On the front line: policing and mental health

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  • Posted:Tuesday 01 October 2019

A podcast about big ideas in health and care. We talk with experts from The King’s Fund and beyond about the NHS, social care, and all things health policy and leadership. New episodes monthly.

What role do the police play in responding to people in mental health crisis? Helen McKenna talks to Chief Constable Mark Collins, National Police Chief’s Council Lead for Mental Health, Sarah Hughes, Chief Executive of the Centre for Mental Health and Marsha McAdam, an expert by experience and Co-Chair of the Greater Manchester Personality Disorder Strategy Group.

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Key:

HM: Helen McKenna

MC: Mark Collins

SH: Sarah Hughes

MM: Marsha McAdam

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 King's Fund. In this episode we're exploring the different ways in which the police interact with people with mental health conditions and in particular their role in responding to people in crisis. Now we're very lucky to welcome fantastic guests onto the podcast but once in a while we can't get everyone in the same place at the same time, so this episode is brought to you in two parts. To start we're going to speak to Chief Constable Mark Collins, the National Police Chiefs' Council lead for Mental Health and Policing and then in the second part we welcome two guests who will help us explain the health policy context as well as exploring this topic from the perspective of someone who is an expert by experience, but more on that later in the episode. First, let's hear more about the role of the police in relation to mental health from Mark Collins. Mark, welcome to the podcast.
MC: Thank you.
HM:So it would be really helpful if you could start by telling us a bit about your role as the lead for mental health and what this involves.
MC:

So, as you've said, I'm the National Police Chief's Council lead for Mental Health and Policing which basically means I represent all of the chief constables and their police forces in discussions and debate about the police's response to dealing with people with mental health crisis. I'm also the Chief Constable of Dyfed-Powys police which is one of the Welsh police forces.  

HM:Fantastic. So let's start with a bit of an overview of the role of police in this area. Can you tell us a bit about the legal duties and responsibilities that the police have in relation to mental health?
MC:

Yes, well we probably use two main powers that are given to us; one is what's called section 136 of the Mental Health Act, which is basically a police officer can detain a person that we believe is going to harm themselves or another person, we can detain those people for a mental health assessment which means taking them to an approved suite where they are seen by a psychiatrist and given a full mental health assessment. The other power that we've got that we most frequently use is probably section 135 of the Mental Health Act, which is a warrant of entry which allows us to gain entry into a private premises with an approved social worker and a doctor to carry out an assessment there. 

HM:When you're talking about a suite, is that the place of safety?
MC:It would be in my opinion a health-based place of safety. Accident and emergency units would be deemed places of safety. We have pushed very hard to reduce the number of times that we take people to police cells as a place of safety, we don’t think that's proper and correct, but of course there are occasions where somebody is so violent that they need to be detained in a place where they can be monitored and a police station and a cell has been deemed the only place suitable especially if there's not a health-based place of safety available. I'm pleased to say that we've reduced our numbers significantly, most police forces are down to single figures now where they take someone into a police cell as a place of safety and in fact you may be aware that Sir Simon Wessely has recently done a review of the Mental Health Act and one of the recommendations that comes from that review is a complete ban of the use of police cells going forward as a place of safety. I have pushed very strongly and very hard for that to happen.  
HM:And tell us a bit more about that. Are you saying that really in no case is it appropriate for somebody in crisis to be-
MC:Well I think there are occasions where people need to be detained, be detained for quite considerable periods of time until they calm down. We use handcuffs and we've seen leg restraints being used and spit guards and things like that, but actually you can have that same facility in a health-based placed of safety, you can have a padded room, you can have all the facilities there and actually what you've got there are doctors and nurses and medical staff, clinicians that are able to deal with people and unfortunately on occasions we've seen deaths in police custody where people have become so ill and we've not got crash teams available in police stations, we've not got the appropriate levels of support there. So the health setting is much better.  
HM:I was reading a report put out by Her Majesty's Inspectorate of Constabulary, I imagine you were probably in developing that report, yes.
MC:

We were and I was indeed, yes.

