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next session. So can I invite the Panelists for our next session? That's Peter May and Owen Harkin and Ursula Mason to come up and join us on the stage. So even get applause before you start here, which is great. Um, And then what we can do is compare the applause at the end of the applause at the start. And, uh, just before I introduce the speakers, I think you know who they all are. But, um, I just want to share with you comment, and I hope that he doesn't mind that I share it with you. It's too late if he does. Uh, I heard from Shane Devlin the other day. Now, Shane, of course, was chief executive the Southern Trust and is now, uh, chief executive of the integrated care system in Bristol. And I was speaking to Shane the other day about the challenges of system working and integration, uh, in England. And what he said to me was that his experience in England had made him feel that he had not not exploited the potential that existed in Northern Ireland because of the level of integration, because of the kind of capacity of change makers to get together in a room and make things happen. And he looked back and thought, Why didn't I managed to achieve more? Given the resources, the proximity and the integration that I had in Northern, I thought was a quite an interesting point. And as I say, I hope he doesn't mind me sharing it with you. So let's get into this session, and we're going to hear it first from Peter May Hood. You know, it's permanent secretary at the Department of Health. Peter, over to you. Okay. Thanks very much. Good to see everybody here today. And And thanks for the invitation. I want to start, uh, about six months in my job. So I've met many of you, uh, various travels, and I want to thank you all for the time you've given me and your patients in helping to explain the intricacies of the health and social care system. I just want to take a few minutes today to set out a few thoughts on where I think we are and what we might do to go forward. Um, some of the themes have already come through in one or two of the presentations already, but I'm certainly going to try not to avoid, uh, to avoid saying the same things that our our minister said. Um, I guess you know, uh, if if I asked the mythical man or woman from Mars, where are we today? I might get the response that I wouldn't start from here if I was you. Um, and I think we can all understand and see that the pressures on our health and social care system and all its elements are really an acute that there are no quick fixes. And, you know, we we face into a challenging winter, which, despite all of the efforts that individual agencies and the system collectively are going to make, uh, to mitigate those risks, we still face into substantial challenges. And it would be easy to get depressed the thought that there's not going to be help coming from London. Stormont, there's not, uh, there's not an easy answer to some of these questions. So I then ask myself, What can I do? And I suppose, by inference, what can we do? And I want to offer three suggestions today, and the first is absolutely to focus on the things that are within our control. That is, how do we maximize, uh, what we already have? How do we improve and enhance our productivity agenda and are efficiency agenda? Not because we want to make this some sort of widget counting, but because that is the way in which we can deliver better the health and social care needs of our community today. And it's really good to see the progress that's been made in recent months in relation to some of the the, uh, seeking to return to pre coated levels. And we now need to build on that. It's not about asking people to work harder. It's about looking at how we work. It's about identifying the things that either aren't working at all. Or we're not getting a sufficient bang for our buck from and stopping those things so that we can invest the time and the energy into the things that will make the difference. The service improvements where we can learn from best practice from others, whether that be others in this room or others across health and social care, whether it be from the technological enablers that we're developing and bringing forward whether it be from using the skills that we have in our workforce in a smarter way and finding ways of maximizing the use of that. And if we're able to maximize what we've done, even then, we won't have got all of the way. So the second question is, who can we influence? And that implies rightly, I think that we don't necessarily have complete control of our future. Destiny is my view that we will need a sustained investment in healthcare going forward. Uh, and, uh, you know, I know from having sat, uh, looking at health from a different sector. Previously, there is a risk that people will see health as a bottomless pit. So that's all the more reason why we need to be able to evidence that what we do, we are making the most of what we've already got. And if we look at who we need to influence, it would be natural. And I think right, we do need to influence our political classes. It's not just about money, it's also about some of the prioritization decisions that are key, Michael said. We can't continue to do everything, and that's absolutely right, and it's also about taking some of those difficult decisions about how we reconfigure our services going forward. But it's not just the Cialis that we need to think about, because we need to think who influences the MLS. And while we might think we influence them, the people who most fundamentally influence them, of course, of their constituents. That's our community, our patients. So the way in which we engage with our communities matters hugely is picking up, perhaps on something that Matthew just said, quoting Shane Devil in. And if I made, it takes me on to the third of my thoughts, which is, uh, to think about where we need to