Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

You know that many of yourselves and your colleagues across the system are changing their mental model and tapping into new ways of thinking to deliver change in a way that is not necessarily lead from the top in this session. We turn a spotlight on just a few of those people who are leading in their own environments to grasp the nettles that they see each will address a problem that's needed to be addressed and result the change that they needed to make and their takeaway lessons. So let me introduce you to Clare Humphrey Clare is Bernardo's Children service manager, Claire works in the thrive initiative. It's a collaboration of parents, schools, community groups and organizations, helping Children and young people thrive. Tony Griffiths is Senior Business Intelligence analyst for the Western Health and Social Care Trust. He has a pivotal role in transforming the way data is used to help in the delivery of care. And Dr Ruth Gray is the woman behind the Camper Van of Dreams. I've been there. I've got the button badge, but she's actually going to talk now about the, the project in the Southeastern Trust where she's Director of Quality improvement and innovation. And Ruth and her team worked with prisoners to design their own health and care program. So this session is all about sharing experiences as each of the panel of members take us through their problem solving. So I'm going to begin with Claire. So Clare, first of all, tell us a little bit about your role and in particular about thrive. Hi, it's really good to be here. So I'm Claire Humphrey and I have been coordinating the thrive collaboration in the Rath pool amongst town areas of New Aby. So an area of significant socioeconomic deprivation, you can sit over here. I'm gonna sit in here. We'll have a wee cuddle, cuddle, right? You can, we're gonna share that. Um So let's identify the problem that you had in the system and, and what you wanted to address. So about eight years ago, um we had a fairly substantial funding crisis um which was going to result in the loss of a big family support project. And we started having some conversations about the neverending conversation where we're going to get the money, where are we going to get the money? And we started having conversations together about there must be a different way of doing this. Um Instead of chasing wee bits of money for wee bits of programs and we started having conversations I suppose about the real systemic factors that were really affecting um communities like um Rathcoole Monkstown Complex entrenched impact of poverty over many years. And so we started talking with local Children, young people and parents about what is it that would really make a difference um to your lives. And they together, together, we started talking about three main things. They talked about a lack of energy buzz momentum about doing well. And that's the effect of poverty on people's experience. And so they wanted something that kind of gave a wee bit of belief that things could get better. The second thing was they wanted to have good G CSE results with good literacy and numeracy skills for, to be able to work. And the third thing they said was they wanted to be well and they wanted to be able to have strong mental health and to be in resilient families. And so we got our heads together to go. This isn't just about getting money for another wee project. We've got to take a really long term systemic perspective on how we're going to work with them as a whole collection of schools, churches, community groups, um voluntary organizations and statutory services to really look at how we could work with them, to help address some of those issues. People listening to this would say a mammoth problem, a mammoth task. Although you were very much service user centered, you asked them what, what they needed. So how did you produce results? So what we did? And it's interesting that you mentioned about mental models and mind shifts because that's what we had to do together on a journey. We had to really start thinking much longer term to have this real understanding of the system around Children and young people and their achievement and their wellbeing. We had to think. Let's look at the evidence. What does the evidence say about how you tackle some of these really complex, messy, sticky problems that we're all beating our heads against walls to try to solve. We knew we needed to innovate and experiment and take a few risks. And we had a good, fantastic group of people who were like willing to go. Right. Let's look at something different. Um, and really, really important, we knew we needed to use the trusted relationships that many of the community and voluntary organizations and schools had with Children and young people and really shift power and agency to them because they knew they knew what they needed and they knew what would help them make those changes. But we all needed each other because they couldn't do that on their own either. And they needed, um, people around them in the system to really, um, support change. And so we came to understand, we've all got a role to play. We're all needed and to really value and respect the role that we could each play the things that we could each do together. And so we did three things. I'm not sure if the slides are here but um let me just check. No, maybe not, maybe not. Um So we did, we did um we did. Yeah. Is that ok? So we did three things. So the first thing we did was we looked at a wee bit of evidence about how could we make a collective impact. So not just one school, one church, um you know, one health visiting team. Um We just, we looked at like, what do we need to do to make a real collective impact? And we set up a structure um which enabled conversations. So we had a, a project board uh that was made up of decision maker. But then we also got groups of young people together, groups of parents together, all the schools, all the churches, all the earlier, all the designated teachers, numerous groups which were really to keep conversation and make connections and collaborations with each other about how we were going to solve this thing um together. And the third thing that we did was we started to really talk about can we pool resources? And we created a pooled budget. And so anybody who was involved in thrive, who had any money, um We really started to think about them as investors in a process and we call them collaborative investors. And so we've currently got about um nine government departments and, and funders all contributing to a common pot which is really working on those three things together. So you had collaboration. That's no mean feat bringing all of those investors together and you were very much service user focused. What lesson do you think the delegates in the conference should take from what you had in front of you and how you solve that problem? Yeah, thank you. So um a really fantastic um example of how this works. Um We, we often tell of a young man um called Marcus who was part of a program to really help him get his G CSE S so likely to be excluded from school really on a very difficult trajectory, probably going to get involved in criminality. Um And he got his 9 g CSE S 9 g CSE S. And when he came in the room on G CSE day, when the board was meeting, we were like beyond ourselves with excitement about Marcus's achievement. And after he left and we were delighted for him. People in the room went, that's my mental health strategy right there. That's my tackling and paramilitary strategy right there. That's my economic and activity strategy right there. And we started to see that we could make a difference when the system all came together around Children and young people in a place that was impacted by poverty. And I think that what we learned was just really the importance of centering the lived experience of people who live and work in these places who really, really know better than anybody what's needed. And they've got good ideas about good solutions, but they can't make the change happen on their own. And so this idea of place based poverty affected communities where we're really all trying to make a collective impact. And I think the last thing I would just say was, you know, to really give consideration to kind of grasp on that collaboration, metal um collaborations, hard, it's hard work. Um But our system needs to really give consideration to how we can work in a way, way, better joined up. Um Way. Well, Claire, congratulations, well done to you and your team. That's, that's clearly a successful outcome. II think that deserves a round of applause described the thrive initiative learning from each other. Uh Tony, you're a behind the scenes man. Now you're in front of scene. So it's lovely to have you here te tell, tell the delegates a little bit about what you do. Sure. Hi, everyone. Uh My name is Tony Griffiths and I am the senior Business Intelligence analyst for the Western Health and social care Trust. I've been working for the Trust for the last five years and I help them to transform the way they use data and how your insights are derived to better inform care of delivery, intelligence analyst. Yes, he's, he's probably a member of MENSA as well. Uh What, what sort of problem did you have that needed to be addressed? OK. So our problem was within the area of domiciliary care and for clarity. Domiciliary care is a range of services that help people live independently in their own homes. The area of domiciliary care accounts for a substantial amount of the annual Western health and social care trust expenditure. So it's therefore closely monitored. However, timely and enhanced um information within domiciliary care was becoming a challenge for our trust. This was partly due to the small internal reporting resources but also the ever increasing demand for intelligence and forecasting information within this area of care. And this then was leading to lengthy wait times between request to and delivery for domiciliary care reporting. And it's something that the director and one of the assistant directors within the director of community and older people's services wanted to address. So really to summarize, we were trying to make efficiencies in the data