Professor Dame Elizabeth Anionwu: nursing, resilience and building statues

Key:

HM: Helen McKenna
DEA: Professor Dame Elizabeth Anionwu

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, a Senior Fellow here at the Fund and your host for this episode and today I’m delighted to be joined by a wonderful and incredibly inspiring guest. Someone who’s been a Nurse and Health Visitor who went on to become the first Sickle Cell and Thalassaemia Nurse Specialist in the UK and who then went on to become a professor or Nursing, a Dean of Nursing and a Patron of the Sickle Cell Society as well as Fellow of the Royal College of Nursing and as if that wasn’t enough, she is now Emeritus Professor of Nursing at the University of West London and in 2016, published her memoir called ‘Mixed Blessings from a Cambridge Union’ which I can highly recommend. And that someone is Professor Dame Elizabeth Anionwu who also received a CBE for her services to Nursing and in 2018 was named one of the 70 most influential nurses and midwives in the history of the NHS and just this week was named one of 100 Greatest Black Britons, Welcome Dame Elizabeth, it’s a true honour to have you with us on The King’s Fund Podcast.

DEA:   Thank you very much Helen, I’m really pleased to be invited to do the podcast with you, thank you.

HM:   So later in the episode we’ll be talking in a bit more detail about your career and your leadership journey and much, much more, I have endless questions that I want to ask you. Before we start, just something a little bit light-hearted, as a published author, are there any characters from the world of books, whether that be fiction, non-fiction, history, who you’d like to meet and if so, who?

DEA:   Actually, Elizabeth from Pride and Prejudice.

HM:   Really is that one of your favourite books?

DEA:   It was the first, let’s say, very long book I read as a teenager and the fact that I couldn’t put the book down. I just found it so funny, the opening sentences are just hilarious, and I hadn’t expected that from a classic, I have to be honest and I like Elizabeth, she’s feisty. So that’s one.

HM:   Brilliant, so I wanted to begin, spend a little bit of time on your early years because I guess, your career has been absolutely stellar, but in your memoirs, you describe a childhood that sounds incredibly tough. Could you tell us a little bit about your upbringing?

DEA:   Yes, certainly. I called my memoirs, ‘Mixed Blessings from a Cambridge Union’ because I was the outcome of a short affair, my father who was studying Law and my mother who was in the second year, studying Classics. My mother came from a very strict, loving but strict Catholic family. She wasn’t married, she didn’t get married to my father, so my arrival caused a huge shock and scandal, but my maternal grandparents were extremely supportive despite the terrible time they went through in a way. So, my mother never, ever wanted to give me up for adoption. She was very obstinate about this, but she just wasn’t able to provide a home for me and it took nine years for her to do this. So, I came out of the children’s home at that age and went to live with her and my stepfather in the midlands. Unfortunately that didn’t last, although it started out all right, obviously my mother was very welcoming and so was my stepfather, but he gradually changed towards me and I later found out that it was mainly due to the fact that he was being teased by his mates at work that he had a ‘half-caste’ in the home. We’re talking about the mid-fifties. I was the only Black child in the neighbourhood, so he started to physically abuse me as a result of the teasing, and I was rescued by maternal grandparents and I went to live in the North West of England for my adolescence. Then at 18 I came down to London to study Nursing.

HM:   So that sounds like a lot of upheaval and emotional distress as a young child and I guess also what I’m hearing there is elements of racism and cultural attitudes of stigma at that time, kind of, shaping your experiences.

DEA:   Yes, you’re absolutely right, I think I moved six times in the space of ten years.

HM:   Wow, that’s so much upheaval. So, when did you first become interested in nursing and what do you think drove you in that direction?

DEA:   I was very, very young in the children’s home which was a Catholic institution, run by nuns, in Birmingham and I had very, very bad eczema, I called her the white nun. All the nuns were white but she wore a white habit instead of the traditional black one and I used to visit her regularly in the sick bay because I needed to get my eczema looked at and cream put on it and dressings and changing the dressing could be extremely painful if it wasn’t done expertly. I used to look round the sick bay door to see if the white nun was there, because she used to change my dressings without causing any pain, in fact she created laughter, she was very funny and later on, as an adult, she was using distraction therapy. So, I really idolised this woman because I didn’t’ connect her to pain. When I discovered she was something called a nurse, that’s what I decided I wanted to do, and I never swayed from that ambition.