change our own thinking and thinking of others. And I think it feels to me like one of those areas where I would offer that we need to consider is how we how we see patients and communities within our system. So I think we all by into the concept that we want the individual patient to feel a sense of agent agency over their own health, and we want to enable that, and we know there are some things that will make that easier going forward. So they'll be technological enables, such as the encompass system that will give the patient pretty much real time access to their medical records and so on. But my question is, have we enough? Have we put enough in place to actually fundamentally bring about that change, uh, to make the patient feel that they have that heightened sense of agency? Uh, and we think about our communities, Uh, again, we have a vehicle coming, the integrated care system, the ICS that, uh could and should provide a real impetus in this area. But have we got the surrounding way of thinking at the moment that is going to be needed to to make the community feel that they have a real say about how how their health and social care services are delivered. So those are just three thoughts from me things that I'm certainly trying to apply, uh, to myself. Internally, I offer them to you because if the people in this room and indeed the people that many tens of thousands of people who work in health and social care pick up some of those ideas, then we have a movement in a real prospect of making a substantial change. So thank you for listening. Thank you, Peter. I think it's it's incredibly heartening to hear that. You see, your task is empowering those in the system, and I think very often in the health service, I think the NHS in England, we've kind of seen each level of the hierarchy says it's task is controlling those below them. Rather than empowering those, uh, and wanted to kind of invert the previous, that's very powerful to hear you say that. Just one question before I turn to tell because you're relatively new to the role. This is a question I can ask you now. I wouldn't be able to ask you in a year's time, but what was most surprised you in terms of getting to know the way the health and care system works? I suppose the biggest surprise for me is we call it a health and social care system, but it doesn't feel like one system all of the time. I when I'm talking to people, I do find that people are very focused on what other people need to do to sort problems out and not necessarily focused enough on the part they can play and how they can influence others. So that sounds critical. It's not meant to be. I think it's a sign of a system under pressure. When people feel under pressure, they automatically think who else could could be doing better to try and help this. But it comes back to the point Shane Devlin make, which is we? Actually, we do have some advantages here, and one of them ought to be. We know each other. We have the relationships. We ought to be able to try and think about how we try and smooth some of those systemic issues in all sorts of different ways. So perhaps that's been the biggest surprise. Yeah. And I think that goes to the point, Doesn't about the forms of leadership that we need That and I talked about also in her natural. Thanks, Peter. And I'm sure they'll be questions for you and me. We get to that part of the session, so, uh, heartburn is filling in for Jennifer. Uh, well, uh, thank you. First of all, for for responding at the last moment, Uh, Deputy Chief executive, the Northern Trust. So, uh, I went over to you for your kind of reflections on the kind of priorities for us, given the challenges we face over the next five years. Thank you, Matthew. Good morning, everyone. Supposed Firstly, I'd like to take a step back and focus for a moment on environment, which we operate on Northern Ireland as a small place. Uh, emphasize that we are a small place. And I stress that because we really do need to get to the point where we fully understand that, yes, it has disadvantages. And we've touched on some of those already this morning. But the fact is that because it is so small, that means we can get our arms around it. We should be able to get our arms around it. And indeed, we're the scale of a single ICS back to shave a single ICS and the English system. So we have advantages in that. And then that, I believe, is the direction travel for us all in health and social care. I'll come back to that in a moment. We need to operate as Peter Liberty as a system which is free of competition, continuing to blur the limits and the boundaries across our system. Um and I believe that, uh, integrated partnership boards are really vehicle for us to deliver that further. We also need to be up front and open and honest with ourselves and amongst ourselves as well as with the public. That means no self serving deals or actions done by stealth for behind closed doors, which has been which will have a considerable impact, not one impact elsewhere in the system and and has already described the challenges for Northern Ireland particular and also internationally. And I made a roll and roll I have is the national presence of H, FMLA and Zach around branches across England. It's very clear they're dealing with the same sorts of challenges as we currently have. Flow E. D. And the flow through hospitals and particularly out of hospitals were all faced with the same challenges are more challenges at the most. I suppose our particular position has recently been reflected by the Fiscal Counsel report, which identified the ongoing squeeze that we can expect that to continue on health and social care funding going forward and pointed to inefficiencies absolutely and workforce shortages within our system which absolutely need to be addressed. But we do need to avoid reverting to demand limb that is not on our interests as leaders on health and social care across Northern