{"version":"1.0.0","segments":[{"startTime":1.05,"endTime":3.93,"body":"- [Announcer] Welcome to this"},{"startTime":1.05,"endTime":3.93,"body":"Petauri Evidence webinar."},{"startTime":3.93,"endTime":6.51,"body":"At Petauri Evidence, we"},{"startTime":3.93,"endTime":6.51,"body":"deliver market access"},{"startTime":6.51,"endTime":9.99,"body":"and HEOR support throughout"},{"startTime":6.51,"endTime":9.99,"body":"the product lifecycle"},{"startTime":9.99,"endTime":13.263,"body":"to bring new treatments to"},{"startTime":9.99,"endTime":13.263,"body":"patients across global markets."},{"startTime":14.46,"endTime":18.99,"body":"Follow us on LinkedIn for more"},{"startTime":14.46,"endTime":18.99,"body":"great content from our team."},{"startTime":18.99,"endTime":21.57,"body":"We hope you enjoy the discussion."},{"startTime":21.57,"endTime":24.29,"body":"- Welcome, everyone, to"},{"startTime":21.57,"endTime":24.29,"body":"our third live Q\u0026A session"},{"startTime":24.29,"endTime":27.81,"body":"in this NHS Whispers webinar series."},{"startTime":27.81,"endTime":30.24,"body":"In this series, we've been"},{"startTime":27.81,"endTime":30.24,"body":"following the evolving structure"},{"startTime":30.24,"endTime":32.46,"body":"of the NHS, which is now obviously shaped"},{"startTime":32.46,"endTime":33.9,"body":"by the new 10-year plan."},{"startTime":33.9,"endTime":35.04,"body":"And exploring your questions"},{"startTime":35.04,"endTime":36.75,"body":"around what these changes really mean,"},{"startTime":36.75,"endTime":38.31,"body":"what's happening on the ground,"},{"startTime":38.31,"endTime":40.86,"body":"and what you need to consider"},{"startTime":38.31,"endTime":40.86,"body":"in the coming weeks and months"},{"startTime":40.86,"endTime":43.26,"body":"in terms of your market access strategies."},{"startTime":43.26,"endTime":44.25,"body":"I'm Katie Mulholland,"},{"startTime":44.25,"endTime":47.31,"body":"part of the UK Market Access"},{"startTime":44.25,"endTime":47.31,"body":"team at Petauri Evidence,"},{"startTime":47.31,"endTime":49.71,"body":"a global market access"},{"startTime":47.31,"endTime":49.71,"body":"and HEOR consultancy"},{"startTime":49.71,"endTime":51.48,"body":"within the Petauri platform."},{"startTime":51.48,"endTime":52.86,"body":"For those of you who may not know,"},{"startTime":52.86,"endTime":55.247,"body":"we specialise in supporting"},{"startTime":52.86,"endTime":55.247,"body":"biopharma companies"},{"startTime":55.247,"endTime":58.17,"body":"across the full spectrum"},{"startTime":55.247,"endTime":58.17,"body":"of market access strategy"},{"startTime":58.17,"endTime":60.09,"body":"with particular expertise in UK launches,"},{"startTime":60.09,"endTime":62.22,"body":"navigating NHS dynamics."},{"startTime":62.22,"endTime":65.82,"body":"Our work is deeply informed"},{"startTime":62.22,"endTime":65.82,"body":"by our in-house experience"},{"startTime":65.82,"endTime":68.76,"body":"and enriched by our network"},{"startTime":65.82,"endTime":68.76,"body":"of NHS partners as well."},{"startTime":68.76,"endTime":71.76,"body":"We provide really valuable"},{"startTime":68.76,"endTime":71.76,"body":"insights through advisory boards,"},{"startTime":71.76,"endTime":73.11,"body":"strategic input and feedback"},{"startTime":73.11,"endTime":75.78,"body":"on value propositions and messaging,"},{"startTime":75.78,"endTime":78.03,"body":"just as a few examples."},{"startTime":78.03,"endTime":80.82,"body":"We're delighted to welcome our"},{"startTime":78.03,"endTime":80.82,"body":"guests for today's session."},{"startTime":80.82,"endTime":82.59,"body":"And we're really looking"},{"startTime":80.82,"endTime":82.59,"body":"forward to a lively"},{"startTime":82.59,"endTime":84.51,"body":"and insightful discussion again,"},{"startTime":84.51,"endTime":86.7,"body":"and hopefully you'll all find it helpful."},{"startTime":86.7,"endTime":89.1,"body":"Firstly, we have Sarah Everest Ford."},{"startTime":89.1,"endTime":91.95,"body":"So Sarah is currently working"},{"startTime":89.1,"endTime":91.95,"body":"as a Programme Director"},{"startTime":91.95,"endTime":93.87,"body":"in a Health and Care Partnership"},{"startTime":93.87,"endTime":95.73,"body":"leading a number of"},{"startTime":93.87,"endTime":95.73,"body":"transformation programmes"},{"startTime":95.73,"endTime":98.16,"body":"including neighbourhood"},{"startTime":95.73,"endTime":98.16,"body":"health and integration."},{"startTime":98.16,"endTime":99.87,"body":"And her background is varied"},{"startTime":99.87,"endTime":102.9,"body":"from starting as a children's"},{"startTime":99.87,"endTime":102.9,"body":"nurse over 25 years ago"},{"startTime":102.9,"endTime":104.94,"body":"to the last 10 years where"},{"startTime":102.9,"endTime":104.94,"body":"Sarah's worked in a number"},{"startTime":104.94,"endTime":106.41,"body":"of senior roles in commissioning,"},{"startTime":106.41,"endTime":108.48,"body":"business development and strategy."},{"startTime":108.48,"endTime":109.803,"body":"So welcome, Sarah."},{"startTime":110.85,"endTime":112.44,"body":"Next we have Paddy McGee."},{"startTime":112.44,"endTime":115.95,"body":"So Paddy joined the NHS to"},{"startTime":112.44,"endTime":115.95,"body":"do the NHS graduate scheme,"},{"startTime":115.95,"endTime":117.45,"body":"and has been in various operational"},{"startTime":117.45,"endTime":120.18,"body":"and commissioning roles since."},{"startTime":120.18,"endTime":122.49,"body":"Most recently he's been Head"},{"startTime":120.18,"endTime":122.49,"body":"of Strategy and Planning"},{"startTime":122.49,"endTime":125.31,"body":"in the NHS Greater Manchester ICB."},{"startTime":125.31,"endTime":127.89,"body":"And he's currently the"},{"startTime":125.31,"endTime":127.89,"body":"Deputy Programme Director"},{"startTime":127.89,"endTime":129.6,"body":"for LSE Pathology."},{"startTime":129.6,"endTime":131.7,"body":"So welcome, Paddy."},{"startTime":131.7,"endTime":134.25,"body":"And then finally we have"},{"startTime":131.7,"endTime":134.25,"body":"our own Phil Richardson,"},{"startTime":134.25,"endTime":137.73,"body":"who I'll be posing questions"},{"startTime":134.25,"endTime":137.73,"body":"to you as well today."},{"startTime":137.73,"endTime":140.37,"body":"So Phil was the former"},{"startTime":137.73,"endTime":140.37,"body":"Dorset ICS System Lead,"},{"startTime":140.37,"endTime":141.69,"body":"and he's got loads of experience"},{"startTime":141.69,"endTime":143.82,"body":"in the changing NHS landscape"},{"startTime":143.82,"endTime":146.763,"body":"having led the formation"},{"startTime":143.82,"endTime":146.763,"body":"of one of the first ICSs."},{"startTime":147.63,"endTime":150.537,"body":"We've had a really fantastic"},{"startTime":147.63,"endTime":150.537,"body":"turnout so far for this series,"},{"startTime":150.537,"endTime":152.79,"body":"and we've had a lot of"},{"startTime":150.537,"endTime":152.79,"body":"listeners submitting questions"},{"startTime":152.79,"endTime":154.62,"body":"for our previous Q\u0026A sessions."},{"startTime":154.62,"endTime":156.57,"body":"And thank you so much to those of you"},{"startTime":156.57,"endTime":159.48,"body":"who've submitted questions"},{"startTime":156.57,"endTime":159.48,"body":"for today's session as well."},{"startTime":159.48,"endTime":161.73,"body":"Just to remind you, there"},{"startTime":159.48,"endTime":161.73,"body":"is a question box for you"},{"startTime":161.73,"endTime":164.37,"body":"to submit any further questions"},{"startTime":161.73,"endTime":164.37,"body":"too throughout the session."},{"startTime":164.37,"endTime":167.07,"body":"So please just check"},{"startTime":164.37,"endTime":167.07,"body":"that you can see this."},{"startTime":167.07,"endTime":168.15,"body":"And do use it."},{"startTime":168.15,"endTime":169.86,"body":"We'll try and come to any other questions"},{"startTime":169.86,"endTime":171.63,"body":"that you may have submitted at the end."},{"startTime":171.63,"endTime":174.24,"body":"If we don't get to your"},{"startTime":171.63,"endTime":174.24,"body":"questions during the session,"},{"startTime":174.24,"endTime":176.07,"body":"we'll follow up via email after"},{"startTime":176.07,"endTime":178.62,"body":"just to make sure that"},{"startTime":176.07,"endTime":178.62,"body":"you do have an answer."},{"startTime":178.62,"endTime":181.8,"body":"So I think that brings"},{"startTime":178.62,"endTime":181.8,"body":"us to our questions."},{"startTime":181.8,"endTime":184.71,"body":"So to start, we've had quite"},{"startTime":181.8,"endTime":184.71,"body":"a few questions have come in"},{"startTime":184.71,"endTime":186.61,"body":"around the ongoing structural changes."},{"startTime":187.62,"endTime":188.453,"body":"The first question,"},{"startTime":188.453,"endTime":190.383,"body":"Sarah, I'm going to come to you first."},{"startTime":191.452,"endTime":192.448,"body":"And the first question is,"},{"startTime":192.448,"endTime":194.58,"body":"\"Are the ICB in NHS England redundancies"},{"startTime":194.58,"endTime":195.96,"body":"really going to happen,"},{"startTime":195.96,"endTime":198.057,"body":"and what is driving this decision?\""},{"startTime":199.47,"endTime":202.29,"body":"- Thanks, Katie. Great first question."},{"startTime":202.29,"endTime":206.25,"body":"I think it all comes down"},{"startTime":202.29,"endTime":206.25,"body":"to who is going to pay."},{"startTime":206.25,"endTime":208.86,"body":"I know there's lots of"},{"startTime":206.25,"endTime":208.86,"body":"conversations taking place"},{"startTime":208.86,"endTime":213.86,"body":"at the moment between NHSE"},{"startTime":208.86,"endTime":213.86,"body":"and central government."},{"startTime":213.9,"endTime":217.35,"body":"I know locally, the ICB that I work with,"},{"startTime":217.35,"endTime":219.78,"body":"I've got some real financial challenges"},{"startTime":219.78,"endTime":222.0,"body":"and don't have the money"},{"startTime":222.0,"endTime":224.665,"body":"to pay for the redundancies in year."},{"startTime":224.665,"endTime":226.95,"body":"I know other ICBs are looking at splitting"},{"startTime":226.95,"endTime":230.19,"body":"the redundancy costs"},{"startTime":226.95,"endTime":230.19,"body":"across more than one year."},{"startTime":230.19,"endTime":233.64,"body":"So I think there's some"},{"startTime":230.19,"endTime":233.64,"body":"real conversations happening"},{"startTime":233.64,"endTime":235.56,"body":"about the actual money side."},{"startTime":235.56,"endTime":237.39,"body":"But I think more importantly, for me,"},{"startTime":237.39,"endTime":238.89,"body":"it's that human perspective."},{"startTime":238.89,"endTime":240.75,"body":"We're talking about people's lives."},{"startTime":240.75,"endTime":244.53,"body":"A lot of my colleagues from the ICB,"},{"startTime":244.53,"endTime":246.15,"body":"they went through a restructure last year."},{"startTime":246.15,"endTime":249.59,"body":"I think they lost about 25 to 30%"},{"startTime":249.59,"endTime":251.493,"body":"of the workforce through that."},{"startTime":252.57,"endTime":256.044,"body":"And again is now looking at another 50%"},{"startTime":256.044,"endTime":258.78,"body":"and then 50% effect"},{"startTime":256.044,"endTime":258.78,"body":"going out into providers."},{"startTime":258.78,"endTime":261.6,"body":"I just think it's a lot for"},{"startTime":258.78,"endTime":261.6,"body":"people to be dealing with,"},{"startTime":261.6,"endTime":263.85,"body":"and it's really interesting"},{"startTime":261.6,"endTime":263.85,"body":"that I think there's a real lack"},{"startTime":263.85,"endTime":266.88,"body":"of interest in the media, I think,"},{"startTime":266.88,"endTime":268.62,"body":"because it's generally seen as managers"},{"startTime":268.62,"endTime":270.873,"body":"and not so much frontline staff."},{"startTime":272.042,"endTime":274.17,"body":"And I think it's just"},{"startTime":272.042,"endTime":274.17,"body":"really tough for people."},{"startTime":274.17,"endTime":277.41,"body":"People might be left with"},{"startTime":274.17,"endTime":277.41,"body":"a job, they might not be,"},{"startTime":277.41,"endTime":280.59,"body":"it might be a different role"},{"startTime":277.41,"endTime":280.59,"body":"to the one they want to do."},{"startTime":280.59,"endTime":283.05,"body":"Thinking about kind of"},{"startTime":280.59,"endTime":283.05,"body":"strategic commissioner,"},{"startTime":283.05,"endTime":285.12,"body":"a lot of my colleagues have"},{"startTime":283.05,"endTime":285.12,"body":"spent the last sort of five,"},{"startTime":285.12,"endTime":289.14,"body":"10 years working in a"},{"startTime":285.12,"endTime":289.14,"body":"much more integrated way"},{"startTime":289.14,"endTime":291.63,"body":"and collaborative way with providers"},{"startTime":291.63,"endTime":294.75,"body":"and what the strategic"},{"startTime":291.63,"endTime":294.75,"body":"commissioner role will look like"},{"startTime":294.75,"endTime":297.81,"body":"going forward I think is is a bit unknown."},{"startTime":297.81,"endTime":299.43,"body":"It's been really disruptive."},{"startTime":299.43,"endTime":302.43,"body":"I think it impacts decision-making,"},{"startTime":302.43,"endTime":305.07,"body":"and I think what is it"},{"startTime":302.43,"endTime":305.07,"body":"actually sort of costing"},{"startTime":305.07,"endTime":307.593,"body":"from a human and an economic perspective."},{"startTime":309.6,"endTime":311.43,"body":"- Yeah, thank you. Some"},{"startTime":309.6,"endTime":311.43,"body":"really good points."},{"startTime":311.43,"endTime":314.49,"body":"I don't, know Paddy, maybe"},{"startTime":311.43,"endTime":314.49,"body":"you've got some other bits"},{"startTime":314.49,"endTime":315.323,"body":"to add there."},{"startTime":317.79,"endTime":321.3,"body":"- I mean, firstly sort of"},{"startTime":317.79,"endTime":321.3,"body":"share the sentiment with Sarah"},{"startTime":321.3,"endTime":325.713,"body":"that it is difficult from a"},{"startTime":321.3,"endTime":325.713,"body":"sort of human factor side."},{"startTime":327.27,"endTime":330.273,"body":"Secondly, there is obviously"},{"startTime":327.27,"endTime":330.273,"body":"the impact on actual delivery."},{"startTime":331.8,"endTime":336.033,"body":"ICBs were brought about sort"},{"startTime":331.8,"endTime":336.033,"body":"of two or three years ago now."},{"startTime":337.434,"endTime":341.28,"body":"And the commissioning function"},{"startTime":337.434,"endTime":341.28,"body":"is not where it needs to be."},{"startTime":341.28,"endTime":344.52,"body":"So we do need to draw"},{"startTime":341.28,"endTime":344.52,"body":"this sort of restructure"},{"startTime":344.52,"endTime":345.93,"body":"to a close at some point."},{"startTime":345.93,"endTime":349.59,"body":"Obviously Sarah referenced"},{"startTime":345.93,"endTime":349.59,"body":"that there's no confirmation"},{"startTime":349.59,"endTime":352.32,"body":"of where the funding will"},{"startTime":349.59,"endTime":352.32,"body":"come from at the moment."},{"startTime":352.32,"endTime":354.93,"body":"So Jim has recently said that NHSE"},{"startTime":354.93,"endTime":359.93,"body":"never promised central"},{"startTime":354.93,"endTime":359.93,"body":"funding for the redundancies."},{"startTime":360.15,"endTime":363.15,"body":"The current sort of"},{"startTime":360.15,"endTime":363.15,"body":"projected redundancies,"},{"startTime":363.15,"endTime":367.74,"body":"you know, will cost sort"},{"startTime":363.15,"endTime":367.74,"body":"circa a billion quid."},{"startTime":367.74,"endTime":371.07,"body":"So there's certainly not that"},{"startTime":367.74,"endTime":371.07,"body":"within any of the ICP budgets"},{"startTime":371.07,"endTime":374.34,"body":"that I'm close to or aware of."},{"startTime":374.34,"endTime":375.78,"body":"So I think it is difficult."},{"startTime":375.78,"endTime":377.643,"body":"I do think it's going to happen."},{"startTime":378.69,"endTime":383.46,"body":"I think based on that"},{"startTime":378.69,"endTime":383.46,"body":"central government policy,"},{"startTime":383.46,"endTime":384.69,"body":"some something needs to happen."},{"startTime":384.69,"endTime":386.763,"body":"So Jim said himself a couple months ago,"},{"startTime":387.9,"endTime":391.293,"body":"the NHS budget is the size"},{"startTime":387.9,"endTime":391.293,"body":"of the whole GDP of Portugal."},{"startTime":392.16,"endTime":395.22,"body":"So we do need to do something to sustain"},{"startTime":395.22,"endTime":397.32,"body":"and improve the provision of services."},{"startTime":397.32,"endTime":398.64,"body":"We have to act in some way."},{"startTime":398.64,"endTime":401.94,"body":"So I do think we are going to get there,"},{"startTime":401.94,"endTime":405.63,"body":"and Sir Jim Mackey has a reputation"},{"startTime":405.63,"endTime":408.03,"body":"for delivering what he"},{"startTime":405.63,"endTime":408.03,"body":"says is going to deliver."},{"startTime":408.93,"endTime":411.12,"body":"So I do, it answer the original question,"},{"startTime":411.12,"endTime":412.8,"body":"yes, I do think it will happen."},{"startTime":412.8,"endTime":414.093,"body":"How is the difficult bit."},{"startTime":415.26,"endTime":416.73,"body":"- Yeah. No, thank you."},{"startTime":416.73,"endTime":421.47,"body":"And in terms of NHS England"},{"startTime":416.73,"endTime":421.47,"body":"and what might replace it"},{"startTime":421.47,"endTime":424.74,"body":"and over what time period,"},{"startTime":421.47,"endTime":424.74,"body":"do you have any thoughts?"},{"startTime":424.74,"endTime":426.33,"body":"I'll come back to you again, Paddy,"},{"startTime":426.33,"endTime":427.86,"body":"do you have any thoughts on that?"},{"startTime":427.86,"endTime":429.423,"body":"Has there been any updates?"},{"startTime":437.34,"endTime":438.3,"body":"Well, I can't hear you, Paddy."},{"startTime":438.3,"endTime":439.26,"body":"I don't know if that's just me"},{"startTime":439.26,"endTime":440.82,"body":"or if that's others as well."},{"startTime":440.82,"endTime":443.82,"body":"- Sorry, I'm mute too myself"},{"startTime":440.82,"endTime":443.82,"body":"'cause of the feedback."},{"startTime":443.82,"endTime":445.29,"body":"Can you hear me now Katie, yeah?"},{"startTime":445.29,"endTime":446.22,"body":"- Yeah."},{"startTime":446.22,"endTime":448.02,"body":"- Yeah. Okay, thanks."},{"startTime":448.02,"endTime":450.51,"body":"I think Wes Streeting"},{"startTime":448.02,"endTime":450.51,"body":"announced a time period"},{"startTime":450.51,"endTime":451.53,"body":"of roughly two years,"},{"startTime":451.53,"endTime":456.53,"body":"both for the NHSE absorption"},{"startTime":451.53,"endTime":456.53,"body":"into the Department for health"},{"startTime":458.575,"endTime":462.633,"body":"and also to the changes to"},{"startTime":458.575,"endTime":462.633,"body":"ICSs and the changes to region."},{"startTime":464.7,"endTime":467.61,"body":"I think that two-year"},{"startTime":464.7,"endTime":467.61,"body":"period will obviously"},{"startTime":467.61,"endTime":470.37,"body":"depend on the previous question"},{"startTime":467.61,"endTime":470.37,"body":"around the redundancies"},{"startTime":470.37,"endTime":471.423,"body":"in the restructure."},{"startTime":474.752,"endTime":475.92,"body":"It will sort of depend on that I think"},{"startTime":475.92,"endTime":480.92,"body":"in terms of how that new sort"},{"startTime":475.92,"endTime":480.92,"body":"of centralised body will look."},{"startTime":482.28,"endTime":485.64,"body":"It will be a reabsorption"},{"startTime":482.28,"endTime":485.64,"body":"of many of NHSE's functions"},{"startTime":485.64,"endTime":486.9,"body":"into Department of Health."},{"startTime":486.9,"endTime":491.73,"body":"A reduction of the duplication"},{"startTime":486.9,"endTime":491.73,"body":"of policy teams in both NHSE"},{"startTime":491.73,"endTime":494.16,"body":"and Department for Health,"},{"startTime":494.16,"endTime":498.48,"body":"and NHSE that's focused"},{"startTime":494.16,"endTime":498.48,"body":"strongly on standards"},{"startTime":498.48,"endTime":500.463,"body":"and major programmes of change."},{"startTime":502.838,"endTime":505.65,"body":"A much stricter performance"},{"startTime":502.838,"endTime":505.65,"body":"assurance regime,"},{"startTime":505.65,"endTime":507.78,"body":"which you'll have seen through"},{"startTime":505.65,"endTime":507.78,"body":"the recent league tables"},{"startTime":507.78,"endTime":510.87,"body":"issued by the Department for Health."},{"startTime":510.87,"endTime":514.26,"body":"We know from the NHSE"},{"startTime":510.87,"endTime":514.26,"body":"model region guidance"},{"startTime":514.26,"endTime":516.3,"body":"that was recently published"},{"startTime":514.26,"endTime":516.3,"body":"that more authority"},{"startTime":516.3,"endTime":520.2,"body":"and risk will sit with regions and ICSs"},{"startTime":520.2,"endTime":521.397,"body":"and provide collaboratives."},{"startTime":521.397,"endTime":523.16,"body":"And also the other point"},{"startTime":521.397,"endTime":523.16,"body":"I would make as well"},{"startTime":523.16,"endTime":525.567,"body":"is that over this two-year time period,"},{"startTime":525.567,"endTime":528.24,"body":"the transformation team has been appointed"},{"startTime":528.24,"endTime":531.18,"body":"as the sort of NHSE exec board."},{"startTime":531.18,"endTime":532.34,"body":"But if you look at the members of that,"},{"startTime":532.34,"endTime":534.843,"body":"it is very acute trust focused."},{"startTime":536.07,"endTime":538.65,"body":"So I think that potentially"},{"startTime":536.07,"endTime":538.65,"body":"gives us a signal"},{"startTime":538.65,"endTime":540.753,"body":"of where we are headed in the long-term."