. To be sure, some patron categories definitely demand and receive better service than others, since most of the district general hospital libraries are open only to medical staff. It is expected, however, that the concept of the hospital library, so common in North America, will become more acceptable and appropriate in N.I. as the nursing profession moves toward a fully graduate membership, and the concept of the health care team receives more than lip service. The idea of a "hospital library" is generally accepted by librarians in the U.K. [7], but N.I. is certainly not the only place where users appear to want separate facilities for different categories of staff. The greatest problems experienced by the library over the past twenty years have been those experienced by most other health sciences libraries: the rising costs and increasing quantity of publications, and static or shrinking budgets. Surprisingly to an outsider, N.I.'s political unrest seems to have had little effect on library service. The central library has been closed for a few days over the years, and evening hours have been restricted from time to time when staff had difficulties coming to work, but regional service has continued to expand, and the regional librarians have no difficulty in visiting the outlier libraries. Bull Med Libr Assoc 78(4) October 1990
Library service in N. Ireland
In other parts of the U.K., library services offered to health professionals are not as centralized as those in N.I. Six of the fourteen English Regional Health authorities have appointed regional librarians, and others have accepted the "primacy" of a library within their region. The majority of these (eight of the fourteen) are not university-based and all act, more or less, as coordinators of independent libraries, sponsors of regional union lists, and organizers of training courses. Only in N.I. does the university medical librarian head a regional medical library service where the outlier libraries are essentially branches and where the amount of unique material held outside the central library is minimal. N.I. is also unique in the U.K. in that its regional medical library service serves the needs of social workers. Since the central library's collection is not supplemented by other health collections within the network, and all collections are cataloged centrally, the efforts of other U.K. regional medical librarians to produce union lists of serials and union catalogs of monographs are not necessary in N.I. All the staff's energies can be devoted to reference work, collection development, training staff in the outlier libraries, and working with users. In due course, the catalog of the University of Ulster, which holds potentially useful material in several paramedical disciplines and in health care administration, will be fully available to network participants, as their OPAC will be linked with that of Queen's University. The organization of the Northern Ireland Health and Social Services Library/Queen's University Medical Library works well. Its success has been built upon a history of service to N.I.'s health care community by the Queen's University Faculty of Medicine and its library. The extended library has built upon this history and has been aided by the DHSS
Bull Med Libr Assoc 78(4) October 1990
(N.I.), which is the source of most health and social services funding in N.I. By using accidents of history, geography, and politics, the Queen's University Medical Library has been able to obtain significant extra funding (£500,000 [U.S. $850,000] per year) and has increased both the size and the scope of its collection. More importantly, it has been able to better serve not only the users of the central library, but all health and social services personnel working in N.I. DEDICATION This paper is dedicated to Jessie B. Webster, M.A., F.S.A.(Scot), (1909-1983), librarian of the Queen's University Medical Library from 1954-1974; she built a strong foundation.
REFERENCES 1. CHAPLIN NW, ED. Health care in the United Kingdom. London: Kluwer Medical, 1982. 2. LEvrrr R, WALL A. The reorganised National Health Service. 3d ed. London: Croom Helm, 1984. 3. The provision of education: a strategy for Northern Ireland. Belfast: National Board for Nursing, Midwifery and Health Visiting for Northern Ireland, 1989. 4. Working Party on Library Facilities in the Restructured Health and Social Services: A Report. Belfast: Ministry of Health, 1974. Typescript. 5. LINTON WD. Automation in a network. In: Picken FM, Kahn AMC, eds. Medical librarianship in the eighties and beyond. London: Mansell Publishing, 1986:39-43. 6. LINTON WD. The Ulster way: a regional health care library service. Bibl Med Can 1981;2(7):178-80. 7. Providing a district library service. London: Kings Fund, 1985.
Received August 1989; accepted February 1990
369
McGill University Health Sciences Library 3655 Drummond Street Montreal, Quebec H3G 1Y6 Canada
The regional medical library service provided to physicians, hospitals, nurses, social workers, and health care administrators throughout Northern Ireland by the Queen's University of Belfast is described. A brief outline of the National Health Service in the United Kingdom is given, and the library service is described in terms of collections, cataloging, interlibrary loan, and reference.
