People powered reform of health...thats got me singin.

Yet again I have had to engage with the NHS recently and I have been treated with respect, compassion, taken seriously and supported with clinical competence. I'm so grateful to all who play their part. In many ways the system works well for me, especially as I  have a good level of health literacy, given my nursing and public health background. But when it comes to my Mums needs, frankly, its poor. Frail both physically and mentally now she is so vulnerable and without my sisters nearby support, coordinating her care, advocating for her, plugging the many gaps and lack of joined up thinking I really find it hard to see how she would have survived, and certainly not at home.

Aged 86 and well until recent years she has done well, but its heartrending to see her decline now. She is typical, not unusual. Thankfully she and my father saved for this rainy day and it is helping her afford the care she needs but my sister has the finger in the dyke of her need and lives with the constant anxiety of what will happen next.

It's no surprise to me therefore that we have had reports of the pressure on the system, on waiting times, on recruitment, on burnout of staff. I have suggested in the past like others we need to decouple health and social care from politics but let's be honest that's not likely to happen. But the pressures on our health and care system is echoed across healthcare systems in the developed world. The combination of us living longer and therefore developing longer term and more complex needs for care and treatment of course are part of this. So too is the development of expensive treatments that extend and improve life in a way we couldn't have imagined a generation ago. We look on and expect others to make decisions on which drugs to fund, to play God or a kind of Russian roulette to decide who can have the life extending drugs and which we can't afford.

We expect targets to be met at the same time as politicians in Westminster are saying austerity measures cannot be avoided. It's not sustainable to expect both and we all need to be part of the conversation to decide how we improve and sustain things in the longer term; as well as what we are willing to pay to achieve this. There is no doubt that health will become the political battle ground of the next election but I fear that will serve nobody in the longer term.

We need a vision that enables a greater wellbeing for all, that works with individual and community assets not their deficits,we need to bring love and humanity into the whole process of care, and have honest conversations about what we prioritise and what we don't. And we need to stop thinking that changing structures or organisations will solve things, they won't. The best thing our politicians of all hues and nations could do now is get around the table with representatives all of those who work in and experience the service. Then commit to working with them, to really listen and to learn from them to work out the best way forward and indeed what that will cost.

Let's also have the wider civic conversations like we had in the run up to the referendum here in Scotland about our health and care system and recognise that we all have our part to play to support the services of health and social care to thrive. 14,000 people in Scotland did submissions to the Smith Commission, can we harness that engagement around our health and care service and shape together the future service we need?

I think we can, I think we need to. We know this matters to people, let's trust them to understand the issues and  to help shape the future.   

I leave you with the words of that well known optimist Leonard  Cohen for all you who feel concerned that the opportunity for positive change wont come," Youve got me sininging."