Where are we with diabetes prevention and treatment in England? Helen McKenna sits down with Dr Partha Kar, Consultant in Diabetes and Endocrinology at Portsmouth Hospitals NHS Trust and Associate National Clinical Director for Diabetes at NHS England, to talk about progress so far, the NHS workforce, and his leadership journey.
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- HM: Helen McKenna
- PK: Dr Partha Kar
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’m going to be your host for the next half an hour or so. I am honoured to be joined by Dr Partha Kar who is a consultant in Diabetes and Endocrinology at Portsmouth Hospitals NHS Trust, as well as Associate National Clinical Director for Diabetes at NHS England and the Getting It Right First Time Lead at NHS Improvement. Partha, welcome to The King’s Fund podcast. PK: Thank you very much for the invite, a pleasure to be here. HM: So, we’re going to be talking more about your career journey and your work on diabetes later in the episode. But first, to start us off, I understand that you are a massive fan of comic books, and that you’ve actually produced a comic for people with type 1 diabetes. So, my first question, just to kind of get you in the mood is, if you were a superhero, a real-life comic book hero, what would your superpower be? PK:
So, ironically, one of the most favourite characters for me in any comic books has been a character called Nick Fury. What I’ve always liked about that is that he’s a person without any superpowers, but he somehow manages to get a lot of people with superpowers together, to form a team. And if you look at the comic books, or any of the movies that have come since, it shows the importance of what that can achieve. And I tend to try and take that into real life. So, not completely taking the analogy forwards. But if you see what I try and do is in any events, I try to get a lot of people with diabetes together, and somehow it seems to work together. But if I had a superpower, probably the way the whole NHS is, glimpsing at the future would be very, very helpful. And there are superpower heroes with those sorts of power, that would be extremely useful to have at the present moment.
HM: Amazing. And your answer to that just sounds like the perfect answer to an interview, like a proper interview question for a job. So, you currently hold a range of roles, including your posts at NHS England and NHS Improvement, and also your consultant role in Portsmouth. Can you tell us a bit about your career journey and what led you to where you are now? PK:
Yes. So, I did a lot of my training in the Midlands, and then eventually settled on the south coast of England, finished my specialist training in diabetes endocrinology and took up a consultant job in 2008. 2009 I did my first management role. So, one year in, I became the clinical director of the department, probably a lot by default. And it was … I wouldn’t say a baptism of fire, because I had really, really good supportive colleagues, but, it was an experience builder in those days. And after that in 2010 came the new NHS, the Health and Social Care Act, that changed a lot of things. So, it was interesting, being in the middle of that, with CCGs and everything being formed etc. Then over the course of time, I’ve continued to do my day job and finished my clinical director job in 2015. I started doing a bit of national roles which was not quite related to NHS England, but was more about taking some leadership roles in, for example, NHS Diabetes, in those days, the day before it all got amalgamated.
2016, middle of 2016, I joined NHS England as one of the Associate National Clinical Directors, took on certain portfolios, and then in 2017, there was the Getting It Right First Time role, seemed to sort of work together. So, it has been a very interesting journey, portfolio career, so to speak. But in the middle of that, I’ve also actually worked beyond diabetes in Community Trusts. And that was more as a role across mental health, and also worked as a secondary care adviser to a CCG which was Ascot and Bracknell CCG. And I suspect a lot of the reason for doing those bits and parts of roles was just to get some experience before taking on the national role. I would say that has held me in lots of good stead along the way.
HM: So, you’re one of the few people actually that I’ve met that talks about the Lansley reforms as something that you kind of ran towards as something interesting, rather than ran away from, which is fascinating. And then in terms of the extra roles that you’ve done beyond diabetes, the Community Trust roles and the secondary care adviser to a Clinical Commissioning Group, was that something … I know you’re saying it has helped you in your national role. Were you aiming for that national role, is that why you took those additional responsibilities? PK:
No, I wouldn’t say that. I think it was … so, my fundamental belief, even when I started my role, I never quite understand the concept, or I still haven’t, as to why a diabetologist has to be a hospital diabetologist or a community diabetologist. I have always said and I continually say that a national role, the term community diabetologist is a bit of a tautology, you know? A hospital is part of the community. And when I see these roles advertised, I have never quite understood the point. And to test the theory, I took on the other roles to see what actually goes on in the community. And I think it has been part of the learning experience. It has also been, when you’re sitting in a hospital, it is very easy to say the CCG didn’t do this, or the CCG didn’t do that. Doing that role, the advisory role, was probably about getting a sight of the challenges they have and diabetes is just a fraction of what they do.
