The Thought Leader's Voice Podcast

Rachael Kinsella: Hello and welcome to the Thought Leader’s Voice. I’m Rachael Kinsella, Editor in Chief at iResearch Services and your host for today’s episode; Investing in Smarter Solutions for the Healthcare Industry. We’re incredibly excited to welcome as our guest today clinical consultant for Alcidion, and Expert Representative for IT in Digital Development at the Royal College of Nursing, Douglas Hamandishe.

Rachael Kinsella: Douglas has spent over 15 years as a clinician who has worked tirelessly to introduce and bring innovative technologies to the hands of healthcare professionals. He has a real passion for patient empowerment, and these innovations support patient empowerment and user experience while also improving healthcare outcomes. Douglas has implemented large-scale IT transformation projects in health and social care for the NHS as well as for private software companies. Douglas also has a strong background in broadcasting, communicating, and engineering. His own podcast series – Centric Health Media, is a clinically led interactive media platform bringing incisive insights and sharing best practices in digital healthcare to a health and social care audience. We’re thrilled to have you here today, Douglas. Thank you for joining us at what is certainly a challenging time for the healthcare industry and for patients alike.

Douglas Hamandishe: Thank you very much. I’m very honoured to be here and humbled as well. So, I look forward to an engaging, dynamic conversation. So yeah, it is a very challenging time for the NHS. It seems as if we haven’t yet caught our breath from COVID, and staff are still dealing with their own personal issues regarding the effects of COVID on themselves and their families, as well as the rejigging of working roles.

A lot of workflows had to change because of the pandemic, and again we’ve not caught our breath, into really take a look at the whole panacea and say is this working? What can we do differently? What’s not working etcetera? So, it’s a unique time to be within the NHS at the moment, plus we’ve got the bed pressures because of the backlog caused by the pandemic as well, and projects had to be put on hold, so we’ve got the backlog we’re trying to contend with. Typical, with the pressures that we’re still not resolved, as well as the rapid change of transformation and a changing workforce, so there’s a lot of- it’s all the ingredients make the perfect storm. I would say.

Rachael Kinsella: Absolutely, it’s just coming at all sides and of course, with the rise of COVID in current times, that just adds extra pressure to all areas of the NHS, and whilst dealing with this backlog and having to shift working models, workflows, and adopt new technologies very quickly, and as you say, very little time to even draw breath. Can you talk to us around some of those? Sort of you know, you’ve talked us through some of the key challenges, can you talk through the way the landscape has changed? We’ve seen that evolving through COVID and it’s still evolving in response to multiple challenges today.

Douglas Hamandishe: Oh yeah, yeah, most definitely. You can take a look at it from an operational side, and we start to drill down. From operational side, you’ve seen organisations having to pivot, having to rely a lot more on data’s coming from outside of health services. (Rachael – Right). We’ve seen integrated care systems being rolled out, how that will fit into a certain geographic location, so those teams, those services are still yet to find their feet. There’s a big difference between social care budgets traditionally and healthcare budgets, technology being adopted across health, social care, education, and other factors. Other specialties all come to bear to bring about better health outcomes, so trying to coordinate that approach is very, very difficult. I must also include at the same time, say, social prescribing groups as well, voluntary groups who were instrumental and pivotal in getting this nation on its feet during the COVID pandemic. They were so instrumental, but how can we then harness that data, post-COVID? So, from operational side, you’ve got these pressures, and also, like I said, the staffing issue is one that needs to be discussed further because a lot of people don’t realize this, but the vast majority of NHS workers are not directly employed by the NHS. They are employed by agency workers, agency staff. Yeah, agencies. Yep, they recruit a vast bulk of staff, so they need to be communicated to and work in partnership with the NHS to ensure staffing levels are kept to optimum. And so, there’s a divide in terms of the gap that needs to be closed, in terms of the skills, as well as the pay; the remuneration that staff member will have say, working for agency as opposed to working directly for trust. So as when the staff go, they leave deficits behind on the ward because sometimes it’s making decisions based upon what’s the most economically viable place for them to work in, opposed to where they would like to work. So, staff are not only in a difficult situation operationally, but senior managers are also struggling to make sure and retain staff so that they can fulfil their obligation. So yeah, there’s a lot of moving pieces in there that needs to be resolved there from operational side and if you distil that down to from a clinical perspective, it is so much change coming to board, to come into bear on you straight away that it can seem difficult for you to find the value.

