Marvin Rees, Mayor of Bristol: the role of cities and place in shaping health

Key:

HM: Helen McKenna
MR: Marvin Rees

HM: Hello and welcome to The King’s Fund podcast where we talk about the big issues and ideas in health and care. I’m Helen McKenna, I’m a Senior Fellow here at the fund and I am going to be your host for this episode. Like many people at the moment, we at The King’s Fund are working from home which means we’re recording this episode remotely. So, please excuse any background noises you might hear. Today I’m so pleased to be joined for this episode by the Mayor of Bristol, Marvin Rees. Marvin, you’ve had a really exciting career journey including roles with the International Development Agency Tier Fund and you’ve spent time in the US in Washington DC, working for a social justice organisation, I think? And you’ve also previously worked with the NHS and as a broadcast journalist for the BBC.

So, I’m hoping to ask you a bit about your career to date later in the episode. But first, just a massive welcome from us to you Marvin because we’re so delighted to have you with us today.

MR: Oh, thank you for having me on, really appreciated.

HM: So, a nice easy question for you to start with. I gather you were born and bred in Bristol? What is your favourite thing about your home city?

MR: I like the fact that you can get to the edge of it and you can see the edge of the city from the middle of the city which is quite special. So, you don’t feel totally entombed by concrete.

HM: That’s nice. How long does it take? Can you walk there?

MR: Yes. I’m in the centre of the city right now at City Hall. But on a bike, I could get to the North Somerset border probably in about ten minutes with a fair wind.

HM: That’s amazing. That’s not like London at all.

MR: I was told not to say that the best thing is you can get to the edge of it because -

HM: Because it sounds like you’re trying to get out?

MR: - Exactly. But there’s always something very special about being able to… just to see the edge of something. Lots of green space in Bristol as well which is also very, very, positive.

HM: So, you were elected Mayor of Bristol back in 2016? But as I mentioned in the intro, obviously, prior to becoming Mayor, you’d already had a really impressive career spanning loads of different sectors here and abroad? What’s the unifying thread or theme between the different roles that you’ve had?

MR: Well it’s interesting you call it impressive. I wouldn’t call it that. I’d call it chaotic.

HM: I don’t think so.

MR: And, just, the easiest thing to talk about is the unifying thread. The unifying thread has been trying to find out a way of making the world better. So, when I worked for the Aid Agency, that speaks for itself. When I went to Washington and worked with Sojourners, again, that speaks for itself. An organisation that came out of the back of the aftermath of the civil rights movement and was involved in Call to Renewal, Jubilee 2000, the Campaign for Debt Cancellation for the world’s poorest countries in the late nineties. When I went to the BBC, I really wanted to find a way of giving a voice to the voiceless. People who were often not heard, voluntary sector.

The same in the Health Service. When I worked at the NHS in public health, I was working on the Race Equality Mental Health Programme. Again, that just… it’s to find expression in politics. So, actually, it, kind of, qualifies my relationship to elected office. I didn’t grow up wanting to be in elected office. This is just the current expression of what I wanted to do because it’s another means of trying to make the world better.

HM: And the role of democratically elected mayor in Bristol is obviously relatively new? So, I think, it was first introduced in 2012. And you’re the second person to hold the position. How does it fit in, how does your role fit in with the structures of government at a local level and what does the role involve?

MR: Well we’ve had to adjust the structures of local government. And I ran in 2012 and lost. But the point I made back then is, it would be a mistake to just take a mayoral model stick it on the old model of local government and expect it to work. The mayoral model is very different. Under the leader, the political leader model, the group of… the party with the highest numbers of councillors go into a room and decide amongst themselves who the political leader is going to be. So, it has got nothing really to do with the city. So, you could have 33 people going into a room, 17 of them say who they want, and that person becomes the leader of the city, irrespective of what the city thinks. The mayoral model is directly elected and directly accountable.

So, that changes the nature of the relationship between the mayor and the city. It also changes the nature of the relationship between the mayor and the local authority and the councillors. It’s a whole different dynamic and we have to work out what those dynamics are and that’s what we have been trying to do. So, my model of political leadership is much more looking outward to the city than it is getting involved in the machinations of local authority. My point has been, I am more accountable because I’m more visible. If stuff doesn’t happen, you know it’s me, that’s accountability. The people know it’s me. When you ask the question, ‘Why didn’t houses get built in 2007?’ no-one knows, right? Because it’s just an anonymous committee. So, invisibility is the best form of not having accountability. So, we’ve been trying to really transform.

