Speaker1: [00:00:00] Hello, I'm Suhail Mirza and welcome to this episode of Voices of Care. My guest today is Sarah Woolnough, chief executive officer of the King's Fund. 

Speaker2: [00:00:10] Voices of Care, the healthcare podcast. 

Speaker1: [00:00:13] Sarah, welcome to Voices of Care. I'm delighted you could make the time from a very busy schedule to join us. 

Speaker3: [00:00:19] Great to be here.

Speaker1: [00:00:20] Well, I feel like I'm a little bit of a part of the family at King's Fund. We've been really blessed to have two of your colleagues, Pritesh and Siva, join us. It is an extraordinary time. Your first year at the King's Fund. And most of us know the work of the King's Fund and devotees. But I wanted to find out a little bit more about your vision for the King's Fund. I know it's to improve the health and care of people in England, but it's an extraordinary time you're tackling some big issues.

Speaker3: [00:00:51] That's one way of putting it. Yeah. I feel I've joined at a fantastic time. I'm very focused on how we at the King's Fund through the different things we do publishing, research, convening, leadership, and development programs. How we drive a positive impact. We're actually working on a new strategy at the moment. So we're going back to first principles and thinking about how we can make the most impact over the next five, ten years. But I'm really interested in both how we can provoke new thinking, bring new and fresh ideas into our health and care system, but also recognising there's quite a lot of consensus about some of the shifts and changes we need to see. How we can be a force for good in making that happen. You know, driving policy into practice and change in the world. 

Speaker1: [00:01:40] And you're used to terms of advocacy dealing with governments. I think you were at Cancer Research for 15, 18 years or something along those lines. 

Speaker3: [00:01:48] Yeah, I spent many years, 15 years at Cancer Research UK, which I loved and did lots of different things but was really passionate about. I suppose driving the fruits of medical research into policy and practice and change for people and patients. And then most recently, I've led the merger of the two national respiratory charities to become Asthma and Lung UK, and then to really advocate for and fund research into respiratory disease, but advocate for people living with lung conditions who often get a really raw deal, and think about how each part of the system, health and care services, people and communities can work together to drive change.

Speaker1: [00:02:30] And I think you've been on record as someone who obviously is about patients. This is about people who ultimately use the services. You've gone on record to say you're impatient in terms of making sure change is affected. So I guess a think tank that wants to make sure that people are doing things.

Speaker3: [00:02:48] Yeah, I mean, I do feel impatient for change. I spent so much of my career. Day in, day out, you know, having the privilege of spending time with people and communities who are often experiencing, you know, difficult health challenges, poor health outcomes. And I think, you know, it's a great privilege joining the King's Fund. It's a wonderful organisation. I think we've got a responsibility to be impatient for change, and not least because the external context, which I know will come on and talk about, is so challenging. You know, we have the great fortune to have different capabilities, and we want to put that to really good use to help, to help, to be a constructive partner as well, to try to improve health and care for everyone, but really putting people and patients at the heart of that.

Speaker1: [00:03:37] Well, I mean, we've talked about the fact that there's a lot happening at the moment. A new government, a mission-orientated government. Keir Starmer making it clear that a fairer Britain, where people can expect to live well longer, I think is the backdrop. But just as a snapshot before we go into some of the details, King's Fund has been extraordinarily busy in the pre-election post-election period. What's your view? Just as a broad picture, because we've got, on the one hand, Rachel Reeves talking about a £22 billion gap in the finances. We've got the King's Speech with some really quite innovative, even bold policy suggestions and commitments. 

Speaker3: [00:04:15] Yeah, the government has a long to-do list is a shorthand way of saying, you know, we know our health and care system is really challenged, but it's the same across many public services. And, you know, you've got a government talking about the need for a decade or more of renewal, of really being honest. I think about the challenges we face, but also being optimistic and hopeful for the future with a, you know, hopefully, radical policy agenda. So that's what the King's Fund, you know, we do quite a lot of sense-making. And we are trying to keep track of, you know, what the government is saying and trying. But then also of course influence so that we get some sustained and transformative change, because that's what we need.

Speaker1: [00:05:02] Now we'll start with the NHS first. I mean, we're talking about health and social care and the whole gamut here. Wes Streeting is really early on, as well as saying he wanted the department to be an economic growth department. He's described the NHS as broken. What do you say? 

