{"version":"1.0.0","segments":[{"startTime":0.72,"endTime":3.393,"body":"- [Announcer] Welcome to"},{"startTime":0.72,"endTime":3.393,"body":"this Mtech Access webinar."},{"startTime":4.35,"endTime":7.5,"body":"At Mtech Access, we"},{"startTime":4.35,"endTime":7.5,"body":"provide health, economics,"},{"startTime":7.5,"endTime":8.76,"body":"and outcomes research,"},{"startTime":8.76,"endTime":10.68,"body":"and market access services"},{"startTime":10.68,"endTime":13.972,"body":"from strategy through to implementation."},{"startTime":13.972,"endTime":17.07,"body":"Our unique NHS relationships"},{"startTime":13.972,"endTime":17.07,"body":"guide and validate"},{"startTime":17.07,"endTime":19.29,"body":"everything we do in the UK."},{"startTime":19.29,"endTime":21.87,"body":"We work with over 80 NHS associates"},{"startTime":21.87,"endTime":23.13,"body":"to bring our pharmaceutical"},{"startTime":23.13,"endTime":27.0,"body":"and Medtech clients authentic"},{"startTime":23.13,"endTime":27.0,"body":"insights into the NHS."},{"startTime":27.0,"endTime":30.72,"body":"We can help you answer key"},{"startTime":27.0,"endTime":30.72,"body":"questions related to the NHS,"},{"startTime":30.72,"endTime":33.54,"body":"from how to communicate with"},{"startTime":30.72,"endTime":33.54,"body":"integrated care systems,"},{"startTime":33.54,"endTime":36.12,"body":"places, and primary care networks,"},{"startTime":36.12,"endTime":39.092,"body":"to how to capture pathways of care."},{"startTime":39.092,"endTime":43.5,"body":"Get in touch today to discuss"},{"startTime":39.092,"endTime":43.5,"body":"your market access goals."},{"startTime":43.5,"endTime":46.23,"body":"First, though, I hope"},{"startTime":43.5,"endTime":46.23,"body":"you enjoy the webinar."},{"startTime":46.23,"endTime":47.063,"body":"- Good afternoon."},{"startTime":47.063,"endTime":50.19,"body":"Welcome to the highly"},{"startTime":47.063,"endTime":50.19,"body":"anticipated Mtech Access Webinar."},{"startTime":50.19,"endTime":52.29,"body":"I'm Rob Hull, and I'm a senior consultant"},{"startTime":52.29,"endTime":54.382,"body":"in the NHS Insight and Interaction Team"},{"startTime":54.382,"endTime":55.83,"body":"here at Mtech Access."},{"startTime":55.83,"endTime":57.81,"body":"And it's my pleasure to"},{"startTime":55.83,"endTime":57.81,"body":"extend a warm welcome"},{"startTime":57.81,"endTime":59.4,"body":"to our speakers for today's session"},{"startTime":59.4,"endTime":62.61,"body":"and our attendees who have"},{"startTime":59.4,"endTime":62.61,"body":"joined us from around the globe."},{"startTime":62.61,"endTime":64.44,"body":"For those of us who"},{"startTime":62.61,"endTime":64.44,"body":"don't know us very well,"},{"startTime":64.44,"endTime":67.8,"body":"Mtech Access is a specialist"},{"startTime":64.44,"endTime":67.8,"body":"market access consultancy,"},{"startTime":67.8,"endTime":69.477,"body":"and we provide strategy and"},{"startTime":67.8,"endTime":69.477,"body":"solutions to help Pharma"},{"startTime":69.477,"endTime":72.78,"body":"and Medtech companies bring"},{"startTime":69.477,"endTime":72.78,"body":"interventions to market,"},{"startTime":72.78,"endTime":75.27,"body":"both in the UK and globally."},{"startTime":75.27,"endTime":77.307,"body":"We also work as a collaborative"},{"startTime":75.27,"endTime":77.307,"body":"partner to the NHS"},{"startTime":77.307,"endTime":79.51,"body":"and in these webinars we speak to"},{"startTime":80.64,"endTime":83.28,"body":"our NHS Associates and"},{"startTime":80.64,"endTime":83.28,"body":"connections across the NHS"},{"startTime":83.28,"endTime":86.76,"body":"to share their insights"},{"startTime":83.28,"endTime":86.76,"body":"on sort of key topics."},{"startTime":86.76,"endTime":89.04,"body":"Today, we are joined by David Thorne"},{"startTime":89.04,"endTime":91.56,"body":"and Richard Smale, who are"},{"startTime":89.04,"endTime":91.56,"body":"two experts in their fields."},{"startTime":91.56,"endTime":92.58,"body":"And they're going to share with us"},{"startTime":92.58,"endTime":93.413,"body":"a wealth of their knowledge"},{"startTime":93.413,"endTime":95.7,"body":"around their experience on funding flows"},{"startTime":95.7,"endTime":98.46,"body":"in NHS regions and their insights,"},{"startTime":98.46,"endTime":100.17,"body":"so I'm sure it'll be thought-provoking"},{"startTime":100.17,"endTime":102.69,"body":"and give some valuable perspectives"},{"startTime":102.69,"endTime":104.82,"body":"that will be really"},{"startTime":102.69,"endTime":104.82,"body":"interesting to hear from."},{"startTime":104.82,"endTime":106.56,"body":"So I'm thrilled that so many"},{"startTime":104.82,"endTime":106.56,"body":"of you could join us today,"},{"startTime":106.56,"endTime":109.29,"body":"for what will be a really"},{"startTime":106.56,"endTime":109.29,"body":"insightful discussion."},{"startTime":109.29,"endTime":111.57,"body":"So I'm going to hand over to David Thorne,"},{"startTime":111.57,"endTime":112.925,"body":"our facilitator for this section"},{"startTime":112.925,"endTime":114.95,"body":"to give a bit more of"},{"startTime":112.925,"endTime":114.95,"body":"a formal introduction."},{"startTime":114.95,"endTime":116.94,"body":"So over to you David."},{"startTime":116.94,"endTime":117.773,"body":"- Thank you, Rob."},{"startTime":117.773,"endTime":119.37,"body":"Thanks very much and"},{"startTime":117.773,"endTime":119.37,"body":"good afternoon everyone."},{"startTime":119.37,"endTime":121.189,"body":"Thanks for joining us."},{"startTime":121.189,"endTime":122.58,"body":"My name's David Thorne."},{"startTime":122.58,"endTime":123.84,"body":"If you haven't met me before,"},{"startTime":123.84,"endTime":127.32,"body":"my career is equally split between the NHS"},{"startTime":127.32,"endTime":129.42,"body":"and market access roles."},{"startTime":129.42,"endTime":133.8,"body":"So part of what my aim is to"},{"startTime":129.42,"endTime":133.8,"body":"be a kind of translator today,"},{"startTime":133.8,"endTime":138.21,"body":"but mostly we're going to"},{"startTime":133.8,"endTime":138.21,"body":"hear from Richard Smale,"},{"startTime":138.21,"endTime":140.34,"body":"and I'm going to allow"},{"startTime":138.21,"endTime":140.34,"body":"Richard to introduce himself"},{"startTime":140.34,"endTime":141.81,"body":"in a minute."},{"startTime":141.81,"endTime":146.81,"body":"I've had sight of your"},{"startTime":141.81,"endTime":146.81,"body":"previously submitted questions,"},{"startTime":147.51,"endTime":151.38,"body":"and if questions do come"},{"startTime":147.51,"endTime":151.38,"body":"through while we're live today,"},{"startTime":151.38,"endTime":154.293,"body":"I may also be able to see those as well."},{"startTime":155.34,"endTime":157.08,"body":"Richard hasn't had sight of them."},{"startTime":157.08,"endTime":158.52,"body":"He's a really capable guy."},{"startTime":158.52,"endTime":159.63,"body":"I've spoken to him before,"},{"startTime":159.63,"endTime":161.58,"body":"but it's some months ago since I did."},{"startTime":161.58,"endTime":164.25,"body":"And I know that he likes to"},{"startTime":161.58,"endTime":164.25,"body":"be prompted and stimulated,"},{"startTime":164.25,"endTime":166.44,"body":"so don't hold back from your questions."},{"startTime":166.44,"endTime":168.57,"body":"If I do my job properly today,"},{"startTime":168.57,"endTime":170.91,"body":"there are basically three questions"},{"startTime":170.91,"endTime":172.77,"body":"that we're going to try and resolve today."},{"startTime":172.77,"endTime":173.603,"body":"Where are we?"},{"startTime":173.603,"endTime":175.44,"body":"Where are we headed?"},{"startTime":175.44,"endTime":177.24,"body":"What does any of that mean"},{"startTime":177.24,"endTime":180.24,"body":"for those of you out there"},{"startTime":177.24,"endTime":180.24,"body":"in our audience today?"},{"startTime":180.24,"endTime":182.25,"body":"And I'm going to be really intrigued."},{"startTime":182.25,"endTime":184.02,"body":"I'm speaking to you from"},{"startTime":182.25,"endTime":184.02,"body":"the far north of England,"},{"startTime":184.02,"endTime":185.64,"body":"right up on the Scottish border,"},{"startTime":185.64,"endTime":189.48,"body":"which is why it seems to"},{"startTime":185.64,"endTime":189.48,"body":"be quite dark on my screen."},{"startTime":189.48,"endTime":193.38,"body":"Richard's in a horizontally"},{"startTime":189.48,"endTime":193.38,"body":"different position"},{"startTime":193.38,"endTime":194.97,"body":"in the South West of England."},{"startTime":194.97,"endTime":197.1,"body":"So Richard, who are you and what you do?"},{"startTime":197.1,"endTime":198.963,"body":"Please introduce yourself."},{"startTime":199.89,"endTime":202.02,"body":"- Yeah, thanks David and"},{"startTime":199.89,"endTime":202.02,"body":"good afternoon everybody."},{"startTime":202.02,"endTime":205.02,"body":"So, as David said, my"},{"startTime":202.02,"endTime":205.02,"body":"name's Richard Smale."},{"startTime":205.02,"endTime":207.78,"body":"I've worked in the health"},{"startTime":205.02,"endTime":207.78,"body":"service for most of my career,"},{"startTime":207.78,"endTime":211.44,"body":"starting as a graduate trainee"},{"startTime":207.78,"endTime":211.44,"body":"in finance many years ago."},{"startTime":211.44,"endTime":214.38,"body":"My current role is as an Interim Director"},{"startTime":214.38,"endTime":219.38,"body":"of System Coordination within"},{"startTime":214.38,"endTime":219.38,"body":"the NHSE South West region."},{"startTime":220.08,"endTime":222.36,"body":"But prior to that, I spent four years"},{"startTime":222.36,"endTime":224.85,"body":"in the BANES, Swindon and"},{"startTime":222.36,"endTime":224.85,"body":"Wiltshire Integrated Care System,"},{"startTime":224.85,"endTime":227.67,"body":"working as a Director of"},{"startTime":224.85,"endTime":227.67,"body":"Strategy and Transformation."},{"startTime":227.67,"endTime":230.97,"body":"And my role really at the"},{"startTime":227.67,"endTime":230.97,"body":"moment is about that interface"},{"startTime":230.97,"endTime":232.83,"body":"that exists between the region"},{"startTime":232.83,"endTime":235.68,"body":"and the seven systems in the South West,"},{"startTime":235.68,"endTime":238.8,"body":"and how we get real value"},{"startTime":235.68,"endTime":238.8,"body":"through that interface"},{"startTime":238.8,"endTime":241.83,"body":"and support the systems"},{"startTime":238.8,"endTime":241.83,"body":"to be as successful"},{"startTime":241.83,"endTime":243.72,"body":"as they can be really."},{"startTime":243.72,"endTime":244.553,"body":"- And that's great."},{"startTime":244.553,"endTime":246.45,"body":"So you can see there,"},{"startTime":244.553,"endTime":246.45,"body":"one of the things that,"},{"startTime":246.45,"endTime":248.43,"body":"one of the reasons I so"},{"startTime":246.45,"endTime":248.43,"body":"enjoy doing these sessions"},{"startTime":248.43,"endTime":249.72,"body":"with Mtech Access"},{"startTime":249.72,"endTime":252.24,"body":"is the themes are based on things"},{"startTime":252.24,"endTime":255.57,"body":"that you guys out there in"},{"startTime":252.24,"endTime":255.57,"body":"the audience have submitted."},{"startTime":255.57,"endTime":257.94,"body":"So one of the things that"},{"startTime":255.57,"endTime":257.94,"body":"people really want to talk about"},{"startTime":257.94,"endTime":260.01,"body":"was the role of NHS regions,"},{"startTime":260.01,"endTime":261.563,"body":"how the funding flows between them,"},{"startTime":261.563,"endTime":263.73,"body":"what is the relationship between them?"},{"startTime":263.73,"endTime":266.91,"body":"So Richard's excellent"},{"startTime":263.73,"endTime":266.91,"body":"succinct introduction there is"},{"startTime":266.91,"endTime":267.99,"body":"he's just spot on."},{"startTime":267.99,"endTime":272.1,"body":"So there are seven NHS regions,"},{"startTime":267.99,"endTime":272.1,"body":"42 Integrated Care Systems."},{"startTime":272.1,"endTime":274.5,"body":"And as you said, he"},{"startTime":272.1,"endTime":274.5,"body":"represents, at the moment,"},{"startTime":274.5,"endTime":278.22,"body":"he's working in the South West"},{"startTime":274.5,"endTime":278.22,"body":"region with seven systems."},{"startTime":278.22,"endTime":280.86,"body":"So Richard, let's go"},{"startTime":278.22,"endTime":280.86,"body":"straight away to that,"},{"startTime":280.86,"endTime":284.373,"body":"and our focus today on funding"},{"startTime":280.86,"endTime":284.373,"body":"flows and how all this works."},{"startTime":285.24,"endTime":288.54,"body":"Tell us about the South"},{"startTime":285.24,"endTime":288.54,"body":"West region, your role,"},{"startTime":288.54,"endTime":290.73,"body":"and as you said there,"},{"startTime":288.54,"endTime":290.73,"body":"there that interface"},{"startTime":290.73,"endTime":294.603,"body":"between the region and seven"},{"startTime":290.73,"endTime":294.603,"body":"Integrated Care Systems."},{"startTime":295.74,"endTime":297.907,"body":"- Yeah, and David, there's"},{"startTime":295.74,"endTime":297.907,"body":"that great quote, isn't there?"},{"startTime":297.907,"endTime":299.85,"body":"\"Once you've seen an"},{"startTime":297.907,"endTime":299.85,"body":"Integrated Care System,"},{"startTime":299.85,"endTime":302.01,"body":"you've seen an Integrated Care System.\""},{"startTime":302.01,"endTime":302.843,"body":"They're all different."},{"startTime":302.843,"endTime":305.37,"body":"And the South West ones"},{"startTime":302.843,"endTime":305.37,"body":"are relatively small"},{"startTime":305.37,"endTime":308.25,"body":"compared to some of the"},{"startTime":305.37,"endTime":308.25,"body":"others in the country."},{"startTime":308.25,"endTime":309.39,"body":"But in the South West, as I say,"},{"startTime":309.39,"endTime":312.57,"body":"we've got seven going down from"},{"startTime":309.39,"endTime":312.57,"body":"Gloucestershire to Cornwall."},{"startTime":312.57,"endTime":315.87,"body":"It's quite a long area"},{"startTime":312.57,"endTime":315.87,"body":"that we cover really"},{"startTime":315.87,"endTime":318.054,"body":"and geographically quite challenging."},{"startTime":318.054,"endTime":321.51,"body":"But they are all different organisations,"},{"startTime":321.51,"endTime":323.61,"body":"they've all got different dynamics of"},{"startTime":323.61,"endTime":326.82,"body":"some very urban populations"},{"startTime":323.61,"endTime":326.82,"body":"in the areas like Bristol"},{"startTime":326.82,"endTime":329.49,"body":"and some very rural"},{"startTime":326.82,"endTime":329.49,"body":"counties as you'd expect"},{"startTime":329.49,"endTime":331.557,"body":"with some of Devon and Cornwall."},{"startTime":332.665,"endTime":334.77,"body":"The role really around regions,"},{"startTime":334.77,"endTime":337.56,"body":"and I think that is emerging now."},{"startTime":337.56,"endTime":340.02,"body":"It will continue to be the arm of NHSE"},{"startTime":340.02,"endTime":341.747,"body":"that has an oversight"},{"startTime":340.02,"endTime":341.747,"body":"and an assurance role."},{"startTime":341.747,"endTime":345.36,"body":"And it will continue to"},{"startTime":341.747,"endTime":345.36,"body":"have legal responsibilities"},{"startTime":345.36,"endTime":347.64,"body":"for making sure services are run correctly"},{"startTime":347.64,"endTime":349.53,"body":"through the ICBs and things."},{"startTime":349.53,"endTime":352.29,"body":"But I think increasingly"},{"startTime":349.53,"endTime":352.29,"body":"the emphasis is on"},{"startTime":352.29,"endTime":355.32,"body":"supporting systems and supporting"},{"startTime":352.29,"endTime":355.32,"body":"the integrated care boards"},{"startTime":355.32,"endTime":358.02,"body":"and the Integrated Care"},{"startTime":355.32,"endTime":358.02,"body":"Systems that have been created"},{"startTime":358.02,"endTime":360.06,"body":"to be successful, to be self-governing,"},{"startTime":360.06,"endTime":363.75,"body":"to manage things themselves"},{"startTime":360.06,"endTime":363.75,"body":"as much as possible,"},{"startTime":363.75,"endTime":365.55,"body":"to put the money at their disposal"},{"startTime":365.55,"endTime":368.733,"body":"and allow them to make"},{"startTime":365.55,"endTime":368.733,"body":"decisions and guide things."},{"startTime":369.94,"endTime":371.97,"body":"There will always be national policy."},{"startTime":371.97,"endTime":373.77,"body":"We're a National Health Service,"},{"startTime":373.77,"endTime":375.84,"body":"we're sort of paid for by taxpayers"},{"startTime":375.84,"endTime":377.28,"body":"and governed by ministers."},{"startTime":377.28,"endTime":379.05,"body":"So there'll always be that push around"},{"startTime":379.05,"endTime":380.205,"body":"sort of national priorities."},{"startTime":380.205,"endTime":382.05,"body":"And we know at the moment, don't we?"},{"startTime":382.05,"endTime":383.25,"body":"Things like elective care"},{"startTime":383.25,"endTime":386.49,"body":"and urgent care services are priorities,"},{"startTime":386.49,"endTime":388.83,"body":"but also, I think part of"},{"startTime":386.49,"endTime":388.83,"body":"the regional role will be"},{"startTime":388.83,"endTime":390.6,"body":"to develop and support systems"},{"startTime":390.6,"endTime":393.24,"body":"to really understand"},{"startTime":390.6,"endTime":393.24,"body":"their local populations"},{"startTime":393.24,"endTime":397.5,"body":"and to really champion tackling"},{"startTime":393.24,"endTime":397.5,"body":"their local population needs"},{"startTime":397.5,"endTime":399.72,"body":"alongside those national priorities."},{"startTime":399.72,"endTime":402.06,"body":"Is that enough sort of"},{"startTime":399.72,"endTime":402.06,"body":"context, David, around that?"},{"startTime":402.06,"endTime":405.09,"body":"- Yeah, and there's some really"},{"startTime":402.06,"endTime":405.09,"body":"helpful prompts into there,"},{"startTime":405.09,"endTime":410.09,"body":"because supporting an oversight."},{"startTime":411.33,"endTime":414.81,"body":"Yeah, how does that balance get achieved?"},{"startTime":414.81,"endTime":417.87,"body":"Because who manages an ICS?"},{"startTime":417.87,"endTime":421.923,"body":"If I'm a Chief Executive on"},{"startTime":417.87,"endTime":421.923,"body":"ICS, am I accountable to region?"},{"startTime":423.21,"endTime":425.79,"body":"How does that work in practice?"},{"startTime":425.79,"endTime":428.07,"body":"- So there is, as you'd"},{"startTime":425.79,"endTime":428.07,"body":"expect, wouldn't you,"},{"startTime":428.07,"endTime":430.23,"body":"there is a bit of an oversight"},{"startTime":428.07,"endTime":430.23,"body":"and assurance framework"},{"startTime":430.23,"endTime":431.43,"body":"that has four levels,"},{"startTime":431.43,"endTime":435.06,"body":"and basically at level one,"},{"startTime":431.43,"endTime":435.06,"body":"the ICS is running itself"},{"startTime":435.06,"endTime":437.1,"body":"full steam ahead, everything's okay."},{"startTime":437.1,"endTime":438.628,"body":"And then as you progress up to level 4,"},{"startTime":438.628,"endTime":442.62,"body":"you've got real challenges"},{"startTime":438.628,"endTime":442.62,"body":"in that level of system."},{"startTime":442.62,"endTime":446.82,"body":"So that support to assurance"},{"startTime":442.62,"endTime":446.82,"body":"gradates, if you like,"},{"startTime":446.82,"endTime":448.38,"body":"as you transfer across those four."},{"startTime":448.38,"endTime":450.69,"body":"So with systems in level one,"},{"startTime":450.69,"endTime":452.61,"body":"it would be very light touch,"},{"startTime":452.61,"endTime":454.02,"body":"it would be leaning in to support them"},{"startTime":454.02,"endTime":456.33,"body":"where they ask for help"},{"startTime":454.02,"endTime":456.33,"body":"and things like that."},{"startTime":456.33,"endTime":457.838,"body":"But as you get into levels three and four,"},{"startTime":457.838,"endTime":461.319,"body":"you would have much more"},{"startTime":457.838,"endTime":461.319,"body":"planned interventions."},{"startTime":461.319,"endTime":463.14,"body":"You would have sometimes it would be"},{"startTime":463.14,"endTime":464.52,"body":"absolutely under direction."},{"startTime":464.52,"endTime":467.22,"body":"You would be in there"},{"startTime":464.52,"endTime":467.22,"body":"taking more direct control"},{"startTime":467.22,"endTime":469.5,"body":"as you imply in your question, David."},{"startTime":469.5,"endTime":472.65,"body":"So it does vary and it does"},{"startTime":469.5,"endTime":472.65,"body":"depend where the systems are."