HM: So, it sounds like you’ve shaken things up quite a bit, has that been difficult to manage?

MR: I think there are a number of things that have been difficult for people to take on. One is, I am… everyone claims to be an outsider now in politics, it’s like a mantra, isn’t it? If you talk to any politician, they grew up on a council estate, you know? So, it’s everywhere.

HM: Yes. Or their mum did or their grandma did?

MR: Yes, yes, yes. But I did.

HM: Yes?

MR: For real. So, I think there are a number of adjustments to be made. No matter which way you cut it up, even though everyone claims to be radical, this is a really turgid organisation, historically, politically. It had nothing to do with me growing up as a kid and it certainly didn’t have much to do with me even when I was running the Race Equality Mental Health Programme. So, I am coming in as an outsider and people have struggled with that. Whether race and class is an issue, that’s a conversation for another time. But, yes, I’m supposed to be the first directly elected mayor of African heritage of any major European city. That has brought change too.

And what we’ve also done is, even though I say I look more out to the city, we’ve set something up called the City Office which recognises, which may come up in later questions, that what people receive from Bristol is not the result of decisions made by any single organisation. The local authority is one among many players determining life outcomes for people in the city. The Health Service is a massive shaper of that. And I don’t have control over the Health Service, the police, the criminal justice system, many of our big businesses.

So, what I’ve done is, I’ve put much more energy into working with our city partners, Placeshapers, bringing us together under a shared vision that we’ve all written. It’s called the One City Plan. And working proactively with our partners to make stuff happen. And the opportunity of the mayor is to become a place leader, not just a local authority leader.

HM: When you were describing your role as leader and how you’ve been shaking things up, it made it sound like it’s quite a lonely place to be sometimes, is that right?

MR: It can be. But, to be honest, that’s like anyone. I think in leadership you can feel quite alone. But the secret of that must be having a fairly strong group of trusted friends around you. Any West Wing fans out there, there’s a fantastic moment where -

HM: I’m a massive fan, yes.

MR: - Well, there you go, you might remember this one? Bartlett is leaving the Oval Office to go off to his stately union address. And I think he says to the designated survivors’ young representatives, he says, ‘Have you got a best friend?’ He says, “Yes.” He said, ‘Is he smarter than you?’ He said, ‘Yes.’ He said, ‘Do you trust him with your life?’ He said, ‘Yes.’ He said, ‘There’s your chief of staff.’ And I suppose the secret of leadership is to find people who are smarter than you, who you trust, and bring them around you. And, in fact, that is actually a piece about leadership for me is, I’m around all these people who are smarter than me, who are great, especially … you know, certainly in their specialist areas. But, I guess, one of the qualities of good leaders and I’m not claiming to be necessarily good leaders but, certainly, a quality I aspire to is being comfortable being in a room in which everyone is smarter than me and not needing anyone to be less than they can be to make me feel comfortable. And, you know, there are leaders who do require people to be less and I hope I’m not one of them.

HM: That’s positive. And you want smart people around you but smart people that are trusted but challenge?

MR: Yes. But, then again, the challenge comes from the right place. You know that what we are doing is looking for truth and looking for the best. What we’re not trying to do is build a kingdom. Again, that’s where trust becomes so important. I will share, actually, because I’ve got it on my wall. When I was first elected, I took the cabinet and it was a cross party cabinet, at the time, it’s not anymore. We said, ‘What are the values that we think should shape the way we interact with each other?’ We said, ‘Bold, caring, enabling, trustworthy.’ And I put trustworthy rather than trust, because trustworthy is a quality you develop in yourself for other people. I’m not just going to go and trust you, that would be naïve, right? And the other one was gracious, because we want people to be gracious towards each other, you know?

If you fail, I’m not just going to rip you apart. And there’s a lot within my city, historically, of people giving it to everyone else, you know that?

HM: Oh, yes.

MR: Everyone wants to give blame to someone else for the reason things are happening and the world is much more complicated than that. But graciousness is something that has really, kind of, caught a hold amongst some of the conversation we have in the city.

HM: So, at The King’s Fund, we’re really interested in what we call collective, inclusive and compassionate leadership. And by that we mean, kind of, leadership that shifts away from traditional command and control structures and what’s known as heroic leadership style to styles that distribute leadership to wherever capability and motivation sit and that focus on trying to reach a shared understanding with people. And it actually sounds like you’ve already touched on some of those concepts using different language in how you’ve described what you’ve been doing at the city level. But do you recognise that type of leadership in your own practice?

