Attending #changinghealthcare webinar. Apparently 6 audience members surveyed think the NHS learns from every past success.

6.

More than 0.

Chair @RichardTaunt reveals lessons learned from the week.

Slide:

'We're not good at learning from the past - we keep rediscovering problems'.

I feel vindicated!

Pleased to hear @DrBruceKeogh talk about the value of history from both a medical and organisational perspective at #changinghealthcare.

Busman's holiday now. Watching Change Analyst (sic) @SallyBSheard speaking about how to use history in health policy. Delighted context given centre stage.

Learning from 'success' (NHS anniversaries exploited for institutional purposes) and 'failure' (organisation and patient scandals and crises).

Also like 'planned' versus 'crisis' change. Very familiar theme from interviews. But it is my mentor. So...

Discussing archives. I hope everyone knows my views on this.

TL;DR. Stop burning *everything*.

A photograph I took featuring now. From the internal market witness seminar hosted by @HealthHistLiv. You can download it here:
https://www.liverpool.ac.uk/media/livacuk/iphs/researchgroups/governanceofhealth/Internal,Market,WS,transcript,ESM,15.06.2018.pdf

The Clarke-Marks exchange in the witness seminar was a memorable one TBF.

@SallyBSheard: 'history is messy' and no definitive solution. Individuals a means to understanding systems.

Doubtful of historians' abilities to grasp complexity. Anyone who has ever seen a desk I've used/sat at knows the mounds of paper is a fire hazard. My digital stacks of paper are equally chaotic.

Discussion shifting to @SallyBSheard experiences of engaging with policy-makers and obtaining a seat at the table. Entrepreneurial historians rather than institutional figures the way forward apparently. Case made for resources. Which is reassuring.

Now the turn of @DrBruceKeogh to talk about the future of history in health services. Message the same as @SallyBSheard, but trying to provoke discussion with two points.

1) History is 'just a form of memory' and driven by personal experience of past

Argues all medical science and technology built on history. Speaking on using @bmj_latest as a living history. Which I know through the work of @agnesjuliet is certainly the case.

Going for a 'big history' approach from translating forms of knowledge across different societies and cultures over time.

This proper history is beyond my ken.

Give me 20th century. Or late 19th at a push. A REAL push.

Now moving onto the issue of MRSA and tensions between clinicians and politicians over policies and learning.

2) Nothing stands still.

A key point of #changinghealthcare. The present isn't fixed and constantly subject to change. Applies too within medical service delivery.

Great quote by @DrBruceKeogh talking about 'foggy atmosphere of immediacy' which hangs over policy decision-making. I will shamelessly. SHAMELESSLY steal this.*

*attribute. Obviously.

Conclusion now about thinking what the biggest barrier is to change: people don't fear change but loss. Very interesting in light of Sheard's earlier point on 'learning' with 'winners' and 'losers'.

Drawing on case studies of closure to illustrate the point and the potential loss of a range of issues. I think there is a lot of mileage in this. But a constant, shifting, flowing dynamism of interconnected changes.

Interesting point from @DrBruceKeogh at #changinghealthcare that history often considered in policy discussions but that it doesn't go back far enough.

My knowledge on the 1974 reorganisation is going to come into its own soon. I KNEW IT.

Disagree that history cannot offer nuance but an examination of the consequence. One informs the other in a way which current approaches lack the reflective hindsight.

Good idea @SallyBSheard. There should be History Impact Assessments as well as others when coming to think about policies. Sign. Me. Up.

Some discussion now on different working cultures between policy-makers, doctors and historians. @SallyBSheard talking about 'living history' COVID-19 work being run @HealthHistLiv.

You can read more here with a piece they did for @socscimed. https://www.sciencedirect.com/science/article/pii/S0277953620306420

Sheard says we can't learn directly from response to 1918 flu pandemic directly. Indirectly the lessons revolve around context, systems, networks and decision-making.

Now Bruce speaking about central-local control dimensions relating to 1918, and perhaps more contemporary forms of learning from SARS. Virginia Berridge, Martin Gorsky and @alexnmold have written on this:
https://agus34drajat.files.wordpress.com/2010/10/public-health-in-history.pdf

The work of Virginia Berridge seems particularly germane to this section of the discussion on the tension between immediate priorities, new health issues and shifting existing structures. https://books.google.co.uk/books/about/AIDS_in_the_UK.html?id=WBMgAQAAIAAJ&redir_esc=y

Thinking now to understanding how we define and measure success in relation to history.

Question now from Simon Moralee about 'history is what's happening'.

I know I shouldn't lower the tone, but this comment always reminds me of this great album:

Methodological discussion now about writing history not just from the vantage point of the 'winners' and how to incorporate a range of perspectives. Patients notable by their absence in many histories.

Point now from Bruce about the issue of 'loss' and one way to overcome aversion to potential losses in change is to shift the focus to benefits and gain.

True. To a point.

But 'winners' produce 'losers'. These impacts matter.

Sheard says the #NHS is 'not national' but a series of effective regional and local systems.

Warm glow in my heart.

There is a great quote by @NicholasTimmins (paraphrasing) here where he says 'it is a well-known fact' that the NHS is not really a national monolith, but a series of separate organisations each with their own separate histories.

It's in this from @TheKingsFund. Page 10
https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/The-chief-executive-tale-Kings-Fund-May-2016.pdf

Now moving onto how leaders engage with local narratives to build a case for change to achieve unpopular decisions.

Discussion on how forms of medical knowledge are agreed upon within the profession and how individuals/institutions come into tension. Glad (sort of) that the discussion isn't exclusively policy-focused.

Very interesting point from Bruce about the tension of policy demands and targets in services versus the realities of medical knowledge and delivering care to patients. Using example of MRSA and immuno-suppressed patients with potential mortality/morbidity.

Commentary about international learning in patient process, outcomes and quality indicators and the difficulty of making them meaningful and realisable.

Now @DrBruceKeogh says that history has problems (!) with ease of retrospection which sees the past as teleological.

Strong disagree here. Deep historical excavation is about understanding the 'fog' he described earlier, and how/why decisions were taken.

But @SallyBSheard not pessimistic but realistic, seeing the issue not of historians needing to change but the decision-making processes and structures. Historian's answer. Obvs.

Despite secretly being a geographer. Ssshhh.

Wrapping up now.

TL;DR. History matters.