FEW political issues arouse as much passion as the future of the health service. We all want the reassurance that we and members of our family will get the best possible treatment if we are injured or unwell.

So there was widespread shock locally when, a year ago, the national inquiry team headed by Sir Bruce Keogh, Clinical Director of the NHS, made serious criticisms of Buckinghamshire’s hospitals. When I read the report, one point that struck me was that while the Keogh team had found plenty of examples of very good treatment at both Stoke Mandeville and Wycombe, the Hospitals Trust was not good at making sure that best practice was followed everywhere. For patients, there seemed to be an element of a lottery, with the quality of treatment and care depending on which ward you were in or which staff were on duty.

The Bucks NHS Trust was put into special measures, with advisers brought in from successful hospitals to help the local team turn things round. And the good news is that that effort has succeeded. Earlier this year, inspectors reported very significant improvements and the special measures were brought to an end.

There is of course more to do. End-of-life care and A & E services are not yet as good as they should be.

In fairness to the trust, there are national and not just local challenges over these two areas of care.

With end-of-life care, I never cease to be amazed and impressed by the high standards and tireless commitment of the hospice movement, whether that takes the form of units like Florence Nightingale House, at Stoke Mandeville, or the help given by Iain Rennie and Macmillan Nurses to patients and families in their homes. But most people don’t die in a hospice and I don’t think we’ve yet managed to mainstream hospice standards in hospital wards.

Several different pressures have combined to swell the number of people going to hospital A & E departments. Some of it is down to the fact that many more people these days live to a great age, with the inevitable frailties and risks of ill-health that that brings. Some of the pressure is certainly due to reduced public confidence in out-of-hours services since most GPs withdrew from providing that cover. A third element, and one that GPs themselves mention to me, is that more people than in past generations opt for A & E immediately, rather than look first to the local pharmacist and seeing if the condition will start to clear up after a couple of days of self-treatment.

For as far ahead as I can see, we are going to need to continue spending a large proportion of our taxes on health. That means we need our economy to continue growing. But the reality is also that increased longevity, new drugs and new treatments –all in themselves good things- mean that pressures on the health budget will also grow. That in turn means that we shall need to squeeze the maximum value out of every pound spent and work out ways to relieve pressure on hospital services from people who could get effective treatment elsewhere.