},{"startTime":472.65,"endTime":476.1,"body":"I think the thing that"},{"startTime":472.65,"endTime":476.1,"body":"really we're passionate about"},{"startTime":476.1,"endTime":478.559,"body":"is how can we help all the"},{"startTime":476.1,"endTime":478.559,"body":"systems get to level one."},{"startTime":478.559,"endTime":482.55,"body":"That's the aim, it's not"},{"startTime":478.559,"endTime":482.55,"body":"seeking out an assurance role."},{"startTime":482.55,"endTime":485.91,"body":"It's about supporting systems"},{"startTime":482.55,"endTime":485.91,"body":"to develop and evolve."},{"startTime":485.91,"endTime":487.641,"body":"I think we need to remember"},{"startTime":485.91,"endTime":487.641,"body":"these organisations"},{"startTime":487.641,"endTime":489.48,"body":"are still very new."},{"startTime":489.48,"endTime":492.78,"body":"They're only formed in July, 2022."},{"startTime":492.78,"endTime":494.01,"body":"They're still finding their feet"},{"startTime":494.01,"endTime":497.37,"body":"and the job they've"},{"startTime":494.01,"endTime":497.37,"body":"got to do is difficult."},{"startTime":497.37,"endTime":499.92,"body":"They're doing it in"},{"startTime":497.37,"endTime":499.92,"body":"challenging circumstances,"},{"startTime":499.92,"endTime":502.17,"body":"financially, workforce,"},{"startTime":499.92,"endTime":502.17,"body":"all those challenges."},{"startTime":503.64,"endTime":504.473,"body":"And they're doing it"},{"startTime":504.473,"endTime":507.45,"body":"without perfect governance arrangements."},{"startTime":507.45,"endTime":509.19,"body":"So they're working through"},{"startTime":509.19,"endTime":510.72,"body":"how do you build effective partnerships"},{"startTime":510.72,"endTime":511.917,"body":"with local authorities, things like that."},{"startTime":511.917,"endTime":513.745,"body":"And I think the job of the region"},{"startTime":513.745,"endTime":517.89,"body":"is to be there to be a"},{"startTime":513.745,"endTime":517.89,"body":"good ally alongside them,"},{"startTime":517.89,"endTime":520.71,"body":"but also, if things do start going awry,"},{"startTime":520.71,"endTime":523.53,"body":"it's to have those powers"},{"startTime":520.71,"endTime":523.53,"body":"of intervention where needed"},{"startTime":523.53,"endTime":527.507,"body":"to step in and support systems and yeah."},{"startTime":527.507,"endTime":531.75,"body":"- And on a practical level,"},{"startTime":527.507,"endTime":531.75,"body":"you've got seven systems."},{"startTime":531.75,"endTime":533.16,"body":"How many of those are level one?"},{"startTime":533.16,"endTime":534.633,"body":"How many of them are level four?"},{"startTime":535.501,"endTime":538.74,"body":"- So you've got me right on"},{"startTime":535.501,"endTime":538.74,"body":"the spot there, haven't you?"},{"startTime":538.74,"endTime":540.985,"body":"We've got some areas of our"},{"startTime":538.74,"endTime":540.985,"body":"system that have level four"},{"startTime":540.985,"endTime":543.09,"body":"and have an intensive support programme."},{"startTime":543.09,"endTime":544.17,"body":"We have one I think,"},{"startTime":544.17,"endTime":546.93,"body":"but generally they're in"},{"startTime":544.17,"endTime":546.93,"body":"the twos and threes space."},{"startTime":546.93,"endTime":549.57,"body":"To achieve level one at"},{"startTime":546.93,"endTime":549.57,"body":"this stage for most systems"},{"startTime":549.57,"endTime":552.317,"body":"is a huge challenge,"},{"startTime":549.57,"endTime":552.317,"body":"because they are so new."},{"startTime":552.317,"endTime":554.67,"body":"- If my memory's right, sorry, Richard,"},{"startTime":554.67,"endTime":555.87,"body":"putting you on the spot,"},{"startTime":557.07,"endTime":559.849,"body":"I think Frimley is the"},{"startTime":557.07,"endTime":559.849,"body":"only one that's level one."},{"startTime":559.849,"endTime":561.99,"body":"- That's right, in the country, I think."},{"startTime":561.99,"endTime":564.51,"body":"- You say, most are level two and three."},{"startTime":564.51,"endTime":568.08,"body":"- Yeah, and Frimley, was"},{"startTime":564.51,"endTime":568.08,"body":"operating in a certain way"},{"startTime":568.08,"endTime":569.52,"body":"that is, if you like,"},{"startTime":569.52,"endTime":572.4,"body":"a role model for some of the other systems"},{"startTime":572.4,"endTime":573.893,"body":"earlier than the ICSs"},{"startTime":573.893,"endTime":575.94,"body":"and the Integrated Care"},{"startTime":573.893,"endTime":575.94,"body":"Boards were formed."},{"startTime":575.94,"endTime":577.71,"body":"So it had a bit of a headstart."},{"startTime":577.71,"endTime":579.252,"body":"It's a bit more mature in that sense"},{"startTime":579.252,"endTime":581.28,"body":"and got a bit more practice."},{"startTime":581.28,"endTime":582.809,"body":"Some would say it's also a bit simpler,"},{"startTime":582.809,"endTime":584.617,"body":"it is a system built around one hospital."},{"startTime":584.617,"endTime":586.342,"body":"So there are very different challenges"},{"startTime":586.342,"endTime":588.72,"body":"if you go to somewhere like a Devon"},{"startTime":588.72,"endTime":590.97,"body":"in comparison to a Frimley,"},{"startTime":590.97,"endTime":593.1,"body":"but the aim is how can we get everyone"},{"startTime":593.1,"endTime":595.89,"body":"towards that level one status?"},{"startTime":595.89,"endTime":599.04,"body":"But I think most will be in"},{"startTime":595.89,"endTime":599.04,"body":"two and three for a while."},{"startTime":599.04,"endTime":601.86,"body":"- Okay, and then also"},{"startTime":599.04,"endTime":601.86,"body":"what you saying before"},{"startTime":601.86,"endTime":603.15,"body":"about the funding flows"},{"startTime":603.15,"endTime":604.47,"body":"and as I said in my introduction,"},{"startTime":604.47,"endTime":607.83,"body":"that's a key thing people"},{"startTime":604.47,"endTime":607.83,"body":"want us to talk about."},{"startTime":607.83,"endTime":610.019,"body":"How does money, money"},{"startTime":607.83,"endTime":610.019,"body":"sits there in London,"},{"startTime":610.019,"endTime":612.75,"body":"obviously, through"},{"startTime":610.019,"endTime":612.75,"body":"taxation, Amanda Pritchard,"},{"startTime":612.75,"endTime":616.962,"body":"NHS England has got 150"},{"startTime":612.75,"endTime":616.962,"body":"billion or whatever it will be."},{"startTime":616.962,"endTime":620.31,"body":"Does that then come down"},{"startTime":616.962,"endTime":620.31,"body":"to region, go down to ICSs"},{"startTime":620.31,"endTime":621.303,"body":"and go to trusts?"},{"startTime":622.14,"endTime":624.423,"body":"How does it actually"},{"startTime":622.14,"endTime":624.423,"body":"flow around the system?"},{"startTime":625.65,"endTime":627.36,"body":"- You're right, most of it comes through"},{"startTime":627.36,"endTime":630.21,"body":"and goes into the ICBs and gets allocated"},{"startTime":630.21,"endTime":633.0,"body":"into the provider organisations."},{"startTime":633.0,"endTime":634.59,"body":"And the vast majority does that."},{"startTime":634.59,"endTime":636.205,"body":"There are bits like"},{"startTime":634.59,"endTime":636.205,"body":"specialised commissioning"},{"startTime":636.205,"endTime":638.19,"body":"where the money is held"},{"startTime":636.205,"endTime":638.19,"body":"at a regional level,"},{"startTime":638.19,"endTime":640.81,"body":"because the services operate"},{"startTime":638.19,"endTime":640.81,"body":"at that sort of scale"},{"startTime":640.81,"endTime":642.78,"body":"where it makes sense to do that."},{"startTime":642.78,"endTime":644.16,"body":"And there's various other services"},{"startTime":644.16,"endTime":646.53,"body":"where some public health"},{"startTime":644.16,"endTime":646.53,"body":"services, things like that,"},{"startTime":646.53,"endTime":648.78,"body":"where there is money"},{"startTime":646.53,"endTime":648.78,"body":"held at a regional level,"},{"startTime":648.78,"endTime":651.513,"body":"but the vast majority"},{"startTime":648.78,"endTime":651.513,"body":"does go into the systems."},{"startTime":652.59,"endTime":655.29,"body":"I think we'll see changes"},{"startTime":652.59,"endTime":655.29,"body":"at that system level."},{"startTime":655.29,"endTime":658.533,"body":"So in the previous era, if you like,"},{"startTime":658.533,"endTime":660.3,"body":"we had Clinical Commissioning Groups,"},{"startTime":660.3,"endTime":661.92,"body":"they commissioned the services."},{"startTime":661.92,"endTime":665.01,"body":"I think increasingly what"},{"startTime":661.92,"endTime":665.01,"body":"we're seeing within the systems"},{"startTime":665.01,"endTime":667.47,"body":"is the emergence of"},{"startTime":665.01,"endTime":667.47,"body":"provider collaboratives"},{"startTime":667.47,"endTime":669.45,"body":"and potentially those providers"},{"startTime":669.45,"endTime":672.6,"body":"taking on more of a sort"},{"startTime":669.45,"endTime":672.6,"body":"of commissioning-type role,"},{"startTime":672.6,"endTime":674.79,"body":"holding some of the money"},{"startTime":672.6,"endTime":674.79,"body":"perhaps being lead providers."},{"startTime":674.79,"endTime":677.97,"body":"So I think we'll see change at that level."},{"startTime":677.97,"endTime":680.49,"body":"We've seen change where we've moved money"},{"startTime":680.49,"endTime":682.32,"body":"that was held at region into the system,"},{"startTime":682.32,"endTime":685.23,"body":"so around the dental, community, pharmacy,"},{"startTime":685.23,"endTime":687.003,"body":"optometry-type services,"},{"startTime":687.93,"endTime":689.43,"body":"and there is an aspiration to do that"},{"startTime":689.43,"endTime":691.8,"body":"with specialised services as well."},{"startTime":691.8,"endTime":694.71,"body":"So the aim is to put as"},{"startTime":691.8,"endTime":694.71,"body":"much money into that level"},{"startTime":694.71,"endTime":699.099,"body":"and then allow local decision-making"},{"startTime":694.71,"endTime":699.099,"body":"based on local needs."},{"startTime":699.099,"endTime":701.87,"body":"That's the sort of the"},{"startTime":699.099,"endTime":701.87,"body":"phrase and the approach"},{"startTime":701.87,"endTime":703.95,"body":"we would like to see come."},{"startTime":703.95,"endTime":706.26,"body":"It's building the infrastructure"},{"startTime":703.95,"endTime":706.26,"body":"to make that possible"},{"startTime":706.26,"endTime":708.69,"body":"that we're probably in"},{"startTime":706.26,"endTime":708.69,"body":"that stage at the moment."},{"startTime":708.69,"endTime":710.837,"body":"- So you've given me great prompts there,"},{"startTime":710.837,"endTime":714.01,"body":"because there's at least three or four"},{"startTime":715.8,"endTime":718.197,"body":"sort of pathways that I want to go down to"},{"startTime":718.197,"endTime":720.3,"body":"for the rest of our conversation, okay?"},{"startTime":720.3,"endTime":723.093,"body":"So let's start with the first one of,"},{"startTime":724.53,"endTime":728.34,"body":"usually at this stage we're what,"},{"startTime":728.34,"endTime":730.35,"body":"depending on how you"},{"startTime":728.34,"endTime":730.35,"body":"measure it, five, six weeks"},{"startTime":730.35,"endTime":731.49,"body":"from the end of the financial year,"},{"startTime":731.49,"endTime":733.26,"body":"the start of a new financial year."},{"startTime":733.26,"endTime":734.442,"body":"We'd be talking about the content"},{"startTime":734.442,"endTime":736.951,"body":"of the NHS operating framework"},{"startTime":734.442,"endTime":736.951,"body":"or the operating plan"},{"startTime":736.951,"endTime":739.53,"body":"that would've come out"},{"startTime":736.951,"endTime":739.53,"body":"two, three months ago"},{"startTime":739.53,"endTime":741.75,"body":"that hasn't happened this year."},{"startTime":741.75,"endTime":743.493,"body":"What's the effect of that?"},{"startTime":744.458,"endTime":747.93,"body":"Are your ICBs, are they"},{"startTime":744.458,"endTime":747.93,"body":"clear on where they're going?"},{"startTime":747.93,"endTime":749.37,"body":"Are your Trusts clear"},{"startTime":747.93,"endTime":749.37,"body":"on where they're going"},{"startTime":749.37,"endTime":750.66,"body":"from the 1st of April?"},{"startTime":750.66,"endTime":753.27,"body":"Do we know what the priorities are?"},{"startTime":753.27,"endTime":754.92,"body":"What's the implications of that framework"},{"startTime":754.92,"endTime":756.66,"body":"not being available?"},{"startTime":756.66,"endTime":758.7,"body":"- So there are implications, David,"},{"startTime":758.7,"endTime":761.28,"body":"because that provides clarity, a purpose,"},{"startTime":761.28,"endTime":763.41,"body":"it provides clarity of"},{"startTime":761.28,"endTime":763.41,"body":"direction for everybody."},{"startTime":763.41,"endTime":766.44,"body":"So clearly it would be wrong"},{"startTime":763.41,"endTime":766.44,"body":"to say there's no implications,"},{"startTime":766.44,"endTime":769.576,"body":"but I think as we increasingly"},{"startTime":766.44,"endTime":769.576,"body":"evolve the conversation"},{"startTime":769.576,"endTime":773.915,"body":"to be about local focus,"},{"startTime":769.576,"endTime":773.915,"body":"local services, local needs,"},{"startTime":773.915,"endTime":777.81,"body":"actually I think that dependency"},{"startTime":773.915,"endTime":777.81,"body":"on some of that is less,"},{"startTime":777.81,"endTime":779.4,"body":"and the opportunity is there"},{"startTime":779.4,"endTime":781.77,"body":"for people to shape and design services."},{"startTime":781.77,"endTime":782.94,"body":"And if we're honest,"},{"startTime":782.94,"endTime":785.76,"body":"we don't change the"},{"startTime":782.94,"endTime":785.76,"body":"health service every year"},{"startTime":785.76,"endTime":787.921,"body":"when the operating framework"},{"startTime":785.76,"endTime":787.921,"body":"comes out, we tweak it."},{"startTime":787.921,"endTime":791.64,"body":"And so there's a lot of"},{"startTime":787.921,"endTime":791.64,"body":"stuff that continues on,"},{"startTime":791.64,"endTime":793.68,"body":"gets evolved, gets refined,"},{"startTime":793.68,"endTime":796.65,"body":"but it's not as if somebody"},{"startTime":793.68,"endTime":796.65,"body":"suddenly taken away"},{"startTime":796.65,"endTime":798.36,"body":"all of the rules and"},{"startTime":796.65,"endTime":798.36,"body":"nobody knows what to do."},{"startTime":798.36,"endTime":800.01,"body":"A lot of it is understood."},{"startTime":800.01,"endTime":801.75,"body":"We know that the priorities"},{"startTime":800.01,"endTime":801.75,"body":"are going to be there"},{"startTime":801.75,"endTime":803.55,"body":"around elective care and urgent care."},{"startTime":803.55,"endTime":804.99,"body":"We know the priorities"},{"startTime":803.55,"endTime":804.99,"body":"are going to be there"},{"startTime":804.99,"endTime":806.55,"body":"around mental health."},{"startTime":806.55,"endTime":807.84,"body":"We know the priorities"},{"startTime":806.55,"endTime":807.84,"body":"are going to be there"},{"startTime":807.84,"endTime":809.67,"body":"around tackling inequalities for example."},{"startTime":809.67,"endTime":812.13,"body":"So a lot of the themes are there."},{"startTime":812.13,"endTime":814.11,"body":"The other link I'd make is that"},{"startTime":814.11,"endTime":818.479,"body":"over the last March-time,"},{"startTime":818.479,"endTime":822.0,"body":"all of the systems created"},{"startTime":818.479,"endTime":822.0,"body":"an integrated care strategy."},{"startTime":822.0,"endTime":824.1,"body":"And that was meant to be the"},{"startTime":822.0,"endTime":824.1,"body":"forward-looking document,"},{"startTime":824.1,"endTime":825.51,"body":"the thing that really set the scene"},{"startTime":825.51,"endTime":827.11,"body":"for what are we trying to do"},{"startTime":827.11,"endTime":828.48,"body":"and particularly what are we trying to do"},{"startTime":828.48,"endTime":830.82,"body":"as partners working"},{"startTime":828.48,"endTime":830.82,"body":"with local authorities,"},{"startTime":830.82,"endTime":832.32,"body":"the voluntary sector,"},{"startTime":832.32,"endTime":836.04,"body":"all the agencies in"},{"startTime":832.32,"endTime":836.04,"body":"the area, housing, etc."},{"startTime":836.04,"endTime":839.13,"body":"And I think actually that's the roadmap"},{"startTime":839.13,"endTime":841.35,"body":"that still stands the test of time."},{"startTime":841.35,"endTime":843.48,"body":"Now those integrated care strategies"},{"startTime":843.48,"endTime":845.82,"body":"will get refined and improved over time."},{"startTime":845.82,"endTime":847.38,"body":"But actually a lot of the thinking"},{"startTime":847.38,"endTime":849.51,"body":"that was done at local level,"},{"startTime":849.51,"endTime":851.64,"body":"the joint strategic needs assessments"},{"startTime":851.64,"endTime":853.848,"body":"that the local authorities"},{"startTime":851.64,"endTime":853.848,"body":"produce, things like that,"},{"startTime":853.848,"endTime":855.99,"body":"have all informed those strategies."},{"startTime":855.99,"endTime":858.96,"body":"So for me, I think"},{"startTime":855.99,"endTime":858.96,"body":"there's a real importance"},{"startTime":858.96,"endTime":861.09,"body":"that yes, the operating"},{"startTime":858.96,"endTime":861.09,"body":"framework is helpful,"},{"startTime":861.09,"endTime":862.62,"body":"it provides some clarity,"},{"startTime":862.62,"endTime":864.84,"body":"but we've got so much direction set."},{"startTime":864.84,"endTime":867.822,"body":"We've had so much local"},{"startTime":864.84,"endTime":867.822,"body":"thinking into what services"},{"startTime":867.822,"endTime":870.36,"body":"need to be for local populations,"},{"startTime":870.36,"endTime":873.36,"body":"that actually, this should"},{"startTime":870.36,"endTime":873.36,"body":"be a year of continuity"},{"startTime":873.36,"endTime":876.453,"body":"rather than a year of"},{"startTime":873.36,"endTime":876.453,"body":"significant change in my mind."},{"startTime":877.29,"endTime":880.8,"body":"- So that leads us to,"},{"startTime":877.29,"endTime":880.8,"body":"hopefully quite neatly"},{"startTime":880.8,"endTime":884.88,"body":"to something that's a slight concern"},{"startTime":884.88,"endTime":887.7,"body":"and is a regular feature in the questions"},{"startTime":887.7,"endTime":889.26,"body":"that were pre-submitted,"},{"startTime":889.26,"endTime":892.56,"body":"and a phrase that was used"},{"startTime":889.26,"endTime":892.56,"body":"several times in those"},{"startTime":892.56,"endTime":895.62,"body":"is postcode lottery, okay?"},{"startTime":895.62,"endTime":896.46,"body":"- Yeah."},{"startTime":896.46,"endTime":897.96,"body":"- How do we bridge this gap?"},{"startTime":897.96,"endTime":900.21,"body":"I mean, you and I have spoken before."},{"startTime":900.21,"endTime":901.92,"body":"Bristol always fascinates me."},{"startTime":901.92,"endTime":904.05,"body":"I don't think there's"},{"startTime":901.92,"endTime":904.05,"body":"many big cities in England"},{"startTime":904.05,"endTime":907.95,"body":"where areas of such extremes"},{"startTime":904.05,"endTime":907.95,"body":"in affluence and deprivation"},{"startTime":907.95,"endTime":909.78,"body":"are so near to each other."},{"startTime":909.78,"endTime":911.13,"body":"You mentioned Devon."},{"startTime":911.13,"endTime":914.1,"body":"I mean, I'm sure all"},{"startTime":911.13,"endTime":914.1,"body":"of us who are listening"},{"startTime":914.1,"endTime":915.87,"body":"have got an image of Devon."},{"startTime":915.87,"endTime":917.97,"body":"Well, is that inner city Plymouth"},{"startTime":917.97,"endTime":921.63,"body":"or is it a fading seaside town"},{"startTime":921.63,"endTime":923.613,"body":"or is it a thriving market town?"},{"startTime":924.99,"endTime":926.43,"body":"What is the balance between"},{"startTime":926.43,"endTime":929.22,"body":"that local variation, national priorities?"},{"startTime":929.22,"endTime":932.31,"body":"And I'm quite happy for"},{"startTime":929.22,"endTime":932.31,"body":"you to talk at length here,"},{"startTime":932.31,"endTime":935.52,"body":"because I'll also add"},{"startTime":932.31,"endTime":935.52,"body":"in how do our friends"},{"startTime":935.52,"endTime":939.33,"body":"who are listening, how"},{"startTime":935.52,"endTime":939.33,"body":"do they adjust to that,"},{"startTime":939.33,"endTime":944.04,"body":"that there might be a different"},{"startTime":939.33,"endTime":944.04,"body":"set of policies applied"},{"startTime":944.04,"endTime":946.23,"body":"in one part of Bristol from"},{"startTime":944.04,"endTime":946.23,"body":"another part of Bristol,"},{"startTime":946.23,"endTime":949.683,"body":"let alone between Bristol"},{"startTime":946.23,"endTime":949.683,"body":"and Weston-super-Mare?"