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Welcome everybody to another of our land with nurses sessions. My name is Michaela Nut All and I was just joined by Becky Bones who has just had to dip out for a second because there was a slight computer problem as these things happen. Um, she will be joining me just shortly and this is one of our in conversation events where we will be exploring tonight a little bit about health inequalities. Becky, I was just explaining that you had a slight complete and you just had to disappear for that very topical considering what we're going to be discussing, discussing, discussing tonight. So I hope you're all well and I can see people are joining quite nicely here and stuff that's there. Si's back. Hi, si. Um, but anyone who I haven't met before. Um, as I said, my name, my name is Michaela Nuttall. My background is cardiovascular nursing and public health nursing, but I'm also the founder at Learn with Nurses and I'm Ly joined tonight by the lovely Becky. Becky warns. Do you wanna say a little bit about yourself, Becky? I will. Yeah. Hi, everybody. And for those of you that don't know me, I'm Becky warns. I work as an in independent business consultant, so I work with, um, the NHS and I also work with Pharma as well. I guess most relevant for today's topic is um I help NHS with digital transformation. So at an I CS and a regional level. Um So yeah, that's me. Thanks, Michaela. Lovely. Thank you, Becky. So, tonight's topic and we, we, tonight's in conversation session is about health inequalities. Now, as, as you know, as someone who's worked in public health for many, many years, health inequalities, it doesn't matter which way you cut me health inequalities. It'll be through the middle and public health as it where. And so that's a huge topic that we could have a discussion on. But um we decided to home it down to two particular things that we will spend part the time talking about what I was going to talk about, which is about health literacy and then Becky is going to lead on perfectly and wonderfully. Well, with digital health and the inequalities there and the digital divide. So we know the populations before we start though of who when we're thinking about health inequalities and what that means. And um it can be for variety of different reasons and it can be a variety of different populations that are affected by, by inequalities or inequity. Um So whether that is gender, ethnicity, language, um uh socioeconomical status, it could be all sorts of things, whether it's physical health problems, mental health problems, that mean that there is inequity in the health care that's being received or provided and we could align that to anything else. We wanted to really education and different things. But, but that's really the population that we're thinking about who's missing out on opportunities for better health, um, where we've really got to address those inequalities that sit there. So my first bit is going to be about health literacy and to me, um health literacy is something that is really important. But, er, what we're gonna do is beck and I have decided we're going to do this in a bit of A Q and a type quest session. So Beth is gonna ask me some questions and we're probably gonna take about, you know, 12, 12 minutes or so, 15 minutes and then we're gonna do another 15 minutes back with Becky. So please use that chat function and I can see some of you have already said a hello in there, use that chat function. And what we will do is we know when it's been recorded, people won't be able to see the chat function. So what we'll do is if we see comments, we will have to read out the comments or if it's a question, read out the question so that when people are watching on catch up, they understand what we're talking about. So, um yeah, I'm gonna throw myself at the mercy of Becky. Now, are you ready? Alright. Ok. So let's start with a, with a simple one. Shall we to, to get warmed up Michaela? Health literacy. You're banging on about it. You, you, you talk about it quite a lot in your, in your day job. What, what is it, what's it all about? What's it all about? Well, great. You've asked me that one? Great. You've asked me that one and there are, there are some pretty standard part answers that we can give about. What is health literacy and that will really come from. There's a great um there's a great from the World Health Organization and I, and I, you know, I have to look it up although I should know it, but it's getting all the perfect word wording, right? And it's the personal characteristics and social resources needed for individuals and communities to access. And this is the next bit that gets me a bit more that people miss out, understand appraise and that bit really gets missed out and use information and services to make decisions about health. So that's the definition of it. But when we start to drill down, what does that really mean? Um And often we put, you know, we talk about the health literacy of the person or of the community, but actually as healthcare professionals and as information givers, the onus is on earth is to improve what we do because of the health literacy issues and they're trying to address people's health literacy and improve their health literacy. But also really