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On defining and changing culture and how the tone of leadership can facilitate change. We also heard from Nicola Millard, the Human Caffeine, a futurologist with BT, one of our main sponsors who took us on a journey on how the world of work has really changed. There was so much discussion, so many chat and so much networking in all of the sessions and it was really great to see. And here this really is an A LA carte conference and we want you to feel as free as possible to get to as many sessions as possible to be able to share your thoughts and to network with colleagues and interact with all of the exhibitors. So I hope you have a very worthwhile day. A couple of things I want to mention and to emphasize, please make sure that you book for the specialist sessions on A I building your own app and workforce wellbeing. And also if you want to attend the health committee meeting in the Gran Suite this afternoon, exhibitors are throughout the reception area, but don't forget the Glen Suite and the Riverview Suites as well. For those of you interested in pension advice. Uh the pension man, I met him last night. The pension man is only here this morning. Ok. So get in there. Um And he's upstairs on the wellbeing, the the mead level. Um Also there, remember health check, you can get your nettle tea good for reducing inflammation and blood sugar. Ok. Grasping the nettle, of course is our theme of the conference and I met a great group. And if you want to skill up on doing CPR, that's another place where you can do that. You weren't here yesterday. The Wi Fi is Wi Fi is NI 24 and the passcode is Nikon 24 RM exclamation mark. And you'll see that on signs right throughout the conference. The focus today is about working with partners. So with that in mind to open day two, please welcome Michael Bloomfield, chief executive of the Northern Ireland Ambulance Service and Vice president of Ni Michael First Minister, Minister, Minister Nesbit and Colleagues. Good morning and welcome to the second day of ni 2024. And a particular welcome to any of you who were not available, not able to be with us yesterday. You missed a fantastic day. But the good news is we have an equally excellent program lined up this morning. But our ambition in Nikon is not just to put on a great conference and provide this opportunity for the system to come together to share learning and celebrate some of the excellent work that incredible people across our services are doing every day important though that is. But it's also to use this event as a catalyst to kick start change, to really challenge ourselves to think differently and to energize ourselves to get on and turn that thinking into action. And that was one of the key themes from yesterday. One of those nettles that need to be grasped that there's been enough talking. We really do need to get on with doing Peter May. Our permanent secretary challenged us to enable our people who have wonderful ideas for improvement, to be able to implement those he referred to creating a movement where people feel empowered to get on and make change happen. At one of the parallel sessions I joined at the end of yesterday where we, where we were challenged to think radically, the issue that kept being highlighted for more rapid change is a need to have a different approach to risk that we are still too cautious. We still feel a need for permission to act and we really do need to find a way to adopt new, new ideas more quickly, but there is a huge amount to be positive about. And it was great to hear Lord Victor Adebowale, the chair of NHS Confederation say how he felt a real sense of can do here and of how and of how Northern Ireland can be an example to the rest of the UK. The challenge for all of us, the responsibility of all of us is to get on and realize that potential. Another strong theme from yesterday was the need for a deeper richer engagement with service users. The need to really listen to those who are the experts who know best the ser how services impact on them and what needs to change. And we heard that so powerfully from Nazir Aal, the importance of building trust with service users of putting effort into going out to meet them where and when suits them in their communities and how it's not enough to just listen. We need to act on what they say and it's only by doing that, that we'll build that trust something. I think we have to say we've struggled to do over many years in his opening address yesterday morning, our chair, Jonathan Patton outlined three asks that ni members have to enable change, firstly, collective political support. Secondly, a proper funding strategy and thirdly a whole of government approach and these issues will be the focus for much of our sessions this morning. And I'm delighted that we have the first minister and deputy first minister at conference today and we look forward to hearing from them shortly about how the new program for government can support that change. I'm also pleased to have that. We have Matthew Taylor, the Chief executive of the NHS Confederation with us today to give his thoughts on how a whole of government approach is needed to deliver better outcomes. Ni is part of the wider NHS confederation and we're very grateful to them for the support con fed provide us. So it was great yesterday yesterday to have Lord Victor Adebowale and Matthew with us today, we also have important sessions this morning on embracing innovation when we'll hear from professors Ian Young Tony Young and Cathy Harrison. And we'll conclude with a very appropriate session on leadership from Thea Stein from the Nuffield Trust Aptly titled, it's over to you for it is it is over to us. And of course, there's another set of excellent parallel sessions. So a packed morning of really useful discussions that should have us leave conference, feeling encouraged, uplifted and determined to move ahead during what we all know will continue to be very challenging times. So enjoy the rest of your conference. Thank you. Thank you, Michael. When in this session, we explore the intention and ambition in the recently published draft program for government 2024 our plan doing what matters most. We asked the question, how do we harness transformation and collaboration to drive up our population's health outcomes? Can we deliver a whole of government approach? As Michael said, we're delighted to have the first and deputy first ministers here. We had the Health Minister Mike Nesbitt here yesterday and he couldn't miss out on the party today. So we're delighted that Michael is also here. I always called him, Michael, but everybody now calls him Mike. So please here, put your hands together. I'll introduce him first, Mike Nesbitt. Good morning. Good morning again. Um It is my honor to, to introduce uh our two leaders, the deputy first minister and, and the first minister and I do so with, with a reflection which is this, I have been in MLA now for, for 13 years, which is about half the time that devolution uh has, has been on the go. And when we got back into parliament buildings in February, I immediately sensed a different atmosphere, a better atmosphere, a more positive atmosphere uh based largely I think on the determination that this time we are going to make it work. And then in June, I joined ministerial colleagues for the first time around that big executive table and I got exactly the same sense and, and on that occasion, I knew exactly why it's because of leadership, the leadership that is offered by Emma Little as deputy first minister and by Michelle o'neill as our first minister. So it is an honor to ask you to welcome our first minister Michelle o'neill. Well, good morning, everybody. It's a real pleasure to be here to be back at night. But I was just reflecting with some colleagues um earlier that the last time I was here was in 2016, we just had had the visit from Professor Ben Goa. We had just launched delivering together and all of that in the action plan that came with that. And I am really privileged despite a lot of the headlines and things that the negativity that can sometimes surround health and social care provision, a lot of progress actually has been made from that time. And I think that's down to the testament of all the people in this room, the health and social care family that actually helped to bring it about. So I just want to say thank you for that. Um Because I think that is important just to recognize that but also great to be back. And in the last week, we've had professor Professor Bingo back again. Uh we got to meet with him and to reflect just on that transformation journey that we've been on, but also probably just a refresh and nearly put a re kick back in in terms of what we need to do here. Um Collectively. And as Mike has said, this is a collective effort and we can't do this by ourselves. No one part of the health and