Web Magazine for Information Professionals

The NHS, the Internet and Libraries: The NHS Anglia and Oxford Internet Project

Judy Palmer and Myles Chippendale describe an initiative that is using the Internet to connect widely dispersed health libraries.

In the Higher Education sector, following the Follett Report [1], there has been massive investment in developing and shaping the implementation of the electronic library through the Electronic Libraries Programme (eLib)[2]. Libraries in the NHS have not been so fortunate. Although health librarians are enthusiastic networkers, with no tradition of wide area networking, NHS libraries have had to operate as individual units, unable to communicate with each other apart from by post, telephone and fax. Three years ago, reluctant to wait for wide area networking to become a reality for the NHS, the Health Care Libraries Unit (HCLU)[3] in the NHS East Anglia and Oxford Region took the decision to enhance communication and resource sharing among the health libraries dispersed over the Region by using the Internet. The HCLU coordinates and facilitates resource sharing among the member libraries of the Health Libraries Information Network (HeLIN) in the Region and provides advice to the Anglia and Oxford NHS Executive on issues relating to library and information services. This decision was made possible by the wide-spread emergence of Internet Service Providers (ISPs) who were anxious to woo individual customers and drive down the cost of Internet connectivity.

With funding from Postgraduate Medical Education and the Anglia and Oxford Research and Development Directorate[4], the Internet Project began with the appointment of a Project Officer and the intention to connect 8 pilot sites across the region. However, as the project left the planning stage, it quickly became clear that there was a much larger demand in the region for access to the Internet.

The aims and content of the Project

The aim of the project is to “extend and intensify resource sharing amongst health libraries in the Anglia and Oxford region and improve access to evidence-based health care information for both librarians and users”. This aim is achieved through the provision of connections, training, support and central resources.


Initially, the project proposed to provide Internet access for 8 pilot sites in the region. Subsequently, it was decided that the rest of the libraries in the region also should be connected. In Anglia the additional connections were funded by the Postgraduate Dean. Each library was provided with a modem and a year’s subscription to an ISP. Around 25 sites have now been connected by HCLU.


A first training kit, covering a basic introduction to the Internet, has been developed from the Network Training Materials Project kits. It has been delivered to over 90 librarians and library assistants in the region. A second, intermediate level, training kit has also been created and delivered to 70 librarians.

Technical Support

Many libraries in the region have little or no technical support especially for Internet related hardware and software. Some of the necessary support is provided remotely by the Internet Project Officer.

Central Resources

Access to central resources via the Internet is an important part of the project. These are available primarily through the HCLU mailing list and web server[5] These services can be broken down into 3 types:

1. Electronic versions of printed materials
Services that were previously provided by printed material can quickly be converted to web pages using one of the many conversion programs available today. This increases timely access to, and availability of, these resources whilst adding value by inserting hyperlinks to interesting Internet resources. Examples of such resources include copies of the HCLU calendar of events, HCLU news bulletins and reports. Librarians can now also access the most current version of documents which were previously distributed annually in print, and which, therefore, quickly became outdated, such as the Directory of Libraries and Librarians and the Union List of Periodicals. The latter is available in a searchable format.
2. New materials or services
Resources created in the course of the project and which are Internet related are available including the materials produced for the 2 Internet training kits, archives of HCLU’s electronic mailing list and pointers to Internet sites of interest to librarians and medical practitioners. The whole site (including the mailing list archives) can be searched using keywords.
3. Central access to non-HCLU resources
The web site can be used to mediate access to non-HCLU resources for librarians in the region. At the moment, there is a link to Swet’s contents page service, SwetScan with instructions for HeLIN libraries on connection and use. It is hoped that commercial databases and electronic versions of journals may soon be provided on the central server.