So, it was more about learning. I don’t think it was specifically aimed at being a national role. It was more about believing that a diabetologist could be wider.
HM: Great. And I understand that you spent the first seven years of your life in the west midlands? PK: True, yes. HM: And then you moved to Calcutta in India, where you did most of your education and then began your life as a junior doctor in a hospital there. PK:
HM: So, how did you find training abroad, and then coming into the NHS? PK: So, the interesting thing about Calcutta is that even though India attained independence in 1947, the medical system is a replica of the British medical system. It probably doesn’t, or at least when I was trained, it didn’t have the level of technology at that time. But the training courses and the exams we go through, are pretty much similar to how the British system works, because that’s what the British had left behind. So, even the medical colleges are named still after the way the British had left it. And as a result of that, the training wasn’t very different. What was different is awareness of a bit more advanced technology. So, a simple example would be, even to get a chest X-ray in the middle of Calcutta was very difficult, when I was training, here it would be very simple. So, a simple example. But training wise, there wasn’t a huge amount of difference. HM: Yes. PK:
But when I came here, I still did what in those days was known as a clinical attachment. So, you do an unpaid job for, it’s like shadowing, for six months. And it was, you’re not hands-on, but you shadow the team.
HM: And was that a requirement, coming here? PK: It pretty much was seen as something that would be encouraged, before you took on a job, which I think was a good thing to do, because a new system, you know? New hours, different ways of working. And I did that in a hospital called Wordsley Hospital, which is a very small hospital, and it was just nice to sort of see what the British system was like, so, yes. HM: Okay. So, moving from your training to the NHS workforce, more broadly, so you might be familiar with our recent report, looking at possible solutions for tackling the growing workforce shortages in health and social care. I was really interested to read a piece that you published in the BMJ last week, where you took a slightly different angle to the issue. So, you were looking at the responsibility of senior staff, such as yourself, to the next generation of staff coming through the system. And you were talking a lot about pastoral care, and the importance of that. Can you tell us a little bit more about what you meant there? PK:
Yes. I probably would start off by actually congratulating you on the piece of work you mentioned, because I have read it, and I do read The King’s Fund work.
HM: Awesome, thank you. PK:
And it does resonate, if I’m very honest. Because my personal view is, it’s very easy to criticise everybody else, but I think we should go into that particular stage, after we have sorted our own backyard out. And as consultants, we have got a lot of power in the system, in spite of what people will say so, we’ve got a lot of influence. And the biggest influence we have is what we have in our next generation. I personally find it difficult to believe that consultants do not have the time to have a kind word for a junior for our generation next. I am busy enough, but I take a lot of pride in trying to nurture the next generation.
So, in Portsmouth, we have been very lucky to ensure that we have a steady stream of trainees picking up endocrinology. In fact, our latest colleague used to be an SHO, then she became a registrar, and now she is our consultant colleague. And we’re trying to do the same with the next generation. I have always been fortunate to have consultants who, in spite of being incredibly busy, had the time to just say a kind word, buy a coffee. It doesn’t take a lot of time to do that. So, a pastoral role, I think, is very important. The majority of healthcare staff are there because they want to do it, and they will give you extra, and that’s what draws them towards it. But to make them feel wanted is a skill, and I think that’s part of what we should do.
So, as far as the workforce crisis goes, yes it is there, yes there’s an issue, and it’s a worldwide issue, it’s not just the NHS. But we can do a little bit to make the generation next feel a little bit happier in their job.