Technology has never moved at such a rapid pace; Moore’s law, you know, the rates of technological advancements is doubling in the consumer-grade electronics, but then in health, it seems to have gone exponential. It seems to have gone so far forward. Staff nurses, for example, have three or four logins, still, 3-4 different systems that they need to navigate, all with changing workflows, and understanding how your colleagues will need to use that information is also complicated because the days are long gone where a patient is admitted to your ward, and you retain the physical notes. So, you could write in your very specific way because it was only meant for your team, your ward, who understand how you write, how, you know, but now when you’ve got that data now has to permeate over to other services that might not be health, that puts a lot of pressure on the person scribing their notation to make it understandable across different services. So, that’s just a telling example of what is to be resolved and also the pressures that we feel on the clinical perspective.

And lastly, I want to really touch upon the expert health consumer. COVID has been a unique experience for many in the sense that those who never had direct experience with the NHS, now have direct experience with the NHS in bulk, either directly or indirectly, through loved ones. So, the expectations for the health service have also gone exponential. They expect to engage with the NHS in the same way they’re engaging with retail, grocery services online, all of those things, expecting the same level of customer services and the NHS is struggling to meet them on that term, as well as the fact that they’re holding onto data on their persons like patient recorded data So, on your Fitbit, so on your iWatch?all these types of data and helping that to feed into your health record. So, across the board from top to bottom, there are large, large issues.

Rachael Kinsella: There just seems to be so much. I think there are so many tech challenges and time challenges and different workloads, both operational and physical in terms of patient care. Are you seeing tech innovations trying to help ease that burden? For example, getting different systems, talking to each other or integrated. You mentioned the example of the nurses with their three logins, which you know they don’t have the time or the resources to be able to cope with this sort of set-up. So, are you seeing some innovations come in to try and integrate these systems more and be able to share the data?

Douglas Hamandishe: Yes, I am, as in my both my roles really. I’m at the cutting edge of technology, so I spend a lot of time with start-ups and established tech companies in the health space, so I know there’s a lot of innovation coming. The biggest issue that we have is the infrastructure that data needs to sit on. For example, we know the railways, the roads are the bedrocks of transport within the country. The bedrocks of data flowing between systems is based on interoperability; agreeing the standards for data to move freely across different systems, and that’s been a conversational piece for the last 10 years at least, and we’ve still not cracked it. We still got locking from various providers locking in data, we still got inconsistencies in the quality of data because it’s one thing about letting two systems communicate, but you’ve got to understand that data is only as good as the data that’s being recorded. So, what’s the point in sharing data that is bad? It’s not going to advance anything, it’s actually going to create more patient safety concerns, so levelling up in terms of making sure that data is at agreeable high level of quality across the whole piece, then it’s also about making it accessible and move as quickly as possible.

So, I think on a technological level, the technology is available for us to do that. It’s more to do with a humanistic blocker that comes in the guise of companies, processes, and procedures that need to be really ratified to really create an environment where that is now our reality; the norm. It should be the fundamental foundation of health, but I think it just needs to be championed a lot more.

Rachael Kinsella: Yes, yeah, and it seems like there needs to be a fundamental shake-up or change of these processes, these ways of working as the foundations for being able to use technology effectively to get access to the right data, to provide the best level of patient care, and you know, there are multiple challenges that come with that. As you say, legacy systems?the quality of the data that’s been captured previously. There’s the willingness for patients for their data to be shared and it’s something that has been a challenge for the industry for some time, and as you say, we’re still trying to tackle it. I like the way you point out that really strong human element to it, that people need to be involved in reinvigorating these processes and in changing the way that we work, so that we can get the technology to work in the right way. That’s going to improve patient care, patient empowerment, and better patient outcomes, but also for operationally, for all of the health care workers to make their lives easier when they’re facing so many different challenges. So, there’s a lot of focus on technologies and what we can do with it and how we can get it working together.

There’s that human element that perhaps people don’t touch on so much or perhaps don’t recognise. that it’s crucial to get anything working operationally, and to move forward with digital transformation. I think, certainly, during the pandemic we’ve seen a lot of opportunity for patients to empower themselves with access to different services through e-health solutions, through – you mentioned wearables earlier having your iWatch or your Fitbit or your Whoop – whatever device you’re using to kind of keep an eye on your vitals, but also being able to access video appointments with health care practitioners which has been vital, particularly for people who are in the extremely vulnerable category, who shielding throughout the pandemic and couldn’t actually attend medical appointments to be able to still have access to the care that they need for ongoing conditions and conditions other than COVID. Are you seeing some interesting innovations? Are you seeing a sort of increased uptake? How are you seeing those kinds of levels change? Now, we’re at a different stage of the pandemic, I’d be really interested to hear your thoughts from both a healthcare provider perspective, and from a patient perspective from what you’re seeing here.