thinking at the same time, how can we make sure that the information that we give matches with health literacy, whatever the health literacy is of that person that's there? Ok. That yes, that answers my question nicely. Thank you. OK. So thinking about that in like real world environments, then what, what's the potential impact of actually getting this right? Have you got any experience or any case studies that you could kind of briefly because you haven't got a lot of time. Well, I can tell you works, first of all, what happens when we get it wrong? Ok. And sometimes what happens is we think we're getting it right as well and we still get it wrong and that's, you know, we know that there are time pressures like never before on the NHS and everyone that provides healthcare and a lot of it is get people in and get them out and get them sorted and get that appointment done. And I remember certainly from um from my days on cardiology, which I'm talking 20 years ago, I would get through a shift and I used to just say, right, what's your name? What's your date of birth? What's your allergies? Get your done out, you know, literally, and you got through that shift. So I I'm not, you know, I'm coming at this from a total understanding of how hard it is to be there. But actually if we don't take that extra bit of time for some people, not for all people, but for some people, then actually the cost of health inequalities. First of all, for the health service accounts for about 5% of the extra spend that we don't need to spend. If we took a bit of time to get that right now, it could be as simple as somebody doesn't read. So if you are not able to read or write, then getting, getting letters or texts to say this is when your appointment is, then, then people can't respond to that, then you later on not being able to speak or read or write English. Um And we know that for a lot of times that's very difficult for people to access health care and we often say, well, you know, bring the family member, but sometimes that's a child, sometimes that's the, it's the younger person. And, you know, it's very hard for people to open up in consultations or in clinic appointments with, with a young person. There, particularly something that might be sensitive all the way through to people missing departments. Some people don't know, you know, they wouldn't know that x-ray is radiology. So you might be thinking you're looking for x-ray and you don't know where to go. I read, I heard it the other day about someone who didn't go for their cancer treatment because they were Cannula was going in this arm. But the problem was over here. And so, yeah, because they say, well, why is it not gonna work? It should be in this arm? It's not happening. So it, it, once you start digging into these sort of beliefs that people have thoughts that people have, then it really goes a lot further. Now, the big challenge we have is the average reading age in the UK for the context of health is somewhere between 11 and 14 years. And we know that about 60% of people are able to understand the health information that's given to them when it involves words. But that dropped quite dramatically to about 30 to 40% who really lose that understanding of what it means when statistics gets involved when numbers and percentages and all that gets involved. So, and a lot of our, we talk about percentages and your chance of this happening. And yeah, so you know, and the more we try and give people information, the further we are creating that divide. Now, there is also um I was looking at a small study the other day that was looking at tablets and it was showing that based on health literacy and there's sort of three levels of health literacy that you understand the information you can act on the information and you can do something with the information. Um and what we, what was seen in this study was um said it was just under 400 patients. And so they um had, they were given some tablets. Ok, so they were given some tablets and they were the three different levels of um health literacy, so adequate health literacy, marginal health literacy, and very low health literacy. And if they were told, take two tablets twice daily, that was the instructions. And then when they were asked across the three groups, can you state what the doctor told you? It wasn't a lot of difference. So the lowest was about 70%. So they were people with low literacy and then the, um, the higher level of literacy, people were up to almost 90%. So you can say, well, that's not too bad. Actually, they really know what to do with those tablets until it came to demonstrating because then they said, well, show me what that means. Show many how many pills you would take in one day. And um, so they had to count up four tablets and four out of five people in the adequate. So the ones with the higher rates of health literacy could count out four tablets, but only a third of people with the lower health literacy could count out the right amount of tablets. So what that means is there's a significant proportion of patients who are not going to be taking the right medication because we might tell them what to do and take your tablets and do this and read the instruction leaflet. But unless we ask them to show us we don't know that they're not