HM: Yes. And it’s interesting to hear you talk about the solutions that come from within the workforce itself, rather than, I guess, staff feeling powerless, in terms of making a difference. PK: Yes. There are little things which does make a difference. You’re absolutely right, we can talk about the junior doctors’ contract, that is very emotive etc. But I’ve always said, and that’s what I kept on saying, in the blogs I write, the junior doctors’ contract issue and the emotions that brought out, was also about something deeper. It was not just about the contract, it was about how they were valued by everybody. So, I think we need to be cognisant of that, and try and reflect that in our day to day practice. I don’t think it happens enough and that would be my view. HM: And I’m glad to hear that you were saying on your way up, when you were earlier in your career, you felt that people did have time for a kind word and a coffee, do you feel that something has changed, that means you’re writing about that now? Do you feel the culture has changed? PK: Fundamentally, absolutely. I think a lot of people still do it, but the numbers have changed, there’s no question. One very good example I would give you is that I make it a point that if I’m doing a weekend ward round that the breakfast is bought by me. Now for me that was just common and normal when I was growing up. Nowadays when you do that, it’s seen as a massive surprise to the junior doctors, and that shouldn’t be the case, you know? You thank them after a ward round, or buying them coffee, or whatever. So, I find that slightly interesting, at the same time slightly disheartening that it has become much more rare that that has become the way it is. It shouldn’t be. Are we busier than our predecessors? I don’t think so. I have been in the same NHS now for 20 years. We’re all busy, our predecessors were busy too. HM: So, what do you think has changed? PK:
I don’t know whether it’s a generational thing or whether it’s just a society thing, the whole system seems to be much more angry, and you get that everywhere. Is social media a good thing for that? I think it’s a double-edged sword, where you see that all the time, people are very angry about everything. And people don’t talk about it in the right … or the more happier things don’t quite come out. There are lots of good things that happen in the NHS every day, even day-to-day. So, I think that that is what has changed a lot. And I understand it’s the pressures, but it just seems a bit more angry than everything else.
HM: Yes. And a lot more polarised. PK:
HM: So, in a different BMJ piece, I saw you write that the NHS is not Disneyland, but neither is it Mordor. And that the more you explore different areas, the more likely it is that you’ll find your niche, if you enjoy your job, everything else falls into place. Can you tell us what you enjoy about your job, in particular? PK: I enjoy it full stop. And it’s not even a rhetoric, I mean you can come to my department any time. I’ll give you one example. I’ve come here and today was a day when a couple of our nurses baked me a cake, which has got an Iron Man on top of it, because they just wanted to say thank you. There was no need, absolutely none. HM: So, it was just off the cuff? PK: Just off the cuff. And we do that as a team all the time, you know? HM: That's lovely. PK: And we have fostered that culture. Because, for example, if there’s a job advert coming up, we will go and bat for the nurses ourselves as consultants. So, it works both ways. I really enjoy going to work in Portsmouth, and people have asked me that question, so, for example, would you go higher up in NHS England? No, I’m quite happy where I am, doing what I do, and I’m very happy to fall back and just do my day job. HM: Well that was going to be one of my questions later. PK:
So, for me, I think I have been a registrar there, I have been a consultant there, I’m now there for ten, eleven years, it’s a really lovely place to be part of. And again, it sounds amazing, but I would ask anybody to ask our juniors, or our admin staff, or our healthcare assistants, what they feel about working there. It is a really happy place to work in, and I really love that.
HM: That’s great. And for those of our listeners who are working in the NHS and might currently be struggling, in terms of workforce pressures and other things, struggling to enjoy their work, do you have any advice for them about how to find enjoyment? PK:
I think there are some specialties which are far harder pressed than the others, that’s the reality. I do not believe for a second that I as a diabetologist am more busy than a general practitioner or somebody who is doing emergency medicine, or a paediatrician, that sort of specialty. They are swamped. I just think as a system we should do more for them, just make their life a little bit more easier, somehow, I don’t know how. Whether that’s work/life balance, or what we can offer them. Whether it’s a differential pay, whether it’s more holidays, I don’t know. But I think we need to do something. And there’s always a debate, should it be differential? I think some specialties deserve that.
Today’s world is a lot about work/life balance, and my only advice to them would be try and disassociate yourself from work when you’re off work. Find a good set of friends and just get off the whole barrage of social media, work around you, email, just completely disconnect. Go and enjoy your time with your family, your dogs, whatever you’ve got, just switch off. It’s very difficult to do in the modern world, but that’s the only advice I can give people.