MR: Yes. I mean, I’m not going to overclaim but it’s what we would want to do. I’d say a couple of things in response. One is, my Chief Constable here… he’s not mine, but the Chief Constable, Andy Marsh, he said something over dinner once that I wrote down. He said, ‘World-class public-sector leadership is no longer about what you control, it’s about what you influence.’ I don’t have control over the Health Service, the universities, but because we have come together to write a shared vision, we influence each other.

I also learnt a lesson if I dare pull it in. When I was a teenager, I was going to be a Royal Marine Officer, there was this Royal Marines Officer and he was the most… he led the most decorated troop in the Falklands, you can tell how long ago it was because it was in the 1980s and I was a teenager. We came back for a debrief at the end of the day, running round the Lake District, and, you know, we had all been trying to prove how fit we were, you know, running up the side of hills until snot drips down about a foot from their nostrils, probably too graphic.

HM: Sounds very glamorous, yes.

MR: But no-one stops running, no-one stops moving, because they want to prove how, you know, macho they are. And he said to us, ‘You guys, you think that being the best Royal Marine Officer is all about carrying 100-pound packs up mountains.’ He said, ‘There’s an element of that that’s true. But the best Royal Marines Officer will find the best shot and give them their rifle. The best map reader will give them the map. The fittest guy will give them the heaviest burgon. And then, they will get by on four hours sleep so their guys can have six hours sleep. And I’ve never… obviously, I’ve never forgot that, right? You find the people who are equipped to do the job and then you sacrifice your wellbeing to make sure that they can flourish. That servant leadership is at the heart of that and that has always stayed with me and it’s something I try to practice. I probably don’t get it perfect but, you know, you try.

HM: Obviously you work as mayor for everyone in the city? So, there’s a huge task around balancing the needs and requirements of all the different stakeholders you work with. Is that, kind of, ability to find compromise essential to successfully or effectively leading, in your role?

MR: See, compromise is a loaded word here, right, it’s a challenging word. Because, first of all, I’d say, this is a democracy. And in a democracy when you’re doing a deal, no-one walks away from the table with everything they want. If you don’t compromise you get nothing. You’ll be one of them, what I call, the touchline prophets, you know? They never have to risk getting muddy, they never have to risk anything, because they’re not on the game. But they’re fantastic at telling everyone else how they should run around. That word compromise is a reality of life because the reason it’s problematic because people also flip it with the word sell-out. So, you got elected and now you’re selling out on your principles. And in some sense, they want you to go out in a blaze of glory. And that’s why I find it, you know, a bit of a problem.

HM: A loaded word? Yes.

MR: Yes. But take Barack Obama on the health reform. So, suppose Barack Obama goes to a young African American kid and say, ‘Listen, I’m sorry I didn’t get any health changes that meant that you got your liver operation and you’re going to die, but I just want you to know that ideologically I’m pure. I didn’t compromise, I didn’t cut any deals and I kept true to my principles. And I would say I would not do a deal unless you went 100% where I am.’ It’s pathetic, it’s selfish, it’s self-indulgent.

HM: Well it’s not really understanding the realities of leading and being accountable, is it?

MR: No.

HM: Because if you’re just principled and ideological then you’re not able to secure improvements for people. So, I wanted to talk to you. You brought it up before about the, kind of, powers you do have and the powers you don’t have. We’re very interested at The King’s Fund in the concept of place-based care. So, Bristol, obviously, is a city with a strong identity of its own. But in the health system it’s also part of this wider footprint, the Bristol, North Somerset and South Gloucester Sustainability & Transformation Partnership. So, in that sense, it’s part of a much larger area. And, I just wondered, how that relationship between the STP and your city works in practice? How do you work out what decisions are getting made at each level?

MR: So, primarily, obviously, it’s through the interaction between health and adult social care and then, obviously, through the Health and Wellbeing Board where we bring people together. And that Health and Wellbeing Board is responsible for coming up with a health strand in our One City Plan. So, our One City Plan has six strands to it. Health and wellbeing, education and skills, homeless communities, transport connectivity, economy and environment. We’re due to sub one in soon to have one for children and young people instead of education and skills. But that’s it. So, the idea is that that health voice speaks into the One City Plan.

Can I just gently challenge there and I would love the opportunity to do this, just what you described there. That the health system is not the health of the NHS.