INTRODUCTION The level and type of library service provided to health care professionals depends, to a large extent, upon the health care and library environments in which they are offered. Therefore, library services are not always offered in a standard way, but the end resultthe provision of accurate, timely, and complete information-should be essentially the same. Though the United Kingdom of Great Britain and Northern Ireland (U.K.) is normally thought of as a unified state, there are variations in the government organization in each of its four component countries: England, Wales, Scotland, and Northern Ireland. This paper looks at the organization of health library service in the smallest of these, Northern Ireland (N.I.), and compares its organization to that in other parts of the U.K. NATIONAL HEALTH SERVICE ORGANIZATION
[1-2] In the U.K., the National Health Service (NHS)which is almost completely funded by general tax revenues-is responsible for providing primary health care, hospital care, dental care, and pharmaceutical products to all citizens. Coverage is universal, and all * The research necessary to produce this paper was supported in part by the World Health Organization and the British Council and could not have been undertaken without the help and cooperation of the staff of the Northern Ireland Health and Social Services Library/Queen's University Medical Library, Belfast.
364
citizens are entitled to the same level of care, though the older, the younger, and the chronically ill are exempt from some of the charges made for dental and pharmaceutical services. Private hospitals (both forprofit and not-for-profit) and private physicians do exist, but they are a small part of the total health care community.
In the U.K., the National Health Service is responsible for providing primary health care, hospital care, dental care, and pharmaceutical products to all citizens. Coverage is universal, and all citizens are entitled to the same level of care. NHS is a national service, but it is organized in a slightly different way in each of the four countries. In England the secretary of state for health is the government minister responsible for NHS. In Scotland, Wales, and Northern Ireland, responsibility rests with the secretary of state for that country. In England, much the largest component of the U.K., the secretary of state for health exercises his/her authority through fourteen regional health authorities. These regional health authorities are subdivided into 190 district health authorities; there are also twenty special health authorities responsible for specialized services such as training, health education, and postgraduate teaching hospitals. Primary medical, dental, and optical care is organized through family practitioner committees, which hold service contracts with family practitioners (family physicians), dentists, opBull Med Libr Assoc 78(4) October 1990
Library service in N. Ireland
ticians, and pharmacists and maintain registers of patients in their areas. In Wales the organization of NHS is similar to the English pattern, though there is only one health authority. In Scotland there are health boards, which have most of the responsibilities of the English and Welsh health authorities and also perform the functions of the family practitioner committees. In N.I., which is unique in that social services are a central government responsibility, there are four health and social services boards, and there are neither districts nor family practitioner committees. Though the organization of NHS is different in each of the four countries, the service provided is the same in all parts of the U.K.
CHARACTERISTICS OF NORTHERN IRELAND N.I. is relatively sparsely populated and has a total population of approximately 1.5 million with a population density of 112 per square kilometer. Since over half of the population is concentrated in the Belfast area, this average gives a rather false impression; most of the country has a much lower density than these figures suggest. The shape of N.I. means that no part of it is more than about 130 kilometers (80 miles) from Belfast. An excellent road network has been built, in part with development aid from the European Economic Community, which makes communication by road very fast. There are two universities in N.I. Queen's University, founded in the midnineteenth century, provides medical and dental training, while the University of Ulster, founded in the 1960s, is responsible for a number of paramedical courses. The National Board for Nursing, Midwifery and Health Visiting for Northern Ireland, one of four such boards in the U.K., is responsible for all nurses' training and, as of April 1990, supports five colleges of nursing and one of midwifery. Nurses' training is presently hospitalbased, but the aim (by the year 2000) is to have nursing education based in one of the universities [3]. The National Board is funded by the Department of Health and Social Services (DHSS [N.I.]), while the universities are funded by the Department of Education (N.I.). The Belfast Medical School, now the Faculty of Medicine of Queen's University, was founded in 1836 and has historically provided most of the medical practitioners for the area that is now N.I. As is common elsewhere, the medical school has a tradition of supporting its graduates throughout their careers. When a separate medical library was opened in 1954, it was natural for graduates to look to this library to fill their information needs. This library was built on the university campus at the Royal Victoria Hospital, at that time the main site for clinical training, and served from the start as the hospital library. Though Bull Med Libr Assoc 78(4) October 1990
Queen's University met most of the costs for this library, a small contribution toward this nonuniversity service was made by the Northern Ireland Hospitals Authority, which was at that time, responsible for all NHS hospitals in N.I.