Future developments

Future plans include:

Monitoring and evaluation

After providing access to HCLU information via the web, one of the first questions we asked was “Who uses the HCLU web site, and for what?”. We decided to analyse the log files created by our web server to extract this information, but encountered an immediate difficulty in identifying our librarians separately from the other visitors to our site. Many of the commercial ISPs that the libraries in the region use allocate IP addresses dynamically, which means that there is no unique way to identify these libraries: If someone, for instance, with a Demon account visits our site, there is no way to tell which library it was, or indeed if it was a library in the region by looking at the server logs. Similarly, the use of proxy caches by many of the large ISPs distorts the figures, since people requesting a page from our site might not actually make contact with it and leave a record in the log (since the proxy has the page cached and returns it to the users without requesting the page from the server).

We have found, however, that the statistics about which pages are requested most commonly are useful, since they indicate which types of information are selected by visitors, allowing us to focus our developments on services that people want to use.

Internet Usage Survey

Part of the project involves surveying a subset of libraries in the region about the use made of the Internet by them and their users. Although this survey covers a very small sample (50 libraries have been sampled so far), the results give some impression of the extent to which the Internet is being used in health care libraries. Since the survey has been conducted over a number of months in 3 separate sections, it is interesting to see how responses have changed over time. Although no library has been surveyed twice in this time, and therefore any change in responses could be due to different use in different libraries, anecdotal information suggests that the changes in use and attitudes in this time are representative of changes occurring in most libraries across the region.

The Internet is being increasingly used by Librarians

During the first survey period, under 50% of libraries reported that they had used the Internet in the previous week. The reasons for not using it included not having a connection, a lack of time and not having a reason to use the Internet. In the 3rd and most recent survey period, every library had used the Internet in the previous week. For those libraries that did use the Internet, the average number of times that it was used to find information was roughly 5 times a week.

Besides reading e-mail and finding information, the most common uses of the Internet are for demonstrations or training and dissemination of information.

The Internet is being made available to Patrons

Of the libraries that have been surveyed, only 4 libraries do not allow patrons access to the Internet. Those that do allow access are split evenly between libraries that allow unsupervised access that those that require some sort of registration, appointment or supervision.

Most libraries are the only source of Internet access available to members of their organisation (65%) although 35% of organisations provide Internet access in some other way. It is interesting to note that over 70% of organisations with other connections are HE organisations with JANET connections.

Opinions are changing

The survey allows librarians to feedback general (free-text) information about how they perceive the Internet. Over the course of the survey, the comments received have changed. During the earlier part, many librarians were still dubious about the usefulness of the Internet. Many librarians commented that finding information was either difficult or too time consuming. During the later part of the survey, however, the comments received became more specific, for example requests for help on accessing Department of Health Executive Letters or sites where could they find collections of UK guidelines. Some librarians commented that their users often resort immediately to the Internet, rather than locate the most appropriate source which may be provided locally.

Two comments have recurred regularly - many librarians wished that they had more time to use the Internet, in particular to “explore”, and many also reported that the Internet was still very slow.


Healthcare libraries serve a range of professions both in the higher education sector and in the NHS. During the time that the Internet Project has been running, the Internet has changed from being a curiosity to being a working tool that is used on a day-to-day basis by many health care professionals. Those healthcare librarians who straddle the higher education/NHS divide and who have access to the Joint Academic Network, have developed an awareness of, and skills in, electronic communication and network use. Regrettably, most NHS librarians health care librarians who work in NHS Trusts have been denied this experience and thereby have been disadvantaged. The Internet Project in Anglia and Oxford has supported librarians by providing the means, the training and the support to reverse this situation.


  1. Joint Funding Council’s Libraries Review Group: Report (The Follett Report)
  2. Electronic Libraries Progamme
  3. Health Care Libraries Unit (HCLU)
  4. Anglia and Oxford Research and Development Directorate
  5. HCLU mailing list and web server

Author details

Judy Palmer
(Directory, Health Care Libraries Unit)
Level 3, Academic Centre
John Radcliffe Hospital
Email: judith.palmer@hclu.ox.ac.uk
Myles Chippendale
(Internet Project Officer, HCLU)
Level 3, Academic Centre
John Radcliffe Hospital
Email: myles.chippendale@hclu.ox.ac.uk