Douglas Hamandishe: Now, that’s a great point, and just to round up the last point about interoperability before I talk of this one. Interoperability being the bedrock, it needs to be a prerequisite, which many say it is a prerequisite. However, for many trusted mini-suppliers it’s ‘a like-to-have, to must-have,’ and where it’s been a must-have, there’s no enforceability of it. So, if you have a prerequisite for interoperability to operate it, your systems must connect and engage with one another, and it’s not enforceable by statute. You end up having a must-have or we’ll be able to do that in 2-3 years’ time, etcetera, etcetera. And then, it gets pushed further into the long grass. So that’s what we need, we need to make that info enforceable, so that it then can be a real thing because I think everything that we’re going to talk about hangs on the strength of that.

Rachael Kinsella: Of course, yes. So, you think there’s going to have to be a shift to the regulatory agenda as well, and that policymakers have a part to play in making this enforceable?

Douglas Hamandishe: Absolutely, if you lobby your MP or if you watch Parliament on Question Time or any of these discussions that take place at the highest level of government, how often do we hear interoperability spoken? It’s rare, and so when it’s not spoken about by our MP’s and the understanding of it is very green with the general public. It’s no wonder, it’s not a big thing. You see, we need to really raise awareness how massive an issue it is. For me, it introduces clinical risk. First and foremost, if data is not moving across systems, it just introduces blind spots and we’re becoming more and more health-centric has been the sense that we are becoming the determinants of health. In many instances, I have nothing to do with health anymore. I, as a nurse, I’ve supported young people who have challenging situations at home, and they will tell me, ‘Mummy’s depression will lift if, you can fix the housing situation. If we could just get the housing situation sorted out, the depression will go. I won’t get bullied, I won’t get harassed, my grades will pick up.’ You know, by that young person; I’m treating them for mental health disorders. You see, so often the determinants of health come from other services. So, if we have sight of these other services that interplay with somebody’s wellness, it would help in a far more positive way. You know, again, the foundation of that would be the interoperability of systems.

Rachael Kinsella: Yes.

Douglas Hamandishe: As we’re moving forward, we’ve seen behaviours change and I speak about this being for many parts a humanistic problem, not the technology. Another example, we see habits of visual consultations playing a larger role. We’ve had the technology for video conferencing for over 15 years. It’s been there. We shut down by human processes, by information governance. Yeah, it wasn’t safe. What if somebody in your house walks past when you’re having a consultation with your GP? How many people have been caught out now with their loved one, a pet, the baby – all going past. It’s part of life. Look, the pandemic forced us humans to shift the whole narrative and quell this IT situation. So many times, it’s not going to be the technology that’s going to be standing in the way, it’s going to be how we reconcile humanistic behaviours or the ability to control or contain something. So, to broaden it out, you find the visual consultations as probably the biggest thing that’s come out of COVID in terms of a changing workflow and changing the way we deliver care. It gave the patient another option to engage the NHS and options is always a good thing. Choice is always a good thing and also this helps to stem the flow of traffic to the frontline, to the front door of the hospital trust. You know, you’re saying somebody can connect either through our telephone system, through visual consultations, you don’t have to materialize in A&E, so that choice alone will take time for the public to fully understand it. And also, it can raise expectations of the service because you give them a choice, so we expect somebody to be at the end of the line, we expect the GP to be ready for us where we want a video consultation, we expect our prescriptions to be ready on time because when we do our shopping it comes on time, we know roughly what time our Amazon delivery is going to arrive, but having how many patients are not discharged from wards because medication is not ready. All of these things are coming to bear now, so, the digital divide is real, yes, a lot of people can connect now using digital technologies, but also a lot of people cannot and it’s not due to not wanting to, it’s just an economic situation disenables them to do so.

The government during the time of COVID gave out lots of councils, schools gave out computers to children that were deemed to be coming from economically deprived backgrounds, challenging situations. They gave them laptops. Do you know what they did in the first place, during the summer? After the academic term had finished, a lot of them took back those laptops. A lot of them took back those laptops. Some of those students went from being ongoing to secondary school, going to start their A levels, they had to give back their computers and then they find themselves in another situation again for A Levels. So, this is a situation where the digital divide is so, so real. It’s acutely real, there should be a standard of care that is given to every citizen and that includes technology, the ability to connect and engage with your service. It needs to be out there because, there’s no question if you’re having a video consultation, you’re saving the trust a lot of money. On top of that, you’re also supporting the carbon net zero mandate that every trust has to adhere to by not traveling on a bus, in a taxi. Do you know these things? So that saving should be able to increase the budget for trusts or government bodies to give devices out to people who are most vulnerable so they can engage and connect.

