Please Sir, can we have a Library?

Knowledge resources that were hitherto provided in books and paper journals are increasingly being accessed using Internet based methods. New sources of knowledge such as UptoDate, Map Of Medicine, NHS CKS, MedicinesComplete, Toxbase, DermNet and many others provide information in ways that could not have existed before the Internet. E-Learning, e-Portfolios and online communication between peers are vital to the flows of information we need to provide good care. Healthcare apps have approached the level of maturity and safety where they have genuine clinical utility. All these new technologies depend upon Internet connectivity, and increasingly, on mobile devices using WiFi. More importantly, in order to secure the future development of even better technologies (like ubiquitous electronic decision support, or a comprehensive, ‘access-anywhere’ cradle-to-grave health record) we have to provide an environment in which these ideas can thrive.

Nobody would argue that having a Library within the trust is a waste of taxpayers’ money, and WiFi access is fast becoming the preferred mode of accessing information that we used to get in the library. I’m not saying libraries are obsolete, but I am saying that WiFi access is more than just a trifle, a toy, or a passing fad.

I imagine that at some point in the past, someone had to approach the Victorian philanthropists that funded his hospital and ask: ‘Please Sir, can we have a Library?’ Well, somehow we got to a point where access to the hospital library is an inalienable right for NHS staff, and I hope sometime in the future, we view WiFi access in the same way.


So far there have been around 600 respondents to the Nationwide NHS Staff WiFi survey that was recently conducted and endorsed by a group of organisations including NHS Hack Day, openGPSoC, HANDIhealth, and many individuals. It’s still live, so if you haven’t already filled it in, why not do so here?

It was set up as an impartial survey of WiFi provision for NHS staff by trusts, to get an idea what the current state of affairs was. I think we all kinda knew what it would show though, and we weren’t wrong. Detailed results are in PDF format here, and interested parties can contact me via twitter for any other information you require, including the raw data in other formats. I am working (with some very generous help) to create mapped data from these responses.

The headline figure is that 75% of the respondents had no access to free trust WiFi. Alarmingly, this included the 23% of respondents who said that there were WiFi networks installed at their place of NHS work but they did not have the key. [The format of the survey and our desire to keep it short and snappy prevented us getting more details about why they didn’t have the key and there are many possibilities]

The free text comments were especially interesting , the repeated themes were that trusts are hampering innovations in patient care, agile working practices, e-learning, business-critical modern communications, and patient comfort by failing to recognise the importance of WiFi. Here are a few of the free text comments, selected for the issues they highlight:

“I work for a Hospital foundation trust. Wifi in the community is owned by the community PCT trust. There are issues surrounding access because I am not employed by them”

“My organisation supposedly has a network for specific NHS laptops to access but in my building no one has these laptops or any passwords/access to it. So in practicality there is no wifi.”

“Secure WiFi available at HQ only. Requires work equipment to gain access using a certificate – no key available for Guests.”

“Guest WIFI that needs to be re-logged in for each use.”

On the other hand, there were glimmers of hope:

“Trust-specific internal wifi in development”

“Library has provided free wifi in the library”

68% of respondents felt that having access to free WiFi would improve the care they could provide . 14% didn’t know if it would make a difference, 3.5% said “no effect” , and only 0.5% felt it would worsen care. So there is a strong opinion suggesting that better WiFi provision would improve patient care.

Some of the best of the free text comments in this section:

I do not actually work on the clinical side (I work in the library) but from my own point of view, I often have to use our own wifi on my own netbook to access information that I need for my work (which is often providing information for clinical staff). I am also aware that I have never spoken to a member of staff who is not frustrated by the NHS provided internet access.”

it would enable me to look up guidelines and provide evidence based care. The internet on the desktop computers blocks almost all sites making this impossible unless logged in to individual account but logging in and out on a regular basis isn’t feasible when very busy.”