HM:   So, tell us about your first job in nursing and what that was like?

DEA:   Well at the age of 16, my grandmother sent me back to live with my mother and stepfather and I had to work. There was no question of me continuing with sixth form, so I became a School Nurse Assistant and it was great, it was what I needed. I thoroughly enjoyed it. I ended up working in a school, it would be called a Child Health Clinic now, for a few months but I had a lot of asthma and it was probably the stress of going back to live… not the stress of living with my mum, I got on very well with my mum, but my stepfather had been the one that had physically abused me, although when I went back at 16 there was no threat of that but it wasn’t that many years before that he had. I think the psychological stress impacted and created an exacerbation of my asthma and the School Medical Officer of Health was like a mentor to me looking back and he arranged for me to transfer and work in what was then called a Residential School for Delicate Children. It was in the countryside and it was for children with congenital heart problems, severe asthma, cerebral palsy, conditions like that and it was exactly what I needed. I had my own bed sitting room. I made friends very easily, I loved the work and it was like an 18 months oasis of no anxieties at all, everything was provided, my accommodation etc. Yes, and then when I was 18 that’s when I went to London.

HM:   Then when you got to London you were in Paddington General; how did that go?

DEA:   I loved my three years studying to be a Nurse at Paddington General Hospital. When I was about 16 or 17 I had applied to four London teaching hospitals. All of them wanted to know the name of my father and the occupation of my father which I didn’t know because nobody spoke about my father. They asked for a photograph of myself. I had seven O-levels so I had the academic requirements but none of them replied to me and the School Medical Officer felt as I say, he really looked after me, he was just incandescent with rage, ‘What’s the matter with these hospitals?’ And he gave me the name of Paddington General Hospital, I think he had links as a medical student or something. So, I thoroughly enjoyed my student nursing days. I was very shy for the first year or so, but I made friends. I found it very difficult to go to parties. I was very, very, painfully shy, men used to scare the life out of me, so I missed out on an awful lot of stuff in the sixties essentially. But I did enjoy my three-year programme.

HM:   You mention your father there and not knowing his name until later and the shyness that you experienced when you were first starting out as a Nurse, certainly you don’t come across as shy now. Was there something when you did eventually meet your father and bridge both your identities, you Nigerian ancestry and heritage and your Irish British heritage together? Did that help to give you more confidence?

DEA:   Definitely. I remember as a student nurse, sick with shyness, that knotted feeling in your stomach when I had to go onto a new ward, meet new people. I always thought people were looking at me, now what’s that a sign of… I think it’s insecurity, no self-esteem and my confidence level gradually increased as I made friends, as I started to realise I could relate with patients very easily, that I had a sense of humour. I gradually realised I was quite intelligent but there was always this gap of when people would ask me, ‘Where are you from my dear?’ And they weren’t asking it necessarily in a negative way, it was curiosity, but I knew quickly that they were looking at my brown skin colour and wanting me to explain that side of my heritage and I couldn’t. So, when I found my father, because I actually wrote to my mother and asked for his name. I had my mother’s maiden name, so when I found my father, I found him very quickly, he happened to be in London. I was 25 and there’s no question about it Helen, it totally transformed me, gradually, it took me some time to behave towards him as a daughter. I’d never had this daughter father relationship before. Again, my shyness and not having many male role models around me, father figures or whatever. But once I got used to that, it definitely increased my confidence and I just knew then who I was, I knew both sides of my heritage and it made life a lot easier. I knew my father for eight years before he died quite young unfortunately and halfway through I decided to take on his surname. So I think that tells you, I absolutely adored my mother, so grateful for all my Irish heritage family and the support that they had given me, but there’s no doubt about it, that society saw me as a brown skinned woman and so whilst I was at ease with my Irish white heritage, life became much easier for me when I met my father and knew where the brown skin heritage came from, if you like. It was as though I could hold my head up high and when confronted with racism, inside I’m quite a polite person, it’s the convent upbringing I think but inside I would be swearing actually, seriously. So that helped enormously that all these deep seated repressed feelings of rage and anger and shame, because I grew up where my skin colour was seen as negative and of course it was during the era, we’re talking about the early seventies in Britain where the Black civil rights movements impacted incredibly on me, to not be ashamed of your skin colour, to carry an African, Nigerian surname eventually and do that with pride.