},{"startTime":542.415,"endTime":544.26,"body":"And there is perhaps"},{"startTime":542.415,"endTime":544.26,"body":"a slight contradiction"},{"startTime":544.26,"endTime":546.623,"body":"with the neighbourhood programme there."},{"startTime":547.495,"endTime":550.299,"body":"So I think there's still lots to work out."},{"startTime":550.299,"endTime":551.401,"body":"- Yeah, no thank you."},{"startTime":551.401,"endTime":553.932,"body":"And Sarah, I can see you"},{"startTime":551.401,"endTime":553.932,"body":"were nodding along there,"},{"startTime":553.932,"endTime":556.732,"body":"did you have anything else"},{"startTime":553.932,"endTime":556.732,"body":"to add from your perspective?"},{"startTime":558.03,"endTime":559.436,"body":"- Not really."},{"startTime":559.436,"endTime":564.21,"body":"I mean, there's been a recent"},{"startTime":559.436,"endTime":564.21,"body":"new model region blueprint,"},{"startTime":564.21,"endTime":566.34,"body":"which I think will guide some of this."},{"startTime":566.34,"endTime":569.13,"body":"I guess it's then how there's"},{"startTime":566.34,"endTime":569.13,"body":"so much change happening"},{"startTime":569.13,"endTime":571.17,"body":"at the moment in so many different places."},{"startTime":571.17,"endTime":573.33,"body":"It's how some of that is navigated"},{"startTime":573.33,"endTime":577.49,"body":"and the timescales are"},{"startTime":573.33,"endTime":577.49,"body":"not necessarily aligning"},{"startTime":577.49,"endTime":578.67,"body":"or being pushed back."},{"startTime":578.67,"endTime":580.65,"body":"And I think it's then how"},{"startTime":578.67,"endTime":580.65,"body":"that sort of all works"},{"startTime":580.65,"endTime":584.25,"body":"with the new direction of"},{"startTime":580.65,"endTime":584.25,"body":"travel with neighbourhoods"},{"startTime":584.25,"endTime":587.52,"body":"and what's done at place"},{"startTime":584.25,"endTime":587.52,"body":"and what's done at ICB,"},{"startTime":587.52,"endTime":589.41,"body":"and what's done at region"},{"startTime":587.52,"endTime":589.41,"body":"and what's done nationally."},{"startTime":589.41,"endTime":592.53,"body":"I think there's still a lot of unknowns"},{"startTime":592.53,"endTime":596.133,"body":"in terms of how that's actually"},{"startTime":592.53,"endTime":596.133,"body":"going to work in practise."},{"startTime":599.057,"endTime":601.05,"body":"- And just, I think thinking holistically,"},{"startTime":601.05,"endTime":605.25,"body":"obviously we've said"},{"startTime":601.05,"endTime":605.25,"body":"that change is needed,"},{"startTime":605.25,"endTime":607.71,"body":"but do you think ultimately"},{"startTime":605.25,"endTime":607.71,"body":"this is a real change"},{"startTime":607.71,"endTime":610.95,"body":"for the better that will"},{"startTime":607.71,"endTime":610.95,"body":"bring cost efficiencies"},{"startTime":610.95,"endTime":615.57,"body":"and not just a reshuffle"},{"startTime":610.95,"endTime":615.57,"body":"of chairs, I suppose?"},{"startTime":615.57,"endTime":617.793,"body":"Phil, maybe I'll come to you first."},{"startTime":619.38,"endTime":620.55,"body":"- Thanks, Katie."},{"startTime":620.55,"endTime":621.383,"body":"Hello, everyone."},{"startTime":622.35,"endTime":624.18,"body":"I think that's a great question."},{"startTime":624.18,"endTime":627.057,"body":"If you step back from all"},{"startTime":624.18,"endTime":627.057,"body":"of this, there is the,"},{"startTime":627.057,"endTime":629.19,"body":"why is this happening?"},{"startTime":629.19,"endTime":630.33,"body":"And there's definitely cost pressures."},{"startTime":630.33,"endTime":633.96,"body":"We've talked about cost pressures already."},{"startTime":633.96,"endTime":636.24,"body":"But there was also a"},{"startTime":633.96,"endTime":636.24,"body":"sense of disconnection"},{"startTime":636.24,"endTime":640.26,"body":"between what was happening"},{"startTime":636.24,"endTime":640.26,"body":"at a policy level nationally"},{"startTime":640.26,"endTime":641.79,"body":"in the Department of Health"},{"startTime":641.79,"endTime":644.64,"body":"and how that was executed"},{"startTime":641.79,"endTime":644.64,"body":"through NHS England,"},{"startTime":644.64,"endTime":646.59,"body":"who then had to execute through regions,"},{"startTime":646.59,"endTime":647.73,"body":"and then through ICBs,"},{"startTime":647.73,"endTime":650.28,"body":"and then through trusts and"},{"startTime":647.73,"endTime":650.28,"body":"then down into communities."},{"startTime":650.28,"endTime":653.403,"body":"So there's multi-layers of"},{"startTime":650.28,"endTime":653.403,"body":"interpretation happening."},{"startTime":654.408,"endTime":659.408,"body":"And the action taken"},{"startTime":654.408,"endTime":659.408,"body":"initially by Jim Mackey"},{"startTime":659.64,"endTime":660.72,"body":"and Penny Dash coming in,"},{"startTime":660.72,"endTime":665.34,"body":"which was we need to thin this out a bit"},{"startTime":665.34,"endTime":667.74,"body":"so we can see things."},{"startTime":667.74,"endTime":669.36,"body":"And we need to manage costs,"},{"startTime":669.36,"endTime":672.51,"body":"and we need we need to"},{"startTime":669.36,"endTime":672.51,"body":"have a tighter connection"},{"startTime":672.51,"endTime":675.42,"body":"to the what's happening on the front line."},{"startTime":675.42,"endTime":677.19,"body":"So that was triggered."},{"startTime":677.19,"endTime":679.41,"body":"And as Sarah's talked about already,"},{"startTime":679.41,"endTime":683.4,"body":"there was already a cost"},{"startTime":679.41,"endTime":683.4,"body":"cutting exercise for that"},{"startTime":683.4,"endTime":685.5,"body":"'cause ICBs bloated really quickly"},{"startTime":685.5,"endTime":687.573,"body":"following the CCG changes."},{"startTime":688.8,"endTime":693.123,"body":"So there was a couple of"},{"startTime":688.8,"endTime":693.123,"body":"key events that happened."},{"startTime":694.305,"endTime":696.93,"body":"And then the change of"},{"startTime":694.305,"endTime":696.93,"body":"governments came in."},{"startTime":696.93,"endTime":699.87,"body":"And I think they were struggling to grip"},{"startTime":699.87,"endTime":701.07,"body":"what the NHS was doing"},{"startTime":701.07,"endTime":703.62,"body":"and how it was managing"},{"startTime":701.07,"endTime":703.62,"body":"its spend of money,"},{"startTime":703.62,"endTime":706.32,"body":"'cause there was a constant flow"},{"startTime":706.32,"endTime":708.75,"body":"of NHS representation back"},{"startTime":706.32,"endTime":708.75,"body":"into the Treasury saying,"},{"startTime":708.75,"endTime":711.3,"body":"we need more money, we need more money."},{"startTime":711.3,"endTime":715.44,"body":"But no real discernible"},{"startTime":711.3,"endTime":715.44,"body":"change scene for that."},{"startTime":715.44,"endTime":718.86,"body":"So it was almost a patching"},{"startTime":715.44,"endTime":718.86,"body":"up exercise, it felt."},{"startTime":718.86,"endTime":720.45,"body":"So I think the government's"},{"startTime":718.86,"endTime":720.45,"body":"taking control."},{"startTime":720.45,"endTime":723.66,"body":"And if you have a look"},{"startTime":720.45,"endTime":723.66,"body":"at how it's doing that,"},{"startTime":723.66,"endTime":726.87,"body":"it's bringing everything into the DHSE,"},{"startTime":726.87,"endTime":729.273,"body":"which is then managed centrally."},{"startTime":730.47,"endTime":732.42,"body":"It's proposing to change regions"},{"startTime":732.42,"endTime":736.29,"body":"to become DHSC organisations,"},{"startTime":732.42,"endTime":736.29,"body":"which brings that tetrad."},{"startTime":736.29,"endTime":739.02,"body":"So it's a bringing into the centre."},{"startTime":739.02,"endTime":740.37,"body":"And before that's happened quite,"},{"startTime":740.37,"endTime":742.08,"body":"that's happened a number"},{"startTime":740.37,"endTime":742.08,"body":"of times in the NHS"},{"startTime":742.08,"endTime":745.05,"body":"but it's brought it into"},{"startTime":742.08,"endTime":745.05,"body":"the centre of the NHS."},{"startTime":745.05,"endTime":748.08,"body":"But now the NHS itself has"},{"startTime":745.05,"endTime":748.08,"body":"been brought into the centre."},{"startTime":748.08,"endTime":752.28,"body":"So there's a real collapsing"},{"startTime":748.08,"endTime":752.28,"body":"of the hierarchy almost"},{"startTime":752.28,"endTime":754.563,"body":"between the top and the bottom."},{"startTime":755.52,"endTime":756.78,"body":"So I think that,"},{"startTime":756.78,"endTime":758.67,"body":"I think there's more"},{"startTime":756.78,"endTime":758.67,"body":"to it than cost saving."},{"startTime":758.67,"endTime":763.293,"body":"There's much more about"},{"startTime":758.67,"endTime":763.293,"body":"line of visibility through,"},{"startTime":764.37,"endTime":765.6,"body":"and there's part of that."},{"startTime":765.6,"endTime":768.12,"body":"There's definitely going to be"},{"startTime":765.6,"endTime":768.12,"body":"a cost, there's a cost piece."},{"startTime":768.12,"endTime":770.07,"body":"But I think there's"},{"startTime":768.12,"endTime":770.07,"body":"also a big drive to say,"},{"startTime":770.07,"endTime":773.34,"body":"well, are we spending the"},{"startTime":770.07,"endTime":773.34,"body":"right money in the right way"},{"startTime":773.34,"endTime":774.9,"body":"in the right places?"},{"startTime":774.9,"endTime":777.63,"body":"And I think that ties"},{"startTime":774.9,"endTime":777.63,"body":"in to the 10-year plan,"},{"startTime":777.63,"endTime":780.15,"body":"which probably be talking about later."},{"startTime":780.15,"endTime":785.15,"body":"So it feels like it's a good idea."},{"startTime":785.49,"endTime":787.38,"body":"But as in all these things,"},{"startTime":787.38,"endTime":790.53,"body":"is there really a clear"},{"startTime":787.38,"endTime":790.53,"body":"plan in the way that people"},{"startTime":790.53,"endTime":793.397,"body":"who want to execute"},{"startTime":790.53,"endTime":793.397,"body":"can execute against it?"},{"startTime":793.397,"endTime":795.45,"body":"And the answer is clearly no."},{"startTime":795.45,"endTime":798.12,"body":"We've already touched on"},{"startTime":795.45,"endTime":798.12,"body":"different organisations"},{"startTime":798.12,"endTime":799.68,"body":"will be moving at different speeds"},{"startTime":799.68,"endTime":802.05,"body":"with the different priorities."},{"startTime":802.05,"endTime":803.91,"body":"So there is that element."},{"startTime":803.91,"endTime":806.88,"body":"And then there's a constant"},{"startTime":803.91,"endTime":806.88,"body":"overlaying of new models"},{"startTime":806.88,"endTime":809.43,"body":"of care and new structures,"},{"startTime":809.43,"endTime":813.51,"body":"and everybody really likes to go to,"},{"startTime":813.51,"endTime":817.53,"body":"unpicking what the new"},{"startTime":813.51,"endTime":817.53,"body":"structure is as opposed to,"},{"startTime":817.53,"endTime":819.16,"body":"actually what is the right thing to do"},{"startTime":819.16,"endTime":820.92,"body":"and can we not just get on and do that?"},{"startTime":820.92,"endTime":822.66,"body":"And of course in the"},{"startTime":820.92,"endTime":822.66,"body":"meantime, while all of the,"},{"startTime":822.66,"endTime":825.24,"body":"all of the, if we just use the"},{"startTime":822.66,"endTime":825.24,"body":"chairs thing you mentioned,"},{"startTime":825.24,"endTime":826.47,"body":"will the chairs have been moving around?"},{"startTime":826.47,"endTime":827.64,"body":"And I don't think it is a case"},{"startTime":827.64,"endTime":828.81,"body":"of the chairs being moving around."},{"startTime":828.81,"endTime":831.6,"body":"But while all that activity's happening,"},{"startTime":831.6,"endTime":834.87,"body":"the flow in the front"},{"startTime":831.6,"endTime":834.87,"body":"door's continuing to grow,"},{"startTime":834.87,"endTime":836.37,"body":"it's continuing to build."},{"startTime":836.37,"endTime":838.74,"body":"And the longer people wait for things,"},{"startTime":838.74,"endTime":840.03,"body":"the worse they get."},{"startTime":840.03,"endTime":843.24,"body":"So not only is it is the flow continuing,"},{"startTime":843.24,"endTime":845.4,"body":"but the stacking up of the flow"},{"startTime":845.4,"endTime":849.33,"body":"is causing the overall acuity to rise."},{"startTime":849.33,"endTime":852.63,"body":"So the longer we wait,"},{"startTime":849.33,"endTime":852.63,"body":"the worse it gets really."},{"startTime":852.63,"endTime":854.7,"body":"And I think that's why"},{"startTime":852.63,"endTime":854.7,"body":"certainly Penny Dash"},{"startTime":854.7,"endTime":857.613,"body":"when she came in, wanted it"},{"startTime":854.7,"endTime":857.613,"body":"all to be done by October."},{"startTime":861.116,"endTime":862.29,"body":"And then there's just the practicality"},{"startTime":862.29,"endTime":865.08,"body":"of how you move all these"},{"startTime":862.29,"endTime":865.08,"body":"massive things around"},{"startTime":865.08,"endTime":866.343,"body":"in a tight timeframe."},{"startTime":868.53,"endTime":869.97,"body":"- Yeah, thank you, Phil."},{"startTime":869.97,"endTime":873.39,"body":"I don't know, Sarah or Paddy,"},{"startTime":869.97,"endTime":873.39,"body":"just from your perspectives,"},{"startTime":873.39,"endTime":876.03,"body":"if you have anything else"},{"startTime":873.39,"endTime":876.03,"body":"to add or if you agree"},{"startTime":876.03,"endTime":878.85,"body":"that this is actually a good"},{"startTime":876.03,"endTime":878.85,"body":"change that's happening,"},{"startTime":878.85,"endTime":881.013,"body":"it's just a matter of how and when."},{"startTime":883.26,"endTime":885.42,"body":"- Yeah, I mean, I don't disagree"},{"startTime":885.42,"endTime":887.35,"body":"with anything that Phil said,"},{"startTime":887.35,"endTime":891.24,"body":"and I do think that the"},{"startTime":887.35,"endTime":891.24,"body":"NHS does need to change."},{"startTime":891.24,"endTime":895.77,"body":"I think, you know, you"},{"startTime":891.24,"endTime":895.77,"body":"mentioned about rising acuity,"},{"startTime":895.77,"endTime":900.483,"body":"and I think rising costs and"},{"startTime":895.77,"endTime":900.483,"body":"expectations from the public."},{"startTime":901.38,"endTime":904.32,"body":"But I think the bit for me is that the,"},{"startTime":904.32,"endTime":906.927,"body":"after any period of change in the NHS,"},{"startTime":906.927,"endTime":909.09,"body":"and I think I've done over 25 years now"},{"startTime":909.09,"endTime":911.91,"body":"and have no idea how many"},{"startTime":909.09,"endTime":911.91,"body":"different restructures"},{"startTime":911.91,"endTime":914.55,"body":"or reorganisation there's"},{"startTime":911.91,"endTime":914.55,"body":"been in that time."},{"startTime":914.55,"endTime":919.55,"body":"But it is never given the"},{"startTime":914.55,"endTime":919.55,"body":"period of time to stabilise."},{"startTime":919.95,"endTime":920.783,"body":"And with that, you know,"},{"startTime":920.783,"endTime":922.41,"body":"anybody that works in"},{"startTime":920.783,"endTime":922.41,"body":"sort change management,"},{"startTime":922.41,"endTime":925.353,"body":"you have to have an embedding"},{"startTime":922.41,"endTime":925.353,"body":"and stabilisation period."},{"startTime":926.19,"endTime":929.7,"body":"And it feels like a"},{"startTime":926.19,"endTime":929.7,"body":"new government comes in"},{"startTime":929.7,"endTime":933.39,"body":"or there's some change in"},{"startTime":929.7,"endTime":933.39,"body":"minister and it's reorganised"},{"startTime":933.39,"endTime":935.823,"body":"and you kind of start the cycle again."},{"startTime":936.904,"endTime":938.97,"body":"And I think that makes it really difficult"},{"startTime":938.97,"endTime":940.857,"body":"for the people working"},{"startTime":938.97,"endTime":940.857,"body":"within the NHS as well."},{"startTime":940.857,"endTime":942.36,"body":"And I think that's probably, you know,"},{"startTime":942.36,"endTime":945.48,"body":"one of the reasons why people"},{"startTime":942.36,"endTime":945.48,"body":"get frustrated and leave."},{"startTime":945.48,"endTime":950.48,"body":"And I think the fact that we"},{"startTime":945.48,"endTime":950.48,"body":"have a government NHS plan"},{"startTime":950.55,"endTime":955.473,"body":"rather than a kind of a"},{"startTime":950.55,"endTime":955.473,"body":"cross-party or a single NHS plan"},{"startTime":955.473,"endTime":957.88,"body":"that is for 10 years"},{"startTime":955.473,"endTime":957.88,"body":"and stays for 10 years"},{"startTime":958.92,"endTime":961.92,"body":"will continually have this change"},{"startTime":961.92,"endTime":964.2,"body":"and the change that can't be sustained."},{"startTime":964.2,"endTime":967.05,"body":"And I think it's how we"},{"startTime":964.2,"endTime":967.05,"body":"get past some of that."},{"startTime":967.05,"endTime":970.77,"body":"So I absolutely do think"},{"startTime":967.05,"endTime":970.77,"body":"change does need to happen."},{"startTime":970.77,"endTime":974.97,"body":"And we can't stand still, but"},{"startTime":970.77,"endTime":974.97,"body":"it has to be the right change"},{"startTime":974.97,"endTime":977.902,"body":"for both patients and the workforce"},{"startTime":977.902,"endTime":980.493,"body":"and it has to be given"},{"startTime":977.902,"endTime":980.493,"body":"that chance to embed."},{"startTime":982.5,"endTime":985.62,"body":"- Yeah, no, thank you. Very good points."},{"startTime":985.62,"endTime":989.49,"body":"And just one other, I"},{"startTime":985.62,"endTime":989.49,"body":"guess structural question."},{"startTime":989.49,"endTime":991.32,"body":"Do you know if we've identified"},{"startTime":991.32,"endTime":993.0,"body":"any of the initial integrated health"},{"startTime":993.0,"endTime":995.22,"body":"organisation foundation trusts"},{"startTime":995.22,"endTime":998.31,"body":"and how their effectiveness"},{"startTime":995.22,"endTime":998.31,"body":"will be measured?"},{"startTime":998.31,"endTime":1000.173,"body":"Sarah, I'll ask you that question."},{"startTime":1001.73,"endTime":1005.06,"body":"- Yeah, I think it's a work in progress."},{"startTime":1005.06,"endTime":1008.45,"body":"I think are starting to see"},{"startTime":1005.06,"endTime":1008.45,"body":"some areas being identified."},{"startTime":1008.45,"endTime":1010.403,"body":"But I think for me again,"},{"startTime":1011.24,"endTime":1014.33,"body":"it's what does it actually"},{"startTime":1011.24,"endTime":1014.33,"body":"mean for patients as a result?"},{"startTime":1014.33,"endTime":1015.44,"body":"You know, we've talked,"},{"startTime":1015.44,"endTime":1017.99,"body":"Phil just talked about different changes"},{"startTime":1017.99,"endTime":1021.95,"body":"and there just seems to be"},{"startTime":1017.99,"endTime":1021.95,"body":"a lot happening at once."},{"startTime":1021.95,"endTime":1024.44,"body":"A lot of different terminology"},{"startTime":1024.44,"endTime":1028.073,"body":"or the same terminology being"},{"startTime":1024.44,"endTime":1028.073,"body":"used as different things."},{"startTime":1029.69,"endTime":1033.56,"body":"Where I work, we're part"},{"startTime":1029.69,"endTime":1033.56,"body":"of one of the wave ones"},{"startTime":1033.56,"endTime":1037.64,"body":"for the National Neighbourhood"},{"startTime":1033.56,"endTime":1037.64,"body":"Health Implementation Programme,"},{"startTime":1037.64,"endTime":1042.64,"body":"and the different acronyms"},{"startTime":1037.64,"endTime":1042.64,"body":"and names that are coming out"},{"startTime":1043.224,"endTime":1044.057,"body":"as part of the"},{"startTime":1043.224,"endTime":1044.057,"body":"Neighbourhood Health agenda,"},{"startTime":1044.057,"endTime":1046.04,"body":"kind of like Single"},{"startTime":1044.057,"endTime":1046.04,"body":"Neighbourhood Provider,"},{"startTime":1046.04,"endTime":1047.09,"body":"Multi-Neighborhood Provider."},{"startTime":1047.09,"endTime":1050.84,"body":"How does that fit with kind"},{"startTime":1047.09,"endTime":1050.84,"body":"of like the AIHO structure?"},{"startTime":1050.84,"endTime":1054.71,"body":"I mean, we love a three-letter"},{"startTime":1050.84,"endTime":1054.71,"body":"acronym in the NHS, don't we?"},{"startTime":1054.71,"endTime":1056.29,"body":"It seems to be."},{"startTime":1056.29,"endTime":1059.06,"body":"If it's not three letters,"},{"startTime":1056.29,"endTime":1059.06,"body":"it can't be an acronym."},{"startTime":1059.06,"endTime":1064.06,"body":"But I think, again,"},{"startTime":1059.06,"endTime":1064.06,"body":"coming back to the NHS,"},{"startTime":1064.13,"endTime":1066.74,"body":"how the NHS needs to change"},{"startTime":1066.74,"endTime":1071.74,"body":"and not change for change shake,"},{"startTime":1066.74,"endTime":1071.74,"body":"change sake, I can't speak,"},{"startTime":1071.84,"endTime":1076.84,"body":"and the structural side versus"},{"startTime":1071.84,"endTime":1076.84,"body":"people working differently"},{"startTime":1077.09,"endTime":1078.77,"body":"I think is all the stuff"},{"startTime":1077.09,"endTime":1078.77,"body":"we need to work through."},{"startTime":1078.77,"endTime":1080.75,"body":"But one thing I do believe,"},{"startTime":1080.75,"endTime":1081.59,"body":"I think fundamentally,"},{"startTime":1081.59,"endTime":1084.56,"body":"if we don't sort out the funding flows"},{"startTime":1084.56,"endTime":1087.38,"body":"then it doesn't matter"},{"startTime":1084.56,"endTime":1087.38,"body":"what organisations we have,"},{"startTime":1087.38,"endTime":1089.51,"body":"you know, we want more"},{"startTime":1087.38,"endTime":1089.51,"body":"care out in the community,"},{"startTime":1089.51,"endTime":1092.96,"body":"but if it's sat within"},{"startTime":1089.51,"endTime":1092.96,"body":"the IHA or the acute,"},{"startTime":1092.96,"endTime":1094.037,"body":"how do we do some of that?"