HM:Yes, and I saw that the report suggested that police resources are being diverted from dealing with crime because police are having to deal with calls relating to mental health. Can you talk us through what's going on there? Is there a rise in this type of activity? 
DB:Well I think nationally over two to three years we've seen a 30-40% increase in calls for mental health support. Let me be very clear. I've always said the police have a role in supporting people in the community with mental ill health. Every police force in the country will have a priority around supporting vulnerable people in their communities and it's right and proper that we do that. I do think there's a level of where that support is. So we should be responding to emergency mental health calls, those people that, as the Act says, are threatening to harm themselves or other people, but of course we have a role to play and of course we are the right and proper people to attend in those emergency situations. I think there are some issues in terms of where we're actually interacting in crisis care and community care because the facility and the capacity is just not there in health boards and trusts to support their patients and time and time again we see ourselves being more involved in doing routine calls, welfare check calls and really that's not the role of the police. I have to say I think when we do go to some of these calls we've had some very, very positive feedback. We are the 24/7 default service so we're always available, but actually you have to put yourself in the position of someone in a mental health crisis and seeing a police car turning up and seeing police officers in uniform getting out that car to come and speak with you and support you, are we the right and the proper people to do that? On occasions yes but on occasions and more often not.
HM:Yes, and you say your data suggesting there's been a 30-40% increase nationally -
MC:

Yes.

HM:- in that, and obviously that's going to have … that has a massive impact on your work, you also say police do have a role in this space -
DB:Yes.
HM:- you suggested there that the capacity in other services is not currently present which you see as being one of the reasons why police are having to step into this space, are there other reasons around why you think police are having to pick up the pieces? Is there something around funding for example?
DB:

Well I think if we go back to where we've been in the last ten years in terms of austerity, I think all the services have struggled and the police, I talk about the police there, health boards, local authorities, have all had their budgets cut. I think I have a very good working relationship with our colleagues in NHS England and NHS Wales and I think if they were sat round the table here now they would agree that some of that demand on the police service is not right and does need to shift back to their organisations. However, they can only do what they can do with the money that they've got, facilities that they've got and the capacity that they've got and we recognise this. So I think the opportunity to maximise the use of the £2.3 billion worth of funding that has been made available to NHS England in really looking at the demand on the police service and other agencies as well and shifting that demand back is really welcomed and I know, speaking to my colleagues in NHS England, there is an opportunity for police forces to get round the table and have discussions about the specific demand and actually to make sure that money goes into the right areas. So I think we have been picking up some of the pieces, it's a capacity issue, it's a funding issue and we welcome the long term NHS mental health improvement plan that we're seeing.

HM:I'm really interested in you talk about the police are the 24/7 default service and I just wonder with that because obviously within the emergency services there's also the ambulance service and A&E is open 24/7, so I guess from your perspective what's going on that it's landing on police and it's not being picked up?
MC:

Well I think again it goes back to the provision you've got in each of the health board areas for crisis care and community care. So very often someone in crisis will call their crisis care team or community care team and be told, ‘We've not got the numbers, the people to come and see you, call the police,’ so that happens. The other thing of course is in relation to ambulances. We know the ambulance service has been stretched as well in terms of its targets and its figures, so very often at any given time every police force in this country will be involved in taking people with mental health problems to places of safety for an assessment. Very often, certainly in my own force area, that can be a 120-mile round trip and it can mean my officer sat with patients for sometimes ten, twelve hours waiting for an assessment to take place. Now that takes officers from the front line dealing with crime investigations, crime prevention and being visible in our communities which is what the public wants, but one of the other big issues that we find ourselves contending with is people coming into police custody for minor offences, criminal assault, criminal damage, public order offences, things like that and once they're in custody they're then deemed to be unwell. So we finish with the criminal aspect, they're either released on bail or they're charged with an offence or cautioned and then what happens is we have them assessed and we fail to remove them out of police custody into a health-based place of safety and into a bed and that causes us some huge problems. Across the UK about 4,500 times a year. 