},{"startTime":950.76,"endTime":952.02,"body":"- Yeah, and can I sort of talk about"},{"startTime":952.02,"endTime":953.55,"body":"the two things in that, David,"},{"startTime":953.55,"endTime":956.4,"body":"the sort of postcode"},{"startTime":953.55,"endTime":956.4,"body":"lottery description of that"},{"startTime":956.4,"endTime":957.66,"body":"and also the variation bit,"},{"startTime":957.66,"endTime":961.689,"body":"because there's connections"},{"startTime":957.66,"endTime":961.689,"body":"and there's separate features."},{"startTime":961.689,"endTime":964.012,"body":"One of the things that"},{"startTime":961.689,"endTime":964.012,"body":"happened when we created"},{"startTime":964.012,"endTime":965.7,"body":"some of the Integrated Care Boards"},{"startTime":965.7,"endTime":969.09,"body":"is that they brought together former CCGs."},{"startTime":969.09,"endTime":971.82,"body":"And those former CCGs"},{"startTime":969.09,"endTime":971.82,"body":"were at a smaller scale."},{"startTime":971.82,"endTime":974.91,"body":"So I think we had 209 CCGs"},{"startTime":974.91,"endTime":977.7,"body":"and we've got 42 Integrated Care Boards."},{"startTime":977.7,"endTime":980.04,"body":"So clearly you can see there's a scale"},{"startTime":980.04,"endTime":982.53,"body":"that's happened across"},{"startTime":980.04,"endTime":982.53,"body":"a lot of the country"},{"startTime":982.53,"endTime":984.9,"body":"where things have changed."},{"startTime":984.9,"endTime":987.3,"body":"Now for some of our"},{"startTime":984.9,"endTime":987.3,"body":"systems in the South West,"},{"startTime":987.3,"endTime":988.2,"body":"it hasn't changed."},{"startTime":988.2,"endTime":990.748,"body":"Gloucestershire was always"},{"startTime":988.2,"endTime":990.748,"body":"Gloucestershire as it were."},{"startTime":990.748,"endTime":993.63,"body":"But for many you've seen a consolidation."},{"startTime":993.63,"endTime":996.69,"body":"And what you've found when"},{"startTime":993.63,"endTime":996.69,"body":"you've got that consolidation"},{"startTime":996.69,"endTime":998.16,"body":"is that the different CCGs"},{"startTime":998.16,"endTime":1000.66,"body":"may have taken different"},{"startTime":998.16,"endTime":1000.66,"body":"commissioning approaches."},{"startTime":1001.64,"endTime":1003.08,"body":"Some of those commissioning approaches"},{"startTime":1003.08,"endTime":1004.58,"body":"may be entirely valid,"},{"startTime":1004.58,"endTime":1005.99,"body":"they may be entirely informed"},{"startTime":1005.99,"endTime":1007.64,"body":"by the needs of the population,"},{"startTime":1007.64,"endTime":1011.27,"body":"but some will just be about"},{"startTime":1007.64,"endTime":1011.27,"body":"one system prioritised,"},{"startTime":1011.27,"endTime":1012.89,"body":"one type of care and another system"},{"startTime":1012.89,"endTime":1014.363,"body":"prioritised something else."},{"startTime":1015.35,"endTime":1017.179,"body":"And it wasn't that they looked"},{"startTime":1015.35,"endTime":1017.179,"body":"at everything rationally,"},{"startTime":1017.179,"endTime":1019.932,"body":"it was just their energy"},{"startTime":1017.179,"endTime":1019.932,"body":"went into falls prevention"},{"startTime":1019.932,"endTime":1021.86,"body":"or their energy went into"},{"startTime":1021.86,"endTime":1023.61,"body":"mental health services or whatever."},{"startTime":1024.5,"endTime":1026.66,"body":"So part of what the changes have done"},{"startTime":1026.66,"endTime":1028.277,"body":"is bring that up a scale,"},{"startTime":1028.277,"endTime":1031.76,"body":"and I think it has exposed"},{"startTime":1028.277,"endTime":1031.76,"body":"us a number of ICBs"},{"startTime":1031.76,"endTime":1033.14,"body":"are commissioning things"},{"startTime":1033.14,"endTime":1035.39,"body":"for different parts of their population"},{"startTime":1035.39,"endTime":1037.82,"body":"that there isn't a sound logic as to why"},{"startTime":1037.82,"endTime":1038.653,"body":"some of that's done."},{"startTime":1038.653,"endTime":1040.85,"body":"So I think there's an opportunity"},{"startTime":1038.653,"endTime":1040.85,"body":"in the new arrangements"},{"startTime":1040.85,"endTime":1041.897,"body":"to really begin to unpick those."},{"startTime":1041.897,"endTime":1044.72,"body":"Now as much as you might like to,"},{"startTime":1044.72,"endTime":1046.49,"body":"you can't under-pick"},{"startTime":1044.72,"endTime":1046.49,"body":"all of that overnight,"},{"startTime":1046.49,"endTime":1048.47,"body":"you can't solve it all straight away"},{"startTime":1048.47,"endTime":1051.14,"body":"and you can't simply invest"},{"startTime":1048.47,"endTime":1051.14,"body":"everywhere to bring everyone up."},{"startTime":1051.14,"endTime":1053.9,"body":"There's some real challenges"},{"startTime":1051.14,"endTime":1053.9,"body":"in that conundrum."},{"startTime":1053.9,"endTime":1056.48,"body":"So that postcode bit is certainly there."},{"startTime":1056.48,"endTime":1058.4,"body":"And then the second bit"},{"startTime":1056.48,"endTime":1058.4,"body":"that you spoke about"},{"startTime":1058.4,"endTime":1059.99,"body":"is the variation bit."},{"startTime":1059.99,"endTime":1062.166,"body":"And I think this is"},{"startTime":1059.99,"endTime":1062.166,"body":"potentially one of the most"},{"startTime":1062.166,"endTime":1065.78,"body":"exciting opportunities that we've got."},{"startTime":1065.78,"endTime":1067.563,"body":"We've spoken about tackling inequalities,"},{"startTime":1067.563,"endTime":1069.71,"body":"we've spoken about variation for years,"},{"startTime":1069.71,"endTime":1071.81,"body":"and we do it sometimes really well,"},{"startTime":1071.81,"endTime":1074.0,"body":"there's some places that really do it,"},{"startTime":1074.0,"endTime":1076.85,"body":"but actually I'm not"},{"startTime":1074.0,"endTime":1076.85,"body":"sure that we're doing it"},{"startTime":1076.85,"endTime":1079.19,"body":"with enough of a proportion of our funding"},{"startTime":1079.19,"endTime":1080.27,"body":"to make that difference."},{"startTime":1080.27,"endTime":1083.12,"body":"So how are we really putting"},{"startTime":1080.27,"endTime":1083.12,"body":"a level of investment"},{"startTime":1083.12,"endTime":1085.19,"body":"into more deprived communities"},{"startTime":1085.19,"endTime":1088.35,"body":"and communities with greater"},{"startTime":1085.19,"endTime":1088.35,"body":"needs and really prioritising"},{"startTime":1089.72,"endTime":1092.57,"body":"and sometimes those are the"},{"startTime":1089.72,"endTime":1092.57,"body":"communities we are not very good"},{"startTime":1092.57,"endTime":1094.79,"body":"at reaching out to or we don't hear from."},{"startTime":1094.79,"endTime":1096.56,"body":"And yet other communities are very vocal"},{"startTime":1096.56,"endTime":1097.82,"body":"and we hear a lot from."},{"startTime":1097.82,"endTime":1100.772,"body":"So I think we've got a real opportunity"},{"startTime":1100.772,"endTime":1102.74,"body":"to be upfront and honest about that"},{"startTime":1102.74,"endTime":1104.42,"body":"and have a more honest conversation"},{"startTime":1104.42,"endTime":1106.64,"body":"about if you are going"},{"startTime":1104.42,"endTime":1106.64,"body":"to tackle inequalities,"},{"startTime":1106.64,"endTime":1108.134,"body":"it does mean that you begin to look at"},{"startTime":1108.134,"endTime":1110.27,"body":"your overall spend pattern"},{"startTime":1110.27,"endTime":1112.847,"body":"and you begin to absolutely"},{"startTime":1110.27,"endTime":1112.847,"body":"invest in those communities,"},{"startTime":1112.847,"endTime":1115.861,"body":"those areas that need that investment."},{"startTime":1115.861,"endTime":1118.13,"body":"And if you can do that"},{"startTime":1118.13,"endTime":1120.8,"body":"and all of the evidence is"},{"startTime":1118.13,"endTime":1120.8,"body":"there that tells us this,"},{"startTime":1120.8,"endTime":1124.91,"body":"if we tackle those type"},{"startTime":1120.8,"endTime":1124.91,"body":"of challenges head on,"},{"startTime":1124.91,"endTime":1127.19,"body":"it will make the health"},{"startTime":1124.91,"endTime":1127.19,"body":"service more sustainable,"},{"startTime":1127.19,"endTime":1130.49,"body":"it will reduce demand,"},{"startTime":1127.19,"endTime":1130.49,"body":"the evidence is there."},{"startTime":1130.49,"endTime":1134.21,"body":"So I think we need to have"},{"startTime":1130.49,"endTime":1134.21,"body":"a very honest discussion"},{"startTime":1134.21,"endTime":1136.404,"body":"with the public and with the local MPs"},{"startTime":1136.404,"endTime":1138.77,"body":"and things like that, local counsellors"},{"startTime":1138.77,"endTime":1141.749,"body":"and say, we are going to work"},{"startTime":1138.77,"endTime":1141.749,"body":"hand-in-hand with the councils"},{"startTime":1141.749,"endTime":1144.17,"body":"and with other colleagues"},{"startTime":1141.749,"endTime":1144.17,"body":"who work in this space,"},{"startTime":1144.17,"endTime":1146.27,"body":"the voluntary sector in particular,"},{"startTime":1146.27,"endTime":1148.13,"body":"and really look to say,"},{"startTime":1148.13,"endTime":1150.155,"body":"what does a good wraparound support into"},{"startTime":1150.155,"endTime":1152.99,"body":"more deprived communities look like?"},{"startTime":1152.99,"endTime":1156.11,"body":"And how do we offset that with other areas"},{"startTime":1156.11,"endTime":1159.29,"body":"and other choices we"},{"startTime":1156.11,"endTime":1159.29,"body":"have to make financially?"},{"startTime":1159.29,"endTime":1161.9,"body":"- Because what's underpinning"},{"startTime":1159.29,"endTime":1161.9,"body":"that, at the end of the day,"},{"startTime":1161.9,"endTime":1164.9,"body":"you have a certain limited"},{"startTime":1161.9,"endTime":1164.9,"body":"fixed budget, yeah."},{"startTime":1164.9,"endTime":1167.954,"body":"And so there's a resource pie or pizza."},{"startTime":1167.954,"endTime":1171.32,"body":"If one slice becomes"},{"startTime":1167.954,"endTime":1171.32,"body":"bigger, then by definition"},{"startTime":1171.32,"endTime":1172.82,"body":"one has to become smaller."},{"startTime":1172.82,"endTime":1175.61,"body":"Well, what's your advice to"},{"startTime":1172.82,"endTime":1175.61,"body":"our audience about that then?"},{"startTime":1175.61,"endTime":1179.3,"body":"And I know we won't mention"},{"startTime":1175.61,"endTime":1179.3,"body":"individual products."},{"startTime":1179.3,"endTime":1181.31,"body":"I always think of something like IVF,"},{"startTime":1181.31,"endTime":1183.71,"body":"does that mean yep,"},{"startTime":1181.31,"endTime":1183.71,"body":"we're going to prioritise"},{"startTime":1183.71,"endTime":1187.55,"body":"heart disease or diabetes"},{"startTime":1183.71,"endTime":1187.55,"body":"in certain communities,"},{"startTime":1187.55,"endTime":1190.31,"body":"so you have socioeconomic pressure,"},{"startTime":1190.31,"endTime":1192.53,"body":"and therefore the money's"},{"startTime":1190.31,"endTime":1192.53,"body":"going to come out of IVF"},{"startTime":1192.53,"endTime":1194.24,"body":"or it's going to come"},{"startTime":1192.53,"endTime":1194.24,"body":"out of something else?"},{"startTime":1194.24,"endTime":1197.18,"body":"I mean, how do these decisions get made"},{"startTime":1197.18,"endTime":1200.63,"body":"and what's your advice"},{"startTime":1197.18,"endTime":1200.63,"body":"to, to our colleagues?"},{"startTime":1200.63,"endTime":1203.87,"body":"- I think you've just"},{"startTime":1200.63,"endTime":1203.87,"body":"described the most wicked issue"},{"startTime":1203.87,"endTime":1206.21,"body":"we face as health services, haven't we?"},{"startTime":1206.21,"endTime":1207.68,"body":"Whatever amount of money we put in,"},{"startTime":1207.68,"endTime":1208.807,"body":"there'll always be a sense of rationing."},{"startTime":1208.807,"endTime":1211.37,"body":"You've got to choose, and"},{"startTime":1208.807,"endTime":1211.37,"body":"we don't use that word,"},{"startTime":1211.37,"endTime":1213.47,"body":"but you've got to choose"},{"startTime":1211.37,"endTime":1213.47,"body":"where you spend your money."},{"startTime":1213.47,"endTime":1215.21,"body":"And that's the reality of healthcare."},{"startTime":1215.21,"endTime":1217.34,"body":"And it's the reality of"},{"startTime":1215.21,"endTime":1217.34,"body":"healthcare in every system."},{"startTime":1217.34,"endTime":1219.35,"body":"It's not about this one or any,"},{"startTime":1219.35,"endTime":1222.623,"body":"you have to choose how money"},{"startTime":1219.35,"endTime":1222.623,"body":"gets spent in the best needs."},{"startTime":1223.58,"endTime":1224.413,"body":"And that's difficult."},{"startTime":1224.413,"endTime":1225.59,"body":"And I think the two areas"},{"startTime":1225.59,"endTime":1228.23,"body":"where I see lots of work"},{"startTime":1225.59,"endTime":1228.23,"body":"and effort going on,"},{"startTime":1228.23,"endTime":1231.26,"body":"and again, I think we talk"},{"startTime":1228.23,"endTime":1231.26,"body":"a lot these days, don't we,"},{"startTime":1231.26,"endTime":1233.57,"body":"about being, having a learning culture,"},{"startTime":1233.57,"endTime":1235.46,"body":"having a willingness to learn and accept"},{"startTime":1235.46,"endTime":1236.6,"body":"that we don't know everything"},{"startTime":1236.6,"endTime":1239.24,"body":"and evolving and improving over time."},{"startTime":1239.24,"endTime":1241.49,"body":"And I think that is really important."},{"startTime":1241.49,"endTime":1244.58,"body":"But the two areas where"},{"startTime":1241.49,"endTime":1244.58,"body":"I see that potential"},{"startTime":1244.58,"endTime":1247.61,"body":"is around work where people"},{"startTime":1244.58,"endTime":1247.61,"body":"are really beginning to say,"},{"startTime":1247.61,"endTime":1249.41,"body":"well, what outcomes matter?"},{"startTime":1249.41,"endTime":1251.93,"body":"So we've been counting stuff for years,"},{"startTime":1251.93,"endTime":1254.15,"body":"we've been counting how many"},{"startTime":1251.93,"endTime":1254.15,"body":"things go through the door,"},{"startTime":1254.15,"endTime":1256.58,"body":"we've been counting how"},{"startTime":1254.15,"endTime":1256.58,"body":"many appointments took place"},{"startTime":1256.58,"endTime":1258.2,"body":"or didn't take place."},{"startTime":1258.2,"endTime":1259.649,"body":"But what if we really understood outcomes"},{"startTime":1259.649,"endTime":1261.98,"body":"and what if we really understood outcomes"},{"startTime":1261.98,"endTime":1264.95,"body":"through the perspective"},{"startTime":1261.98,"endTime":1264.95,"body":"of the people we serve?"},{"startTime":1264.95,"endTime":1266.09,"body":"What if they were telling us"},{"startTime":1266.09,"endTime":1267.53,"body":"that their life has got a bit better"},{"startTime":1267.53,"endTime":1271.85,"body":"or whatever metric is important to them."},{"startTime":1271.85,"endTime":1274.46,"body":"So I think we need to"},{"startTime":1271.85,"endTime":1274.46,"body":"pay a lot more attention"},{"startTime":1274.46,"endTime":1277.73,"body":"to those outcomes and how we"},{"startTime":1274.46,"endTime":1277.73,"body":"develop those and think about"},{"startTime":1277.73,"endTime":1280.76,"body":"those with the populations we serve."},{"startTime":1280.76,"endTime":1282.53,"body":"And then the other bit,"},{"startTime":1280.76,"endTime":1282.53,"body":"and I think this is a bit"},{"startTime":1282.53,"endTime":1284.72,"body":"that's particularly pertinent"},{"startTime":1282.53,"endTime":1284.72,"body":"to the people on the call"},{"startTime":1284.72,"endTime":1287.99,"body":"is well, the outcomes is pertinent,"},{"startTime":1287.99,"endTime":1290.27,"body":"because a lot of the people on the call"},{"startTime":1290.27,"endTime":1291.32,"body":"will be experts in saying,"},{"startTime":1291.32,"endTime":1293.3,"body":"look, we can show how we improve outcomes,"},{"startTime":1293.3,"endTime":1296.18,"body":"and are probably also"},{"startTime":1293.3,"endTime":1296.18,"body":"very good at engaging"},{"startTime":1296.18,"endTime":1297.74,"body":"with the people with those outcomes."},{"startTime":1297.74,"endTime":1300.89,"body":"So that bit, but the"},{"startTime":1297.74,"endTime":1300.89,"body":"second bit links back to"},{"startTime":1300.89,"endTime":1302.99,"body":"your question about money."},{"startTime":1302.99,"endTime":1305.72,"body":"We have not had a mature system"},{"startTime":1305.72,"endTime":1308.63,"body":"for really understanding"},{"startTime":1305.72,"endTime":1308.63,"body":"return on investment."},{"startTime":1308.63,"endTime":1311.327,"body":"We've had a cash-based"},{"startTime":1308.63,"endTime":1311.327,"body":"system in a way, if you like."},{"startTime":1311.327,"endTime":1313.25,"body":"Are we balancing the budget"},{"startTime":1313.25,"endTime":1316.13,"body":"rather than are we driving the"},{"startTime":1313.25,"endTime":1316.13,"body":"best value out of the budget?"},{"startTime":1316.13,"endTime":1320.059,"body":"And I see again, over the last"},{"startTime":1316.13,"endTime":1320.059,"body":"few years I've seen the voice"},{"startTime":1320.059,"endTime":1321.95,"body":"of Public Health get louder."},{"startTime":1321.95,"endTime":1323.33,"body":"And I think that's really exciting."},{"startTime":1323.33,"endTime":1325.43,"body":"I think there's a real prospect of saying,"},{"startTime":1325.43,"endTime":1327.71,"body":"if we really understand"},{"startTime":1325.43,"endTime":1327.71,"body":"the return on investment,"},{"startTime":1327.71,"endTime":1330.95,"body":"if we really understand"},{"startTime":1327.71,"endTime":1330.95,"body":"what a exercise programme"},{"startTime":1330.95,"endTime":1334.34,"body":"or a smoking cessation programme"},{"startTime":1330.95,"endTime":1334.34,"body":"or whatever can contribute,"},{"startTime":1334.34,"endTime":1338.33,"body":"and if we can try and encourage"},{"startTime":1334.34,"endTime":1338.33,"body":"a longer term perspective"},{"startTime":1338.33,"endTime":1340.073,"body":"and not just a sort of short-term,"},{"startTime":1341.42,"endTime":1344.48,"body":"somewhat politically-driven timescale,"},{"startTime":1344.48,"endTime":1347.0,"body":"we've got a real opportunity there to say,"},{"startTime":1347.0,"endTime":1349.88,"body":"let's do the interventions that matter."},{"startTime":1349.88,"endTime":1353.21,"body":"Now, we can't turn off huge"},{"startTime":1349.88,"endTime":1353.21,"body":"chunks of the system today"},{"startTime":1353.21,"endTime":1354.68,"body":"and just switch the money."},{"startTime":1354.68,"endTime":1356.821,"body":"We've got to phase out over"},{"startTime":1354.68,"endTime":1356.821,"body":"time, we've got to work out."},{"startTime":1356.821,"endTime":1359.72,"body":"But I think some of your"},{"startTime":1356.821,"endTime":1359.72,"body":"colleagues on the call today"},{"startTime":1359.72,"endTime":1361.079,"body":"will be, they'll be screaming,"},{"startTime":1361.079,"endTime":1364.67,"body":"I'm sure saying we can show"},{"startTime":1361.079,"endTime":1364.67,"body":"the return on investment,"},{"startTime":1364.67,"endTime":1366.767,"body":"how do we get in the rooms"},{"startTime":1364.67,"endTime":1366.767,"body":"to have that conversation?"},{"startTime":1366.767,"endTime":1371.36,"body":"And I think it's on the onus"},{"startTime":1366.767,"endTime":1371.36,"body":"of each and every ICB to say,"},{"startTime":1371.36,"endTime":1372.948,"body":"how is it developing its understanding"},{"startTime":1372.948,"endTime":1377.011,"body":"of return on investment,"},{"startTime":1372.948,"endTime":1377.011,"body":"best use of money?"},{"startTime":1377.011,"endTime":1379.13,"body":"Even if they got really mature at that,"},{"startTime":1379.13,"endTime":1381.29,"body":"you would still have"},{"startTime":1379.13,"endTime":1381.29,"body":"people competing to say,"},{"startTime":1381.29,"endTime":1383.81,"body":"look, our return on investment"},{"startTime":1381.29,"endTime":1383.81,"body":"competing with your return,"},{"startTime":1383.81,"endTime":1386.21,"body":"it's still going to be"},{"startTime":1383.81,"endTime":1386.21,"body":"a difficult decision,"},{"startTime":1386.21,"endTime":1389.39,"body":"but at least you are"},{"startTime":1386.21,"endTime":1389.39,"body":"basing it on good evidence,"},{"startTime":1389.39,"endTime":1391.58,"body":"good analysis, and good perception of"},{"startTime":1391.58,"endTime":1394.16,"body":"this is where money"},{"startTime":1391.58,"endTime":1394.16,"body":"spent in health and care"},{"startTime":1394.16,"endTime":1395.42,"body":"would yield the most value."