social care family can do what we need to do. We need politics and the health and social care family to work together in order to make the transformation happen. And we hope that our presence here this morning is to show you very firmly that that is our commitment to you that we very much see this as a partnership approach. We're not able to say for the rest of the day. But we know we've got a very packed program, Emma and I are going back to chair an executive meeting this morning, but just to be here this morning and maybe just to give us a chance to set out what we intend to do what we're trying to do with the program for government. And Mike's absolutely right. This executive is different. Um, folks just to say that it really is and we are determined to lead from the front to work together. And I want to reflect that in some of the commentary that um that I want to offer up to you um this morning because the health and wellbeing of people is all of our priority. I believe it's the priority of the executive, but it's also the priority of people out there who perhaps need our health and social care system at different times of their lives. And I believe that I'm certainly a big believer actually in um whenever you look at any issue that we have to tackle, particularly whenever it comes to tackling the difficult ones, we should always start at the point or one of the things that unites us. And this is something that absolutely um unites us the importance of health and social care and also equally alongside that because we wouldn't have um the provision that we have without the workforce right across health and social care. And that certainly also unites us So just from the outset, I want to say thank you, I want to say thank you for the leadership that has been shown over the last number of years as our health system has faced down some of the most extraordinary challenges, perhaps of some of the most extraordinary challenges that we'll ever face in our life in our lifetime. Um So thank you to the workers who represent um whose dedication, whose compassion, whose resilience has been nothing short of inspirational. And I know that there's no doubt that over the course of the last number of years, people's limits have been tested and been tested over and over again. But yet people still rise above and still go over and beyond and that doesn't go unnoticed, that cure for people that protection of people whenever they need it most. So I'd be grateful for all those in the room just to convey that thanks um on behalf of the executive to the health and social care workforce whenever you get the chance to do. So, I'm pleased to assure them that we are determined to do everything that we can, to support them, to do what they do and to support the people that they look a look after. And in fact, that's exactly what our program for government is designed to do. It's about making people's lives better, it's about doing what matters most um to enable, to achieve all of that. And we believe that the draft program for government is a significant milestone for us as an executive, I think we're now nine or maybe 10 months um in from February. But we just don't want the program for government to be a policy document that sits on the shelf. That's something that we can, you know, point to every now and again, it has to be something that actually is meaningful and that belongs to everybody and that we all recognize that in order for it to be successful, we all have a part to play in actually making sure that that um happens. So whenever we launched the first um program launched the draft program for government, we've set out nine priorities um for this mandate, one of which obviously is explicitly related to health. However, none of them work in silos, I mean, all work collectively. And I think that um whenever you look towards across all of the nine priorities, they're all come back to the actual point of improving people's lot. I mean, they all come back to the point about improving wellbeing for everybody, for our community, for both now in the immediate future or immediate period, but also way into the future and all roads will lead back to health. And we also know that the long term solutions for the health and social care system, it has to be strategic thinking, it has to be innovation, it has to be collaboration, not just in the executive but as I said, very much in partnership with all of you and wider society because I think that conversation with the public is also a crucial component part to us being successful. And we definitely, as I said, want this to be very much a partnership approach and that's actually the collective will of the executive from day one. How can we do the things that we need to do work in partnership with wider society. So by including measures such as more social and affordable um and sustainable homes, providing more affordable childcare, seeking to build all these things come together, build a cumulative effect and will help to alleviate some of the pressures that people are feeling, but also support them to participate in society in the economy and to make their lives better. We know the importance of someone having a warm home and the difference that can make to their health um outcome. We know it's important to lower people's energy bills. So that and that's why it's important that we progress our social inclusion strategies, including developing the antipoverty strategy. We also know that we have the highest rates of economic inactivity on these islands and that over half of people are not working because of, of those people are not working because of ill health or disability. And you can't divorce that from the relationship between people and the length of time that they're waiting for treatment. Perhaps in our system, you can't that has to be all recognized as part of a bigger cycle here. And of course, the fundamental issue that must be tackled head on and is the conversation that you are very acutely aware of. And that is the need for the reform and transformation of how we do things. Whenever I was health minister back in 2016, I always joke and say I was health minister for a pregnancy. I was there for nine months but II was just, I was just offering up to, to Mike. I was asking, did he enjoy the job to which he of course said he does. Um I found it as one of the most rewarding times as being a minister. Um It is something that we can all be very passionate about. It's something that you can actually feel that you're making a difference. And you also, you also recognize that to be successful, you have to have the buy in of the whole of the health and social care system. And um I think that's something that mi and I sure and hopefully leads to the collectivity that we're trying to create in the executive in terms of understanding some of these um challenges. But we're very conscious of the fact that as are you, of course, the transformation can't be an aspiration. It's something that's an absolute necessity if we're going to get this right? And also that it requires urgent attention. So when I was reflecting on your program for today. Grasping the nettle. Um how appropriate, of course. Um because transformation is a journey and along that journey, there are many nettles to grasp difficult decisions. The honest conversations about what we can and can do are absolutely necessary. They're complex and they're challenging at times. Um But it won't be easy. But I think if we're upfront and honest with people about what we can do when we can do it, that we're working towards a certain point, I think we'll get much, much more buy in from the public. There's no doubt that this all will take time, but we need to work together to turn the tide and I know that we all are determined to do so, we need to address the financial situation because obviously, we need the finances in which to do the things that we need to do. It isn't always about money, of course, because that was always something, um, that I was very conscious of sometimes changing how we do things actually can create a better outcome. But the finances are absolutely um crucial and we are determined to fight the case for all of our public services in terms of ensuring that we have a proper funding model that allows us to invest in public services and actually allows us to make the big improvements that uh we want to make. That's AAA Nettle for myself and Emma and, and the rest of the executive to continue to, to lead from the front. And we take every opportunity that we can. And even in the last week, we've had conversations with the chancellor, we've had conversations with the Prime Minister and every turn, we are making the case for our strong public services here and investment in our health and social care workers and we'll never be found wanting on that front. But Emma and I are determined to provide the direction to provide the leadership, to