processing, the analysis and the visibility of um domiciliary care data. So then what did you do to get the results that you, you required and you you wanted? Ok. So this project really was all about collaboration and harnessing innovative technology. Um So we established a core cross functional project team at the outset. This included um senior management from the request and director, Business Intelligence, staff, information governance, digital services and subject matter experts. Now, initially, the aim was to develop a single digital data analytic application that would bring together all of the domicile care data. However, the more that we looked at our project aims. We realized that we actually need to develop two applications. A strategic application primarily aimed at our senior management team that would provide them with historical analysis of our trust Roader utilization information. And then an operational application geared more towards front line staff, such social workers um hospital discharge teams. And this would provide them with in the moment analysis of data such as social worker caseloads, domicile care, patients reporting into ed uh being admitted into hospital and coming out of hospital. But the real challenge with this one is that the data was quite difficult to integrate because it was separated over three disconnected data systems. And this is where we really started to harness innovative technology. So thanks to the data analytic uh software called Clicks Sense, I was able to extract, transform and connect that data into a central repository and then into visualizations and then into intuitive dashboards. But the two analytic applications weren't the only wins for us in in this project. We were also happy with how we've impacted people safety, uh accuracy and also culture. So we think about um our people, our management and frontline staff. Now you have access to the data that they require, empowering them to act faster and more independently. Um quality or data quality and accuracy has improved on the source systems. And this is due to the enhance visibility of the data. Um It's making it easier easier for us to identify our data quality issues and then safety by providing people with access to real time data that is showing our domiciliary care patients reporting into Ed. It's helping us hopefully um reduce hospital admissions, um improve patient care and really relieve some of the stresses on the overall hospital system. And then finally, our culture. So self service analytics has allowed us to shift towards a more data driven proactive approach to managing our services from the delegates point of view. Those who maybe are, they don't have the understanding of the data and the analysis that you and your team have. What would you say that they need to take from you and the lessons that you learned as a team that could be shared across the system? I think the the big lesson that we took out of this project is and I would encourage everybody. I'm sure a lot of people are already doing it. If not everybody is that we absolutely should be using data to where possible to enhance our decision making. However, when you're doing that, please don't forget the narrative. Now, not all data needs to have a narrative attached to it. For example, on one of her applications, we list all of the domicile care patients that are currently in our emergency departments. So that data is quite self-explanatory. We really don't need a narrative attached to that. However, there's another part of the application where we analyze how well each of the domiciled care Rotas are being utilized and that does need a narrative with it. So let's say we've got two Rhoda Rhoda A Rhoda B last week, Rhoda A delivered 100 care contacts to clients out in the community and Rhoda B delivered 60. So on the face of it, it may look like Rhoda B has actually been underutilized. But in actual fact, this is where the narrative is important. Rhoda B is delivered across a vastly rural geographical landscape and the time to uh time to get from one client to the next client is much greater compared to that of Rhoda A. So actually, when you attach the narrative to the data, Rhoda B has actually been well utilized and that's really important because ultimately, what we don't want to be doing is using data and making flawed decision making. Thank you very much and congratulations to your team in that problem solving. Ruth. Um Tell the delegates if you can a little bit about what you're doing in particular in the prisons. So I'm gonna talk about a project that's been in that we've been undertaken in the prisons for the last six years. Um And it's really focusing on the difficulty of people entering custody. Um We all know that that can be a very uh emotive time, a difficult time, there's evidence for increased risk of self harm, trauma and incidences on landing. So it's a really complex problem which is across the criminal justice system um about transitioning into and out of different services and institutions. So you had a problem, quite complex problem. Everyone is unique with their own individual needs. So, so what did you do? Ok. So we started with listening and I think it's ii it's fundamental and, and Claire's already mentioned this, but we conducted um over 100 and 50 in depth interviews. We used our regional tool um to do that. That was adapted for the prison. Um uh 10,000 voices and what we did, we really wanted to understand the experience of entering custody, but also the expectations of people as they entered custody with regards to health care. When we took those 100 and 50 interviews, we analyzed them and we established what really mattered at that time for people as they entered uh custody. There were two big themes, medication and information and I'm gonna just focus on the information one for now. So, uh it was really obvious, we, we knew that our teams, our, our, our healthcare and prison team and the, and the prison service themselves were imparting lots and lots of information at that time of custody. But when we interviewed people, most people said they hadn't any information or, or very little about our services because it was a wrong time, wrong place, wrong mode. And so what we wanted to do collectively, we gathered people in custody, people from the prison, our, our partners, our inreach partners from lots of different community involuntary organizations, we got together. And the first thing we wanted to do was have a shared ambition and we wanted to change the narrative and ask each other, what would a welcome be as people entered custody? And so that was our focus. That's what we based this whole work on about creating. Welcome. And so there's lots, it's a very long story. I uh bridging a bridging a bridging, but we created um a peer mentor network. So we have men in custody and we've just started in high bank with some of the the ladies as well who are our navigators. There are health care navigators and what they are doing is they are meeting people at that time of need when we are often very pressured and process driven, they are there and they're coming alongside every single person who enters custody and going. Hello, how's your head? What do you need? And we've created co-signed with the guys in custody, what the main focus is and we have created uh pathways for them and it is all about being present to the need and the the the results have been unbelievable. The guys in custody have seen over 6000 people in the last number of years. Um This month, they had 600 conversations with people new into custody. Um that then um has many pathways around uh referrals to services. For example, there's 280 referrals for HEP B vaccination. That was a, that was a, a place where we were not getting any traction whatsoever. And when it's peer to peer and people understanding each other and having time for the conversations, it is starting to change how we provide care. We're moving from the medical model and really understanding what it means to embark on population health and, and embark those conversations are so important briefly, if you can the lesson that you learned that the wisdom that you can pass to the other delegates. OK. So complex issues, we need to create space and we need deep, deep listening. And I, and I've heard that lots in the camper today as well from lots of you around uh the power of community assets. There's a community living in prison, there's a community working in prison and it is so rich and full of ideas and creativity and resource. And it's, it's, it's, it's changing that perspective that we are here to provide care that we are actually here to core um seeing power and that takes really brave leadership. I love the funding, the changing of funding. I want to acknowledge the bravery of our governors in H and P mcgahay to cede power and recognize social capital. That's a different way of doing things. And the last thing is change is predicated on trust. If we're going to collaborate, we really have to listen and learn and trust each other and take risks along the way. Ruth Clarant are going to be here for the rest of the conference. Unfortunately, we could have dedicated an hour to this, but this is all, all we have. Many of you are already leading projects and changing from the middle and grasping those metal. But our thanks please to our panelists, it's going to be musical chairs next. So in preparation for the conference, I mentioned this earlier, the conference brought members together to agree a set of priorities to collectively support change. And Jonathan Patton mentioned it as well at the start of the day, those nettles that ni members wanted to grasp now, you should all have a copy of the leaflet. All seven nettles are summarized there on what the members said and we've been doing it all today and we'll do it tomorrow. We will revisit those seven medals, right? Throughout the two days of the various sessions. In this session, we have leaders representing their peers who will set out their thinking as we focus on implementation, like on wants to support those leaders and those who are working individually and are proactive in trying to build a more collective culture to deliver better outcomes. So if they could make their way to the stage, please, the