},{"startTime":1395.42,"endTime":1398.36,"body":"And I think for the taxpayers,"},{"startTime":1395.42,"endTime":1398.36,"body":"that would be a huge asset."},{"startTime":1398.36,"endTime":1400.76,"body":"And for people who are passionate about"},{"startTime":1400.76,"endTime":1402.11,"body":"improving health and outcomes,"},{"startTime":1402.11,"endTime":1404.48,"body":"that would be a good thing as well."},{"startTime":1404.48,"endTime":1406.76,"body":"- But as I listened to you as a citizen,"},{"startTime":1406.76,"endTime":1408.62,"body":"I'm really encouraged by that, yeah."},{"startTime":1408.62,"endTime":1413.62,"body":"But then I would look at my"},{"startTime":1408.62,"endTime":1413.62,"body":"ICB's finance performance"},{"startTime":1414.77,"endTime":1416.54,"body":"at the moment and probably yours as well,"},{"startTime":1416.54,"endTime":1419.42,"body":"if I looked it up on the internet,"},{"startTime":1419.42,"endTime":1421.04,"body":"and what I would probably see on there"},{"startTime":1421.04,"endTime":1424.19,"body":"is money being taken"},{"startTime":1421.04,"endTime":1424.19,"body":"away from public health,"},{"startTime":1424.19,"endTime":1425.903,"body":"prevention, primary care,"},{"startTime":1427.46,"endTime":1429.683,"body":"and going into, you know"},{"startTime":1427.46,"endTime":1429.683,"body":"what I'm going to say,"},{"startTime":1429.683,"endTime":1433.55,"body":"and be going into"},{"startTime":1429.683,"endTime":1433.55,"body":"ambulance response times,"},{"startTime":1433.55,"endTime":1435.41,"body":"elective waiting times."},{"startTime":1435.41,"endTime":1439.07,"body":"We keep talking the talk of"},{"startTime":1435.41,"endTime":1439.07,"body":"moving upstream of prevention."},{"startTime":1439.07,"endTime":1441.11,"body":"How do we break the cycle"},{"startTime":1439.07,"endTime":1441.11,"body":"that you've just said?"},{"startTime":1441.11,"endTime":1445.31,"body":"Because what you said to me"},{"startTime":1441.11,"endTime":1445.31,"body":"makes absolute sense, but how?"},{"startTime":1445.31,"endTime":1446.868,"body":"- And David, I'm not going"},{"startTime":1445.31,"endTime":1446.868,"body":"to disagree with you."},{"startTime":1446.868,"endTime":1449.1,"body":"I've seen those things as well."},{"startTime":1449.1,"endTime":1450.71,"body":"And that is the reality"},{"startTime":1450.71,"endTime":1452.51,"body":"of people having to make difficult choices"},{"startTime":1452.51,"endTime":1455.0,"body":"and they're having to make"},{"startTime":1452.51,"endTime":1455.0,"body":"difficult choices at this moment,"},{"startTime":1455.0,"endTime":1457.563,"body":"and under the pressure sort of there."},{"startTime":1457.563,"endTime":1460.19,"body":"I think this is where,"},{"startTime":1457.563,"endTime":1460.19,"body":"going back to that strategy"},{"startTime":1460.19,"endTime":1462.358,"body":"that I mentioned earlier,"},{"startTime":1460.19,"endTime":1462.358,"body":"the integrated care strategy"},{"startTime":1462.358,"endTime":1464.42,"body":"was written by all the partners."},{"startTime":1464.42,"endTime":1468.02,"body":"It's owned by much more than"},{"startTime":1464.42,"endTime":1468.02,"body":"the NHS or it should be."},{"startTime":1468.02,"endTime":1469.735,"body":"It very clearly, if you read most of them,"},{"startTime":1469.735,"endTime":1471.196,"body":"they would talk about inequalities,"},{"startTime":1471.196,"endTime":1473.24,"body":"they would talk about"},{"startTime":1471.196,"endTime":1473.24,"body":"prevention and wellbeing."},{"startTime":1473.24,"endTime":1475.58,"body":"They would say all these things."},{"startTime":1475.58,"endTime":1479.51,"body":"As systems, I think part"},{"startTime":1475.58,"endTime":1479.51,"body":"of the maturing journey"},{"startTime":1479.51,"endTime":1481.94,"body":"will be how well do we pay attention"},{"startTime":1481.94,"endTime":1484.28,"body":"to tackling those things?"},{"startTime":1484.28,"endTime":1486.92,"body":"How genuine are we being"},{"startTime":1484.28,"endTime":1486.92,"body":"about whether our money"},{"startTime":1486.92,"endTime":1488.27,"body":"is going into, as you say,"},{"startTime":1488.27,"endTime":1491.448,"body":"dental prevention versus treatment?"},{"startTime":1491.448,"endTime":1494.72,"body":"And there's not a magic switch for this,"},{"startTime":1494.72,"endTime":1496.01,"body":"there just isn't."},{"startTime":1496.01,"endTime":1498.56,"body":"But there is an evolving maturity I think"},{"startTime":1498.56,"endTime":1499.393,"body":"that will come with it."},{"startTime":1499.393,"endTime":1503.03,"body":"And I think you asked earlier"},{"startTime":1499.393,"endTime":1503.03,"body":"about the role of regions."},{"startTime":1503.03,"endTime":1505.22,"body":"I think region can play a"},{"startTime":1503.03,"endTime":1505.22,"body":"really helpful role here."},{"startTime":1505.22,"endTime":1508.187,"body":"It can be partners"},{"startTime":1505.22,"endTime":1508.187,"body":"alongside the ICBs and ICSs"},{"startTime":1508.187,"endTime":1511.88,"body":"and be saying, you said"},{"startTime":1508.187,"endTime":1511.88,"body":"this in the strategy,"},{"startTime":1511.88,"endTime":1513.44,"body":"how are you getting on with evidencing it?"},{"startTime":1513.44,"endTime":1514.82,"body":"How can we help you evidence it?"},{"startTime":1514.82,"endTime":1516.92,"body":"How can we draw on the best"},{"startTime":1514.82,"endTime":1516.92,"body":"evidence from elsewhere?"},{"startTime":1516.92,"endTime":1519.74,"body":"So, I've sat on calls in the last week"},{"startTime":1519.74,"endTime":1521.336,"body":"where colleagues are really"},{"startTime":1519.74,"endTime":1521.336,"body":"getting under the skin"},{"startTime":1521.336,"endTime":1522.169,"body":"of some of that"},{"startTime":1522.169,"endTime":1524.69,"body":"return on investment"},{"startTime":1522.169,"endTime":1524.69,"body":"opportunities and things."},{"startTime":1524.69,"endTime":1527.72,"body":"So I think the green shoots are there,"},{"startTime":1527.72,"endTime":1530.99,"body":"the pressure to do what you've"},{"startTime":1527.72,"endTime":1530.99,"body":"described in that question"},{"startTime":1530.99,"endTime":1532.22,"body":"is there as well."},{"startTime":1532.22,"endTime":1535.01,"body":"And we need honest discussions"},{"startTime":1532.22,"endTime":1535.01,"body":"about how we prioritise."},{"startTime":1535.01,"endTime":1537.95,"body":"And I think giving the"},{"startTime":1535.01,"endTime":1537.95,"body":"voice to Public Health,"},{"startTime":1537.95,"endTime":1540.601,"body":"giving the voice to the senior doctors"},{"startTime":1540.601,"endTime":1542.7,"body":"as chief medical officers, chief nurses"},{"startTime":1542.7,"endTime":1545.87,"body":"and things like that at the ICBs"},{"startTime":1545.87,"endTime":1548.27,"body":"and the Integrated Care"},{"startTime":1545.87,"endTime":1548.27,"body":"Systems is absolutely key."},{"startTime":1548.27,"endTime":1552.44,"body":"- And yeah, so there and a"},{"startTime":1548.27,"endTime":1552.44,"body":"particular strand, again,"},{"startTime":1552.44,"endTime":1555.38,"body":"our colleagues listening"},{"startTime":1552.44,"endTime":1555.38,"body":"would be interested in is,"},{"startTime":1555.38,"endTime":1558.02,"body":"so where does NICE sit in this?"},{"startTime":1558.02,"endTime":1559.99,"body":"Because one of the things I'm"},{"startTime":1558.02,"endTime":1559.99,"body":"sure they're screaming about"},{"startTime":1559.99,"endTime":1562.16,"body":"at the moment, or many of"},{"startTime":1559.99,"endTime":1562.16,"body":"them listening now are saying,"},{"startTime":1562.16,"endTime":1564.02,"body":"well, yeah, but I work for a company,"},{"startTime":1564.02,"endTime":1565.65,"body":"we've got a NICE recommendation"},{"startTime":1566.87,"endTime":1568.46,"body":"that the pull through on that in,"},{"startTime":1568.46,"endTime":1570.92,"body":"I don't know, Liverpool"},{"startTime":1568.46,"endTime":1570.92,"body":"is very different from"},{"startTime":1570.92,"endTime":1572.933,"body":"what it is in Norwich, why is that?"},{"startTime":1573.77,"endTime":1575.864,"body":"And some of it could"},{"startTime":1573.77,"endTime":1575.864,"body":"possibly be explained by"},{"startTime":1575.864,"endTime":1578.63,"body":"the kind of local variation"},{"startTime":1575.864,"endTime":1578.63,"body":"you are talking about,"},{"startTime":1578.63,"endTime":1580.88,"body":"about epidemiology and demography,"},{"startTime":1580.88,"endTime":1583.16,"body":"but a lot of it isn't,"},{"startTime":1580.88,"endTime":1583.16,"body":"it's much more finance"},{"startTime":1583.16,"endTime":1584.27,"body":"or something else."},{"startTime":1584.27,"endTime":1588.77,"body":"I mean, how does NICE actually"},{"startTime":1584.27,"endTime":1588.77,"body":"get managed in practice?"},{"startTime":1588.77,"endTime":1592.22,"body":"If NICE makes a decision"},{"startTime":1588.77,"endTime":1592.22,"body":"this week, what happens next?"},{"startTime":1592.22,"endTime":1594.32,"body":"- And this is the dilemma, isn't it?"},{"startTime":1594.32,"endTime":1595.97,"body":"Because as you said earlier,"},{"startTime":1595.97,"endTime":1597.614,"body":"if one piece of the pizza gets bigger,"},{"startTime":1597.614,"endTime":1599.18,"body":"another piece gets smaller."},{"startTime":1599.18,"endTime":1600.98,"body":"And that's the harsh reality here"},{"startTime":1600.98,"endTime":1603.74,"body":"is we recommend these things,"},{"startTime":1603.74,"endTime":1606.32,"body":"because the evidence base says they work,"},{"startTime":1606.32,"endTime":1607.795,"body":"but it doesn't take away"},{"startTime":1606.32,"endTime":1607.795,"body":"the other challenges"},{"startTime":1607.795,"endTime":1610.16,"body":"that the system is facing."},{"startTime":1610.16,"endTime":1612.5,"body":"I do very genuinely think, David,"},{"startTime":1612.5,"endTime":1615.92,"body":"this is probably a five to"},{"startTime":1612.5,"endTime":1615.92,"body":"ten year journey of maturing"},{"startTime":1615.92,"endTime":1618.17,"body":"and understanding return on investment."},{"startTime":1618.17,"endTime":1621.35,"body":"It is about understanding"},{"startTime":1618.17,"endTime":1621.35,"body":"how the choices get made"},{"startTime":1621.35,"endTime":1624.26,"body":"and NICE guidance is one factor"},{"startTime":1624.26,"endTime":1625.91,"body":"coming into the mix here."},{"startTime":1625.91,"endTime":1629.9,"body":"But sometimes that NICE"},{"startTime":1625.91,"endTime":1629.9,"body":"guidance will be at the far end"},{"startTime":1629.9,"endTime":1631.67,"body":"when somebody's already"},{"startTime":1629.9,"endTime":1631.67,"body":"ill and what have you."},{"startTime":1631.67,"endTime":1633.659,"body":"Well, what if we'd spent the"},{"startTime":1631.67,"endTime":1633.659,"body":"money originally on prevention?"},{"startTime":1633.659,"endTime":1637.28,"body":"And these are all the"},{"startTime":1633.659,"endTime":1637.28,"body":"tensions we've got to explore."},{"startTime":1637.28,"endTime":1639.47,"body":"And how do we balance"},{"startTime":1637.28,"endTime":1639.47,"body":"the need to spend money"},{"startTime":1639.47,"endTime":1641.9,"body":"on those people already in ill health"},{"startTime":1641.9,"endTime":1644.12,"body":"with the need to keep"},{"startTime":1641.9,"endTime":1644.12,"body":"particularly children"},{"startTime":1644.12,"endTime":1645.8,"body":"and young people who are fit and healthy"},{"startTime":1645.8,"endTime":1648.2,"body":"and give them the best start in life."},{"startTime":1648.2,"endTime":1650.39,"body":"And there are no silver bullets to this."},{"startTime":1650.39,"endTime":1654.32,"body":"I think what we would"},{"startTime":1650.39,"endTime":1654.32,"body":"hope to see over time,"},{"startTime":1654.32,"endTime":1656.99,"body":"and I think at the scale of 42,"},{"startTime":1656.99,"endTime":1657.89,"body":"you stand a chance."},{"startTime":1657.89,"endTime":1658.94,"body":"If you're trying to do everything"},{"startTime":1658.94,"endTime":1662.067,"body":"at the scale of 209 systems,"},{"startTime":1658.94,"endTime":1662.067,"body":"that's quite difficult."},{"startTime":1662.067,"endTime":1665.72,"body":"But at the scale of 42, you"},{"startTime":1662.067,"endTime":1665.72,"body":"can create some critical mass,"},{"startTime":1665.72,"endTime":1668.12,"body":"you can begin to share the evidence"},{"startTime":1668.12,"endTime":1669.95,"body":"and the data more efficiently."},{"startTime":1669.95,"endTime":1673.1,"body":"We've got better ability to do"},{"startTime":1669.95,"endTime":1673.1,"body":"that now than we've ever had."},{"startTime":1673.1,"endTime":1674.39,"body":"I think nationally there's a lot"},{"startTime":1674.39,"endTime":1675.83,"body":"of good work going on at looking,"},{"startTime":1675.83,"endTime":1678.08,"body":"how do we pull together"},{"startTime":1675.83,"endTime":1678.08,"body":"the evidence spaces,"},{"startTime":1678.08,"endTime":1680.84,"body":"make them available, make it accessible?"},{"startTime":1680.84,"endTime":1683.99,"body":"So I hope ultimately what you have"},{"startTime":1683.99,"endTime":1687.62,"body":"is Integrated Care"},{"startTime":1683.99,"endTime":1687.62,"body":"Systems where the leaders"},{"startTime":1687.62,"endTime":1690.32,"body":"are able to look at a"},{"startTime":1687.62,"endTime":1690.32,"body":"really good set of evidence,"},{"startTime":1690.32,"endTime":1692.42,"body":"they're able to look at the"},{"startTime":1690.32,"endTime":1692.42,"body":"numbers and understand them"},{"startTime":1692.42,"endTime":1694.43,"body":"in terms of what they're"},{"startTime":1692.42,"endTime":1694.43,"body":"returning for them,"},{"startTime":1694.43,"endTime":1696.8,"body":"and they're able to begin"},{"startTime":1694.43,"endTime":1696.8,"body":"to prioritise and shape."},{"startTime":1696.8,"endTime":1698.468,"body":"But that isn't going to happen overnight."},{"startTime":1698.468,"endTime":1701.54,"body":"Some of the more advanced"},{"startTime":1698.468,"endTime":1701.54,"body":"systems will be better at that."},{"startTime":1701.54,"endTime":1706.362,"body":"But we know, we're a really"},{"startTime":1701.54,"endTime":1706.362,"body":"complex set of different things."},{"startTime":1706.362,"endTime":1709.61,"body":"Providing specialist care"},{"startTime":1706.362,"endTime":1709.61,"body":"is really different to"},{"startTime":1709.61,"endTime":1710.96,"body":"providing prevention and wellbeing."},{"startTime":1710.96,"endTime":1714.38,"body":"And so we've got to work"},{"startTime":1710.96,"endTime":1714.38,"body":"that through as partners"},{"startTime":1714.38,"endTime":1715.34,"body":"where we invest."},{"startTime":1715.34,"endTime":1718.095,"body":"And over time we can get better at it."},{"startTime":1718.095,"endTime":1720.2,"body":"It won't happen overnight."},{"startTime":1720.2,"endTime":1722.66,"body":"- So let's move on to that"},{"startTime":1720.2,"endTime":1722.66,"body":"specialised commission."},{"startTime":1722.66,"endTime":1725.69,"body":"But before we do, particularly"},{"startTime":1722.66,"endTime":1725.69,"body":"for a couple of the people"},{"startTime":1725.69,"endTime":1727.1,"body":"who submitted questions,"},{"startTime":1727.1,"endTime":1729.781,"body":"if you want to go back, we"},{"startTime":1727.1,"endTime":1729.781,"body":"can't really go into the detail"},{"startTime":1729.781,"endTime":1733.762,"body":"of this today, but two of"},{"startTime":1729.781,"endTime":1733.762,"body":"the questions in particular"},{"startTime":1733.762,"endTime":1736.01,"body":"were based on the assumption,"},{"startTime":1736.01,"endTime":1737.57,"body":"which I've heard before,"},{"startTime":1737.57,"endTime":1740.3,"body":"that if NICE makes a decision today,"},{"startTime":1740.3,"endTime":1745.141,"body":"specific ring-fenced money"},{"startTime":1740.3,"endTime":1745.141,"body":"would then come down from London"},{"startTime":1745.141,"endTime":1749.42,"body":"to Richard's region that"},{"startTime":1745.141,"endTime":1749.42,"body":"would then go down to ICSs"},{"startTime":1749.42,"endTime":1753.47,"body":"and then would go down to"},{"startTime":1749.42,"endTime":1753.47,"body":"individual hospitals or whatever."},{"startTime":1753.47,"endTime":1755.9,"body":"And just that is not the case."},{"startTime":1755.9,"endTime":1757.52,"body":"If you're wondering about that"},{"startTime":1757.52,"endTime":1758.87,"body":"and you want more detailed things,"},{"startTime":1758.87,"endTime":1760.94,"body":"approach the people from Mtech Access,"},{"startTime":1760.94,"endTime":1762.77,"body":"because I know they've,"},{"startTime":1760.94,"endTime":1762.77,"body":"they've got some really good"},{"startTime":1762.77,"endTime":1765.59,"body":"simple training programmes"},{"startTime":1762.77,"endTime":1765.59,"body":"that can explain it."},{"startTime":1765.59,"endTime":1769.58,"body":"And an area that is even more"},{"startTime":1765.59,"endTime":1769.58,"body":"cloudy, we'll get into now,"},{"startTime":1769.58,"endTime":1772.01,"body":"that Richard's mentioned a couple of times"},{"startTime":1772.01,"endTime":1773.66,"body":"is specialised commissioning."},{"startTime":1773.66,"endTime":1778.13,"body":"So specialised commissioning"},{"startTime":1773.66,"endTime":1778.13,"body":"in what five, six weeks time"},{"startTime":1778.13,"endTime":1780.89,"body":"is being devolved at a local level."},{"startTime":1780.89,"endTime":1782.57,"body":"What does that actually mean in practice"},{"startTime":1782.57,"endTime":1784.365,"body":"to the region and the ICSs?"},{"startTime":1784.365,"endTime":1787.193,"body":"Spec comm, as we call it, is coming down."},{"startTime":1788.09,"endTime":1791.63,"body":"The budgets for it"},{"startTime":1788.09,"endTime":1791.63,"body":"initially are going to be"},{"startTime":1791.63,"endTime":1793.583,"body":"kind of managed on a shared basis."},{"startTime":1794.69,"endTime":1795.523,"body":"How will that work,"},{"startTime":1795.523,"endTime":1797.75,"body":"particularly in the examples"},{"startTime":1795.523,"endTime":1797.75,"body":"that you've just used"},{"startTime":1797.75,"endTime":1802.4,"body":"about local decisions"},{"startTime":1797.75,"endTime":1802.4,"body":"around how money is used"},{"startTime":1802.4,"endTime":1804.173,"body":"and moving the slices of the pizza?"},{"startTime":1805.31,"endTime":1808.04,"body":"- And I think that's"},{"startTime":1805.31,"endTime":1808.04,"body":"the key to this, David,"},{"startTime":1808.04,"endTime":1810.2,"body":"it's about making the decision"},{"startTime":1810.2,"endTime":1812.45,"body":"and looking at the whole pot of spend."},{"startTime":1812.45,"endTime":1815.099,"body":"I don't think it's about"},{"startTime":1812.45,"endTime":1815.099,"body":"trying to manage those services"},{"startTime":1815.099,"endTime":1817.61,"body":"or oversee those services"},{"startTime":1815.099,"endTime":1817.61,"body":"at a local level."},{"startTime":1817.61,"endTime":1820.31,"body":"I think it's more about"},{"startTime":1817.61,"endTime":1820.31,"body":"getting oversight of the money"},{"startTime":1820.31,"endTime":1822.62,"body":"at that local level and saying,"},{"startTime":1822.62,"endTime":1824.36,"body":"are we aware that we spend this chunk on"},{"startTime":1824.36,"endTime":1826.37,"body":"specialised services as opposed to"},{"startTime":1826.37,"endTime":1827.69,"body":"could we have spent it somewhere else?"},{"startTime":1827.69,"endTime":1830.0,"body":"And I think that's where the conversation,"},{"startTime":1830.0,"endTime":1831.98,"body":"the richness of the"},{"startTime":1830.0,"endTime":1831.98,"body":"conversation and the richness."},{"startTime":1831.98,"endTime":1835.82,"body":"So when I think about the"},{"startTime":1831.98,"endTime":1835.82,"body":"devolution of dental and optometry"},{"startTime":1835.82,"endTime":1838.13,"body":"and pharmacy into systems,"},{"startTime":1838.13,"endTime":1840.56,"body":"that gives them a massive"},{"startTime":1838.13,"endTime":1840.56,"body":"opportunity to say,"},{"startTime":1840.56,"endTime":1843.38,"body":"hold on, we've got all"},{"startTime":1840.56,"endTime":1843.38,"body":"this primary care spend,"},{"startTime":1843.38,"endTime":1844.67,"body":"are we spending it in the right way?"},{"startTime":1844.67,"endTime":1845.69,"body":"Do we want to top it up?"