Evolution of the regional library service By the mid-1960s, it was apparent that these rather ad hoc arrangements should be examined. At the same time, the Northern Ireland Hospitals Authority and the General Health Services Board, which had a statutory duty to provide postgraduate training for doctors and dentists, joined with Queen's University to create the Northern Ireland Postgraduate Medical Education Board. This board was charged with the responsibility of formulating policies and providing administrative facilities for the development of postgraduate medical and dental education in N.I. The board decided to provide this training through postgraduate medical centers that were to be attached to the larger district hospitals throughout N.I. The first of five postgraduate medical centers was opened in 1967, and the other four opened between 1968 and 1971. Each offered postgraduate training courses, had a permanent administrative staff, and was supervised by a clinical tutor appointed by the board. The funding for the postgraduate medical centers was provided by DHSS (N.I.). A five-year grant of £15,000 (U.S. $36,000)t was received from the Nuffield Provincial Hospitals Trust; this allowed each center to have a small reference library and made it possible for Queen's University to hire an additional librarian. This was the first university-based regional medical librarian post established in the U.K. The librarian's responsibilities included selecting and organizing books and journals for each center, training the centers' administrative staff to look after the collections, and serving as a contact person for library users based outside the Queen's University/Royal Victoria Hospital complex. Though collections of books had previously existed in some of these hospitals, it is fair to say that these were the first real medical libraries in N.I. outside Belfast. By providing a point of contact, these libraries allowed the Queen's University Medical Library to reach a far larger number of potential users. In the early 1970s, just as the Nuffield grant expired, local government in N.I. was reorganized, and at about the same time, NHS was reorganized throughout the U.K. As a result, the four health and social services boards were created in N.I. The NHS reorganization gave greater powers to DHSS (N.I.), and they cont Currency conversions are based on the rate at the time mentioned.
365
Crawford
vened a working party to examine the provision of library and information services. The working party had representatives from DHSS (N.I.), the Department of Education (N.I.), the Northern Ireland Council for Nurses and Midwives (the predecessor of the National Board for Nursing, Midwifery and Health Visiting), the Northern Ireland Council for Postgraduate Medical Education (previously called the Postgraduate Medical Education Board), and Queen's University. Partly because the Queen's University Medical Library was already providing library service to all Queen's University staff (students and graduates), to staff of the Royal Victoria Hospital in Belfast, and to anyone taking a course at one of the postgraduate medical centers, it was recommended that DHSS (N.I.) should fund the establishment of a provincial medical library and that this should be based at the Queen's University Medical Library. In the summer of 1974, DHSS (N.I.) accepted the report. It was implemented, following an exchange of letters between the permanent secretary (the senior civil servant) of DHSS (N.I.) and the vice-chancellor of Queen's University in late 1974.
Professional library staff should be concentrated at the central library, similar to the manner in which the librarian responsible for the postgraduate medical centers had functioned since 1968, and locally based staff should remain the financial responsibility of the hospital, nursing college, or social services center where they were based. Essentially, the report recommended that the Northern Ireland Health and Social Services Library/ Queen's University Medical Library should be created to incorporate formally the existing functions of acting as the university's medical and dental library and supporting the libraries in the postgraduate medical centers [4]. In addition, it should extend service to all NHS staff in N.I., to social workers employed by the health and social services boards, and to nurses in training. Furthermore, it should act as the health administration (health care management) library for N.I. This was a sizable increase in the library's responsibilities and involved a considerable expansion in both staff and collection needs. While the expansion envisaged was large, the working party recommended that funding for the service should come from only two sources. Queen's University should support the teaching needs, and DHSS (N.I.) should support the needs of all the other components. In practice, DHSS (N.I.) takes "a slice off the top" of the budgets of the four health and social services boards; 366
the National Board for Nursing, Midwifery and Health Visiting; and the Council for Postgraduate Medical Education and allocates these funds to the library service in a global manner. The working party recommended that the professional library staff should be concentrated at the central library, similar to the manner in which the librarian responsible for the postgraduate medical centers had functioned since 1968, and that locally based staff should remain the financial responsibility of the hospital, nursing college, or social services center where they were based.