chief executive of the patient client council, Mayo Monaghan, chair, also of the regional chief exec group, Anne o'reilly is Chair of the Northern Health and Social Care Trust if you want to make your way up, please take ap and on the trust chairs of the forum. Roisin Coulter is Chief Executive of the Southeastern Health and Social Care Trust and Chair of the Trust of the Chief Executives Group. And Mr Niall mcgonagall is Northern Ireland, Director, Royal College of Surgeons of England, Northern Ireland, Representative on the Academy of Medical Royal Colleges. Now I'm going to guide each of them, we're going to go through a few of the metals and then um I really want to take your questions from, from them as well. Um If we can start um with you, issue number one in the nettles list was the need to promote honest dialogue, right, with the public as partners. Um Do you think that's happening effectively enough? And can the chief executives do more to, to address that? Thanks Donna. Um I think a really interesting thing about the regional A LB forum is that we all deliver services regionally and therefore have a strength and perspective um about what the collective priorities for change and improvement uh could be. And this collective approach to public engagement and an honest dialogue with the public as partners in care is such a critical component of that. Um I think to think about this critically, we need to understand what it looks like to embrace the public as assets in that. And there's been a lot of this as a theme throughout the conference. Uh today already. Um Assets is something that's of value to our system. And uh people are experts by their experience and their care and they often bring the solutions to uh what services could deliver and that experience shouldn't be lost to the system. I think there is the potential for us to unlock uh that more effectively if we have better strategic cohesion and how we go about that dialogue. Um And as we know, the best partnerships are based on understanding on trust um on diversity of perspectives in the room and on building a consensus towards a shared vision. So I think the first part of that is there is a strong history of engagement and involvement in health and social care in Northern Ireland. But I think the next step for us is to really embrace more strategic cohesion in that regionally. Um And to engage in constant conversation with the public because it's a two way. Um And that, that really involves a fundamental mind shift for us uh in viewing the public as not just passive recipients in care but as active partners. Yes. And we heard that in some of the panel sessions as well, especially those patients and service users who have a vulnerability but still have as as much of a voice or should have as much of a voice as everybody else. Um If I can move on to an and two of the issues on the Nettle list. Refer to the need for collaboration across government health and social care. Um Are you confident that there is a commitment to that collaboration or from your perspective? Do you think that there are still barriers to that sense of sharing? Um As chair of a trust, people will know these are large complex organizations and you then bring that up into six trusts with 70,000 staff, 100s and 100s of places that we deliver care uh care that's to do with acute care as well as social care. So it is to understand the complexity and the scale and the size has to be part of the context that said, that said I'm in the chair about a year and a half. Uh My background is the volunteering community sector. So for me, it is in the DNA of my sort of ideology to work collaboratively and to work in partnership. And I would have to say this, I work with the six chairs and I'm here not just as the chair of the Northern Trust, but on behalf of the HSC chairs forum and as chairs, we are very actively proactively and maturely working together. We cannot do it all. But what I think we've sort of getting to grips with today is that there are areas that we can focus on so that we can move forward. I think we have more opportunity. I've been coming to Nikon for years now and I would say I would probably feel that the mood music to work collaboratively has is at a scale and at a level and a commitment that I haven't experienced in the whole time, I've been there. Well, I think even for people to come here, there's a sense that they want to make changes and they're, they're willing to share and, and to learn from others. Um Roisin, you're the lead across the chief executives, issue three and issue four of the Nettles. We need to build the capacity in communities to manage care and making primary care fit for the future. Um It's a slow process that successful outcome in primary care, isn't it? We're lagging behind. We hear it on the news all the time. I think uh we, we just need to keep reminding ourselves about, you know, the citizens, the population, the people that live in northern Ireland. What do they need to make their life work and to start with the person um who lives here and think about services in home or as close to home as possible. But you know, it's, we know it's, we know the, the rhetoric, we know what the right direction of travel is. And I think what we want to do in terms of an event like this, genuinely, in terms of grasping the nettle is that, you know, in Northern Ireland, whenever people become um unwell our culture is that the emergency department or the acute hospital is the first resort in England. What I have learned is it is the last resort. So genuinely the population, the message, the culture, the society is going to hospital is seen as the last resort. And if, if we're really serious about flipping that there is something very, very important about that whole public engagement, public narrative about saying it, you know, it is much better to stay at home, to have your services close to home. And what we need to do that is to say, you know, there is a a nettle here, if you like to say, you know, we need hospital at home for everyone. We need multidisciplinary teams in primary care so that we can avoid what is happening currently in acute hospitals. And that's the challenge is how can we do that whilst we're still in the middle of, of such a demand crisis? And I heard you mention that at one of the parallel sessions about that hospital at home, but that was using innovation that was training staff that also needs money. But does it also need a mental mind shift as well? I think it may need a mental mind shift for the public. But what I will say is not for staff because we know about better outcomes. We know that whenever people come into an acute hospital system that you know, they have more and more interventions than they would have in the community, they have a longer length of stay particularly our free and older people. We want to provide better services for free and older people, don't we, in terms of um deconditioning, supporting people with dementia. Um And we know that if we can, so our staff, I would say are absolutely signed up to providing um hospital at home services, et cetera. And again, it's for, it's for the public uh message. But what I will say, and I think through um patient client council as well is honestly the feedback from uh families and patients who do receive services and community services. They're absolutely excellent. And you know, they really, really um appreciate them very much. 85 to 90% of services across health and social care are provided outside of hospitals. Yet the focus of dialogue and investment is is not uh relative. So for me, it is absolutely about that community message we've heard very clearly even at NHS con fed the whole line and it is difficult to do is about investment in community and building up and sustaining a primary care model and primary care needs, multidisciplinary teams wrapped around them. Um Neil, I was at one of your sessions and uh your other colleagues will, will probably know all the stats and figures. But I was actually shocked at the percentage of time that a surgeon spends in the in the theater, given all that was going on. So one of the the Nettles was reduce elective waiting times and I know there has been collaboration amongst your colleagues and, and about clinicians as well. But tell me more about that working together and how difficult that collaboration has been and what we could do more of. Uh Absolutely right. I mean, it, it's only about working together and none of us are we actually going to come to a solution uh and change things. We have seen some progress over a period of time. We've looked at the, the surgical hubs and how they've brought about elective worker and how and sort of the last number of quarters that they've brought some of those waiting lists down, but they probably are just, you know, dealing with the low hanging fruit uh to begin with, there will be the patients that have been waiting longer and have gotten more complex that unfortunately move from one potential operation process to another. Um We're quite fortunate that recently within northern Ireland as well, we've now developed a Northern Ireland Royal College Alliance, which is all of the, essentially the Royal Colleges coming together be that surgery, physicians, emergency medicine, radio, radiology, you know, we've even, and, you know, although it's not a royal college, we have the forum for the uh allied Health Professionals as well. So we have everyone together. Um Fortunately, we're a bit behind that we have genetics and who's the chair of the, the Academy of the Royal Colleges in England. So it's becoming that together and going through all those various different disciplines and saying, well, actually there are a large three main things that have been cross cutting for us that is workforce, patient safety and, you know, bringing it all together to say, look, it's only by getting these together, will we actually make any progress on these? Looking at the period of time over the last 10 years? Don, as you, you, you've pointed out, we've not gone in the right direction, we've gone completely in the wrong direction. And that's why we really do need to ramp up and change and say the only solution is to start making change. And to me, there are two groups, we talk about