},{"startTime":1845.69,"endTime":1847.58,"body":"So we've seen, haven't"},{"startTime":1845.69,"endTime":1847.58,"body":"we, those questions about"},{"startTime":1847.58,"endTime":1850.31,"body":"if we could get more dentists,"},{"startTime":1847.58,"endTime":1850.31,"body":"if we spent more money there,"},{"startTime":1850.31,"endTime":1852.647,"body":"that would have a huge impact."},{"startTime":1852.647,"endTime":1855.5,"body":"And the impact on, again, small children"},{"startTime":1855.5,"endTime":1859.727,"body":"coming through school with"},{"startTime":1855.5,"endTime":1859.727,"body":"tooth decay is dramatic."},{"startTime":1859.727,"endTime":1864.56,"body":"So I think the oversight of the"},{"startTime":1859.727,"endTime":1864.56,"body":"money for me is the key bit,"},{"startTime":1864.56,"endTime":1868.04,"body":"not necessarily that instantly"},{"startTime":1864.56,"endTime":1868.04,"body":"they start making changes"},{"startTime":1868.04,"endTime":1869.48,"body":"to the way specialised services work,"},{"startTime":1869.48,"endTime":1871.55,"body":"because you could very easily destabilise"},{"startTime":1871.55,"endTime":1874.01,"body":"some of those services"},{"startTime":1871.55,"endTime":1874.01,"body":"if you're not careful."},{"startTime":1874.01,"endTime":1876.53,"body":"There could be real"},{"startTime":1874.01,"endTime":1876.53,"body":"unintended consequences."},{"startTime":1876.53,"endTime":1880.19,"body":"So I think that keeping"},{"startTime":1876.53,"endTime":1880.19,"body":"an oversight at a scale"},{"startTime":1880.19,"endTime":1882.35,"body":"that is appropriate for"},{"startTime":1880.19,"endTime":1882.35,"body":"each specialised service"},{"startTime":1882.35,"endTime":1883.97,"body":"feels really important to me."},{"startTime":1883.97,"endTime":1886.49,"body":"But allowing each of"},{"startTime":1883.97,"endTime":1886.49,"body":"the local systems to see"},{"startTime":1886.49,"endTime":1888.289,"body":"how they spend the total."},{"startTime":1888.289,"endTime":1890.428,"body":"The money they spend on their population,"},{"startTime":1890.428,"endTime":1893.63,"body":"how is it spent as a total"},{"startTime":1890.428,"endTime":1893.63,"body":"offers a real insight"},{"startTime":1893.63,"endTime":1894.463,"body":"that we just haven't had-"},{"startTime":1894.463,"endTime":1896.227,"body":"- And if you don't mind me coming in now,"},{"startTime":1896.227,"endTime":1897.863,"body":"it was just last week,"},{"startTime":1898.7,"endTime":1903.7,"body":"I saw they're still described"},{"startTime":1898.7,"endTime":1903.7,"body":"as draft budgets for ICBs,"},{"startTime":1904.31,"endTime":1906.61,"body":"primary care, mainstream services,"},{"startTime":1906.61,"endTime":1909.11,"body":"in other words secondary care mainly,"},{"startTime":1909.11,"endTime":1910.43,"body":"and then spec comm."},{"startTime":1910.43,"endTime":1912.377,"body":"And you can see the"},{"startTime":1910.43,"endTime":1912.377,"body":"variation by population"},{"startTime":1912.377,"endTime":1913.73,"body":"and things like that."},{"startTime":1913.73,"endTime":1915.2,"body":"I think you've given a great answer."},{"startTime":1915.2,"endTime":1917.928,"body":"Again, if I was a citizen"},{"startTime":1915.2,"endTime":1917.928,"body":"in the South West,"},{"startTime":1917.928,"endTime":1919.88,"body":"I'd be really reassured by that."},{"startTime":1919.88,"endTime":1921.38,"body":"So just for our audience,"},{"startTime":1921.38,"endTime":1925.07,"body":"let's say it was MS or"},{"startTime":1921.38,"endTime":1925.07,"body":"haematology or whatever,"},{"startTime":1925.07,"endTime":1927.98,"body":"don't expect anything"},{"startTime":1925.07,"endTime":1927.98,"body":"dramatic at the start,"},{"startTime":1927.98,"endTime":1929.798,"body":"but people like yourself"},{"startTime":1927.98,"endTime":1929.798,"body":"and your colleagues"},{"startTime":1929.798,"endTime":1931.16,"body":"and the clinicians,"},{"startTime":1931.16,"endTime":1933.47,"body":"they're going to get a"},{"startTime":1931.16,"endTime":1933.47,"body":"much better picture now"},{"startTime":1933.47,"endTime":1937.22,"body":"of the spend on MS or haematology"},{"startTime":1933.47,"endTime":1937.22,"body":"across the South West."},{"startTime":1937.22,"endTime":1940.58,"body":"And they can connect that with"},{"startTime":1937.22,"endTime":1940.58,"body":"the spend in primary care,"},{"startTime":1940.58,"endTime":1943.127,"body":"community care, possibly even social care"},{"startTime":1943.127,"endTime":1945.92,"body":"and start to make some"},{"startTime":1943.127,"endTime":1945.92,"body":"plans based on that,"},{"startTime":1945.92,"endTime":1949.473,"body":"but not to expect sudden"},{"startTime":1945.92,"endTime":1949.473,"body":"changes at the start."},{"startTime":1949.473,"endTime":1951.53,"body":"- And the thing that really struck me"},{"startTime":1951.53,"endTime":1954.32,"body":"over the last four years when"},{"startTime":1951.53,"endTime":1954.32,"body":"I've worked in a system is"},{"startTime":1954.32,"endTime":1957.11,"body":"it is so big, there's"},{"startTime":1954.32,"endTime":1957.11,"body":"so many moving parts,"},{"startTime":1957.11,"endTime":1958.13,"body":"there's so many things"},{"startTime":1958.13,"endTime":1961.7,"body":"and it's really difficult"},{"startTime":1958.13,"endTime":1961.7,"body":"to see the rationale of,"},{"startTime":1961.7,"endTime":1963.92,"body":"making an individual"},{"startTime":1961.7,"endTime":1963.92,"body":"decision in the context"},{"startTime":1963.92,"endTime":1964.753,"body":"of that bigger thing."},{"startTime":1964.753,"endTime":1967.343,"body":"So you're right David,"},{"startTime":1964.753,"endTime":1967.343,"body":"this will take time."},{"startTime":1968.24,"endTime":1969.8,"body":"When we're most effective sometimes"},{"startTime":1969.8,"endTime":1972.59,"body":"is when we focus in on a"},{"startTime":1969.8,"endTime":1972.59,"body":"particular service area"},{"startTime":1972.59,"endTime":1974.78,"body":"and say, right, let's have"},{"startTime":1972.59,"endTime":1974.78,"body":"a proper look at this."},{"startTime":1974.78,"endTime":1977.03,"body":"And I think that's the dilemma we've got."},{"startTime":1977.03,"endTime":1978.41,"body":"You can't fix everything."},{"startTime":1978.41,"endTime":1980.9,"body":"You can't change funding"},{"startTime":1978.41,"endTime":1980.9,"body":"flows for everything"},{"startTime":1980.9,"endTime":1983.36,"body":"perfectly overnight, but if"},{"startTime":1980.9,"endTime":1983.36,"body":"we really go after things."},{"startTime":1983.36,"endTime":1986.928,"body":"So colleagues tell me,"},{"startTime":1983.36,"endTime":1986.928,"body":"coronary heart disease"},{"startTime":1986.928,"endTime":1988.19,"body":"and things like that,"},{"startTime":1988.19,"endTime":1990.167,"body":"these are the areas where we"},{"startTime":1988.19,"endTime":1990.167,"body":"could really pay attention"},{"startTime":1990.167,"endTime":1991.61,"body":"and get something."},{"startTime":1991.61,"endTime":1993.739,"body":"Children's mental health, another example,"},{"startTime":1993.739,"endTime":1996.41,"body":"what are we going to"},{"startTime":1993.739,"endTime":1996.41,"body":"prioritise to really look at?"},{"startTime":1996.41,"endTime":1998.3,"body":"And that does unfortunately mean"},{"startTime":1998.3,"endTime":2000.82,"body":"not everything can be"},{"startTime":1998.3,"endTime":2000.82,"body":"looked at at the same time."},{"startTime":2000.82,"endTime":2003.43,"body":"But I think again, keep"},{"startTime":2000.82,"endTime":2003.43,"body":"gathering the evidence,"},{"startTime":2003.43,"endTime":2006.07,"body":"keep talking about it,"},{"startTime":2003.43,"endTime":2006.07,"body":"keep making it available,"},{"startTime":2006.07,"endTime":2010.36,"body":"because there's so much data."},{"startTime":2010.36,"endTime":2012.28,"body":"The better the way you"},{"startTime":2010.36,"endTime":2012.28,"body":"can tell your story,"},{"startTime":2012.28,"endTime":2014.05,"body":"the more concise a story can be told"},{"startTime":2014.05,"endTime":2016.06,"body":"about a particular service or whatever,"},{"startTime":2016.06,"endTime":2017.47,"body":"the more it will help those"},{"startTime":2017.47,"endTime":2019.9,"body":"who are making decisions understand it."},{"startTime":2019.9,"endTime":2021.809,"body":"And the other thing I would say is,"},{"startTime":2021.809,"endTime":2023.769,"body":"nobody's trying to make bad decisions."},{"startTime":2023.769,"endTime":2026.08,"body":"Work with them, lean in, support them,"},{"startTime":2026.08,"endTime":2028.688,"body":"help them come on that"},{"startTime":2026.08,"endTime":2028.688,"body":"journey of learning,"},{"startTime":2028.688,"endTime":2032.95,"body":"understanding all those things"},{"startTime":2028.688,"endTime":2032.95,"body":"and support that process."},{"startTime":2032.95,"endTime":2034.87,"body":"Even if it feels like you've"},{"startTime":2032.95,"endTime":2034.87,"body":"been doing that for years"},{"startTime":2034.87,"endTime":2035.86,"body":"and it hasn't quite worked,"},{"startTime":2035.86,"endTime":2040.06,"body":"I would say now's the time that"},{"startTime":2035.86,"endTime":2040.06,"body":"we can really learn together"},{"startTime":2040.06,"endTime":2041.53,"body":"and move forward."},{"startTime":2041.53,"endTime":2043.66,"body":"- So if I summarise some of that"},{"startTime":2043.66,"endTime":2044.98,"body":"and then you can come back and say,"},{"startTime":2044.98,"endTime":2046.203,"body":"I'll summarise, it's a"},{"startTime":2044.98,"endTime":2046.203,"body":"bit hard for the audience."},{"startTime":2046.203,"endTime":2047.68,"body":"You can come back and just say"},{"startTime":2047.68,"endTime":2049.33,"body":"that I've done it incorrectly."},{"startTime":2049.33,"endTime":2051.73,"body":"Firstly, I can't resist"},{"startTime":2049.33,"endTime":2051.73,"body":"throwing a little fact in here"},{"startTime":2051.73,"endTime":2054.18,"body":"was I was part of some"},{"startTime":2051.73,"endTime":2054.18,"body":"meeting the other day,"},{"startTime":2054.18,"endTime":2057.697,"body":"in my eyes it'd be 1/3 of calls to NHS 111"},{"startTime":2057.697,"endTime":2059.173,"body":"are for dental pain."},{"startTime":2060.04,"endTime":2062.65,"body":"There's a classic area"},{"startTime":2060.04,"endTime":2062.65,"body":"that if we sorted out"},{"startTime":2062.65,"endTime":2063.73,"body":"the cause of that"},{"startTime":2063.73,"endTime":2066.91,"body":"we wouldn't be spending"},{"startTime":2063.73,"endTime":2066.91,"body":"money on calls to NHS 111"},{"startTime":2066.91,"endTime":2068.98,"body":"and presumably dreadful consequences"},{"startTime":2068.98,"endTime":2070.69,"body":"for some of the people who are ringing up."},{"startTime":2070.69,"endTime":2073.18,"body":"But going back to your point,"},{"startTime":2073.18,"endTime":2075.04,"body":"there'll be people on"},{"startTime":2073.18,"endTime":2075.04,"body":"the call listening today"},{"startTime":2075.04,"endTime":2080.04,"body":"who are concerned that they"},{"startTime":2075.04,"endTime":2080.04,"body":"sell a product or a medicine"},{"startTime":2080.11,"endTime":2083.37,"body":"or a device that's covered in spec comm"},{"startTime":2083.37,"endTime":2086.08,"body":"that's now going to go to local decisions"},{"startTime":2086.08,"endTime":2090.46,"body":"and they see threats to"},{"startTime":2086.08,"endTime":2090.46,"body":"the continued use of it."},{"startTime":2090.46,"endTime":2092.35,"body":"What you're saying, if I've got it right,"},{"startTime":2092.35,"endTime":2094.6,"body":"is embrace that opportunity,"},{"startTime":2094.6,"endTime":2096.46,"body":"because if they can show the value of that"},{"startTime":2096.46,"endTime":2098.56,"body":"and the holistic benefit of that,"},{"startTime":2098.56,"endTime":2101.71,"body":"but in order to do so,"},{"startTime":2098.56,"endTime":2101.71,"body":"instead of just looking at"},{"startTime":2101.71,"endTime":2103.66,"body":"what happens in a tertiary hospital"},{"startTime":2103.66,"endTime":2105.43,"body":"in the middle of Bristol, for example,"},{"startTime":2105.43,"endTime":2108.19,"body":"they need to follow the"},{"startTime":2105.43,"endTime":2108.19,"body":"whole chain through."},{"startTime":2108.19,"endTime":2111.37,"body":"The diagnostics, the primary"},{"startTime":2108.19,"endTime":2111.37,"body":"care, the prevention,"},{"startTime":2111.37,"endTime":2113.05,"body":"and to see it as a holistic thing"},{"startTime":2113.05,"endTime":2116.5,"body":"and therefore the benefits"},{"startTime":2113.05,"endTime":2116.5,"body":"on a longitudinal basis."},{"startTime":2116.5,"endTime":2117.632,"body":"Yeah, is that?"},{"startTime":2117.632,"endTime":2120.28,"body":"- Absolutely, and that"},{"startTime":2117.632,"endTime":2120.28,"body":"is a challenge, isn't it?"},{"startTime":2120.28,"endTime":2122.95,"body":"Because if we've made a lot of money,"},{"startTime":2122.95,"endTime":2124.18,"body":"because people get sick"},{"startTime":2124.18,"endTime":2125.56,"body":"and we start doing a lot of prevention,"},{"startTime":2125.56,"endTime":2126.46,"body":"that stops them getting sick,"},{"startTime":2126.46,"endTime":2127.601,"body":"that's going to change the business model."},{"startTime":2127.601,"endTime":2130.9,"body":"And I think, let's be honest"},{"startTime":2127.601,"endTime":2130.9,"body":"about those conversations."},{"startTime":2130.9,"endTime":2133.09,"body":"Let's talk about how services can work,"},{"startTime":2133.09,"endTime":2134.804,"body":"let's talk about how"},{"startTime":2133.09,"endTime":2134.804,"body":"things can keep people"},{"startTime":2134.804,"endTime":2136.0,"body":"healthy and well."},{"startTime":2136.0,"endTime":2138.79,"body":"But let's also recognise"},{"startTime":2136.0,"endTime":2138.79,"body":"need appropriate spend"},{"startTime":2138.79,"endTime":2140.71,"body":"for when people are ill"},{"startTime":2138.79,"endTime":2140.71,"body":"on the right products"},{"startTime":2140.71,"endTime":2141.58,"body":"and the things that work"},{"startTime":2141.58,"endTime":2142.75,"body":"and the things that treat them well."},{"startTime":2142.75,"endTime":2146.11,"body":"So it's a conundrum"},{"startTime":2142.75,"endTime":2146.11,"body":"how you balance it all."},{"startTime":2146.11,"endTime":2148.96,"body":"But being open, sharing the information"},{"startTime":2148.96,"endTime":2152.5,"body":"and thinking about it and"},{"startTime":2148.96,"endTime":2152.5,"body":"working with decision-makers,"},{"startTime":2152.5,"endTime":2153.333,"body":"I think is key."},{"startTime":2153.333,"endTime":2155.86,"body":"And I know that's easy for"},{"startTime":2153.333,"endTime":2155.86,"body":"me to sit here and say,"},{"startTime":2155.86,"endTime":2157.41,"body":"and it's not always easy to do."},{"startTime":2158.62,"endTime":2161.276,"body":"- The other thing which if"},{"startTime":2158.62,"endTime":2161.276,"body":"anybody follows me on LinkedIn,"},{"startTime":2161.276,"endTime":2162.76,"body":"I follow you Richard,"},{"startTime":2162.76,"endTime":2166.38,"body":"for example, now they will"},{"startTime":2162.76,"endTime":2166.38,"body":"have seen me comment about"},{"startTime":2166.38,"endTime":2169.48,"body":"is the variation, it's"},{"startTime":2166.38,"endTime":2169.48,"body":"often not appreciated"},{"startTime":2169.48,"endTime":2171.28,"body":"the budgets I was talking about before."},{"startTime":2171.28,"endTime":2172.6,"body":"And if you're not familiar with these,"},{"startTime":2172.6,"endTime":2175.18,"body":"Mtech Access, can again explain them"},{"startTime":2175.18,"endTime":2177.37,"body":"and show you the actual figures."},{"startTime":2177.37,"endTime":2180.4,"body":"But where I live and work,"},{"startTime":2180.4,"endTime":2184.45,"body":"we're funded at something"},{"startTime":2180.4,"endTime":2184.45,"body":"like 25% per capita higher"},{"startTime":2184.45,"endTime":2187.78,"body":"than most of the ICBs in your region."},{"startTime":2187.78,"endTime":2190.67,"body":"So, all the ICBs start"},{"startTime":2187.78,"endTime":2190.67,"body":"from different places"},{"startTime":2190.67,"endTime":2192.25,"body":"as you are saying,"},{"startTime":2192.25,"endTime":2195.79,"body":"and now I was talking"},{"startTime":2192.25,"endTime":2195.79,"body":"to somebody last week"},{"startTime":2195.79,"endTime":2197.14,"body":"from the East of England"},{"startTime":2197.14,"endTime":2199.06,"body":"where the hospitals"},{"startTime":2197.14,"endTime":2199.06,"body":"have got this RAAC issue"},{"startTime":2199.06,"endTime":2202.183,"body":"and so that's going to be"},{"startTime":2199.06,"endTime":2202.183,"body":"devil in the next few years."},{"startTime":2204.31,"endTime":2206.62,"body":"How do you cope with that for start?"},{"startTime":2206.62,"endTime":2209.08,"body":"Because the South West"},{"startTime":2206.62,"endTime":2209.08,"body":"has got particular issues"},{"startTime":2209.08,"endTime":2211.363,"body":"about influxes of holiday makers."},{"startTime":2211.363,"endTime":2216.363,"body":"You alluded to before"},{"startTime":2211.363,"endTime":2216.363,"body":"about the road transports"},{"startTime":2216.61,"endTime":2220.06,"body":"through your patch is"},{"startTime":2216.61,"endTime":2220.06,"body":"dreadful to be blunt."},{"startTime":2220.06,"endTime":2221.5,"body":"The communication issues,"},{"startTime":2221.5,"endTime":2223.3,"body":"half of Plymouth is closed down today,"},{"startTime":2223.3,"endTime":2227.77,"body":"because of the Luftwaffe and so on,"},{"startTime":2227.77,"endTime":2229.9,"body":"but anyway, to be serious,"},{"startTime":2229.9,"endTime":2231.97,"body":"you've got all these regional variations,"},{"startTime":2231.97,"endTime":2234.28,"body":"nobody starts in the same place."},{"startTime":2234.28,"endTime":2237.64,"body":"But again, how do our"},{"startTime":2234.28,"endTime":2237.64,"body":"colleagues cope with that?"},{"startTime":2237.64,"endTime":2240.43,"body":"- And this is one of the"},{"startTime":2237.64,"endTime":2240.43,"body":"eternal questions, isn't it?"},{"startTime":2240.43,"endTime":2242.92,"body":"And every few years the"},{"startTime":2240.43,"endTime":2242.92,"body":"formula will get revised"},{"startTime":2242.92,"endTime":2245.65,"body":"and there'll be a sort of"},{"startTime":2242.92,"endTime":2245.65,"body":"different emphasis upon it"},{"startTime":2245.65,"endTime":2247.9,"body":"and it will never please everybody"},{"startTime":2247.9,"endTime":2249.673,"body":"and it will never be exactly right."},{"startTime":2250.78,"endTime":2253.547,"body":"When I was a trainee accountant,"},{"startTime":2250.78,"endTime":2253.547,"body":"I used to have a saying,"},{"startTime":2253.547,"endTime":2255.46,"body":"\"Please stop talking to"},{"startTime":2253.547,"endTime":2255.46,"body":"me about the 10 pounds"},{"startTime":2255.46,"endTime":2256.293,"body":"you haven't got."},{"startTime":2256.293,"endTime":2258.52,"body":"Tell me what you're doing"},{"startTime":2256.293,"endTime":2258.52,"body":"with the 100 pounds you have.\""},{"startTime":2258.52,"endTime":2260.89,"body":"And I think the first"},{"startTime":2258.52,"endTime":2260.89,"body":"thing we have to focus on"},{"startTime":2260.89,"endTime":2263.5,"body":"is these health and care"},{"startTime":2260.89,"endTime":2263.5,"body":"systems, the one I worked in"},{"startTime":2263.5,"endTime":2265.0,"body":"was 1.5 to 2 billion,"},{"startTime":2265.0,"endTime":2267.46,"body":"depending whose money"},{"startTime":2265.0,"endTime":2267.46,"body":"you included in the pot."},{"startTime":2267.46,"endTime":2269.8,"body":"That is a lot of money to"},{"startTime":2267.46,"endTime":2269.8,"body":"be paying attention to."},{"startTime":2269.8,"endTime":2272.171,"body":"And I think if we start by"},{"startTime":2269.8,"endTime":2272.171,"body":"paying attention to that,"},{"startTime":2272.171,"endTime":2274.756,"body":"the value we get from what we have got,"},{"startTime":2274.756,"endTime":2277.18,"body":"we've got to have a bit of faith then that"},{"startTime":2277.18,"endTime":2278.74,"body":"if the formula needs to be tweaked,"},{"startTime":2278.74,"endTime":2280.093,"body":"because of as you say,"},{"startTime":2280.093,"endTime":2281.95,"body":"RAAC is a classic example, isn't it?"},{"startTime":2281.95,"endTime":2283.3,"body":"Of where did that come from?"},{"startTime":2283.3,"endTime":2286.12,"body":"Suddenly we've got a huge"},{"startTime":2283.3,"endTime":2286.12,"body":"bill that nobody saw coming."