able to do it. So, it's something, even as simple as medication has that real impact. Yeah. Yeah. Yeah, I can imagine. And you're, you're talking about tablets thinking about asthma or COPD in inhalers. Yeah. They're complicated at the best of times, aren't they to get? Right. Yeah. So, make some choices about. Should I stop smoking? Where do I go? I've got a pain in my leg. Where do I go? What do I access? It's just, it's, it's so vast that actually we, we really need to, to try. And even when we say, you know, we might think we've explained things and we've said, do you, have you understood what I've said? People often say yes. Yeah. But they haven't. But, but, but they say yes, because they don't want to seem stupid, do they? And then it's like, I'll go away and I'll read it and they've got a massive patient information leaflet in a box which is like this size letter in massive, not really meant for patients. Although it is interesting, interesting concept. OK. So in terms of sort of practicalities, then what can we do? What can the audience do to really support patients and, and kind of support health literacy? Then there are two relatively simple and I say simple, it's simple to say, probably difficult to do in practice two different techniques. One is called the teach back and that is getting the patient or whoever it is, you have the person, the client to explain back to you what you've said. So, and you can say things like um can you tell me how you're actually gonna explain this to your family when you get home later? And I just wanna make sure that you've understood what I've, I've asked you to do. Can you tell me what I've asked you to do and, or even things. Yeah, just getting people to tell you back what it is that you've told them. And that's where we can then start to understand. Have they heard and understood what we've said a simple way rather than saying, do you understand what I've said? So, very, very different, different, um, different, different bit. Now, the second bit is this, uh, is this chunk and check? So this chunk and check instead of saying, right, we've got this bottle of medications for you. There's two sets of tablets. This one you need to take with water after a meal. This one you take twice a day, da da da da du. So, um, yeah, instead of doing that chunk it down in two single bits, you know, we've got two different types of medication for you. Pause check. So, how many different types of medication have we got? I need to check that. You understand that you've got two different ones, right? This one this one needs to be taken with food. Can you tell me which of these two needs to be taken with food? So, you know, it's, it's really trying to and I, we've talked a lot about medication which is just has to be examples, but we can relay that in so many different ways. Um Yeah, so it's almost uh if I had some tips for taken away, it will be just think about our situations where we're working, how we give out information, you know, people receive information in all different ways, whether it's literature, online, digital, which we'll be doing in a minute, verbal. Um Just really think about how we give that information and there's lots out there information standards for, you know, reading ages that works right. You know, and getting rid of making text easy for people to read and demystifying things. But it really is, I would say go away and not necessarily try and change things straight away, but almost pause and reflect on what you're doing. I think it's called a baseline. If I thought about in public health, have a look what you're doing and have a look at your organization where you're working where that information is being given out. And is there a way we can improve it in this, in sort of relatively simple ways that should hopefully allow or enable people to understand, which is what we want them to do, understand. Um But then when we get to this place of appraise, which is a much more difficult thing. How do we decide which treatments we want to go for? Decide which that's a whole different level. Um It is all about reducing inequalities and improving equity. So that's on health and you call it on my bit of um health literacy and I know I bang on about it all the time, don't I, I bang on about it. And that only last night I was with a lovely group of volunteers from a go and seniors dancing club and somebody from a health watch organization, it was just all of them and we were just exploring and discussing what other people perceive from health literacy too. Very good. That's my turn. That's me done. So now I think it's time to quiz you a little bit because you're gonna talk to us a little bit about the digital divide and I am and I guess I, what I wanna do and, and I'm guessing people understand now what we mean by digital because in the world of healthcare that's really been fast tracked in the last couple of years. But I want you to sort of, I wanna explore will a digital first approach to health care widen or improve the inequality gap? What do you think that it, it's a really good question. And I think the way like as you were saying COVID has just brought a massive influx of digital tech to the NHS and it, it's almost being kind of forced onto I CS s onto primary care, onto secondary care. It's just, yeah, I