Rachael Kinsella: Yes, it’s interesting because in that situation as well it’s looking at the patient and their needs in context. So, you were saying the economic context around treating patients for depression and addressing needs within the family, looking at it in the context of their housing, their economic situations, the burden that their family has, and in the same way, looking at it in context, looking at it economically from the trust perspective, looking at the SDG (Sustainable Development Goals) goals and the net zero carbon objectives and looking at a lot of work that needs to be done in terms of sustainability within the health care service, but then it’s also trying to provide that equality of care and looking at ways to do that so. Is it an awareness issue? Is it a budgeting issues, sort of not being able to look at the bigger picture in context because it seems that you know something that seems quite simple when you explain it but when viewed in context, actually it ticks a lot of boxes for budget, for sustainability and also improving patient care? So, why are these things not being addressed? Is it time? Is it budget allocations still being allocated to areas that are pre-pandemic or that aren’t as viable? Or do you think it’s just not enough people are aware of it?

Douglas Hamandishe: I think it touches everything you’re saying really, but I’ll just break down a point. Until patient data is owned, and patients are responsible for their data, and they take ownership of their data. They are going to have this issue. We are quick to surrender our data to health organization, and the health organization take that data and put it in systems and the system provider might take ownership of that data. Yes, they might say theoretically it’s still the patient data, but the patient doesn’t have that data and doesn’t make decisions about that data. If you look at a maternity ward, mothers, expectant mothers have their paper records, and they hold onto it themselves. You see the behaviour of expectant mothers’; how protective they are of their medical records. It debunks the whole myth that patients wouldn’t know what to do with their own records. It’s about being able to present it in a way that they will understand and be able to look after it effectively. So, it’s again, going back and going to the nucleus of this whole problem, you have got to decouple patient data from software, and until you decouple the two, you are going to have patient data locked into software held by a provider that has a commercial interest pertaining to that data.

Douglas Hamandishe: So what about a revolution, health services now need to be turned on. Like I said, I was trained in a time to deliver care. As a nurse, my primary function was, to treat. Somebody’s sick, I treat, sick; I treat. I’ve found over the years that doesn’t work. My role now is morphing into more a sign poster, a personal cheerleader. The person is then coached in a way that they take responsibility for their care because they want to get on their feet themselves. It’s just that with some patients who traditionally turn up say, what are you going to do for me to get better? But more and more, we’re seeing this shift in role and being able to have a service that is taught at pre-registration for doctors, nurses, social workers that support a recovery-based model, that supports a model of care that says you now are not in the business of just treating, you’re in the post, you’re in the business now of enabling people to get on and liberate themselves from health services. That is a different type of care, it requires a different health system, requires a wellness system, the NSH is just a treatment-focus system that hasn’t really focused too much on other parameters pertaining to somebody’s health and well-being. You break a leg, we could put a cast on it, and sends you back home, but not realizing maybe that person staircase in their house is actually dangerous.

We’ll fix you when you come back again. Sometimes we know prevention is better than the cure, and if we get in early, the intervention not only is less costly to the NHS, the chances of somebody getting better increase, satisfaction also increases, so there’s more benefits in having this type of integrated care system which is being brought up by the ICSs, but a lot needs to take place before we can really target all the health inequalities that the divides that we see that it’s emerging, and that’s one good thing about digital is you can see where your problem areas are from; diversity from ethnic groups, religion, you know, where you live, all of these things, the data is as brutal as you can. As brutal as it can be, what then do you do with that data when it comes to you with the budget that you have? Is it enough to stop applying interventions locally in your community? For the greater part, I’ll say no. That’s why we still leverage the support from social prescribing groups that can help people that typically run for nothing.

Rachael Kinsella: It’s a huge shift in mindset as well, isn’t it? So, as you say, it’s a massive change to systems and the way the services work, but it’s a huge shift in mindset for patients and for health care workers and for carers, and it feels like there needs to be a lot more education on that and a lot more awareness of how healthcare practitioners can empower patients to take control, to take more control over their health and also, sort of, you know, look at recovery plans as you, as you mentioned and look at preventative options and lifestyle options that are going to help avoid, having to have as many treatment visits or you know as many different treatments or medications or whatever the case may be, so it feels like that there needs to be a lot more education on both the patient side and the healthcare industry side. And as you say, how it all pins around having the right data and being able to do the right things with it again. There needs to be awareness and an education on that, on both sides as well.