patients, but there's also the workforce as well over a period of time that are tired, are burnt out, have come through COVID and have seen sort of times where we've not really, maybe just worked as closely and as quickly together as we could have. So how do you support that workforce and how do you um cultivate uh an AAA culture that they are trusted that they are supported and that they're valued value is the most important thing for any workforce. But it's about delivering on these ideas, delivering on transformation to say this is in the best interest, not just of patients but of hospitals and of clinicians as well. And listening to them, been able to say, you know, we've talked about people always talk about, you know, you can hear, but there's a difference between hearing and listening. And until you start listening, there will not be a change. We're going to take questions from the floor. Ladies and gentlemen, with roving microphones, if you could put up your hand very, very high because I have a big spotlight in my eyes. So I might not see you. Um Heather is our mic assistant. Anybody got a question for any member of our panel? I can hardly see anyone, anyone at the front here question. Are you all dazed? You've had so much information today and so much learning that you're all dazed. Um Can anyone from their perspective and their service? Thanks for turning that off guys from their service. Um Reiterate what any member of our panel is saying and you know, we had solutions in our earlier panel about problem solving. Is there anyone who would like to share their experience of their service that either it really needs AAA dose of energy or that you have actually um problem solved? Anyone at all? Anyone who want to put up their hands. This is the first for, this is usually what's this? This is the first for they're all very well. We're going to have the human, oh, behind you, they're going to have the human caffeine woman coming up soon. So, hello, how are you doing? Um If you could just introduce a medical Director of South Trust. Um and I put up my hand, somebody needs to speak. I think it strikes me that the folk on community care is the key for that. And it, it's about getting the mindset of the public and patients to expect that hospital is the last resort and they should be looking for care at the home and care where they come in to a secondary care center. Yes. But they go home again the same day because they can get everything done properly. And that's work we're certainly doing in Southern Trust to try and enhance services for that. And it really is key and it really the idea of that you have to come into the hospital and patients coming in with the suitcase expecting to stay, that has to change where people actually expect to go back home. And I often liken it if patients in the hospital were stealing life from them because they're having to stay in the hospital, they should be at home with their families, with getting care if at all possible at home. And that's certainly our focus. So I think it's, we need to really get that message across to the public and that staff have confidence that they can do that safely. And that's the best practice. Of course, it's a great credential to say, you know, I want to be in hospital because they're the best, that's the best place to be. You often say it to a member of your family, you say Oh, he's in the best place. He's in the best place. But actually he or she could be at home as well. And that, that initiative that you talked about. One of your parallel sessions about hospital at home is an amazing initiative. But it does need to be, it does need to be funded. Could I heather, go ahead. Can I ask you a question? Um We've worked quite hard over the last 2 to 3 years to really try and build a culture of working together. Could I ask uh the panel, what they think would help them to do that even more proactively? So that has definitely begun an ans, right? I think the mood music has changed. What do we need to do to capitalize on that mayor? Would you want to take that? Well, I think, I mean, I, no surprise, I'll come at it from the public perspective. Um I think the, the example that's just been given about the conversation with the public about the realities of how, how current needs to be delivered now is an important one when we consider what we mean by engagement in conversation. Because I think we often consider engagement with the public whenever something needs to change or whether there's a crisis or whether there's a collapse of service. I think there's a way of us shifting to thinking about talking to people along a number of different streams. One of those is about building and understanding and reality of what the health service and care needing to be delivered currently is because I think there is often a disconnect between the reality of those working in the service and those who are at a touch point of it and understanding exactly what uh what that looks like currently. So I think that's the first point. Then there's a piece about um how services need to change and what transformation could look like and how they would get engaged, man. Those are very 22 very different things. And I think to the point about working together, um there is a need for us to think strategically about how we deliver on, on, on all of those elements of public engagement um rather than just involving or consulting on service changes. But also thinking about how we engage and participate the the the public in a broader conversation about the realities of health and social care in today's environment. And I also think to the point about cross governmental engagement, when we think about that, we need to think about historic health inequalities in Northern Ireland and health literacy and how we engage the public in that conversation. Um and the socioeconomic and, and social determinants of health that are not just within health's control to address there, there's justice, housing education issues to be considered. Um So I think an enabler for that is obviously the new program for government and the commitment to partnership there. And so I think the cross governmental approach to that public conversation is critical in the next number of months and years. And you wanted to pick up on that. Yeah, I just wanted to pick up the theme around. Well, if we want to make that shift into community, I think we just need to bring a wise counsel to that and recognize and have a deeper consciousness about the role of informal carers. Because in terms of making that shift, we need to particularly, I mean, I was involved at the hospital at home way back when and involved in the audit of intermediate care. And what really struck a chord with me at the time is we need to build the confidence and certainty of care support as a guarantee to making sure that care in the community comes to pass because the last thing we can do is transfer risk to sort of families in the community. And I think we just need to be very mindful of when we talk about partners in care, informal carers, our partners in care in equal numbers to the workforce that we have across the health and social care system. So from my point of view, I think as trust boards and as a system, uh I think having a responsibility be mindful of our responsibilities for our population, which includes, I think that strong cohort of informal carers across the life course with learning disability, mental health older people. There is a context to, to the change agenda. We're talking about that that needs to bring a consciousness I believe. And II would want to flag it up because it wasn't mentioned today about the role of informal carers. Thank you, Ann Mark Taylor. Um Can I ask the panel clearly, we're looking and we have a chief executive, a chair, chief executive, a patient CCL council and a college director. Are we less siloed now or more siloed now compared to the past? And I'll ask each of you that question. If you don't mind, I'll, I'll go first because I've got the cons. But um it's interesting, you asked me that mark because I was just about to talk about that and, and my own personal experience with a lot of things, um was I was lucky enough to be a consultant, came back here seven years ago after being a consultant in England for six years. And I was very surprised at the difference in styles and how things ran. Um And all I can think about is last week is that little slide that professor Bingo up, put up with the, the two jigsaw pieces and the clinicians pulling at one side and the uh managerial team pulling at another piece. And that was the impression I got when I came back to Northern Ireland compared to working in a system where I felt that I delivered as a clinician and a managerial team and trust team were there with a very engaging chief executive, were there to support me in my role? I certainly feel that over maybe this last three years there has been a sea change here in Northern Ireland. And I feel very positive about that sometimes. I think maybe they just think there's mcgonagall, he's like a dog with a bone. He won't let go, just give to him. But I do see a seismic change there. Mark, I see there are no doubt still those silos in various places, but I think we should be very proud that there has been a change here over the last number of years. Roisin as chief executive. Yes. Um No, thank you, Mark for that. Um I think, you know, my mind goes to it, it depends what uh what you're thinking about in terms of silos, but, you know, straight off in terms of health and social care, there's absolutely no doubt that we have definitely moved w way on, you know, we've made leaps and bounds now, moving on from what was more silo based working. Um I mean, just for example, you know, I'm currently the chair of the chief executives Forum for Northern Ireland, um and the chair of the chair's forum and uh you know, what, what the system will get uh is one consistent voice and one consistent approach uh with a very robust, um cohesive leadership team in terms of providers coming together So, you know, that has, you know, one of the benefits of managing the COVID-19 pandemic has been that there, there was a massive vehicle for us all working at pace at scale together to do that. And we have continued that