Ireland, as that compare me throughout all parts of our organizations and only adds to misery and anxiety problems. We need real, genuine, creative thinking of going forward. Maybe we need to learn to adapt a more entrepreneurial approach. Um, interested in Harvard Business School describes entrepreneurship as the pursuit of opportunity beyond the resources currently controlled. So I believe in these times, adversely. There are always opportunities. So what are they for us in the brief time I'm available? Like to touch on to the first of the need for societal change, which has been mentioned already and secondly, what the latest census is also telling us. Matthew, I've heard you talked before about the women's daily. Uh, for those of us aren't aware of it. The big deal is an informal agreement between the council and everyone who works and lives in the area to create a better borough, and that has delivered some absolutely excellent outcomes. There's no reason why we, with a bit of imagination and a lot of hard work, can't arrive at a point where health and social care outcomes become a new contract with our public again, back to Michaels Point from earlier. That's where we need to go. If we're going to be serious about another good care, we need to separate the position with the public. Become, are genuine partners and where there is a gradual shift away from a belief that is a state problem. Only recently I've heard one of our respiratory consultants talking about the concept of Health University, where we as health and social care organizations, might better enable individuals to find, understand and use information that better inform their own health. Choice is, action's going forward. I suppose that's the patient. That sensitivity that Anna described earlier All that might seem like a bit of a utopia. But I believe that as possible, if we continue to break down system buyers and use data and technology to drive improved outcomes at the local level, I'm sure that that's the goal with personal. And that's the direction. Travel letter and the latest census is supposed to help us understand and determine what needs to be done going forward. The census tells us that in the last 10 years, the population ages or 65 is increased by 24% and that changed over 85 is increased by 25% and that short term year period. If we simply paid up service to numbers like that, all we're doing is delaying the inevitable. We need to really tackle those numbers and understand the impact that they have every day on the service. We provide do too complex probabilities of health and social care and on the cost of that service. So let me give you let me give you a local example of how we see that being needing careful attention as we go forward, take the college, the coast and glands area. This round figures tell us that over the next 20 years, the number of births in that area protected to fall by 11% the biggest fall in any area in Northern Ireland. At the same time, the elderly population is expected to grow by 65%. So the population served by Causeway hospital, for example, is changing, and we need to change with it. So what does that mean for service delivery? Looking at the situation logically, it seems to me we need to develop services focused on the particular needs of that area. In other words, we will probably be looking at developing and improving ambulatory care for the fertility. Looking at the improvement and enhancing diagnostic services, extending our electric care provision and and considering mental health requirements will look better. Friendship here also, that's only one example. It shows how one particular center might very well to a regional design plan. I finished now, but in summary we must lose the main boom. We must search for the opportunities and ruthlessly pursue them using digital health. Started using the best evidence from around the world and data technology to digital health and to drive transformation efficiency consistently across the system. And doing so, we can then start to tell our story the public so that no one can argue with it and bring them with us. And I really believe we can start to achieve good things. Thank you. Thanks. I mean, I spoke earlier about this challenge for leaders of addressing the urgent and pressing challenges, but also keeping in mind the need for deeper change. Do you feel that that that is something that you're able to do, uh, sometimes use the phrase split screen thinking, which is how do you look at what's in this screen the urgent and that screen, which is where you want to be in five or 10 years, and that it's really important to have both screens because you what we often do in the health care system was, we make short term decisions which don't actually align with the long term vision that we've got for for how we want the health service to be. How possible do you think it is to be able to do that kind of split screen thinking? And how clear do you feel is the vision of where you want to be in five or 10 years? Personal view is, I think that's where we've been going wrong, Shane. Back to Shane's point. I think we've had a number of reports over the years, loads of reports on all shelves all around the place, but what we never really could almost get to what I call the punch line. So what does the redesign plan looks like? What's the health service going to look like in five or 10 years? we need to start thinking about that and really put that on a page remembers my trust. You know, I'd love to see things on the page people can understand and interpret, and therefore we can build that vision for for people. I think it's been particularly challenging in the last few years with Coated, Uh, we've been fire fighting so much, and now we're trying to be seven organization and completely different times. But absolutely, we need to take a long term place. And And our steps in the meantime, need to be about that long term patient with