Old rules still apply in new times

Alex Prinsley

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.

Grandpa D qualified as a doctor in 1942. Months later he was drafted into the RAF as a medical officer in World War 2. He served in the RAF for four years, in England and in the Middle East. When he returned to England in 1947 the war was over, the NHS was yet to form and, he tells me, there was a surplus of junior doctors!

Medical students, himself included, had had their training condensed so that they could join their comrades in the war effort. And when he returned, there were more doctors in need of work or 'something to make themselves useful' as he describes it, than there were jobs.

After some time he found ways to 'make himself useful' and in doing so went on to be part of the cohort of medics who established geriatric medicine as a distinct discipline, which was needed to cater for the unique needs of older people. His journey from Hartlepool Monkey Hanger to geriatric pioneer was what I was hoping be able to share at TEDxNHS. The conversations that followed were spectacular, meaningful and once in a lifetime. But it's the 'incidental' findings, as is so often the case, that was where the real magic happened.

Click on image to see all 20 rules.

Grandpa D

One such incidental was a document I found while snooping (with permission) through his study. 'Prinsley's Rules' is a list of 20 observations that Grandpa D had made and written down while he was in America in the 1980s. As I read these, I was astonished. Every single one applied to the health service I know today, including:
No. 1 If you put up a bed, somebody will come lie in it.
No. 16 It's not easy to transfer systems of care between areas.
No. 20 No job is ever perfect.

I asked Grandpa D about these and some of the other truly profound nuggets he had given me: you need to care for the person first, and then the disease; it's important not just to ask about the person in hospital, but also the person who brought them there.

He simply couldn't fathom that anyone was going to be interested in his stories and thoughts. After some convincing, he asked me, "Well if it's still going on, what did I change?"

Shit. I'd unravelled a 97 year old man's life work.

Except that I hadn't. And the more that I thought about it, the more I realised life isn't a piece of string where we learn from the past, never to retrace the same ground and the future looks completely different. It's also not a continuous loop in which we are doomed to repeat all of our mistakes and successes. Maybe it's more like a spiral, or spaghetti. It's messy, unpredictable, and it doesn't repeat. We don't repeat. But it's really important to notice that among the human chaos there are some consistent truths. Some 500 years ago Shakespeare wrote tales of love, tragedy, comedy and that relative we'd rather forget, and we still relate to these. Grandpa D isn't Shakespeare but he has highlighted some of the consistent truths we see when delivering health services.

So, while we so often dwell upon the cyclical upheaval of centralisation / decentralisation, money / no money, managers / no managers that can make us feel quite powerless, it's worthwhile reflecting that underpinning that are some things that don't change. And that, irrespective of whether you are an old dog, a new dog or a middle manager, those tricks are here to stay. Our challenge is to notice them and to interpret them in the most meaningful way for the moment we are in.
 
TEDxNHS will take place on 21 August. 500 NHS staff will be with us on the day, and NHS organisations and staff across the UK can join via livestream. For more information about how to livestream TEDxNHS 2018, visit the TEDxNHS website.

Alex Prinsley is Business and Transformation Manager at Cental and North West London NHS Foundation Trust.

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