HM: No, absolutely.

MR: So, I think… and I know this is a King’s Fund, kind of, thing. So, I did a lot of thinking and certainly when I was in the Health Service myself and then when I was actually trying to get involved with the Leadership Academy some years ago that I saw the NHS going on this, kind of, journey. But you can correct me if I’m wrong. One is, it started talking about leadership at all, right? So, it discovered that there is such a thing called leadership. You don’t just become a manager and boss people around, right?

HM: Yes.

MR: And then you start to get onto this conversation around, okay, well what is a good leader, right? A good leader of your team? Then it started to talk about systems leadership. And I did a programme a few years ago called Interset which is supposed to be about systems leadership. Interestingly, we spent a day, I won’t say where, but it was with the CCG, Chief Exec, we were supposed to be being told about systems leadership. And she talked about A&E. But as she left, when she left, and we were doing our debrief, I said, ‘What we are talking about here is not health systems leadership, we’re talking about Health Service systems leadership. Because you’re just talking about the NHS. The health system is life, right? The health system is housing, education, criminal justice system, transport and connectivity, quality food and how those things all work together to create better wellbeing and improve health resilience. If we only operate on the NHS bandwidth, we’re talking about fractures and heart surgery and when people are already sick.’

HM: Yes. But to be fair, and I totally take your challenge, but to be fair to the NHS, sustainability and transformation partnerships and their success of the, kind of, integrated care systems, they are meant to be bringing in those other elements and thinking much more in a, kind of, broader health sense, rather than this, kind of, NHS centric, NHS focused sense. Do you think that’s still not happening?

MR: No. We’ve got people in the city in Bristol who are, generally thinking about it, Robert Woolley, Chief Exec of University Hospital Bristol. They had the Chair, as well, Jeff Farrar, Andrea Young at North Bristol Trust, they have been people that have actually stepped up as we’ve opened the door to come in and start talking to us about, okay, how can they begin to push upstream? So, if we’re going to reduce the demand or the pressure on the NHS in ten, 15 years, we’ve got to give people good quality homes today, right? We’ve got to give children access to good quality nutrition. We’re having the same conversation with Peter Blair who’s our city recorder, you know, the top Judge? Those organisations need to begin pushing upstream to say how are we going to reduce, you know, the demand on their future services? So, there has been that vision.

But I think the NHS has a huge role to play as a Placeshaper because it has a great deal of moral authority to be able to say, “We want that housing development to come through”, you know? “We want the investment in mental health in our schools. We want you to make sure that children and young people have access to good quality work experience because by helping them to escape poverty, they” -

HM: And they can create those opportunities?

MR: - Yes.

HM: And, also, they employ so many people in the area.

MR: Exactly. Their role is not just about the health services they provide, it’s estate managers, employers and then agenda setters for the rest of the city.

HM: Yes? And I’d like to talk a little bit more about the other footprint that you’re part of, the West of England combined authority. And I know that as part of that deal that I think was done in 2016, I think, just before you took power, as mayor, you managed to secure additional powers over transport planning, skills and employment? Have those additional powers helped you to, as mayor, create a healthier place in Bristol?

MR: Somewhat. We’re certainly able to put some agenda items down there. But, to be perfectly honest, the combined authority model is an important one because it begins to recognise the way the political economy actually works. It works on a broader footprint than just our local authority boundaries. The challenge is that whatever central governments say about devolution, it doesn’t mean anything, unless you begin to put some money in it and to really invest. And what we need as places to be able to shape our future is predictable finance. Like, this is the point I make time and time again. We don’t even know as a local authority what our financial settlement is going to be next year. That undermines our ability to plan. And our ability to plan, replanning and then rebuilding of our city so that it’s decarbonised, more healthy, and all the rest of it, that depends on a ten, 15 year, 20 year, journey we need to go on. But we don’t have the, kind of, financial vehicles or relationship with central government that allow us to do that.

HM: And so, I was going to ask you, why didn’t you go for the devolved powers in relation to health, like Greater Manchester did? Because it sounds like you somewhat think you don’t have the powers but also, I’m imagining that possibly that’s because you feel you won’t have the money that needs to go alongside that?

MR: Yes. Remember too, Manchester had a couple of decades of experience of working together anyway. So, there’s a different, kind of, relationship, I think. And, again, I dare to be challenged. But the relationship between Manchester and its movement to a combined authority is different to where we were. Manchester’s collection of local authority relationships have grown over a couple of decades. We didn’t have that.