addressing short term challenges. Great. Thanks very much for that. Um, and so, uh, last, but obviously not least one a mason. His chair elected the Royal College of GPS over to you. Thank you very much. Math. You and good morning, everyone. It's lovely to be here in person and thank you for the opportunity to join in what I think is going to be, firstly, a bit of discussion from ourselves. But I'm hoping to take some, uh, really interesting questions from the floor later. Um, I suppose I'm going to give you the view from general practice and I'm going to sort of reiterate what someone said earlier on. I mean, there's a lot of doom and gloom out there and a huge number of challenges, and I'm not going to minimize those challenges. But there is certainly a lot of positivity and innovation happening in primary care despite the challenges. And I'm going to perhaps give you a few examples of those and talk a little bit about where we are in general practice at this moment in time. I mean, I think we faced into the pandemic in a really difficult situation. We already had workforce and workload challenges at that time, and between then and now that has been compounded. So we are trying to do with an increasing demand on our service with a workforce shortage, Um, and also a degree of increasing difficulty to manage the patients that we have in primary care because of some of the other challenge is right across the system because we don't work in isolation. We all work together and I think that's a really important thing to remember. So what we find in primary care is that the fracture points and the pressure points across the system get compounded and magnified at our level and we'll then also see that as an an increasing difficulty for us to try and meet the needs of our patients in the communities. It was really interesting to hear Anna talk about this and we know that there is a need to shift care into the community. Our patients need to be seen by the right person in the right place at the right time. But most importantly, first time and one of the things that we've seen in primary care in certain areas across Northern Ireland has been the introduction of multidisciplinary teams, and that has certainly gone some way to meeting needs of patients in our communities. But unfortunately it isn't a widespread rule out across Northern Ireland at the moment. And for those practices that are support by the MG T s, they are certainly being able to deliver more for their patients in the community, while those practices who have yet to have that important rule out of additional staff and skill set in primary care are struggling to meet those demands. And that's creating a huge inequity for the patients that we serve and I think that's one thing that I would say that would make a huge difference to primary care would be to consider, um, increasing that roll out and giving communities the access to very, very important, um, practitioners who can both support our communities but also support our practice teams. And I I don't say that lightly. I mean, we have I mentioned earlier that we have a workforce shortage and we have practice is really struggling to survive in the current climate that we're operating and and you know, it'll come as no surprise to you. You see it in the newspapers frequently over the last couple of months, where practices have been handing back their contracts and services. Having been are needing to be, um, patients have need to be either redistributed to other practice is causing a knock on effect of pressure on those, or we're having to find a new contract holders, and all of that has an impact on the care that each local community can deliver or each practice can deliver to the local community, and mg ts can go some way to helping improve that. But in addition to that, we do need to see a sustained, um workforce strategy. We need to see, um, an increase in our GP training numbers, and we also need to improve the recruitment and retention of GPS within our workforce at the moment. So that's a little bit of the negativity. But I'm going to really talk about what can general practice do because we are a very flexible profession and our practices can adapt and move to meet the needs of our local communities. We've seen that very clearly during the pandemic so overnight, the development of our primary care coated centers, protecting our patients, protecting our staff and also protecting our secondary care colleagues in terms of actually seeing and managing our patients within the community setting that happened within the space of a few weeks. And I think it's a huge testament to our GP leaders and colleagues and also our colleagues in our trusts and getting those up and running. And I think that's a really good example of the innovation that can happen when backs are at the wall and we need to do something to actually create safe places for our patients. I think it would be important to to uh, in terms of recognizing, um, it was the commitment of our GP workforce with regards the vaccine rollout 1.6 million vaccines delivered in primary care is a huge accomplishment. And again, you know, this is an opportunity for me to say, you know, primary care can deliver, and it can deliver if it's resourced and empowered and and also it can do that for all of our communities. I want to touch a little bit about access and perhaps talk a little bit about, um, it's a digital innovation. Um, I think we're all patients here, and we all have a GP and I probably if I asked anyone everyone to stand up in the room if they had difficulty getting through to the GP practice. I think quite a lot of people would be standing up and we recognize that, and we understand the frustration and that and and we want to deliver a good quality, safe and effective care for our communities and our patients. But access is only one little part of the system, and and I would challenge the access discussion and say