},{"startTime":2286.12,"endTime":2289.33,"body":"That's what happens to an"},{"startTime":2286.12,"endTime":2289.33,"body":"organisation as big and complex"},{"startTime":2289.33,"endTime":2291.31,"body":"as health and care services really."},{"startTime":2291.31,"endTime":2295.48,"body":"So, but the emphasis on"},{"startTime":2291.31,"endTime":2295.48,"body":"are we doing the best"},{"startTime":2295.48,"endTime":2298.12,"body":"with what we've got and"},{"startTime":2295.48,"endTime":2298.12,"body":"energy going into that"},{"startTime":2298.12,"endTime":2301.33,"body":"I think would be the priority"},{"startTime":2298.12,"endTime":2301.33,"body":"for me in any system,"},{"startTime":2301.33,"endTime":2304.3,"body":"rather than what would we"},{"startTime":2301.33,"endTime":2304.3,"body":"do if we had 10 pounds more?"},{"startTime":2304.3,"endTime":2307.15,"body":"And that's a difficult thing to say,"},{"startTime":2307.15,"endTime":2308.56,"body":"but in all of these systems,"},{"startTime":2308.56,"endTime":2309.73,"body":"they are spending a lot of money"},{"startTime":2309.73,"endTime":2312.12,"body":"and justifying the use of that money."},{"startTime":2312.12,"endTime":2314.68,"body":"It is really critical."},{"startTime":2314.68,"endTime":2315.79,"body":"- Great."},{"startTime":2315.79,"endTime":2317.783,"body":"I can see why you're"},{"startTime":2315.79,"endTime":2317.783,"body":"working at region now."},{"startTime":2317.783,"endTime":2320.86,"body":"That's really nuts."},{"startTime":2322.93,"endTime":2326.59,"body":"Moving on, when we do get"},{"startTime":2322.93,"endTime":2326.59,"body":"the operating framework"},{"startTime":2326.59,"endTime":2328.813,"body":"and you've said before that we perhaps,"},{"startTime":2328.813,"endTime":2330.37,"body":"unless I've got it wrong,"},{"startTime":2330.37,"endTime":2332.353,"body":"we shouldn't expect too many surprises."},{"startTime":2333.79,"endTime":2336.368,"body":"We're probably going to"},{"startTime":2333.79,"endTime":2336.368,"body":"have an election this year."},{"startTime":2336.368,"endTime":2339.13,"body":"If we were having this"},{"startTime":2336.368,"endTime":2339.13,"body":"meeting again in year's time,"},{"startTime":2339.13,"endTime":2341.47,"body":"hopefully Mtech Access will bring you back"},{"startTime":2341.47,"endTime":2343.693,"body":"and we'll look back a year from now,"},{"startTime":2345.22,"endTime":2347.407,"body":"what might we be saying in year's time?"},{"startTime":2347.407,"endTime":2349.84,"body":"Are we expecting any differences?"},{"startTime":2349.84,"endTime":2352.54,"body":"Are we still going to"},{"startTime":2349.84,"endTime":2352.54,"body":"have the same drivers?"},{"startTime":2352.54,"endTime":2354.97,"body":"And if they are the same"},{"startTime":2352.54,"endTime":2354.97,"body":"drivers, what are they?"},{"startTime":2354.97,"endTime":2356.26,"body":"We've kind of alluded to them,"},{"startTime":2356.26,"endTime":2358.36,"body":"but I want to give you"},{"startTime":2356.26,"endTime":2358.36,"body":"the chance to be specific."},{"startTime":2358.36,"endTime":2360.16,"body":"I've thrown in things like ambulance,"},{"startTime":2360.16,"endTime":2361.72,"body":"you talked about mental health."},{"startTime":2361.72,"endTime":2364.9,"body":"What do you think are going"},{"startTime":2361.72,"endTime":2364.9,"body":"to be the big hooks this year?"},{"startTime":2364.9,"endTime":2369.28,"body":"- So access times are really important,"},{"startTime":2369.28,"endTime":2370.63,"body":"whether you can access a GP,"},{"startTime":2370.63,"endTime":2372.64,"body":"whether you can access an ambulance,"},{"startTime":2372.64,"endTime":2376.24,"body":"whether you can get into A\u0026E,"},{"startTime":2376.24,"endTime":2377.41,"body":"these things are important,"},{"startTime":2377.41,"endTime":2379.06,"body":"how quickly you can access your surgery."},{"startTime":2379.06,"endTime":2380.59,"body":"So we can't ignore those things."},{"startTime":2380.59,"endTime":2384.07,"body":"They have absolutely direct"},{"startTime":2380.59,"endTime":2384.07,"body":"impact on the people we serve."},{"startTime":2384.07,"endTime":2384.97,"body":"So they're important."},{"startTime":2384.97,"endTime":2387.346,"body":"They sit as part of the"},{"startTime":2384.97,"endTime":2387.346,"body":"stuff we need to manage"},{"startTime":2387.346,"endTime":2389.26,"body":"and we need to do better."},{"startTime":2389.26,"endTime":2392.17,"body":"The COVID pandemic caused"},{"startTime":2389.26,"endTime":2392.17,"body":"some challenges to that."},{"startTime":2392.17,"endTime":2395.02,"body":"Industrial action has caused"},{"startTime":2392.17,"endTime":2395.02,"body":"some challenges to that,"},{"startTime":2395.02,"endTime":2397.27,"body":"and workforce shortages are adding to"},{"startTime":2397.27,"endTime":2398.299,"body":"some of those challenges."},{"startTime":2398.299,"endTime":2400.96,"body":"So we need to keep paying"},{"startTime":2398.299,"endTime":2400.96,"body":"attention to those things."},{"startTime":2400.96,"endTime":2404.44,"body":"But I think for me, the hope in the future"},{"startTime":2404.44,"endTime":2407.89,"body":"is that alongside those,"},{"startTime":2404.44,"endTime":2407.89,"body":"we are giving equal"},{"startTime":2407.89,"endTime":2409.18,"body":"or more weight"},{"startTime":2409.18,"endTime":2411.46,"body":"to those conversations about prevention,"},{"startTime":2411.46,"endTime":2412.96,"body":"about tackling inequalities,"},{"startTime":2412.96,"endTime":2415.57,"body":"that we are sitting down"},{"startTime":2412.96,"endTime":2415.57,"body":"at Integrated Care Boards"},{"startTime":2415.57,"endTime":2417.01,"body":"and beginning to say,"},{"startTime":2417.01,"endTime":2420.22,"body":"look, we're beginning to see"},{"startTime":2417.01,"endTime":2420.22,"body":"not necessarily the outcomes"},{"startTime":2420.22,"endTime":2421.15,"body":"of our interventions,"},{"startTime":2421.15,"endTime":2422.56,"body":"but we can at least identify"},{"startTime":2422.56,"endTime":2424.81,"body":"and be really clear"},{"startTime":2422.56,"endTime":2424.81,"body":"about the interventions."},{"startTime":2424.81,"endTime":2426.13,"body":"We can see how we are using"},{"startTime":2426.13,"endTime":2429.31,"body":"population health management"},{"startTime":2426.13,"endTime":2429.31,"body":"data in particular,"},{"startTime":2429.31,"endTime":2430.96,"body":"use the insight that we've got about"},{"startTime":2430.96,"endTime":2434.02,"body":"the populations we serve better"},{"startTime":2434.02,"endTime":2438.01,"body":"and be really beginning to sort of measure"},{"startTime":2438.01,"endTime":2439.6,"body":"some of the outcomes"},{"startTime":2438.01,"endTime":2439.6,"body":"that are coming through."},{"startTime":2439.6,"endTime":2443.62,"body":"And I'd love to see more reporting of"},{"startTime":2443.62,"endTime":2445.93,"body":"this is what the people"},{"startTime":2443.62,"endTime":2445.93,"body":"who use our services"},{"startTime":2445.93,"endTime":2447.308,"body":"are saying, not this-"},{"startTime":2447.308,"endTime":2448.69,"body":"- I was going to say,"},{"startTime":2448.69,"endTime":2451.499,"body":"because you've mentioned"},{"startTime":2448.69,"endTime":2451.499,"body":"outcomes several times."},{"startTime":2451.499,"endTime":2452.74,"body":"What is that?"},{"startTime":2452.74,"endTime":2454.39,"body":"Is that a good death?"},{"startTime":2454.39,"endTime":2457.42,"body":"Is that curing me in inverted commas?"},{"startTime":2457.42,"endTime":2461.38,"body":"Is it keeping me out of the hospital?"},{"startTime":2461.38,"endTime":2463.78,"body":"Because sometimes I'm part of"},{"startTime":2461.38,"endTime":2463.78,"body":"those conversations every day"},{"startTime":2463.78,"endTime":2464.867,"body":"and I'm guilty of it."},{"startTime":2464.867,"endTime":2467.62,"body":"So I say, we'll stop people"},{"startTime":2464.867,"endTime":2467.62,"body":"going in hospital, stop it."},{"startTime":2467.62,"endTime":2468.453,"body":"And you think, what"},{"startTime":2467.62,"endTime":2468.453,"body":"does that actually mean?"},{"startTime":2468.453,"endTime":2470.74,"body":"Does that mean someone's"},{"startTime":2468.453,"endTime":2470.74,"body":"going to be stuck at home"},{"startTime":2470.74,"endTime":2473.56,"body":"now in pain and discomfort, incontinent?"},{"startTime":2473.56,"endTime":2478.48,"body":"So what are the outcomes"},{"startTime":2473.56,"endTime":2478.48,"body":"that you would advocate."},{"startTime":2478.48,"endTime":2480.61,"body":"- And somebody who's just"},{"startTime":2478.48,"endTime":2480.61,"body":"had a repaired broken wrist"},{"startTime":2480.61,"endTime":2483.37,"body":"when we need emergency"},{"startTime":2480.61,"endTime":2483.37,"body":"and specialist services,"},{"startTime":2483.37,"endTime":2484.203,"body":"we want them."},{"startTime":2484.203,"endTime":2487.03,"body":"So this isn't about decrying"},{"startTime":2484.203,"endTime":2487.03,"body":"any bit of the system."},{"startTime":2487.03,"endTime":2488.92,"body":"We need the whole system,"},{"startTime":2488.92,"endTime":2491.5,"body":"but I think you are right,"},{"startTime":2488.92,"endTime":2491.5,"body":"it's not a singular outcome,"},{"startTime":2491.5,"endTime":2493.39,"body":"but it is about different things."},{"startTime":2493.39,"endTime":2495.52,"body":"So you used a good death example."},{"startTime":2495.52,"endTime":2497.74,"body":"I happened to spend the"},{"startTime":2495.52,"endTime":2497.74,"body":"day a couple of weeks ago"},{"startTime":2497.74,"endTime":2499.3,"body":"with three of our local hospices"},{"startTime":2499.3,"endTime":2501.01,"body":"doing a bit of design work for them,"},{"startTime":2501.01,"endTime":2503.02,"body":"collaborating, working"},{"startTime":2501.01,"endTime":2503.02,"body":"together in new ways"},{"startTime":2503.02,"endTime":2505.96,"body":"and really exciting change of culture"},{"startTime":2505.96,"endTime":2508.723,"body":"and change of behaviour coming forward."},{"startTime":2509.56,"endTime":2512.59,"body":"And you're right, for"},{"startTime":2509.56,"endTime":2512.59,"body":"that particular cohort"},{"startTime":2512.59,"endTime":2514.21,"body":"there's a really significant,"},{"startTime":2514.21,"endTime":2515.68,"body":"what does a good death look like?"},{"startTime":2515.68,"endTime":2518.08,"body":"And what looks right for you, David"},{"startTime":2518.08,"endTime":2519.55,"body":"could be completely different for me."},{"startTime":2519.55,"endTime":2522.04,"body":"And one of them I was"},{"startTime":2519.55,"endTime":2522.04,"body":"speaking to a few months ago"},{"startTime":2522.04,"endTime":2523.21,"body":"and they said,"},{"startTime":2523.21,"endTime":2526.66,"body":"the chap absolutely wanted"},{"startTime":2523.21,"endTime":2526.66,"body":"to die in the hospice,"},{"startTime":2526.66,"endTime":2528.73,"body":"because he didn't want"},{"startTime":2526.66,"endTime":2528.73,"body":"the home to be the place"},{"startTime":2528.73,"endTime":2530.464,"body":"where his wife remembered him dying."},{"startTime":2530.464,"endTime":2533.62,"body":"And that's a different dynamic"},{"startTime":2530.464,"endTime":2533.62,"body":"to what lots of people say."},{"startTime":2533.62,"endTime":2535.74,"body":"So we have to be really subtle"},{"startTime":2533.62,"endTime":2535.74,"body":"with these things, don't we?"},{"startTime":2535.74,"endTime":2537.22,"body":"We really have to get under the skin"},{"startTime":2537.22,"endTime":2539.116,"body":"of understanding individuals."},{"startTime":2539.116,"endTime":2540.64,"body":"For children and young people,"},{"startTime":2540.64,"endTime":2542.286,"body":"there's loads of evidence about,"},{"startTime":2542.286,"endTime":2544.909,"body":"the school attainment at"},{"startTime":2542.286,"endTime":2544.909,"body":"school being a major factor"},{"startTime":2544.909,"endTime":2546.22,"body":"in the rest of their lives."},{"startTime":2546.22,"endTime":2549.67,"body":"So what if we really put"},{"startTime":2546.22,"endTime":2549.67,"body":"all of our energy into that?"},{"startTime":2549.67,"endTime":2552.61,"body":"So if children are not attending"},{"startTime":2549.67,"endTime":2552.61,"body":"school due to dental health"},{"startTime":2552.61,"endTime":2554.56,"body":"or mental health or whatever,"},{"startTime":2554.56,"endTime":2557.227,"body":"we are setting them up with poor outcomes"},{"startTime":2557.227,"endTime":2559.03,"body":"for the rest of their lives really."},{"startTime":2559.03,"endTime":2561.67,"body":"So what effort and energy"},{"startTime":2559.03,"endTime":2561.67,"body":"could we put into that?"},{"startTime":2561.67,"endTime":2563.05,"body":"For people a working age,"},{"startTime":2563.05,"endTime":2564.52,"body":"there's lots of evidence isn't there,"},{"startTime":2564.52,"endTime":2566.95,"body":"that if people can hold down a good job"},{"startTime":2566.95,"endTime":2568.6,"body":"and be successful in employment"},{"startTime":2568.6,"endTime":2571.87,"body":"and things like that,"},{"startTime":2568.6,"endTime":2571.87,"body":"then that adds huge value."},{"startTime":2571.87,"endTime":2573.61,"body":"It keeps them healthy, it keeps them well,"},{"startTime":2573.61,"endTime":2574.671,"body":"it gives them purpose."},{"startTime":2574.671,"endTime":2578.44,"body":"So I think we have to have that ability"},{"startTime":2578.44,"endTime":2580.87,"body":"and I believe we've got that ability now,"},{"startTime":2580.87,"endTime":2583.69,"body":"we've got the technologies,"},{"startTime":2580.87,"endTime":2583.69,"body":"we've got the capability"},{"startTime":2583.69,"endTime":2587.14,"body":"to really say, let's"},{"startTime":2583.69,"endTime":2587.14,"body":"have personalised care."},{"startTime":2587.14,"endTime":2589.24,"body":"That's the word, the"},{"startTime":2587.14,"endTime":2589.24,"body":"phrase that we use is,"},{"startTime":2589.24,"endTime":2591.04,"body":"personalised care,"},{"startTime":2589.24,"endTime":2591.04,"body":"let's really think about"},{"startTime":2591.04,"endTime":2592.75,"body":"what each and every individual is saying"},{"startTime":2592.75,"endTime":2593.938,"body":"is important to them."},{"startTime":2593.938,"endTime":2595.84,"body":"And if for one person"},{"startTime":2595.84,"endTime":2597.82,"body":"it's attending their daughter's wedding"},{"startTime":2597.82,"endTime":2600.793,"body":"before they have surgery or whatever,"},{"startTime":2601.75,"endTime":2605.98,"body":"then that's where if we're"},{"startTime":2601.75,"endTime":2605.98,"body":"a really healthy system,"},{"startTime":2605.98,"endTime":2607.33,"body":"that's what we can accommodate."},{"startTime":2607.33,"endTime":2610.27,"body":"It's not easy when our"},{"startTime":2607.33,"endTime":2610.27,"body":"frontline teams are working out"},{"startTime":2610.27,"endTime":2612.52,"body":"under absolute pressure at the moment."},{"startTime":2612.52,"endTime":2616.78,"body":"But again, the evidence tells"},{"startTime":2612.52,"endTime":2616.78,"body":"us if we personalise care,"},{"startTime":2616.78,"endTime":2619.09,"body":"actually there's less demand for it."},{"startTime":2619.09,"endTime":2621.79,"body":"People aren't going to just"},{"startTime":2619.09,"endTime":2621.79,"body":"say, \"I need more and more.\""},{"startTime":2621.79,"endTime":2624.49,"body":"On average, they will generally"},{"startTime":2621.79,"endTime":2624.49,"body":"say, \"I don't need that."},{"startTime":2624.49,"endTime":2625.99,"body":"I just need support for this bit."},{"startTime":2625.99,"endTime":2629.05,"body":"Help me get a job, help me,"},{"startTime":2625.99,"endTime":2629.05,"body":"achieve the school results"},{"startTime":2629.05,"endTime":2629.883,"body":"for my child."},{"startTime":2629.883,"endTime":2632.567,"body":"Help me have that good"},{"startTime":2629.883,"endTime":2632.567,"body":"death in a supported way.\""},{"startTime":2632.567,"endTime":2635.743,"body":"- Well, it can be as small as, yeah."},{"startTime":2637.09,"endTime":2638.71,"body":"And forgive me audience now,"},{"startTime":2638.71,"endTime":2640.67,"body":"I was talking to somebody just recently"},{"startTime":2641.65,"endTime":2643.51,"body":"from a major Pharma company"},{"startTime":2643.51,"endTime":2645.493,"body":"and one of the things I said there was,"},{"startTime":2646.637,"endTime":2648.76,"body":"\"How important it is to"},{"startTime":2646.637,"endTime":2648.76,"body":"have a downstairs toilet"},{"startTime":2648.76,"endTime":2649.6,"body":"in your house.\""},{"startTime":2649.6,"endTime":2651.328,"body":"And they said, \"Well, everybody's"},{"startTime":2649.6,"endTime":2651.328,"body":"got a downstairs toilet"},{"startTime":2651.328,"endTime":2652.93,"body":"in their house, haven't they?\""},{"startTime":2652.93,"endTime":2655.09,"body":"And I thought, \"Well, do you want to come"},{"startTime":2655.09,"endTime":2656.56,"body":"and live in the United Kingdom?"},{"startTime":2656.56,"endTime":2658.81,"body":"Because that's not what I observe.\""},{"startTime":2658.81,"endTime":2661.87,"body":"But anyway, what I'm sure our audience"},{"startTime":2661.87,"endTime":2663.257,"body":"will be screaming at is,"},{"startTime":2663.257,"endTime":2667.03,"body":"\"Right, we get it, Richard,"},{"startTime":2663.257,"endTime":2667.03,"body":"we're with you, we hear it."},{"startTime":2667.03,"endTime":2669.01,"body":"Who would we need to engage with?\""},{"startTime":2669.01,"endTime":2671.35,"body":"Particularly as you've"},{"startTime":2669.01,"endTime":2671.35,"body":"several times mentioned"},{"startTime":2671.35,"endTime":2673.57,"body":"local authorities, you've"},{"startTime":2671.35,"endTime":2673.57,"body":"brought employment into it,"},{"startTime":2673.57,"endTime":2676.42,"body":"then you've brought schools"},{"startTime":2673.57,"endTime":2676.42,"body":"in, which is local authority."},{"startTime":2676.42,"endTime":2679.12,"body":"And a lot of our audience are constrained"},{"startTime":2679.12,"endTime":2680.98,"body":"by compliance systems,"},{"startTime":2680.98,"endTime":2683.77,"body":"but also, because they"},{"startTime":2680.98,"endTime":2683.77,"body":"don't know these people."},{"startTime":2683.77,"endTime":2686.29,"body":"Who do they talk to in the NHS"},{"startTime":2686.29,"endTime":2688.603,"body":"and around the Archipelago with the NHS?"},{"startTime":2689.56,"endTime":2691.6,"body":"Do they find people like you?"},{"startTime":2691.6,"endTime":2693.933,"body":"Who on earth do they talk to?"},{"startTime":2693.933,"endTime":2696.07,"body":"- So I would really recognise that."},{"startTime":2696.07,"endTime":2700.27,"body":"I used to be head of IT at"},{"startTime":2696.07,"endTime":2700.27,"body":"the IUH many years ago in Bath"},{"startTime":2700.27,"endTime":2702.677,"body":"and I always used to say to suppliers,"},{"startTime":2702.677,"endTime":2705.01,"body":"\"We must be a hard customer to deal with,\""},{"startTime":2705.01,"endTime":2706.87,"body":"just because it is hard"},{"startTime":2706.87,"endTime":2708.61,"body":"and it's not the National Health Service,"},{"startTime":2708.61,"endTime":2710.863,"body":"you don't sell it once and"},{"startTime":2708.61,"endTime":2710.863,"body":"sell it everywhere, do you?"},{"startTime":2710.863,"endTime":2712.78,"body":"In terms of what you do."},{"startTime":2712.78,"endTime":2714.245,"body":"So I would really recognise that dilemma"},{"startTime":2714.245,"endTime":2716.077,"body":"that you've presented there, David"},{"startTime":2716.077,"endTime":2718.36,"body":"and I don't yet know"},{"startTime":2718.36,"endTime":2720.43,"body":"how many systems are"},{"startTime":2718.36,"endTime":2720.43,"body":"ready and mature for that."},{"startTime":2720.43,"endTime":2722.65,"body":"I think what we've had things like"},{"startTime":2722.65,"endTime":2725.8,"body":"the Academic Health Sciences"},{"startTime":2722.65,"endTime":2725.8,"body":"networks over recent years,"},{"startTime":2725.8,"endTime":2727.66,"body":"which have tried to support working"},{"startTime":2727.66,"endTime":2729.25,"body":"with innovation and companies"},{"startTime":2729.25,"endTime":2731.63,"body":"and trying to create that link between"},{"startTime":2732.467,"endTime":2736.06,"body":"the commercial sector and"},{"startTime":2732.467,"endTime":2736.06,"body":"research and development"},{"startTime":2736.06,"endTime":2738.49,"body":"and delivery of frontline services."