HM: So, are you saying you’re not ready for them, you’re not ready for devolved powers over health?

MR: Well, I think … I mean, I’d be always wary about saying we’re not ready but I’m saying it comes as a challenge. If you’ve got a track record of working together across boundaries as local authorities, in a joined up way, there’s something that’s much more organic about that, what you’re growing into. To be honest, the way the combined authority was presented and I say this quite a bit is, it was back to front. So, basically, what happened was, after the first mayoral experiment didn’t quite take off, because Bristol was the only city in 2012 that said, “Yes, we want a mayor.” The government were, I guess, looking for a new machine. Government basically said to us, ‘Here’s a model of governance, here’s a structure, a bureaucratic structure, we would like you to take it on. If you take it on, we will release money. If you don’t, you won’t get those money and powers and, by the way, you might not even get a place at the table.’

What they should have said was, ‘To flourish, this country needs local authorities to begin behaving in a certain way, right? We need you to start planning over the long term and working co-operative across boundaries. Go away and work out how to do it, show us the governance structure you’ll put in place to support those behaviours and then we’ll come and then negotiate with you about how much we invest in those.’ Simply adopting a new bureaucratic structure does not mean you get the behaviours and the values you need. So, I think, it was fundamentally back to front. Now we’re trying to retrofit behaviours and values into a structure. Now that can work but it can also be problematic.

HM: You mentioned Andy Burnham in Greater Manchester and his, kind of… you know, the pushback to government that he has been making over the past couple of weeks around Covid-19. And I just wonder, so, I don’t think his pushback was technically about him having devolved health powers but, I assume, they gave him more of a platform in a, kind of, soft power, sort of way? Do you think having those powers in your region would make a difference to your ability to respond or deal with Covid-19?

MR: It could do. But, bear in mind, much of our response to Covid-19 has been about people’s awareness of the principles of transmission and working with our partners to manage our population to build trust. So, that, in and of itself, is not necessarily the NHS. It’s about life, isn’t it, and how we’ve got food out of people? So, we’ve got a whole city network to get food out to people, right? That has enabled people to stay in their homes and isolate. That’s not an NHS system, that’s a city system. I have actually been a little bit… and, again, I’m here to be challenged but, from the beginning, I just thought, we need to… this pandemic is not just about the National Health Service. And so much of it has been defined in terms of ICU beds. This is a social crisis.

I read a paper that was in a Lancet and my DPH said to me… written by a guy called Horton, I think, said, 'This is not a pandemic, this is a syndemic.'

HM: Yes.

MR: I’d never heard of the term before.

HM: Me neither, but it’s a really good term, isn’t it?

MR: It absolutely fits. I used it in my State of the City last week. Because it absolutely fits with what we are talking… what we have been talking about in Bristol which, I think, is a public health informed approach to health leadership within Bristol. You have to look at pre existing conditions overlaid on the top of inequalities to understand what is going on. If we think that the only threat to health is the virus and we don’t take account of all those other drivers of health, there’s a real problem. So, unemployment is a threat to health, as you’ll be aware, for example. And so, we need… we need that conversation to be expanded. I’ve said this to government and I’ve said it to our shadow health team as well in the Labour Party, that we need to mature the national conversation on health beyond the National Health Service to actually public health.

My concern is that the protections around public health that used to exist when it was in the NHS have now disappeared, because it’s within local government. And local government, you know, is an easy target. And the quality of relationship between national government and local government is not good and that’s a real problem.

HM: So, as you’ve spoken about, we’ve seen how the health impact of the virus and then the social effects of lockdown have affected different communities in different ways. What has the experience been in Bristol?

MR: Well our numbers in Bristol have been comparatively good. We’ve had a good level of compliance in Bristol. We won’t claim to have come across any secret formula for how we’ve had relatively low numbers because, to be perfectly frank, we know there’s a little bit of compliance and behaviour that we’ve done. But the other thing is, we don’t know, we’ve probably just been quite lucky.

HM: And you don’t know what’s yet to come, right?

MR: No, we don’t know and our numbers are going up now. So, it’s a real challenge for us. So, you know, that has essentially been our experience. But we have… we noticed very early doors, we anticipated inequalities from the virus itself landing on certain communities. We saw that coming. But we also saw the consequences of lockdown. We identified the consequences of lockdown as a health threat, right from the start, as well. So, we set up our feeding programme, for example. We’d already had a big city-wide programme to tackle child hunger and that was reoriented towards just getting food out to people. We started work on our economic recovery plan which has just been published last week. We started it before … within the first week of the lockdown so that we could say to the city, 'You may be going through economic dire situations but we are doing our best to plan our way out of it. Survival, recovery and flourishing economy, so, you’ll have jobs at the other end.' So, we were very proactive around those wider consequences as well.