this is more a demand and capacity problem rather than an access problem and in order to meet demand and capacity, we need to think about well, do we have the workforce to deal with the demand, or is our demand coming in a very different way? Should we be having conversations around selfcare around self efficacy? And also, I think, a very robust discussions about what it is that primary care can deliver within the current. It was resource that we have and if we can't deliver that, how do we empower primary care and GPS and their teams to do that? And I think we do need to see an increase in our workforce. I think we need to see a change in how we manage patients in the community. I think we need to talk to our partners in community pharmacy within the community and voluntary sector, and also our colleagues and secondary care about how we manage the healthcare system and the needs based of our patients at the point that they need care. Um, I think there is a real need to embrace the digital transformation that is coming down the line. I think we certainly welcome the initial sort of additional resource to improve our infrastructure and primary care and around our telephony services and and how we interact with our patients. But I think it's really just a stepping stone, and we need to use that and we need to rule that out. We need to empower our practices, and we need to, I think, interface from a digital perspective, with our colleagues in secondary care and elsewhere within the communities. So I'm going to finish by. I talked about the fact that you know, we are that foundation of healthcare, um, in in communities. And I talked about the fact that, you know, there are the pressures that we feel are both related to those aging population multi morbid and the fact that there is a shift into the community and we also see, and we also feel the pressures that come from secondary care and elsewhere, and what I would call on those within a leadership perspective and and have the ability to do that is to strengthen and sustain primary care. Because if you do that, then the rebuild or the move to do anything else within the system will have a really strong foundation. And when it's built, it is less likely to have those fracture points because we will be there underneath as the strong foundation that we have been. We want to be in the future, and I think we can be so thank you so as you know, when I when I engage with systems in England, by far the most varied bit of the system is primary care, so in hospitals can vary from national specialist hospitals to struggling D G H s. But hospitals are hospitals hospital. In the end, primary care in some places is well organized. Is a player at system and place level working with all of the providers within systems to shape system solutions? Other places. To be frank, it's a bunch of grumpy GPS. They don't like each other, um, too. And that makes a huge difference for the reasons that you've talked about, because we need primary care to be absolutely part of this conversation. So if you think of the future of primary care, a future in which it's not really about GPS, so much about the primary care team and GPS are managing that broader primary care team where primary care is around. Population health management not just responding to the people who ring up and walk through the door and where primary care is a real player in terms of the development of systems solutions and things like emergency urgent emergency care pathways going back to the point, I kind of made tha going to what extent do you think there's a clear account of where primary care needs to be in Northern Ireland in five or 10 years? They kind of North star and And what would the resistance that? Because one of the characteristics of GPS is the kind of fierce independence. Is it possible to articulate that vision and then, through a variety of methods of nudging, bribing, whatever it might be encouraging, that kind of new model of primary care to emerge and emerge across Northern Ireland? So that's a very long question. I apologize. That's an extremely long question. Absolutely. I'll try not to answer it as a grumpy GP, though, so I suppose there is difficulty there because we're interfacing with colleagues and secondary care. It's very different practitioners because we're all independent contractors and there are 319 independent contractors within Northern Ireland in terms of GDP practice. Certainly that was at the last count and I'm hoping it's going to stay like that for a while and not fall any any quicker. But with that you get or the potential to get 319 different viewpoints and I think that's the challenge. But most importantly, I mean, primary care can collectively come together in a more unified voice and we are seeing that more through our GP federations. So Northern Ireland is in a very fortunate place. And so every single GP practice is Federated within one of the 17 federations across Northern Ireland and through that that there is an amplification of the primary care voice, but also a collectivity to it as well. And what federations are striving to do is to look at what is needed within their local community. So not just at practice level, but more at population level. So each federation is around 100 110,000 patients. And so again, when you see that as a collective and you use that as a model to move forward and to drive innovation and also to bring services to local communities, there is real potential and I think by harnessing that and by working together within our integrated care systems, federations, as the voice of primary care, are much That's a greater amplified voice. And it is probably a greater enabler of being able to work together to meet the outcomes and the needs of our patients in those communities. Uh, NHS conflict is organization, which represents primary care as well as the rest of the system in England. So it would be great for my con to work