have a bit of that and, and this is gonna make your life so much easier. Um, and it, it's interesting because, because it's so new, there's relatively few studies in whether it will actually increase or decrease health inequality. It's that new, there hasn't been enough studies. Obviously you've got your suppliers who are saying yes, it will help everybody and everyone's gonna be amazing and get on with this, you know, this tech and it's gonna be great. I think in reality time will tell, I, I think there's a potential for it to certainly, um certainly improve health inequalities. Most definitely, it's giving people greater access to health information. It's given people greater access at times to clinicians. Whereas before, maybe somebody out in, in r rural country down here in the west down here, um might have to get sort of, you know, a couple of buses to get to a doctor's surgery. We've now got telehealth, we've now got video conferencing, tele teleconferencing where people can ring from the comfort of their own home. Now, I appreciate the staff shortages. I appreciate there's issues around resource in the NHS at the moment. Um But thinking, you know, re realistically in an ideal world, these solutions could provide a lot greater access for a lot more people. And I think also, when you think about hospitals, if you trust you've got paid, I don't know, 10 lb to park, you've got to, you know, queue up for a car park. There's all sorts of reasons why virtual consultations for an example is one part of digital tech could really make a massive impact from a clinician's point of view. They're going to reduce the amount of time that you actually spend, you know, messing around in between that patient interface piece. If you like, you can get down to business quite quickly. Um And I think, you know, the benefits, I think do outweigh the negative. But at the moment, we're in a position and it is very much a transition. So we've got NHS England going, yeah, take some tech and they are investing millions, hundreds of millions of pounds into technology at the moment right across the NH SS. It's going into your I CBS and they are then responsible for deciding what project or program it goes on. But I guess really what it comes down to is adoption and it comes down to obviously patients wanting to use it, knowing how to use it. But before then it it starts with, it starts with clinicians and my, my day job, as I say, I do um remote monitoring for, for an I CS. I'm also doing digital consent to support an I CS. So programs around those one of the big things that is missing is the stakeholder engagement, which is the the healthcare professionals. So I came into these programs as, as a consultant and I was asked to have a look at what's going on in this population. What can we do? How can we, how can we support this? How can we get remote patient monitoring virtual wards rolled out. The one thing that hadn't happened is nobody had spoke to the doctors, the nurses community to say, what is it you want from a solution? So we ended up with a lot of supplier issues because interfaces, so the the part of the screen you're looking at and playing with every day wasn't really geared up for clinicians, wasn't geared up for clinical conversations. It was geared up for some it developer who created a bit of software and thought it was brilliant, simple really well. So I mean, clunking up the order you do things in. Absolutely. Yeah. So I think there are times when the technology itself is preventing adoption and therefore not helping to, to sort of give itself a good name. If you like, there's potential, it needs to be done, right? The implementation is key. I think. So coming at it from a slightly different perspective then on how it could increase the divide. And I and I hear what you're saying and actually I hadn't thought about it from the perspective of the person this side of the screen or this side of the, you know, the ease of use. You think more about your patience and the general public and the clients and stuff and we've just had some comments come in and I'm gonna read some of them out for you. Um So, and I'll go back to um Allison's in a moment because, well, actually I'll go back because that was about health literacy, which is really good. But Lyn said she's got patients who cannot afford any wifi or data, which I think makes it really, really, really difficult and have no understanding of anything technical including mobile phones. Now I come back with a comment saying absolutely very hard for the elderly population. Whereas my, my mother who I put in that while she's 76 now she's an absolute whiz on it. She always said, oh, you know, and so some people actually, you're not everybody and I'm just gonna go through them all and then you can address also registered blind and deaf, have struggles with technology, have an elderly patient who cannot use a phone at all. So what in those digital solutions is going to help when we've got not enough wifi no wi fi data. And actually people who cannot interface first of all with the wifi thing, the way that N HSE kind of explain their justification is that over 80% of the UK population has a smart phone, they don't actually think that 80% you know, it's not necessarily the fact that 80% know how to use it or