HM:   Yes, so I recently read an interview that you gave to the Royal College of Nursing Magazine where you said, ‘It’s not a glass ceiling for Black Nurses it’s a brick wall.’ I don’t know if you recall that quote?

DEA:   I do, yes.

HM:   My colleague, Shilpa Ross and others here at The King’s Fund recently published a research report looking at the lived experience of ethnic minority staff in the NHS which highlighted among other things, bias in recruitment and promotion processes. I just wanted to ask you about how disappointing it is that in 2020, we’re still in that position and what you think needs to change?

DEA:   Do you know Helen, it’s more than disappointing that we’re still in this situation, it’s scandalous actually and it’s a blot on aspects of the health service, not all of course. The irony is, people, on the whole want to go into healthcare to care for people and you naively expect that they wouldn’t have all these discriminatory factors that impact on their behaviour. Obviously I’m talking about myself now, as I gradually learned what the real world was all about, health professionals are part of society, society is racist, not everybody is racist, but society is racist, so why am I surprised that we have racism in the behaviour of certain health professionals?

So, it’s not acceptable. I’ve gradually realised, and I’m normally a half glass full person but racism is here to stay. I used to hear more of this in the eighties and nineties which was, ‘Whatever your attitudes are, they’re yours, we’re not going to change your attitudes, but don’t behave in that negative, discriminatory way at work. Do what you like in your own home, nothing to do with us, but racist behaviour, for example, homophobic behaviour, sexist, misogynist, whatever it is it’s unacceptable in the workplace and if you do display that behaviour, there will be actions as a result.’ These were the really good workplaces. I can live with that. I was naïve, I always thought education could… no, well I’ve seen very well-educated people who’ve been on various courses and then the mask has slipped, and you realise, for some people…

HM:   I guess I’m naïve then, because I guess, just saying, ‘Oh don’t do it at work, keep it to your personal life,’ to me that only stamps out the egregious aspects of discriminatory behaviour in the workplace because those are the ones that people will spot and do something about. But lots of it is also subtle pervasive, microaggressions that are very hard, sometimes for other people to catch, or call out and is that are you saying then that that’s something that we tolerate?

DEA:   No, I’m not saying we tolerate it, I’m just being realistic and pragmatic and I’m 73 Helen, I’m just looking back on how experience has altered some of what I consider now, naïve aspirations, naïve hopes. I don’t mean naïve in a negative way. I think it’s just part of life. No of course it’s not acceptable, and of course education and not tolerating such behaviour should carry on, however, I just realised that instinctively there appears to be a need for some people to feel superior towards others. There might be a whole set of psychological, economic reasons whatever, I haven’t got the time to work out what it is, all I know is that it remains with some people, even though if they are astute enough they’ll know that in this situation, you don’t demonstrate it but in this situation, maybe you can. That’s really what I’m saying.

HM:   And in your book you also mention experiencing negative working culture and environment and I was really interested in that because we recently published a report which was commissioned by the RCN Foundation exploring how we can support nurses and midwives to deliver high quality care and looking at collective leadership and psychologically safe cultures and tackling excessive workloads. What do you think could help address some of the stressors that nurses face in their work today?

