Promoting Health: Libraries your community asset

An event at the City Centre Campus of the University of Wales, Newport on Thursday 17th January,  saw a wide range of librarians and health professionals gather to discuss and celebrate the contributions that public libraries make to health and wellbeing (HWB). In the afternoon the Minister for Housing, Regeneration and Heritage launched the "First incomplete field guide to wellbeing in Libraries" (see this blog for further information). Here I provide information from the formal sessions in the morning.



Promoting Health - morning speakers
L to R: Prof Neil Frude, Susan Morris, Linda Tomos, Diane Raybould, Prof Sir Mansel Aylward (Chair)

This report follows the format of the event programme:

• Book Prescription Wales - Prof. Neil Frude
• Libraries Inspire - Linda Tomos
• Cancer information in the community - Susan Morris
• Making it work in Rhondda Cynon Taf - Diane Raybould
• Panel Question Time

 Book Prescription Wales (BPW) - Professor Neil Frude

Come, and take choice of all my library, And so beguile thy sorrow. (Shakespeare. Titus Andronicus, Act 4, Scene 1)

Professor Neil Frude, a clinical psychologist who was instrumental in the development of the BPW scheme, spoke persuasively and with huge passion. Neil is a truly fantastic advocate for libraries! The session provided background on the formation of the BPW, considered possible future developments with the scheme and outlined a broader picture of libraries in supporting HWB.

Book prescription - origins in Wales

The Cardiff Book Prescription Scheme, a truly innovative and now widely copied initiative, was launched in 2003. A collaboration between:

•  mental health experts who identified quality resources for the book list,
• general practitioners who made the prescriptions, and
•  public libraries who made the core list of titles widely available from safe, accessible, welcoming, respected premises

Book Prescription recognises and exploits that self-help treatment manuals for some minor and moderate mental health conditions (e.g. depression, anxiety, eating disorders etc) can be extremely effective in enabling sufferers to overcome these conditions. Books encapsulate the expertise of highly successful therapists, and enable cheap onward delivery, meaning that book prescription is usually extremely cost effective.

In 2005 the Book Prescription Scheme was expanded to operate throughout Wales. The book list has been revised and expanded, and a broader spectrum of health professionals now refer to the Scheme (e.g. Community Psychiatric Nurses, Health Visitors, Counsellors) as well as other agencies (e.g. prison libraries, workplace occupational health services, job centres, voluntary groups). BPW has gone from strength to strength and now accounts for more than 30,000 book loans each year, and three out of ten of the most borrowed non-fiction titles are from the BPW list. The scheme now includes audio-books, with four titles in Welsh, and there is also parallel scheme for childrens' books.

Future direction?

Neil wonders whether the BPW scheme could be expanded further to encompass some titles for dealing with physical illness - for instance coping with chronic pain, arthritis, managing diabetes effectively.  These texts work by empowering people, enabling them to improve the management of their condition - self-management.  In order to achieve this further collaborative work would be required: the appropriate professionals (from a variety of health care fields) would need to select suitable resources; libraries would need to stock them; and health care professionals know to prescribe them. Overall this could be incredibly cost-saving and life enhancing.

Wider benefits of libraries in HWB

Neil closed his presentation by briefly summarising the wider benefits of libraries to HWB, noting the MLA report of 2010 from England. There are actual, potential and incidental benefits to health and wellbeing through libraries, in addition to specific schemes that operate directly to benefit HWB: therapeutic reading groups; books on prescription; creative bibliotherapy; specific themed events etc.

Libraries Inspire - Linda Tomos (Director, CyMAL)

In a session that asked more questions than provided answers, Linda challenged participants to provide ideas to enhance Libraries Inspire - the national strategy for libraries. The Strategy will be in place until the next Assembly Election (2016) and so there is still time to influence and implement. We must demonstrate what we do (and The First Incomplete Field Guide toWellbeing in Libraries is a fantastic example of this), but also what more we could do if given additional resource. Government will be keen to learn of new ways to deliver services with less money.

Although CyMAL's primary role is to provide informed advice to Ministers on museums, archives and libraries, it also see itself as a an enabler, fostering the art of the possible. Synergies should be identified and exploited. The partnerships between health and libraries is a great example of how rewarding these links can be.

Aside from bibliotherapy and the likes of BPW, Linda also noted that libraries offer fantastic opportunities for volunteers, and in doing so libraries have contributed to the HWB of their volunteers. [This is of course true, but it is yet one further, and in my view regrettable, steer from CyMAL to encourage the use of volunteers in libraries].

Linda noted the previous strong and exciting but unsuccessful bid to the Big Lottery Fund to develop BPW for the management of some physical illnesses. Picking up on Neil's session, Linda now wondered whether it might be appropriate to revisit the proposal and to try again. [Again, I welcome this suggestion, but at the same time can't help but be saddened that government funding couldn't be sought for such an initiative].

The Welfare Reform process, including Universal Credit, introduced by the Westminster Government, will have significant impact in Wales. We need to work effectively to protect the most vulnerable in our societies. However, significant progress has been made in the past. The widespread introduction and use of adaptive technologies in Welsh Libraries needs to be celebrated. The Peoples' Network was phenomenally significant. Should we now be thinking along the lines of PN Mark 2?