HM: And just to push you on the pay differentials, Partha Kar setting pay, which specialties would you pick for that? PK: Front door. I know it’s a broad term, front door. But I’ve got a lot of respect and time for emergency physicians, with the work they do. I absolutely would not be able to do the work they do, and I don’t even say that in a light way. Because on the very few occasions I have walked in, when the hospital is overflowing, I look at what they do and I do think they deserve a differential pay to let’s say what I do. I do an outpatient speciality, I do community work. Yes, it’s important, but it’s not as heavy top-loaded as what they’re doing. Again, general practitioners, I would say, I would probably say primary care as a whole needs a different way of looking at what they do. Because it’s such a big workforce gap and we need to do something to help them out. But as I said, my first pick would be emergency physicians. HM: Great. So, I’m now going to ask you a few questions about your work on diabetes, and also your work on digital technology. So, looking at where we’re at in terms of managing diabetes, it seems like we’re on a journey. So, shifting from a focus on a medical model to one on prevention. I wanted to get your view, or your assessment, on where you think we currently are at on that journey. How much progress have we made, and what do you think needs to happen next, to make sure that we finish the journey? PK:
So, if you look at type 2 diabetes where we’re talking about the majority of people in topical prevention, I think the steps that have been taken are very ambitious. It’s the first of its kind in the world. The issue is, people are feeling their way around it. And there’s a lot of debate about what’s the right intervention. Is it about face to face, is it about digital means? Is it just about the type of diet? And that’s the whole debate that goes around in circles. One of the big determinants, and if you look at data is, actually hinges around socioeconomic divides. And I think we tend to forget that. Because I’m always caught up in a debate when people … there is a lot of evangelism about diet right now. And people will come and say, “Why don’t you support one diet?” And I’ve got a very, very straightforward line which is, “The best diet in the world is the one you can afford, you can tolerate and sustain.” And of those three, afford is a big thing.
It is very easy to say to somebody that you should have bacon and avocado for your breakfast. But when you’re standing in one of the food banks, and you’re getting a tin of beans, you’re not worried about the carbohydrate content, you’re just happy to have some food. And that is the fundamental issue to tackle, when you’re talking about prevention of cardiovascular disease or type 2 diabetes. So, taking a step back, I think the approach that the NHS England team diabetes have taken is, okay, we are trying the face to face, we are trying some digital means, we are trying calorie, low calorie diets, and I think we are trying to gather the data to see which one works best. But the fundamental thing we are really focused on is saying how do you make sure these are targeted at a group of people, irrespective of the social economic divide. And that is a big piece of the work which everybody is right now wrapped into.
HM: And on that, how well is the state doing, in terms of levelling up the socioeconomic divide? PK: So, that’s a broader question as to where politics is taking us as a country. And I think there’s lots of data coming out that the gap seems to be widening. And there is, for example, if we touch upon technology, let’s say, I’ll give you our example in type 1 diabetes, there’s good evidence the upper middle class white affluent have got more access to technology than the ones who are not. So, just saying to us, “Give us more technology” is not the answer. You’re just making the better a little bit more better. HM: And the worried well, in some cases? PK:
HM: Yes? Okay. So, I’m really interested in the stuff you’ve been doing on TAD talks, and your comic book on type 1 diabetes. Can you tell us a little bit more about those initiatives? PK:
So, the TAD talks, it was quite simple actually. It’s not quite TED talks. But the idea was that how would it be if we got a few people with type 1 diabetes to stand up and just tell us what life is about. And it’s a mixture of people who have achieved some amazing stuff, like people who have walked round the Arctic Circle, to people who are just daily lives, a mum, somebody who is a teacher. And over the course of time it has grown. And the idea is that you open it up to an audience and just let them speak. So, this year, we had a mixture. We had James Norton who has type 1 diabetes, and it was quite good fun to have him there. And then we also had Amy who is somebody who is trying to be a bio marine engineer, who was talking about her life. And I think the idea is to also inspire people that, don’t worry, you can have a completely healthy life, you can have a completely fantastic life, it depends as to the challenges.
And for me, any chronic condition is hinged on peer support. And that’s what TAD talks is about, getting people together. Peer support is probably the best way you can improve chronic conditions, and the medical model doesn’t work, and every single data set will tell you that.
