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A couple of years ago I spoke to healthcare professionals in the US about what makes for a joyous day at work as part of a project sponsored by the Commonwealth Fund, when I was working in America as a Harkness fellow.

I heard about Writing the Future through my friend Kate, who works in health. "You like writing," she said. "Why don’t you enter this?" A short story competition about healthcare in 2100? It was an intriguing topic: 83 years from now, what kind of world would our descendants inherit?

"You can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something - your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life." - Steve Jobs 

Having been part of the panel judging the splendid recent Writing the Future competition, I've been asked to pen a few words about the writer's job; specifically how the world 'out there' gets filtered through the writer's imagination so that it arrives 'down there' on the page.

Writing the Future is a vanity exercise. A piece of ephemera only of interest to the eccentric, whimsical, or those with far too much time on their hands. I don’t agree; and having come up with the idea originally, I’m not sure you’d expect me to.

When Richard Taunt invited me to do this, I should have given him a warning. That my least favourite forms of fiction are science fiction and fantasy. That when it comes to the future, I am right there with the American baseball star Yogi Berra – to whom is often attributed the famous quote: "Never make predictions, especially about the future."​

How do we get our heads around this fact: we have so much knowledge, so much skill, so much progress – but still: so many blind spots, so many obvious insights not acted upon.

The lesson from pre-1865 medicine is that there is no reason to believe health care will always have an overall positive effect on health, no reason to believe that we can construct a system to which we attach lofty ideals and rhetoric, yet is deadly.

Culture is possibly the most important, but also over-used and, at times, meaningless concept deployed by those interested in the organisation and improvement of healthcare. But what is culture? Is there 'good' and 'bad' culture? How can we use our understanding of culture to improve our current healthcare system?

As the NHS has restructured over the years we have taken professional tribes and overlaid them with organisational tribes – commissioner and provider, hospital and community, physical and mental health, health and social care. Sometimes we recognise this, and we learn to speak each other’s dialect – but all too often we simply adopt a new jargon – the “special words used by a profession or group that are difficult for others to understand.” And we hold on to our positional power.