Speaker3: [00:05:24] I say the NHS is, you know, incredibly challenged and, you know, there is a crisis of sorts. I would probably describe it slightly differently. And I would say, you know, we've got an NHS model that hasn't fundamentally changed since 1948, and the NHS is doing an awful lot for lots and lots of people. The reality is we've got, you know, a different population with different health needs. We've got, you know, an ageing population. The NHS is able to deliver different types of care and treatments that we wouldn't have dreamed of decades ago. So there's a crisis. But our model isn't fit for purpose. I say that, but I'd also say, I suppose, particularly to this point of is the NHS broken? I think we've seen society hugely challenged, a bit of social breakdown and so lots of issues that don't start as health issues end up at the NHS door. So is the NHS broken or is society fractured and challenged and a bit broken? And I say that because I've spent quite a bit of time over the last eight months that I've been at the King's Fund, and before that, of course, I was spending time out in communities and with patient groups, going and seeing different parts of the health and care system. And everywhere you go across the country, you hear a familiar tale of, well, there's a huge demand that often services can't meet or they can't keep up with. And you say why? And you hear so often, ah, well, you know, I was at a mental health trust last week and they were talking about essentially social context, social factors, you know, poverty, cost of living, unemployment, poor housing is playing into physical and mental ill health. And that's landing at the NHS front door.

Speaker1: [00:07:23] So I think, as you said, if the NHS is broken, you're not saying it is or isn't. It's challenged, but is society broken? I just want to pick up a couple of those points. I think it's a really interesting context to put that question in because we can't look at it alone in a silo. Let's take poverty, for example. There's been interesting work, of course, you know, from the Joseph Rowntree Foundation around poverty and stigma. I think the latest stats, 1 in 5 people in the country are living in poverty. 14 million. So this has a huge impact on health and inequalities.

Speaker3: [00:07:56] It has a massive impact, and it's really close to my heart because I've seen it in previous jobs. You know, sort of first hand, you know, if you are if you are living in deprivation, you're likely to have worse health. You're likely to struggle to access services, you're likely to have poorer outcomes. And we've done work with the Joseph Rowntree Foundation and, you know, quite recent work. We've seen a spike in poverty. We've seen a spike in, you know, levels of deep poverty. And that plays out in health outcomes. I don't often feel there's enough national conversation about some of this stuff. You know, poverty makes a difference. Housing is a massive issue. You know, poor quality housing, damp, and mould as one example. Or, you know, housing that isn't fit for purpose often then has an impact on physical and mental health. Same with unemployment. You know, and we've seen, you know, you can look across the board at different metrics. Really high. High levels of mental ill health, mental distress on the rise. Again, they're interconnected. But I think we must understand the social context and make sure we have enough conversation about that versus, I suppose, some stuff that's potentially easier to measure or talk about, such as, you know, NHS performance stats, but what's really informing that at a deeper level.

Speaker1: [00:09:20] And I think the broader picture you've touched upon I think in such an important and refreshingly candid way, if I may say so. The whole idea around inequalities, I think the stats are life expectancy is a good example, which had grown by 20 years for a century. I think it's stalled in 2010. That's the life expectancy of someone living healthy in the most deprived area is ten years shorter than someone in the least deprived area. But going to work for a second, I want to just touch upon that, because Labour has made some significant commitments around work as part of its missions, but there's been a big focus on and a huge increase in the number of people unable to work. Economic inactivity, I think, is the term of art, has gone from up to 2.8 million. Maybe beyond that. And ill health, people who are in work I think has increased from 3 to 3.8 million in a few years. So this is a huge ticking time bomb, isn't it?

Speaker3: [00:10:20] It really is. And again, I think it's on the one hand. Well, has there been enough conversation about it? So you're absolutely right that there's a really stark picture around life expectancy. Not only has it stalled over the last decade or so, actually for some groups it's worsened. And we are an outlier in the UK versus some other comparable countries. And, you know, I work with brilliant colleagues at the King's Fund and one of whom talks about, you know, we need to be on a war footing around some of this stuff, you know, because we've got really challenging population health out there. And if we are to have a healthy workforce, we've had lots of and more than that. You know, we want people to live good lives, in decent health for as long as possible. And that requires attention and it requires deliberate action. And that is broad. That requires a broad government response, which is, in a way, why I'm so excited about the potential of the missions, because I think we're after transformative change. That's what we need. The challenges are pretty stark. Let's hope that's what we can drive towards.