and whether that's now through setting up the Regional Coordination Center looking to further widen out into the development of provider collaborative arrangements. Um you know, there's definitely a great progress in relation to that. But I suppose my challenge would be, you know, it's not just the silo of health and social care. I definitely think we are, we are moving forward, but we need to do more. Um And that is about putting the public health agenda right at the front and the inequalities um right at the front of our health and social care service offer. Um and that is something that we are starting to do. So for me, it's not, you know, it's about the narrative about a service that people want from us as providers, a service is provided on two people that live here in northern Ireland. But that honestly needs to really, really quickly change to saying about this is about everybody playing their part. Um every citizen that lives here in terms of, you know, looking at that self responsibility for your own health, prevention, health and wellbeing because if you don't, then, you know, this is these are the consequences whenever we see that we're working with colleagues across the UK and the Republic of Ireland and healthy life expectancy in northern Ireland decreasing, you know, that is a symptom of what is happening um because of so much emphasis that we have had to place on secondary care and, and crisis response. So for me, the s the silos are not only about the service delivery arms, but they are about the messaging uh out to the people that live in northern Ireland. And I generally do think that the public don't, they don't have all this information. And if they do have all of this information and there were behavior based incentives to change behaviors and working closely closer with communities, community and voluntary sector, service users, local authorities. Um then we will be able to help shift what is still a health and social care service that's focused and based on illness rather than prevention and wellness. And I really do mean that because we've been talking about that uh in these forums for many, many years, but it is a compliment to the public health agency and Aidan Dawson and Joanne and the team of, of bringing that agenda to the front and the for of every single meeting and plans that we are in, in terms of addressing inequalities and healthy life expectancy. I think, I think we also have to recognize the voluntary and the community organizations and the part they play in health and social care. And, and Anne mentioned there the informal carers as well from your point of view, as a chair and part of that chair, forum group. What sort of separation or silos do you see the trusts compared to the Department of Health? I know there's been some collaboration, but do you think those silos still exist and those barriers need to be broken down? Is there still too much politics in all of this? Um I can't get away from the fact that it's a complex system we're trying to operate within. There's no doubt about that, but complexity does not uh justify paralysis. And I think we're getting beyond paralysis now because we are recognizing a sense of urgency and I think the test of collaboration will be, I think we have agreed as chairs and chief executives and wider sort of cohorts to focus on two or three key priorities that hopefully will make a, a difference and demonstrate that we can work collaboratively as one system. People keep saying to me do we should we have six trusts? It's not about the structures. It's about, can we operate as one system with local autonomy? Because it's very because our, our health and social care is a local thing, the population are really care about it. They want to know what's happening. And I think the message is we do need more engagement and public engagement around that. So it's not about structural change. It really genuinely is, can we demonstrate to the public that we can work as one system because I was really taken by the fact that public confidence in us is quite low. And I think we need to acknowledge that. But the fascinating thing was there's still great confidence in our workforce. And I think that's where we have. And I think someone said it earlier, we've got to maintain hope and optimism um and be someone said earlier about being radically realistic. And I think it's about being radically realistic about a couple of priorities that we really can commit to across the whole system and demonstrate to the public that we can do something different to rebuild that confidence and trust. Can we just take the last comment from Mayo? What Mark had asked there? Do you think there are still too many silos here? Are we getting better at that and breaking down the barriers and having more collaboration from a PCC point of view? Well, I think that it very much depends as Roisin said on how you frame the the partners in that picture. And I think the critical pieces we all have a role to play. So there are policymakers, there are commissioners, there are service deliveries, there are the public critically. And I think we all need to recognize that there is the potential always to develop better collaboration when you recognize the fulsome of all of those partners that are in that picture as well as the community sector. And that's the critical piece. Thank you for all of your insights, our panel, ladies and gentlemen, the wife, thank you very much. Some of you may be waning. Some of you may have thought you've had enough caffeine at this stage of the day, but be warned as I said earlier, our next speaker was once described as human caffeine and we are delighted to welcome Dr Nicola Millard to inject a positive espresso shot of energy into us. At the end of day one, Nicola uses design thinking, psychology, anthropology, computing, and business consulting, consulting to explore how the world of work is changing. Now, in this session, we invite you to glimpse into the future and be part of harnessing the wave of change revolution. So put your hands together, please for the futurologist at BT, the conference's principal Innovation Partner, Doctor Nicola Millard time ago. Thank you very much. So, hello. My name is Nicola. Um Yes, I was bt's futurologist. Um and I can always feel the question coming through the ether at me, which is usually, do you have a crystal ball? Um The answer to that question is yes, I do. Um Sadly, I saw no future in it. Um So uh crystal balls are a little a bit rubbish. I have to say in terms of trying to figure out what's coming along in the future. And to be honest, if I did spend my entire day looking at crystal balls or tea leaves. That would be quite a boring job. And although my job title is officially a little bit more boring, now, I am a principal innovation partner with BT. That does not mean my job is boring whatsoever. It's a great job to have. So I'm part of bt's innovation. The I am a slightly weird part of bt's innovation team in that, I think whenever people come and see a BT speaker, they expect us to talk about network and cloud and all of that lovely stuff. Now, to be honest, that is not what I talk about mainly because I'm only half a technologist basically and I'm never terribly sure which half I am whether it's the slightly boring bottom half or I think I'm starting my Christmas vibe with this particular way. Although I feel as if I should have gone Halloween by the decorations around the hotel. But, but, but whichever half is, is not the technologist is a psychologist. So, um I always play, I look at the most, I guess, disruptive part of innovation, which is of course not technology at all. It's us because unless we embrace it and we use it to change the ways that we work rest and play, it's pretty useless. So I spend a lot of my time looking at behaviors particularly in terms of why we adopt technologies or not. And in that, in those in those fields, I guess I look at two elements of human behavior. One is around patient experience, customer experience, citizen experience, whatever you want to call them. That's one side of the coin. The other flip side of the coin is about employees and employee experience. And I'm going to talk about both today. You're gonna get a little bit of a glimpse into the minds of both customers and employees. Now, of course, the first thing to say is they are the same people, they're us. Um So one of the things that we do find very consistently around things like employee experience is that employees are bringing a lot of their customer expectations into the workplace. And that's why that's where really the two bits of our uh our research intersect. Um So I'm gonna talk a little bit about how we're thinking slightly differently um from three perspectives. Um Firstly about people. Uh Now you're in a people business, uh your business is all about being human. Um But we need to be human in a digital world. Um And that requires us to concentrate firstly on what do, what do our customers want? What do our patients want, what citizens actually want from us? Because ultimately, they're the reason we exist. So firstly, it's trying to understand those behaviors. But again, on the flip side, we've got a question, are we actually responding well to those changing customer needs in terms of designing our workspaces, designing how we work and designing employee experiences. Obviously, there's a lot of chat about the future of work at the moment, almost playing out on a daily basis. In the press, lots of debates around things like hybrid working four day work weeks. All of that is really probing and questioning whether the ways that we work work. And I guess the data because I'm data led, I don't have a crystal ball is telling us that actually employees often aren't very engaged in their work. So the first question to ask is how do we make work, work for both the consumers of that work, but also the people doing it. The second challenge is productivity now, frankly, productivity has been a bit rubbish over the past 10 to 15 years. Despite the fact, we have a whole raft of new technologies that have been helping us now, partly that could be because we're measuring the wrong things in terms of productivity. But largely if we're going back to the sort of traditional industrial measures of