I grew up in the NHS, even before I left school I tested out my future career by volunteering. I was smitten from the start. That sense of community, of working for a common good and being able to make a difference some times in a small way, sometimes in a huge way. Yes it's tiring usually, stressful often, the shift-work a pain but the satisfaction a balancing point usually. But I wonder if things are balanced now?
Levels of stress, of workload, of pressure from targets and- in England at least- endless reorganisation that has no apparent value or indeed common sense at its root, are taking their toll.
The workforce is struggling that much is evident. What is amazing in a way is how much great work is done nonetheless; day in, day out. The evidence of cost effectiveness of a national health service is plentiful, we know it’s not perfect but it’s nonetheless impressive. It’s part of our psyche, part of what we are proud of as a nation; be that UK or Scotland.
As regular readers of my blog know I have had many opportunities to be grateful for the work of the NHS and indeed to challenge it to be as good as it can be. I have twice had treatment for cancer and I haven't had to "break bad" to pay for it. Haven't had to see myself be financially crippled through bills (unlike my peers in the US in particular) to protect my long-term health. Of course I have had many other impacts and some of them financial but it’s not from paying for healthcare. I also know I would stand at the barricades to defend the NHS and its principle of free at the point of need.
But I look at the situation in England and see the integration of healthcare being fragmented, see private companies in the business of profit moving in to improve a service we are told and I see a situation when the tax payer funded sector is starting to fund private healthcare sector who are accountable to shareholders and not those who pay for it and I wonder where will this end? As it slowly shifts to private sector delivery, what is the logical next step in England?
I notice in myself a tendency to cross my fingers that this could never happen in Scotland. Health after all is devolved. And we have given commitment in Scotland to staying with a model of collaboration, of integration, of ensuring the voice of lived experience helps to shape not only the person-centred one to one care but also the service improvement. I applaud this and like to think I , along with many others have helped to influence this. And we see the positive impact of investing in self-management, of the reality of how involving people truly shapes policy and practice in a person-centred way, unencumbered by reorganisation, that is at best a distraction, at worst decimates a service that was previously successful.
How fragile is this approach however although it currently has collective support, a policy we sign up to and are still admittedly finding our way with. But as policy elsewhere in the UK shifts and changes how much does that create a tension that is unsustainable? How much does that shifting budget, between public and private, impact on how Scotland's budget is allocated over time? The budget then becoming the driver of a policy we don't want?
The political discussion around the referendum in Scotland has only recently shifted to focus on the NHS. And at first I was probably guilty of complacency. The policy here is so different, cross party consensus in health is fairly solid in most part but as I have looked at the question of divergence and budgets, my concern has grown.
I heard it said recently that so many in Scotland are "aff their sofas" and engaged in this vital constitutional debate. What I would urge us all across the UK to do is get "aff" our collective sofas and join in the battle for our NHS. Let's not be guilty of only realising what we had after we have lost it. But equally we shouldn't worship at its temple, more importantly we need to help it evolve, improve and be truly responsive in partnership with those it serves. Maybe we all need to be willing to properly invest in it too. And finally to ensure that those who govern are properly accountable to us for our health service and not impose policy that we didn't vote for and don't want; whatever our nation is now and in the future.
Reasons to be cheerful: the sun is shining and I have worked with some super people this past few weeks. Not least in my first experience as a speaker for Women for Independence. I loved the engagement of the audience and the passion of those with a vision for a more socially equal and just society. It's inspiring to be part of this movement for change.