Speaker1: [00:11:26] Absolutely. I want to move on to that in due course. But let's now bring the camera a little bit more closer to home. That's the broad picture. I think you've painted it very eloquently. Let's look at the way, what effect that's had on the system. I mean, again, from your picture, the NHS performance stats, I mean, all the measures. I think the four-hour target hasn't been hit in over a decade. And the numbers speak a system that's really creaking under a lot of pressure.

Speaker3: [00:11:57] The system is under huge pressure. There's increased demand. Access is a major issue. You know, if you look at public satisfaction with the NHS, it's at its lowest levels ever. And when you dig beneath that and you ask, what are you most, what's most difficult? Access comes up time and time again, you know, struggling to access primary care or in a way that feels timely. Clearly, some of the NHS performance stats speak for themselves. You know, long ambulance waits at times completely unacceptable. Impacting health. Long waits in A&E. Long waits for elective care. You name it, that there are challenges. So, you know, we find ourselves in a situation that is incredibly challenging for people, for services and of course, for NHS staff, because there's often sort of moral injury there that, you know, you're wanting to do a good job, but it feels really tough. 

Speaker1: [00:12:57] And that is having the effect, as you say. At the same time, we've got the financial constraints where I think the reports are some trusts are being asked to deliver between 5 and 11% in efficiencies, which is unheard of. But I just want to touch upon the staff. You made that point. All of this system has an effect on the staff and the latest NHS staff survey. I think there was some positive stuff in there, but some bleak things that I picked up. 29% of the staff were considering leaving and there was a big increase from 7 to 9% approximately of those who'd suffered discrimination at the hands of their fellow workers. 

Speaker3: [00:13:33] Yeah. You can't read the latest NHS staff survey and I think feel anything other than, you know, gosh, some of this stuff is shocking actually. You know, high levels of bullying, harassment, racism, you know, a workforce that in many instances doesn't feel well looked after or nurtured, and just some practical things that we can and should get better at. You know, giving people nutritious food when they're at work and places to have a break and have a rest. So and you know, this is sort of 101 isn't it. You know, we're nothing without our people, any organisation or service. So really taking this stuff seriously in a sustained way is just so fundamental to how we improve our health and care service. I mean, just the only thing I'd say, though, is because it's very easy to paint such a bleak picture without hope. You know, there's also brilliant stuff happening every day across, across the health service. And both of these things can be true. So, you know, when I go out and visit places, you know, you're often seeing fantastic examples of, you know, inspiring staff working in integrated ways, delivering brilliant patient care. At the same time, let's, you know, the honest answer is the national picture is pretty bleak.

Speaker1: [00:14:53] I'm glad you made that point. It's one of the raison d'etres of Voices of Care. We wanted to highlight some of the really brilliant, innovative work right across the system health, health, social care, voluntary sector. And going back to the survey, you mentioned the lowest levels of satisfaction recorded in the British Social Attitudes Survey. I think 40 odd years now, 1983, I think it began. But at the same time, there's also within that survey, a reaffirmation of the public's commitment to the founding principles of the NHS. And I wanted to now move and focus. Looking ahead. We've got a budget coming. There's a whole raft of proposals. Lord Darzi's review, a new ten-year plan. What would you like to see? I guess there's some immediate things and some more strategic things. There's always a challenge to fix things immediately, but there's also quite a lot of promise because of the fact that society absolutely believes in the NHS.

Speaker3: [00:15:53] Exactly right. There's a huge opportunity over the next year and I think we want to be realistically optimistic and we do need to deliver some shifts that we have been talking...

Speaker1: [00:16:05] In the short term.

Speaker3: [00:16:06] But in the short term and the long term, you know, of course there are, you know, any government is going to want to show progress. And I suppose it cuts to the heart of where we started. We're all impatient for change and improvement and as we should be and impatient for, you know, improvement for patients and people in receipt of care. But the shifts are really important. So something I believe very strongly the King's Fund has talked a lot about is, you know, one way of putting it, the answer to overcrowded hospitals isn't just to build more hospitals. We need to deliver more of a left shift to focus more on how we keep people healthy and population health, how we deliver more care in the community you know, through primary and community care, help people manage their conditions. So many people, as we age, as a population are living with multiple long-term conditions. And so we need to deliver that shift, you know, less focus on acute, more focus on primary community social care. You know, as a health and care sector, I feel as though we've been saying this for decades. Successive governments have been talking about it for decades, but yet we haven't delivered it. Now there is an opportunity with a new government with hopefully some stability and, you know, a few years at least.

Speaker1: [00:17:33] Large majority.

Speaker3: [00:17:33] Large majority to double down on this, let's really focus on how we deliver that shift. They'll need to be short-term improvements of course along the way. But that would be a big prize.