things like GDP, it's not vastly improving. And although we have some interesting new technologies that might improve it, that does rely on those technologies like A I to be adopted in the first place in order to improve productivity. And then obviously, we have a climate crisis as well. So if we're going to reinvent things, let's make sure we don't destroy the planet in the process. So all of those are the themes that I'm going to be exploring in a very fast, kind of 25 minutes, I guess. Uh because I know I'm between you and um, and refreshments basically. Now, the lovely thing about my job is, is basically we, as people are quite contrary, certainly we can design fabulous technologies, but often people don't use them in the ways that we've designed them. Now, this is this any of you who work in human factors and usability will be very familiar with this slide because it's the slide that everyone shows because this is a classic example of our being very lazy and lazy is a very, very big dictator of the wave that we behave. So frankly, the designer of this pavement designed a beautiful pavement. It is a great pavement to walk on, it's very comfortable and yet to save probably about five seconds, we actually don't use the pavement and we start to walk across the grass and we do that in efficient numbers that we end up wearing a muddy path across it. And of course, the designer of the technology, the pathway gets a bit cross about that and that's classic behavior. So we as designers of technology could design brilliant technologies. But then it's all about how these technologies are used based around one of those very big behaviors that we find and that is a behavior around easy or effort. One of the things we've been researching over the years, certainly in terms of what customers want from a customer experience is that they generally don't want to work very hard when they're engaging with you for a start. Um So how do we design effort, free customer experiences. But as I said, we're employed and customers at the same time. So if we're designing technologies to change the way that employees work as well, we also want to make their lives easier. Now, preferably we make both sides easier in terms of their life, engaging with technology and doing their job. Now, I don't do my job on my own because again, the crystal wall doesn't work. I am surrounded by some very clever people across universities around the world and indeed our own researchers within BT this particular piece of research around effort we've been doing with Professor Moira Clarke who is a fabulous lady who works for Henley Business School and has been looking at this from a customer perspective for a very long time. And her question is if you're going to design particularly innovative, innovative new experiences, what do we need to think about in terms of that design and how could technology help? So she's broken down this notion of effort into four parts that we need to think about when we're designing new technologies. Now, it has to be said that the first three constitute about 20% of our perception of effort. And the last one, emotion is about 80% because emotion colors absolutely everything else. And again, you are in an emotion business. So a lot of your work is colored by how does it make people feel? Let's break these down a little bit more. What do we need to think about? The first obvious thing is cognitive effort. There's a lot of talk at the moment around cognitive load. Some jobs have incredibly high cognitive load. I would include health care in that. That's simply how hard does my brain need to work in order to figure out what I need to do today. Now, I have to say that picture on the end, there is actually almost a picture of me buying jeans about three weeks ago. Um because one of the problems certainly with the world today is there is a lot of choice. Now, I even just trousers. Can, there's lots and lots of choices. I discovered, I have no idea what mom cut is, but I have discovered that there is such a thing as mu cut. I mean, that's great, but I have no idea what that is and it increases the amount that my brain is trying to process when faced with a bewildering amount of choice just in trousers and that's just trousers. There's not a lot of emotion in trousers. So the first thing to say is it choice is brilliant but too much choice freezes my brain. So how do we mediate choices? Now, obviously, we do have technologies like machine learning, a personalization tools that can start to learn a little bit about me. Now, this is not New Amazon have been doing this for years. I have taught them pretty much everything they know about me so that they mediate those choices. They only offer me the choices that hopefully the choices that are relevant to me. Therefore, my brain does not have to process infinite amounts of choice other things around cognitive loading. Well, language is another interesting one. Again, you're in quite technical fields, you tend to use jargon. And again, is that jargon loading my brain up a little bit more. So how do we use language that particularly when you're talking to customers, citizens patients, is it the language they recognize or is it really technical jargon that's going to completely confuse me emotion to that as well? Particularly if it's something like a cancer diagnosis. Yeah, your brain goes completely into overdrive there because the person hears cancer, they don't hear anything else after that. So if we're going to deliver any information after that diagnosis, it has to be incredibly simple. So simplicity is key to try and reduce cognitive load. And as I said, that also applies to employees. Second and more obvious part of effort is time. And obviously, this tends to be things like queuing is an obvious example. Now it's interesting that queuing, although it's something that we recognize in the physical space has now gone digital. So I don't know if any of you tried to get oasis tickets a few weeks back. But you were in a very long digital queue at that point. And you know, that's a problem because queuing again is, I mean, it's using our time up and time actually is as much a currency as money frequently for people. So how do we manage people's perception, particularly if inevitably they hit a queue, whether that's in physical space or in digital space. So the first thing to say is queuing is a weird thing. We work with a guy at Mit Massachusetts Institute of Technology over in Boston who we've nicknamed Professor Q. Not because he's an X man or a superhero, he could be to be honest. But, but because he actually looks into the psychology of queuing and the weird thing about queuing is it's all a bit wiggly wobbly timing by me because actual time in a queue is not necessarily perceived time in a queue because actually, our emotion often colors how long we think we've been in the queue. Now, there are things we can do to change people's perception of time in queue. Now, a great example of this is Disney. Now, if you've been to a Disney Park, and I ask you at the end of the day, how was your experience in, at Disney? You'll probably start to talk about rides. But in actual fact, you were probably on the rides about 20% of the time, the rest of the time was largely about queuing. It's just they are very good at distracting you. And there are lots of things that you can do where appropriate in order to manage people's expectations of queuing, potentially bypass the queue, fast track the queue. There are all sorts of things that we can think about in terms of that queuing experience. And again, that's going to be colored by the emotion bit physical effort. I love that picture, but largely this is about OK. Where do I need to go to get this? Is there parking? Do I need to carry heavy stuff? All of that again, colors are, I just can't be bothered type reaction to things. But again, that can be colored by how we feel. All of this, as I said is about how we feel and we really do need to engage with that as well because if we're going to design experiences like the experiences that you have to deliver, whether that's on the customer side or the employee side, we need to figure out how people are feeling about this in order to make it successful. Let's make this a little bit more tangible. This is a graph, you won't be able to see that graph for the back of the room. Don't worry, we can share the slides, but I love a good graph because I am quite sad, but this is all about why people contact organizations and how they use them and the evolution of how we contact organizations. And I've done, I've put this up because I am working quite a lot with the police at the moment around particularly emergency versus non emergency contact. And it's quite intriguing, this is not just emergency contact, by the way, this is any contact. Why do people want to contact organizations? How are they doing that? This omni channel challenge that we often talk about, particularly in things like the contact space. Now, interestingly enough, what we find is the more channels you put in to talk to customers, the more channels customers use. However, so customers will use the channels that they perceive are easy. So that's the first thing again, going back to that easy piece. But you've also got to put in channels that you find easy as well. Because if you put in loads and loads of channels and customers use loads and loads of channels, it infinitely increases the complexity that you have in the back end to tie those channels together because customers often use more than one. They start on the easiest channel and then they thrash if that channel fails. And we can see this in this behavior. This is actually UK data. We have measured how people want to contact organizations over the past 14 years actually. And we started to see a pattern. Firstly, the dull channels, we kind of find quite easy. So the phone, for example, it's quite a dull channel. It's been around for a long time, but people trust it and it's perceived to be quite an easy channel. Um So what we found was we thought the phone was down and out and then suddenly it went back up again. Why, why, what was going on in? I think it was 2015. Um, that made, it was 2017 that made the phone go back up. The answer is that we put lots of digital