},{"startTime":1094.037,"endTime":1098.957,"body":"And I think that's going to be"},{"startTime":1094.037,"endTime":1098.957,"body":"a real challenge moving forward."},{"startTime":1098.957,"endTime":1103.957,"body":"And I think we kind of need"},{"startTime":1098.957,"endTime":1103.957,"body":"to establish some of that"},{"startTime":1104.03,"endTime":1105.53,"body":"to help the new models work"},{"startTime":1105.53,"endTime":1107.54,"body":"and not just focus on organisational form,"},{"startTime":1107.54,"endTime":1110.04,"body":"'cause it's, you know,"},{"startTime":1107.54,"endTime":1110.04,"body":"fundamentally about people."},{"startTime":1111.56,"endTime":1113.21,"body":"- Yeah, no thank you."},{"startTime":1113.21,"endTime":1116.0,"body":"And, Paddy, I'll come to you."},{"startTime":1116.0,"endTime":1118.01,"body":"Just in terms of national policy,"},{"startTime":1118.01,"endTime":1120.74,"body":"how can national policy interact"},{"startTime":1120.74,"endTime":1123.413,"body":"and inform the current NHS restructure?"},{"startTime":1126.38,"endTime":1128.18,"body":"- I suppose national policy"},{"startTime":1128.18,"endTime":1131.79,"body":"is obviously driving"},{"startTime":1128.18,"endTime":1131.79,"body":"the direction of travel"},{"startTime":1132.68,"endTime":1134.66,"body":"with the 10-year health plan,"},{"startTime":1134.66,"endTime":1138.17,"body":"life science strategy,"},{"startTime":1134.66,"endTime":1138.17,"body":"certainly overarching"},{"startTime":1138.17,"endTime":1141.71,"body":"sort of priorities for"},{"startTime":1138.17,"endTime":1141.71,"body":"prevention efficiency,"},{"startTime":1141.71,"endTime":1144.983,"body":"which we've spoken a lot"},{"startTime":1141.71,"endTime":1144.983,"body":"about this morning so far."},{"startTime":1145.94,"endTime":1148.07,"body":"Digital transformation."},{"startTime":1148.07,"endTime":1151.487,"body":"So the restructures being"},{"startTime":1148.07,"endTime":1151.487,"body":"shaped around those priorities,"},{"startTime":1151.487,"endTime":1152.48,"body":"(clearing throat) excuse me,"},{"startTime":1152.48,"endTime":1155.27,"body":"as well as things like access to ED"},{"startTime":1155.27,"endTime":1158.66,"body":"and access to general practise,"},{"startTime":1158.66,"endTime":1159.68,"body":"and even dentistry,"},{"startTime":1159.68,"endTime":1162.83,"body":"which we know is a"},{"startTime":1159.68,"endTime":1162.83,"body":"challenge in some areas."},{"startTime":1162.83,"endTime":1165.54,"body":"We've discussed how NHSE"},{"startTime":1162.83,"endTime":1165.54,"body":"is being slimmed down"},{"startTime":1166.702,"endTime":1167.78,"body":"and absorbed into,"},{"startTime":1167.78,"endTime":1169.55,"body":"or their functions being absorbed"},{"startTime":1169.55,"endTime":1171.1,"body":"into the Department for Health,"},{"startTime":1172.49,"endTime":1176.24,"body":"consolidating the assurance"},{"startTime":1172.49,"endTime":1176.24,"body":"and procurement processes,"},{"startTime":1176.24,"endTime":1180.14,"body":"which I know we'll talk about"},{"startTime":1176.24,"endTime":1180.14,"body":"at some point in this session."},{"startTime":1180.14,"endTime":1183.353,"body":"And really aiming to produce"},{"startTime":1180.14,"endTime":1183.353,"body":"that duplication and variation."},{"startTime":1185.12,"endTime":1186.65,"body":"The next bit as well."},{"startTime":1186.65,"endTime":1189.113,"body":"I know there's questions"},{"startTime":1186.65,"endTime":1189.113,"body":"around national policy,"},{"startTime":1190.28,"endTime":1191.78,"body":"but equally then it's the translation"},{"startTime":1191.78,"endTime":1194.69,"body":"into regional delivery, I suppose."},{"startTime":1194.69,"endTime":1197.3,"body":"And that's where national have asked ICBs"},{"startTime":1197.3,"endTime":1200.87,"body":"to develop and embed"},{"startTime":1197.3,"endTime":1200.87,"body":"five-year planning frameworks"},{"startTime":1200.87,"endTime":1202.49,"body":"aligned to that 10-year health plan."},{"startTime":1202.49,"endTime":1205.19,"body":"So the 10-year health plan is, you know,"},{"startTime":1205.19,"endTime":1206.87,"body":"the plan, the strategy,"},{"startTime":1206.87,"endTime":1208.01,"body":"and then it's how we going to deliver"},{"startTime":1208.01,"endTime":1212.33,"body":"that over five-year"},{"startTime":1208.01,"endTime":1212.33,"body":"cycles refreshed annually."},{"startTime":1212.33,"endTime":1215.663,"body":"So I think that's the sort of next steps."},{"startTime":1217.28,"endTime":1219.56,"body":"- Yeah, no, that makes complete sense."},{"startTime":1219.56,"endTime":1222.01,"body":"Sarah, do you have any"},{"startTime":1219.56,"endTime":1222.01,"body":"other points to add there?"},{"startTime":1223.52,"endTime":1226.61,"body":"- Yeah, I think Paddy is absolutely right."},{"startTime":1226.61,"endTime":1229.88,"body":"I guess the other bit for"},{"startTime":1226.61,"endTime":1229.88,"body":"me is it's not one way."},{"startTime":1229.88,"endTime":1233.6,"body":"So how can we take"},{"startTime":1229.88,"endTime":1233.6,"body":"what's happening locally,"},{"startTime":1233.6,"endTime":1236.9,"body":"that local experience innovation"},{"startTime":1233.6,"endTime":1236.9,"body":"to inform national policy?"},{"startTime":1236.9,"endTime":1239.42,"body":"I know, so through the wave one"},{"startTime":1239.42,"endTime":1242.18,"body":"National Neighbourhood Programme."},{"startTime":1242.18,"endTime":1244.01,"body":"It's that collective learning"},{"startTime":1244.01,"endTime":1246.32,"body":"and then that informing"},{"startTime":1244.01,"endTime":1246.32,"body":"direction of travel."},{"startTime":1246.32,"endTime":1249.44,"body":"And I think it's how we"},{"startTime":1246.32,"endTime":1249.44,"body":"continue to do some of that."},{"startTime":1249.44,"endTime":1251.63,"body":"I think policy gives us the framework"},{"startTime":1251.63,"endTime":1254.87,"body":"but then it's how the providers, councils,"},{"startTime":1254.87,"endTime":1256.22,"body":"architecture organisations,"},{"startTime":1256.22,"endTime":1258.23,"body":"community and industry"},{"startTime":1256.22,"endTime":1258.23,"body":"really make it happen."},{"startTime":1258.23,"endTime":1260.88,"body":"So I think it's how we"},{"startTime":1258.23,"endTime":1260.88,"body":"connect some of that together."},{"startTime":1262.73,"endTime":1265.67,"body":"- Yeah, no, thank you. That makes sense."},{"startTime":1265.67,"endTime":1268.16,"body":"And I guess one of the big topics"},{"startTime":1268.16,"endTime":1270.65,"body":"that's been raised always being discussed"},{"startTime":1270.65,"endTime":1271.49,"body":"from the 10-year plan"},{"startTime":1271.49,"endTime":1273.64,"body":"is the move to a single"},{"startTime":1271.49,"endTime":1273.64,"body":"national formulary."},{"startTime":1274.749,"endTime":1276.197,"body":"And we've had quite a few"},{"startTime":1274.749,"endTime":1276.197,"body":"questions around that."},{"startTime":1276.197,"endTime":1278.69,"body":"And I guess a broad question first"},{"startTime":1278.69,"endTime":1281.12,"body":"is how could that possibly work?"},{"startTime":1281.12,"endTime":1282.62,"body":"Paddy, maybe I'll come to you."},{"startTime":1284.42,"endTime":1288.383,"body":"- Yeah, I think first we"},{"startTime":1284.42,"endTime":1288.383,"body":"have to learn from others."},{"startTime":1289.55,"endTime":1291.293,"body":"Yes, it can definitely work."},{"startTime":1292.641,"endTime":1294.41,"body":"(clears throat) Excuse me, sorry."},{"startTime":1294.41,"endTime":1296.81,"body":"It can definitely work"},{"startTime":1294.41,"endTime":1296.81,"body":"'cause it does elsewhere."},{"startTime":1297.8,"endTime":1299.693,"body":"Wales and Scotland already use,"},{"startTime":1301.1,"endTime":1302.9,"body":"not quite a single national formulary,"},{"startTime":1302.9,"endTime":1306.89,"body":"but centralised approaches,"},{"startTime":1306.89,"endTime":1308.54,"body":"albeit their geographies"},{"startTime":1306.89,"endTime":1308.54,"body":"is obviously a bit smaller"},{"startTime":1308.54,"endTime":1310.61,"body":"than England, but they already do it."},{"startTime":1310.61,"endTime":1312.98,"body":"Australia and NZ do it there."},{"startTime":1312.98,"endTime":1314.87,"body":"There are examples across the world"},{"startTime":1314.87,"endTime":1318.23,"body":"of where single national formularies work."},{"startTime":1318.23,"endTime":1321.18,"body":"So I don't think it's something"},{"startTime":1318.23,"endTime":1321.18,"body":"that we should disregard"},{"startTime":1322.04,"endTime":1325.1,"body":"based on their fairly positive experience,"},{"startTime":1325.1,"endTime":1328.07,"body":"showed national consistency around equity"},{"startTime":1328.07,"endTime":1331.223,"body":"and purchasing power for the centre."},{"startTime":1333.23,"endTime":1334.67,"body":"The difficult balance obviously"},{"startTime":1334.67,"endTime":1338.573,"body":"is that the strong central"},{"startTime":1334.67,"endTime":1338.573,"body":"governance, which is required,"},{"startTime":1340.28,"endTime":1342.95,"body":"and balancing that with"},{"startTime":1340.28,"endTime":1342.95,"body":"the local flexibility"},{"startTime":1342.95,"endTime":1346.91,"body":"to reflect not only like the"},{"startTime":1342.95,"endTime":1346.91,"body":"specific needs of a population,"},{"startTime":1346.91,"endTime":1349.34,"body":"which will naturally be different"},{"startTime":1349.34,"endTime":1352.97,"body":"from Northeast North"},{"startTime":1349.34,"endTime":1352.97,"body":"Cumbria to Northwest London"},{"startTime":1352.97,"endTime":1353.813,"body":"for example."},{"startTime":1355.25,"endTime":1360.25,"body":"But also the supply"},{"startTime":1355.25,"endTime":1360.25,"body":"chain vulnerability that,"},{"startTime":1360.5,"endTime":1361.333,"body":"you know, you can expect."},{"startTime":1361.333,"endTime":1363.74,"body":"And I know lots of sort of stakeholders"},{"startTime":1363.74,"endTime":1366.71,"body":"across the system are quite"},{"startTime":1363.74,"endTime":1366.71,"body":"worried about that bit."},{"startTime":1366.71,"endTime":1368.39,"body":"So I think we can expect"},{"startTime":1368.39,"endTime":1371.78,"body":"some form of flexibility in the design."},{"startTime":1371.78,"endTime":1373.91,"body":"Obviously that single"},{"startTime":1371.78,"endTime":1373.91,"body":"nationalised increases risk"},{"startTime":1373.91,"endTime":1377.513,"body":"if there are supply chain shocks."},{"startTime":1378.98,"endTime":1381.53,"body":"So I do think there'll"},{"startTime":1378.98,"endTime":1381.53,"body":"have to be some flexibility"},{"startTime":1381.53,"endTime":1385.31,"body":"around local stock and supply"},{"startTime":1385.31,"endTime":1388.82,"body":"and how you may have"},{"startTime":1385.31,"endTime":1388.82,"body":"sort of approved products"},{"startTime":1388.82,"endTime":1390.35,"body":"that maybe aren't first on the list."},{"startTime":1390.35,"endTime":1392.09,"body":"But this is the national direction,"},{"startTime":1392.09,"endTime":1393.92,"body":"I think you can see from"},{"startTime":1392.09,"endTime":1393.92,"body":"the Drug Tariff Guidance"},{"startTime":1393.92,"endTime":1394.753,"body":"that's come out as well,"},{"startTime":1394.753,"endTime":1397.79,"body":"this is where we are going as an NHS."},{"startTime":1397.79,"endTime":1399.04,"body":"You can see that the NHS,"},{"startTime":1400.411,"endTime":1402.59,"body":"for a couple of years now at least,"},{"startTime":1402.59,"endTime":1407.22,"body":"has been trying to consolidate"},{"startTime":1402.59,"endTime":1407.22,"body":"sort of large procurement"},{"startTime":1408.65,"endTime":1410.69,"body":"of things like equipment and consumables"},{"startTime":1410.69,"endTime":1412.67,"body":"through NHS supply chain."},{"startTime":1412.67,"endTime":1414.38,"body":"It is very much an approach to start"},{"startTime":1414.38,"endTime":1417.68,"body":"to consolidate, centralise"},{"startTime":1417.68,"endTime":1420.86,"body":"and go in that sort of single fashion."},{"startTime":1420.86,"endTime":1421.693,"body":"As far as I'm aware,"},{"startTime":1421.693,"endTime":1426.41,"body":"there's not yet an"},{"startTime":1421.693,"endTime":1426.41,"body":"explicit sort of document"},{"startTime":1426.41,"endTime":1427.58,"body":"as to how we'll approach that,"},{"startTime":1427.58,"endTime":1429.77,"body":"but I'm sure that will come."},{"startTime":1429.77,"endTime":1431.393,"body":"But yes, it definitely can work."},{"startTime":1432.86,"endTime":1434.48,"body":"- Yeah, no, thank you."},{"startTime":1434.48,"endTime":1436.07,"body":"In terms of how it might evolve,"},{"startTime":1436.07,"endTime":1439.32,"body":"obviously there's a two-year"},{"startTime":1436.07,"endTime":1439.32,"body":"target for it to happen within"},{"startTime":1440.185,"endTime":1442.07,"body":"or the move to happen within,"},{"startTime":1442.07,"endTime":1443.87,"body":"do you think that it's"},{"startTime":1442.07,"endTime":1443.87,"body":"going to be evolving,"},{"startTime":1443.87,"endTime":1445.04,"body":"more of an evolving process?"},{"startTime":1445.04,"endTime":1446.06,"body":"Do you think it's realistic"},{"startTime":1446.06,"endTime":1448.04,"body":"that everything gets sorted"},{"startTime":1446.06,"endTime":1448.04,"body":"within in the two years,"},{"startTime":1448.04,"endTime":1449.45,"body":"or actually it might be more"},{"startTime":1449.45,"endTime":1453.05,"body":"of an evolution over the 10"},{"startTime":1449.45,"endTime":1453.05,"body":"years of the 10-year plan?"},{"startTime":1453.05,"endTime":1455.48,"body":"And we also had a question"},{"startTime":1455.48,"endTime":1458.39,"body":"around whether you think"},{"startTime":1455.48,"endTime":1458.39,"body":"it will likely be molecule"},{"startTime":1458.39,"endTime":1460.37,"body":"or brand based?"},{"startTime":1460.37,"endTime":1461.92,"body":"Sarah, maybe I can come to you."},{"startTime":1463.58,"endTime":1466.34,"body":"- Yeah, I mean, I think"},{"startTime":1463.58,"endTime":1466.34,"body":"it's going to evolve."},{"startTime":1466.34,"endTime":1469.82,"body":"I don't think anything moves"},{"startTime":1466.34,"endTime":1469.82,"body":"massively quickly in the NHS"},{"startTime":1469.82,"endTime":1473.24,"body":"isn't the set target of a"},{"startTime":1469.82,"endTime":1473.24,"body":"timeframe, and it's going to evolve."},{"startTime":1473.24,"endTime":1477.62,"body":"I don't think it's something"},{"startTime":1473.24,"endTime":1477.62,"body":"that's going to be static."},{"startTime":1477.62,"endTime":1480.8,"body":"And I guess in terms"},{"startTime":1477.62,"endTime":1480.8,"body":"of the areas of focus,"},{"startTime":1480.8,"endTime":1484.07,"body":"it might be more on high"},{"startTime":1480.8,"endTime":1484.07,"body":"volume, high costs to start with"},{"startTime":1484.07,"endTime":1487.68,"body":"where variation create"},{"startTime":1484.07,"endTime":1487.68,"body":"creates inequity in waste"},{"startTime":1489.996,"endTime":1492.56,"body":"and as that sort of real"},{"startTime":1489.996,"endTime":1492.56,"body":"world data can be built up"},{"startTime":1492.56,"endTime":1494.51,"body":"and outcomes and then the formulary"},{"startTime":1494.51,"endTime":1496.22,"body":"could be expanded and refined,"},{"startTime":1496.22,"endTime":1501.053,"body":"yeah, I think it'll be"},{"startTime":1496.22,"endTime":1501.053,"body":"quite an evolving process."},{"startTime":1502.73,"endTime":1504.38,"body":"- Yeah, no, that makes sense."},{"startTime":1504.38,"endTime":1507.23,"body":"And just in terms for those products"},{"startTime":1507.23,"endTime":1510.473,"body":"that are included on tariff"},{"startTime":1507.23,"endTime":1510.473,"body":"or national frameworks,"},{"startTime":1511.37,"endTime":1513.65,"body":"do you have any thoughts on"},{"startTime":1511.37,"endTime":1513.65,"body":"how it would change the process"},{"startTime":1513.65,"endTime":1515.963,"body":"of getting onto either of these?"},{"startTime":1517.73,"endTime":1522.65,"body":"- I think tariffs, national"},{"startTime":1517.73,"endTime":1522.65,"body":"frameworks, reimbursement"},{"startTime":1522.65,"endTime":1527.65,"body":"as a whole, I would look"},{"startTime":1522.65,"endTime":1527.65,"body":"to the Drug Tariff Guidance"},{"startTime":1529.88,"endTime":1532.01,"body":"and the processes that"},{"startTime":1529.88,"endTime":1532.01,"body":"they've outlined there"},{"startTime":1532.01,"endTime":1534.92,"body":"in terms of how you get onto a framework"},{"startTime":1534.92,"endTime":1538.31,"body":"if you are initially"},{"startTime":1534.92,"endTime":1538.31,"body":"refused from a framework,"},{"startTime":1538.31,"endTime":1540.17,"body":"how you then get back on,"},{"startTime":1540.17,"endTime":1543.02,"body":"I think the Drug Tariff"},{"startTime":1540.17,"endTime":1543.02,"body":"Guidance is a good example"},{"startTime":1543.02,"endTime":1548.02,"body":"of how the NHS are going to"},{"startTime":1543.02,"endTime":1548.02,"body":"procure full stop going forward."},{"startTime":1548.24,"endTime":1551.87,"body":"Again, it will evolve, but"},{"startTime":1548.24,"endTime":1551.87,"body":"the sort of the principles,"},{"startTime":1551.87,"endTime":1554.183,"body":"I would say, will be applied generally."},{"startTime":1556.1,"endTime":1557.663,"body":"- Yeah, no, thank you."},{"startTime":1558.83,"endTime":1562.01,"body":"I've got a few questions"},{"startTime":1558.83,"endTime":1562.01,"body":"now just around budgets"},{"startTime":1562.01,"endTime":1564.02,"body":"and the balance of short-term costs"},{"startTime":1564.02,"endTime":1566.153,"body":"and longer term benefits."},{"startTime":1567.23,"endTime":1569.333,"body":"Phil, I might come to you first."},{"startTime":1571.01,"endTime":1572.75,"body":"From your perspective, how do the one,"},{"startTime":1572.75,"endTime":1576.293,"body":"three and five-year budgets"},{"startTime":1572.75,"endTime":1576.293,"body":"link into a shift to prevention?"},{"startTime":1579.47,"endTime":1580.94,"body":"- This has been a perennial challenge."},{"startTime":1580.94,"endTime":1581.84,"body":"I remember 10 years,"},{"startTime":1581.84,"endTime":1583.287,"body":"a director of Public Health saying to me,"},{"startTime":1583.287,"endTime":1585.74,"body":"\"We could massively change"},{"startTime":1583.287,"endTime":1585.74,"body":"cardiovascular disease"},{"startTime":1585.74,"endTime":1587.747,"body":"if we started 10 years ago.\""},{"startTime":1589.49,"endTime":1591.83,"body":"And I think that the prevention agenda"},{"startTime":1591.83,"endTime":1594.95,"body":"in the main gets a bit overshadowed"},{"startTime":1594.95,"endTime":1597.563,"body":"by an acute hospital agenda."},{"startTime":1598.56,"endTime":1601.16,"body":"And I think there is"},{"startTime":1598.56,"endTime":1601.16,"body":"a real willingness now"},{"startTime":1601.16,"endTime":1605.21,"body":"to want to move that because"},{"startTime":1601.16,"endTime":1605.21,"body":"at the end of the day,"},{"startTime":1605.21,"endTime":1606.89,"body":"if we can stop things happening,"},{"startTime":1606.89,"endTime":1608.24,"body":"or we can catch things early,"},{"startTime":1608.24,"endTime":1612.09,"body":"or we can help people navigate issues"},{"startTime":1613.58,"endTime":1615.23,"body":"in an earlier stage way,"},{"startTime":1615.23,"endTime":1619.7,"body":"then the downstream costs are"},{"startTime":1615.23,"endTime":1619.7,"body":"massively affected by that,"},{"startTime":1619.7,"endTime":1621.08,"body":"as is the workforce pressure,"},{"startTime":1621.08,"endTime":1623.273,"body":"as is the operational pressure."},{"startTime":1624.44,"endTime":1625.73,"body":"So I think,"},{"startTime":1625.73,"endTime":1630.02,"body":"I think without saying"},{"startTime":1625.73,"endTime":1630.02,"body":"it wasn't serious before,"},{"startTime":1630.02,"endTime":1632.19,"body":"I think there's a really"},{"startTime":1630.02,"endTime":1632.19,"body":"serious effort now"},{"startTime":1633.852,"endTime":1636.59,"body":"to do something about prevention."},{"startTime":1636.59,"endTime":1639.11,"body":"But we've got to move away from prevention"},{"startTime":1639.11,"endTime":1641.99,"body":"being a sort of a"},{"startTime":1639.11,"endTime":1641.99,"body":"worthiness that, you know,"},{"startTime":1641.99,"endTime":1645.563,"body":"everybody needs to eat well,"},{"startTime":1641.99,"endTime":1645.563,"body":"drink well, exercise more."},{"startTime":1647.9,"endTime":1650.21,"body":"And that sort of only appeals as a message"},{"startTime":1650.21,"endTime":1653.6,"body":"to the people who we eat well,"},{"startTime":1650.21,"endTime":1653.6,"body":"drink well, exercise more."},{"startTime":1653.6,"endTime":1655.28,"body":"And I think we need to move"},{"startTime":1655.28,"endTime":1656.96,"body":"into a holistic prevention model,"},{"startTime":1656.96,"endTime":1658.55,"body":"which is how do we help communities?"},{"startTime":1658.55,"endTime":1660.23,"body":"And the neighbourhoods approach"},{"startTime":1660.23,"endTime":1664.61,"body":"is absolutely aimed at"},{"startTime":1660.23,"endTime":1664.61,"body":"supporting that and enabling it,"},{"startTime":1664.61,"endTime":1668.24,"body":"but there's got to be a"},{"startTime":1664.61,"endTime":1668.24,"body":"real sense of priority"},{"startTime":1668.24,"endTime":1670.163,"body":"that cascades down to,"},{"startTime":1672.38,"endTime":1675.8,"body":"for it to be taken seriously"},{"startTime":1672.38,"endTime":1675.8,"body":"in a day-to-day conversation."