Speaker1: [00:17:46] And that's been a prize that's been on the horizon. You say, for a long time. My memories. I'm just jogging it. Five-year forward view 2014. So it's been about a decade. I just want to touch upon that because the importance of primary care is fundamental. And the shift, as you've said. But it's interesting that the proportion of the NHS budget on primary care has tended to fall in recent years. A number of consultants have grown. So are you confident because the government have set their stall on neighbourhood primary care delivery? Mr. Streeting has made that a really a key pillar of his policy.

Speaker3: [00:18:24] Yeah, it's difficult to do, which is why it hasn't happened, because it's not as though there isn't willing and there isn't understanding and to some degree rather a lot of consensus that it's a shift we want to make. As you say, you know, five-year forward view, it said that's what would happen. And it hasn't fundamentally. So I think we've got to be really honest about why. And the reality is with an NHS running so hot you can't just take billions of pounds out of the acute sector. It's not going to happen because it's so challenged. Or it's certainly not going to happen short term. You know, you do need to do some element of you know, either double running or finding a way to invest, in primary and community care and begin to deliver this shift whilst still driving improvements in the acute setting. You know, with some key NHS performance metrics. It's hard. It has to be part of the solution because our NHS model isn't fit for purpose. And if I give you an example, I know a lot about, you know, cancer is a really good example where, you know, by embracing cancer prevention, swifter diagnosis, we can improve cancer outcomes so that we can deliver curative treatment more, more effectively. And often in the UK or in England versus comparative countries, we have diagnosed too late, which makes curative treatment harder. So this shift, you know, embracing prevention, embracing screening and early diagnosis delivers benefits. But we've got to be realistic about the challenges we face as a health system. You can't switch one off whilst you switch another on.

Speaker1: [00:20:10] That means drawing in a more strategic approach medicine, preventative, personalised care. And if we could talk about the community, I'm absolutely compelled to mention the importance of social care, something that I think is very close to the King's Fund's work. And I just wanted to talk about that must surely be part of the solution strategically.

Speaker3: [00:20:34] Yes. I let out a big sigh.

Speaker1: [00:20:37] I heard it.

Speaker3: [00:20:38] Yeah. Of course. And so far, let's say that the signs haven't been that encouraging early into the new government's tenure. I mean, there's a lot we have a social care system that isn't really fit for purpose, but I think there are lots of issues we could talk about. I mean, a headline would be you've got more people requesting help and social care and you've got fewer people in receipt. You've got huge pressures on the funding model. And essentially you've got lots of people who need care, who aren't getting access to it. There's an access issue, so it does need attention. I think there is another element to some of this nationally, which is often people don't have a very good understanding of how the social care system works. So it comes as a big shock to them if they or their family need care. Yes, it's so difficult to navigate that we do have this issue of some people facing catastrophic costs, but there are a whole host of other issues as well. You know, we've got high staff vacancies, we've got workforce retention issues. And so it has to be part of our solution, not just as it's often talked about in the media, so that we can, you know, de-clog up our hospitals. But because there's intrinsic value in care. It's hugely valuable. It makes a massive difference to people's quality of life. And I happened to visit a care home in southwest London a few weeks ago, and it was just so uplifting, you know, wonderful care being delivered and but some perverse incentives, so much so that that they were reporting to me, they're often in receipt of people who are, you know, in a pretty bad way and then through care and attention and what they're able to do, they're seeing such an improvement that they're having conversations with the local authority saying, we'll do these people need to be here now, which doesn't seem quite right. But, you know, we need to value care, and it does need attention over, over this parliamentary term. 

Speaker1: [00:22:40] And I think you've pointed out we're not alone in England and the UK in terms of facing these challenges. There's some recent studies done. I think Commonwealth Fund, some areas in terms of patient experience is better than internationally. Some are not. But I think you talked about the social care on its own needs to be respected. But it also is that just some simple wins, I guess. Inverted commas. The hospital discharge blocks a number of beds, which caused a huge impact. And I think that presumably will be should be a high priority because if you fund social care properly, you're more likely to make that less of an issue in terms of productivity in the NHS.

Speaker3: [00:23:22] Yes, I mean, there's clearly a role for and I know this is a high priority in lots of parts of the country really thinking about optimising discharge. And you know, we know we have many thousands of people sort of medically fit to leave hospital who are for one reason or another still in hospital. So yeah, we do need to think about how we can, you know, help people be in the place that's best for them as well. Because, I mean, the other thing I know from lots of previous roles is, you know, for people, for patients, they either want to be at home or they want to be in a different care setting. It's good for them. It optimises use of NHS resources.