provide the partnership to create the forum in which we can have healthy conversations about what it is we need to do to take on these challenges and I'll finish where I started, which is back to the point of partnership. I do genuinely believe that we will get so much more done in life whenever we work together. If everybody puts their shoulder to wheel to the wheel, in terms of any particular challenge, there isn't a solution that we can't find. We're determined to play our part. I want to offer to you that partnership approach in which to do all the things that we're all very, very passionate about. So, thank you very much. Thank you very much Michelle. And I think um the first minister has outlined so well. Um our vision um and our optimism about the future. It's fantastic to be here this morning. As Michelle has as indicated, we were really keen to come along here this morning to show you our full support in terms of both the challenges, the task, but also the opportunities ahead. Also to send a very clear message that this is not just an issue for the Health Minister, this is an issue that the Northern Ireland executive will be there supporting working hand in hand, shoulder and shoulder with the Health Minister. We absolutely acknowledge the scale of the task and we know that we cannot do it. As Michel has said without all of you in this room, uh We need that partnership, we need that partnership across the executive. We need that partnership with Treasury and the UK government in terms of a proper funding settlement. But we also need to work with you people who are on the front line who understand the issues. It's a new way of doing government. It's been very much mainstreamed at every aspect of that. And I think it is critically important. Um I want to echo Michelle's words as well of thanks to all our health and social care workers, your contributions continue to be nothing sure of heroic. You were there for the most vulnerable in our society, ensuring they were looked after and supported in the face of unimaginable circumstances. And your work has always been essential. We know that but of course, during the pandemic, it was brought into much sharper focus. I think many more people perhaps who hadn't engaged with your services could see the vital and important work that you did. And I want to uh echo those words of, of my thanks to all of you for the incredible role that you played on taking office. We pledge to work with all parties across the executive and the assembly to confront the challenges we face and to seize the many opportunities on offer to deliver a better future for Northern Ireland. I'm really heartened to hear actually, already in just some of the conversations this morning about, you know what optimism that there has been in the room over the last couple of days that there is that sense that yes, there are big challenges ahead. Um But with help and support, there are also incredible opportunities. I know that every single person in this room wants the service to work and to work the very best that it can you want and we want staff to be supported. We want people to get the services they need when they need them and where they need them. And that is a huge piece of work, but it's a piece of work that brings with it incredible opportunities. We recognize absolutely that this is a collaborative process and that is why we wanted a key health priority to be in our draft program for government. The draft program for government, of course, does not outline all of our ambitions in the executive nor does it outline all of the work that we will be doing within the particular departments and across departments. But we wanted it to be indicative of the key priorities. And that is why we, we made sure that there was a reference to um health and particularly health uh readiness. We know that this is not as simple as simply just reducing numbers. It requires a whole system transformation. We we recognize how much work that this will require. But again, we felt it was incredibly important to have this right at the heart of our draft program for government to emphasize that point that we are there to work with the health minister as an executive to work with all of you as a system to give that political support, the leadership. Um but also the necessary listening to you about what is necessary about what it is that we need to do tackling waiting times, requires solutions across our entire health and social care system, including increasing capacity within the system through service reform and reconfiguration. We also need to address health inequality and help to improve the long term health and wellbeing of our population. I think in in northern Ireland, the types of constituencies that we have. There's not a single MLA that doesn't uh work for an area where within walking distance, there is a stark difference in those health inequalities. And we know that very often the drivers of that are around poverty, it's around opportunity. And as Michelle has outlined, we, we also recognize that actually tackling those big issues does not lie just with um Magnes, but his health minister, but it lies across many different departments through communities, through the work that we do to help everybody to have those healthy, thriving lives, regardless of what circumstances that you are born into, regardless of the barriers that you may face as a young person, as a family. And that's what we want to do, we want and it's not going to be easy. But we want to ensure that no matter what part of this place we call home, that you are born or the circumstances that you are born into, that you can live the best healthy life that you can for the longest period of time possible and that will require. And I know Mike always says it about shift left. I've no doubt he said it yesterday as well. Um But this move to um prevention and that is that is a message that we are absolutely bought into because we recognize that it is true. There is only so much that we can do in terms of supporting you through transformation. But unless we can change the flow of people within the system with the types of issues that they're presenting with at the age that they're presenting with them, then the system is going, going constantly, going to be overwhelmed in the years ahead. So those are key messages. Um Many people right throughout Northern Ireland know what they need to do. But we all recognize that we don't do it, we don't do it enough. And that is a big task for us. And I think that's why it is critical that these issues are right at the heart of our draft program for government connected to some of those other issues such as affordable and social housing, such as educational opportunities, the facilitation of affordable childcare in terms of supporting parents into work and how that can transform families and opportunities, life chances of the Children within that family. So we recognize that all of these things are interconnected. I've been around um government um most of the time in the shadows and some of the time in a public role. And we've talked and talked and talked about the key messages of collaboration, breaking down silo working transformation. And I welcome the comments that were said at the beginning of this session that you know, people are frustrated with talking, people are frustrated with people just outlining the problems, what people want are to see solutions, they want to see action and they want to see delivery. We are acutely aware of that. We will continue to listen to you on that to people who know best what the right solution is and where it ought to go. But that will require as the first minister has outlined a proper funding settlement will require the right interventions in terms of transformation. It is all about that delivery because very often we can set out a vision and you all know this within your various areas of work. If we set out the vision, but we don't deliver it in the way that actually reaches those outcomes, then there's a huge amount of money, there's a huge amount of effort and critically at time that is wasted on all of that. You know, we know that we must get this right. And that means all of the cogs in that big big system working together to produce the right outcomes. And that will enable us to have the headspace in parallel to continue through an ambitious uh policy of prevention and tackling those health inequalities for all of the reasons that they arise. So we know that these issues are systemic. We know that we must work together across the executive to deal with them and we know that we must work with you. And uh as Michelle has said, and as Mike has said, that is why we really did want to come along here this morning. Unfortunately, we can't stay to hear a lot of the program. I've taken the opportunity to look at the program. It's incredible in terms of both the breadth and the depth of what