},{"startTime":1675.8,"endTime":1677.72,"body":"'Cause things like"},{"startTime":1675.8,"endTime":1677.72,"body":"prevention as a concept,"},{"startTime":1677.72,"endTime":1679.34,"body":"everybody does intellectually"},{"startTime":1679.34,"endTime":1680.63,"body":"noting that's a really great idea."},{"startTime":1680.63,"endTime":1682.28,"body":"We should definitely do prevention."},{"startTime":1682.28,"endTime":1683.69,"body":"Then there's a lot of workup models"},{"startTime":1683.69,"endTime":1685.37,"body":"which says this is how"},{"startTime":1683.69,"endTime":1685.37,"body":"we could do prevention."},{"startTime":1685.37,"endTime":1687.89,"body":"And there's a lot of"},{"startTime":1685.37,"endTime":1687.89,"body":"epidemiological modelling,"},{"startTime":1687.89,"endTime":1689.84,"body":"there's a lot of public health modelling,"},{"startTime":1689.84,"endTime":1690.71,"body":"there's a lot of things which say,"},{"startTime":1690.71,"endTime":1694.16,"body":"look how much we could"},{"startTime":1690.71,"endTime":1694.16,"body":"help if we did do this."},{"startTime":1694.16,"endTime":1696.2,"body":"And then suddenly you've"},{"startTime":1694.16,"endTime":1696.2,"body":"got a queue of people"},{"startTime":1696.2,"endTime":1699.32,"body":"with a need for some urgent treatment."},{"startTime":1699.32,"endTime":1701.36,"body":"And well, we'll just"},{"startTime":1699.32,"endTime":1701.36,"body":"see those people first"},{"startTime":1701.36,"endTime":1703.25,"body":"and then we'll get onto prevention."},{"startTime":1703.25,"endTime":1705.56,"body":"And of course the queue"},{"startTime":1703.25,"endTime":1705.56,"body":"of people never stops."},{"startTime":1705.56,"endTime":1708.92,"body":"So that whole prevention thing changes."},{"startTime":1708.92,"endTime":1710.39,"body":"But if I have a look at"},{"startTime":1708.92,"endTime":1710.39,"body":"the director generals"},{"startTime":1710.39,"endTime":1713.78,"body":"that are being appointed at"},{"startTime":1710.39,"endTime":1713.78,"body":"the national level in the DHSC,"},{"startTime":1713.78,"endTime":1717.11,"body":"there's some very serious players in there"},{"startTime":1717.11,"endTime":1719.57,"body":"who could help shift the agenda"},{"startTime":1719.57,"endTime":1723.89,"body":"from an acute medicine model"},{"startTime":1719.57,"endTime":1723.89,"body":"into a prevention model."},{"startTime":1723.89,"endTime":1726.11,"body":"But it's a huge ask,"},{"startTime":1726.11,"endTime":1729.05,"body":"and our day-to-day operational teams"},{"startTime":1729.05,"endTime":1730.79,"body":"are not set up to do that."},{"startTime":1730.79,"endTime":1732.8,"body":"So it's a big thing to do"},{"startTime":1732.8,"endTime":1737.0,"body":"and it's a big shift in"},{"startTime":1732.8,"endTime":1737.0,"body":"what work type has done."},{"startTime":1737.0,"endTime":1740.48,"body":"And there needs to be a bigger"},{"startTime":1737.0,"endTime":1740.48,"body":"emphasis on decision-making"},{"startTime":1740.48,"endTime":1744.68,"body":"at a senior level that can"},{"startTime":1740.48,"endTime":1744.68,"body":"carry a prevention discussion"},{"startTime":1744.68,"endTime":1748.82,"body":"and decision over and above"},{"startTime":1744.68,"endTime":1748.82,"body":"a public health input."},{"startTime":1748.82,"endTime":1752.723,"body":"So it needs to be as part of"},{"startTime":1748.82,"endTime":1752.723,"body":"the core mechanism, I think."},{"startTime":1754.64,"endTime":1756.33,"body":"- Yeah, no, thank you."},{"startTime":1756.33,"endTime":1758.03,"body":"I don't know, Paddy,"},{"startTime":1756.33,"endTime":1758.03,"body":"from your perspective,"},{"startTime":1758.03,"endTime":1760.423,"body":"is there anything else that you think?"},{"startTime":1761.969,"endTime":1764.143,"body":"- I think Phil's covered it in the main."},{"startTime":1764.143,"endTime":1769.143,"body":"I think the time length"},{"startTime":1764.143,"endTime":1769.143,"body":"of budgets is part of it."},{"startTime":1771.11,"endTime":1773.87,"body":"So clearly if we have"},{"startTime":1771.11,"endTime":1773.87,"body":"such a short-term focus"},{"startTime":1773.87,"endTime":1777.86,"body":"on sort of realising"},{"startTime":1773.87,"endTime":1777.86,"body":"efficiency, for example,"},{"startTime":1777.86,"endTime":1781.802,"body":"in short-term outcomes, which"},{"startTime":1777.86,"endTime":1781.802,"body":"we very much are in the NHS"},{"startTime":1781.802,"endTime":1784.04,"body":"and particularly at the"},{"startTime":1781.802,"endTime":1784.04,"body":"moment with the big drive"},{"startTime":1784.04,"endTime":1787.7,"body":"on reducing spend, we're"},{"startTime":1784.04,"endTime":1787.7,"body":"very short-term focused."},{"startTime":1787.7,"endTime":1789.6,"body":"Now, clearly that's not an environment"},{"startTime":1790.46,"endTime":1795.46,"body":"that encourages a long-term"},{"startTime":1790.46,"endTime":1795.46,"body":"proactive prevention approach"},{"startTime":1796.01,"endTime":1798.503,"body":"to sort of supporting healthy populations."},{"startTime":1801.811,"endTime":1804.32,"body":"The main crux of the issue"},{"startTime":1801.811,"endTime":1804.32,"body":"is less so that though,"},{"startTime":1804.32,"endTime":1806.69,"body":"that's again a key part of it,"},{"startTime":1806.69,"endTime":1808.88,"body":"but is what Phil was referring to"},{"startTime":1808.88,"endTime":1810.53,"body":"in terms of where the money goes."},{"startTime":1811.67,"endTime":1816.67,"body":"And it's essentially"},{"startTime":1811.67,"endTime":1816.67,"body":"unrealistic to ask acute trusts,"},{"startTime":1819.02,"endTime":1822.98,"body":"ops people to focus"},{"startTime":1819.02,"endTime":1822.98,"body":"primarily on prevention,"},{"startTime":1822.98,"endTime":1824.833,"body":"because if I'm to do that"},{"startTime":1824.833,"endTime":1828.08,"body":"and I'm senior manager on call tonight,"},{"startTime":1828.08,"endTime":1829.793,"body":"there'll be 120 people in the ED,"},{"startTime":1830.63,"endTime":1833.27,"body":"seven-hour waiting list as a minimum."},{"startTime":1833.27,"endTime":1836.51,"body":"So it's how am I supposed"},{"startTime":1833.27,"endTime":1836.51,"body":"to transact prevention"},{"startTime":1836.51,"endTime":1839.613,"body":"when I've got a lot of reaction to do?"},{"startTime":1843.207,"endTime":1846.59,"body":"- Yeah, and I suppose,"},{"startTime":1843.207,"endTime":1846.59,"body":"do you have any thoughts,"},{"startTime":1846.59,"endTime":1849.74,"body":"Sarah, maybe, on what"},{"startTime":1846.59,"endTime":1849.74,"body":"potential solutions could be"},{"startTime":1849.74,"endTime":1853.94,"body":"to overcoming the barrier"},{"startTime":1849.74,"endTime":1853.94,"body":"of the short-term challenges"},{"startTime":1853.94,"endTime":1857.543,"body":"and costs versus long-term benefits?"},{"startTime":1858.44,"endTime":1861.111,"body":"- Well, that's a very"},{"startTime":1858.44,"endTime":1861.111,"body":"big question. (laughs)"},{"startTime":1861.111,"endTime":1863.108,"body":"I think it's, (laughs)"},{"startTime":1863.108,"endTime":1865.94,"body":"I think it's a really"},{"startTime":1863.108,"endTime":1865.94,"body":"important challenge to discuss."},{"startTime":1865.94,"endTime":1868.313,"body":"I think Paddy was just alluding to,"},{"startTime":1869.179,"endTime":1872.81,"body":"the NHS is often forced into"},{"startTime":1869.179,"endTime":1872.81,"body":"those short-term decisions"},{"startTime":1872.81,"endTime":1874.973,"body":"because of immediate pressures."},{"startTime":1876.32,"endTime":1879.02,"body":"And we do know the real value"},{"startTime":1876.32,"endTime":1879.02,"body":"of investing longer term"},{"startTime":1879.02,"endTime":1881.27,"body":"around health and prevention."},{"startTime":1881.27,"endTime":1883.88,"body":"I don't think it's one"},{"startTime":1881.27,"endTime":1883.88,"body":"thing I think Paddy start"},{"startTime":1883.88,"endTime":1887.51,"body":"to touch on it, I think around the funding"},{"startTime":1887.51,"endTime":1889.253,"body":"and where the funding goes."},{"startTime":1891.23,"endTime":1894.87,"body":"We have to be investing in communities"},{"startTime":1896.18,"endTime":1898.1,"body":"if we want to really focus on prevention"},{"startTime":1898.1,"endTime":1899.573,"body":"and early prevention."},{"startTime":1901.1,"endTime":1903.86,"body":"The challenge is the financial return"},{"startTime":1903.86,"endTime":1905.39,"body":"won't happen for several years."},{"startTime":1905.39,"endTime":1906.92,"body":"Could be even generational,"},{"startTime":1906.92,"endTime":1909.17,"body":"particularly when there's some deep rooted"},{"startTime":1909.17,"endTime":1911.363,"body":"health inequalities and health challenges."},{"startTime":1912.38,"endTime":1915.2,"body":"I know locally, we've made the decision"},{"startTime":1915.2,"endTime":1917.78,"body":"to really invest some of our"},{"startTime":1915.2,"endTime":1917.78,"body":"health inequalities grant"},{"startTime":1917.78,"endTime":1919.97,"body":"and things like customer and"},{"startTime":1917.78,"endTime":1919.97,"body":"community first approach,"},{"startTime":1919.97,"endTime":1923.22,"body":"because we do know that if we invest now"},{"startTime":1924.11,"endTime":1925.763,"body":"it's that longer term return,"},{"startTime":1926.6,"endTime":1929.657,"body":"but it's how we demonstrate"},{"startTime":1926.6,"endTime":1929.657,"body":"the impact along the way."},{"startTime":1929.657,"endTime":1931.733,"body":"And that can be a real challenge."},{"startTime":1933.389,"endTime":1934.222,"body":"And I think linked to that,"},{"startTime":1934.222,"endTime":1935.36,"body":"something about how we"},{"startTime":1934.222,"endTime":1935.36,"body":"really measure the value."},{"startTime":1935.36,"endTime":1937.4,"body":"If we're only counting today's savings,"},{"startTime":1937.4,"endTime":1940.973,"body":"we miss the wider economic"},{"startTime":1937.4,"endTime":1940.973,"body":"and patient-person impact."},{"startTime":1941.866,"endTime":1942.83,"body":"You know, using measures"},{"startTime":1941.866,"endTime":1942.83,"body":"that capture things"},{"startTime":1942.83,"endTime":1945.38,"body":"like avoided admission,"},{"startTime":1942.83,"endTime":1945.38,"body":"improved independence,"},{"startTime":1945.38,"endTime":1947.99,"body":"or even people's ability to stay in work"},{"startTime":1947.99,"endTime":1950.0,"body":"really helps demonstrate"},{"startTime":1947.99,"endTime":1950.0,"body":"that bigger picture,"},{"startTime":1950.0,"endTime":1951.83,"body":"which I think quite often we view it"},{"startTime":1951.83,"endTime":1955.28,"body":"through the single NHS lens."},{"startTime":1955.28,"endTime":1956.9,"body":"I mean, we've done some really great work."},{"startTime":1956.9,"endTime":1960.38,"body":"I say we, my team have"},{"startTime":1956.9,"endTime":1960.38,"body":"done some really great work"},{"startTime":1960.38,"endTime":1962.42,"body":"around the Know Your Numbers campaign"},{"startTime":1962.42,"endTime":1963.857,"body":"over the last sort of week or so,"},{"startTime":1963.857,"endTime":1968.15,"body":"and that's about pressing"},{"startTime":1963.857,"endTime":1968.15,"body":"checking blood pressure checks."},{"startTime":1968.15,"endTime":1971.51,"body":"And that is a really good"},{"startTime":1968.15,"endTime":1971.51,"body":"way to be able to demonstrate"},{"startTime":1971.51,"endTime":1973.79,"body":"just by doing those checks now,"},{"startTime":1973.79,"endTime":1975.737,"body":"the savings that that"},{"startTime":1973.79,"endTime":1975.737,"body":"has in the longer term"},{"startTime":1975.737,"endTime":1976.967,"body":"and some really good evidence about that."},{"startTime":1976.967,"endTime":1979.55,"body":"And I think it's how"},{"startTime":1976.967,"endTime":1979.55,"body":"we can do more of that"},{"startTime":1979.55,"endTime":1981.62,"body":"how can we build the"},{"startTime":1979.55,"endTime":1981.62,"body":"evidence to demonstrate"},{"startTime":1981.62,"endTime":1984.41,"body":"that the savings will"},{"startTime":1981.62,"endTime":1984.41,"body":"come in the long term."},{"startTime":1984.41,"endTime":1987.8,"body":"It's that age old thing of"},{"startTime":1984.41,"endTime":1987.8,"body":"trying to prove something"},{"startTime":1987.8,"endTime":1991.1,"body":"that's not going to happen,"},{"startTime":1987.8,"endTime":1991.1,"body":"if that makes sense."},{"startTime":1991.1,"endTime":1991.933,"body":"And then I think,"},{"startTime":1991.933,"endTime":1994.43,"body":"yeah, we've got to be able to align policy"},{"startTime":1994.43,"endTime":1996.56,"body":"with the financial flows."},{"startTime":1996.56,"endTime":2001.33,"body":"As I said, we need to get more"},{"startTime":1996.56,"endTime":2001.33,"body":"money out into communities,"},{"startTime":2001.33,"endTime":2004.0,"body":"very much that population health approach"},{"startTime":2004.0,"endTime":2006.49,"body":"and moving away from"},{"startTime":2004.0,"endTime":2006.49,"body":"those single year cycles."},{"startTime":2006.49,"endTime":2008.454,"body":"Paddy touched on it,"},{"startTime":2008.454,"endTime":2010.57,"body":"you know, it's starting to happen."},{"startTime":2010.57,"endTime":2014.676,"body":"The annual planning from NHSE"},{"startTime":2014.676,"endTime":2016.21,"body":"and ICB is earlier this year."},{"startTime":2016.21,"endTime":2019.27,"body":"And it does include that sort of short,"},{"startTime":2019.27,"endTime":2021.94,"body":"medium and long-term as"},{"startTime":2019.27,"endTime":2021.94,"body":"well as the short-term."},{"startTime":2021.94,"endTime":2026.05,"body":"And I think if we can give"},{"startTime":2021.94,"endTime":2026.05,"body":"providers longer contracts,"},{"startTime":2026.05,"endTime":2027.07,"body":"then they have the ability"},{"startTime":2027.07,"endTime":2029.263,"body":"to be more creative and innovative."},{"startTime":2030.49,"endTime":2033.52,"body":"And I think it's fundamentally"},{"startTime":2030.49,"endTime":2033.52,"body":"about seeing patients"},{"startTime":2033.52,"endTime":2035.17,"body":"as people and not seeing it"},{"startTime":2035.17,"endTime":2037.03,"body":"as today's cost or balance sheet."},{"startTime":2037.03,"endTime":2039.733,"body":"And I think if we can"},{"startTime":2037.03,"endTime":2039.733,"body":"get some of that right,"},{"startTime":2041.38,"endTime":2043.81,"body":"the economics and the"},{"startTime":2041.38,"endTime":2043.81,"body":"patient outcomes will align."},{"startTime":2043.81,"endTime":2047.53,"body":"We just need to start trading"},{"startTime":2043.81,"endTime":2047.53,"body":"today against tomorrow."},{"startTime":2047.53,"endTime":2049.48,"body":"I think that's one of"},{"startTime":2047.53,"endTime":2049.48,"body":"the biggest challenges"},{"startTime":2049.48,"endTime":2051.733,"body":"in how the NHS currently operates."},{"startTime":2053.11,"endTime":2054.31,"body":"- Yeah, no, thank you."},{"startTime":2054.31,"endTime":2057.61,"body":"And I suppose just in terms of industry"},{"startTime":2057.61,"endTime":2059.65,"body":"and how they might be able to support,"},{"startTime":2059.65,"endTime":2061.87,"body":"Phil, I'll come to you for your thoughts."},{"startTime":2061.87,"endTime":2066.19,"body":"Do you have any ideas for"},{"startTime":2061.87,"endTime":2066.19,"body":"how the NHS and pharma"},{"startTime":2066.19,"endTime":2069.73,"body":"or wider industry could work together"},{"startTime":2069.73,"endTime":2072.19,"body":"to deal with the management"},{"startTime":2069.73,"endTime":2072.19,"body":"of long-term conditions"},{"startTime":2072.19,"endTime":2074.653,"body":"when budgets are so short-term currently?"},{"startTime":2076.93,"endTime":2078.73,"body":"- Yeah, thanks, Katie."},{"startTime":2078.73,"endTime":2080.38,"body":"I'd like to sort of join"},{"startTime":2078.73,"endTime":2080.38,"body":"the two conversations"},{"startTime":2080.38,"endTime":2081.55,"body":"together for me."},{"startTime":2081.55,"endTime":2084.013,"body":"I think there is a bit which is,"},{"startTime":2086.32,"endTime":2088.78,"body":"where prevention plays a key"},{"startTime":2086.32,"endTime":2088.78,"body":"role in long-term conditions"},{"startTime":2088.78,"endTime":2090.67,"body":"and then there is long-term"},{"startTime":2088.78,"endTime":2090.67,"body":"condition management,"},{"startTime":2090.67,"endTime":2092.89,"body":"but it's actually all on"},{"startTime":2090.67,"endTime":2092.89,"body":"the same continuum really,"},{"startTime":2092.89,"endTime":2095.68,"body":"'cause a number of long-term conditions"},{"startTime":2095.68,"endTime":2099.04,"body":"actually start with a preventable start"},{"startTime":2099.04,"endTime":2104.04,"body":"or at least an ability to"},{"startTime":2099.04,"endTime":2104.04,"body":"reduce the impact at the start."},{"startTime":2104.47,"endTime":2107.736,"body":"And an example that might help with that"},{"startTime":2107.736,"endTime":2111.403,"body":"is the recent session"},{"startTime":2107.736,"endTime":2111.403,"body":"bringing together the,"},{"startTime":2112.57,"endTime":2116.26,"body":"bringing together the cancer alliances"},{"startTime":2116.26,"endTime":2119.29,"body":"and industry joining that conversation"},{"startTime":2119.29,"endTime":2123.46,"body":"to say how can we detect cancer earlier,"},{"startTime":2123.46,"endTime":2125.95,"body":"right up to the point is"},{"startTime":2123.46,"endTime":2125.95,"body":"what are the new things"},{"startTime":2125.95,"endTime":2127.12,"body":"we should be looking for"},{"startTime":2127.12,"endTime":2132.12,"body":"as opposed to the more traditional"},{"startTime":2127.12,"endTime":2132.12,"body":"biomedical type markers?"},{"startTime":2132.16,"endTime":2135.1,"body":"And what was really cool about"},{"startTime":2132.16,"endTime":2135.1,"body":"that is it had organisations"},{"startTime":2135.1,"endTime":2138.94,"body":"in the room who have a"},{"startTime":2135.1,"endTime":2138.94,"body":"quite large proportion"},{"startTime":2138.94,"endTime":2140.44,"body":"of their business"},{"startTime":2140.44,"endTime":2145.15,"body":"on dealing with the later"},{"startTime":2140.44,"endTime":2145.15,"body":"stage cancer challenges."},{"startTime":2145.15,"endTime":2147.913,"body":"And they were in the"},{"startTime":2145.15,"endTime":2147.913,"body":"room actively engaging,"},{"startTime":2149.11,"endTime":2151.48,"body":"trying to diagnose it earlier."},{"startTime":2151.48,"endTime":2155.77,"body":"So moving into that early"},{"startTime":2151.48,"endTime":2155.77,"body":"diagnosis stroke prevention space."},{"startTime":2155.77,"endTime":2157.6,"body":"And I think if I connect that then"},{"startTime":2157.6,"endTime":2159.79,"body":"with the prevention agenda,"},{"startTime":2159.79,"endTime":2162.16,"body":"I think there's a real role for industry"},{"startTime":2162.16,"endTime":2165.1,"body":"just to work in collaboration"},{"startTime":2165.1,"endTime":2169.21,"body":"with some of the teams who are leading on"},{"startTime":2169.21,"endTime":2171.46,"body":"how do we get prevention"},{"startTime":2169.21,"endTime":2171.46,"body":"engaged in the community,"},{"startTime":2171.46,"endTime":2175.45,"body":"how can we support long-term"},{"startTime":2171.46,"endTime":2175.45,"body":"hospital engagement?"},{"startTime":2175.45,"endTime":2178.03,"body":"I think there's a real"},{"startTime":2175.45,"endTime":2178.03,"body":"opportunity to do that."},{"startTime":2178.03,"endTime":2182.14,"body":"And that would help catalyse"},{"startTime":2178.03,"endTime":2182.14,"body":"the importance of this"},{"startTime":2182.14,"endTime":2183.82,"body":"by starting to demonstrate"},{"startTime":2182.14,"endTime":2183.82,"body":"some of the evidence"},{"startTime":2183.82,"endTime":2185.8,"body":"that Sarah's just touched on"},{"speaker":"because that's one of the challenges","startTime":2188.38,"endTime":2191.02,"body":"how do we see our return on effort?"},{"speaker":"because that's one of the challenges","startTime":2191.02,"endTime":2193.71,"body":"And one of the big challenges"},{"speaker":"because that's one of the challenges","startTime":2191.02,"endTime":2193.71,"body":"with funding is that,"},{"speaker":"because that's one of the challenges","startTime":2193.71,"endTime":2197.053,"body":"so something like 75% of"},{"speaker":"because that's one of the challenges","startTime":2193.71,"endTime":2197.053,"body":"funding is people related."},{"speaker":"because that's one of the challenges","startTime":2198.37,"endTime":2201.4,"body":"So if industry can provide"},{"speaker":"because that's one of the challenges","startTime":2198.37,"endTime":2201.4,"body":"some people related horsepower"},{"speaker":"because that's one of the challenges","startTime":2201.4,"endTime":2203.41,"body":"into the mix, then the"},{"speaker":"because that's one of the challenges","startTime":2201.4,"endTime":2203.41,"body":"funding requirements"},{"speaker":"because that's one of the challenges","startTime":2203.41,"endTime":2205.11,"body":"suddenly a very different profile."