Do you feel that – you mentioned the social prescribing initiatives, which have been fantastic throughout the pandemic, and I feel a real case study of success for being able to offer other options, as you mentioned, to patients. Particularly for people who are in the vulnerable category and were unable to leave the house at one point and being able to offer access, someone to join up the dots between different services or to put patients in touch with other options and other services that are available. I think it is incredibly valuable, but again, there’s not much awareness about those initiatives and what they’re doing, and as you say, for the most part, they’re running for free by volunteers, but it’s an example of something that’s worked very well in partnership with GP practices, for example. So, where do you think the future lies with these kinds of services, with these kinds of new models? So, what practical steps can we discuss from a healthcare industry perspective and from a patient perspective to try and make this transition a bit easier?

Douglas Hamandishe: So I think we need to help the transition. I think you’re right. Education; we need to re-educate first and foremost, the educators. There’s no point in training, delivering training, to privileged health professionals by health professionals that have a training set that’s obsolete. You know, technology is so fast now, stuff that you study in your first year becomes obsolete by time you qualify. So, you want to have an up-to-date refresh mandate, there’s no use in having a training program that you refresh every six years, because what we find is lot conditions turn up on the ward and they can’t believe how what they were trained is not what we actually do? For example, very quickly, when I was training as a nurse, I was never trained in administration, in filing documents. Not trained in it. When I presented myself on the ward, I had to learn on the go. Hence, medical records go missing because people not trained to understand the administrative part of record keeping. Although nurses have been saying that 50% of their time at least is spent on administration, but we’re not trained on administration. You see, so we need to make sure some systems are designed in such a way, that it’s designed, so that it’s logical, users can understand the workflow, so we need a lot more conditions getting involved in informatics. That’s what we need. Doctors, nurses, social workers, we need to have that collaborative spirit all come together to share the information. Also, we need to have strategic people who understand how systems work; the interplay between systems, for example. If you are creating a service that means patients no longer need to go to A&E, but they’re shipped by the state in the community, for example. Who’s going to see them in the community? You create even a problem somewhere else in the system that might not have the resources to deal with the influx of patients. You’ll stop them; go in one place, they go in somewhere else, so it’s being able to understand how, tnot just your own environment, your own ward or your own hospital, but understanding how community teams operate, how voluntary services operate and also increase the budget for these social prescribing groups so they can digitize, a lot of groups, like for example, I support a group that helps women going through domestic violence.

All those conversations that we have, they’re on paper. So, at best it’s scanned and uploaded back into medical records, but it doesn’t do anything because nobody has time to look at scanned and uploaded documents.

Douglas Hamandishe: Right, so those volunteer groups need to have the technology so that they can digitize their processes. So yeah, it is a massive undertaking. I think we need to create more roles within trusts, more roles within government to take a look at this stuff and stop keep changing the mandates between NHS or NHS Digital and whatever these organisations are doing, the number one priority I believe should be cracking interoperability, because nothing moves until that’s done.

Rachael Kinsella: Yes. Yeah, absolutely. And that’s one of the questions I was going to ask you. So, you’ve already answered it for me but is there scope for more roles to be able to support this transition and to support these new ways of working? And it’s interesting that you point out that there need to be more roles from a government perspective there as well and indeed from a policy perspective. Do you think leadership has an important role to play in this, both with the bringing about the shift in mindset, but also changing the way that we use systems in being able to bring interoperability in?

Douglas Hamandishe: Absolutely. Leadership is key. This is why for MPs who cannot pronounce interoperability and never use the word interoperability, they cannot lead on interoperability. So, we need to have leadership across the whole health and social care panacea. We do, and then the question is, what constitutes a good leader within this field? Traditionally, the leadership that has been within health has been very much top-down. You do as I tell you, it’s very major, matriarchal, matron driven-type delivery of leadership. That isisnot the leadership we need in the NHS. We need transformational leadership which is a completely different ball game because when we transform services we transform human beings, and if you cannot motivate, you cannot inspire, you cannot encourage, you cannot give hope, and you cannot actually be the embodiment of change yourself. You cannot lead, successfully, you can force people, but the health service is an environment that’s unique. We vote with our feet. If we don’t like you, we don’t do what you have to say, , as long as we remain accountable to our governing bodies, we don’t have to do everything that you say and at least, and at least we can go slow. So, we need to get buying for somebody, from people that can do those things, can inspire, and I don’t see too much of that style of leadership. I see too many change agents coming in to fix a problem and its whole humanistic experience is negated. You know, on a humanist level, what do we go through when you go through change, you go through a loss, of you know, go through a deskilling exercise, you go through fear? These are conversations we don’t hear leaders talk about all the time. I don’t hear it. I hear ‘we need to transform our services, we need to do this,’ but prepare the people that have to deliver that transformation, they’re left out only because the leaders don’t understand transformational leadership from a humanistic perspective.

