Space for Change in Health and Care with Prime PLC

The Principles for Change in NHS Estates

Prime PLC Season 1 Episode 1

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0:00 | 35:54

Featuring Leighton Chumbley, the Chief Executive of Prime, and his colleague Emma Sargent, Associate Director for Construction. They are joined by Paul Sherriff, Director of Partnerships at the NHS, Birmingham and Solihull CCG, Doctor Christina Walding Management Consultant for Infrastructure, Government and Healthcare at KPMG, and Matt Tebbatt, MD of One Creative Environments. 

This expert panel will be discussing the extraordinary rate of change that COVID-19 has caused and the knock on effect on NHS estates, particularly focussing on the importance of leadership and partnership to ensure they are fit for purpose for the future. 


From Prime, this is Space for Change in Health and Care. A new podcast series exploring how we can create a future where outstanding care is never restricted by the space it is delivered in. Hello, and welcome.

 

00:31

This first episode is a roundtable conversation on the principles needed for change and the impact of Coronavirus. You'll hear from a panel of experts including Leighton Chumbley, the chief executive of Prime and his colleague, Emma Sargent, who is Associate Director for construction. You'll also hear from Paul Sheriff, who is Director of Partnerships at the NHS Birmingham and Solihull CCG, Dr. Christina Walding is at KPMG. She's management consultant for infrastructure, government and healthcare. And finally, Matt Tebbett, MD of One Creative Environments. The conversation is hosted and introduced by Natalie Burns, Partner at UnitedUs, and it takes as a launching point, the report ending change paralysis in NHS estates. So here's Natalie Burns to introduce the panel and give us some context.

 

01:28

This past year has seen incredible changes across the NHS as care providers were required to reevaluate every aspect of their working practice. With all of these changes came the need to scrutinise the limitations of the physical environment in which we deliver and receive care. seemingly overnight Health and Care estates began to transform, with new buildings erected pathways rerouted and even the most humble of GP practices reimagined. And while there are many lessons that can be learned from 2020 This conversation intends to focus on that one particular aspect, how such significant change in estates can happen and can happen fast. In the words of Sir Robert Naylor. One certainty in the NHS is constant change. But there is a critical area that has proved notoriously slow to evolve. estates. fundamental shifts in health and care estates often take years, if not decades to address. Yet this year, incredible people and organisations like those represented here on our panel managed to deliver truly unprecedented change. Today, we hope to explore some of the attitudes that enabled this transformation to take place so that we can foster a conversation and understanding about the mechanisms of leadership, collaboration and collective action that will help us move the NHS estates forward for the future. And I'm very pleased to introduce our panelists for today. Leighton Chumbley, the chief executive of Prime the UK is leading health and care property developer and his colleague Mr. Sargent, associate director of construction. Paul Sherriff, Director of Partnerships at NHS Birmingham and Solihull CCG, Dr. Christina Walding, management consultant, infrastructure, government and healthcare at KPMG. Matt Tebbett, managing director and owner of one creative environments and myself. I'm Natalie burns, strategy director at united us I'm your host for today. So I thought I'd kick off with a little bit of context. In our earlier report called ending change paralysis in NHS estates. From January of this year, we published the quite shocking statistic that a three year delay, not untypical of NHS estates can cause an often insurmountable jump of 49% of the total project cost, given this immense financial incentives for organisations to actually get their spades in the ground and address change. What do you think are the underlying attitudes that have previously held leaders back from making change happen and happen fast? Late, and I'd love to hear your thoughts on that to kick us off.

 

04:00

Thanks, Natalie. I personally think that the leaders within the health providers and leaders at the local level have got a very great desire to see spades go in the ground, and they do everything they possibly can to achieve that. I think the two things that that hold that back are sometimes a lack of capability and capacity within their own organisations, because they are dealing with the day job and managing the day job, from the state's perspective is an incredibly complex and time consuming process, and then trying to find time to do the new is astonishingly difficult. So I think there's partly capacity and capability. Partly it's because to be honest, at a local level, there's very little authority for the leaders to actually enact that change themselves. The process of approvals means that they're somewhat disempowered to do anything themselves, and they have to look to a higher authority for permission to do so.