Collections and staffing [5-61 Prior to 1974, the collections of the Queen's University Medical Library had been almost completely provided with university funds and had covered only medicine and dentistry. Since 1974 the collections have been provided with a mixture of university and DHSS (N.I.) funding, and now cover all aspects of health sciences and health care administration. Though the growth of the collection has been substantial, and despite a working party recommendation for a new jointly funded library building, the space allocated to the library has not increased. Both readers and staff must operate in very cramped quarters, and much of the collection is in closed-access stacks. DHSS (N.I.) provided a one-time grant of £100,000 (U.S. $240,000) to develop the central collection; DHSS (N.I.) also provides an annual grant to cover staffing in the central library and services and collections in both the central and the outlier libraries. By 1989 this annual grant had grown to approximately £500,000 (U.S. $850,000). To operate this greatly expanded service, twelve new posts were created in 1974. These included four professional posts directly responsible for providing regional service. As recommended by the working party, these librarians were based at the central library and were each responsible for a subject area/ group of clients throughout N.I. One librarian was responsible for the provision of service to nurses, the role of the existing postgraduate medical education librarian was expanded to include the approximately thirty libraries in larger general hospitals, and a social services librarian was appointed to establish libraries and provide services for practicing social workers. Though it had been decided not to establish health administration collections in each of the health and social services boards, an additional librarian was appointed in the library with responsibility for collection development and services to health care managers throughout N.I. These four regional service librarians are responsible for service to their own user groups and are assisted by the other staff of the library, who order, Bull Med Libr Assoc 78(4) October 1990
Library service in N. Ireland
catalog, process, and photocopy material for both the central and the outlier libraries. Almost all material ordered for an outlier library is duplicated in the central library; outlier material is cataloged to exactly the same level as material added to the central library. The central library is one of four branches of the Queen's University library system and thus experiences the benefits and the drawbacks inherent in being part of a large library system. Queen's University recently became a member of the Birmingham Cooperative Library Mechanisation Project (BCLMP) library automation system. This has provided an online public access catalog (OPAC) and a systemwide computer output microform (COM) catalog, but has resulted in cards and printed lists no longer being available to the outlier libraries. As outlier libraries are really small working collections with comparatively inexperienced users, cards or printed lists are the preferred form of catalog until funds can be allocated to mount their own catalogs on local microcomputers, using the BCLMP database to provide the machinereadable records.
The central library is one of four branches of the Queen's University library system and thus experiences the benefits and the drawbacks inherent in being part of a large library system. Queen's University recently became a member of the Birmingham Cooperative Library Mechanisation Project (BCLMP) library automation system. In addition to being responsible for the training of staff in their outlier libraries and for collection development in their specialties, the regional librarians are also responsible for reference services to their respective client groups. These reference questions can be referred by the public services staff in the central library, can come directly by telephone and letter, or can be sent by the staff in charge of the outlier libraries. Since DHSS (N.I.) funding is given to provide for the information needs of the users covered by the 1974 agreement, all reference work including online searches and interlibrary loan-and photocopies of articles are provided to these designated patrons without charge. This arrangement, though reducing administrative costs considerably, results in a certain amount of conflict between students (who must pay for these services) and DHSS (N.I.)/NHS staff (who receive them free).