HM:And the huge problem being the experience and outcomes for those people?
MC:Well the experience is they are kept in a police cell until a bed is made available for them or found to be available for them. So at a certain point in time we are, as a police service, keeping them unlawfully in custody whilst we are waiting for a bed. My officers and medical staff contained within custody units will monitor and support that individual waiting for that bed to be made available, but on some occasions that can be five, six days and whilst we welcome the NHS long-term plan to change mental health provision, inpatient beds is something that probably won't be where it needs to be until about 2023/2024, so that is a huge issue for us.
HM:Yes, and there's a question about what gets done in the interim.
MC:Yes indeed.
HM:Just thinking about the impact of this work on individual officers, how well equipped are they to deal with, for example, working with people in crisis but also managing people when they have been assessed as unwell after they've been arrested? 
MC:

So in line with the College of Policing guidance every police force in the country will give some level of training around mental health to the frontline officers and that training may be specific custody training for those working in the custody environment, in terms of front line policing there will be training for front line responders and we haven't touched upon it yet, but every police force area in the country has some form of mental health street triage and that triage could be either a mental health nurse based in the control room or a mental health nurse or worker going out with a police officer in a vehicle to respond to calls or bit of a hybrid situation where you do a bit of both. Those staff working specifically on triage will have a more enhanced level of training again to work alongside the mental health workers and nurses, but for me there is a level of training that's needed and I think once we start going beyond that level of training we're starting to take ourselves out of being police officers to being medical staff and that's not the right thing to do.

HM:In the collaborative work that police have been doing with health services and other services, I know that there have been some innovative new models that have been developed, can you tell us a bit about some of those different models and also maybe something about the impact that those models are having?
MC:

Well the models are really based around triage and we've seen some really good examples of partnership working. So for instance in the north east there is what is called a one-stop-shop.  So what you'll have there is one number to phone in for crisis care, community care, triage, whatever you need is on a one number and actually all of the teams work together. They discuss individual clients and patients, make sure the best level of service is given to that individual. So that for me is almost like a Rolls Royce model if you like. Every police force area will be paying for the mental health provision that comes in to support them. So in Wales at the moment the four police forces spend over a million pounds a year buying in community nurses, mental health workers to come into the control room or go out with police officers. We pay for that.  

HM:Does that get reimbursed by the health-?
MC:No we pay for that.
HM:Okay.
MC:We pay for that and we see that as a necessary investment because what it actually gives us is access very early to mental health care plans and patient records so we understand very, very quickly what the issues are with the individual and of course what it allows the mental health nurse to do is to give advice and guidance in relation to does that person need to come back in for an assessment? Does that person need an urgent appointment with their GP? Can we get the crisis care team to go out tomorrow and see them? Things like that.  
HM:Yes.
MC:So that's one model, but in my own force area I've got 1,120 officers seven of my officers are completely tied up on a rota to do mental health street triage. So put the cost of buying in the nurses, put the cost of the vehicles in, put the cost of the officers in and suddenly you're up to probably about half a million pounds in one of the smallest police force areas in the country, biggest geographical area but smallest in terms of numbers and budget. So that's a big drain on us. So we've got that issue to contend with. I think triage was set up almost as an insurance policy to police forces and services to make sure we had access to these health records, we had access to mental health colleagues. Where I think the model is working very well is where we're starting to see what I would call crisis care cafes, sanctuary cafes in our communities usually run 24/7, usually made up of mental health qualified nurses, ex-service users, the voluntary sector because not everyone of course that we come into contact with needs a 136 assessment. Many people just need to be signposted to a service that they need, to sit down, have a cup of tea, have a conversation with someone to really understand what their issues are. They're anxious, they've got some issues, but actually that doesn't need an inpatient bed and ongoing treatment, it just needs some support. 
HM:In terms of those different models, are they being evaluated in terms of developing an evidence base to understand what works and what doesn't work? 
MC:

So we started to do some evaluation around triage. I mean triage is not the preferred option for everyone. I think triage is seen as a stopgap and I think with the rollout of mental health, transforming mental health services, we need to get into a place where we don't need triage anymore, when we've got those mental health workers back in crisis teams, community care teams doing the job that they should be doing and we've got cops back on the beat supporting our communities and being visible in our communities and detecting crime.

HM:So that's the ideal scenario -?
MC:

For me it is, yes.

HM:- from the police perspective? 
DB:Yes definitely.
HM:Well thank you so much Chief Constable Mark Collins -
MC: Thank you.
HM:- for joining us, it's been really interesting and very helpful to hear. 
MC:

Thank you very much indeed.

