This will be my last piece for After 20 years serving on health authorities and trust boards, I am leaving for pastures new.

It would be easy to abuse my current status as a here today and gone tomorrow trust chair to rant about what might have been if such and such had happened or what could have been achieved if this and that had happened. But it would serve no purpose at all other than to give me some passing pleasure.

So what am I going to do? I am going to make a simple plea based on what I have seen and experienced over the past 20 years.

The only way we are ever going to make real progress and meet people's healthcare needs is by sharing ownership of the issues and the problems. This applies equally to organisations and individuals.

Rising demand

The health service makes a rod for its own back. It has always done so and must continue to do so. Every new drug or procedure that saves a life or extends life is a wonderful thing, but there are also consequences that affect the health service as people live longer. As more and more of us become elderly and frail, we need more health services. If we are to meet this demand, all those involved in providing public services need to work as one to determine how to do this with the resources that are available.

We must recognise that only by changing the way things are done will we be able to do what needs to be done in the future.

Changing structures and inter-organisational relationships has an impact but only a limited one. Changing the way people think and how organisations behave is the big prize. One way of doing it is to give people their own pot of money and then put in place systems to help them buy what they need.

Another, the way that has been chosen in Wales, is to plan services on a population basis and ensure services are in place to meet the needs of the people. I firmly believe this can work but only if traditional barriers are broken down and buck passing stops.

Citizen centred

The citizen-centred approach we have adopted in Wales can drive this. But we must not allow people to be passed from organisation to organisation as they try to get what they need.

Patients and the public are as much a part of making the health service a success as the organisations responsible for planning and delivering health services.

People must be supported in making their own informed choices about things such as smoking, eating and exercising. When people make their own choices, it makes a real and lasting change for the good. And this applies as much to the decision to give up smoking as it does to the part people play in a decision to fundamentally change the way health services are delivered.

NHS values

One last thought before I go. As my face is plastered all over the front page of the local rag once again, people often ask what keeps me going. Two people have been much more important than they realise in helping me make sense of what the NHS is really about.

The first is the nursing assistant I often meet when I am walking my dog very early in the morning. He is always cheerful and brightens my day as I am sure he does for the elderly patients he cares for.

And the second is my butcher, who has used my trust's services quite a bit over the years. After ribbing me about yet another appearance in the South Wales Echo, he always says: "You know what kid, I can't fault the NHS."