 

05:10

I think you're right. And I think it's incredibly challenging. So, so whilst I work in a clinical commissioning group, and I'm not operational in terms of running of healthcare services, were part of the NHS system or public sector services that quite often go through constant periods of change. So people change, but systems and processes also change. And some of these projects do take an incredibly long period of time and regimes move in may shift. And it isn't always clear, I don't think who has the authority to make decisions. So I don't actually believe it's a lack of desire or will, I genuinely don't believe it's because there's a lack of need, but there's a complexity to the way the system operates. And whilst in your introduction, Natalie, you can refer to how we manage to get some things done in in some of the strange times that we've been living through, some of that was removed, some of those barriers weren't placed in front of us. So we had a much clearer view on what needed to be done. And when it needed to be done by so I just reinforced actually, you know, that the points that lanes made, it's a complex system. And we've seen sort of that kind of authority or the autonomy to act isn't always at the front line, it has to go through several layers of governance and approval, those elements really often hamstring us. And that's what often introduces delays in my experience.

 

06:28

In smaller organisations, the phrase that gets bandied about quite a lot is, is asked for forgiveness. And do you think that it is a case of that there are bureaucratic barriers in place, or that actually, it's that environment of psychological safety that that allows people to think that they can make those decisions. That is the kind of blocker to that change happening?

 

06:53

Because there's a scarcity of resource, or we have to make sure the results that we do have we spent to the best effect to get the kind of value for money, I often think it's about layers of assurance to make sure that that goes to the right place. Because we can't do everything. I think it's incredibly challenging in an environment that's often quite competitive, to get a shared vision and a shared view on what those priorities are. So I think the best of intentions at all layers in terms of the decision making process, just trying to make sure that everybody agrees this is the right thing to do. And perhaps inadvertently, that process in itself often introduces delays. But it's an unintended consequence, rather than a deliberate one,

 

07:36

the level of complexity that's been created around a state and the decision making around the state, and the accounting policies, and the tax consequences from the procurement issues, in that it becomes incredibly difficult to move something forward and create any momentum. There's lots of Yes, but have we considered this? Or Yes, but should we have done this? Or Yes, but is there a better way of doing this, and there are always options, and one person's preferred route might be another person's nightmare outcome. It is a very complex world. And one that is difficult for everybody involved to walk through, I

 

08:20

completely agree with what Layton and Paul have said, however, I would also kind of challenge that there are certain leadership styles, and certain team environments that will can weather the storm of its complexity to a much better extent. And we talked about psychological safety. And for me, when you start to look at environments where actually, you've got a really, really clear direction, I've travelled from a bold leader, who actually can make those decisions in a rapidly changing environment, but create an environment where people think, actually, you know, I'm supported to make a decision. If I get it wrong, then we'll have the conversation collectively, we will learn from that collectively, we will be open, honest and transparent. And where we have the emotional intelligence to be able to tap into people's individual strengths, and ensuring kind of get the most out of people. You know, a lot of people talk about this, and then you know, it's the bread and butter of what everyone does. But actually, this is the kind of magic pots that if you get all of these traits, right? If you create the environment where people do feel psychologically safe, to really push those boundaries, within a safe limit, but to push those boundaries and to make those bold decisions, then you can actually achieve amazing things within a really, really short amount of time. And you can maintain the momentum. But you know, it does take the right environments. And I think sometimes that can be something that can be lacking in certain areas. And it makes a huge amount of difference in the amount of progress that can be made. And I think when you start to look at all of the examples of the phenomenal work that's been completed during the COVID pandemic, you start to see that these traits really come to the forefront and really stand out for people. So I think if we can learn to to harness that, and specify what that kind of magic pot of ingredients that are, then we can do, we can do phenomenal things. And we can really push the boundaries of the constraints that we've described.

 

10:11

And that's where these these partnerships are really, really important on a, because it's, it's not just about the estate's teams themselves. It's about, you know, spreading that responsibility. And if you can break down that the red tape and the bureaucracy, you know, and use the strengths of, you know, the wider industry, and all the partnerships, like we've got here that, yeah, you can do great things. And it's about being just like you said, open and honest and transparent and being brave, having conviction that you're doing the right thing. If everyone's on the same side, you get to the solutions and the answers a lot quicker. Both

 

11:10

Christina and Matt have said about the urgency there that that COVID gave us in operations across the country with the nightingale hospitals and other facilities. During the construction phase, we quite often will feel that sense of urgency and occupiers and clients will feel that urgency, and all of a sudden, the building is very, very real. And people aren't always feeling empowered, or they have to go to somebody to feel empowered to push that build forward and keep up with the change that is happening around them. What would be really great is if we got to that urgency that we've had through the COVID period into the development phase, up until financial closes prior to construction, because change during construction is chronically difficult for everybody. It's doable, but it's not the ideal. And it is it doesn't give value for money. We've proven with that COVID period that that sense of urgency and the trust in people and driving that ambition to get something done. Because it's happening now. It is doable. And we don't need to have this delayed difficult process to get a building on site or to get an estate developed or changed, we can do it quickly and efficiently. And with that value for money that is required.