channels in that weren't that easy. So web chat was one of them. You know, when you're on a web page and a little chat box comes up and goes, would you like to chat and you'll go, oh, this looks easy. Let's push the button. And then oddly enough, you go into a digital queue and then sometimes because generally we look at the economics of things like web chat. Um We've generally got one advisor on 3 to 5 different conversations, not easy for them, not easy for the customer either because it makes it very disjointed. And what happens is it's a bad experience. It's not an easy experience. People then thrash, they go onto the phone because they think that's going to be the channel that's going to be the easiest channel to resolve that problem. So even with things like channel choices, we're seeing these easy behaviors, these lazy behaviors with customers, but emotion colors this as well. As I said, our behaviors are mostly dictated by how we feel about things. And this can be the problem between things like emergency and non emergency contact because it's very emotive. And typically what we found is when we do interviews about people around, you know, how do you want to contact organizations? They don't really care about channels, they just want to get their problem solved. And typically underlying that goal is an intention state and that intention state is usually either positive, negative or neutral and that is dictating behavior. So if we're positive, we want to manage our health, we want to get healthier, we want to run a marathon, all of those things. We are willing to invest some time, some energy, some effort to do. So we'll use a lot of channels to do that. We might be a bit paranoid, we might need a bit of advice. We might need a little bit of a nudge, but actually, we're quite happy at that point. The problem is when things get difficult, when we hit a barrier, we tip into a very different type of customer. So we, we go negative and actually we can start negative as well. This obviously working with the police, no one rings the police up for anything lovely. It has to be said it's always very negative stuff. We're in crisis. Those of you who know a lot about brain will probably know better than I do that. The chemistry of the brain starts to change when you're angry and frustrated. You're not logical for a start. Second thing is your short term memory capacity is compromised so you can't put complex information in front of a customer that has got a compromise short term memory capacity. So I to design those lovely IVR you know those press ones, press two s that everyone loves. I apologize. I used to try and design really good ones, but you would generally design to short term memory capacity. So press one for this press two for that press three for that, that is about short term memory capacity. It's thought to be between seven and nine bits. And that's when I am calm now. I'm angry, frustrated, scared my short term memory capacity halves. So press one for this press two for yeah, I can't remember what one was for. So instantly we start to see if we're going to put complex technologies in. It probably won't work when we're in crisis. And that's why the phone tends to get the bulk of customers in crisis. But we're not always in that extreme of positive and negative. There is a mid point and we call it utilitarian. These are routine tasks, buying carrots, paying bills, getting your rota. It's not that emotive. You just want to do it quickly, you want to do it easily. And that's where a lot of easy technology solutions come in. So again, we've started to look very differently at coloring customer experiences and employee experiences with emotion but easy is another interesting. There's a challenge, I guess in the particularly in the employee space around easy which is actually connection, particularly back to the office being contactable can be a real problem for people. This is particularly in the context, as I mentioned earlier, employee experience is a lot of discussion at the moment around how do we change the ways that we work? A lot of those discussions tend to be about how many days should we be in an office? Obviously, there was a big headlines around Amazon recalling their employees for five days because the CEO believes that being in an office five days a week is the best way of working. Is this the wrong discussion to have? Because actually, it doesn't matter if I'm in an office in a physical space. I am still contactable. I am because I'm connected back to my workplace by those little devices that are always on and always on us and that causes techno stress. We go into crisis for a very different reason. We are too contactable. Kevin Kelly at Wired Magazine said that the problem of the future is probably not connection. It's disconnection and we've done quite a lot of work around. How do we given that? It's very easy to stay connected to work 24 hours a day. What do we need to think about? Because we know that long hours cultures are not productive cultures. In fact, we know, long hours, cultures tend to burn people out. So it's not good for people. It's not good for productivity. We've been looking into this notion of techno stress and one of the things we've been trying to do is to recognize what some of the drivers around this compulsion to be connected, to be easy to contact all the time. And I mean, there's lots of things going on here. This is actually some research that we did with Lancaster University looking at all of the drivers that typically keep us connected. Everything from the fact that our devices tend to make us multi task, going back to cognitive loading, multi tasking is a little bit like my brain juggling for 89, 10, maybe more hours a day. And if we physically juggled for 89, 10, many hours of the day, we'd be exhausted. Our brains probably can only cope with about four hours to be honest of intensive cognitive load during an average working day. And yet our devices are maybe interrupting us, distracting us and causing us to multi task. We know that is not a productive way of working. And in particular, when we look at A I coming in, the background is hopefully going to take away all of the easy stuff. But that means we're going to have to do the stuff that does require concentration does require higher cognitive load. So maybe we need to think about single tasking again. The other one that tends to really be problematic, particularly if we're not in a physical location. If we're working either remotely or in a hybrid fashion, is this pressure to be always on? And ultimately the drivers of that are the M and M and MS. So, meetings, messages and managers, those are the three things that tend to keep us connected all the time. Now with Cambridge University, we actually worked. Um just to look at, you know, if we could identify that the M and M and MS were a problem, how do we actually solve that problem? And we worked with them on a diet, which we were going to call the Cambridge diet. But someone sadly got there before us. So we call it the balanced communication diet for business, which is a little bit more difficult to say. But basically, it's a five step plan to better communications behavior, whether that's about managing your messages, better, managing your managers better or indeed looking at the problem of meetings. Now, meetings are a particular challenge. It's something that we've been looking into because certainly if you look at some of the companies that have trialed a four day work week, for example, had to identify what the key time vampire was preventing them for doing five days of work in four days. And you have to look at where are the faffy things? Where are the things that are basically those time vampires and to be honest meetings is one of those things that probably is preventing us from being as productive as we should be because we are always in them. And this got exacerbated in lockdown. I don't know about you, but certainly I did tend to wake up in lockdown with an impending sense of zoom. Now, the problem is obviously other platforms are available. But, but you know that compulsion that particularly if you're fully remote, it's very easy to stack our diaries full of 30 to 60 minute meetings. Again, it's easier to say yes than no. So we just fill our diaries up. Now. Interestingly enough, we know that that is not a very productive way of working. Now, Microsoft even proved this. The Microsoft researchers are great. I love them because they wired people's brains up on death by meeting days and looked to see what happened. And you remember I was talking about cognitive load capacity, I call it pig brain. Typically, what we found was after four hours of a death by meeting day, you can literally see the brain die. Um So again, this is not a productive way of working. Why are we doing this to ourselves, particularly if we want to manage people and productivity. So the first thing to ask is, should this be a meeting? But then let's add an extra layer of fun, let's make it a hybrid meeting. Um And this is kind of, this is kind of a good example of how hybrid can be a bit messy. I call them horrible hybrids because hybrid meetings are a nightmare. Um, so, you know, you've got half the people in the room, you've got half the people coming in remotely. The trouble. Obviously, if you're remote is that you can't see anyone in the room for a start. And, and worst case scenario, you've got a camera at the end of the room and you've got a whole load of ant people sitting around table that then gets shrunk to the size of a postage stamp when anyone is presenting. So you can't see who's in the room and you can't read body language. So you're instantly at a disadvantage. You also, if you're digital, have no presence in the room, so you can be very easily ignored. Now, we had a meeting about three months ago. It was a four hour in person meeting. We suddenly realized two minutes before the meeting finished that there were people online. Oh my God. And they've been having a lovely conversation by the way on chat. Um Now because we were in the room, we were not on the chat platform and this is a big clue as to hybrid. So hybrids hard for a start. So again, laziness, but hybrid is default to a common platform and that common platform is digital, not