},{"speaker":"because that's one of the challenges","startTime":2206.705,"endTime":2208.39,"body":"And if that can work"},{"speaker":"because that's one of the challenges","startTime":2206.705,"endTime":2208.39,"body":"in a collaborative way"},{"speaker":"because that's one of the challenges","startTime":2208.39,"endTime":2212.11,"body":"as a joined up team, which I've"},{"speaker":"because that's one of the challenges","startTime":2208.39,"endTime":2212.11,"body":"seen work really effectively"},{"speaker":"because that's one of the challenges","startTime":2212.11,"endTime":2216.31,"body":"and it can be focused on"},{"speaker":"because that's one of the challenges","startTime":2212.11,"endTime":2216.31,"body":"prevention in a therapeutic area"},{"speaker":"because that's one of the challenges","startTime":2216.31,"endTime":2221.31,"body":"or comorbid area that the"},{"speaker":"because that's one of the challenges","startTime":2216.31,"endTime":2221.31,"body":"organisation is familiar with,"},{"speaker":"because that's one of the challenges","startTime":2221.95,"endTime":2225.22,"body":"then that could start to"},{"speaker":"because that's one of the challenges","startTime":2221.95,"endTime":2225.22,"body":"unlock some real benefit,"},{"speaker":"because that's one of the challenges","startTime":2225.22,"endTime":2228.7,"body":"and it could start to unlock it earlier."},{"speaker":"because that's one of the challenges","startTime":2228.7,"endTime":2230.38,"body":"But the funding for long-term conditions"},{"speaker":"because that's one of the challenges","startTime":2230.38,"endTime":2232.423,"body":"has been a perennial problem."},{"speaker":"because that's one of the challenges","startTime":2233.53,"endTime":2235.81,"body":"And what typically happens is they end up"},{"speaker":"because that's one of the challenges","startTime":2235.81,"endTime":2239.8,"body":"in a primary care space with quite a bit"},{"speaker":"because that's one of the challenges","startTime":2239.8,"endTime":2243.4,"body":"of the time doing routine follow-ups,"},{"speaker":"because that's one of the challenges","startTime":2243.4,"endTime":2245.56,"body":"diagnostic rechecking."},{"speaker":"because that's one of the challenges","startTime":2245.56,"endTime":2250.03,"body":"And some of the interventions"},{"speaker":"because that's one of the challenges","startTime":2245.56,"endTime":2250.03,"body":"from a digital point"},{"speaker":"because that's one of the challenges","startTime":2250.03,"endTime":2251.44,"body":"of view can really help that."},{"speaker":"because that's one of the challenges","startTime":2251.44,"endTime":2254.77,"body":"So wearables and remote"},{"speaker":"because that's one of the challenges","startTime":2251.44,"endTime":2254.77,"body":"monitoring are a key part."},{"speaker":"because that's one of the challenges","startTime":2254.77,"endTime":2257.83,"body":"So we need to think about the answer"},{"speaker":"because that's one of the challenges","startTime":2257.83,"endTime":2262.18,"body":"may not be a medical answer,"},{"speaker":"because that's one of the challenges","startTime":2257.83,"endTime":2262.18,"body":"it could be a broader answer"},{"speaker":"because that's one of the challenges","startTime":2262.18,"endTime":2263.89,"body":"by bringing together some technology,"},{"speaker":"because that's one of the challenges","startTime":2263.89,"endTime":2266.47,"body":"some data and collaborative working"},{"speaker":"because that's one of the challenges","startTime":2266.47,"endTime":2267.793,"body":"with industry and others."},{"speaker":"because that's one of the challenges","startTime":2270.7,"endTime":2271.953,"body":"- Thank you."},{"speaker":"because that's one of the challenges","startTime":2271.953,"endTime":2273.13,"body":"And that actually really nicely brings me"},{"speaker":"because that's one of the challenges","startTime":2273.13,"endTime":2274.42,"body":"onto my next question,"},{"speaker":"because that's one of the challenges","startTime":2274.42,"endTime":2275.5,"body":"which is all about"},{"speaker":"because that's one of the challenges","startTime":2275.5,"endTime":2278.53,"body":"how we're going to be adopting"},{"speaker":"because that's one of the challenges","startTime":2275.5,"endTime":2278.53,"body":"innovative technologies."},{"speaker":"because that's one of the challenges","startTime":2278.53,"endTime":2279.46,"body":"Obviously now more than ever,"},{"speaker":"because that's one of the challenges","startTime":2279.46,"endTime":2282.28,"body":"there's more and more coming through."},{"speaker":"because that's one of the challenges","startTime":2282.28,"endTime":2284.35,"body":"And one of the key targets"},{"speaker":"because that's one of the challenges","startTime":2282.28,"endTime":2284.35,"body":"within the 10-year plan"},{"speaker":"because that's one of the challenges","startTime":2284.35,"endTime":2286.12,"body":"has been around introducing efficiencies"},{"speaker":"because that's one of the challenges","startTime":2286.12,"endTime":2288.673,"body":"through automation and AI as well."},{"speaker":"because that's one of the challenges","startTime":2290.05,"endTime":2293.02,"body":"Just the first question"},{"speaker":"because that's one of the challenges","startTime":2290.05,"endTime":2293.02,"body":"just around budgets,"},{"speaker":"because that's one of the challenges","startTime":2293.02,"endTime":2294.91,"body":"efficiencies that need to be made."},{"speaker":"because that's one of the challenges","startTime":2294.91,"endTime":2297.19,"body":"Obviously ICBs are needing to cut costs"},{"speaker":"because that's one of the challenges","startTime":2297.19,"endTime":2298.96,"body":"and it's just a question"},{"speaker":"because that's one of the challenges","startTime":2298.96,"endTime":2301.93,"body":"around how the 2% efficiency mandate"},{"speaker":"because that's one of the challenges","startTime":2301.93,"endTime":2303.22,"body":"will likely affect the adoption"},{"speaker":"because that's one of the challenges","startTime":2303.22,"endTime":2305.62,"body":"of new innovative technologies."},{"speaker":"because that's one of the challenges","startTime":2305.62,"endTime":2308.427,"body":"Paddy, maybe I can come"},{"speaker":"because that's one of the challenges","startTime":2305.62,"endTime":2308.427,"body":"to you first with that."},{"speaker":"because that's one of the challenges","startTime":2309.552,"endTime":2314.552,"body":"- Yeah, so I actually"},{"speaker":"because that's one of the challenges","startTime":2309.552,"endTime":2314.552,"body":"think it's more like 3%"},{"speaker":"because that's one of the challenges","startTime":2314.65,"endTime":2316.66,"body":"or quite a bit more in some cases"},{"speaker":"because that's one of the challenges","startTime":2316.66,"endTime":2319.483,"body":"where there are already"},{"speaker":"because that's one of the challenges","startTime":2316.66,"endTime":2319.483,"body":"significant deficits."},{"speaker":"because that's one of the challenges","startTime":2320.53,"endTime":2325.53,"body":"Obviously that poses a"},{"speaker":"because that's one of the challenges","startTime":2320.53,"endTime":2325.53,"body":"real tension for boards"},{"speaker":"because that's one of the challenges","startTime":2325.66,"endTime":2328.39,"body":"where the NHS urgently needs innovation"},{"speaker":"because that's one of the challenges","startTime":2328.39,"endTime":2331.93,"body":"to drive the productivity, prevention,"},{"speaker":"because that's one of the challenges","startTime":2331.93,"endTime":2334.38,"body":"population health agenda"},{"speaker":"because that's one of the challenges","startTime":2331.93,"endTime":2334.38,"body":"that we've spoken about."},{"speaker":"because that's one of the challenges","startTime":2335.29,"endTime":2337.18,"body":"But again it's balanced against"},{"speaker":"because that's one of the challenges","startTime":2337.18,"endTime":2340.04,"body":"that sort of blunt cost cutting pressure"},{"speaker":"because that's one of the challenges","startTime":2341.11,"endTime":2343.57,"body":"that potentially crowds"},{"speaker":"because that's one of the challenges","startTime":2341.11,"endTime":2343.57,"body":"out that investment"},{"speaker":"because that's one of the challenges","startTime":2343.57,"endTime":2346.84,"body":"or at least that intention to invest."},{"speaker":"because that's one of the challenges","startTime":2346.84,"endTime":2351.609,"body":"We've spoken a lot"},{"speaker":"because that's one of the challenges","startTime":2346.84,"endTime":2351.609,"body":"already around the mandate"},{"speaker":"because that's one of the challenges","startTime":2351.609,"endTime":2355.54,"body":"that pushes ICBs to towards"},{"speaker":"because that's one of the challenges","startTime":2351.609,"endTime":2355.54,"body":"those short-term cash release"},{"speaker":"because that's one of the challenges","startTime":2355.54,"endTime":2358.99,"body":"and savings rather than the"},{"speaker":"because that's one of the challenges","startTime":2355.54,"endTime":2358.99,"body":"long-term transformation,"},{"speaker":"because that's one of the challenges","startTime":2358.99,"endTime":2362.71,"body":"which can make it a little bit"},{"speaker":"because that's one of the challenges","startTime":2358.99,"endTime":2362.71,"body":"harder to fund upfront costs"},{"speaker":"because that's one of the challenges","startTime":2362.71,"endTime":2365.86,"body":"for new technologies 'cause"},{"speaker":"because that's one of the challenges","startTime":2362.71,"endTime":2365.86,"body":"of that short-term focus,"},{"speaker":"because that's one of the challenges","startTime":2365.86,"endTime":2369.913,"body":"which is where I think industry,"},{"speaker":"because that's one of the challenges","startTime":2372.1,"endTime":2375.237,"body":"so it needs to frame frame technologies"},{"speaker":"because that's one of the challenges","startTime":2375.237,"endTime":2377.53,"body":"as not really just nice to have,"},{"speaker":"because that's one of the challenges","startTime":2377.53,"endTime":2382.53,"body":"but as efficiency enablers"},{"speaker":"because that's one of the challenges","startTime":2377.53,"endTime":2382.53,"body":"and things that will introduce"},{"speaker":"because that's one of the challenges","startTime":2383.44,"endTime":2386.233,"body":"at least partially a short-term benefit."},{"speaker":"because that's one of the challenges","startTime":2387.16,"endTime":2390.34,"body":"I think industry needs"},{"speaker":"because that's one of the challenges","startTime":2387.16,"endTime":2390.34,"body":"to help the NHS achieve"},{"speaker":"because that's one of the challenges","startTime":2390.34,"endTime":2391.51,"body":"that short-term benefit"},{"speaker":"because that's one of the challenges","startTime":2391.51,"endTime":2393.31,"body":"whilst also focusing on the long term."},{"speaker":"because that's one of the challenges","startTime":2393.31,"endTime":2396.22,"body":"Now, that's not always possible"},{"speaker":"because that's one of the challenges","startTime":2396.22,"endTime":2399.523,"body":"but it probably does need to be the focus."},{"speaker":"because that's one of the challenges","startTime":2401.23,"endTime":2405.28,"body":"Any business cases need"},{"speaker":"because that's one of the challenges","startTime":2401.23,"endTime":2405.28,"body":"to be absolutely robust"},{"speaker":"because that's one of the challenges","startTime":2405.28,"endTime":2407.53,"body":"that are able to realise something"},{"speaker":"because that's one of the challenges","startTime":2407.53,"endTime":2409.79,"body":"within sort of an in-year benefit"},{"speaker":"because that's one of the challenges","startTime":2411.52,"endTime":2413.74,"body":"with potentially I think"},{"speaker":"because that's one of the challenges","startTime":2411.52,"endTime":2413.74,"body":"flexible commercial models"},{"speaker":"because that's one of the challenges","startTime":2413.74,"endTime":2416.59,"body":"around risk share and stage payments"},{"speaker":"because that's one of the challenges","startTime":2416.59,"endTime":2418.843,"body":"and sort of partnerships."},{"speaker":"because that's one of the challenges","startTime":2419.92,"endTime":2422.03,"body":"So I think that the efficiency mandate"},{"speaker":"because that's one of the challenges","startTime":2424.21,"endTime":2426.16,"body":"doesn't necessarily stifle innovation,"},{"speaker":"because that's one of the challenges","startTime":2426.16,"endTime":2428.98,"body":"but it does raise the"},{"speaker":"because that's one of the challenges","startTime":2426.16,"endTime":2428.98,"body":"bar for business cases."},{"speaker":"because that's one of the challenges","startTime":2428.98,"endTime":2432.64,"body":"Only those solutions that"},{"speaker":"because that's one of the challenges","startTime":2428.98,"endTime":2432.64,"body":"directly release cash,"},{"speaker":"because that's one of the challenges","startTime":2432.64,"endTime":2434.17,"body":"save staff time,"},{"speaker":"because that's one of the challenges","startTime":2434.17,"endTime":2436.505,"body":"and by staff I mean in the main, I mean,"},{"speaker":"because that's one of the challenges","startTime":2436.505,"endTime":2438.433,"body":"you know, clinical time,"},{"speaker":"because that's one of the challenges","startTime":2440.02,"endTime":2444.94,"body":"or demonstrably reduce"},{"speaker":"because that's one of the challenges","startTime":2440.02,"endTime":2444.94,"body":"demand will make it through."},{"speaker":"because that's one of the challenges","startTime":2444.94,"endTime":2447.25,"body":"And those that don't tick two or three"},{"speaker":"because that's one of the challenges","startTime":2447.25,"endTime":2449.77,"body":"of those boxes will probably struggle."},{"speaker":"because that's one of the challenges","startTime":2449.77,"endTime":2452.62,"body":"I think the last point I'll make, Katie,"},{"speaker":"because that's one of the challenges","startTime":2452.62,"endTime":2455.5,"body":"is just that we've also got"},{"speaker":"because that's one of the challenges","startTime":2452.62,"endTime":2455.5,"body":"the health innovation networks"},{"speaker":"because that's one of the challenges","startTime":2455.5,"endTime":2459.91,"body":"as well, which are in place"},{"speaker":"because that's one of the challenges","startTime":2455.5,"endTime":2459.91,"body":"to support the adoption"},{"speaker":"because that's one of the challenges","startTime":2459.91,"endTime":2461.353,"body":"of innovative technologies."},{"speaker":"because that's one of the challenges","startTime":2462.43,"endTime":2466.15,"body":"So whilst there are cuts at"},{"speaker":"because that's one of the challenges","startTime":2462.43,"endTime":2466.15,"body":"the centre and regionally"},{"speaker":"because that's one of the challenges","startTime":2466.15,"endTime":2470.65,"body":"and in ICBs, hopefully the"},{"speaker":"because that's one of the challenges","startTime":2466.15,"endTime":2470.65,"body":"health innovation networks"},{"speaker":"because that's one of the challenges","startTime":2470.65,"endTime":2472.933,"body":"will be able to balance that in some way."},{"speaker":"because that's one of the challenges","startTime":2474.31,"endTime":2476.921,"body":"- Yeah, no, great. Thank you."},{"speaker":"because that's one of the challenges","startTime":2476.921,"endTime":2478.57,"body":"Sarah, do you have anything else to add"},{"speaker":"because that's one of the challenges","startTime":2478.57,"endTime":2480.31,"body":"from your perspective?"},{"speaker":"because that's one of the challenges","startTime":2480.31,"endTime":2482.62,"body":"- That's very comprehensive, Paddy."},{"speaker":"because that's one of the challenges","startTime":2482.62,"endTime":2484.3,"body":"I think just to add, I guess,"},{"speaker":"because that's one of the challenges","startTime":2484.3,"endTime":2489.3,"body":"it's balancing the longer term impact"},{"speaker":"because that's one of the challenges","startTime":2490.09,"endTime":2491.47,"body":"versus that short term."},{"speaker":"because that's one of the challenges","startTime":2491.47,"endTime":2495.61,"body":"And I think we're good at in"},{"speaker":"because that's one of the challenges","startTime":2491.47,"endTime":2495.61,"body":"the NHS of looking for quick,"},{"speaker":"because that's one of the challenges","startTime":2495.61,"endTime":2497.53,"body":"I like to call 'em quick wins."},{"speaker":"because that's one of the challenges","startTime":2497.53,"endTime":2501.23,"body":"And I think when there's money to be saved"},{"speaker":"because that's one of the challenges","startTime":2502.147,"endTime":2503.5,"body":"or there's an efficiency mandate,"},{"speaker":"because that's one of the challenges","startTime":2503.5,"endTime":2505.96,"body":"it is the quick wins"},{"speaker":"because that's one of the challenges","startTime":2503.5,"endTime":2505.96,"body":"that get the attention,"},{"speaker":"because that's one of the challenges","startTime":2505.96,"endTime":2507.79,"body":"but actually all the quick wins often do"},{"speaker":"because that's one of the challenges","startTime":2507.79,"endTime":2510.643,"body":"is just put a bit of a"},{"speaker":"because that's one of the challenges","startTime":2507.79,"endTime":2510.643,"body":"stick in pasta row there."},{"speaker":"because that's one of the challenges","startTime":2512.23,"endTime":2514.3,"body":"It might make a a short-term impact,"},{"speaker":"because that's one of the challenges","startTime":2514.3,"endTime":2516.79,"body":"but we want to make real"},{"speaker":"because that's one of the challenges","startTime":2514.3,"endTime":2516.79,"body":"long-lasting change,"},{"speaker":"because that's one of the challenges","startTime":2516.79,"endTime":2521.59,"body":"it's about how those"},{"speaker":"because that's one of the challenges","startTime":2516.79,"endTime":2521.59,"body":"innovative technologies"},{"speaker":"because that's one of the challenges","startTime":2521.59,"endTime":2523.03,"body":"that can do that around the things"},{"speaker":"because that's one of the challenges","startTime":2523.03,"endTime":2525.04,"body":"that Paddy has just described."},{"speaker":"because that's one of the challenges","startTime":2525.04,"endTime":2526.0,"body":"And I think it'd also add into that"},{"speaker":"because that's one of the challenges","startTime":2526.0,"endTime":2529.18,"body":"is improving patient outcomes"},{"speaker":"because that's one of the challenges","startTime":2529.18,"endTime":2531.82,"body":"as being a top priority as well."},{"speaker":"because that's one of the challenges","startTime":2531.82,"endTime":2534.64,"body":"But yeah, I think it's not"},{"speaker":"because that's one of the challenges","startTime":2531.82,"endTime":2534.64,"body":"focusing on the quick wins"},{"speaker":"because that's one of the challenges","startTime":2534.64,"endTime":2538.3,"body":"but looking at at the longer term impact,"},{"speaker":"because that's one of the challenges","startTime":2538.3,"endTime":2540.7,"body":"and being able to"},{"speaker":"because that's one of the challenges","startTime":2538.3,"endTime":2540.7,"body":"demonstrate those savings"},{"speaker":"because that's one of the challenges","startTime":2540.7,"endTime":2542.92,"body":"and improvements along the way,"},{"speaker":"because that's one of the challenges","startTime":2542.92,"endTime":2544.993,"body":"but that not being the first focus."},{"speaker":"because that's one of the challenges","startTime":2546.67,"endTime":2548.715,"body":"- Yeah, thank you-"},{"speaker":"because that's one of the challenges","startTime":2546.67,"endTime":2548.715,"body":"- Katie."},{"speaker":"because that's one of the challenges","startTime":2548.715,"endTime":2550.03,"body":"Katie, can I just sort of jump in?"},{"speaker":"because that's one of the challenges","startTime":2550.03,"endTime":2552.761,"body":"Sorry, didn't need to get across here."},{"speaker":"because that's one of the challenges","startTime":2552.761,"endTime":2554.983,"body":"But I think the important thing here is,"},{"speaker":"because that's one of the challenges","startTime":2556.39,"endTime":2560.59,"body":"say there's a bit of a smoke"},{"speaker":"because that's one of the challenges","startTime":2556.39,"endTime":2560.59,"body":"and mirrors conversation"},{"speaker":"because that's one of the challenges","startTime":2560.59,"endTime":2562.12,"body":"often happens around savings."},{"speaker":"because that's one of the challenges","startTime":2562.12,"endTime":2564.85,"body":"So if I just comes back"},{"speaker":"because that's one of the challenges","startTime":2562.12,"endTime":2564.85,"body":"to my commissioner role,"},{"speaker":"because that's one of the challenges","startTime":2564.85,"endTime":2569.26,"body":"we would often be given"},{"speaker":"because that's one of the challenges","startTime":2564.85,"endTime":2569.26,"body":"a business case would say"},{"speaker":"because that's one of the challenges","startTime":2569.26,"endTime":2571.633,"body":"you do a thousand of these a month,"},{"speaker":"because that's one of the challenges","startTime":2572.74,"endTime":2575.35,"body":"we'll save a pound on each case."},{"speaker":"because that's one of the challenges","startTime":2575.35,"endTime":2578.95,"body":"That means you've got a thousand"},{"speaker":"because that's one of the challenges","startTime":2575.35,"endTime":2578.95,"body":"pounds worth of savings."