HM:Thank you. So we had a really helpful overview there from Mark about how things are working in this area from a policing perspective, now I want to explore this from a health policy and practice perspective and also really importantly from the perspective of someone who has been in crisis in the past and received support from the police and other services. So I'm delighted to welcome to the podcast Sarah Hughes, who is the Chief Executive of Centre for Mental Health and Marsha McAdam, an expert by experience and co-chair of the Greater Manchester Personality Disorder Strategy Group. Sarah, I'm going to come to you first. Could you introduce yourself and tell us a bit about your background and interest in this area? 
SH:

Yes, sure. Yes, I'm Sarah and I'm Chief Exec of the Centre for Mental Health. I've worked in the voluntary sector for quite a long time, and mental health for about 28 years, and previous to my current role I worked in Cambridge and Peterborough which is quite a famous site now for developing a huge amount of innovation especially in crisis care actually. I originally trained as a social worker but have done all sorts of different things since then, but social work values are still very much how I see the world. 

HM:Thank you and welcome and Marsha, could you also introduce yourself and tell us a bit about your interest in this topic? 
MM:So my name is Marsha McAdam and I have borderline personality disorder otherwise known as emotional unstable personality disorder. After receiving life changing therapy called mentalisation-based therapy it completely transformed my life. However, before that most weekends I was in A&E or being picked up by the police through self harming in one way or absconding and the last time I had crisis dealing specifically with the police was about six or seven years ago.
HM:I'm really glad to hear that things have improved a little bit in recent years and great to have you here.
MM:Thank you.
HM:Sarah, before we go into the specifics of policing and mental health, I just wanted to start with a broad question about how things are in the sector at the minute, what are you seeing in your role at the Centre for Mental Health and your interactions with people working in the sector? 
SH:

I mean I think there's no doubt that mental health is both in the political priority in a way that it has never been in my lifetime. I think it's in the mind of society in a way that it also hasn't been in my lifetime. So the government have made huge promises around investment for the NHS long-term plan, carrying on from the Five Year Forward View particularly focusing on huge investment into crisis.

HM:That's the good news, but?
SH:So that's the good news but anyone who knows me will know that there is sadly a but, and the but really is that whilst there has been innovation round the country for crisis care particularly and I think as we're talking about that, in our perspective from the Centre for Mental Health we're very clear that health intervention is only one part of the puzzle and that people actually only ever get to health when they've explored every other avenue for help. If all of the other things aren't in place then people are going to be getting into crisis more frequently, the revolving door kind of syndrome is going to carry on. We want to see social care housing, communities, welfare, benefits, all of those things being considered at the same level as health. We can provide the best clinical intervention in the world which I do think we do on many occasions but if you're sending somebody home from that best treatment to unstable housing and no money and poor relationship or addiction issues, then that excellent treatment is not going to have the long-term impact we need to see. 
HM:So we heard earlier in the episode from Chief Constable Mark Collins and he told us about how the police are often the first responders when it comes to providing support to people in crisis. Recently there have been reports published that suggest that police are finding themselves spending more and more of their time responding to people experiencing a mental health crisis. Sarah, starting with you, why do you think it's ending up with police shouldering more of the responsibility here? 
SH:

Yes, I mean I think it's true that certainly the police are having to deal with more and more complicated issues every day relating to mental illness and that's often I think because the system hasn't been geared up until very recently to deal with people in crisis in the way that we need people to be supported at that very difficult time, and the police are quick, they can access places in ways that nobody else in the system can. So I have an ambivalence between thinking we don't want the police to feel like 75% of their work is mental health related, to actually people with mental illness live in the community so why wouldn't the police just -

HM:Absolutely.
SH:- deal with the people who are living in our community and -
HM:And who serve the public. 
SH:

- our society and they… so it's a kind of double bind again really between thinking are they the best people, to they do need to respond to the public in a rapid, sensitive, compassionate way when that is appropriate. In recent times, I wouldn't have said this a decade ago I have to say, but in recent times I've seen police respond in quite extraordinarily compassionate ways and I've worked very closely with them and been quite inspired and felt humbled by their compassion and really wanting to do the right thing. You have a conversation with most police officers and they will say that they are equally troubled when they arrive to somebody and realise that that person is in crisis because they're not getting the help they need. 