I use 3G but it is very patchy. I would love to have better access to data, apps and guidelines at POC. I use UptoDate in addition to many high quality apps. This makes the care of my patients better, more evidence based. I improve my practice by learning more every day using easily accessible information. Except it’s not easily accessible as there is no wifi and it takes too long to login to NHS computers or there aren’t enough of them when they are shared between doctors, nurses, physios, pharmacists”

“I use my smartphone on 3G to access apps, guidelines and other knowledge sources. This makes my practice more evidence based and higher quality at the point of care. I can also continuously learn and develop my professional knowledge. It is not convenient to use static NHS computers as it takes too long to login and they have to be shared with other doctors/nurses/physios/OTs/pharmacists. My 3G signal is patchy and unreliable within the hospital. Wifi would have a very real, positive effect on my ability to provide high quality care in the NHS”

A mandatory requirement of my training is to complete online workplace based assessments which are supposed to be done in real time with the consultant. Although I have an ipad which would allow me to do this I am not allowed access to the hospital wifi. I work in theatres, there are not spare computer terminals available.”

“Free WiFi is now a standard in every other industry, it is frustrating to see that the hospital managers do not see the urgent need to allow their staff access to information whilst at work, that would improve efficiency and help us provide patients with better care.”

I would like to hold ward meetings using SKYPE or facetime but would need to bring in own laptop as work computers not up to it so WiFi would be great.”

“What would you most like to be able to do with WiFi access at your workplace?” (this was a “ranking” question in the survey, the following results are a list of what people ranked as their 1st choice. The full ranking would be a little difficult to display here but is in the downloadable PDF)

  1. Knowledge resources on Internet (41.69%)
  2. Email and other communications (16.33%)
  3. Electronic medical record access (13.41%)
  4. NHSMail (9.91%)
  5. Getting results of patients’ tests (7.58%)
  6. Trust Intranet access (5.54%)
  7. Ordering tests for patients (3.79%)
  8. Patients’ demographic details & tracking (1.75%)

WiFi for patients? Disappointingly only 25.6% could say “Yes, there is WiFi for patients”. There is a separate campaign for patient WiFi access which is being spearheaded by others (see here). The arguments for patient WiFi are somewhat different to those for staff, but in many ways are also compelling. We have chosen to focus on Staff WiFi in order to try and focus on the arguments most relevant to staff. The following comment suggests that trusts may view WiFi as a service for premium patients only, but of course it gives away that trusts must therefore regard WiFi as a ‘thing worth having’:

“Wifi for private patient wards but not for NHS”

Detailed results:

Total number of respondents 576 (accessed 29.05.2013)

Which part of the NHS do you MAINLY work in?
Primary Care / GP 10.21%
Secondary Care / Hospital 77.85%
Community Services** 6.92%**
Other** 5.02%**

[Interesting that the respondents were predominantly hospital/secondary care based – although it’s not surprising that WiFi provision is less of an issue for GPs, given that most GPs work from a static desk and thus have ready access to internet based resources including email, web browsing, and knowledge resources. Contrast this with hospital staff who work in a much more mobile fashion and would have much worse access to Internet resources presently]

Which of the following best describes Staff access to WiFi at your usual place of NHS work? (For the purposes of this answer include only WiFi provided at/by your place of work, not WiFi from smartphone 3G tethering etc)
No WiFi – there are no WiFi networks at all 31.49%
My organisation has a free WiFi network but I do not have the password/key 23.18%
My organisation has a free WiFi network and I have the password/key to use it 23.36%
A commercial provider (Wifispark, BT OpenZone or similar) WiFi service that is not free 4.33%
EduRoam academic network 1.56%
My place of work has installed its own free WiFi outside of NHS provision (eg a GP practice which has BT WiFi) 3.11%
Other 12.98%

Which of the following best describes Patient/Visitor access to WiFi at your place of NHS work:
WiFi for patients and visitors is free without registration 9.86%
WiFi for patients and visitors is free with registration 9.34%
WiFi for patients and visitors is open but chargeable/non-free 6.40%
I don’t know 34.78%
Other 38.41%
No answer 1.21%

[I really should have thought to put a “There is no patient WiFi” option on this question, because virtually ALL of the 38% that replied “Other” qualified this in the free text box as meaning “no patient WiFi”]

Do you think access to Wireless Internet (WiFi) during your NHS work would affect the care you can provide for your patients? (please feel free to expand on your response in the free text box)
It would improve my ability to provide good quality care 68.28%
I am not sure what effect it would have 14.38%
It would have no effect 3.52%
It would worsen the care I provide 0.52%
No answer 3.29%