DEA:   Before lockdown and going around the country being invited to talk about my memoirs. It just reinforced what I was aware of, that there can be awful behaviour towards individuals and the stress that it causes them, where they haven’t got the choice to leave that situation. They’re economically dependent on that job. It made me realise that a lot of these individuals need a safe confidential space where they can reveal what is happening to them and then you really then obviously want that whoever they’re speaking to is in a position of authority to actually intervene and change something about their environmental circumstances, the work circumstances. What I also kept hearing is the sense of futility in going to senior management and often sometimes it was senior management anyway that had these negative racist behaviours and it was those individuals were trapped in that work situation which, no wonder there’s a high level of high blood pressure within the Black community. No wonder they’re vulnerable to covid, the stress factors are horrible. They really are. So, what is needed is an organisational culture that knows what the heck is going on, because sometimes I’m thinking, ‘Do some of the managers know exactly what some of their staff are going through?’ I’ve been a manager and this was in higher education and I was managing nurse educationalists, nurse tutors, it was astounding what some individuals had put up with and that really opened my eyes to, ‘Wow this is their workplace, this is where they’re spending so much of their life.’ These are the pressures that they’re under and we’re talking about pressures that they shouldn’t have had. Again, that was an eye opener for me yes.

HM:   I just wanted to spend a bit of time reflecting on your work on sickle cell. Your career obviously evolved over time, you became a health visitor and then you started specialising in sickle cell and you were the first ever Sickle Cell and Thalassaemia Nurse Specialist in the UK. So, I just wanted to ask what led you to become interested in sickle cell?

DEA:   There were various factors, both personal and professional and they all happened around the same time in the early 1970s and this was when I’d come back from France. I had met a French African Midwife there who I had revealed to when as a child, I’d wash my face, I don’t know how many times, ten times, to try and become white like my friends in the children’s home and she said, ‘You know, you really need to read ‘Black Skin White Masks’ by Frantz Fanon.’ He really described what I had been going through which was a gradual realisation of what my full identity was and how part of my identity was negatively viewed by certain sections of society and how that could affect you if you didn’t do anything about it.

So that led me to realising that actually, virtually all of my life I’d spent in a white environment, I needed to know a lot more Black people and that transformed my life actually. I still retained the relationships and activities with my white colleagues and friends but that led me to be interested in Black health issues and the one that stood out was sickle cell. Also, I’d met my father by this time, and I met my family members and one of my cousins has sickle cell anaemia and so that’s where the personal and the professional all rolled into one. I would say personal, professional and political, the three Ps. I then was working at the Central Middlesex Hospital, I had an office there and I was fortunate to see Dr Misha Brozovic who was fairly recently arrived Consultant Haematologist, was giving a series of talks and one of them was on sickle cell anaemia. I thought, wow. So, I went to one of her talks and asked a lot of questions. She gave another lunch time talk, I went to that, asked a lot of questions and she came running after me after the second talk, said, ‘You seem very interested.’ To cut a very long story short I ended up working with her informally and then formally. She found funding for my salary as a Sickle Cell Nurse Specialist and I got that idea that I could be more active in supporting sickle families from a nursing perspective, only after I’d been to the United States, partly on holiday but partly to look at sickle cell provisions in Los Angeles and that’s where I met a Sickle Cell Nurse Specialist. I thought, ‘Oh hold on, nurses can have a role.’ Came back, discussed it with Dr Brozovic, she found the Funding and that’s how I became the first Sickle Cell Nurse Specialist.

HM:   Brilliant and obviously you did so much work to improve the treatment of people with sickle cell anaemia and I just wondered, you mention in the book you speculate on to what extent was there not sufficient prioritisation of that condition and enough research going into it at that time because it primarily affected ethnic minority communities. I just wondered in your view are other conditions now that are also not receiving enough attention or focus that the system should be thinking about?

DEA:   Well of course, Covid-19 has just thrown that up. It’s like Black Lives Matter, the death of George Floyd, covid and the horrific impact it’s had on both Black and minority ethnic communities but Black and minority health professionals as well they’ve lost their lives and there is a feeling and I think there is evidence that they were disproportionately exposed, sent to the front line, had a higher viral load as a result. What is all that about? It’s about racism pure and simple. It’s embedded within other factors. That’s what I really want to say. So, you asked if there are other examples, I think there’s a huge amount of evidence and The King’s Fund has played its part in disseminating this in terms of mental health.

I think mental health is the area that frightens me so much because it can destroy families, it can destroy individuals’ quality of life. Way, way back there was evidence coming out of the United States, of stress caused by racism and its impact on physical and emotional wellbeing of African Americans and we can see exactly the same effects. So, you take all the environmental, all the social factors. So, we know such communities are going to have the worst housing, the worst employment opportunities, the worst level of financial security, on and on and on. So, who’s surprised that their mortality, their morbidity, all the statistics that one would look at are generally worse.