you're talking about here today, all of these issues so incredibly important. Um But we did want to come along for the time that we could to send a very clear message to all of you. We are on your side. We are here to back you in doing what it is that you need to do. We want to see that transformation. We recognize that you want to see that transformation and we can only do this but working hand in hand and also to collectively as three members of the executive to send that message from the Northern Ireland executive, not just from a party perspective or an individual perspective, but that this executive is backing reform and transformation. It is back better outcomes. It is backing that shift towards prevention and tackling inequalities which we know will help you. Uh not just uh today or tomorrow, we know this is long term, but this transformation will truly, I believe bring about the opportunity that we all want to see. I'm optimistic about the future. I think working together we can do this and we will be fighting incredibly hard to get you exactly what it is that you need to enable that to happen. Thank you very much. It really is great to hear that message of partnership and collaboration and the focus that the ministers and the rest of the executive has on our health and social care provision. As Michelle said, they are heading off now to the executives so we wish them well in whatever nettles they have to grasp at that meeting are thanks again for all three ministers to be with us this morning. Thank you. Thank you, Mike. So let's move on. Ladies and gentlemen, ahead of this conference. When Confederation members were asked about what nettles they thought needed to be grasped in our systems. On the list was capitalizing on digital innovation and remote care. So let's rethink research and innovation. Well, it's an opportunity for HSE to address population needs, improving outcomes in health and driving our economy in this session. We are delighted to welcome the Chief Clinical Innovation Officer at NHS England. Tell the story of how the work that's being developed across the water will also learn about the local work that's being done to develop innovation here with more exciting things to explore. So please welcome to the stage, Professor Ian Young, who is the Chief scientific Officer at the Department of Health in Northern Ireland. Ian is joined by Professor Tony Young, who's Chief Clinical Innovation Officer, as I said at NHS England, Professor Cathy Harrison, chief pharmaceutical Officer at the Department of Health. And Eddie Ritson. Eddie is Director of Digital Transformation and Innovation. If you could make your way to this stage. Thank you. 1213. We don't have everybody but we'll, we'll, we'll, we'll start anyway. Now I'm going to prompt as I did yesterday. Ladies and gentlemen, I have a little bell. So I'm going to prompt each um each person to talk a little bit about innovation, embracing innovation and um and then I want to get as many of you involved as possible. So I'll, I'll throw questions out to the floor and, you know, we heard in so many of the parallel sessions yesterday in the Fringe sessions, the positivity in embracing that innovation on all of that digital inclusion, remote working hospital at home, all of that. So I would love to get your experiences and your questions to the panel as much as possible. Um Ian, if I may start with you to put in context. Um Yes, if you wouldn't mind taking that um where we are here in embracing innovation and the sort of ambitions that we have as well. So thank you Donna. And it's a pleasure to be here this morning and to be joined by Cathy and Professor Tony Young, no relation, by the way, um You only need to look at the amount of hair, we have to realize that that is the case. Um But I think all of us um recognize the enormous needs and challenges that face our population in terms of their health and care. That's been a repeated focus of discussion so far in this conference, we simply can't carry on doing the same things that we have always done in the same way and expect to have the sort of transformation that we need and key to um changing things to doing better, to delivering the right care in the right place at the right time for all of our population is innovation. Um Innovation needs to be considered quite broadly. We're going to have a focus today perhaps on particular areas. But whenever we change a patient pathway, whenever we deliver a car in a different way, then that forms part of innovation as well. Of course, as taking advantage of changes in technologies and science, which are more dramatic, more remarkable now, probably than they ever have been in my career and which offer the potential for introducing greater, more dramatic change that we must take advantage of Northern Ireland has a long history of innovation. Um If you ever look up the number of innovations that have changed the world that have come from Northern Ireland, you'll be surprised at their nature and extent. My favorite one of course is the penalty kick in football, um which I always love to talk about whenever I'm speaking to English colleagues in, came from here, it did penalty kick. The penalty kick was originated and invented in Northern Ireland and subsequently changed the lives of many people, some in a positive way and some in a less positive way. But there have also been tremendous innovations in terms of science and technology and in health, we always talk about Frank Pantry um and the portable defibrillator. But there are many other examples um where Northern Ireland has developed things has changed, how we deliver care and continues to do so even now. Um in my world of laboratory medicine, we lead the UK in terms of our use of digital pathology um in terms of innovation and development here. And I am always proud when I hear colleagues from the pathology community, um speaking elsewhere in the UK and the UK, learning from our um examples, innovation isn't only good for the health of our population. It's also good for our economy. And the two are intricately intimately linked First Minister and Deputy First Minister alluded to that, the key to changing the health of our population and preventing disease is um to have a prosperous economy, better educational outcomes so that people adopt different behaviors from an early point in life and that will be key to um preventing disease. So, innovation that is good for the health of our system and is good for the economy will be good for all of us. Sometimes in health, we feel a bit guilty or bad about working with industry. Um Very recently, I featured in the British Medical Journal in terms of one of my roles, the UK scientific Advisory Committee for Nutrition where people were criticizing the fact that um members of the committee had ties to industry. I disagree strongly. I think that co-working with industry in ways that we try to develop mutual benefit are very important, both for the economy and for the health of our population. We need to do it in the context of good governance. But I think it's important that we do it and in terms of our innovators because there are innovators in all professional groups all the way through our health and social care system. What we need to do is create an environment where they are valued and appreciated and supported to innovate. We need to be prepared for failure in innovation and that's fine. Many great ideas turn out not to be so great when you try to test them and roll them out. But when we find those gems, then the people who have brought them in need to be supported, valued and we need to find ways of adopting and rolling out those innovations throughout our system so that we don't just do things well in ward X of trust X. But we learn from that, we adopt it, we spread it, we value it, we roll it out and I'm sure we'll pick up on some of these themes as we go through the conversation. Thank you for that. Ian Tony. What happened in England in regard to innovation? What can we learn from it? Were you prepared to fail? Thank you. So, first of all, thank you very much for inviting me to join you today. And learning from failure was really important and Ian's the scientist and I'd ask him, can you name the journal that reports scientific failures? It doesn't exist. We just share successes because you don't get rewarded for that. So how can we learn from failure when you're not rewarded to share it to share those learnings from it. I think it would be a great journal. Actually, it would be like, you know, the videos that went wrong on the X factor, it would be really good. But so a couple of comments first, I was taken by something you just said Ian about, we can't do it on our own and I really agree with that in how we work in partnership. So, in England, I don't think we've ever discovered or manufactured a drug. In fact, we most of the digital services, the well over 90 per cent of