Linda urged this to be the start of a conversation for enhancing Libraries Inspire in the run up to 2016. And to question what we are doing, are we doing it well, and is this providing maximum benefit for our communities?

Cancer Information in the Community - Susan Morris, Macmillan Cancer Support Wales

The story of cancer has changed significantly over recent years. People diagnosed with cancer are living longer and with improved quality of life. Sixty percent of people diagnosed with cancer will live for five or more years beyond their diagnosis. In those diagnosed with breast cancer 80% will have a five year survival rate. In Wales 17,000 people will receive a diagnosis of cancer each year.

Susan reminded us that much of the focus for cancer remains in clinical settings. For many people this is a really difficult place to receive, retain, understand and act on information. It also means that the broader emotional, psychological, social and financial needs of people with cancer are unmet. Information and support needs are huge, and extend for a longer time as cancer, in many cases, becomes a chronic condition. The impact, support and information needs reside not only with the person with the cancer diagnosis, but with family members, friends, colleagues and carers.

Macmallan's view is that information and support needs to be available in the community, that it is available from diagnosis, through treatment and afterwards, and should be available for all touched by cancer, and needs to cover holistic needs (emotional, psychological, social and financial). In this context  MCSW have four 3 year pilot projects, providing Cancer Information Specialists in South East Wales operating within public library services and contactable online or by telephone. Macmillan have also provided training and support to 75 Boots pharmacists in Wales, so that they can provide greater support and signposting.

Things are changing. The Welsh Government's Five Year Cancer Delivery Plan identifies the need for personalised and holistic assessment of needs. Public Health Wales have also been charged with providing a Strategic Information Lead, recognising the difficulties in easily accessing high quality. consistent information on the internet. Macmillan Cancer Support  already do much for the dissemination of high quality, digestible information. But having a single source for reliable, reviewed and trusted health information would clearly be advantageous.

Rhondda Breast Friends - Diane Raybould

Diane spoke about her personal experience, her struggle and war, resulting in personal action in the community. Rhondda Breast Friends was established in 2006, recognising the huge and mostly unmet information needs of people and families facing breast cancer. In 2009 RBF established partnership projects with Public Libraries in RCT. This recognised that libraries were close to their communities, were open to all and provided safe spaces to provide information and support. The provision of appropriate information can help empower and educate, and thereby relieve anxiety and fear. Diane echoed Susan's point that hospitals / clinical settings aren't good spaces to deliver this continuing and extended information support. This support needs to be:

• clear, easy to understand, and given at appropriate times
• locally available, with 1:1 support, and able to accommodate learning disabilities etc.
• provided in a suitable environment - safe, comfortable, aways from the "medical blur", provided with a listening ear with someone who cares and believes in you
• empowering - actions need to result

Libraries are "centres of empowerment" and therefore they are obvious points of delivery for these types of service.

Panel Question Time

Regrettably, my note taking during the panel session wasn't as good as it should have been. I won't directly attribute comments therefore.

Q1 noted the excellent sustainability of the BPW scheme: it is a simple scheme, backed up by extensive evidence of effectiveness, and is extremely cost effective. Are there parallels that we can draw from this?

• BPW use for chronic conditions doesn't seem so straightforward to achieve, or so certain.
• There is no single one-stop-shop for quality health care information. Public Health Wales' strategic lead for this could be great, and hugely beneficial.
• A reminder to use what you've got, but to use it more effectively. This may be a case of bringing together existing (and often statutory) services, so that they can work more effectively together.
• Using Big Lottery Funding to pump-prime projects that then realise financial savings / benefits and so are therefore fundable from existing resources
• Noted that BPW tackles a very discrete set of issues and it's impact can therefore be readily determined. Other health care contexts are more complex and diffuse, there are a variety of interventions, and a wide range of benefits. Attributing cause and effect in these contexts is difficult. The value of social intervention is difficult to gauge.

Q2. Is it possible to role out BPW to include physical conditions? We've already seen the example of Exercise on Prescription!

• Establishing a list of quality audited resources would be more difficult because of the wide range of health care professionals that would need to be involved.
• Great ideas can easily get parked and buried - Neil gave evidence to a House of Commons Select Committee on the effectiveness of book prescription but nothing came of this. Ministers need clear evidence of effectiveness but in some instances this evidence isn't available. Under such circumstances we become trapped in a scientific Catch-22 situation.

Q3. Comment from Steve Hardman (Swansea Libraries). What happens when there are no public libraries? We need to act before it is too late. In Swansea 26,000 HWB loans were made last year. People borrow these items because they need them, not because they are great reads. Who will provide this service if public libraries aren't there?

• Linda responded that BPW was funded from health budgets. We need to seek alternative funding sources to help us develop our services.

Sir Mansel also reminded the audience that the Public Health Green Paper will place health high on the policy agenda. We need to be wary of it's impact, to be actively involve in consultation and dialogue, and to sieze opportunities that arise from it.