},{"speaker":"because that's one of the challenges","startTime":2578.95,"endTime":2580.03,"body":"Then you think,"},{"speaker":"because that's one of the challenges","startTime":2580.03,"endTime":2580.96,"body":"well, no, not really"},{"speaker":"because that's one of the challenges","startTime":2580.96,"endTime":2583.873,"body":"because we'll still be doing a thousand,"},{"speaker":"because that's one of the challenges","startTime":2585.61,"endTime":2587.8,"body":"we'll be using your new"},{"speaker":"because that's one of the challenges","startTime":2585.61,"endTime":2587.8,"body":"technology or solution"},{"speaker":"because that's one of the challenges","startTime":2587.8,"endTime":2589.78,"body":"which will be costing us more"},{"speaker":"because that's one of the challenges","startTime":2589.78,"endTime":2592.39,"body":"and I can't get the pound out,"},{"speaker":"because that's one of the challenges","startTime":2592.39,"endTime":2594.25,"body":"I can't find a way of"},{"speaker":"because that's one of the challenges","startTime":2592.39,"endTime":2594.25,"body":"getting the pound out"},{"speaker":"because that's one of the challenges","startTime":2594.25,"endTime":2595.903,"body":"to give it to somebody else."},{"speaker":"because that's one of the challenges","startTime":2596.8,"endTime":2597.93,"body":"So I think there needs to be bit"},{"speaker":"because that's one of the challenges","startTime":2597.93,"endTime":2600.49,"body":"of an asset test on savings."},{"speaker":"because that's one of the challenges","startTime":2600.49,"endTime":2603.073,"body":"It is what is actually cashable?"},{"speaker":"because that's one of the challenges","startTime":2607.93,"endTime":2611.62,"body":"Will I have cash in my hand at"},{"speaker":"because that's one of the challenges","startTime":2607.93,"endTime":2611.62,"body":"the end of the business case"},{"speaker":"because that's one of the challenges","startTime":2611.62,"endTime":2613.36,"body":"that I didn't have before?"},{"speaker":"because that's one of the challenges","startTime":2613.36,"endTime":2615.46,"body":"And in a lot of cases, you can't."},{"speaker":"because that's one of the challenges","startTime":2615.46,"endTime":2617.95,"body":"And even if it's like clinical savings."},{"speaker":"because that's one of the challenges","startTime":2617.95,"endTime":2620.83,"body":"So we had examples such as physiotherapy"},{"speaker":"because that's one of the challenges","startTime":2620.83,"endTime":2623.83,"body":"which said, well, we could provide apps"},{"speaker":"because that's one of the challenges","startTime":2623.83,"endTime":2624.94,"body":"that people can use at home,"},{"speaker":"because that's one of the challenges","startTime":2624.94,"endTime":2629.38,"body":"which will mean they can"},{"speaker":"because that's one of the challenges","startTime":2624.94,"endTime":2629.38,"body":"do physiotherapy activities"},{"speaker":"because that's one of the challenges","startTime":2629.38,"endTime":2630.34,"body":"by following the app"},{"speaker":"because that's one of the challenges","startTime":2630.34,"endTime":2632.227,"body":"as opposed to having a"},{"speaker":"because that's one of the challenges","startTime":2630.34,"endTime":2632.227,"body":"physiotherapist show them"},{"speaker":"because that's one of the challenges","startTime":2632.227,"endTime":2633.91,"body":"how to do the activity."},{"speaker":"because that's one of the challenges","startTime":2633.91,"endTime":2636.61,"body":"And you think, well, that"},{"speaker":"because that's one of the challenges","startTime":2633.91,"endTime":2636.61,"body":"all sounds very interesting."},{"speaker":"because that's one of the challenges","startTime":2637.48,"endTime":2641.833,"body":"So that will save 20% of"},{"speaker":"because that's one of the challenges","startTime":2637.48,"endTime":2641.833,"body":"your physiotherapy costs,"},{"speaker":"because that's one of the challenges","startTime":2642.911,"endTime":2643.744,"body":"but I'm not really going to reduce"},{"speaker":"because that's one of the challenges","startTime":2643.744,"endTime":2645.417,"body":"my physiotherapy workforce by 20%,"},{"speaker":"because that's one of the challenges","startTime":2645.417,"endTime":2647.77,"body":"'cause those physiotherapists"},{"speaker":"because that's one of the challenges","startTime":2645.417,"endTime":2647.77,"body":"are also deployed"},{"speaker":"because that's one of the challenges","startTime":2647.77,"endTime":2649.09,"body":"in other things,"},{"speaker":"because that's one of the challenges","startTime":2649.09,"endTime":2650.47,"body":"which would then be a hundred percent"},{"speaker":"because that's one of the challenges","startTime":2650.47,"endTime":2652.033,"body":"stopping that activity."},{"speaker":"because that's one of the challenges","startTime":2653.14,"endTime":2655.57,"body":"And 20% of the physios,"},{"speaker":"because that's one of the challenges","startTime":2655.57,"endTime":2657.253,"body":"we can't really take a, you know,"},{"speaker":"because that's one of the challenges","startTime":2657.253,"endTime":2661.06,"body":"20% of a person away 'cause"},{"speaker":"because that's one of the challenges","startTime":2657.253,"endTime":2661.06,"body":"they're working full time"},{"speaker":"because that's one of the challenges","startTime":2661.06,"endTime":2663.13,"body":"and they allocate their"},{"speaker":"because that's one of the challenges","startTime":2661.06,"endTime":2663.13,"body":"time in different ways."},{"speaker":"because that's one of the challenges","startTime":2663.13,"endTime":2665.8,"body":"So something about cost saving where,"},{"speaker":"because that's one of the challenges","startTime":2665.8,"endTime":2668.65,"body":"and, you know, I thought about earlier,"},{"speaker":"because that's one of the challenges","startTime":2668.65,"endTime":2671.983,"body":"70% plus of the costs of people costs."},{"speaker":"because that's one of the challenges","startTime":2672.82,"endTime":2675.28,"body":"Then you need to make"},{"speaker":"because that's one of the challenges","startTime":2672.82,"endTime":2675.28,"body":"some fundamental decisions"},{"speaker":"because that's one of the challenges","startTime":2675.28,"endTime":2677.7,"body":"about what the purpose of your case is."},{"speaker":"because that's one of the challenges","startTime":2677.7,"endTime":2679.87,"body":"Is it to allow deployment of staff"},{"speaker":"because that's one of the challenges","startTime":2679.87,"endTime":2681.94,"body":"into a wider range of activities?"},{"speaker":"because that's one of the challenges","startTime":2681.94,"endTime":2684.25,"body":"And if it is, where are they going exactly"},{"speaker":"because that's one of the challenges","startTime":2684.25,"endTime":2685.75,"body":"and is that where they're going,"},{"speaker":"because that's one of the challenges","startTime":2685.75,"endTime":2687.22,"body":"is it efficient where they're going"},{"speaker":"because that's one of the challenges","startTime":2687.22,"endTime":2689.38,"body":"because you could just"},{"speaker":"because that's one of the challenges","startTime":2687.22,"endTime":2689.38,"body":"waste money doing that?"},{"speaker":"because that's one of the challenges","startTime":2689.38,"endTime":2693.19,"body":"Or can you show direct cashable savings?"},{"speaker":"because that's one of the challenges","startTime":2693.19,"endTime":2696.4,"body":"And I think there's quite a lot that sits"},{"speaker":"because that's one of the challenges","startTime":2696.4,"endTime":2700.513,"body":"in that precision around"},{"speaker":"because that's one of the challenges","startTime":2696.4,"endTime":2700.513,"body":"commissioning decisions,"},{"speaker":"because that's one of the challenges","startTime":2703.165,"endTime":2704.83,"body":"which could release cash right now,"},{"speaker":"because that's one of the challenges","startTime":2704.83,"endTime":2707.13,"body":"but you would change"},{"speaker":"because that's one of the challenges","startTime":2704.83,"endTime":2707.13,"body":"your workforce structure."},{"speaker":"because that's one of the challenges","startTime":2712.21,"endTime":2714.36,"body":"- Yeah, some great"},{"speaker":"because that's one of the challenges","startTime":2712.21,"endTime":2714.36,"body":"points, Phil. Thank you."},{"speaker":"because that's one of the challenges","startTime":2715.87,"endTime":2717.01,"body":"I've just got another question"},{"speaker":"because that's one of the challenges","startTime":2717.01,"endTime":2720.163,"body":"around actually implementing"},{"speaker":"because that's one of the challenges","startTime":2717.01,"endTime":2720.163,"body":"some of these innovations."},{"speaker":"because that's one of the challenges","startTime":2721.007,"endTime":2723.61,"body":"\"How will the NHS ensure that AI"},{"speaker":"because that's one of the challenges","startTime":2723.61,"endTime":2726.64,"body":"and clinical informatics"},{"speaker":"because that's one of the challenges","startTime":2723.61,"endTime":2726.64,"body":"are safely integrated"},{"speaker":"because that's one of the challenges","startTime":2726.64,"endTime":2728.11,"body":"into everyday practise"},{"speaker":"because that's one of the challenges","startTime":2728.11,"endTime":2731.05,"body":"without adding to the digital burden?\""},{"speaker":"because that's one of the challenges","startTime":2731.05,"endTime":2732.883,"body":"Sarah, maybe I can come to you."},{"speaker":"because that's one of the challenges","startTime":2734.23,"endTime":2735.43,"body":"- Yeah, thanks, Katie."},{"speaker":"because that's one of the challenges","startTime":2735.43,"endTime":2737.923,"body":"I mean, I think this is"},{"speaker":"because that's one of the challenges","startTime":2735.43,"endTime":2737.923,"body":"really, really important."},{"speaker":"because that's one of the challenges","startTime":2739.3,"endTime":2741.37,"body":"I love tech, especially AI."},{"speaker":"because that's one of the challenges","startTime":2741.37,"endTime":2745.18,"body":"It makes my job easier, it"},{"speaker":"because that's one of the challenges","startTime":2741.37,"endTime":2745.18,"body":"makes me more time efficient."},{"speaker":"because that's one of the challenges","startTime":2745.18,"endTime":2746.8,"body":"But I'm not necessarily certain"},{"speaker":"because that's one of the challenges","startTime":2746.8,"endTime":2748.84,"body":"that the whole workforce feel the same."},{"speaker":"because that's one of the challenges","startTime":2748.84,"endTime":2752.5,"body":"I think we've got a bit"},{"speaker":"because that's one of the challenges","startTime":2748.84,"endTime":2752.5,"body":"of a skills gap challenge."},{"speaker":"because that's one of the challenges","startTime":2752.5,"endTime":2756.64,"body":"I think we've got some"},{"speaker":"because that's one of the challenges","startTime":2752.5,"endTime":2756.64,"body":"people who embrace technology"},{"speaker":"because that's one of the challenges","startTime":2756.64,"endTime":2759.37,"body":"and want to use it more."},{"speaker":"because that's one of the challenges","startTime":2759.37,"endTime":2762.403,"body":"And then we've also got people"},{"speaker":"because that's one of the challenges","startTime":2759.37,"endTime":2762.403,"body":"who aren't that interested."},{"speaker":"because that's one of the challenges","startTime":2763.24,"endTime":2765.37,"body":"And I think if we also"},{"speaker":"because that's one of the challenges","startTime":2763.24,"endTime":2765.37,"body":"then play into the mix"},{"speaker":"because that's one of the challenges","startTime":2765.37,"endTime":2768.16,"body":"around sort of health inequalities,"},{"speaker":"because that's one of the challenges","startTime":2768.16,"endTime":2771.52,"body":"I heard the other day I think"},{"speaker":"because that's one of the challenges","startTime":2768.16,"endTime":2771.52,"body":"it was 10 million people"},{"speaker":"because that's one of the challenges","startTime":2771.52,"endTime":2775.42,"body":"in the country don't have the skills"},{"speaker":"because that's one of the challenges","startTime":2775.42,"endTime":2777.73,"body":"to be able to use new technologies,"},{"speaker":"because that's one of the challenges","startTime":2777.73,"endTime":2779.92,"body":"and 3 million, I think"},{"speaker":"because that's one of the challenges","startTime":2777.73,"endTime":2779.92,"body":"it's about 3 million"},{"speaker":"because that's one of the challenges","startTime":2779.92,"endTime":2783.16,"body":"that don't have access to the"},{"speaker":"because that's one of the challenges","startTime":2779.92,"endTime":2783.16,"body":"data or the digital tools."},{"speaker":"because that's one of the challenges","startTime":2783.16,"endTime":2786.123,"body":"So I think exclusion is a real challenge."},{"speaker":"because that's one of the challenges","startTime":2786.123,"endTime":2788.62,"body":"There's a big push"},{"speaker":"because that's one of the challenges","startTime":2786.123,"endTime":2788.62,"body":"through the 10-year plan"},{"speaker":"because that's one of the challenges","startTime":2788.62,"endTime":2792.74,"body":"from analogue to digital"},{"speaker":"because that's one of the challenges","startTime":2788.62,"endTime":2792.74,"body":"and using the NHS app,"},{"speaker":"because that's one of the challenges","startTime":2794.65,"endTime":2795.76,"body":"which I, you know,"},{"speaker":"because that's one of the challenges","startTime":2795.76,"endTime":2797.41,"body":"think is great and we"},{"speaker":"because that's one of the challenges","startTime":2795.76,"endTime":2797.41,"body":"need to use that more"},{"speaker":"because that's one of the challenges","startTime":2797.41,"endTime":2800.756,"body":"and it needs to be built"},{"speaker":"because that's one of the challenges","startTime":2797.41,"endTime":2800.756,"body":"so it has more capability,"},{"speaker":"because that's one of the challenges","startTime":2800.756,"endTime":2801.94,"body":"but we need to be really mindful"},{"speaker":"because that's one of the challenges","startTime":2801.94,"endTime":2804.55,"body":"that there's a real risk"},{"speaker":"because that's one of the challenges","startTime":2801.94,"endTime":2804.55,"body":"around inequalities."},{"speaker":"because that's one of the challenges","startTime":2804.55,"endTime":2807.13,"body":"And what we don't inadvertently want to do"},{"speaker":"because that's one of the challenges","startTime":2807.13,"endTime":2811.69,"body":"is make that inequality gap wider,"},{"speaker":"because that's one of the challenges","startTime":2811.69,"endTime":2814.12,"body":"both digital exclusion for our communities"},{"speaker":"because that's one of the challenges","startTime":2814.12,"endTime":2816.82,"body":"but also for our workforce."},{"speaker":"because that's one of the challenges","startTime":2816.82,"endTime":2820.09,"body":"We need to make sure that"},{"speaker":"because that's one of the challenges","startTime":2816.82,"endTime":2820.09,"body":"proper training is in place"},{"speaker":"because that's one of the challenges","startTime":2820.09,"endTime":2821.56,"body":"so it's not seen,"},{"speaker":"because that's one of the challenges","startTime":2821.56,"endTime":2825.82,"body":"I think Phil talked earlier a"},{"speaker":"because that's one of the challenges","startTime":2821.56,"endTime":2825.82,"body":"little bit about the challenge"},{"speaker":"because that's one of the challenges","startTime":2825.82,"endTime":2829.39,"body":"between managing crisis on"},{"speaker":"because that's one of the challenges","startTime":2825.82,"endTime":2829.39,"body":"the day versus is prevention."},{"speaker":"because that's one of the challenges","startTime":2829.39,"endTime":2832.57,"body":"And we need to make sure"},{"speaker":"because that's one of the challenges","startTime":2829.39,"endTime":2832.57,"body":"that this is not seen"},{"speaker":"because that's one of the challenges","startTime":2832.57,"endTime":2835.69,"body":"as something extra like I"},{"speaker":"because that's one of the challenges","startTime":2832.57,"endTime":2835.69,"body":"think prevention can often be,"},{"speaker":"because that's one of the challenges","startTime":2835.69,"endTime":2838.81,"body":"it's like how can the technology be"},{"speaker":"because that's one of the challenges","startTime":2838.81,"endTime":2842.5,"body":"absolutely making people's jobs easier"},{"speaker":"because that's one of the challenges","startTime":2842.5,"endTime":2846.61,"body":"and making sure that we've got"},{"speaker":"because that's one of the challenges","startTime":2842.5,"endTime":2846.61,"body":"people with the right skills"},{"speaker":"because that's one of the challenges","startTime":2846.61,"endTime":2848.71,"body":"and that we're providing opportunities"},{"speaker":"because that's one of the challenges","startTime":2848.71,"endTime":2850.75,"body":"for people in communities"},{"speaker":"because that's one of the challenges","startTime":2848.71,"endTime":2850.75,"body":"who don't have access"},{"speaker":"because that's one of the challenges","startTime":2850.75,"endTime":2853.66,"body":"and don't have the skills"},{"speaker":"because that's one of the challenges","startTime":2850.75,"endTime":2853.66,"body":"not to be digitally excluded"},{"speaker":"because that's one of the challenges","startTime":2853.66,"endTime":2854.833,"body":"and widening that gap."},{"speaker":"because that's one of the challenges","startTime":2857.98,"endTime":2858.847,"body":"- Yeah, thank you."},{"speaker":"because that's one of the challenges","startTime":2858.847,"endTime":2860.47,"body":"And I don't know if"},{"speaker":"because that's one of the challenges","startTime":2858.847,"endTime":2860.47,"body":"you've got any thoughts"},{"speaker":"because that's one of the challenges","startTime":2860.47,"endTime":2863.41,"body":"on how industry might be able to support"},{"speaker":"because that's one of the challenges","startTime":2863.41,"endTime":2864.28,"body":"and show their ability"},{"speaker":"because that's one of the challenges","startTime":2864.28,"endTime":2866.78,"body":"to actually support the"},{"speaker":"because that's one of the challenges","startTime":2864.28,"endTime":2866.78,"body":"changes that are going on."},{"speaker":"because that's one of the challenges","startTime":2868.63,"endTime":2869.463,"body":"- I think-"},{"speaker":"because that's one of the challenges","startTime":2871.33,"endTime":2872.163,"body":"- Sorry, Sarah."},{"speaker":"because that's one of the challenges","startTime":2873.135,"endTime":2876.13,"body":"You go and then I'll"},{"speaker":"because that's one of the challenges","startTime":2873.135,"endTime":2876.13,"body":"come onto Paddy as well."},{"speaker":"because that's one of the challenges","startTime":2876.13,"endTime":2880.84,"body":"- Yeah, I think for me"},{"speaker":"because that's one of the challenges","startTime":2876.13,"endTime":2880.84,"body":"this is is where industry"},{"speaker":"because that's one of the challenges","startTime":2880.84,"endTime":2884.92,"body":"can provide support,"},{"speaker":"because that's one of the challenges","startTime":2884.92,"endTime":2887.74,"body":"whether that's in kind"},{"speaker":"because that's one of the challenges","startTime":2887.74,"endTime":2891.16,"body":"or whether that's resource"},{"speaker":"because that's one of the challenges","startTime":2887.74,"endTime":2891.16,"body":"around digital initiatives."},{"speaker":"because that's one of the challenges","startTime":2891.16,"endTime":2894.46,"body":"And then we've been looking"},{"speaker":"because that's one of the challenges","startTime":2891.16,"endTime":2894.46,"body":"at some things recently"},{"speaker":"because that's one of the challenges","startTime":2894.46,"endTime":2896.86,"body":"'cause we've got a real"},{"speaker":"because that's one of the challenges","startTime":2894.46,"endTime":2896.86,"body":"challenge with inequalities"},{"speaker":"because that's one of the challenges","startTime":2896.86,"endTime":2900.13,"body":"where I work, and people"},{"speaker":"because that's one of the challenges","startTime":2896.86,"endTime":2900.13,"body":"being digitally excluded."},{"speaker":"because that's one of the challenges","startTime":2900.13,"endTime":2903.7,"body":"And actually if we're"},{"speaker":"because that's one of the challenges","startTime":2900.13,"endTime":2903.7,"body":"working with industry"},{"speaker":"because that's one of the challenges","startTime":2903.7,"endTime":2905.38,"body":"or we're working with a local business,"},{"speaker":"because that's one of the challenges","startTime":2905.38,"endTime":2907.27,"body":"how can they support"},{"speaker":"because that's one of the challenges","startTime":2907.27,"endTime":2909.44,"body":"through that kind of social value agenda"},{"speaker":"because that's one of the challenges","startTime":2910.42,"endTime":2912.76,"body":"in terms of helping us"},{"speaker":"because that's one of the challenges","startTime":2910.42,"endTime":2912.76,"body":"fill some of those gaps"},{"speaker":"because that's one of the challenges","startTime":2912.76,"endTime":2913.593,"body":"that we've got."},{"speaker":"because that's one of the challenges","startTime":2913.593,"endTime":2914.68,"body":"Particularly as we've talked a lot today"},{"speaker":"because that's one of the challenges","startTime":2914.68,"endTime":2916.693,"body":"about funding being a challenge."},{"speaker":"because that's one of the challenges","startTime":2918.85,"endTime":2919.683,"body":"- Thank you."},{"speaker":"because that's one of the challenges","startTime":2919.683,"endTime":2921.29,"body":"Paddy, do you have any other thoughts?"