physical. So we will probably need to at least be on the platform for that kind of meeting now, technology is starting to run to catch up on this. We are starting to get multiple camera solutions that can zoom in on people's faces using A I and pattern recognition. So at least you can see who's in the room sensitive microphones that can pick up actually even whispered conversations. So watch out and also people eating crisps we've also found. But you know, it's starting to bring up meetings alive a little bit more. And to be honest, the big people problem with managing complex meetings like hybrid meetings is moderating. Those meetings are incredibly hard. And again, it's easy for a moderator, get to get very lazy and just moderate the people in the room rather than bring the people online in as well. So meetings are a great example of firstly, you know, are we just being lazy having a meeting for meeting's sake, could we be more productive by working in other ways? But also a very good illustration of hybrid can be quite hard. And of course, that's why a lot of ceos are going well. We just want people back in physical spaces, we want to do it in a traditional way. And to be honest, that is a very powerful way of doing things, but it can exclude people particularly from the workforce. So if we look at people with disabilities, people on the neuro diverse scale, actually five days a week in the office might not be the best solution for them, we know homeworking works certainly for the 50 per cent of people who are primarily knowledge workers. But of course, for your front line workers, which again, you have a lot of, they can't choose where they work, however they do value flexibility and time. And that's why I think there's a whole load that we can start to do for front line workers on, not necessarily giving them choice on place, but giving them flexible work patterns, shift bartering patterns, all sorts of things that we can start to do to offer different solutions for them in terms of flexibility and time. So homework is still going to stick around for those of us that are lucky to do it. There is a third space as well. I was actually one of these this week. I used to call this the c it's not, it's not an office, it's not home, it's somewhere in between. It's maybe a little bit more green in terms of commute. So I actually walked to my office this week rather than having to go for maybe an hour, hour and a half commute into an office. They had good coffee. That's the main thing I run on to be perfectly honest, but it was, you know, it was a space I could work in. Now, this could be a coffee shop, a hotel lobby or indeed the board up there is my local pub. So the p as I like to call it. Now, this particular pub has noticed it's quite empty during the day and they have good wifi and they have good tea and coffee. So they're offering for 10 lbs tea, coffee wi Fi and vouchers at the end of the day to have that gin and tonic that you probably did earn. The key to. This is one size doesn't fit all, it doesn't fit all with customers with citizens and it does not fit all with employees. So we need to be quite creative in terms of making things work for people within boundaries of who they are, what their job is, how they're managed and where they are located, we need to ask all of those questions in order to make work work. One of the things we have particularly problematic is in offices, in physical spaces, in hospitals. We don't necessarily know how people collaborate. One of the excuses to bring people in five days a week is, oh, everyone bumps in and has serendipitous conversations around water coolers. Well, the first thing is, do we actually do that? So I would question whether that's actually a thing. I mean, occasionally, yes, but if it is supposedly a thing, how do we know it's happening? Do we measure it? Do we manage it? And actually one of the problems is that we don't know what happens in physical spaces as much as we know in digital spaces. And there is starting to become a science is kind of being accelerated by things like the internet of things that we can start to instrument and understand data a little bit better in terms of how people are indeed working. Actually, again, you can't see this at the back, this is a hospital and this is a lovely brilliant lady called Kirsten say, say, who's been looking at how hospital environments could change in terms of how we interact, how we collaborate in those kind of works spaces. So we can understand how our spaces work. Actually, we have a better case to bring people into them and a better argument in terms of how work can work. Um I'm going to finish because I know I'm out of time and people are whispering in the front because I, I've got, I've got, I would get my innovation credentials revoked if I didn't mention to innovation things. One is of course, the metaverse, are we going to be living working in the metaverse in the future? Well, firstly, probably not because it's science fiction. Secondly, it's also dystopian science fiction. So do I want to work from the matrix? Do I want to work from ready player one? No, I do not. Also, if you put a virtual reality headset on me, the clue is I call it vomiting reality. You generally need a bucket quite close. So we're not talking about working from the metaverse. What we are talking about is the baby steps towards the metaverse that might change the dynamics of how we collaborate. So a couple of examples, a paramedic wearing an augmented reality headset, broadcasting live high definition video back using 5 g to a remote clinician that clinician can see through the paramedics. Eyes. The fun bit though is the clinician has a joystick and that joystick can nudge the paramedics hand because he's got a haptic glove on. Now. Any of you who are have nightmares, don't worry, the paramedic has full control of their hand. It's not a horror scenario, but the idea behind that was can it change the front of back off dynamic so that the paramedic can do stuff that they wouldn't be able to do unsupervised. So maybe reducing hospital admissions actually in Belfast Harbor. Again, we've got a train inspector with a similar headset, not quite as exciting. This one, he's just got a checklist, making sure he goes through all the health and safety checks he needs. We're also looking at drones that we can fly around the train so they don't have to climb the train. So again, health and safety implications, then of course, we could actually act at an extra dimension to a lot of things. So bringing people in, not quite physically, I always say I'm a science fiction fan, so I'm a Star Wars fan especially and I'm quite keen on holograms. Now, my fantasy at the moment is not having to stand in front of you physically but actually being somewhere else being beamed in obviously as a Star Wars fan, I've got Danish pastries on my ears and I am saying help me everyone can over you. My only hope but this is volumetric video. It's doable now. It's fairly clunky but so was video about 20 years ago. So, could that be the future dynamic? Could we be seeing a holographic consultant rather than necessarily a physical one? And I'm not saying that's going to wipe out face to face. But if we have no other option that the person is not physically there, can we at least embody them in those hybrid meetings? If you were beamed around the room, we're looking at Immers of environments here. So could you be people around the room so they could not be ignored, give them actual presence and then finally, absolutely finally, because I know people are now trying to get me off the stage. What's A I going to do for this as well? I mean, there's a lot of press at the moment around A is going to wipe out all of the jobs. The evidence so far is it's really not, but it's not also going to improve productivity as much as it was claimed actually have just revised their 10 year perspective on A I improving productivity to less than 1% of GDP, which is not the productivity gains that we were maybe be looking for, but it is starting to make inroads on certain things. And this is a game Microsoft's research, improving employee productivity is one very big thing and one very big thing that it's starting to do in terms of things like copilot is meaning that we don't have to go to meetings anymore. We can save about on average 32 minutes a day by sending a to a meeting rather than go to a meeting. Now, this can upset the person that's running the meeting by the way. So, you know, it's saving us some time if it's a pointless meeting frankly. So that might force what's this meeting for? If it's a 1 to 1, you're in real trouble by the way. But um I'm not gonna go through this because I'm running out of time. I am just gonna say that A I is not great for the planet either. Its energy efficiency is somewhat questionable but it isn't, it's a cognitive technology. So this isn't about replacing our brain, it's about augmenting our brain. Um And I'm gonna leave you because you're definitely wanting me off the stage. Now, I know uh with a story about Gary Kasparov who I had the privilege of meeting about two years ago. Uh He of course got beaten um by A I at chess and he could have just given up chess because that was a bit humiliating. He didn't, he realized that there was a new form of chess and that's a form of chess where humans in A I play other humans in A I. And it changes the dynamic of chess. Firstly, you do not need to be a good chess player to be to play augmented chess. So it can raise people's abilities quite considerably without necessarily having to be expert chess players and putting those 10,000 hours in. The second thing is obviously chess grandmasters don't play chess grandmasters to train anymore. They play a so equally, we can see that they have quite a lot around raising people's efficiency and time to productivity, but also changing the way that we train people as well. So I think it's much more of a symbiotic relationship than maybe the press play to. So I have completely run out of time now. I am between you and drinks, so I am going to shut up. Um There's a lot of research underlying uh this. So if you do want any of the research, if you're having trouble sleeping, I can probably help. Uh But thank you very much for listening.