with those federations and think about this this future model. Now I'm going to do something radical for the next five the next 10 minutes. But then you will get your coffee, I promise. Right. Uh, thank you for entering into the spirit of Of that so well, So I'm going to take a handful of comments or questions from the floor. You get particular, you get particular credit. If what your point is is in terms of what the person sitting next to you said to use, it's not your idea of, you know. So this person next to me, she said, something really fascinating. So, um, let's get some comments, and I'm going to bring the panel in. They have 90 seconds each side. You listen to his comments. Panels. Just choose the one or two things don't respond to all the points. Just choose the one or two you want to respond to. And here is a hand here. Very good. And the microphone is rushing. It's way towards you. Although it isn't. Where is it? Here. Here. Have we only got one like person? Okay, one there. One there. Where's the other person I want to do, right? Yes. Andrew Google, chair of the board of the Public Health Agency. Um, the Minister this morning mentioned productivity in my 39 years in health productivity hasn't been a word that's been married about and discussing it with my colleague here this morning, she says, you know, people don't mention the word productivity. We talk about efficiency. We talked about, we're working maximally at the minute. We're doing the best we can at the minute. But I wonder, you know, with type resources with the fact that resources are not going to increase. And I've been saying this for sometime. We need to have the discipline to look at things we've been doing in the past. And do we still need to do those that were there 10 years ago? And I wonder, can we ensure that the skills and improve productivity can be ingrained within professions, across professions, in general, practice, in the community and in hospitals? I think right and then middle might just choose a couple of people because I can't really see. Okay, my name is Francis. She'll say I'm from the patient client counsel. A service user representative and I address my remarks specifically to Peter and Owen in terms of, uh, patient involvement in the planning and delivery of services. I first started working in the N H s in the 19 seventies, and we have been talking then about consultation with changed. Now it's participation. Uh, and we're talking about partnerships, but partnerships have to be partnerships of equals, and I think that in terms of expert, uh, people who are expert by virtue of their little experience, when I go into rooms in the NHS now, I see people like me retired people. Where are the younger people and what are we actually doing in terms of inviting and making younger people feel welcome? I think There's a big issue around the language that the NHS uses and the facts around training of people who may be interested. And then there's a further barrier, which is the fact that people who engage with the NHS from the surface use your point of view. We don't really feel that valued because everybody else in the room is being paid to be there and we aren't and for younger people, particularly who are, you know, in the situation where they have mortgages to pay and whatever to get time off work, to participate in the very important work of developing health services. I think it needs some form of payment. Uh, I'm a medical student. My name is Sarah, and I really agreed with what you said Peter about equity and efficiency in allocating financial resource. But I was wondering how we can improve the workforce is understanding and appreciation of the financial component of healthcare delivery. I don't feel personally that I feel a personal responsibility for the finances, and I don't believe that I appreciate it. The implications of the budget and how that's done necessarily, uh, you want to understand how the finances it's all Uh, yes, yeah, and then someone from the back because I can't see back there and they go to the back of the room and find somebody You don't mind. Go to the background. Hello. Hi. My name is Jennifer From Elemental Access Elemental Just on the digital front side of things. Um, we provide a platform that's been really well adopted across Wales and England. Greater Manchester, Scotland. And there's a lot of talk about digital and making it happen, But it's just it's very challenging here in Northern Ireland when you have software that works and is has been used by GPS and primary care and secondary care, and it brings community involuntary sector organizations together. It's just notoriously hard to get it to be adopted here for I don't know for what reason, but it's just flagging that just be able to say it's great to talk about digital but practically get things implemented. It's not always that straightforward, even when they're proven outcomes, and I put some impact for the community voluntary sector reducing, demanding on NHS services. I'm trying to relieve some of my colleagues. I've never heard them so quiet before. Clifford works in it's just a Q, and he's bound to have something to say. Guard Martin from the Western Trust. I just looked at the breaking news on the Northern Ireland BBC website saying Dizzy Hill Hospital loses emergency general surgery and I suppose for me it's about the messages. Other ministers decision. How can we work with media and other organizations in terms of actually engage in the public around the messaging of some of those and very important decisions around safety, but also sustainability of services in some of our hospitals? Great. Okay, so just choose one or two points. Um, we're gonna reverse order. Okay, Well, I'm going to choose productivity and also digital, and I'm going to talk a little bit about and I suppose we feel we've been punching way above our weight in terms of productivity and primary care and again, innovation and the change that happened around Covitz. So we went from being a largely face to face disappointment service to another, a largely telephone first with face to face conversion service, and that has actually allowed us to increase our productivity. So when I talked earlier on about the fact that it's very hard to get an appointment. Demand was outstripping capacity were actually innovating and changing what we do to try and meet those demands. 