HM:And Marsha, just coming to you, does that chime with your experience of your interactions with the police on the occasions that you have… you've had?
MM:

Yes, though it would sometimes be the good cop and the bad cop. I think the last time that I was taken to A&E by the police and I think they had to blue light it because there was no ambulance that came, but I was really distressed and the police came in the front door and then some came in the back door and one of them had a Taser, but luckily my son was there and everything was fine. So that was really, really scary. With the persistent distress that I used to have it was like the police were the only ones that really you could get that would look after you, but then to me it was a game of when they came I'd run round my house and try and hide and it was quite distressing, going back to the last time, one of them said to me, "We've got a lost child that we need to look for." So that was really, really bad and making me feel even more of a hindrance or that I was not valued. I know that during those times I wouldn't have wanted to stood outside a room at A&E with me. I used to say to them, "There's no point in you staying with me as soon as I'm seen I'm going to be sent home," and then I started to see how the police… actually their disbelief at that happening, but I do really feel for the police officers.

HM:When you say you really feel for them, is that because you feel they're in a difficult position in terms of the impact on their resourcing or the difficulty of the work given they're not health professionals?
MM:For me I really feel for them because they're at the forefront of everything and in Greater Manchester the three mental health trusts have come together and they've done a training package for 1,200 police officers that has been specifically tailored for Greater Manchester police and it's actually built a really positive relationship between police and the mental health services and I think to me that feels right. It feels like the police officers are actually being taken care of.
HM:Okay, so you really see a need for the police to also get support with this work and it's really interesting you bring up the issue of the joint working between the police and services and it sounds like there's some really positive work going on in Greater Manchester. What I'd like to talk about now is places of safety because I know that part of the role of the police is to take people to an appropriate place of safety so that they can be properly assessed, and in the past because of the lack of appropriate facilities in health settings there were too many cases where police cells were used as places of safety, has that changed? 
SH:So I think that's definitely the policy, that people should not be taken to police cells in great distress, but I think that there are circumstances in which it happens because the resources aren't yet in place.
HM:So there's still...
SH:

So there are still instances I'm quite confident in saying that and again it comes from the system hasn't quite caught up with the policy yet. So it's okay to say, ‘We're not going to take people to police cells,’ but we haven't yet built capacity within the system to take somebody somewhere else. If you don’t have a non-clinical environment to take people to, then you are really at a loss and I think that there is a real dilemma there for the police and clinicians about what to do to keep somebody safe and nobody in that situation feels happy about taking somebody to a police cell because it absolutely puts them at very immediate risk. So from our perspective the investment that the NHS long-term plan provides for crisis services, one of the real brilliant opportunities that that affords us is to create more places of safety. Those places of safety can be actually building capacity in hospitals for one or two spaces but also really develop non-clinical spaces that people can be taken to as long as they are not at immediate risk and perhaps haven't overdosed and don't need a clinical intervention but actually are in such great distress that they would really benefit from being in a supportive, compassionate, non-threatening an environment. That's what the NHS long-term plan is offering us, the opportunity to develop those around the country and the point that Marsha makes around the mental health of our police force is an absolutely critical one which we must not underestimate and I do think that that affects how the system works. I think it actually affects a police officer's ability to then deal with situations well and when you go to the nurse… you go to A&E with somebody who is in great crisis and A&E within five minutes sends them home again, that sets up quite a difficult relationship between the police and the nursing staff. So what we've seen as well around the country is conflict building because both parts of the system don't have the resources to do what they really feel they would like to do and inevitably we have seen situations where you've seen police blame the nurses and the nurses blame the police and in the middle of it is a really vulnerable person and that's what it boils down to.

HM:Marsha.
MM:

The two police officers were waiting with me on the corridor and I was sitting in a wheelchair because we were waiting for a long time, they brought me in the side area, and this nurse came up to me and was really nasty. I then tried to walk out and the police officers were wrestling me, I was covered in bruises, down so that I didn't get out and the nurse was standing over me saying, "You know exactly what you're doing." If you're facing that then you start acting out and playing up and then I used to then disappear and then the police had to get called and then this was all because there was no stability.