The library and its services in the 1980s As of 1990, the regional medical library service in N.I. has been in operation in its present form for over Bull Med Libr Assoc 78(4) October 1990
fifteen years. It was reviewed in 1987 by the Efficiency Services Branch of DHSS (N.I.). Their report recommended, yet again, that a new library be built and that another working party be established by DHSS (N.I.) and Queen's University to review the funding base for the library and examine the long-term staffing needs of the service. This working party was set up in late 1988 and is due to report in 1990. In addition to DHSS (N.I.) and Queen's University representatives, the working party has, as an external assessor, a senior health care librarian from England. Despite the obvious problems caused by lack of suitable space and shortage of funds, the establishment of the Northern Ireland Health and Social Services Library/Queen's University Medical Library has made possible the expansion and rationalization of health and social services library resources in N.I. In addition to the five postgraduate medical center libraries established between 1968 and 1972, there are now libraries in all the colleges of nursing and midwifery-some with additional outlier collections in hospitals used for training, eight collections in social services training units, libraries in larger district general hospitals, and one multidisciplinary library. This multidisciplinary library, at Altnagelvin Hospital in Londonderry, provides service to hospital staff, to the college of nursing, to local health managers, and to the postgraduate medical center; its collection is also of use to practicing social workers and trainers. This was the first outlier library to employ a professional librarian, but the National Board for Nursing, Midwifery and Health Visiting has recently agreed that all colleges of nursing/midwifery in N.I. should appoint professional librarians who will work under the supervision of the regional nursing librarian. It is expected that these staff will be hired during 1990. In addition to these librarians in the outlier libraries (who are locally funded), a university-funded librarian is in charge of the sub-branch library serving the preclinical science departments and the Queen's University School of Pharmacy. Since this library is situated in the other main teaching hospital, the Belfast City Hospital, it also serves as the main contact point for all NHS staff working in this hospital. It is expected that its responsibilities in this area will increase since most of the collection from the library of the Belfast Postgraduate Medical Center will be moved into this library, and a number of the university's clinical departments will transfer to this site. In the U.K., interlibrary loan (ILL) services are highly developed. The British Library Document Supply Center (DSC) at Boston Spa has a mandate to provide ILLs both quickly and comprehensively. Though DSC was developed originally as a source of scientific material, its collections now cover all disciplines, and its retrospective collection is strong. The health sciences collection at DSC is particularly good 367
Crawford
and is supported by a network of resource libraries, such as those of the Royal Society of Medicine and the British Medical Association. DSC supplies loans or copies of material for a single price; payment is by prepaid coupon. These omnipresent coupons are used as "library currency" throughout the U.K.; DSC will redeem coupons from other net lenders. Since DSC can supply a very high proportion of the ILL requests required by the library (over 95%), and they do so very quickly, it is the library's practice to send all ILL requests to DSC in the first instance. Some may be referred by them to one of the resource libraries, but it is much easier to access only one initial source. The library is able to obtain almost 15,000 ILL requests each year using one nonprofessional staff member with limited professional supervision. As mentioned earlier, ILL requests are supplied free to all staff covered by the 1974 agreement. With fast ILL service and exceedingly cramped quarters, it is seen as a better investment to spend more of the budget on DSC coupons and, thus, less on collections. As outlier libraries get professional staff, the ILL requests for their patrons will be sent directly to them by DSC, but will still be ordered centrally so that titles can be identified for purchase. In general, the library is trying to get away from viewing collection size as a measure of success and is attempting to provide the most information at the lowest cost, no matter where the information comes from or who owns it. When the Northern Ireland Health and Social Services Library/Queen's University Medical Library was established in 1974, it was built upon the existing university medical library. In 1974 the DHSS (N.I.) grant allowed for an additional twelve posts to be added; in 1978 an additional five DHSS (N.I.)-funded and four university-funded posts were created. Furthermore, the collection profile of the library has been extended from a basic medical/dental library to an all-encompassing health sciences library. Though the 1974 working party recommended a simpler funding formula, it is still complex. The university provides and maintains the library building, all staff in the central library are employed by the universitythough many are funded by the DHSS (N.I.)-and all central collections belong to the university, though more and more are purchased with DHSS (N.I.) funds. Major expenditures, such as the much-discussed new library accommodation or the reclassification of DHSS (N.I.)-funded staff, require agreement from both funding bodies. Until recently the director of the library was advised by a subcomittee of the University Library Committee, which consisted of both university and DHSS (N.I.) members. Under a "rationalization" of the university committee structure, the branch library subcommittees of the university library committee have been abolished. It is expected that the current working party will address the lack 368
of a forum for ongoing dialog between the health care library and its patrons.