Speaker1: [00:24:06] The other bigger picture you talked about the system could be broken. The society may be broken. There's certain aspects that need to change. I just want to touch upon some of the strategic things that might be done there. Of course, there's some really interesting work in terms of the Pathway to Work Commission, chaired by Alan Milburn in Barnsley, which talked about this issue around helping people who are facing ill health get back to work. The broader picture now, the canvas is what promise do you think that the integrated care systems could play here? Because they were, I think, to quote a phrase from the King's Fund, they were born in a storm, but they offer quite a quite big potential.

Speaker3: [00:24:46] There's huge potential. And I think the premise on which they were founded, which is you know, there's a huge opportunity to deliver a higher quality care if you integrate and if you wrap services around people is one that, you know, I there's a huge amount of support for. They have faced a rocky few years. We've published quite a bit recently and actually, there are reasons to be hopeful because you are seeing, I think, a real shift in certain places. If I give you a couple of examples, we looked at ICS development through the lens of dementia as one example, and we showed that where local areas, ICSs, had prioritised dementia. You are seeing some really positive innovations, some shifts, working differently with local partners, voluntary and community sector, different agencies. We've also recently published a piece looking at workforce development.

Speaker1: [00:25:48] Systems Approach. 

Speaker3: [00:25:48] Systems approach to work. And there's some fantastic examples of areas saying, how can we optimise our workforce to deliver better health. And so breaking down organisation, organisational barriers and silos and sharing workforce, or thinking more flexibly about the workforce. So I think, you know, there's huge opportunity. It's still relatively early days. And, in this context of, you know, many ICSs have had to find very significant savings. We've got to give them a chance to succeed, and we've got to make sure, I suppose the context is right, that they can drive improvements. 

Speaker1: [00:26:27] And their commitment to health and tackling health inequalities is the backdrop around, what you're really calling on the government to do more a philosophical, even psychological point? It is hard. I think you've made this multiple complex factors at play here. Not switching one button on. It's not just funding. What would you like to see in terms of. I think you've been on record as saying you'd like to see some courage and boldness from government. What specifically do you mean by that? Because they are under the spotlight. They've made some big commitments. But sometimes people can be timid. 

Speaker3: [00:27:03] They can. And I think, you know, particularly at the beginning of a parliamentary cycle, new government, big majority. You know, this is the moment of maximum political capital. So it's only unfortunately for any government, probably downhill from here. So now's the time to be bold. I would like to see, you know, a pretty, a bold and a courageous approach to population health to public health. I think the health mission is a huge opportunity to do that. I think there's also a huge opportunity to knit together with other public services to think about housing to think about employment. Think about physical and mental health. And I've seen fantastic examples in the past. You know, some that are dear to me from previous roles, you know, tobacco control. You know, I worked on the smoking ban in public places many years ago, and it did require some political courage.

Speaker1: [00:28:01] Sometimes quite a lot of resistance.

Speaker3: [00:28:02] Well, there is. I mean, I do think politicians often worry more than they need to. And, you know, we've done our own polling, but there's plenty of polling out there to show the public understand some of this stuff very well and are really supportive of a whole raft of public health measures. So I think we need some bravery and courage there. I think we need some bravery and courage in a whole host of other areas, actually. So, I mean, you know, one would be technology and, you know, patient data. We feel stuck in a circular discussion at times and over the years about accelerating work and progress in this area. And if I had a penny for every time I've heard someone say, we need a national conversation about data sharing. Now we have made progress. But this is a big deal. You know, we could unlock huge amounts from a productivity perspective, but also from a patient public benefit perspective. We've got to do it right. We've got to do it carefully, but we've got to commit to some of these things. We've got to go for them. We've got to have the difficult conversations and show some courage and bravery where we think it's the right thing to do. And maybe finally just on this shift, you know, I completely understand, you know, politicians are constituency MPs first and foremost. It's really difficult to do things like reconfigure local health services. And anyone like standing outside a sort of shiny new building. But what's right for the health needs of the local population? And sometimes it might not be that glamorous to, you know, focus on reconfiguring a particular part of your service or bolstering services that aren't as visible, and maybe where there's not a shiny building. But if that's what we need to improve population health to deliver this left shift, to diagnose and treat earlier and help people stay well in a model that's fit for the 21st century, that's what we've got to do.