commissioned out to work with industry. So if we don't work with industry, we're not going to be able to deliver a health service at all. So partnership is fundamental to what we do. And then I really liked what, you know, the first Minister and Deputy First Minister standing here, if there was a nation built on partnership going forward, this is it. And that's what the thing was, wasn't it? Innovation and collaboration from the first minister? And the deputy first minister said we want to see action and solutions and I just love that combination, different approaches, but getting to the same goal. So innovation is a, it's a term that's often used and people often confuse it with invention and it's got five key features. I think we look at it has to be new to your system. It doesn't have to be a new invention just as you were saying, Ian, it's about how do we get that taken up everywhere. So not just new, but it has to scale across the system. It has to add value to the system. It has to impact our people. It could be the patients or the carers, it could be the workforce that it does and it has to have synergy as well. So the components of it, when you add them together are more than the sum of the parts. And if you look at any innovation, it's like that. And then in England, even though we're not 11 NHS, but it's not one joined up system. Um Sometimes you can make observations. And Tim Ferris who used to run Mass General in the United States came over to be our Director of Transformation at England for three years. And at the end of that time, he said, Tony, I've noticed something, there are five features of innovations that get adopted across your healthcare system. One, they have to meet a national priority. Number two, they have to reduce steps in the care pathway. Number three, it has to be slippery, it just has to be frictionless how it gets in to workflow. So people can adopt them. Number four, it must produce in year cash release and financial savings. And number five is real world evidence. We're moving away from randomized controlled trials to actually what's the data in use in your organization. And if you look at artificial intelligence now, of course, which is coming into play in many parts of our lives, the, you know, algorithm changes every time a new loop goes around because data, how can you put that in a randomized controlled trial that takes two or three years to complete? It's not possible. So we have to change the way we assess things. So we've heard it from almost every speaker so far this morning. More of the same. It's just not going to work. We can't use the methods and things that we did to get where we are now to get to where we're going to get to or technology is going to bypass us and we're not going to have a clue. We owe it to our workforce to support them and we owe it to our patients. So I think innovation is at the heart. It's how we get to a better future. We can't stay here where we are in England. We have, I suspect the same challenges you have six of them. I'm going to say five or six workforce. We've got a 10 per cent vacancy. I heard from the president, the Royal College of Radiologists. Just this week, we have now have a 15 per cent vacancy in diagnostic radiology consultant posts in England waiting lists. I think about 7.7 million overall people come to harm on waiting lists. We have to sort that out. We cannot carry on with that. Health inequalities. We've heard a little bit about that already. We net zero. The climate crisis should be zero should have been negative. Should our ambition be even further in what we do on that financial balance? We've already heard on this stage this morning, how important those financial settlements are but actually the costly way, we do some things at the moment. So for and of course, the last one is what I call the long term plan. So how we get serious about prevention and how we have excellent care pathways throughout your life that we've heard of. So just going back to financial balance for a moment and how we support innovation. So, so one of the things we've done in England and we have partnered with Irani and with you in Northern Ireland to launch a clinical entrepreneur program. So now the world's largest and most successful entrepreneurial workforce development program in healthcare and life sciences. So we support clinicians who want to be academics and clinicians who want to be leaders and clinicians who want to be teachers. But if you wanted to be a clinician and an entrepreneur until about 89 years ago, the National Health Service didn't offer any systematic support for that. In fact, quite the reverse. And clinicians were leaving, they were raising uh uh you know, two junior doctors came to see me, they raised half a million pounds and they were told you can be entrepreneurs or trainees you cannot be both and so they quit. So we developed this workforce development program which provides commercial coaches and mentors, educational days, industry days, connections to customers and funding testing and trialing international visits. But they create an ecosystem, a network and between them, they've done something quite remarkable. So I get given 350,000 lbs a year to run the clinical entrepreneur program in England. And in our first seven years, um we've created 505 life science companies. Between them, they benefited 180 million patients and professionals. We can count, they have raised over a billion pounds in inward investment coming into the United Kingdom. And they built nearly 8% of the UK Life Science industry from scratch from a workforce program that supports the front line of the NHS to do things in an innovative and entrepreneurial way and they are changing our healthcare system. So one example is a company called Deep Medical, run by a little medical registrar called Ben out of ST George's Hospital in London who teamed up with the Computer Science Division U who were looking at predicting non attendance at outpatient appointments. 12 per cent of people don't turn up to their appointments on average across the NHS 100 million appointments. That's 12 million places a year. We pay for the clinicians, we pay for the support staff, we pay for the buildings, we pay for the investigations and tests but 12% of the time, no one shows. So with this machine learning algorithm that they've now built, they're up to 97 per cent sensitivity and specificity of being able to predict two weeks in advance whether you'll turn up for that appointment. We've now rolled it out across my trust and I don't get DNAs anymore. I'm paid to see 12 patients in the morning and I see 12 patients. What does that mean? Well, it's not only an improvement in cost efficiency because we're getting what we pay for, but every single patient I see sooner, takes one patient off that waiting list and improves quality of care. So working, embracing entrepreneurship, you know, it is one of the things we hadn't done entrepreneurship changes every other aspect of our life. But in health care, we kind of said no, I don't think we can do that involves money working with funders and investors and industry. We absolutely have to do that because so much of what we do on healthcare is dependent on technology, whether it's digital or other that's coming out from that sector. And if we don't equip the national health service workforce with knowledge and skills from that industry, then how are they going to know how to, how to work with these latest, how to understand, let alone quantum, which is coming and that really has the chance to change everything. So I think I heard on the stage of I'll just conclude in a moment a couple of things um from the first and Deputy Affairs Ministers, um we want to see action and solutions so I can't leave this stage without offering you some opportunities for action and solutions. So, in partnership with Haran every year, we bring our clinical entrepreneurs to Northern Ireland and the timing couldn't be more perfect because it's tonight and tomorrow. So at the Mac in Belfast tonight, we're hosting one of our pit stops as we call them. Any of you here will be welcome if you're in Belfast this evening to come and join us. I think it's about six o'clock on. We start, you will meet about 100 of the most disruptive front line staff, many from Northern Ireland who are joining us, but many have flown over today to come and try and build that ecosystem in culture and you will be absolutely blown away by the mindset where you're gonna hear some amazing founder stories and there's food and drinks and networking to follow. But the other thing is you might be sitting there going well, all very well, innovations for someone else. It's not for me, but it has to be, you're here now. There is no other leadership, not, there's not another door over there with all the leaders in it. It's you here. And if you don't step forward and take hold of these advantages, so