Some patron categories definitely demand and receive better service than others, since most of the district general hospital libraries are open only to medical staff. CONCLUSIONS There is no doubt that the library services provided to health and social services staff in N.I. have increased substantially since 1974. Not only have the college of nursing libraries been established to support the aim of a more academic nursing education, but the provision of professionally supervised collections in district hospitals and social services training centers has given most staff in these units access to current reference material and a point of contact with the greatly expanded resources of the central library. All staff employed by the health and social services boards and all general practitioners have a right to use all library services, and to do so without charge. Apart from the obvious need for a central library with open-access stacks, the system provides library service to a disparate group of patrons and does so in a nonbureaucratic and cost-effective manner. To be sure, some patron categories definitely demand and receive better service than others, since most of the district general hospital libraries are open only to medical staff. It is expected, however, that the concept of the hospital library, so common in North America, will become more acceptable and appropriate in N.I. as the nursing profession moves toward a fully graduate membership, and the concept of the health care team receives more than lip service. The idea of a "hospital library" is generally accepted by librarians in the U.K. [7], but N.I. is certainly not the only place where users appear to want separate facilities for different categories of staff. The greatest problems experienced by the library over the past twenty years have been those experienced by most other health sciences libraries: the rising costs and increasing quantity of publications, and static or shrinking budgets. Surprisingly to an outsider, N.I.'s political unrest seems to have had little effect on library service. The central library has been closed for a few days over the years, and evening hours have been restricted from time to time when staff had difficulties coming to work, but regional service has continued to expand, and the regional librarians have no difficulty in visiting the outlier libraries. Bull Med Libr Assoc 78(4) October 1990
Library service in N. Ireland
In other parts of the U.K., library services offered to health professionals are not as centralized as those in N.I. Six of the fourteen English Regional Health authorities have appointed regional librarians, and others have accepted the "primacy" of a library within their region. The majority of these (eight of the fourteen) are not university-based and all act, more or less, as coordinators of independent libraries, sponsors of regional union lists, and organizers of training courses. Only in N.I. does the university medical librarian head a regional medical library service where the outlier libraries are essentially branches and where the amount of unique material held outside the central library is minimal. N.I. is also unique in the U.K. in that its regional medical library service serves the needs of social workers. Since the central library's collection is not supplemented by other health collections within the network, and all collections are cataloged centrally, the efforts of other U.K. regional medical librarians to produce union lists of serials and union catalogs of monographs are not necessary in N.I. All the staff's energies can be devoted to reference work, collection development, training staff in the outlier libraries, and working with users. In due course, the catalog of the University of Ulster, which holds potentially useful material in several paramedical disciplines and in health care administration, will be fully available to network participants, as their OPAC will be linked with that of Queen's University. The organization of the Northern Ireland Health and Social Services Library/Queen's University Medical Library works well. Its success has been built upon a history of service to N.I.'s health care community by the Queen's University Faculty of Medicine and its library. The extended library has built upon this history and has been aided by the DHSS
Bull Med Libr Assoc 78(4) October 1990
(N.I.), which is the source of most health and social services funding in N.I. By using accidents of history, geography, and politics, the Queen's University Medical Library has been able to obtain significant extra funding (£500,000 [U.S. $850,000] per year) and has increased both the size and the scope of its collection. More importantly, it has been able to better serve not only the users of the central library, but all health and social services personnel working in N.I. DEDICATION This paper is dedicated to Jessie B. Webster, M.A., F.S.A.(Scot), (1909-1983), librarian of the Queen's University Medical Library from 1954-1974; she built a strong foundation.
REFERENCES 1. CHAPLIN NW, ED. Health care in the United Kingdom. London: Kluwer Medical, 1982. 2. LEvrrr R, WALL A. The reorganised National Health Service. 3d ed. London: Croom Helm, 1984. 3. The provision of education: a strategy for Northern Ireland. Belfast: National Board for Nursing, Midwifery and Health Visiting for Northern Ireland, 1989. 4. Working Party on Library Facilities in the Restructured Health and Social Services: A Report. Belfast: Ministry of Health, 1974. Typescript. 5. LINTON WD. Automation in a network. In: Picken FM, Kahn AMC, eds. Medical librarianship in the eighties and beyond. London: Mansell Publishing, 1986:39-43. 6. LINTON WD. The Ulster way: a regional health care library service. Bibl Med Can 1981;2(7):178-80. 7. Providing a district library service. London: Kings Fund, 1985.
Received August 1989; accepted February 1990
369