Rachael Kinsella: So it comes back down to that human perspective again, and being able to see the human effects of change of transformation and being able to see the bigger picture and look at it on a strategic level and which is even more about the people than it is about the technology, in this situation and indeed, many other situations requiring a transformational change. And it’s just very interesting to see it from that perspective, because externally you don’t see that, and as you say, you don’t hear about interoperability unless you’re talking to the tech providers or people who are kind of deeply entrenched in the various different processes and systems. You don’t hear about it from outside the healthcare service or even outside of the medtech space. Again, that’s the awareness, recognizing the human impacts of tech advancement and the pace of change that we’re seeing and the volume of challenges that we were discussing at the start of our conversation, and you can’t just solve a problem at a time and tackle it piecemeal. It has to be looked at strategically and from the bigger, bigger picture, and I think, all the elements that we’ve discussed today really tie into that and it’s very clear that significant change in mindset, in approach and processes and workflows needs to happen, but that does need to come from a different type of leadership and a different setup, which obviously the industry is in the process of building, but there are these various different blocks that need to be in place to build that foundation, as we discussed earlier. So, in a way, there’s an awful lot of challenge, but to look at it from a more positive note, there is a real opportunity for positive change in a number of very important areas. Ultimately, to help improve the lives of healthcare professionals and patients, but there’s so many different elements to tackle from the challenge perspective. I think technology seems to be making a difference in some areas and with the right infrastructure in place on a human level and a tech level as you’ve discussed, that’s how we’re going to get things moving in the right direction. Are there any other more positive developments that you would like to talk to us about, where we can kind of look to balance the many challenges and issues that we face?

Douglas Hamandishe: I think the positive thing that we can do is have these conversations, so I really welcome the opportunity to be on this on this show talking about these issues because it’s rare for me to observe a platform that shares these types of conversations, let alone be on one. So, the change is going to come when we as a collective, take the responsibility to start to shape the health service in a better way. If we leave it, for example, if you let the market decide, it’s going to continue doing what it’s been doing for the last 10 years. We have to intervene. There has to be an intervention, there just has to be an intervention. Either we have to be strategic and make sure that we vote where we’ve got the power to vote for the right people who can drive their health service forward in the right direction and they will create the environment for all of us to then add value into it, and we want leaders to be courageous. So, I think I’m very positive; technology-wise, I’m very positive, with the clinicians that I speak to on a daily basis, I’m very positive and there’s a lot of energy. There’s still a lot of enthusiasm, and with every cohort that’s qualified, the expectations also increased, but I will say that the patient needs to be up skilled in understanding how they too can leverage their own data to improve their own lives as well as to enable the NHS to continue to innovate, because there’s no question as we’re moving forward. Technology is so fast. Your car is going to be your ambulance. Your home is going to be your hospital and your watch is going to take all your vital signs for you. So, at what point is a hospital going to be involved, you know? So, we got to be preparing ourselves for that sort of environment in order for us to prosper, and I think there’s going to be lots of conversations still to be had, so I remain positive. Thank you very much.

Rachael Kinsella: Thank you. I think that’s very important looking to the future. Looking at it with energy and positivity and enthusiasm from all the different participants involved and I think as you say, Thought Leadership in itself is an enabler for this change to happen, to raise awareness, to educate on the issues and the challenges that the industry and patients are facing, but also talking with people like yourself, who are demystifying so many different areas of the industry and bringing that human perspective to light, which is just so important; and I think it’s very exciting to have you here talking to us today, sharing your insights, but also helping to spread awareness and demystify some of these areas. So, thank you so much for joining us today. We hope to speak with you again and see how things continue to develop and then we’ll keep tuning into Centric and find out what else you’re talking about and who else you’re speaking with.

Douglas Hamandishe: Thank you very much. It was an honour and pleasure to speak with you, Rachael. Thank you very much!

Rachael Kinsella: Likewise, thank you very much!