Speaker1: [00:30:04] And the final point, if I may, this is going to require a leadership that you've alluded to, but it's also going to require the machinery of government to work. And it's I think it's a well-laid story. Sometimes the tension between the health department and Treasury, etc.. But, talk to us a bit about the idea that this now has to be joined up, non-siloed, because otherwise it's never going to work because you've already pointed out the Department of Work and Pensions has to be very much involved. Housing, healthcare. We're beginning to see a bit of that. I don't know because you've spent a lot of time with everybody. Does that give you some confidence?

Speaker3: [00:30:42] Yeah, it does give me hope again. It's a hard road and so we can't pretend it's going to be easy. But I think the intention is good. And I think some of the kind of diagnosis of actually, if you're going to get under the skin of some of these intractable issues, you have to work in a different way. And so that is, you know, grown-up conversations about what really shifts the dial at national level. I also think it is really important to think about national, regional place and local level. You know, I've gone out and seen some just such fantastic examples of, for example, local authorities leading great work on public health or, you know, systems. ICSs working with local partners. So there's also got to be a recognition. And often there is this tension that plays out and that of course.

Speaker1: [00:31:28] Not everything in the centre, devolve.

Speaker3: [00:31:30] No, it's difficult. It's difficult because ultimately there's an accountability at the centre. But the reality is you can't possibly drive everything from the centre. You've also got to empower people. And partly that's what ICSs were set up to do, is to really understand population health need at local level and act on it. You've got to then accept the consequences of that which is, well, people will choose to prioritise on different things in different places and neighbourhoods. And, you know, that's legitimate. That's what working with communities rather than, you know, more of a sort of top down, paternalistic view is that's what we've said we'll try to, you know, deliver through. We've got to give it a chance. So I think it's both about national infrastructure working better together. You know, we can't improve fundamentally the health of the nation purely through the NHS. It's broader. And it is also about taking a national, regional, local place approach to things.

Speaker1: [00:32:29] And finally with your work, new strategy, the King's Fund obviously very involved. I think you lost Sally Warren to the Department a couple of months ago. Priorities for you in the next few months, obviously, to keep everything on track and accountable in terms of the government. But a couple of specific things that you're really top of your agenda.

Speaker3: [00:32:50] Yeah, I think it is about, you know, we can't preach being bold and brave if we're not willing to be. So I think there's something about, you know, holding feet to the fire a little. And I want the King's Fund to be, you know, not afraid to speak out. I think sometimes people have said, you know, we can be, you know, quite close to government. We want to be a great partner. And partly that is about great collaboration with whoever. But we've also got to be unafraid of, you know, telling it how it is. We're doing some fantastic work at the Fund on a whole range of different areas. And maybe if I just pick some work on poverty that we're interested in taking forward. And that is to give a bit more voice to some of this social context and the transformative opportunity that the health mission that the government is talking about does offer. How can we make sure in that scenario, that we are helping influence and inform that because so often the short term, the immediate can take precedent.

Speaker1: [00:33:59] Winter pressures, etc..

Speaker3: [00:34:00] Exactly that.

Speaker1: [00:34:01] So the idea of turning that dial just to finish that off, I think you started at the top saying it could be society that's broken, but if you turn the dial on poverty as an example, that can, that alone could have a dramatic effect. Taking away the stigma.

Speaker3: [00:34:15] Absolutely. And also just trying to be pretty practical as well. So, you know, we did publish a piece saying, well, what can the NHS do? And so again, sharing best practice examples, the King's Fund has got a long history of doing that. You know, case studies where it works, trying to spread best practice and good learning. And I suppose one of my observations is because the system is running so hot at the moment. You know, people then don't necessarily have the time, the resource to go and visit other places to learn. And, you know, great innovation and best practice doesn't get spread in the click of a finger. And if we can make a positive contribution to helping that happen, I would be pleased.

Speaker1: [00:34:55] Well, I wish you the best of luck with that, and I hope you'll come back and update us on your strategy and your work. But in the meantime, it's been a huge pleasure, Sarah, and thank you for your time and your wisdom today. 

Speaker3: [00:35:07] Thank you for having me.

Speaker1: [00:35:08] My pleasure. If you've enjoyed this episode, please like, follow, or subscribe wherever you receive your podcasts. And if you want to learn more about how we're turning the dial on the health and social care debate, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you very much for joining us, and I look forward to seeing you on the next podcast.

Speaker2: [00:35:29] Voices of Care, the healthcare podcast.