the government of Northern Ireland have funded places on the Clinical entrepreneur program, it's open for applications for another two weeks, nc.com. And if you want to transform, if you want to take some action and come and learn commercial skills, knowledge and experience, you don't have to spin out a unicorn. Although we have about four on the program at the moment. Um You could just want to learn that skill to come and be a better leader to transform healthcare services as an entrepreneur. So applications are open for that at the moment and you should apply and come and join us. But the last thing is, and we were hearing about risk. There's a risk in the counterfactual and what I mean by that, we often say we can't do that. It's new, it's innovative. There's a risk people could come to harm. People are coming to harm now by what we currently do and we don't measure that and take that into account and we need to do that and balance that against the risks of doing new things. So we have to have the right governance. We have to have the right processes in place. I absolutely agree and support that, but there's also a risk of not doing something. So I would encourage you to step forward, come and join us in Belfast tonight. Have a look at the entrepreneur program and why don't we build 500 Northern Irish start ups in the life I sector, we could do it. Why not? Why not? Those are challenge Cathy Tony mentioned by the can do attitude in regard to pharmacy provision and services. There really has been a can do attitude over the last while in introducing innovative ways of working and providing services for the public take us through that. Well, first of all, um I really agree with a lot of what um Ian and Tony have said and I would have to say innovation is for everyone. And um I would challenge everyone in the room and say, if you don't know what it means for you and your business, you really need to understand that it's not a nebulous concept. You need to understand what it means because I'm always trying to influence change and get people to get people to agree with uh um changes that we, I want to introduce and you need to have a clear ask. Ok, so today I'm gonna talk a little bit more about embedding innovation. Um because that is, uh that is what I'm most interested in in terms of the benefits for our patients and our population. And as Chief Pharmaceutical Officer, my interest in innovation is in medicines primarily. And my priorities in that area are that I need to embed innovation into our clinical pathways that help support the um equitable and timely access to new medicines. And what I want to tell you about new medicines is we in northern Ireland follow. Nice. So we have a tremendous pipeline of innovation coming through in new medicines and innovative medicines in um, England, Wales and Northern Ireland. And just to put it in context, we're approving around 80 new medicines a year. And before the pandemic, that was about 20. Now, that means those medicines are life saving and life extending and, and really life-changing for many, many patients in cancer, rare diseases and other long term conditions. So we have a responsibility to embed those medicines in. But with those medicines these days comes a lot of complexity often. And that's why we need to embed innovation more into our clinical pathways. And that's a genuine challenge for our health service here and across the UK. So that's my number one, that my second priority is to do that cost effectively and sustainably. These medicines are very, very expensive and what goes with them in terms of the support that we need in digital uh medical technologies, screening and, and diagnostics are also costly as well as the investment we need to put into our new clinical skills and in our clinical teams and also in working with our patients so that patients understand their, their pathway and how that will change and how the medicines will benefit them. My third priority is workforce and that's embedding innovation in to help our workforce. Tony gave a great example there around waiting lists, but we need to think innovatively around how we can make the best use of all of our workforce. For me, that's the pharmacy workforce, Donna. You're right. We have really thought about this. We have a cross sector workforce and I am very determined to make the best use of their skills. We're investing in their training and they have a lot to offer, but they're not alone and they work within multidisciplinary teams. So we actually have an approach in Northern Ireland. Um that's been established now for nine years and I co-founded the Medicines Optimization Innovation Center nine years ago with Professor Mike Scott. And that was an intentional decision that we made in the department to invest in a space for innovation. And a big part of that was to allow partnerships, external partnerships because we don't have all the ideas in health. We don't have the time and we don't have the resource. And over those nine years, tremendous partnerships have been developed with academia here um in Northern Ireland, with um with uh organizations and agencies right across Europe and, and globally and also with the pharmaceutical industry and uh in 2020. Uh yeah, I don't know what we were thinking to be honest, but we did it, we did it. There was a, in 2020 we launched a formal partnership between the Medicines Optimization Innovation Center and the Association of British Pharmaceutical Industry ABP. And that was to support innovative practice. It was not to do the work of the health service. It was to support different approaches to support these clinical pathways. And we've had some good successes, but they have been small scale. And so today, I'm really delighted to say we are renewing that partnership. Minister has, has, has relaunched it. There will be, it will be in the we have a press release, et cetera. And that means we actually have a vehicle now to work with industry to support innovation within our clinical pathways. Now, I know that works and I'll tell you why because I've been doing it for years in our pharmacy service pathways. And what we do is we use the skills of the M YC to evaluate tests of concept and small scale change. We evaluate it. Are they cost effective? Are they safe or are they improving patient outcomes if they meet those criteria or commissioners in pharmacy? Listen and they have embedded that change into our pharmacy practice that's really helped us to bring forward some big changes like pharmacy first and also our general practice workforce. So now I think we can extend that with confidence into wider clinical pathways. And over the next few months, I am going to be going out on tour to talk to anyone who wants to talk to us about this. But I my first stop is our commissioning leads those decision, the decision makers who are responsible for the our complex clinical pathways because they are sitting with real challenges at the moment. And I know, I'm giving them a challenge with new medicines and the new medicines alone are not going to work unless we can wrap that around with some of the other innovation. Thank you. Thank you. Um I'm going to open it to the floor. Ladies and gentlemen, if we have roving mics around there, I think uh Claudia and um, well, Heather definitely is one if you could put your hand up high, please. So I can see um over on the left Heather or anyone down? Oh, here on the, the lady with the white top. Thank you. If you could just introduce yourself to the panel. Thank you and ask your question. Thank you, Siobhan Broderick, Director of Population Health in the Department of Health. Thank you for your contributions this morning. They've been really insightful, but a lot of the discussion has focused on, you know, the health workforce and innovation within our staff. Is there something around innovation to help the citizen improve their wellbeing? So we do get that shift to the left, the prevention. I do you want to take that up and then, and then Tony. So I am so pleased you asked that. It's like I planted you in the audience. I have been fighting since day one that we found the clinical entrepreneur program to include patients and only took me seven years last year. NHS England agreed and we launched the patient entrepreneur program. 