Language is a crucial marker of tribal identity. Both ethnic and professional tribes use language to recognise members of their own tribe and to exclude members of other tribes. Two ethnically related tribes may be distinguished by their use of different languages, but in other cases the linguistic differences may be subtle.
Small but significant linguistic markers of identity are known as shibboleths, after the Old Testament story in which the pronunciation of this word was used to identify members of an 'out-group.'
Where two tribes share a genuinely common language, tribal politics may encourage the creation of artificial shibboleths. Serbs and Croatians share what used to be a common language, but Serbs chose to write it using the Cyrillic (Russian) alphabet while Croatians adopted the Latin script. Over time, small differences in usage have evolved.
Someone somewhere once said you can't teach an old dog new tricks. But who said anything about new tricks?
I recently had the immense pleasure of visiting my family in Australia. I'll admit, it's a familiar route for me, but this time was different; I was on a mission. I had arranged that while I was in Melbourne I would film my Grandpa for a TEDxNHS talk. He is quite something. Old Jewish Grandparents are supposed to bore their friends kvelling over their average to over-achieving grandchildren but the tables have most definitely turned in this case.
My grandfather was one of the first NHS surgeons, becoming a consultant ophthalmologist in North Wales in 1948; my father was a consultant physician in London and Bristol from the early 1970s; and I - well, I suppose you could say I am a consultant of sorts at Kaleidoscope, which is not part of the NHS but functions, we hope, as a benign disruptor in its ecosystem.
Seventy years after its birth, the NHS continues to exert a strong gravitational pull on my family, and on so many other families.
And my family is an early example of another NHS phenomenon that has grown in importance over the generations - and, like the NHS as a whole, is perhaps at a turning point. Since its inception, the NHS has been a generous employer of migrants.
We recently spent two stimulating days at HSRUK 2018. Our colourful tablecloth, quirky leaflets and coffee maker attracted a lot of great people and we asked them all the same question: "What gets in the way of research, policy and practice working together?"
The good news: people not caring is not the issue.
Nonetheless, there is a range of factors that people in health services research seem to run into on a regular basis: misaligned agendas and languages, a perceived lack of time because everyone's always busy, not knowing how to engage properly, logistical problems such as different locations and timescales, and the absence of clear logic models ahead of implementation.
At the Health Services Research UK 2018 Conference, plagued with mid-conference excitement, I cannot help but ponder the curious way we talk about and go about disseminating research: as dedicated but inexpert gardeners, and as children holding dandelion blossoms, respectively.
Dandelions can do more than sully your pristine lawn; they can be used in both savoury and sweet recipes and are loaded with health benefits. But if you want to cultivate them for such purposes, you wouldn’t grab the stem, blow the seeds and wait for your salad and tea in the kitchen. Wishful thinking.
What drives successful (and sustainable) system change? This won't stop being a relevant and compelling question. We should perhaps acknowledge though that, at least in terms of healthcare, we have a prevailing orthodoxy - that top down, mandated and performance managed changed is the default method.
The healthcare system has been trained to receive and act upon the annual operating plan. That plan describes the what, the how, the 'by when', and the 'how much'.
I watch and read a lot of dystopian fiction and one of the grimmest things about the world to come is the extremes of 'identity': think red cloaks in The Handmaid's Tale, unseeing Ul Qoma in The City and the City, or a replicant in the persistent rain of 2019 Los Angeles. People do like to categorise.
I include myself in the catch-all; anyone who's ever seen me present on analytical matters will often hear me kick off by apologising for being a career analyst (it can be an awkward admission to make, especially in taxis) as a way of laying out my stall.
There is a long running joke in my family that I don't like change. It's true, I don't (the irony of having to make four major geographical locations over 8 years working in the NHS hasn't been lost on me). Change is hard, especially when it isn't on your own terms.
In part of my role, I work with the HS. Accelerator and the Department for International Trade to help health technology startups grow abroad. This involves overcoming myriad barriers and obstacles that prevent change being effective, if happening at all. It's not for no reason that adoption of innovations at scale takes around 17 years.
We at the Stroke Association are boldly pro-reconfiguration. As an organisation representing over a million stroke survivors and advocating for the best possible treatment and care, how could we be anything else?
We see it as our duty to ensure as many patients as possible get access to world-class treatments and round-the-clock care – both of which are more likely in reconfigured acute stroke services.
Stroke is not the same as cancer. Maternity services are not the same as psychological therapies. But is there learning to be gained from thinking about how system change happening in one clinical area could be transferred to others?
That was the premise behind our event series, in partnership with UCL, and funded by the National Institute for Health Research, which explored how the learning from stroke reconfiguration in London and Greater Manchester could support successful system change across the NHS.