 

12:29

I don't want to agree for the sake of it. But I am going to agree with those comments, because it's been an incredibly unique period really, and and we could go over the obvious reasons for that. But actually, if I just reflect I've worked in, I suppose you could say primary care for seven years, and that that's probably a career that spans nearly 30 in the NHS. In those last seven years, there are a number of things that were fairly unique around, because some of the work we've done around estates, it was that kind of shared view, and it was around an urgency to do it. So we knew what we were aiming to do. But actually, it's the first time that we put capacity and capability together in the right quantities to do something. So I don't want to speak critically of the sector that I work in, I work with some fantastic colleagues, colleagues that have given, you know, they're all to their jobs onto their organisation. But actually, this was the first time I would say I worked in a truly multidisciplinary team of different professional backgrounds, from project management through to the various disciplines in construction, as well as people that were clinically qualified Minister, you know, the provision of healthcare, so that that was completely unique, and why that I think, drove value for money, in my opinion, and why that drove the project to deliver on time and why we got things doing, you know, the kind of the urgency that we needed to, there was a complete focus. We knew what we set out to do. So there was a shared vision and there was agreement. So there was no missing event. It was resourced properly. And that was the job card, get on with it. And we've touched on lots of other things often clutter arrangements. So I think it's a combination of colleagues psychological safety, call it the partnership working. And there's only kind of summarised that, you know, a real focus and urgency, but I think you need to bring all three together. And I think that's probably the kind of blend that we got in our response to COVID To begin with, and that's going to be really hard to replicate. But those are the comics some of the key ingredients to

 

14:30

me. And that would be the crime in all of this, wouldn't it that when COVID is over, you know, when we haven't got a national emergency, you know, everyone's going to sit back and just breathe and think that but we don't want to default back to what we used to do. You know, we need to still embrace that approach, don't we? And it doesn't need a national emergency to do wonderful things and do great things does it should be on every project. And it could be

 

14:59

I think that's the inspiring thing about when we have these conversations about health and care Estates is that it's a really tangible impact that we can have on the delivery of great health and care service provision and something that, that on a day to day basis affects everyone who is involved in the creation of that new GP practice of that new hospital of that new referral centre, whatever it might be, it's a very tangible impact that you can see happening. And I wonder why, you know, prior to the kind of sharpening of focus that's caused by the pandemic, why we don't attack all projects with that same focus, that same excitement about making that impact happen really quickly. Does anyone have any kind of feelings about why that kind of same urgency isn't there? Or? Or if it is there, what is stopping people from really acting on it from really bringing that forward in their attitudes to the projects that they work on?

 

15:57

You know, we have an intolerance to risk I guess, and people find him making mistakes through this COVID period. I don't think anybody's going to dumb you for making a mistake. Things needed doing and then you're doing now and that's, it's got done. And yes, in hindsight, you might have done something a little bit better if you had more time. But going back to the empowerment and allowing people to learn from mistakes, and allowing estates personnel, to go out and learn and explore how we can do things better learn from other partners, or the CCGs, or the primary care of states, acute hospitals learning from each other. Yes, try and avoid the mistakes but but accept that sometimes happen, but empower people to take that bit of risk sometimes to move forward.