12 patients joined us with their real lived experience of the healthcare system and services this year. Not only are we expanding that, but the Alzheimer's Society in the UK said we've got a real problem that we are. You know, there's, we're not getting enough interest in fundamental dementia research. But actually, the problem is in changing people's lives with dementia today. So many people not just in health care, but in social care too, have got great solutions. Can we have a dementia innovators version of that? So now any citizen, whether you're a patient or a carer, whether you're someone that's interested in something like dementia, but you're not a medic, you're not qualified. You don't work in the NHS, you can come and work with us and you know how they challenge us and the insights out patients, things I would never have thought of a little girl. Olivia, a little, not a little girl. She's a young woman. Now, when she was a little girl, she had about 15 cardiac operations through her childhood. And her lasting memory of that is the embarrassment she felt because her hospital gown didn't have a back now. I it's never bothered me. I'm a urologist. You know, I don't mind about such things. I know it was. So she has developed a different type of hospital gown, joined our program and we're helping to take that forward with her. But why is it as doctors? We think, you know, everyone has to have that backless gown that shows your rear. Um Why is that? Why can't, when I, when has that ever been useful to me in 30 years of clinical practice? If I've needed to get it off someone, we've cut it off them. So why can't a child have their favorite pajamas or night dress? Why do we have to put them in the, I would never have thought of that. So, you're absolutely right. We're not going to get the solutions with the good and the great sitting here telling people how to do it, we have to bring them to the front. Ok, Tony, and then I'll go Ian and then I'll go to the here. So just to look at another aspect of that, which I think you were also alluding to, which is innovation seeking to empower patients to improve their health and prevent disease. And I think that that that is extremely important and there are two challenges I think that we need to reflect on carefully. One is one that Tony alluded to the fact that innovation which delivers ine savings seems relatively easy to introduce. But innovation looking to prevention by its nature involves short term financial costs for somebody to achieve longer term benefit. And we're bad at that in the system across the system. Um in terms of how we support that. The second thing that I think we need to focus on because most of my scientific work has been about disease prevention. And that's the area I'm really interested in. The thing that worries me always is the potential to inadvertently and unintentionally increase inequalities by giving empowering patients to prevent disease. But we're only those who are educated or who are somewhat affluent, um, easily take advantage of those innovations and we see lots of those floating around and probably many of you will see them on your social media feeds. I'm not going to get into the science of the Zoe app, for example. Um It's everywhere but if you look at it and what's associated with it, the people who take it up are from a particular segment of the population. So we need to find ways and this is part of innovation of ensuring equality of access to what we to the innovations we seek to introduce, um especially around prevention. Yeah, it was interesting. I had a, a discussion with a dietician out of one of the exhibition stands yesterday and they were talking about starting off with Children at a young age and all of that prevention and the work that's needed and the focus and, and, and finance, of course, that needs to be directed uh uh to young, young, young people. Hello. Thank you. If you could just introduce yourself to the panel. Thanks. Hello, I'm Penny Per I work at the Health Foundation. I lead the Q community which is a community of people involved in improvement. I guess I was hearing a lot about how innovation is much more than invention and your call to involve many people in improvement and really and innovation make the most of kind of collaborations. So in that context, I'm interested in how do you see the opportunity to bridge a divide that sometimes exists between innovation and improvement in some of the ways in which we talk about things. When our experience at the Health Foundation is often people working more at the front line, they're wanting to make change happen. They're seeing opportunities to combine innovation with improvement methods that help you then target and embed it. It's really interesting what you see as opportunities there. Anyone in particular for that question? I was particularly prompted by Tony's question. You go. I was hoping Cathy, you were going to have a go that way. Do you want to have a? Come on. Yeah. Do you know what I think it's a really, it's a really interesting observation because I think that is the challenge that people are facing. And for me, II don't II think we need to stop thinking about them as different things. I really do because I don't think within our clinical pathways and within, you know, within our health and social care system, people are necessarily thinking like that. They're not thinking, oh, that's my innovation. And then this is my improvement, you know, methodologies and things I know there are different ways of approaching improvement. Um But I think it is really around what I said at the start, you know, our clinical teams need to understand as well and they do, they are, they do understand exactly what they want to improve. So I think how can innovation help you improve? You know, it's embedded, it's all together really. Um, you know, I, so, and, and I suppose I do think quite strongly about innovation as, as a way of life, you know, it isn't, it isn't something, it isn't a hat you put on and you think, oh, now I'm going to think about innovation in that. And I think in, in health systems, you know, we have a major innovation in digitally going on and, and, and, and in secondary care at the moment, but that's not the only innovation that, that, that's existing. And, you know, my obviously, I'm looking at it through the lens of medicines, but do you need anything to? So, I it's a great question. Um And uh so when I was a boy and I had short hair, um the um I trained to do one thing and trained to do that really well. I was going to be able to remove your prostate and I am still very good at doing that. That's what I trained as a surgeon to do. Just that one thing. It took me uh 1718 years through training and research to eventually become a consultant. And I was really good at that but on the way, I realized the world was changing. And if I really wanted to have impact on patient care and outcomes and on my wider society around me, I had to learn other skills along that way. So we've moved from this siloed nature of, I'm just a clinician. I'm an innovator. I'm a researcher and inventor. I'm a quality improver. I'm great at tech. I'm a Chief Digital Officer. I understand A I, I'm a chief A I officer if we ever get such things um to a situation where I just speak one language through my training. But now as a leader, I'm a Multilingual. So I have to learn the quality improvement. I have to understand how to create industry partnerships. I have to understand the commercial side. I have to understand the science and the clinical practice and the leadership and the tech and the A I and the digital and the innovation and the entrepreneurship. And that's hard. And where is the global training program that's gonna upskill our workforce and all of that? Well, it's the clinical entrepreneur program come and join us tonight. Heather here and then behind you, Heather, there's a, hello there. I jos and I can jos, I lead Haran, which is the Health Innovation Research Alliance in Northern Ireland. And we're running the pit stop with Tony tonight and worked closely with Cathy and Ian to discuss innovation. I just, and just to sort of pull some of the threads together. I just wondered that uh if you could comment at all that. So it's great to hear the work that you're doing Cathy Ian. You talked about um digital pathology and how we're leading the UK. And we've got the Clinical Entrepreneur program here in Northern Ireland. But can you sort of comment on um uh how we might compare to other regions? I know there are funded health innovation networks there. Um But how can we move forward and enable this demand signaling with that wraparound, you know, diagnostics and digital that comes together with the great medicines work that you're doing? Um You know, where's the home for innovation in Northern Ireland? And how can we work together with you? What's, what's the next steps that we need to take, Ian? Do you want to take that? I think as um as as Joanne is, is aware, um there's an ongoing piece of work um within the department at the moment which our colleague, Eddie Ritson is um leading on and we'll be talking about earlier. I thought Eddie would have joined us, but he's not, he's, he's at another thing. He'll be talking. I think about it later this morning, a separate session, um which is looking at how we can develop better structures to support innovation um within Northern Ireland in the health and social care system. And that will including include seeing what we can learn from the health