have wifi. So it's a great stat to hang your hat on. But it doesn't actually mean anything with regard to the wifi. What you'll find is your public health teams will be working with local libraries, with town halls, village, village halls to um improve access to wifi to allow people free access to Wi Fi. That's one of the solutions that I'm going to come back to you though. If that's all right, because I, I've got a hospital appointment coming up and I, well, I haven't, but I'm imagining I've got a hospital appointment coming up and I'm gonna have my consultation and I've got to go to the library and talk about something embarrassing is that almost the expectation, what people are going to have to do the, this has been brought up actually as a bit of a bar in, in areas where it is allowed where, where space allows, there will be um promotion of rooms so that people can lock themselves away with a computer and take a, take a, a GP appointment or a hospital appointment. It's not ideal and it doesn't solve the problem. And even if I was me personally, even if I was in a room, I don't feel I'd like to be sharing everything in a public space. I don't, I mean, some people might, you'll get arrested, Michael. So yeah, there are kind of solutions but they are not 100% solutions. And I think with regard to, um, elderly population in particular, you know, they've grown up picking up a, getting used to picking up a phone and getting a GPS appointment or a nurse's appointment in primary care within a couple of days. Now, that's like a month. If you're lucky in some areas, it's probably two months, there's a massive shift in a massive change and that, that sort of cohort of the population is really struggling because they are being forced to adopt a technology that they don't want to adopt. And the whole thing with digital health for getting NHS England's spiel on it is that it shouldn't be forced on people. It should be a choice and it should be a hybrid model. If you like, people should be able to say I want to see a GP or a nurse, I want to physically go to a hospital. It's, it's something that is very sort of contentious at the moment. And I think as much as I say, a lot of money is being plowed into, into I CS S at the moment for the digital transformation, it's going in whether these systems are going to be utilized is gonna be another issue. You know, I, I don't think they are gonna get full um adoption by the clinicians or by patients when you're looking at deaf, blind, excuse me, blind and deaf people. There are some digital solutions that are available via public suppliers. Um And II I haven't, I can't remember the name of it. Right. Car Medic um is really good. Actually, she, the lady that's the um I'm not being, being paid by them, but it's a really good resource. The lady that's actually created, it is a, is a clinician so she knows what she's doing. Um It's a really good resource to help support language barriers, blind, deaf patients. And there's various um digital technologies that are used to actually help a patient in that instance. But it's one, it's one solution that I know in a massive massive environment. So it, it's not, it's not great and there, it's there. I just think that can we do you want to just read out what Joanne's just said? Because that's a really interesting one. I work in patient, I work in prisons. My patients can't access the internet. I spend a lot of time printing off information. That is really interesting because I'm also working on a pri prisons project to bring VR virtual headsets in to help their wellbeing. Um which is so it's, it's such a variance isn't there across, across the country who's got wifi, who hasn't, who's got smartphone? Who hasn't, you know, at the end of the day, who wants it? That's the biggest question. Who wants to be using the technology? I think we, well, I, sorry, go on. No, I was gonna say with, with the printing information off and booking face to face appointments. I think again, it's, it's, I, I think that the targets and the aspirations are a little bit sort of high in the sky at the moment. It's not, it's not a solution right now. That's going to change your world as healthcare professionals overnight. It's not gonna happen. And do you think what might happen is that we will maybe free up? I love the thought that we could free up some time. But actually if some people could access things digitally say or access appointment remotely and all of that, then that might be in the ideal world that would free up some of the clinician time to be able to spend more time or work out a different way to get to people who can't access. Yeah, exactly. That, that there was a study done by a guy in America called Eric Topol who again is a clinician and he wrote a report for NHS England. And he basically in this report summarized by saying digital health isn't going to take the place of a clinician. It's not going to put people out of work, which is what, you know, 56 years ago, everyone was worried about what it's actually gonna do is take the mundane jobs away and it's gonna give clinicians more time to spend with patients that really need it, not the patients that come in and need their pills, pills checked or you know, whatever I can't think of basic basic stuff but, you know, not the basic stuff