Hi Folks,

Apologies for the delay in reporting back from Harrogate, but here it is at
last!

My general impressions of the conference were that it was, well organised,
with a good spread of issues, and an extensive series of exhibition halls.
On the whole well worth attending, for anyone thinking of going next year.

Issues covered during the day:

1) What UK nurses, midwives and health visitors want from an Internet
service?
Rod Ward from the School of Nursing at the University of Sheffield reported
on his recent survey on nurses use of the internet.  He compiled a list of
what nurses wanted from the internet.  The top categories were - nurse
focused sites relevant to specialties, peer reviewed articles and
bibliographic databases.   They were less interested in jobs, local
information and mailing lists.    (Nurses unlike librarians don't see email
discussion lists as professionally useful!)  Rod concluded that usage of the
internet amongst nurses was increasing and that the internet was seen as an
important componet of available resources.  
Of particular interest to librarians was Rod's comment that the future
development of services was dependant upon collaboration between Higher
Education and the NHS.  He announced that the NELH had submitted a bid in
conjunction with OMNI/BIOMED and the result should be known in May 2000.   A
further interesting point was the feedback he received from his survey
respondents that community nurses had difficulties gaining access to
libraries out of hours.  It was also a sore point amongst nurses that Pubmed
is free but Cinahl isn't. 

2) Nursing and health informatics education and training: problems disguised
as opportunities?
Pete Murray from Telematics Consultancy highlighted existing problems with
informatics education as; lack of consensus on programme content between
different institutions, limited access to resources, nursing faculty are not
taught to teach IT and there is no relationship between education and
student knowledge.  Pete then highlighted current access issues; the NHSnet
is generally not available at ward level, the amount of home access to the
internet is increasing, there is a high level of internet use amongst GP but
not amonst practice nurses and there are few clinical IT systems.  In terms
of HE, he commented, that there were a few isolated visionary individuals
but that too many tutors don't use informatics themselves and therefore do
not integrate informatics into the curriculum.  In colleges of nursing there
is a serious lack of informatic skilled educators.  (A gap in the market
which should be filled by Librarians - unfortunately this was not a question
and answer session so I didn't get the chance to make my point known to the
audience). EPR and telehealth are increasing training needs.  The NHS
Education, Training and Development Strategy is a major development in
meeting unmet training needs.

3) The Internet "haves" and "have nots" in nursing
Denis Antony, Professor of Nursing Informatics at De Montford University,
talked about the lack of internet provision in developing countries.   The
key difficulties are; the lack of penetration of telecommunications and the
fact that access to the internet is only for the very rich.  These problems
are compounded by political turmoil, low literacy and high infant mortality.
This compares with the USA where 70% graduates and 70% of households with
more than 30,000$ have access to the internet.  Denis concludes that in the
USA most internet users are highly educated.  There is a similar pattern of
usage in the UK where 59% Class AB have access compared to  only 14% Class
DE.   The pattern of access to the NHSnet is still very patchy.  For
instance at Glenfield all wards have terminals with access to the intranet
whereas at Leicester and Rutland Community hospital there are no access to
terminals.  However even where ward based access is available seniority
plays a major part in deciding who gets access.  Ward staff are less likely
to have access than Senior staff.  Denis identified a resources shortfall
within the NHS in terms of training budgets and terminals.  He then went on
to discuss the fact that in 1998 no national organisations from the 8
poorest countries in the worlds had access to the internet.  However this
was inversely related to their enthusiasm for the internet.  The poorest
countries are those with a special enthusiasm for internet access.  They see
the internet as a means to overcome the problems caused by their
geographical isolation, poverty and sparsely distributed population.
Therefore a lack of internet access is not explained by apathy or ignorance.
In 2000 the very poorest countries are still without access to email or
internet.  The USA has more telephoned lines that China, Russia, India,
Pakistan, Indonesia and Bangladesh combined.   Poverty is still the major
issue in internet access.   Denis then posed the moral question - is it a
duty for very rich countries to assist the poorest countries to get access
to the internet?  He proposed that the richest countries should nominate
which poorer countries they would assist.  There was a short question and
answer session at the end.  A regional librarian, from one of the southern
regions, made the point that it was patronising to only consider what we can
give to developing countries without first considering what they can give to
us.

4) Identification of critical success factors in the implementation of
clinical governance within primary care
Beverley Ellis from the University of Central Lancashire discussed her study
of the clinical governance framework within 2 PCG's in Lancashire. She
highlighted the critical success factors for clinical governance as a core
activity in terms of ; consensus on objectives, effective and continuous
dialogue, benchmarking, information management, learning from experience,
responsive and participative culture, blame free environment and clinical
time available.  She discussed the significance of conflicting management
and clinical agendas and the difficulties of balancing contrasting agendas.
She argued that clinical staff would not participate in management agenda's
unless they perceived a clear benefit for themselves.  She emphasised the
importance of managers creating a cultural environment where knowledge was
seen as a source of competitive strength.  In her opinion the Contingency
Theory i.e. there is no optimum state only that which is contingent, is a
key success factor. Her concluding comment was that the management of change
always takes time and resources.   

5) Passion, evaluation and health informatics: the vital ingredients of
clinical governance for primary care
Carol Cowley from Newcastle University highlighted the significance of
professional self regulation and the life long learning agenda within the
clinical governance framework.  She then went on to discuss the key elements
of clinical judgement within primary care. Judgements were person based,
using diagnostic labels, based upon the judicious balance of certainty and
probability and intuition v analytic thought and were time based.  Carol
then described the cognitive continuim underlying clinical judgements.  The
continuim is intuitivie, peer aided, system aided, quasi experiment,
controlled trial and scientific experiment.  Carol also analysed the key
elements of knowledge - knowledge for action and  knowledge in action.  In
terms of clinicians learning from experience, the key factors were,
reflection, experience, selection, organisation and interpretation.  Carol
finished off by saying that consultations were increasingly  tripartite
consisting of the patient, the clinician and the knowledge support, health
record system. 
 
All in all it was a busy, but informative day.  On my wanders around the
exhibition hall I collected a good range of leaflets from the NHS
Information Authority and the NHS Executive.  These are currently been
distributed around the Bay if anyone is interested in seeing them please
contact either Paul Longbottom (RLI) or Pam Rigden/Jenny Tancock (FGH).

regards

Fiona Gorrell
Librarian
Morecambe Bay Hospitals NHS Trust
Westmorland General Hospital
Burton Rd
Kendal
Cumbria
LA9 7RG

Tel 01539 795234 Fax 01539 795308
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