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I watch and read a lot of dystopian fiction and one of the grimmest things about the world to come is the extremes of 'identity': think red cloaks in The Handmaid's Tale, unseeing Ul Qoma in The City and the City, or a replicant in the persistent rain of 2019 Los Angeles.

Social challenges are as tough and engrained as ever. With the increasing strain on health and care services, the mantra ‘more for less’ has become deafening and, on occasion, paralysing.

It is a commonplace assertion that society, the economy and public services face unprecedented challenge: from demographic pressures to a stuttering economy; to critical workforce shortages and developments in technology that outpace our ability to harness them for public good. In order to survive (let alone thrive) we must change; work differently, think differently, live differently. 

I haven’t always loved being a doctor. Too often during my training, I left work wondering how I could drum up the enthusiasm needed to return to work the next morning. Long hours on call, constantly rotating to new wards and clinics, and the sense of futility I felt was intense.

We at the Stroke Association are boldly pro-reconfiguration. As an organisation representing over a million stroke survivors and advocating for the best possible treatment and care, how could we be anything else? 

Stroke is not the same as cancer. Maternity services are not the same as psychological therapies. But is there learning to be gained from thinking about how system change happening in one clinical area could be transferred to others? 

Dr Angus Ramsay looks at the learnings from our recent webinars on the reconfiguration of stroke services, where we had wide-ranging discussions of key aspects of major system change.

It’s probably a bit strange to see a minor illness as a sign of a successful event. However, as we come to the end of our event series with the British Red Cross and Co-op Partnership on tackling loneliness, I’ve completely lost my voice! And I’m taking that as a good sign, after a few weeks which have brought real focus to the power of conversation and the value of human connection.

I'm excited about this month's upcoming events to discuss the lessons of the changes to stroke services in London and Greater Manchester. The events will draw on the findings of the study led by Professor Naomi Fulop of UCL, which brought together a team of researchers, clinicians and service users from London and Manchester to examine the effectiveness of stroke reconfiguration.

How do you know if you're part of a family? Your parents, siblings – that's not too difficult. How about being part of a family of services? It's a question we've been exploring in our shared learning series with the British Red Cross and Co-op partnership tackling loneliness.