},{"startTime":2738.49,"endTime":2740.35,"body":"Those are positive routes in,"},{"startTime":2740.35,"endTime":2743.08,"body":"but I'm increasingly of the view"},{"startTime":2743.08,"endTime":2746.59,"body":"that we could do a bit"},{"startTime":2743.08,"endTime":2746.59,"body":"more on the NHS end to say,"},{"startTime":2746.59,"endTime":2749.65,"body":"how could we create, organisations"},{"startTime":2746.59,"endTime":2749.65,"body":"like your own in a way"},{"startTime":2749.65,"endTime":2750.91,"body":"do some of this work, don't you?"},{"startTime":2750.91,"endTime":2754.597,"body":"You work on that access"},{"startTime":2750.91,"endTime":2754.597,"body":"interface between the systems"},{"startTime":2754.597,"endTime":2756.25,"body":"and the organisations."},{"startTime":2756.25,"endTime":2758.87,"body":"But I wonder if there there could be more"},{"startTime":2759.94,"endTime":2763.567,"body":"open collaboration,"},{"startTime":2759.94,"endTime":2763.567,"body":"sharing, events type things."},{"startTime":2763.567,"endTime":2765.46,"body":"And I know I've referenced this before"},{"startTime":2765.46,"endTime":2767.86,"body":"and I haven't yet"},{"startTime":2765.46,"endTime":2767.86,"body":"managed to land the thing"},{"startTime":2767.86,"endTime":2770.11,"body":"that's in my head, but"},{"startTime":2767.86,"endTime":2770.11,"body":"I'm hoping, over time"},{"startTime":2770.11,"endTime":2771.73,"body":"we might work with some of those systems"},{"startTime":2771.73,"endTime":2774.19,"body":"and say, okay, how do you"},{"startTime":2771.73,"endTime":2774.19,"body":"know you've got the best"},{"startTime":2774.19,"endTime":2777.25,"body":"pharmaceutical products, being"},{"startTime":2774.19,"endTime":2777.25,"body":"prescribed in your system?"},{"startTime":2777.25,"endTime":2779.38,"body":"How do you know that you"},{"startTime":2777.25,"endTime":2779.38,"body":"are making the best use"},{"startTime":2779.38,"endTime":2783.4,"body":"of technology or AI or"},{"startTime":2779.38,"endTime":2783.4,"body":"whatever element it is?"},{"startTime":2783.4,"endTime":2785.034,"body":"And I think that's the bit where"},{"startTime":2785.034,"endTime":2787.63,"body":"when people are extremely busy,"},{"startTime":2787.63,"endTime":2789.67,"body":"this feels like a nice"},{"startTime":2787.63,"endTime":2789.67,"body":"to have conversation."},{"startTime":2789.67,"endTime":2792.573,"body":"I think we have to try and"},{"startTime":2789.67,"endTime":2792.573,"body":"prioritise it in a way that says,"},{"startTime":2792.573,"endTime":2795.67,"body":"no, no, no, this is an essential"},{"startTime":2792.573,"endTime":2795.67,"body":"bit of the conversation"},{"startTime":2795.67,"endTime":2797.77,"body":"about sustainable health and care services"},{"startTime":2798.82,"endTime":2801.157,"body":"and perhaps look at ways"},{"startTime":2798.82,"endTime":2801.157,"body":"for how we facilitate that."},{"startTime":2801.157,"endTime":2803.95,"body":"And I think regions do"},{"startTime":2801.157,"endTime":2803.95,"body":"some of that really well."},{"startTime":2803.95,"endTime":2806.29,"body":"I think the AHSNs do"},{"startTime":2803.95,"endTime":2806.29,"body":"some of that really well,"},{"startTime":2806.29,"endTime":2807.52,"body":"but I think we could do more"},{"startTime":2807.52,"endTime":2810.844,"body":"and particularly where"},{"startTime":2807.52,"endTime":2810.844,"body":"you've got smaller suppliers,"},{"startTime":2810.844,"endTime":2812.38,"body":"they can't afford the time"},{"startTime":2812.38,"endTime":2814.96,"body":"to be working their way"},{"startTime":2812.38,"endTime":2814.96,"body":"around everywhere, can they?"},{"startTime":2814.96,"endTime":2819.19,"body":"So what are the opportunities"},{"startTime":2814.96,"endTime":2819.19,"body":"of regions, AHSNs, others"},{"startTime":2819.19,"endTime":2821.984,"body":"working with systems"},{"startTime":2819.19,"endTime":2821.984,"body":"to say let's understand"},{"startTime":2821.984,"endTime":2823.17,"body":"what the market can bring to us."},{"startTime":2823.17,"endTime":2825.37,"body":"- Well, let's spend a"},{"startTime":2823.17,"endTime":2825.37,"body":"couple of minutes with that."},{"startTime":2825.37,"endTime":2828.43,"body":"I wasn't planning to ask you"},{"startTime":2825.37,"endTime":2828.43,"body":"this, but I think I ought to."},{"startTime":2828.43,"endTime":2830.44,"body":"So there's seven regions."},{"startTime":2830.44,"endTime":2832.143,"body":"Give us an idea just so we get..."},{"startTime":2832.143,"endTime":2833.86,"body":"You are the South West region,"},{"startTime":2833.86,"endTime":2835.75,"body":"you cover seven ICBs, right?"},{"startTime":2835.75,"endTime":2838.09,"body":"Huge patch, millions of people."},{"startTime":2838.09,"endTime":2840.64,"body":"How many of you work at"},{"startTime":2838.09,"endTime":2840.64,"body":"region approximately?"},{"startTime":2840.64,"endTime":2841.72,"body":"Let's give an idea."},{"startTime":2841.72,"endTime":2843.22,"body":"For our colleagues listening,"},{"startTime":2843.22,"endTime":2844.51,"body":"they're probably wondering"},{"startTime":2844.51,"endTime":2846.88,"body":"is it a massive tower block in Bristol?"},{"startTime":2846.88,"endTime":2848.35,"body":"What is region?"},{"startTime":2848.35,"endTime":2852.61,"body":"- So it is people dispersed"},{"startTime":2848.35,"endTime":2852.61,"body":"across the area really."},{"startTime":2852.61,"endTime":2856.21,"body":"So it was, I believe don't quote"},{"startTime":2852.61,"endTime":2856.21,"body":"me entirely on the numbers,"},{"startTime":2856.21,"endTime":2857.77,"body":"but I think these are pretty accurate."},{"startTime":2857.77,"endTime":2859.03,"body":"I think it was around 900."},{"startTime":2859.03,"endTime":2862.21,"body":"We are the size of regions is changing."},{"startTime":2862.21,"endTime":2864.04,"body":"Some of that's because"},{"startTime":2862.21,"endTime":2864.04,"body":"people are being moved"},{"startTime":2864.04,"endTime":2865.45,"body":"into systems directly."},{"startTime":2865.45,"endTime":2867.58,"body":"So some of that's a really positive,"},{"startTime":2867.58,"endTime":2869.8,"body":"get the resource to the front line."},{"startTime":2869.8,"endTime":2872.41,"body":"Some of it is because we're"},{"startTime":2869.8,"endTime":2872.41,"body":"being asked to save some money."},{"startTime":2872.41,"endTime":2875.11,"body":"So I think it will be"},{"startTime":2872.41,"endTime":2875.11,"body":"about 600 in the South West"},{"startTime":2875.11,"endTime":2878.069,"body":"is about the right number."},{"startTime":2878.069,"endTime":2881.08,"body":"And so those people are dispersed across,"},{"startTime":2881.08,"endTime":2885.49,"body":"a strong medical, clinical"},{"startTime":2881.08,"endTime":2885.49,"body":"nursing-type grouping"},{"startTime":2885.49,"endTime":2888.64,"body":"where they lean into programmes associated"},{"startTime":2888.64,"endTime":2891.01,"body":"absolutely with the medical, clinical."},{"startTime":2891.01,"endTime":2893.59,"body":"You have got people who"},{"startTime":2891.01,"endTime":2893.59,"body":"are there for performance"},{"startTime":2893.59,"endTime":2896.541,"body":"and oversight-type roles,"},{"startTime":2896.541,"endTime":2899.77,"body":"but you've also got people"},{"startTime":2896.541,"endTime":2899.77,"body":"who've traditionally supported"},{"startTime":2899.77,"endTime":2901.3,"body":"programmes of work."},{"startTime":2901.3,"endTime":2903.73,"body":"So be that mental health, be"},{"startTime":2901.3,"endTime":2903.73,"body":"it children and young peoples"},{"startTime":2903.73,"endTime":2904.563,"body":"and things like that."},{"startTime":2904.563,"endTime":2908.98,"body":"And I think those people leaning"},{"startTime":2904.563,"endTime":2908.98,"body":"in and working with systems"},{"startTime":2908.98,"endTime":2911.59,"body":"and really helping them"},{"startTime":2908.98,"endTime":2911.59,"body":"deliver the transformation work"},{"startTime":2911.59,"endTime":2915.73,"body":"is one of the key parts of the"},{"startTime":2911.59,"endTime":2915.73,"body":"changes we're trying to make."},{"startTime":2915.73,"endTime":2919.3,"body":"- And I wasn't expecting, so"},{"startTime":2915.73,"endTime":2919.3,"body":"for our friends out there,"},{"startTime":2919.3,"endTime":2920.68,"body":"I've carried the bag,"},{"startTime":2920.68,"endTime":2923.293,"body":"okay, it was as we call it in our side."},{"startTime":2924.73,"endTime":2926.02,"body":"If I were going to do that again,"},{"startTime":2926.02,"endTime":2927.97,"body":"I'd be really interested in mapping out."},{"startTime":2927.97,"endTime":2929.95,"body":"The regions have good websites"},{"startTime":2929.95,"endTime":2932.413,"body":"and you can see the"},{"startTime":2929.95,"endTime":2932.413,"body":"people, the main people."},{"startTime":2934.168,"endTime":2937.09,"body":"The risk of making Richard blush,"},{"startTime":2937.09,"endTime":2940.51,"body":"regions tend to be full"},{"startTime":2937.09,"endTime":2940.51,"body":"of very experienced,"},{"startTime":2940.51,"endTime":2943.36,"body":"highly qualified people, senior people,"},{"startTime":2943.36,"endTime":2946.69,"body":"well-paid, influential."},{"startTime":2946.69,"endTime":2949.27,"body":"He's hit on something"},{"startTime":2946.69,"endTime":2949.27,"body":"a couple of minutes ago"},{"startTime":2949.27,"endTime":2951.79,"body":"that I thought, \"Yeah, that's right.\""},{"startTime":2951.79,"endTime":2954.507,"body":"In my experience,"},{"startTime":2951.79,"endTime":2954.507,"body":"generally, people at region"},{"startTime":2954.507,"endTime":2956.32,"body":"have a more open attitude"},{"startTime":2956.32,"endTime":2958.57,"body":"to dealing with commercial organisations"},{"startTime":2958.57,"endTime":2963.43,"body":"than people a bit further"},{"startTime":2958.57,"endTime":2963.43,"body":"down the line, okay?"},{"startTime":2963.43,"endTime":2966.28,"body":"And I'm thinking of"},{"startTime":2963.43,"endTime":2966.28,"body":"people in my own region"},{"startTime":2966.28,"endTime":2968.8,"body":"at the other end of the"},{"startTime":2966.28,"endTime":2968.8,"body":"country from Richard's."},{"startTime":2968.8,"endTime":2970.06,"body":"And if you think of my region,"},{"startTime":2970.06,"endTime":2971.77,"body":"it's got a population"},{"startTime":2971.77,"endTime":2974.65,"body":"that is bigger than Wales"},{"startTime":2971.77,"endTime":2974.65,"body":"and Scotland combined."},{"startTime":2974.65,"endTime":2978.07,"body":"Huge organisations, but"},{"startTime":2974.65,"endTime":2978.07,"body":"there are many people,"},{"startTime":2978.07,"endTime":2979.9,"body":"not just several, and I"},{"startTime":2978.07,"endTime":2979.9,"body":"know you said several,"},{"startTime":2979.9,"endTime":2983.11,"body":"there's many people at my"},{"startTime":2979.9,"endTime":2983.11,"body":"region who I would go to"},{"startTime":2983.11,"endTime":2985.21,"body":"if I was in a promotional role"},{"startTime":2985.21,"endTime":2987.37,"body":"and I thought I had a value"},{"startTime":2985.21,"endTime":2987.37,"body":"proposition that made sense"},{"startTime":2987.37,"endTime":2988.9,"body":"and I was being frustrated."},{"startTime":2988.9,"endTime":2992.14,"body":"There are people there that"},{"startTime":2988.9,"endTime":2992.14,"body":"can unblock things that can"},{"startTime":2992.14,"endTime":2995.41,"body":"prompt, invite you to"},{"startTime":2992.14,"endTime":2995.41,"body":"things, open doors for you."},{"startTime":2995.41,"endTime":2997.96,"body":"Yeah, I think regions are really powerful."},{"startTime":2997.96,"endTime":2999.61,"body":"I'm keeping an eye on the time"},{"startTime":2999.61,"endTime":3001.677,"body":"just to show I've been"},{"startTime":2999.61,"endTime":3001.677,"body":"carefully listening to you."},{"startTime":3001.677,"endTime":3005.31,"body":"I'm going to go right back to"},{"startTime":3001.677,"endTime":3005.31,"body":"something said at the start,"},{"startTime":3005.31,"endTime":3007.53,"body":"because it's something that"},{"startTime":3005.31,"endTime":3007.53,"body":"is a hobby horse of mine"},{"startTime":3007.53,"endTime":3008.793,"body":"that is rarely covered."},{"startTime":3009.72,"endTime":3011.85,"body":"My ICB has a provider collaborative"},{"startTime":3011.85,"endTime":3014.07,"body":"for all the foundation trusts,"},{"startTime":3014.07,"endTime":3016.05,"body":"has one for the mental health trusts,"},{"startTime":3016.05,"endTime":3018.18,"body":"it also has one for primary care"},{"startTime":3018.18,"endTime":3020.85,"body":"and I'm on the board of that, okay?"},{"startTime":3020.85,"endTime":3023.55,"body":"You mentioned provider"},{"startTime":3020.85,"endTime":3023.55,"body":"collaboratives before."},{"startTime":3023.55,"endTime":3025.53,"body":"Briefly, you're very"},{"startTime":3023.55,"endTime":3025.53,"body":"good at being succinct,"},{"startTime":3025.53,"endTime":3027.78,"body":"much more effective than me."},{"startTime":3027.78,"endTime":3029.7,"body":"What's a provider collaborative?"},{"startTime":3029.7,"endTime":3033.0,"body":"And would you advise our"},{"startTime":3029.7,"endTime":3033.0,"body":"friends who are listening"},{"startTime":3033.0,"endTime":3035.79,"body":"to have interaction with"},{"startTime":3033.0,"endTime":3035.79,"body":"the provider collaborative?"},{"startTime":3035.79,"endTime":3038.73,"body":"- Yeah, so certainly"},{"startTime":3035.79,"endTime":3038.73,"body":"the second part to that"},{"startTime":3038.73,"endTime":3039.57,"body":"is a definite yes,"},{"startTime":3039.57,"endTime":3041.713,"body":"but I'll come back to why in a minute."},{"startTime":3042.72,"endTime":3045.75,"body":"We've spent 20 years"},{"startTime":3045.75,"endTime":3047.218,"body":"haven't we in health services"},{"startTime":3047.218,"endTime":3051.57,"body":"designing competition between"},{"startTime":3047.218,"endTime":3051.57,"body":"units of organisations."},{"startTime":3051.57,"endTime":3054.66,"body":"So be that between"},{"startTime":3051.57,"endTime":3054.66,"body":"hospitals to some degree,"},{"startTime":3054.66,"endTime":3055.53,"body":"you chase the money,"},{"startTime":3055.53,"endTime":3057.51,"body":"so you're creating competition"},{"startTime":3057.51,"endTime":3060.39,"body":"between primary and secondary"},{"startTime":3057.51,"endTime":3060.39,"body":"care, community services,"},{"startTime":3060.39,"endTime":3061.26,"body":"all those sorts of things."},{"startTime":3061.26,"endTime":3063.48,"body":"So we've had quite a small scale,"},{"startTime":3063.48,"endTime":3065.22,"body":"I know they're still large organisations,"},{"startTime":3065.22,"endTime":3067.236,"body":"they employ tens of thousands of people,"},{"startTime":3067.236,"endTime":3070.17,"body":"they run at a billion pounds a year."},{"startTime":3070.17,"endTime":3071.97,"body":"They're big organisations in one sense,"},{"startTime":3071.97,"endTime":3074.52,"body":"but actually they've been designed"},{"startTime":3074.52,"endTime":3075.87,"body":"to be in competition with each other"},{"startTime":3075.87,"endTime":3078.6,"body":"and that has driven certain benefits."},{"startTime":3078.6,"endTime":3080.01,"body":"You would look at certain times"},{"startTime":3080.01,"endTime":3081.253,"body":"and say, well, that had"},{"startTime":3080.01,"endTime":3081.253,"body":"a benefit in terms of"},{"startTime":3081.253,"endTime":3084.336,"body":"some of the elective treatment"},{"startTime":3081.253,"endTime":3084.336,"body":"times and what have you."},{"startTime":3084.336,"endTime":3088.26,"body":"But we're now in an era of"},{"startTime":3084.336,"endTime":3088.26,"body":"encouraging collaboration"},{"startTime":3088.26,"endTime":3089.94,"body":"and I think the provider collaboratives"},{"startTime":3089.94,"endTime":3093.21,"body":"are where we're encouraging"},{"startTime":3089.94,"endTime":3093.21,"body":"providers to work together."},{"startTime":3093.21,"endTime":3096.47,"body":"So some are absolutely"},{"startTime":3093.21,"endTime":3096.47,"body":"provider collaboratives"},{"startTime":3096.47,"endTime":3097.5,"body":"of the same sector."},{"startTime":3097.5,"endTime":3098.7,"body":"So they're three hospitals"},{"startTime":3098.7,"endTime":3100.68,"body":"joining together, working together."},{"startTime":3100.68,"endTime":3102.54,"body":"And what they might do"},{"startTime":3100.68,"endTime":3102.54,"body":"is they might look at"},{"startTime":3102.54,"endTime":3106.11,"body":"some of their support functions,"},{"startTime":3102.54,"endTime":3106.11,"body":"procurement, finance, HR,"},{"startTime":3106.11,"endTime":3108.256,"body":"and say, well we don't"},{"startTime":3106.11,"endTime":3108.256,"body":"all need one of these,"},{"startTime":3108.256,"endTime":3109.89,"body":"we could share that."},{"startTime":3109.89,"endTime":3112.26,"body":"They might look at their"},{"startTime":3109.89,"endTime":3112.26,"body":"clinical front teams and say,"},{"startTime":3112.26,"endTime":3116.64,"body":"actually we're delivering"},{"startTime":3112.26,"endTime":3116.64,"body":"three bits of service,"},{"startTime":3116.64,"endTime":3118.14,"body":"perhaps not as good as we could,"},{"startTime":3118.14,"endTime":3119.28,"body":"but if we collaborated,"},{"startTime":3119.28,"endTime":3121.05,"body":"maybe we could get a really good service"},{"startTime":3121.05,"endTime":3124.02,"body":"and structure it slightly differently."},{"startTime":3124.02,"endTime":3126.6,"body":"In all of this, you've got"},{"startTime":3124.02,"endTime":3126.6,"body":"the public voice in that."},{"startTime":3126.6,"endTime":3129.78,"body":"So I'm aware of local initiatives"},{"startTime":3126.6,"endTime":3129.78,"body":"around stroke services"},{"startTime":3129.78,"endTime":3133.35,"body":"at the moment, where two"},{"startTime":3129.78,"endTime":3133.35,"body":"organisations not that far apart,"},{"startTime":3133.35,"endTime":3135.93,"body":"are trying to reconfigure, but"},{"startTime":3133.35,"endTime":3135.93,"body":"of course that's contentious."},{"startTime":3135.93,"endTime":3137.58,"body":"The public have a view"},{"startTime":3135.93,"endTime":3137.58,"body":"about what they want"},{"startTime":3137.58,"endTime":3139.233,"body":"at their local hospital."},{"startTime":3141.15,"endTime":3142.83,"body":"So part of it is about"},{"startTime":3142.83,"endTime":3145.74,"body":"single-sector organisations"},{"startTime":3142.83,"endTime":3145.74,"body":"working together,"},{"startTime":3145.74,"endTime":3148.56,"body":"but increasingly I think what"},{"startTime":3145.74,"endTime":3148.56,"body":"we'll see is cross-sector."},{"startTime":3148.56,"endTime":3151.29,"body":"We will see hospitals,"},{"startTime":3148.56,"endTime":3151.29,"body":"mental health trust,"},{"startTime":3151.29,"endTime":3154.38,"body":"community services and"},{"startTime":3151.29,"endTime":3154.38,"body":"elements of primary care"},{"startTime":3154.38,"endTime":3156.24,"body":"coming together and saying,"},{"startTime":3156.24,"endTime":3159.69,"body":"if we're genuinely going"},{"startTime":3156.24,"endTime":3159.69,"body":"to offer integrated care,"},{"startTime":3159.69,"endTime":3161.779,"body":"it's not helpful for"},{"startTime":3159.69,"endTime":3161.779,"body":"us to be all operating"},{"startTime":3161.779,"endTime":3164.823,"body":"in a slice of this space really."},{"startTime":3166.35,"endTime":3168.9,"body":"So there's a real opportunity here,"},{"startTime":3168.9,"endTime":3171.564,"body":"but what we mustn't do is obsess"},{"startTime":3168.9,"endTime":3171.564,"body":"about the structural change"},{"startTime":3171.564,"endTime":3174.87,"body":"and have another load of"},{"startTime":3171.564,"endTime":3174.87,"body":"structural changes without saying,"},{"startTime":3174.87,"endTime":3177.15,"body":"but why, what difference"},{"startTime":3174.87,"endTime":3177.15,"body":"is this going to make?"},{"startTime":3177.15,"endTime":3179.46,"body":"So if the difference it's going to make"},{"startTime":3179.46,"endTime":3182.31,"body":"is that a specialist is"},{"startTime":3179.46,"endTime":3182.31,"body":"going to work more closely"},{"startTime":3182.31,"endTime":3185.04,"body":"with a local team to look after people"},{"startTime":3185.04,"endTime":3187.17,"body":"with long-term conditions,"},{"startTime":3187.17,"endTime":3189.09,"body":"and they're going to spend"},{"startTime":3187.17,"endTime":3189.09,"body":"more of their time supporting,"},{"startTime":3189.09,"endTime":3191.43,"body":"educating, contributing to that"},{"startTime":3191.43,"endTime":3193.62,"body":"and keeping people out"},{"startTime":3191.43,"endTime":3193.62,"body":"there in the community,"},{"startTime":3193.62,"endTime":3195.45,"body":"keeping them well, keeping them working,"},{"startTime":3195.45,"endTime":3197.19,"body":"then you can see real benefit in that."