 

16:42

I've worked in the public sector, before working for KPMG my whole career, which obviously is very short and very, very young, clearly. By Potter, I popped around a few different organisations that are government, NHS nationally and locally. And I think, you know, no one gets out of bed in the morning goes today, I'm going to be difficult. Today, I'm going to create barriers to prevent people from mobilising a project or delivering a new hospital in a really efficient way. Yeah, but that's not what people go there to do, I hope. But we operate in a very, very complex healthcare system where we have multiple organisations who are contracted and commissioned in different ways. They're, they're monitored their performance in very different ways. They're accountable for very different things. When we have that complex environment, then it creates organisational interests. And I think what we saw in COVID, is we saw that those organisational interests literally got screwed up and put in the bin overnight. And actually, the COVID pandemic superseded those 1000 times more than their organisational interest, and that allow people to really come together in a truly collegial way to make progress. And I think that was the uniqueness of the COVID pandemic. I think, fundamentally, whilst we do have this very complex organisational interest, then it does create barriers, and it does create complexities. And I think that is, you know, significant challenge for the healthcare economy in the UK moving forward is how do we actually bring people together in a truly integrated way. So they can operate in a much more similar collegial way that we saw during the COVID pandemic.

 

18:16

That's why I think a lot of projects lack is a very clear, bold purpose. There's a very detailed clinical health strategy. But there isn't a unified unifying statement, which is kind of one sentence that says, We're doing this because and that statement ought to be based upon human outcomes, not economic benefits. And I think if with really strong leadership, you had a very clear pilot purpose behind the project that would break down some of the organisational interests or it would at least allow people to test there's organisational interests against the very clear purpose that people have agreed to. I'm hopeful, actually, that we are moving toward a world where there's organisation organisational interests aren't quite as divergent as they have been in the past, as we move towards integrated systems. There's, there's a huge opportunity ahead of us here that we need to grasp. But even when we do come together with that, or unified, integrated system, somebody needs to stand in the middle and say, right, the reason why we're doing this is because and everybody needs to listen to that clear purpose, embrace that clear sign up like this, and then at least you can move forward with some confidence that everybody is clear as to why you're you're actually embarking on the journey

 

19:46

yourself to follow that I think around the shift from competition, perhaps between partners for the same funding streams to one of collaboration. So I think the shift to a system view and not the lighting just touched on, on ICs are an integrated system is going to be key, I think. I think funding is going to be challenging. I can't, I can't predict the future. But I think we would all perhaps agree that funding is going to become even more challenging. So we're going to have a very clear view around where the priorities are going to be. So, you know, one of the one of the challenges for me is being honest about that, you know, we won't be able to do everything. So what are the right things, and then have a very clear purpose about why we're doing otherwise, we will constantly go back and re engineer, one project have to that we've all been involved in multiple projects, quite honestly, where they run for years and years and years, and what you end up trying to deliver a something that is a million miles away from where you started. And that's because they actually weren't clear at the outset, why we were doing it the purpose. So I can only agree with that, I think it has to be balanced off with the kind of real honesty amongst all of us that we're going to be moving into an economic regime, it's going to be tough, so it's even more important,

 

21:02

and get it right first time, isn't it, you know, get rid of the waste of that protracted process, and that elongated process to get a project going and complete?

 

21:14

Well, I was gonna say in terms of getting it right first time, the other way of looking at it is not strive for the perfect answer. Because again, that's that's something that from, from the state's perspective, there's lots of rule books, there's lots of examples and guidelines that you need to adhere to when you're developing healthcare building. And that's right, because it is a very complex space that you're creating, to look after some very sick people often. So it's important that you get it right, from a design specifications point of view. But we we take that to us to an incredible level, within the health service, we are determined to design the building to a point where every single turn is understood. And the business case around that presumes that that room is going to be you for that purpose, for the next 25 to 30 years, when you get to that, that level of complexity and detail, that design has no ability to shift to flex. So you get a different clinical strategy come from the centre, or you have a new person involved in the project who has a different, slightly different idea and, and how they should deliver the service within that building. And then everything shifts, the reality is healthcare changes all the time. So what we need to do is embrace the fact that healthcare changes all the time, and build in that flexibility. So you're not trying to say that tap is gonna have to be in that room in that place for the next 30 years. You're saying this space is going to deliver healthcare, and it needs to flex and if you if you're able to design and build in that flexibility, that wouldn't require so much agonising over the exact layout of a clinical building as you go through the design process.

 

23:13

There's something that's, that's fascinating for me, actually, we're obsessed with ownership. So there's most flexibility in how the space can be used. But I think we have, quite frankly, I do need to look at the flexible use of buildings and who uses them. Because I think what the COVID experience has shown me anyway, is that we probably don't need the same number of buildings that we currently got. We're working in different ways. I think those environments need to therefore be designed in different ways.

 

23:41

So we need to be rewriting the rulebook. So then we we need to learn from this. And how can we change the rules and the regulations to allow us to design buildings that can be more flexible, more adaptable?