},{"speaker":"because that's one of the challenges","startTime":2924.039,"endTime":2927.4,"body":"- I think Sarah's covered it mostly."},{"speaker":"because that's one of the challenges","startTime":2927.4,"endTime":2932.4,"body":"I think, I would reflect on"},{"speaker":"because that's one of the challenges","startTime":2927.4,"endTime":2932.4,"body":"my previous point slightly,"},{"speaker":"because that's one of the challenges","startTime":2932.47,"endTime":2936.01,"body":"is if you want adoption in the NHS"},{"speaker":"because that's one of the challenges","startTime":2936.01,"endTime":2940.24,"body":"then it needs to be"},{"speaker":"because that's one of the challenges","startTime":2936.01,"endTime":2940.24,"body":"safe as a bare minimum."},{"speaker":"because that's one of the challenges","startTime":2940.24,"endTime":2941.89,"body":"So you need to be able to prove that,"},{"speaker":"because that's one of the challenges","startTime":2941.89,"endTime":2943.453,"body":"and obviously there's various, you know,"},{"speaker":"because that's one of the challenges","startTime":2943.453,"endTime":2946.873,"body":"sort of regulatory frameworks"},{"speaker":"because that's one of the challenges","startTime":2943.453,"endTime":2946.873,"body":"that should ensure that."},{"speaker":"because that's one of the challenges","startTime":2948.16,"endTime":2950.71,"body":"But it also does need to de deliver value"},{"speaker":"because that's one of the challenges","startTime":2950.71,"endTime":2952.45,"body":"both in the short-term and the long-term"},{"speaker":"because that's one of the challenges","startTime":2952.45,"endTime":2957.45,"body":"and save time for staff,"},{"speaker":"because that's one of the challenges","startTime":2952.45,"endTime":2957.45,"body":"particularly clinicians."},{"speaker":"because that's one of the challenges","startTime":2957.85,"endTime":2959.35,"body":"I think the other point I would make,"},{"speaker":"because that's one of the challenges","startTime":2959.35,"endTime":2962.83,"body":"and it's I think easily forgotten"},{"speaker":"because that's one of the challenges","startTime":2962.83,"endTime":2966.73,"body":"is the integration with existing systems."},{"speaker":"because that's one of the challenges","startTime":2966.73,"endTime":2970.3,"body":"So if I was to bring in automation"},{"speaker":"because that's one of the challenges","startTime":2970.3,"endTime":2973.78,"body":"into pathology or"},{"speaker":"because that's one of the challenges","startTime":2970.3,"endTime":2973.78,"body":"diagnostics, for example,"},{"speaker":"because that's one of the challenges","startTime":2973.78,"endTime":2978.78,"body":"I would have to make sure"},{"speaker":"because that's one of the challenges","startTime":2973.78,"endTime":2978.78,"body":"that my product integrated"},{"speaker":"because that's one of the challenges","startTime":2978.97,"endTime":2982.72,"body":"seamlessly with various"},{"speaker":"because that's one of the challenges","startTime":2978.97,"endTime":2982.72,"body":"different types of RIS/PACS,"},{"speaker":"because that's one of the challenges","startTime":2982.72,"endTime":2984.97,"body":"various different types of LIMS,"},{"speaker":"because that's one of the challenges","startTime":2984.97,"endTime":2987.58,"body":"various different types of"},{"speaker":"because that's one of the challenges","startTime":2984.97,"endTime":2987.58,"body":"order comms, potentially."},{"speaker":"because that's one of the challenges","startTime":2987.58,"endTime":2990.163,"body":"Certainly various different types of EPRs."},{"speaker":"because that's one of the challenges","startTime":2991.24,"endTime":2994.723,"body":"You know, potentially"},{"speaker":"because that's one of the challenges","startTime":2991.24,"endTime":2994.723,"body":"different types of GP,"},{"speaker":"because that's one of the challenges","startTime":2995.74,"endTime":2996.64,"body":"management systems,"},{"speaker":"because that's one of the challenges","startTime":2996.64,"endTime":2998.98,"body":"different types of patient"},{"speaker":"because that's one of the challenges","startTime":2996.64,"endTime":2998.98,"body":"administration system."},{"speaker":"because that's one of the challenges","startTime":2998.98,"endTime":3000.52,"body":"I could go on."},{"speaker":"because that's one of the challenges","startTime":3000.52,"endTime":3003.78,"body":"And I do think that is a key challenge."},{"speaker":"because that's one of the challenges","startTime":3003.78,"endTime":3007.92,"body":"So if you want fast adoption in the NHS,"},{"speaker":"because that's one of the challenges","startTime":3007.92,"endTime":3012.411,"body":"make sure that you are"},{"speaker":"because that's one of the challenges","startTime":3007.92,"endTime":3012.411,"body":"at least integratable,"},{"speaker":"because that's one of the challenges","startTime":3012.411,"endTime":3015.06,"body":"for want of a better phrase,"},{"speaker":"because that's one of the challenges","startTime":3012.411,"endTime":3015.06,"body":"with some of the big players"},{"speaker":"because that's one of the challenges","startTime":3015.06,"endTime":3017.76,"body":"in the APR space and the LIMS space,"},{"speaker":"because that's one of the challenges","startTime":3017.76,"endTime":3019.563,"body":"and the RIS/PACS space."},{"speaker":"because that's one of the challenges","startTime":3020.7,"endTime":3023.49,"body":"Or otherwise you might have"},{"speaker":"because that's one of the challenges","startTime":3020.7,"endTime":3023.49,"body":"a very good AI product,"},{"speaker":"because that's one of the challenges","startTime":3023.49,"endTime":3025.143,"body":"but it's of absolutely no use."},{"speaker":"because that's one of the challenges","startTime":3026.34,"endTime":3027.48,"body":"- Yeah, no, thank you."},{"speaker":"because that's one of the challenges","startTime":3027.48,"endTime":3030.27,"body":"And just on the topic of industry again,"},{"speaker":"because that's one of the challenges","startTime":3030.27,"endTime":3032.82,"body":"is there an appetite for"},{"speaker":"because that's one of the challenges","startTime":3030.27,"endTime":3032.82,"body":"strategic partnerships"},{"speaker":"because that's one of the challenges","startTime":3032.82,"endTime":3034.53,"body":"with industry across NHS?"},{"speaker":"because that's one of the challenges","startTime":3034.53,"endTime":3038.04,"body":"And if so, what type of"},{"speaker":"because that's one of the challenges","startTime":3034.53,"endTime":3038.04,"body":"initiatives would add most value,"},{"speaker":"because that's one of the challenges","startTime":3038.04,"endTime":3039.248,"body":"do you think?"},{"speaker":"because that's one of the challenges","startTime":3039.248,"endTime":3041.16,"body":"Paddy, I'll come to you again for that."},{"speaker":"because that's one of the challenges","startTime":3041.16,"endTime":3046.16,"body":"- Yeah, so I think the"},{"speaker":"because that's one of the challenges","startTime":3041.16,"endTime":3046.16,"body":"appetite is sort of selective,"},{"speaker":"because that's one of the challenges","startTime":3048.51,"endTime":3049.343,"body":"I would say."},{"speaker":"because that's one of the challenges","startTime":3050.64,"endTime":3051.78,"body":"NHS leaders at the moment"},{"speaker":"because that's one of the challenges","startTime":3051.78,"endTime":3054.123,"body":"are under extreme financial pressures."},{"speaker":"because that's one of the challenges","startTime":3055.5,"endTime":3057.12,"body":"Extreme workforce pressures"},{"speaker":"because that's one of the challenges","startTime":3057.12,"endTime":3059.733,"body":"that does vary by system and by provider."},{"speaker":"because that's one of the challenges","startTime":3061.08,"endTime":3064.26,"body":"So partnership has to mean"},{"speaker":"because that's one of the challenges","startTime":3061.08,"endTime":3064.26,"body":"help solving system problems."},{"speaker":"because that's one of the challenges","startTime":3064.26,"endTime":3067.11,"body":"Not just commercial engagement"},{"speaker":"because that's one of the challenges","startTime":3067.11,"endTime":3071.92,"body":"or a long-term partnership"},{"speaker":"because that's one of the challenges","startTime":3067.11,"endTime":3071.92,"body":"that delivers value financially"},{"speaker":"because that's one of the challenges","startTime":3073.001,"endTime":3073.953,"body":"for the supplier."},{"speaker":"because that's one of the challenges","startTime":3075.0,"endTime":3077.55,"body":"There obviously needs to"},{"speaker":"because that's one of the challenges","startTime":3075.0,"endTime":3077.55,"body":"be benefit and kind there."},{"speaker":"because that's one of the challenges","startTime":3078.66,"endTime":3081.75,"body":"I think the NHS has has"},{"speaker":"because that's one of the challenges","startTime":3078.66,"endTime":3081.75,"body":"demonstrated largely its open"},{"speaker":"because that's one of the challenges","startTime":3081.75,"endTime":3085.863,"body":"to strategic partnerships,"},{"speaker":"because that's one of the challenges","startTime":3081.75,"endTime":3085.863,"body":"particularly at the centre."},{"speaker":"because that's one of the challenges","startTime":3089.646,"endTime":3091.77,"body":"I think industry needs to keep in mind"},{"speaker":"because that's one of the challenges","startTime":3091.77,"endTime":3096.403,"body":"when engaging the sort of NHS"},{"speaker":"because that's one of the challenges","startTime":3097.976,"endTime":3100.95,"body":"and the wider public sector"},{"speaker":"because that's one of the challenges","startTime":3097.976,"endTime":3100.95,"body":"that actually a lot of people"},{"speaker":"because that's one of the challenges","startTime":3100.95,"endTime":3103.2,"body":"that have worked that work in"},{"speaker":"because that's one of the challenges","startTime":3100.95,"endTime":3103.2,"body":"the NHS have only ever worked"},{"speaker":"because that's one of the challenges","startTime":3103.2,"endTime":3105.87,"body":"in the NHS and worked in"},{"speaker":"because that's one of the challenges","startTime":3103.2,"endTime":3105.87,"body":"the NHS for 20 to 30 years"},{"speaker":"because that's one of the challenges","startTime":3105.87,"endTime":3109.173,"body":"and are actually instinctively"},{"speaker":"because that's one of the challenges","startTime":3105.87,"endTime":3109.173,"body":"suspicious of industry."},{"speaker":"because that's one of the challenges","startTime":3110.04,"endTime":3113.97,"body":"So I do think there's a"},{"speaker":"because that's one of the challenges","startTime":3110.04,"endTime":3113.97,"body":"barrier to get past there"},{"speaker":"because that's one of the challenges","startTime":3113.97,"endTime":3115.353,"body":"in terms of engagement."},{"speaker":"because that's one of the challenges","startTime":3116.7,"endTime":3119.61,"body":"So, and that's my point in"},{"speaker":"because that's one of the challenges","startTime":3116.7,"endTime":3119.61,"body":"terms of the appetite can vary."},{"speaker":"because that's one of the challenges","startTime":3119.61,"endTime":3121.77,"body":"But that appetite will be strongest"},{"speaker":"because that's one of the challenges","startTime":3121.77,"endTime":3125.52,"body":"where industry co-invest, share risk,"},{"speaker":"because that's one of the challenges","startTime":3125.52,"endTime":3129.183,"body":"bring capability that the"},{"speaker":"because that's one of the challenges","startTime":3125.52,"endTime":3129.183,"body":"NHS doesn't have internally."},{"speaker":"because that's one of the challenges","startTime":3130.71,"endTime":3134.193,"body":"I think in terms of where"},{"speaker":"because that's one of the challenges","startTime":3130.71,"endTime":3134.193,"body":"initiatives would add most value,"},{"speaker":"because that's one of the challenges","startTime":3135.06,"endTime":3137.19,"body":"one of the key things"},{"speaker":"because that's one of the challenges","startTime":3135.06,"endTime":3137.19,"body":"we've spoken about today,"},{"speaker":"because that's one of the challenges","startTime":3137.19,"endTime":3138.873,"body":"prevention, community care."},{"speaker":"because that's one of the challenges","startTime":3139.74,"endTime":3143.76,"body":"We've also spoken about"},{"speaker":"because that's one of the challenges","startTime":3139.74,"endTime":3143.76,"body":"workforce productivity,"},{"speaker":"because that's one of the challenges","startTime":3143.76,"endTime":3146.19,"body":"digital transformation, supply,"},{"speaker":"because that's one of the challenges","startTime":3146.19,"endTime":3148.143,"body":"resilience and sustainability."},{"speaker":"because that's one of the challenges","startTime":3150.21,"endTime":3152.31,"body":"So I think there's various things there."},{"speaker":"because that's one of the challenges","startTime":3152.31,"endTime":3154.31,"body":"The other final point I'll make is that,"},{"speaker":"because that's one of the challenges","startTime":3155.633,"endTime":3157.17,"body":"and I think most most"},{"speaker":"because that's one of the challenges","startTime":3155.633,"endTime":3157.17,"body":"colleagues know this,"},{"speaker":"because that's one of the challenges","startTime":3157.17,"endTime":3160.86,"body":"but pathway focused things,"},{"speaker":"because that's one of the challenges","startTime":3160.86,"endTime":3162.9,"body":"models of care focused solutions"},{"speaker":"because that's one of the challenges","startTime":3162.9,"endTime":3165.75,"body":"that Phil was referring"},{"speaker":"because that's one of the challenges","startTime":3162.9,"endTime":3165.75,"body":"to right at the start."},{"speaker":"because that's one of the challenges","startTime":3165.75,"endTime":3170.61,"body":"Not just single independent products"},{"speaker":"because that's one of the challenges","startTime":3170.61,"endTime":3175.11,"body":"to be added to a formulary or"},{"speaker":"because that's one of the challenges","startTime":3170.61,"endTime":3175.11,"body":"a framework for reimbursement."},{"speaker":"because that's one of the challenges","startTime":3175.11,"endTime":3178.11,"body":"Things that actually"},{"speaker":"because that's one of the challenges","startTime":3175.11,"endTime":3178.11,"body":"solve pathway problems,"},{"speaker":"because that's one of the challenges","startTime":3178.11,"endTime":3182.073,"body":"from the GP to the hospital and back out."},{"speaker":"because that's one of the challenges","startTime":3184.5,"endTime":3185.333,"body":"- Thank you."},{"speaker":"because that's one of the challenges","startTime":3186.516,"endTime":3189.143,"body":"Yeah, that's a great answer"},{"speaker":"because that's one of the challenges","startTime":3186.516,"endTime":3189.143,"body":"with lots of good points there."},{"speaker":"because that's one of the challenges","startTime":3190.02,"endTime":3193.2,"body":"I've got a final question to wrap up."},{"speaker":"because that's one of the challenges","startTime":3193.2,"endTime":3196.98,"body":"But before that, we have had"},{"speaker":"because that's one of the challenges","startTime":3193.2,"endTime":3196.98,"body":"a couple of questions come in."},{"speaker":"because that's one of the challenges","startTime":3196.98,"endTime":3198.06,"body":"The first one,"},{"speaker":"because that's one of the challenges","startTime":3198.06,"endTime":3201.33,"body":"they're both around a bit"},{"speaker":"because that's one of the challenges","startTime":3198.06,"endTime":3201.33,"body":"more of a commissioning focus."},{"speaker":"because that's one of the challenges","startTime":3201.33,"endTime":3203.67,"body":"The first one is with the devolution"},{"speaker":"because that's one of the challenges","startTime":3203.67,"endTime":3207.03,"body":"of specialised commissioning"},{"speaker":"because that's one of the challenges","startTime":3203.67,"endTime":3207.03,"body":"for many areas to ICBs,"},{"speaker":"because that's one of the challenges","startTime":3207.03,"endTime":3208.8,"body":"what are your thoughts"},{"speaker":"because that's one of the challenges","startTime":3207.03,"endTime":3208.8,"body":"on this being held here?"},{"speaker":"because that's one of the challenges","startTime":3208.8,"endTime":3210.81,"body":"And do you think that ICBs have a plan"},{"speaker":"because that's one of the challenges","startTime":3210.81,"endTime":3212.91,"body":"for the management of this increased load?"},{"speaker":"because that's one of the challenges","startTime":3214.14,"endTime":3217.863,"body":"Don't know if anyone"},{"speaker":"because that's one of the challenges","startTime":3214.14,"endTime":3217.863,"body":"feels they can start off."},{"speaker":"because that's one of the challenges","startTime":3219.424,"endTime":3221.13,"body":"- I think, well, so it's why I don't work"},{"speaker":"because that's one of the challenges","startTime":3221.13,"endTime":3222.427,"body":"in ICB at the moment."},{"speaker":"because that's one of the challenges","startTime":3222.427,"endTime":3224.033,"body":"Obviously I know lots of people that do,"},{"speaker":"because that's one of the challenges","startTime":3225.377,"endTime":3227.85,"body":"and I was around when some of"},{"speaker":"because that's one of the challenges","startTime":3225.377,"endTime":3227.85,"body":"this was being spoken about."},{"speaker":"because that's one of the challenges","startTime":3227.85,"endTime":3228.72,"body":"I think it depends,"},{"speaker":"because that's one of the challenges","startTime":3228.72,"endTime":3230.37,"body":"which I know is not a very"},{"speaker":"because that's one of the challenges","startTime":3228.72,"endTime":3230.37,"body":"good answer necessarily,"},{"speaker":"because that's one of the challenges","startTime":3230.37,"endTime":3233.31,"body":"but it would depend on the different ICBs."},{"speaker":"because that's one of the challenges","startTime":3233.31,"endTime":3235.74,"body":"Some of them I know are very prepared,"},{"speaker":"because that's one of the challenges","startTime":3235.74,"endTime":3237.84,"body":"and those that are very prepared"},{"speaker":"because that's one of the challenges","startTime":3237.84,"endTime":3239.1,"body":"have already had it devolved"},{"speaker":"because that's one of the challenges","startTime":3239.1,"endTime":3240.9,"body":"or will have it devolve sooner than those"},{"speaker":"because that's one of the challenges","startTime":3240.9,"endTime":3243.003,"body":"that are less prepared."},{"speaker":"because that's one of the challenges","startTime":3244.17,"endTime":3245.88,"body":"Obviously there is still the risk"},{"speaker":"because that's one of the challenges","startTime":3245.88,"endTime":3248.16,"body":"and I do feel like I'm"},{"speaker":"because that's one of the challenges","startTime":3245.88,"endTime":3248.16,"body":"banging on about it,"},{"speaker":"because that's one of the challenges","startTime":3248.16,"endTime":3252.15,"body":"but there is still that"},{"speaker":"because that's one of the challenges","startTime":3248.16,"endTime":3252.15,"body":"risk of reducing funding,"},{"speaker":"because that's one of the challenges","startTime":3252.15,"endTime":3254.013,"body":"but then devolving more powers."},{"speaker":"because that's one of the challenges","startTime":3254.97,"endTime":3256.98,"body":"And I do think that's a"},{"speaker":"because that's one of the challenges","startTime":3254.97,"endTime":3256.98,"body":"difficult balance to strike."},{"speaker":"because that's one of the challenges","startTime":3256.98,"endTime":3258.91,"body":"But a lot of ICBs have brought it"},{"speaker":"because that's one of the challenges","startTime":3260.34,"endTime":3262.23,"body":"within their exec team and appointed,"},{"speaker":"because that's one of the challenges","startTime":3262.23,"endTime":3265.05,"body":"you know, specialised"},{"speaker":"because that's one of the challenges","startTime":3262.23,"endTime":3265.05,"body":"commissioning people."},{"speaker":"because that's one of the challenges","startTime":3265.05,"endTime":3266.583,"body":"The problem is, I think,"},{"speaker":"because that's one of the challenges","startTime":3268.41,"endTime":3270.963,"body":"capacity is one thing,"},{"speaker":"because that's one of the challenges","startTime":3268.41,"endTime":3270.963,"body":"capability is the other."},{"speaker":"because that's one of the challenges","startTime":3271.9,"endTime":3272.733,"body":"Spec comm is something"},{"speaker":"because that's one of the challenges","startTime":3272.733,"endTime":3275.01,"body":"that's pretty much always"},{"speaker":"because that's one of the challenges","startTime":3272.733,"endTime":3275.01,"body":"been done nationally."},{"speaker":"because that's one of the challenges","startTime":3275.01,"endTime":3279.54,"body":"So then to add it into systems,"},{"speaker":"because that's one of the challenges","startTime":3279.54,"endTime":3282.33,"body":"they may not have the capability to do it"},{"speaker":"because that's one of the challenges","startTime":3282.33,"endTime":3285.06,"body":"in some cases some of"},{"speaker":"because that's one of the challenges","startTime":3282.33,"endTime":3285.06,"body":"the talent has followed,"},{"speaker":"because that's one of the challenges","startTime":3285.06,"endTime":3287.88,"body":"but there's 42 ICBs at the moment,"},{"speaker":"because that's one of the challenges","startTime":3287.88,"endTime":3288.87,"body":"sooner there will be less."