},{"startTime":3197.19,"endTime":3198.99,"body":"So the vision has to be, I think about"},{"startTime":3198.99,"endTime":3200.643,"body":"what difference is it going to make,"},{"startTime":3201.69,"endTime":3204.72,"body":"not just about the organisations"},{"startTime":3201.69,"endTime":3204.72,"body":"being bolted together"},{"startTime":3204.72,"endTime":3206.73,"body":"and scale being better than small-scale,"},{"startTime":3206.73,"endTime":3209.31,"body":"because we've all seen that cycle."},{"startTime":3209.31,"endTime":3211.02,"body":"- And there's a particular"},{"startTime":3209.31,"endTime":3211.02,"body":"opportunity there."},{"startTime":3211.02,"endTime":3213.39,"body":"But I think, I have to go back."},{"startTime":3213.39,"endTime":3214.53,"body":"These sessions are being recorded"},{"startTime":3214.53,"endTime":3216.45,"body":"and I want to listen"},{"startTime":3214.53,"endTime":3216.45,"body":"to the start again now,"},{"startTime":3216.45,"endTime":3219.239,"body":"but I'm sure you kind of"},{"startTime":3216.45,"endTime":3219.239,"body":"mentioned provider collaboratives"},{"startTime":3219.239,"endTime":3222.81,"body":"and the contractual opportunities"},{"startTime":3219.239,"endTime":3222.81,"body":"that are around now,"},{"startTime":3222.81,"endTime":3225.06,"body":"through the provider"},{"startTime":3222.81,"endTime":3225.06,"body":"selection regime and things."},{"startTime":3225.06,"endTime":3226.44,"body":"So going back to my ICB,"},{"startTime":3226.44,"endTime":3228.93,"body":"what we're expecting is the"},{"startTime":3226.44,"endTime":3228.93,"body":"ICB would give contracts"},{"startTime":3228.93,"endTime":3231.78,"body":"and the provider collaborative,"},{"startTime":3228.93,"endTime":3231.78,"body":"they might subcontract them,"},{"startTime":3231.78,"endTime":3233.61,"body":"for example, to primary care networks"},{"startTime":3233.61,"endTime":3234.87,"body":"or individual practices,"},{"startTime":3234.87,"endTime":3238.5,"body":"and create some real, I don't know,"},{"startTime":3238.5,"endTime":3241.44,"body":"a bit of vim in the system"},{"startTime":3238.5,"endTime":3241.44,"body":"to go away from competition"},{"startTime":3241.44,"endTime":3243.99,"body":"to bring people together"},{"startTime":3241.44,"endTime":3243.99,"body":"and cut the bureaucracy out"},{"startTime":3243.99,"endTime":3247.44,"body":"and meaning we can"},{"startTime":3243.99,"endTime":3247.44,"body":"accept innovation faster."},{"startTime":3247.44,"endTime":3248.81,"body":"I mean, you were nodding there."},{"startTime":3248.81,"endTime":3249.81,"body":"Is that correct from your-"},{"startTime":3249.81,"endTime":3253.14,"body":"- Yeah, let's not deny the fact"},{"startTime":3253.14,"endTime":3255.09,"body":"that commissioning is difficult."},{"startTime":3255.09,"endTime":3257.76,"body":"Understanding how you prioritise"},{"startTime":3255.09,"endTime":3257.76,"body":"how resources are spent"},{"startTime":3257.76,"endTime":3259.44,"body":"on a population is really difficult."},{"startTime":3259.44,"endTime":3260.64,"body":"So we've got to be careful here."},{"startTime":3260.64,"endTime":3262.65,"body":"We can't just take a"},{"startTime":3260.64,"endTime":3262.65,"body":"commissioning conundrum"},{"startTime":3262.65,"endTime":3265.29,"body":"that hasn't quite worked"},{"startTime":3262.65,"endTime":3265.29,"body":"to the best of its ability"},{"startTime":3265.29,"endTime":3266.28,"body":"and move it somewhere else"},{"startTime":3266.28,"endTime":3268.2,"body":"and think suddenly it will be better."},{"startTime":3268.2,"endTime":3270.03,"body":"But there are certainly opportunities,"},{"startTime":3270.03,"endTime":3273.21,"body":"I think, for providers to"},{"startTime":3270.03,"endTime":3273.21,"body":"say, this isn't a win-lose,"},{"startTime":3273.21,"endTime":3275.88,"body":"we're not taking some money"},{"startTime":3273.21,"endTime":3275.88,"body":"off you and giving it to you,"},{"startTime":3275.88,"endTime":3277.5,"body":"because we think that's a better way."},{"startTime":3277.5,"endTime":3279.9,"body":"What we're saying is,"},{"startTime":3277.5,"endTime":3279.9,"body":"here's the whole pot,"},{"startTime":3279.9,"endTime":3283.251,"body":"you work out whether you could"},{"startTime":3279.9,"endTime":3283.251,"body":"run a system more sustainably"},{"startTime":3283.251,"endTime":3284.79,"body":"by moving that resource."},{"startTime":3284.79,"endTime":3286.327,"body":"And if you say, right, we're going to move"},{"startTime":3286.327,"endTime":3288.27,"body":"some of our specialists out the hospital,"},{"startTime":3288.27,"endTime":3290.16,"body":"they're going to work"},{"startTime":3288.27,"endTime":3290.16,"body":"more in the community,"},{"startTime":3290.16,"endTime":3292.5,"body":"then that's a really"},{"startTime":3290.16,"endTime":3292.5,"body":"positive change of direction."},{"startTime":3292.5,"endTime":3295.44,"body":"But it's an organisation"},{"startTime":3292.5,"endTime":3295.44,"body":"owning that decision,"},{"startTime":3295.44,"endTime":3297.99,"body":"making it happen, as opposed"},{"startTime":3295.44,"endTime":3297.99,"body":"to a commissioner saying,"},{"startTime":3297.99,"endTime":3300.54,"body":"right, we're taking some money"},{"startTime":3297.99,"endTime":3300.54,"body":"from A and giving it to B."},{"startTime":3300.54,"endTime":3303.66,"body":"And I think, again, I've got to be honest,"},{"startTime":3303.66,"endTime":3305.46,"body":"these things will take time to mature."},{"startTime":3305.46,"endTime":3308.76,"body":"The behaviours that have been"},{"startTime":3305.46,"endTime":3308.76,"body":"associated with competition"},{"startTime":3308.76,"endTime":3311.46,"body":"are very different to"},{"startTime":3308.76,"endTime":3311.46,"body":"those with collaboration."},{"startTime":3311.46,"endTime":3312.6,"body":"People are going to have to let go."},{"startTime":3312.6,"endTime":3315.27,"body":"And a lot of our leaders"},{"startTime":3312.6,"endTime":3315.27,"body":"today have succeeded"},{"startTime":3315.27,"endTime":3317.13,"body":"in the world of competition."},{"startTime":3317.13,"endTime":3320.34,"body":"So either, they've got"},{"startTime":3317.13,"endTime":3320.34,"body":"to relearn the skills of"},{"startTime":3320.34,"endTime":3322.8,"body":"collaboration and the"},{"startTime":3320.34,"endTime":3322.8,"body":"behaviours that come with it"},{"startTime":3322.8,"endTime":3324.42,"body":"and teams have to as well."},{"startTime":3324.42,"endTime":3328.29,"body":"So it's not a quick fix, but"},{"startTime":3324.42,"endTime":3328.29,"body":"that's the direction of travel,"},{"startTime":3328.29,"endTime":3329.397,"body":"we're being encouraged to go in."},{"startTime":3329.397,"endTime":3332.58,"body":"And I think what we need"},{"startTime":3329.397,"endTime":3332.58,"body":"to do is make sure that"},{"startTime":3332.58,"endTime":3334.92,"body":"whatever emerges in those collaboratives"},{"startTime":3334.92,"endTime":3336.12,"body":"does commissioning really well,"},{"startTime":3336.12,"endTime":3337.92,"body":"that it takes on those responsibilities"},{"startTime":3337.92,"endTime":3340.071,"body":"of understanding the"},{"startTime":3337.92,"endTime":3340.071,"body":"needs of the population"},{"startTime":3340.071,"endTime":3342.87,"body":"and working out how the"},{"startTime":3340.071,"endTime":3342.87,"body":"resources that are spent"},{"startTime":3342.87,"endTime":3345.48,"body":"across the whole pathway"},{"startTime":3342.87,"endTime":3345.48,"body":"could be better utilised."},{"startTime":3345.48,"endTime":3348.39,"body":"So back to that conversation"},{"startTime":3345.48,"endTime":3348.39,"body":"we had earlier, really, David."},{"startTime":3348.39,"endTime":3352.14,"body":"- And if I'm going to be"},{"startTime":3348.39,"endTime":3352.14,"body":"didactic for our audience here,"},{"startTime":3352.14,"endTime":3353.607,"body":"and which I really shouldn't be,"},{"startTime":3353.607,"endTime":3355.26,"body":"but I can't resist doing it."},{"startTime":3355.26,"endTime":3356.97,"body":"Basically, if you've got a marketing plan"},{"startTime":3356.97,"endTime":3359.19,"body":"or a territory plan or if"},{"startTime":3356.97,"endTime":3359.19,"body":"you're looking at your KOLs"},{"startTime":3359.19,"endTime":3362.285,"body":"and it's not taken into account"},{"startTime":3359.19,"endTime":3362.285,"body":"provider collaboratives,"},{"startTime":3362.285,"endTime":3363.727,"body":"if you're sitting there thinking,"},{"startTime":3363.727,"endTime":3365.85,"body":"\"I don't know what"},{"startTime":3363.727,"endTime":3365.85,"body":"Richard's talking about,\""},{"startTime":3365.85,"endTime":3368.37,"body":"you need to think about it."},{"startTime":3368.37,"endTime":3370.62,"body":"It is a real opportunity for you"},{"startTime":3370.62,"endTime":3373.59,"body":"and it's a way your"},{"startTime":3370.62,"endTime":3373.59,"body":"traditional links will be in"},{"startTime":3373.59,"endTime":3376.53,"body":"with the providers, with the"},{"startTime":3373.59,"endTime":3376.53,"body":"clinical KOLs, for example,"},{"startTime":3376.53,"endTime":3377.67,"body":"and they can push upwards"},{"startTime":3377.67,"endTime":3379.83,"body":"and access funding and access change."},{"startTime":3379.83,"endTime":3381.68,"body":"So, that's why I wanted to come back."},{"startTime":3381.68,"endTime":3385.14,"body":"I thought it was a great spot"},{"startTime":3381.68,"endTime":3385.14,"body":"from Richard at the start."},{"startTime":3385.14,"endTime":3388.05,"body":"- And David, that's"},{"startTime":3385.14,"endTime":3388.05,"body":"such an important part."},{"startTime":3388.05,"endTime":3389.49,"body":"Can I just emphasise"},{"startTime":3388.05,"endTime":3389.49,"body":"what you've said there?"},{"startTime":3389.49,"endTime":3391.2,"body":"- Yeah."},{"startTime":3389.49,"endTime":3391.2,"body":"- It's such a key opportunity."},{"startTime":3391.2,"endTime":3394.62,"body":"They will be making a lot"},{"startTime":3391.2,"endTime":3394.62,"body":"of the buying decisions"},{"startTime":3394.62,"endTime":3397.448,"body":"and so getting in and talking"},{"startTime":3394.62,"endTime":3397.448,"body":"with them, working with them"},{"startTime":3397.448,"endTime":3400.62,"body":"and demonstrating how your solution"},{"startTime":3400.62,"endTime":3403.8,"body":"could help them solve the"},{"startTime":3400.62,"endTime":3403.8,"body":"problem they now own entirely."},{"startTime":3403.8,"endTime":3405.903,"body":"Whereas in the past they only"},{"startTime":3403.8,"endTime":3405.903,"body":"owned a bit of the problem."},{"startTime":3405.903,"endTime":3408.03,"body":"They now will own more of that problem."},{"startTime":3408.03,"endTime":3409.807,"body":"So there is a real opportunity there"},{"startTime":3409.807,"endTime":3411.75,"body":"to have a different relationship,"},{"startTime":3411.75,"endTime":3413.28,"body":"but it will take time, it won't happen"},{"startTime":3413.28,"endTime":3414.57,"body":"just because you pick up the phone."},{"startTime":3414.57,"endTime":3415.83,"body":"It will take time to mature."},{"startTime":3415.83,"endTime":3418.41,"body":"- Yeah, and we're kind of making"},{"startTime":3415.83,"endTime":3418.41,"body":"the rules as you go along."},{"startTime":3418.41,"endTime":3419.52,"body":"We've got a couple of minutes left"},{"startTime":3419.52,"endTime":3420.353,"body":"and I'm going to leave it to"},{"startTime":3420.353,"endTime":3422.79,"body":"Robert at Mtech Access to summarise."},{"startTime":3422.79,"endTime":3424.41,"body":"But Richard, I always ask this question."},{"startTime":3424.41,"endTime":3426.61,"body":"I'm never likely to interview you,"},{"startTime":3426.61,"endTime":3429.69,"body":"but I always ask this question"},{"startTime":3426.61,"endTime":3429.69,"body":"at interviews and things."},{"startTime":3429.69,"endTime":3431.07,"body":"What should we have asked you?"},{"startTime":3431.07,"endTime":3434.22,"body":"What were you expecting"},{"startTime":3431.07,"endTime":3434.22,"body":"to talk about today"},{"startTime":3434.22,"endTime":3436.08,"body":"that we haven't covered?"},{"startTime":3436.08,"endTime":3438.353,"body":"Is there anything that we've missed off?"},{"startTime":3438.353,"endTime":3441.03,"body":"- I'm glad we didn't entirely"},{"startTime":3438.353,"endTime":3441.03,"body":"talk about money or flows,"},{"startTime":3441.03,"endTime":3441.863,"body":"I'll be honest with you, David,"},{"startTime":3441.863,"endTime":3444.57,"body":"I would've struggled to do that justice."},{"startTime":3444.57,"endTime":3446.82,"body":"I think we've covered the big themes."},{"startTime":3446.82,"endTime":3449.16,"body":"I think it is a changing landscape"},{"startTime":3449.16,"endTime":3450.63,"body":"and it's an evolving landscape"},{"startTime":3450.63,"endTime":3453.93,"body":"and I think I would often say,"},{"startTime":3453.93,"endTime":3455.76,"body":"we need to be kind to each other"},{"startTime":3455.76,"endTime":3457.37,"body":"and we need to have"},{"startTime":3455.76,"endTime":3457.37,"body":"empathy with the fact that"},{"startTime":3457.37,"endTime":3460.08,"body":"it is a changing landscape and"},{"startTime":3457.37,"endTime":3460.08,"body":"people are doing their best."},{"startTime":3460.08,"endTime":3462.15,"body":"And I think on all sides,"},{"startTime":3462.15,"endTime":3464.55,"body":"let's start with that mindset in a way."},{"startTime":3464.55,"endTime":3468.9,"body":"And for me, a lot of the"},{"startTime":3464.55,"endTime":3468.9,"body":"problems we have are behavioural,"},{"startTime":3468.9,"endTime":3471.0,"body":"and if we start with"},{"startTime":3468.9,"endTime":3471.0,"body":"changing our own behaviour,"},{"startTime":3471.0,"endTime":3472.545,"body":"then I think we can influence others."},{"startTime":3472.545,"endTime":3475.476,"body":"The operating framework will"},{"startTime":3472.545,"endTime":3475.476,"body":"guide us and be helpful,"},{"startTime":3475.476,"endTime":3477.27,"body":"but actually, it's the behavioural stuff"},{"startTime":3477.27,"endTime":3479.32,"body":"that will be the biggest gain in my mind."},{"startTime":3480.42,"endTime":3481.47,"body":"- I totally agree with you."},{"startTime":3481.47,"endTime":3484.56,"body":"Let me just check this out in 20 seconds."},{"startTime":3484.56,"endTime":3486.12,"body":"When the operating framework comes out,"},{"startTime":3486.12,"endTime":3487.38,"body":"if you do a word count of it,"},{"startTime":3487.38,"endTime":3489.083,"body":"I think productivity"},{"startTime":3487.38,"endTime":3489.083,"body":"will be one of the words"},{"startTime":3489.083,"endTime":3491.41,"body":"that is mentioned frequently in there."},{"startTime":3491.41,"endTime":3493.35,"body":"What that actually means in practice"},{"startTime":3493.35,"endTime":3495.21,"body":"is change the behavioural stuff, isn't it?"},{"startTime":3495.21,"endTime":3497.67,"body":"- Yeah."},{"startTime":3495.21,"endTime":3497.67,"body":"- I can remember"},{"startTime":3497.67,"endTime":3499.637,"body":"working in a hospital"},{"startTime":3497.67,"endTime":3499.637,"body":"where the nurses in theatre"},{"startTime":3499.637,"endTime":3501.09,"body":"started at half past seven"},{"startTime":3501.09,"endTime":3502.95,"body":"and the doctors came in at eight o'clock"},{"startTime":3502.95,"endTime":3506.487,"body":"and everyone couldn't"},{"startTime":3502.95,"endTime":3506.487,"body":"understand why the theatre"},{"startTime":3506.487,"endTime":3509.04,"body":"has always overran by half an hour."},{"startTime":3509.04,"endTime":3510.24,"body":"It's that kind of thing."},{"startTime":3511.56,"endTime":3514.05,"body":"And being kind to each"},{"startTime":3511.56,"endTime":3514.05,"body":"other and flexibility."},{"startTime":3514.05,"endTime":3517.71,"body":"One of the big takeaway"},{"startTime":3514.05,"endTime":3517.71,"body":"messages I'll hear today"},{"startTime":3517.71,"endTime":3519.51,"body":"is your point about,"},{"startTime":3519.51,"endTime":3521.88,"body":"it's not just saying, can"},{"startTime":3519.51,"endTime":3521.88,"body":"we have another 10 quid?"},{"startTime":3521.88,"endTime":3524.46,"body":"It's what we are doing"},{"startTime":3521.88,"endTime":3524.46,"body":"with the billion quid"},{"startTime":3524.46,"endTime":3527.523,"body":"that we've currently got"},{"startTime":3524.46,"endTime":3527.523,"body":"and how do we spend it?"},{"startTime":3527.523,"endTime":3529.42,"body":"That makes a lot of sense to me"},{"startTime":3530.34,"endTime":3533.01,"body":"as a citizen, as a taxpayer as well."},{"startTime":3533.01,"endTime":3535.222,"body":"Richard, thank you so much"},{"startTime":3533.01,"endTime":3535.222,"body":"for all your insights today,"},{"startTime":3535.222,"endTime":3538.41,"body":"absolutely cracking and your candour"},{"startTime":3538.41,"endTime":3540.241,"body":"and also how skillfully you've negotiated"},{"startTime":3540.241,"endTime":3543.69,"body":"some of the policy things"},{"startTime":3540.241,"endTime":3543.69,"body":"given your place at region."},{"startTime":3543.69,"endTime":3546.72,"body":"So thank you very much for that."},{"startTime":3546.72,"endTime":3548.73,"body":"- Thank you for the opportunity."},{"startTime":3548.73,"endTime":3549.563,"body":"- Thank you Richard."},{"startTime":3549.563,"endTime":3550.68,"body":"- Sorry I cut you off there."},{"startTime":3550.68,"endTime":3551.63,"body":"- Rob, over to you."},{"startTime":3552.717,"endTime":3553.65,"body":"- Oh, thank you David."},{"startTime":3553.65,"endTime":3556.11,"body":"Yeah, just basically"},{"startTime":3553.65,"endTime":3556.11,"body":"echoing David, thanks."},{"startTime":3556.11,"endTime":3557.91,"body":"That was a really insightful session today"},{"startTime":3557.91,"endTime":3559.78,"body":"and as we bring the webinar to a close,"},{"startTime":3559.78,"endTime":3562.724,"body":"I just want to offer all the"},{"startTime":3559.78,"endTime":3562.724,"body":"participants the opportunity"},{"startTime":3562.724,"endTime":3563.872,"body":"to work with Mtech Access,"},{"startTime":3563.872,"endTime":3565.101,"body":"those of you who have attended today,"},{"startTime":3565.101,"endTime":3567.24,"body":"if you want to delve"},{"startTime":3565.101,"endTime":3567.24,"body":"deeper into those pathways"},{"startTime":3567.24,"endTime":3569.28,"body":"about funding flows and how"},{"startTime":3567.24,"endTime":3569.28,"body":"they impact your business"},{"startTime":3569.28,"endTime":3572.601,"body":"and looking at products and"},{"startTime":3569.28,"endTime":3572.601,"body":"assets, organisational levels,"},{"startTime":3572.601,"endTime":3574.08,"body":"then that's certainly something"},{"startTime":3574.08,"endTime":3576.0,"body":"that we can help support you with."},{"startTime":3576.0,"endTime":3577.65,"body":"We can also look at"},{"startTime":3576.0,"endTime":3577.65,"body":"some real world examples"},{"startTime":3577.65,"endTime":3581.15,"body":"and identify case studies and"},{"startTime":3577.65,"endTime":3581.15,"body":"stakeholders able to help you."},{"startTime":3581.15,"endTime":3584.49,"body":"So if you'd like to talk us"},{"startTime":3581.15,"endTime":3584.49,"body":"regarding one of these services,"},{"startTime":3584.49,"endTime":3588.99,"body":"please do reach out"},{"startTime":3584.49,"endTime":3588.99,"body":"info@mtechaccess.co.uk."},{"startTime":3588.99,"endTime":3591.353,"body":"Thank you very much both"},{"startTime":3588.99,"endTime":3591.353,"body":"of you, and bye for now."},{"startTime":3591.353,"endTime":3592.186,"body":"- Bye."},{"startTime":3591.353,"endTime":3592.186,"body":"- Cheers."},{"startTime":3592.186,"endTime":3593.97,"body":"Bye Rob, bye Richard, bye-bye everyone."},{"startTime":3595.8,"endTime":3597.39,"body":"- [Announcer] Thank you for watching."},{"startTime":3597.39,"endTime":3600.6,"body":"If you'd like to find out more"},{"startTime":3597.39,"endTime":3600.6,"body":"about our work with the NHS"},{"startTime":3600.6,"endTime":3603.51,"body":"or how we could support"},{"startTime":3600.6,"endTime":3603.51,"body":"your market access goals,"},{"startTime":3603.51,"endTime":3605.65,"body":"please email info@mtechaccess.co.uk"},{"startTime":3608.43,"endTime":3612.603,"body":"or visit our website at mtechaccess.co.uk."}]}