 

24:09

One of the things that I find quite striking as you're talking about this embracing imperfect answers or or being more agile in your thinking about what as a space could be or who it could even be owned by or used by, reflect so closely the environment outside of healthcare, where we are looking at organising, huge organisational change, huge changes in the way that people work and the technologies that we're using. And I think it's it's quite interesting to hear that from a health perspective, it's almost the this because these are bricks and mortar because it's healthcare and it's so precious, that we're only just coming to this point where we're having this conversation of bounce thinking about the space as a as an agile thing, not just a static object that is going to be there forever that actually needs to evolve. overtime, they'd like to bring us back a little bit to that kind of question around them leadership and communicating that vision communicating the potential of that space. How do you, as a leader, go into a project that that will not be as short as some of the projects that we've seen during the pandemic that might be, you know, via a build that takes actually three years to complete or potentially longer? And how do you bring the team together around that scale of project and say, Actually, this space is going to change, it's going to change whilst we're building it, the use cases are going to develop as we're building it, there aren't going to be perfect answers along the way. But the outcome of doing this work is going to be worth it, it's going to be really something that you should all commit to and embrace all these attitudes that we're talking about. How do we do that? How do we take people on that journey when it's a much longer project?

 

25:55

Thank you just outlined an example for us just there, Natalie. So what you just described for me, is a compelling vision. So you know, what is the compelling vision that people should get behind? How do we articulate it in a way that engages people? Let's be honest, if we work in healthcare, it's because we're passionate about healthcare. And we need to bring it back to that, we need to be really, really clear. What are we here to do, we're here to make a difference to the lives of patients in the general public. And here is our compelling vision for that. And you just gave us an example of that. And I think that's the starting point is what's our vision? And how do we communicate that in a way that engages the whole collective around us,

 

26:34

I think there's something about what we bring into the room or our colleagues bring into the room. And some of that around attitude, you know, we tend to bring in, you know, our experiences that we've acquired through time. So if you're approaching a project, where I think you will actually this is going to take me five years to deliver because the last one did, I can put money on it, it'll take you probably five years in a bit. So I think there is something about those of us that are have leadership roles, those of us that are in positions of influence, or have the ability to influence others come in with the right frame of mind and the right attitude. The leader

 

27:07

sets the tone for the project we're working on at the moment with a hospital trust, and a while at the university. And the relationship between those two institutions has been poor for quite some years. So we're coming along to build a new facility. And we need to have cooperation between the organisations in order to make that happen. We have that discussion with the senior team, the leadership team within the hospital trust. And we explain that from the experiences that we've had, on the ground estates team of the hospital Trust and Estates team of the university really do not see eye to eye. And if there's any opportunity whatsoever, for the hospital trust to make life difficult for the university, they will do. And vice versa, because that's, that's the culture or that's the relationship that those two organisations have. Now, in order to try and deliver something within that environment, you might as well give up to be honest, because everybody's pulling in different directions. So the leadership team of the trust, understood that and went out of their way to speak to the leadership team of the university. And they had a very open and honest discussion to say this, this has got to change, our relationship has got to be different, we've got to work in a very different way. The two senior teams agreed that the whole relationship needed to change. But then what they they then did was made that very clear and known through their organisation, for they were then able to turn around to their estates team and said, Look, we want you we need you for these very clear strategic reasons, to change the way that you approached your relationship with the university and both leadership teams were having those discussions down through their ranks. And the change has been magical. So everything that was so difficult to do is now no longer difficult. Everybody's working in the same direction, everybody's pulling in the same direction. And it's, it's a really simple thing to do. But that's the key for leadership is it you're not just standing there, out front, waving the flag saying, you know, who's gonna follow me your task, your job is to take that purpose, that vision, that strategic requirement and communicate that down through the whole of the organisation so that everybody buys into it, and everybody can work together. across organisations, as we've, as we've talked about earlier, to make these things happen. It's absolutely vital that that's a key attribute of leadership.