3200 consultations per week in general practice across Northern Ireland and with over 40% of those face to face, I think that's a fairly impressive figure to quote despite the challenges. And I know that that's not meeting the demand, but it is certainly improved productivity, and and that, again is despite a workforce shortage and a reduction in 10% of whole time equival GPS, um, in terms of value for money, again thinking about the cost to the system for primary care, 95% of all of a person's healthcare needs throughout their lifetime will be met in primary care. Yet we receive just 8% of the budget and an actual fact. That's a very that's very good value for money. Think about what we could do if you resource us even a little bit more and I'm going to put a call out for 11% and put that on record. I'm going to very briefly talk about digital. We've got a really good thing coming down the line in terms of general practice. Um, digital platform. The platforms already in practice is we're starting to use it. It's absolutely fantastic. And I know encompasses a big word, and we and GP land don't know very much about it. And it's sort of sitting outside of us. And here's the problem that you have just talked about, which is how do we integrate this all together? How do we get it all working together in a way which is actually going to improve outcomes? So it's not so much an answer to your question, but a challenge and a confirmation of what you said about, like, how do we get this working well? And how does the digital transformation make sense across all sectors? And I'm going to stop now? I'll touch on two things. First, the communication. One guard. Absolutely, we need. And I think it's back to my point on when you paint a picture for the public, for our staff, about where the direction travel for services over all that, they can see the patch work and that they're assured that there's a service there that's safe and sustainable and resilient. Um, people are showing they're willing to travel for elective care. But we need to give them the insurance that we have the appropriate plans in place to be that ambulance support or whatever, that that deal with emergency cover as well. So it's about painting that picture for my opinion, and that can be a reasonable picture. All the better. Can I touch and productivity as well. Uh, I think there's a massive opportunities as a director of finance and my main day job. There's massive opportunities for efficiency, the fiscal counsel a little bit to it in the headline about how much less you can spend to deliver a basket of acute services compared to England now, there's always going to some degree of this economy in Northern Ireland. But that's not a defense, and that's not a reason to do nothing. So it's about understanding that understand what they offer is to the public, uh, deliver efficiency. There's a great initiatives across the UK I was an event last week where professor Time Briggs spoke from getting getting it right. First time, and I should have, uh, he led the orthopedics review in Northern Ireland. Uh, he's an amazing character. I think It's amazing opportunities for us to drive forward there and compare ourselves on productivity from that point of view, including as much as the case, too impatient ratios, new new review ratios, etcetera. That's about engaging with their staff. That's such a serious point. Then we have. We have a mask task of work to make sure our staff and our clinical teams understand the finances we're driving forward with. The initiative around patient level costing were significantly behind the UK and that that's an opportunity to get really and the understanding and helping our clinicians right across the full pathway from primary care through to, uh, specialist care to understand the cost of pathways and inform their decision making. From that point of view. Thank you, Peter. Your you're standing between people and coffee and the exhibition, so Okay, very briefly. Then, just to pick up on the comments that Francis from the PCC made and to recognize some of the challenges and the fact that I think it is a perennial debate about how to engage communities and how to engage patient representatives. It is really important that we do that on the basis of, uh, you know we're asking the questions. We really are allowing people to have an influence over the solution to rather than ones that actually, there's already a preordained answer. And I think it's important that we start small and try and make things work so that people feel there is a real change. And then they're more likely to want to continue to engage lots of other interesting points I'd love to pick up with Sara. I think it was about how we get clinicians more interested in finance. That would be great. And, um, Dan West is here is going to grab the person who talked about the difficulties of adapting and adopting i thi So, uh, that will be an opportunity there to over coffee sort some of these things out with you. Great. Well, it feels like there's a real sense of despite the challenges of opportunity in the room, and that, I think, bodes well for the next couple of days. You can tell that markets the pro and I'm the amateur because we've overrun. But, uh, could you start the next session, go to the next session to 11. 40 rather than so that's the parallel sessions will start at 11 40 the annual HSC Q. I want to start in here 11. 40. Hold on. But before you go, can I ask you too? Thank are fantastic panel.