Being wrong is interesting isn’t it? When you get a call right, your view of the world is unchanged and things are happening much as you expect them to; all very unexciting. But when you’re wrong, there’s something off with your perspective, or lacking in your knowledge; very interesting indeed.
Luckily, I’m wrong particularly often and accumulate large numbers of these excellent opportunities for learning. I’ve been wrong on some big life stuff and on too many professional and work related decisions to keep track of. I was even wrong in recent attempts to help my daughter with her physics homework, leading to her claim that many of the elements hadn’t been discovered when I was in school.
There’s something in this unfunny and (mostly) untrue teenage sarcasm that I think explains one of the common causes of ‘wrongness’ in that people look to the past to explain the present and predict the future. This might be fine but most of us, including my daughter, have an absolutely lousy sense of historical perspective. Smart Alec history teachers will use any number of examples to highlight how poor this perspective can be. A couple of my favourites in this list of things that just don’t seem right are that Cleopatra lived closer in time to ‘Carry on Cleo’ than to the building of the Great Pyramid at Giza, or that Tyrannosaurus Rex was more a contemporary of Marc Bolan than it was to the Stegosaurus. Similarly, England’s 1966 world cup win is as close to the outbreak of WW1 as it is to the present day, despite it being mentioned every four flipping minutes over the summer.
Broad contemporaries: T-Rex and T-Rex
These examples show that people tend to distort historical perspective by magnifying the recent past and diminishing periods further back. So, to me, my schooldays of the 70s and 80s are useful reference points in understanding how the world works and will continue to work, whilst to my daughter it was when we learned to alloy copper and tin to make our swords. This phenomenon has big implications for how we get things wrong (or how we can avoid making mistakes).
Take climate change, for example. The scientific consensus is that we’re now heading for more than a 2 degree temperature rise on pre-industrial levels and likely implications include 3 metre plus increases in sea level rises. By all rational measures, this information should be dominating the political and economic agendas, with urgent risk management and mitigation measures everywhere we look. But 3 metres… that can’t happen, can it? That would swamp St Helen’s cricket ground in Swansea where Sir Garfield Sobers became the first human to hit six sixes in an over, where all great Welsh cricketers have strutted their stuff over the years (well yes I have played there, actually. Don’t like to go on about it. It’s not like there’s a framed picture in my house of me on the pitch or anything like that *). The scale of this change, that would flood Miami and make the Mumbles Road end at St Helen’s appear only at low tide, is way outside our historical reference points, our ability to visualise the world; so we sort of file it somewhere in our brains and get on with more everyday routine problems.
St Helen’s Swansea – spiritual home of Welsh cricket
So I worry about how our tendency to rely too much on a poor and distorted understanding of the past can make us wrong and complacent over big changes. And I worry about it a lot in the context of health and social care provision.
Our historical perspective here is dominated by the post war model of service provision. This model is an historic anomaly, of course, radically different from that which existed through the rest of human history, but is nonetheless now seen as an unchanging piece of how our bit of the world works. The difficulty is that if you start projecting the next 20 years of demographic change, workforce availability, technology driven cost increase and the amount of funding that an economy can generate for health and care… it’s really, really hard to see how it all holds together to provide the sort of health and care service that people of my age will by then be expecting. I think there’s a tendency to dismiss these forecasts because, well the Health Service has always been short of money hasn’t it, and winters are always a bit tight, but we always get through it in the end…. and basically because our perspective doesn’t help us to imagine a radically different future.
This I think would be terribly complacent and would open up our largely wonderful but already creaking system to existential risk. But whilst I’m a bit of a worrier, I’m also a mostly optimistic type of bloke. There is now a lot of work ongoing on the sorts of disruptive changes that could help to address the apparent perfect storm of pressures building on health and care. Organisations like The Kings Fund have been busy in this field lately (https://www.kingsfund.org.uk/publications/eight-technologies-will-change-health-and-care and https://www.kingsfund.org.uk/publications/digital-change-priceless are good examples) and show how we can move perspective from a future of tweaking our models of care to one where they are genuinely transformed.
I’m wrong about loads of things but I’m pretty confident in predicting that, in order for us to continue to deliver the service our population deserves, we’re going to have to increase the pace of change to models radically different from those established. In D&G we have an outstanding track record of managing major change and this is one aspect of the past that I think is going to be extremely useful in preparing us for the future…
(* ok there is)
Jeff Ace is Chief Executive Officer at NHS Dumfries and Galloway