HM: And it can’t, I guess, because it’s ultimately limited in terms of how much contact it can have with people? PK: Absolutely. If you look at data, it’s actually of a person’s life, the contact with their healthcare professional is 0.02%. How are you going to change their lives in that time? That is impossible. No medical model can solve that. So, long term condition is hinging and will hinge on peer support, a bit of self management. And that’s what TAD talks is all about. HM: And just both of those, the TAD talks, and also the comic book, seem to me another example of how you take your role as being more than just this kind of hospital-based consultant. You’re reaching out into populations and doing a much more population health approach. PK: Yes. The comic book is a very good example that came from talking to somebody who had type 1 diabetes. So, I still remember the conversation I had. She was a 17-year-old girl who said that, “I think type 1 diabetes is a bit like a super power.” And I said, “Explain that one to me.” To which her response was, “It’s a bit like the Incredible Hulk, where you’ve got a power you don’t really want, but then you have to learn to live with it.” HM: Yes. PK:
And then you find other people who have got the same power, but you spend your life trying to get rid of it. And so, she helped us develop the comic book, the first one, and it was fantastic. So, that was the whole concept that it’s a super power I don’t really want. And I think that’s the way it has been seen. And the comic book has been a lovely forum to sort of engage more people, look at it in a different way, and yes, that’s about it.
HM: That’s great. So, you’re also really active on social media. And I checked your Twitter profile out this morning, and I saw that you have 100,000 tweets, which I need to get moving on my Twitter profile, because that is amazing. You also have your own blog. So, how does social media help you achieve your goals? PK: A double-edged sword, I would say. It has taught me a lot. I think it flattens the hierarchy. And one of the big things which I encourage a lot of people within NHS England and NHS Improvement to do is, I think you need to show a human side, as a policymaker. And I think be very open that I cannot do everything. HM: Yes. PK:
I think it’s the expectations we set. And when those expectations are dashed, that’s when people get angry. In general, people appreciate the pressures you work towards. And I think you show a human side, you know? I’ve got a family, I’ve got a dog, I like comic books, I like John Wick and all that sort of stuff. And I think people relate to that, that okay, he’s just a human being, and I’m also very open that I’ve had a bad day at work, or a good day. I would encourage a lot of policymakers to do more of that. I think people hide behind those roles, and they don’t show their normal self. My personal experience is people respond much better, in a much more respectful way, if you’re open and honest and say, “I’m trying, but I can’t deliver everything.”
HM: That’s such a fascinating point, just the idea of opening yourself up so that, in some ways, by making yourself more human, I think people do find it harder to attack you or criticise you because when you’re just a role, you’re just a role. PK: Yes. And I think you also need to push back, so, if people say something which is fundamentally wrong, then I think you can say, “No, I disagree, because this is what we try and this is the pathway.” And I think that’s important because what happens a lot on social media, people say X, Y and Z. Not all of it are based on facts. But if you don’t push back, this is social media, it becomes a fact, it often repeats and that’s the whole world of the fake news and everything. So, you need to challenge some of the rhetoric when people say X, Y and Z. And I think that needs to happen very clearly. And we have done that a number of times when people, for example say, in some cases, unfair, so, people blame the Clinical Commissioning Group. And you say, “No, it’s not true. On this particular one it’s not them.” HM: And so, from your perspective, it really is important not to let things go on some points? PK:
Yes, on some points, I think. I draw a very firm rule on abuse and anything like that. But I think if there’s factually something wrong I spot, I will challenge that.
HM: So, I’m going to ask you a little bit about leadership now. So, can you tell us what, or who, has shaped your approach to leadership, and who you look to for inspiration? PK:
I’d probably divide that into NHS and beyond NHS. If I talked about the NHS, one person who has been a really good guide was Bruce Keogh. So, Bruce came under a lot of fire with the junior doctors thing. A lot of people didn’t know what actually happened behind the scenes, which made me annoyed. But I’ve always been very impressed with his calmness around it. People forget what the man achieved, and I have a lot of time and respect for him. Just to give you one example. When we were redesigning diabetes care, back in 2010 in Portsmouth, we were the first to do something different, he was the one who encouraged me. He was the one who said, “No, carry on, this will become the template” and so it has.