but really that pure engagement piece, which I guess is what made you, you know, go into that career in the first place that really making a difference for patients. And I guess there are some things where we can now just quickly order a repeat prescription on our phone. So there's lots of bits where we probably accept digital stuff quite easily, much better than having to go down and write it and hand it into the practice. So, I mean, maybe don't think about those bits because they slipped into not everybody's world, but a lot of people's world, a lot of people's world and think about COVID and the NHS app and their QR codes that took off on a far bigger scale than anybody ever thought it was going to and, and sort of the elderly population as well to a certain degree also adopted that and found that relatively easy. It's finding things that are simple and it's starting by providing solutions that really do make a difference, not all singing or dancing. Look at my skills as a designer, you know, or a developer, but what really makes a difference to patients. And I guess if I was gonna kind of give some takeaways and, and thoughts really on my experience right now is, is you guys as healthcare professionals out there? The one thing that's seriously lacking is your involvement and you know, speak, speak to whoever within your PC N or whoever within your trust is involved in those digital teams and have a voice. Because firstly, you know, your patients a downside better than project managers like me. But also, and, and your, and your, and your digital teams as well, quite frankly, but also, you know, what works for you. And if you, if, if this technology isn't adopted, there's massive opportunities that are gonna be missed to free up your time. Like you were saying Michaela, but also to bring cost savings into the NHS in the long term. And I think that's something that's much needed to bring some more money in to help reinvest. But you've got, you've got to take your chair and you've got to sit around the table. Um, that, that's the big thing. I think I like the thought of that because often those sorts of digital discussions happen over there and you might, they might get like you do get, and then the nurse involved in digital, but actually we should all be involved in digital somehow or some way. So I want to spend the last couple of minutes because you mentioned VR and you didn't know I was going to ask you about it. But we, we, we've had quite a discussion over VR you and I, and the Yeah, and, and, and how, and you know, because I don't think, I don't think we're gonna get a single solution that will sort everybody out and we've gotta have bits of solutions for different people in different ways and different things. And I think we just in the last few minutes wax lyrical about, you know, something really positive, which is VR virtual reality. So, um now I, I have an interest in VR but not like I've only ever put the headset on once. But what, and that's clearly what I look like if anybody's listening to us that and it, I was amazed by it. Seriously. I was upstairs, it was in my daughter's room. She's in the loft, but, you know, she can come out whenever she wants to. And, um, and so she had this VR stuff and it was quite incredible to, I was knocking cans off and doing all sorts of things. Um, so, um, anyway, my daughter's got a bit of a, she's got a life altering as it, you know, not life limiting life altering. So she's got several complex conditions which fatigue comes in really, really quite a lot through it. And VR has helped her massively partly because she can get involved in things without having to expend a lot of energy to go somewhere. But also it takes your mind off things. You can distract yourself, you can become quite active. And this is something I think people don't realize how much you move whilst you're in. VR. It's not a static thing you're in there and involved and moving around. Not too far cos of course you've got everything set up. Um, and I think the thing that absolutely blew me away without the art was when she said mum, last night I went, I went clubbing and I thought I, I didn't see you leave the house. You know, I was dancing in the art only for a little bit of time. But she said it was great. I could do it in my pajamas and I could just lie down when I'd finished. But she went dancing and the thought of a young woman in her twenties being able to go dancing um and have that same experience of what it would be like without having to put your microphone and take a taxi. Do you know all of that? She wouldn't have been able to do. So I think something like VR I saw really helped to transform somebody that I love dearly at their world. And II I think VR I think it's gonna do really exciting things. There's, there's my bit. So, so tell me OK, so, so yeah, I I agree with you again. I think it's, it, it's very personalized. I think all digital health is there isn't like you said, a one size fits all, not everyone's gonna go and get a headset on prescription and all their worries are, are gone. Yeah. Walking around like that. Yeah. Yeah. Yeah. But I think there is there is massive opportunity there. And a lot of it, um, thinking of it from a mental health perspective because that's the work I've been involved with and