innovation networks in England or academic health sciences networks as they used to be. And seeing if there's scope for similar structures to support innovation in Northern Ireland. And part of that is, I guess a question for all of this audience. Um What are the big issues which you currently are dealing with in your trusts, in your workplaces and community wherever it is, which you think you would welcome innovation to address. Because if we can identify those big questions or smaller questions, um then we can find ways of putting them out to a broad community of interested individuals in our trusts, to our academic researchers, to local and um national and international companies to see if there are solutions that they can help us to work on, which will address those specific needs. So I think Joanne in terms of you talking about demand signaling, I think that's probably what you're alluding to. How do we identify and articulate the unique questions which are relevant to Northern Ireland, put them out there in a way that solutions can be brought forward and then commit as a system to find ways to procure, adopt and roll out across our system. Those innovations which prove through evidence and evaluation to be effective and address our needs. Is that about a core culture though of listening, that everyone from those on the ward, from those in domiciliary care, everyone who has an idea. Oh, I think this might, oh, what do you think that they are listened to and again, it's the can do, let's give it a go. And if it works, let's share it. I think part of it is about listening, but there's also something about the northern Ireland population, um, in terms of, and it includes many of our staff people think and they have good ideas but they're a bit shy about coming forward and articulating them and really being able to express them. Now, the clinical entrepreneurs, Tony works with um tend to be in many cases a bit more confident, but they're also skilled and empowered and supported to bring their ideas forward and all of that wherever we lead in our workplace, we need to try to find ways of doing that with our staff. So no people need to know that they will be listened to, but also given the confidence to be willing to speak de Cathy. Go ahead. II, I suppose I do agree with that and I am absolutely passionate about new innovation. I really am like a nerd like these people on that but, and many of you, but um we have a lot of innovation sitting ready to be that is ready that we could use in, in health already. That's good to go. That's good to go. And I suppose that's where I am and I'm in, I'm in the near patient, you know, the patient space where, you know, we know we have the technology in relation to medicines. And we know also that our challenges and difficulties we've got around digital technologies, medical technologies, screening all the diagnostics that I mentioned earlier. They're the same challenges that the other health systems are facing and there there are solutions there. So I think, I suppose I would see that where Tony is talking about one end of a pipeline, an innovation pipeline and at the other end. So we're ultimately, we're waiting for those solutions to come through and be tested. But there's a lot of those solutions ready now um that we could use. And that's our, that is another challenge as well around affordability, et cetera. And I suppose that's why we do need to look at the our partnership working and allow for some testing briefly, Tony. And then I'm going to take the last question of brief comments when I was in San Francisco a couple of years ago, I met the Chief Medical Officer at Google and I asked her about her culture and how they create the culture. And she said there's one thing we start with. Yes, I've adopted it. I really like it. So if someone comes to me, I start with, yes. OK, much people teach you say no, don't take too much on. I start with yes. The second thing about people being entrepreneurs, being outgoing and I can see one or two of them in the audience and often they have impostor syndrome going I can't do this. So they share that with many people, as you say, Ian in Northern Ireland. But actually you are champions for your peers and your patients. Come on, you're driven to come into healthcare. Didn't go into banking or the drinks industry or gambling. You came into health care, come and step forward for your patients and we will provide the culture that supports you. And then to Jo Ann's Point, we are within the next couple of weeks going to publish our Innovation Ecosystem program paper. We spent 18 months reviewing not just the landscape in the NHS broadly, but also globally around that. And we're going to be publishing our observations on that and that ecosystem and culture is absolutely vital to helping join up everything that we been. OK. Next time I ask my husband a question, he's going to start with the word. Yes. But um and Heather um yes, and we're gonna be, this is going to be our last question and then we'll go back to the panel. Thank you. Good morning everyone. Paul o'kelly from the HSE Leadership Center. And actually, it works both ways, Donna, whenever he asks you a question, you have to say yes as well. Um I think my question leads on from conversations that you've just had and also the messages that I was listening to. Clearly. One of the big things is about us partnering with commercial organizations and that really does Jar with people within health and social care, we sort of feel it goes against the values. Maybe it's because there's profit made out of it. And that's not really why we all joined health and social care. How can we change that? How can we maybe encourage people that it's a win win situation? So that's a great question. And, you know, I have to prep for that because that could be the daily mail headline privatizing it. Every if you do not build a business that is profitable and scalable, it is no good to us in healthcare because we'll spend all our time commissioning it. And next year it will not exist because it didn't survive. There is a, a business is just a, it's like a scientific methodology. Have I got an idea that works and can I scale it? A clinical trial is another scientific methodology. Have I got an idea that works? And can I scale it depending on what the results are? So the start up is to the commercial world as the clinical trial is to the kind of medical and scientific world our whole lives are embraced by that or we cannot ignore it. If we do, we will get worse patient outcomes. We won't deliver that digital transformation, that patient empowerment, that understanding as I and quite rightly brought us back to that health inequality. Why is it in the United Kingdom? You can as long as you speak English or cat or I'm sorry. As long as you speak English, the drug label that gets printed, it might be different on Northern Ireland, on your medications that comes out is just in English. But if you pay taxes in our country your whole life and your first language isn't English, you get English. How is that? Right? Or fair or equal. One of our start ups is addressing that called written Medicine. Now, 40 different languages. It's been deployed across the Royal London Hospital and Bradford teaching hospitals where many of the community's first language isn't English. But what about people who we do it for blind people with brail? But what about for people who are neuro diverse and need symbols and can't understand. So we're doing it for that too. So I think we shouldn't all go over to industry and do I think we should just be a for profit driven system? Absolutely not. There's something very beautiful about the about care free at the point of delivery and we should absolutely hold on to that. But if thing, products processes and services aren't here tomorrow, then we're not going to be able to deliver patient care. So we have to, it is a paradox. I know what you mean. We have to brace them both. Ok, Tony and Cathy will also be part of the parallel sessions that begin at a quarter past 11. Um I'm going to ask them for a very, very, very brief last comment. Um But I want to let do you know that after the coffee break, which is next, there are six parallel sessions lined up for you. Then we're back in this room, the main room at a quarter past 12 for Matthew Taylor, who had a significant influence on the recent Darsey report. Finally, for each of you, what do you want delegates at this conference to take away briefly if you can, Tony, then I then so easy. The happening place right now is here in healthcare at six o'clock. Tonight is the Mac in downtown Belfast. Come and join us. We will call you a chancer here. You know, I one sentence if you can, what should they take away from this conference? Your answer should be yes. When asked can be and innovation is everyone's business and everyone can make a difference. Thank you to our panel.