 

29:51

Sometimes we forget that

 

29:51

people work in healthcare to make a difference to people's lives. We're all human beings at the end of the day, and we're here to make a difference to the lives of the people we serve. And it's the role for the leader in my mind, to be able to bring it back to that and to be able to articulate it in such a compelling way that resonates deeply with people, and then enables them to act, you know, in an inspirational way, that's really, really critical for me. And I think you're right Layton, you know, the leader sets the tone. And the leader sets the behaviours, they set the environment, when you see a leader that is happy to be open and honest and transparent about, you know, having made mistakes, but learn about it, it actually creates an environment where people think, yes, you know, I can, I can make bold decisions, because I know that if I make, you know, all error, or that or it's not as optimal as it can be, then we're in an environment where we'll learn from that, and we'll build on it in a continuous improvement culture. When you look at a lot of organisations, there's quite often a tendency that decisions get escalated. So I don't feel empowered to make decisions. So all escalated up and all escalated up. And what ends up happening is you have very, very senior people making decisions that actually could be made at a much more operational level, and people were empowered. And for me, that's about how you create a coaching culture. So you come to me with a problem. And actually, I say to you once, okay, so how can you solve this? What are the tools and techniques that you can use to solve it? You come to me a second time again, I say, how can you solve this, by the time you come to me for the third time, you're coming to me with a solution. And that's the role of the leader is creating that environment where people can be coached, and not have decisions made for them. And that then sees that decisions are then cascaded down and are empowered at every single level of the organisation. And therefore you get boss nificant momentum behind projects and behind the work that we do.

 

31:42

It's even much simpler things. It's just about, get rid of your egos. It's about excitement. It's about enthusiasm, motivation, and just be really nice. You know, we're all nice people. Just get rid of any angst. And you know, and just enjoy the job and get on with it. And you will get to the right answer.

 

32:05

One of the things I remember so I've been involved, personally, the number of COVID projects now. And one of the things that really stood out for me is, if you dialled into any of the team meetings that we had as an outsider, one, you wouldn't know that people were working from different organisations to you'd hear a huge amount of laughter, you hear a huge amount of Mickey taking. And actually, that's not to be underestimated. Because when people are that comfortable, that they can take the mickey and they can laugh, it means that you've got a true sense of trust. And that's the environment that actually is subtle, but but you need to create, and I think that was the uniqueness that people have commented to me on of the teams that I've worked with as part of our COVID response.

 

32:45

The environment is absolutely key. But I also think a really healthy environment is one that doesn't, doesn't allow itself to be satisfied, you know, with artificial harmony, if I'm honest, you know, it's okay to disagree. And there has to be, you know, we have to have candour, and we have to be open and honest and upfront about it. And actually, you've got to iron that out. Because if you're not comfortable with something, you'll never sign it off, you'll never make a decision. And then people create artificial deadlines, because they're not confident in what they're going to get from you. So I think, you know, let's be really honest, it's nice to have fun and to get on. And I agree with what Christina said. And I think it does make a huge difference. But those environments are also the environments that enable you to disagree, you know, disagree and resolve problems, which is something that we're not particularly good at, you know, I can only speak on a personal level. But I am very guilty of sitting in lots of meetings. And sometimes we allow an artificial harmony to play out, because actually, we think we're getting through it, we're chipping away at it. But we fundamentally won't make the kind of shifts that we need to

 

33:50

I think you all paint a really inspiring picture of what the future of health and care in in at least our country could look like if people adopted these attitudes. And for me, it really reflects one of the the final principles for change that we've outlined in the principles for change document, which is be bold in activating your ambitions. And in order to do that, you need to have done everything else you need to embrace these imperfect answers. You need to find commonality and compromise. You need to take and empower ownership and you need to build these experienced allegiances with with great candour at the table, and great coaching to support people to really be a part of that with you. That's probably enough food for thought for everyone. For today. There's a lot of really insightful experience that you've all shared. And thank you all so much for taking part. Please do tune in to prime plc.com and have a look at the principles for change document which you'll be able to find there if you'd like to explore those a little bit more. And thank you to all of the panellists for joining today. I hope you've inspired others to change the way that they might approach approach Next in the future, so thank you all.

 

35:05

Thank you very much, Natalie. And thank you to our panellists Leighton Chumbley. Emma, Sergeant. Paul Sheriff. Dr. Christina Walding and Matt Tebbett. And of course, thank you for listening. Please subscribe to space for change in health and care wherever you get your podcasts. This podcast is brought to you by prime. The UK is leading health and care property developer. You can find us online at prime plc.com That's prime plc.com. The series is made with support from UnitedUs with editing by me CJ Thorpe-Tracy for Lo Fi Arts. Talk to you next time.