I've worked with some of the teams at Royal Free. We were talking about the, um, the prisons a minute ago as well whereby it's, it's helping people with anxiety. It's helping people with depression. There's programs that are kind of taking people through like AC BT type therapy. It, it's enabling people to just get out of their heads when they need to and just be transported for a, you know, for a sport, small period of time to somewhere else which isn't so stressful. And there's, I think in a few months back, actually, there was some articles about care homes also adopting some VR tech and how elderly absolutely loved it. They just thought it was an amazing experience. I guess the thing is if you were a tradition, traditional sort of clinician and medicine is medicine. Yeah. Ok. I kind of get, there's a few skeptics out there, but I think sometimes it's not all about medicine. It's about, it's about what's going on up here and it's about about changing your brain waves. Sorry. You know, that's not very, isn't it? It's all of it. It's not just, and we spoke a lot about tablets before, but it all got to add to your wellness. Um And so I would say because I just suddenly realized the time if anyone gets the opportunity to put a headset on, do it. It's not all about going shooting things in those war gates. No, it's, it's incredible. I mean, I remember my husband says, oh, Annabella, what do you do? Oh, I shouldn't have said, oh, what are you doing with that one? And she said, dad, imagine when you're on your cross to, you could do it on Mars and it, it just, she said, well, you could do it, look at the leading to of Pisa, this is what you can do. Instead of just being looking at the wall, you can get involved in a very different way. So, um, yeah, one other thing just quickly, which is really cool. You've got, you've got virtual reality, you've also got augmented reality, which is wearing glasses, not goggles. And this is something that's being used in surgery over in the over in the US. So basically a surgeon will put some glasses on, they will be able to see a screen in front of them with clinical data on it or maybe a CT scan or, or something, whatever. Um, but they will be able then to see the patient in real life as well. So it's, it's a bit like your car dashboards, you know, when you look up and you can see on the windscreen your speed and all that kind of stuff. It's that concept. So you've got, so it really will be like off like um ha ha half. It's like having a digital screen in your vision. Yes. And I'm trying to think of which TV film. It was probably loads of them. It's cool and paramedics are trialing that as well over in, in the US. It's, it's some really great technology enables you to be, to have your hands free, be able to look at a patient rather than be, you know, typing away on trying to look at them really great. Sorry, I know we're pressed for time, but that's ok. We, we're there, we're done. So, um, well, thank you. I will say Becky and it was Becky that said, let's do this session, let's do, let's do it in conversation about this and, and I think, you know, our aim wasn't to come up with a perfect solution, but it was actually just have a conversation about things and we thought health inequalities was something really, well, it's always something really important, but we wanted to come at it from a slightly different perspective. Um, so not jumping in with like, you know, saying, oh, you know, we know that women are less likely to have a heart, you know, get their heart attacks recognized than men not coming in from a specific, it's more of a cross cutting um, topics. So, er, thank you, Becky for this thought. That was really good and Allison, don't worry, you'll be able to watch it on, catch up as well. Because these are recorded and you can watch it any time. Also. If you've got any thoughts or ideas of conversations you'd like to see, then us know also, if you've got any thoughts of conversations you might like to be part of, let us know. Or if you've got any ideas of conversations you'd like us to have with other people that, you know, that you may know or not. Now, now just be careful. Of course, you know, there are some people we won't be able to go and have a conversation with, but as long as they're in the health professional world, well, I don't see why not, then we can't go and get them. So a huge. Thank you, Becky and a huge thank you to everybody else who has been listening or is going to listen in the future and yeah, we've got a session tomorrow night. Oh, no, she was chasing, Allison was chasing mercury globules. I remember those days bit of a paper towel chasing them around and you didn't know we didn't even wear gloves. They were just that you sh your thermometer and smash away. It went to that with a digital thermometer anymore. See change in the world of digital and brilliant. Thank you, Zoe. Thank you very much, Zoe. Zoe does a lot amazing quiz as for us, who's there, right? That's us done. And um, we have a session tomorrow night, Becky and I, where we can see the women in cardiovascular disease when it's at the up and start to look at what are the issues there about when we as women have, have heart attacks and heart problems? All right, then that's us signing off. Thanks so much, everyone. Thanks.