SH:But you can see how those experiences when you're in crisis actually are trauma-inducing in themselves. Some of things that I admire about Marsha is that coming out of that being able to share with other people who have also experienced that, that one, you're not alone and that sharing those stories is so important because people are still experiencing it. And it's only by listening to that detail that Marsha is giving us about that, the language that is used, the tone of voice, all of those things matter as well as the millions of pounds that we're putting into the system. So I just feel that we need to really acknowledge that actually.  
HM:And the endpoint has to be the outcomes of -
SH:For the person.
HM:- the individuals and that sounds like that's getting lost and I guess at some point there needs to be a line drawn as what is the role of police and the reasonable amount of resource police can put into training versus the line where police are becoming a health professional. 
SH:Well absolutely and there is a really important debate to be had because we've also got the role of paramedics and we haven't really mentioned them, but the role of paramedics is also incredibly important. I personally have spent hours and hours outside somebody's house with the paramedics and the police with somebody who's locked in their house trying to get them help and …
MM:That sounded like me years ago.
SH:It wasn't you but, I mean… and the person being in great distress, we all in great distress because really not knowing what to do and also actually the paramedics feeling like they had to… it was them that called the police because they thought she's taken an overdose in there, we can't kick down the door but our mates can and I think it's a really complicated issue of do they have enough training to deal with the complexity that they're facing in society today? I think I would argue that they probably don't. It's not just about mental health, I would say addiction, working with older people, children, the list is endless really and I think that that's a real dilemma for the police that I appreciate and respect and understand, but then we have got the public and the public's needs are changing and therefore our psychological framework for what we think the police should do, the paramedics do, the health professionals to do, the teachers should do, has to change. That's going to be the next big debate across the piece that it's not about keeping people's traditional roles traditional but actually thinking, what do the public need today with all of the changing faces that we're seeing? 
HM:

And actually there needs to be a paradigm shift in terms of how we look at… we really understand the needs - 

SH:Absolutely.
HM:

- of the public and then develop services that are tailored to respond to those needs. 

SH:Absolutely.
MM:I've been on the mental health conference circuit for the last four or so years and seen so many presentations and that but I think that the language in the last few months has completely changed. 
HM:For the better do you think?
MM:For the better. It's encouraging that everyone has value and I guess that for me as someone that uses mental health services by having this voice it actually feels to me like I contribute to society and I want others to feel that too but it be done in a safe way and not just a tokenistic way, but really get those voices so…
HM: And it sounds like that's starting to shift? 
MM:Yes definitely.
HM:

And when we spoke to Mark earlier he said that in his view it was essential from a policing perspective that some of the extra money or new money that's going into mental health services gets invested in services that support people in crisis such as crisis resolution services, and I just wondered, Sarah, are you optimistic that that is going to happen?  I know there's the mental health forward view but… and the long-term plan.

SH:I absolutely do feel confident in that that's going to happen. So the long-term plan outlines very clearly the commitment to crisis services over the course of the coming years 23/24. What we expect to see by then is a huge amount of money, there are huge promises in terms of what that means and what it could look like. We're working with NHS England to think about the blueprint for what that could mean in real terms. We would certainly want to see that investment not just being used actually for clinical services. So I would like to see the third sector who have been delivering crisis services for decades without funding to be funded for some of the things that they do, so those non-clinical environments, crisis cafes, the sanctuaries, kind of that investment must occur. So it's not… again I think crisis mustn't be considered as a health problem, this is a systemic societal social care, it's a much broader problem and it requires a thoughtful response that's system-wide and certainly involves community leaders but third sector organisations too. 
HM:

So in a sentence, from each of you, where do you hope we are in say five years' time when it comes to this? What do you hope to see? 

MM:I hope it happens before five years.
HM:Good challenge
MM:I hope that instead of talking literally get down and doing it because we've been talking about it for too long and people are losing their lives.
HM:Thank you.
SH:I think I would echo that but I would also say that whilst I would like to see nationwide effective crisis services and effective sustainable mental health services, I would also like to see in parallel that we are also dealing with the systemic inequality issues that really impact on people's ability to live well, good, happy lives. So I would like us in a double track way to be thinking about housing, to be thinking about poverty, to be thinking about exclusion, to be thinking about all of those things too because actually again having the best crisis care in the world will only deal with one part of the problem and…
HM: Yes and picking up the pieces.
SH:Yes, but it's actually …
HM:

Actually this stuff starts a long way back.

SH:Absolutely. So for me it's a broad church of things that we need to think about.
HM:

Well thank you so much to both of you, Marsha McAdam and Sarah Hughes, it's been a pleasure to talk to you both today.

SH:Thank you.
MM:Thank you.
HM: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 @TheKingsFund, or on my account at @helenamacarena. We hope you can join us next time.