},{"speaker":"because that's one of the challenges","startTime":3288.87,"endTime":3291.42,"body":"But it's whether that talent can be spread"},{"speaker":"because that's one of the challenges","startTime":3291.42,"endTime":3294.45,"body":"across all those different"},{"speaker":"because that's one of the challenges","startTime":3291.42,"endTime":3294.45,"body":"footprints, I suppose,"},{"speaker":"because that's one of the challenges","startTime":3294.45,"endTime":3295.623,"body":"is the challenge."},{"speaker":"because that's one of the challenges","startTime":3298.5,"endTime":3300.515,"body":"- Katie, can I just-"},{"speaker":"because that's one of the challenges","startTime":3298.5,"endTime":3300.515,"body":"- Great, thanks-"},{"speaker":"because that's one of the challenges","startTime":3300.515,"endTime":3301.38,"body":"- Can I just jump in on that too?"},{"speaker":"because that's one of the challenges","startTime":3301.38,"endTime":3302.213,"body":"- Yeah."},{"speaker":"because that's one of the challenges","startTime":3303.6,"endTime":3306.27,"body":"- As Paddy said, there's been an evolution"},{"speaker":"because that's one of the challenges","startTime":3306.27,"endTime":3308.07,"body":"which has been coming for a while"},{"speaker":"because that's one of the challenges","startTime":3308.07,"endTime":3310.02,"body":"and there've been some early adopters,"},{"speaker":"because that's one of the challenges","startTime":3310.02,"endTime":3311.82,"body":"and some who're really quite reluctant"},{"speaker":"because that's one of the challenges","startTime":3311.82,"endTime":3315.573,"body":"for the reasons Paddy said is"},{"speaker":"because that's one of the challenges","startTime":3311.82,"endTime":3315.573,"body":"it's a very specialist skill."},{"speaker":"because that's one of the challenges","startTime":3316.92,"endTime":3320.04,"body":"It takes a huge amount of effort to do"},{"speaker":"because that's one of the challenges","startTime":3320.04,"endTime":3324.09,"body":"in what was seen as diluted way"},{"speaker":"because that's one of the challenges","startTime":3320.04,"endTime":3324.09,"body":"across a number of settings."},{"speaker":"because that's one of the challenges","startTime":3324.09,"endTime":3325.77,"body":"The other challenge is practical"},{"speaker":"because that's one of the challenges","startTime":3325.77,"endTime":3329.76,"body":"in that it will work"},{"speaker":"because that's one of the challenges","startTime":3325.77,"endTime":3329.76,"body":"quite well with an ICB"},{"speaker":"because that's one of the challenges","startTime":3329.76,"endTime":3332.1,"body":"who delivers the tertiary services."},{"speaker":"because that's one of the challenges","startTime":3332.1,"endTime":3335.1,"body":"That specialised commissioning"},{"speaker":"because that's one of the challenges","startTime":3332.1,"endTime":3335.1,"body":"is commissioning."},{"speaker":"because that's one of the challenges","startTime":3335.1,"endTime":3336.36,"body":"Where it's more challenging"},{"speaker":"because that's one of the challenges","startTime":3336.36,"endTime":3339.66,"body":"is where those services are"},{"speaker":"because that's one of the challenges","startTime":3336.36,"endTime":3339.66,"body":"delivered in another ICB,"},{"speaker":"because that's one of the challenges","startTime":3339.66,"endTime":3341.7,"body":"'cause that adds another"},{"speaker":"because that's one of the challenges","startTime":3339.66,"endTime":3341.7,"body":"whole layer of complexity"},{"speaker":"because that's one of the challenges","startTime":3341.7,"endTime":3345.51,"body":"about how you manage the"},{"speaker":"because that's one of the challenges","startTime":3341.7,"endTime":3345.51,"body":"flow of commissioning."},{"speaker":"because that's one of the challenges","startTime":3345.51,"endTime":3348.72,"body":"'Cause in real terms specialised works"},{"speaker":"because that's one of the challenges","startTime":3348.72,"endTime":3351.12,"body":"by being close to the providers"},{"speaker":"because that's one of the challenges","startTime":3351.12,"endTime":3353.58,"body":"who provide those type of services"},{"speaker":"because that's one of the challenges","startTime":3353.58,"endTime":3355.65,"body":"as much as it is just about"},{"speaker":"because that's one of the challenges","startTime":3353.58,"endTime":3355.65,"body":"the commissioning bit."},{"speaker":"because that's one of the challenges","startTime":3355.65,"endTime":3359.76,"body":"So it's that connectivity"},{"speaker":"because that's one of the challenges","startTime":3355.65,"endTime":3359.76,"body":"and the flows of patients."},{"speaker":"because that's one of the challenges","startTime":3359.76,"endTime":3361.53,"body":"So I think that's key."},{"speaker":"because that's one of the challenges","startTime":3361.53,"endTime":3364.44,"body":"But I also think it's"},{"speaker":"because that's one of the challenges","startTime":3361.53,"endTime":3364.44,"body":"just a point of view."},{"speaker":"because that's one of the challenges","startTime":3364.44,"endTime":3367.02,"body":"I think it's possible that"},{"speaker":"because that's one of the challenges","startTime":3364.44,"endTime":3367.02,"body":"there'll be a review of that"},{"speaker":"because that's one of the challenges","startTime":3367.02,"endTime":3368.97,"body":"and some of them will be recentralized."},{"speaker":"because that's one of the challenges","startTime":3369.93,"endTime":3372.33,"body":"So I think there will be a period"},{"speaker":"because that's one of the challenges","startTime":3372.33,"endTime":3373.86,"body":"of time given which says,"},{"speaker":"because that's one of the challenges","startTime":3373.86,"endTime":3375.66,"body":"is this working or is it not?"},{"speaker":"because that's one of the challenges","startTime":3375.66,"endTime":3378.75,"body":"And what is a better way of doing it?"},{"speaker":"because that's one of the challenges","startTime":3378.75,"endTime":3380.85,"body":"Because having what could be"},{"speaker":"because that's one of the challenges","startTime":3380.85,"endTime":3383.52,"body":"at the sort of ICB cluster level,"},{"speaker":"because that's one of the challenges","startTime":3383.52,"endTime":3387.81,"body":"26 people leading on"},{"speaker":"because that's one of the challenges","startTime":3383.52,"endTime":3387.81,"body":"a particular portfolio"},{"speaker":"because that's one of the challenges","startTime":3387.81,"endTime":3389.21,"body":"or specialised commissioning"},{"speaker":"because that's one of the challenges","startTime":3390.09,"endTime":3391.53,"body":"might not be as efficient"},{"speaker":"because that's one of the challenges","startTime":3391.53,"endTime":3394.8,"body":"as a smaller group"},{"speaker":"because that's one of the challenges","startTime":3391.53,"endTime":3394.8,"body":"looking at a bigger scale."},{"speaker":"because that's one of the challenges","startTime":3394.8,"endTime":3398.55,"body":"And specialised have this"},{"speaker":"because that's one of the challenges","startTime":3394.8,"endTime":3398.55,"body":"challenge all the time."},{"speaker":"because that's one of the challenges","startTime":3398.55,"endTime":3401.943,"body":"'Cause in the main, their"},{"speaker":"because that's one of the challenges","startTime":3398.55,"endTime":3401.943,"body":"flow of specialised type work,"},{"speaker":"because that's one of the challenges","startTime":3403.05,"endTime":3404.64,"body":"just the geography of that,"},{"speaker":"because that's one of the challenges","startTime":3404.64,"endTime":3408.66,"body":"doesn't line up particularly"},{"speaker":"because that's one of the challenges","startTime":3404.64,"endTime":3408.66,"body":"well with the ICB geographies."},{"speaker":"because that's one of the challenges","startTime":3408.66,"endTime":3412.89,"body":"So I could see that"},{"speaker":"because that's one of the challenges","startTime":3408.66,"endTime":3412.89,"body":"being re-looked at again,"},{"speaker":"because that's one of the challenges","startTime":3412.89,"endTime":3415.35,"body":"but I think it'll be a while."},{"speaker":"because that's one of the challenges","startTime":3415.35,"endTime":3416.283,"body":"But it's possible."},{"speaker":"because that's one of the challenges","startTime":3421.26,"endTime":3422.67,"body":"- Thank you. I'm just conscious of time."},{"speaker":"because that's one of the challenges","startTime":3422.67,"endTime":3424.38,"body":"We've got two minutes."},{"speaker":"because that's one of the challenges","startTime":3424.38,"endTime":3426.84,"body":"What I might do is just"},{"speaker":"because that's one of the challenges","startTime":3424.38,"endTime":3426.84,"body":"go around very quickly"},{"speaker":"because that's one of the challenges","startTime":3426.84,"endTime":3427.98,"body":"and get your final thoughts."},{"speaker":"because that's one of the challenges","startTime":3427.98,"endTime":3429.96,"body":"If you had one or two pieces of advice"},{"speaker":"because that's one of the challenges","startTime":3429.96,"endTime":3432.6,"body":"around what listeners should"},{"speaker":"because that's one of the challenges","startTime":3429.96,"endTime":3432.6,"body":"do to help navigate them"},{"speaker":"because that's one of the challenges","startTime":3432.6,"endTime":3434.79,"body":"with the changing structure of the system"},{"speaker":"because that's one of the challenges","startTime":3434.79,"endTime":3438.003,"body":"and everything else at the"},{"speaker":"because that's one of the challenges","startTime":3434.79,"endTime":3438.003,"body":"moment, what would that be?"},{"speaker":"because that's one of the challenges","startTime":3440.04,"endTime":3442.013,"body":"Paddy, maybe I'll come to you first."},{"speaker":"because that's one of the challenges","startTime":3444.49,"endTime":3446.79,"body":"- Okay, I think I've already said it"},{"speaker":"because that's one of the challenges","startTime":3446.79,"endTime":3447.99,"body":"probably a couple times throughout,"},{"speaker":"because that's one of the challenges","startTime":3447.99,"endTime":3452.99,"body":"but to reemphasize,"},{"speaker":"because that's one of the challenges","startTime":3447.99,"endTime":3452.99,"body":"cash-releasing benefits,"},{"speaker":"because that's one of the challenges","startTime":3455.13,"endTime":3457.71,"body":"saving stuff time and"},{"speaker":"because that's one of the challenges","startTime":3455.13,"endTime":3457.71,"body":"performance improvement."},{"speaker":"because that's one of the challenges","startTime":3457.71,"endTime":3460.233,"body":"If you're not ticking two"},{"speaker":"because that's one of the challenges","startTime":3457.71,"endTime":3460.233,"body":"out of three of those,"},{"speaker":"because that's one of the challenges","startTime":3461.76,"endTime":3464.46,"body":"you're not going to get very far in an NHS"},{"speaker":"because that's one of the challenges","startTime":3464.46,"endTime":3467.06,"body":"that's very focused on the"},{"speaker":"because that's one of the challenges","startTime":3464.46,"endTime":3467.06,"body":"short-term at the moment."},{"speaker":"because that's one of the challenges","startTime":3468.09,"endTime":3469.343,"body":"- Thank you. Phil?"},{"speaker":"because that's one of the challenges","startTime":3471.217,"endTime":3472.05,"body":"- I would say two things."},{"speaker":"because that's one of the challenges","startTime":3472.05,"endTime":3474.87,"body":"I would say understand"},{"speaker":"because that's one of the challenges","startTime":3472.05,"endTime":3474.87,"body":"who the stakeholders are"},{"speaker":"because that's one of the challenges","startTime":3474.87,"endTime":3478.41,"body":"that are important to where"},{"speaker":"because that's one of the challenges","startTime":3474.87,"endTime":3478.41,"body":"you can add the value."},{"speaker":"because that's one of the challenges","startTime":3478.41,"endTime":3480.21,"body":"If we go back to the digital one,"},{"speaker":"because that's one of the challenges","startTime":3480.21,"endTime":3481.59,"body":"and I was looking at AI,"},{"speaker":"because that's one of the challenges","startTime":3481.59,"endTime":3486.59,"body":"I'd be looking at clinical safety officer,"},{"speaker":"because that's one of the challenges","startTime":3486.6,"endTime":3488.547,"body":"the clinical nursing information officer,"},{"speaker":"because that's one of the challenges","startTime":3488.547,"endTime":3491.58,"body":"and the chief clinical information officer"},{"speaker":"because that's one of the challenges","startTime":3491.58,"endTime":3494.22,"body":"as people to have a"},{"speaker":"because that's one of the challenges","startTime":3491.58,"endTime":3494.22,"body":"good relationship with,"},{"speaker":"because that's one of the challenges","startTime":3494.22,"endTime":3496.74,"body":"'cause they'll understand"},{"speaker":"because that's one of the challenges","startTime":3494.22,"endTime":3496.74,"body":"the practicalities"},{"speaker":"because that's one of the challenges","startTime":3496.74,"endTime":3500.25,"body":"of both digital and safety"},{"speaker":"because that's one of the challenges","startTime":3496.74,"endTime":3500.25,"body":"and clinical practise."},{"speaker":"because that's one of the challenges","startTime":3500.25,"endTime":3501.15,"body":"And then the second bit,"},{"speaker":"because that's one of the challenges","startTime":3501.15,"endTime":3504.0,"body":"which is please don't"},{"speaker":"because that's one of the challenges","startTime":3501.15,"endTime":3504.0,"body":"start any conversation"},{"speaker":"because that's one of the challenges","startTime":3504.0,"endTime":3506.583,"body":"with my product, is it does this,"},{"speaker":"because that's one of the challenges","startTime":3507.646,"endTime":3508.77,"body":"my therapy area is this,"},{"speaker":"because that's one of the challenges","startTime":3508.77,"endTime":3511.02,"body":"and we have products that do this,"},{"speaker":"because that's one of the challenges","startTime":3511.02,"endTime":3512.82,"body":"because nobody knows how"},{"speaker":"because that's one of the challenges","startTime":3511.02,"endTime":3512.82,"body":"to connect to that problem."},{"speaker":"because that's one of the challenges","startTime":3512.82,"endTime":3513.96,"body":"And it just aggravates"},{"speaker":"because that's one of the challenges","startTime":3513.96,"endTime":3515.31,"body":"the way Paddy was talking about earlier,"},{"speaker":"because that's one of the challenges","startTime":3515.31,"endTime":3516.9,"body":"that antibody levels."},{"speaker":"because that's one of the challenges","startTime":3516.9,"endTime":3518.82,"body":"If you came in and said,"},{"speaker":"because that's one of the challenges","startTime":3518.82,"endTime":3521.79,"body":"I can see from my research"},{"speaker":"because that's one of the challenges","startTime":3518.82,"endTime":3521.79,"body":"that you have this challenge,"},{"speaker":"because that's one of the challenges","startTime":3521.79,"endTime":3522.96,"body":"you've set a programme up"},{"speaker":"because that's one of the challenges","startTime":3522.96,"endTime":3524.247,"body":"and actually we've got some"},{"speaker":"because that's one of the challenges","startTime":3522.96,"endTime":3524.247,"body":"great expertise in there"},{"speaker":"because that's one of the challenges","startTime":3524.247,"endTime":3527.823,"body":"and this is how we could help"},{"speaker":"because that's one of the challenges","startTime":3524.247,"endTime":3527.823,"body":"you solve this challenge,"},{"speaker":"because that's one of the challenges","startTime":3529.954,"endTime":3532.14,"body":"then I think you would"},{"speaker":"because that's one of the challenges","startTime":3529.954,"endTime":3532.14,"body":"be welcome with open arms"},{"speaker":"because that's one of the challenges","startTime":3532.14,"endTime":3534.66,"body":"and people be trying to figure"},{"speaker":"because that's one of the challenges","startTime":3532.14,"endTime":3534.66,"body":"out how to work with you,"},{"speaker":"because that's one of the challenges","startTime":3534.66,"endTime":3537.36,"body":"not whether they should work with you."},{"speaker":"because that's one of the challenges","startTime":3537.36,"endTime":3538.833,"body":"- Thanks, Phil. And Sarah?"},{"speaker":"because that's one of the challenges","startTime":3539.79,"endTime":3542.4,"body":"- Yeah, no, I agree with Phil."},{"speaker":"because that's one of the challenges","startTime":3542.4,"endTime":3546.3,"body":"I think focus on helping"},{"speaker":"because that's one of the challenges","startTime":3542.4,"endTime":3546.3,"body":"solve real world problems,"},{"speaker":"because that's one of the challenges","startTime":3546.3,"endTime":3549.0,"body":"getting to know the people"},{"speaker":"because that's one of the challenges","startTime":3546.3,"endTime":3549.0,"body":"and build those relationships."},{"speaker":"because that's one of the challenges","startTime":3549.0,"endTime":3550.68,"body":"and I think it's probably thinking"},{"speaker":"because that's one of the challenges","startTime":3550.68,"endTime":3554.01,"body":"about different stakeholders"},{"speaker":"because that's one of the challenges","startTime":3550.68,"endTime":3554.01,"body":"to maybe ones previously."},{"speaker":"because that's one of the challenges","startTime":3554.01,"endTime":3557.43,"body":"So thinking about who"},{"speaker":"because that's one of the challenges","startTime":3554.01,"endTime":3557.43,"body":"are the leaders in place,"},{"speaker":"because that's one of the challenges","startTime":3557.43,"endTime":3559.47,"body":"working directly with providers."},{"speaker":"because that's one of the challenges","startTime":3559.47,"endTime":3561.09,"body":"And I think there's something important"},{"speaker":"because that's one of the challenges","startTime":3561.09,"endTime":3564.723,"body":"about offering something"},{"speaker":"because that's one of the challenges","startTime":3561.09,"endTime":3564.723,"body":"back so that social value,"},{"speaker":"because that's one of the challenges","startTime":3566.01,"endTime":3568.65,"body":"looking at financial"},{"speaker":"because that's one of the challenges","startTime":3566.01,"endTime":3568.65,"body":"initiatives into communities,"},{"speaker":"because that's one of the challenges","startTime":3568.65,"endTime":3570.69,"body":"and really try to understand"},{"speaker":"because that's one of the challenges","startTime":3568.65,"endTime":3570.69,"body":"the local problems"},{"speaker":"because that's one of the challenges","startTime":3570.69,"endTime":3572.01,"body":"that people want to solve."},{"speaker":"because that's one of the challenges","startTime":3572.01,"endTime":3573.45,"body":"I think if you can help with some of that,"},{"speaker":"because that's one of the challenges","startTime":3573.45,"endTime":3575.65,"body":"then you'll be pushing"},{"speaker":"because that's one of the challenges","startTime":3573.45,"endTime":3575.65,"body":"against an open door."},{"speaker":"because that's one of the challenges","startTime":3577.08,"endTime":3577.95,"body":"- Brilliant."},{"speaker":"because that's one of the challenges","startTime":3577.95,"endTime":3578.82,"body":"Thank you so much."},{"speaker":"because that's one of the challenges","startTime":3578.82,"endTime":3580.98,"body":"I think that brings us to"},{"speaker":"because that's one of the challenges","startTime":3578.82,"endTime":3580.98,"body":"the end of the session."},{"speaker":"because that's one of the challenges","startTime":3580.98,"endTime":3582.32,"body":"Thank you to everyone who's tuned in."},{"speaker":"because that's one of the challenges","startTime":3582.32,"endTime":3585.69,"body":"If we haven't got your question,"},{"speaker":"because that's one of the challenges","startTime":3582.32,"endTime":3585.69,"body":"we'll follow up over email"},{"speaker":"because that's one of the challenges","startTime":3585.69,"endTime":3589.298,"body":"or we'll signpost you"},{"speaker":"because that's one of the challenges","startTime":3585.69,"endTime":3589.298,"body":"in the future as well,"},{"speaker":"because that's one of the challenges","startTime":3589.298,"endTime":3590.131,"body":"if you have any other questions,"},{"speaker":"because that's one of the challenges","startTime":3590.131,"endTime":3591.78,"body":"just to someone that can help."},{"speaker":"because that's one of the challenges","startTime":3591.78,"endTime":3592.89,"body":"Thank you again for joining."},{"speaker":"because that's one of the challenges","startTime":3592.89,"endTime":3594.34,"body":"Have a great rest of the day."},{"speaker":"because that's one of the challenges","startTime":3596.07,"endTime":3597.63,"body":"- [Announcer] Thank you for watching."},{"speaker":"because that's one of the challenges","startTime":3597.63,"endTime":3598.86,"body":"If you'd like to find out more"},{"speaker":"because that's one of the challenges","startTime":3598.86,"endTime":3601.62,"body":"about how we can support"},{"speaker":"because that's one of the challenges","startTime":3598.86,"endTime":3601.62,"body":"your market access goals,"},{"speaker":"because that's one of the challenges","startTime":3601.62,"endTime":3603.48,"body":"get in touch today."},{"speaker":"because that's one of the challenges","startTime":3603.48,"endTime":3607.053,"body":"For more market access"},{"speaker":"because that's one of the challenges","startTime":3603.48,"endTime":3607.053,"body":"insights, follow us on LinkedIn."}]}