HM: And, so, I’m really interested in that idea and the potential of the relationship that cities have with each other. So, how are you not just on Covid but, more broadly, on your ambitions? How are you working with other mayors in the UK and then across the world, with other cities?

MR: So, we are part of a number of prominent city networks. We’re part of core cities in the UK, the ten biggest cities outside of London. I’m on the executive committee of the Global Parliament of Mayors. I’m on the board of the Mayors Migration Council which is there to shape the global compact on migration. That’s with Mayor Garcetti, the Mayor of Los Angeles, made a plan for Montreal, Yvonne Aki-Sawyerr, Mayor of Freetown. I know, obviously about ten of us on that. And I tend to see 40 events which are the mayors at a global network of cities funded by Bloomberg. Those are the big cities like London, New York, on climate change, Los Angeles and so forth. So, we’re very active on the international scene.

There’s a few things that really drive that. I didn’t come in with that big agenda but it’s what is driven. City leaders need the power, not only to control and shape what goes on inside their boundaries but the national and the international context in which they work. Because those international forces shape lives in cities. So, migration lands on Bristol streets, right? It is mad that the UN would go through three years of negotiating the global compact on migration and never talk to city leaders. Talk about cities but never talk to city leaders about how it actually works. If you want to talk about the action we take on climate change, if it decarbonised city systems around housing, waste, energy, transport, it would have a massive impact on climate.

Don’t just talk about us, come and talk to us about the impediments of decarbonising our city systems. So, cities are really becoming quite assertive in that space. It is the big movement. It’s not one that necessarily the world of journalism has caught up with, although it’s starting to listen to a lot more. So, it’s not necessarily something that gets the coverage that it should have right now. But it’s certainly going on.

HM: And are there particular cities when it comes to health, health in its broadest sense, not NHS centric health, that you look to aspiring to or ideas that you particularly take from particular cities?

MR: Yes. So, we’ve launched Bristol Thrive and that had been New York Thrive. And New York had done an amazing piece of work, actually, looking at what produces mental health is the city not just our health services. So, how do we build resilience in the first instance from food to housing to community connectivity to employment opportunity? So, yes, we’ve… we certainly took that model and developed it for ourselves here. I think there’s a London Thrive as well that we’ve managed to draw on as well.

HM: And, I think, final question for you. This question is just about what’s next for Marvin Rees? So, are you thinking, potentially, at some point, that you’ll go for a seat in Westminster or is it Bristol all the way?

MR: Again, I’ll search for those opportunities where I can try and make change and try and make the world better with my limited self, you know? I need to be… not false humility.

HM: That’s a very political answer.

MR: Well it is but that’s not fair. You talk to any of your Health Service Managers. No, no, I’m a fallen human being in a broken political system with an imperfect political party, you know? You just do your best. But, no, it’s not necessarily politics, it’s not necessarily Bristol. It’s going to be wherever I can go, you know? I’m really interested in journalism, you know? It’s a career I pursued that didn’t work out and I love the power of storytelling and putting people in touch with issues. A couple of people are interested in trying to get me to do a book. And I’m really, really, a big believer in this global city networks I’m a part of as well and see them as a source of dynamism, innovation and global leadership that we’re not getting from national governments at the moment. So, I’m sure, there’s… hopefully there’ll be opportunities to pursue avenues in those areas.

HM: That sounds exciting. Well thank you so much Marvin, it has been great to spend time with you today.

MR: Thanks for the time, I appreciate it.

HM: So, that’s it from us. You can find the show notes for this episode and all our previous episodes at www.kingsfund.org.uk/kfpodcast. We’d love you to subscribe, rate and review us on Apple Podcasts or wherever you get your podcasts as it helps others to find us and also helps us to improve the show. So, I’d really encourage you, if you can, please leave us a review. And you can also get in touch with us via Twitter either at The King’s Fund account or my account @helenamacarena. Thanks as always to you for listening but also to our podcast team for this episode, producer Sarah Murphy, researcher Johnathan Holmes and also our colleague Simon Newitt for his advice and assistance. We hope you can join us next time.