So, he has always been a good guide. I probably am nowhere near as calm as him, I would say. I’m much more prone to temper bursts which Bruce, as far as I’m aware, never was. Beyond NHS, there are a few people I look up to. Some of them are in the sporting world. So, for example, I’ve always admired people such as, let’s say, Alex Ferguson, but Manchester United is not my favourite team, but I have a lot of respect as to what he achieved over his course of time. And it was the way he achieved, and how -
HM: What the hairdryer treatment? PK: - Well no. I think if you read his book, the interesting thing I liked about him is how he changed his style. HM: Yes. PK: So, if you look through his book, there was a certain style in the beginning, then it kept on … the only reason he kept on winning because every few years he slightly changed his style. So, his style towards the first call was very different to when he ended. And I think he adapted to generations and changed his style, which was what made him successful. HM: Great, thank you. So, what challenges have you faced as a leader? PK:
If I’m very honest, youth is a challenge. People see you as inexperienced. Colour is a challenge. And I face that at different, different places. There is an underlying … I wouldn’t say disdain, but slightly whiffy sense of, “What are you doing here?” And that has come across in many, many roles that I’ve done.
HM: In the NHS? PK:
In the NHS, yes. But it’s interesting to see that success breeds respect rather than anything else. And I see that a lot is that the last five/six months have been different. People know you from what you have achieved. But there has been a lot that I’ve had to battle against and speak on and a lot of people will say that. Unfortunately, youth and colour are biases and I think I hear the same thing from women, as well, colleagues who are in the same … I think a young lady trying to do leadership roles, probably goes through similar problems. But it is very pale, male and stale, the NHS structure. And it’s a battle, trying to prove your worth. And that has probably been the toughest thing I would say, yes.
HM: Do you think that’s a systemic issue in the NHS? PK: I think that’s … yes it is. I think … so, I am lucky or unlucky you could say to still have no white hairs, right? And I’m 45, and that’s just genetic, my dad, it’s the way it was. But it’s interpreted as being as somebody who is young. I don’t know why the NHS looks at it that way, because if you look at any other industry, youth is really encouraged, whether it be football or anything like that. HM: Yes. PK: It’s not quite in the NHS yet. Leadership roles are associated with being senior. And I think that’s probably the wrong approach. I think you should get more youth into it. Colour, it takes time to change. And it’s very different. There is a fundamental difference in the racism of let’s say Tommy Robinson and Nigel Farage. There is something blue collar about it. And I’m not saying the NHS is like that, but there have been occasions whereby I have faced directly from CCGs, comments about where I come from, understanding culture, and that’s in my national role. So, those things have been tough, but it happens. And I have gone back to it again, after … I’m not somebody who lets things pass, but those are uncomfortable facts of the NHS that we deal with, day in, day out. And that’s something that is still there, it’s less but it’s still there. HM: Okay, thank you. So, you’ve already ruled yourself out of going much further up in national bodies. But what’s next? PK:
It’s an irony. Because I have seen lots of people who believe that one job is a stepping stone to another. I personally believe that sometimes it makes you compromise when you do that, because you’re always thinking about the next step up. And thereby, would you compromise something in your present role, to go on to the next step, okay? The way I look at it is my pinnacle of my career was what my dad wanted me to be. So, my dad sent me here, because my dad used to work here, but never became a consultant, due many reasons, including very clear racial bias in those days. And he … I remember him saying to me, “I just want you to be a consultant in the NHS.” So, 2008, August, was the pinnacle of my career. I had done everything. Ever since then, whatever role I’ve taken on has been a bonus. And that’s why I give 110% to it. I will go pretty much out there, I will put my job on the line with my national roles, or any roles, I will challenge anybody, because my fallback always is, well I can still go and become an NHS consultant.
So, what next, I think it’s an open field. I would take on any opportunity that comes along. But I’m not actually actively saying I want to do X up next. I just think that once you start doing that, you’re open to compromise. Because somebody somewhere can probably make you compromise something, to go up to the next step, and I don’t want to get sucked into that.
HM: Well I hope you do stay in national roles, because I think it’s really important and valuable to have somebody who’s not willing to compromise, and who is willing to challenge. I think that’s a very special thing for patients and the public and the NHS. And so, on that note, thank you Partha for being with us today on the podcast. PK:
Thank you very much.
HM: Well 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. Thanks for listening, and thanks as always to our podcast team and our producers Ian Ford and Sarah Murphy. If you enjoyed this episode, please subscribe, rate and review us on Apple Podcasts. And if you have feedback or ideas for topics that you would like to hear covered in future episodes, then get in touch, either on Twitter at @TheKingsFund, or on my account at @helenamacarena . We hope you can join us next time.