Please note: In October 2007, Professor Lord Ara Darzi published his interim report Our NHS Our Future: NHS next stage review - interim report. The review stated that the role of the National Library for Health will be reviewed as part of the preparation of the NHS for the next decade. The National Knowledge Service will be included in this process, which is being carried out by NICE and the NHS Institute for Innovation and Improvement, and an announcement will be made when the final report is published.

Knowledge is the enemy of disease. The application of what we know will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade. The application of what we know from research, from data analysis, and from experience, can prevent and minimise the eight major healthcare problems:

1. unknowing variation in clinical practice and service delivery;
2. errors of commission and omission;
3. waste;
4. failure to implement new knowledge and technology systematically and appropriately;
5. over-use and under-use - inappropriate care;
6. unsatisfactory patient experience;
7. poor quality clinical practice;
8. failure to manage uncertainty or ignorance.

The mission of the National Knowledge Service, set out in the strategy of NHS Connecting for Health, is to ensure that every decision made by a patient or a healthcare professional can be supported by best current evidence. Knowledge is like water and access to clean, clear knowledge is a right. Knowledge, like water, needs to be managed and every healthcare organisation needs to manage knowledge, even more carefully than they manage money. Resources to support these activities are available at the National Library for Knowledge Management.

The origin of the National Knowledge Service

The Secretary of State for Health announced the creation of the National Knowledge Service in 2002 as part of the government's response to the Kennedy Report on paediatric cardiothoracic surgery in Bristol. Its mission, in the words of the Secretary of State, is to "support the delivery of high quality information for patients and staff" (The DH Response to the Report of the Public Inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984-1995: Point 13) and in response to this the Government have created the National Knowledge Service (23 June 2003: Column 578W, Commons Hansard)

The National Knowledge Service Plan for 2007-2010 will form the basis of annual operational plans. Greater detail about the three workstreams is also available through the following links:

• the Best Current Knowledge Service, responsible for the production and procurement of the evidence that clinicians and patients need;

• the National Library for Health, responsible for the organisation and mobilisation of knowledge to meet the needs of user, and the National Knowledge Infrastructure, which will provide the technical standards and solutions to allow knowledge to be delivered where and when it is needed, either as a result of searching or as a prompt or as a message sent directly to the clinician, patient or healthcare professional, drawing their attention to new knowledge which is essential for their care;

• the National Decision Support Service.

The National Knowledge Service is responsible for planning knowledge management and focusing on describing services and healthcare in 2011, working on the principle that "the future is here. It's just not evenly distributed." - William Gibson - namely that what will be in general use in 2011 can be seen somewhere today. The NKS plan for 2011 is available here.

Co-ordinating Governance

Three bodies will be responsible for governance - the National Knowledge Board, National Library for Health Board and the National Clinical Decision Support Board.

The National Knowledge Board is chaired by Andrew Dillon and its remit can be seen here.

The National Library for Health Board (terms of reference available here), is responsible for the National Library for Health, which consists of three resources. The first consists of the skills and knowledge of 1,275 librarians within the NHS. The second is the national digital knowledge base, a single collection of best current knowledge organised not only to facilitate finding by searching but also to facilitate both "push" and "prompt". The latter, for example the incorporation of knowledge in laboratory report forms or prescriptions, will be of increasing importance as the National Care Record Service is implemented. The third resource is the communities of practice of clinicians and patients, manifest through the National Specialist Libraries which cover three dimensions, as shown in Figure 2.

Figure 2

The National Decision Support Board will be responsible for advising on the tools and rules that should be used throughout the NHS. To read the terms of reference, click here.

The Chairs of these three Boards will constitute the Board for the National Knowledge Service.

J A Muir Gray, Kt, CBE, DSc, MD, FRCPSGlas, FCLIP
Director of the National Knowledge Service

Caroline De Brún, MA, DipLIS, MCLIP
Librarian to the National Knowledge Service