Obviously, there are variations according to which minority ethnic groups you look at. The evidence is there clearly, it’s the action that has to be taken and there has to be trust and acknowledgment of the negativities that have gone on towards such communities and actually the bottom line is, do the, I’m going to call it, white communities, white professionals, white dominated services, are they prepared to acknowledge, ‘Actually we’ve got to let go a bit,’ which might mean a few jobs going because if we’re serious about equitable access, equitable provision, we’ve got to give up, I think it’s been called privilege or whatever. Will it happen? I’m not sure, you can see it happening occasionally but that’s what’s got to happen to have a shift in terms of the allocation of resources, a shift in the allocation of power.

HM:   Yes, it’s great to hear you spell that out so clearly and yes I agree. The evidence is all there and actually we had Professor David Williams come from Harvard and spoke about exactly what you’re talking about. Also, as you say, this is about equity and the NHS, that’s one of the founding principles and yes, so much more needs to be done. I’ve read that you played a key role in campaigning for a statue of Nurse Mary Seacole, could you tell us a bit about who she was and the important role she played in the history of nursing?

DEA:   Yes, I’d like to acknowledge the role the Lord Clive Soley made in establishing the Mary Seacole Statue Appeal. But based on being approached by four Caribbean women in his then constituency when he was an MP and I became Vice-Chair of that appeal. Mary Seacole was a Jamaican Scottish Nurse Doctoress and Entrepreneur, who in the 1850s made her own way out to the Crimean War and sold provisions but also provided nursing care and that’s when she became famous to the British Victorian public and published her very incredible memoirs and so I see her as a role model and I just like the feistiness of Mary Seacole but most importantly her commitment to the care of sick and wounded and dying soldiers and the courage that she displayed but the humour and her entrepreneurial skills. She didn’t come from wealth, she created wealth and I think all those aspects are so relevant today.

HM:   Until there were concerted efforts to raise her profile, she had kind of disappeared from history. We’re coming now into October, it will be Black History Month and I know part of the work you did, you were shocked, talking to other nurses to learn that people didn’t know about her, it wasn’t part of their learning, it hadn’t been part of your education either, when you were training to be a nurse. I just wondered, are there black medical professionals, who have been forgotten, are there any that you’d like to name and for us to think about as we enter Black History Month, not just Black History Month obviously but always?

DEA:   I would prefer personally that the recognition should be to the black health professionals today. We’ve got examples of, it isn’t that difficult, if people really wanted to find out, just go onto Google, go onto Patrick Vernon’s 100 Black Britons over the years and one can see Black health professionals from the 1900s. People should get that energy to do a little bit of research and doing that they should also be aware that around them there are some incredible black health professionals. I would just like to flag up a group called Melanin Medics, they’re active on Twitter and the reason I’m so enthused by them, they’re predominantly students. It’s wonderful to see this younger generation or not necessarily always young but new in the profession, whatever their age, having the confidence to use social media in the way that they do it and have the resources and have the confidence to make the comments and link up with other people.

HM:   I wanted to ask you about a time or a moment in your leadership journey that you feel most proud of?

DEA:   The proudest moment for me was becoming the first Sickle Cell Nurse Specialist in the UK in 1979 because I do like innovation. I also like dealing with challenges and people trying to knock you back, I know that sounds a bit weird but it happened when I became the first Sickle Cell Nurse Specialist, they said, ‘This is a minority, it’s not a public health issue.’ Also working with the Trustees in the Mary Seacole Memorial Statue Appeal because some of the racist, negative comments that we were the subject of, that’s what I’m proud of.

I love working as a team, I know I’ve got certain strengths, and I’ve got a heck of a lot of weaknesses as well, and therefore I love working within a team. I think those are the two examples, the sickle cell movement in this country, and the Mary Seacole Statue Appeal. If people really want to know how things change, they need to look closely at the variety of people and organisations involved in ensuring change. It’s very rarely one person, however history does get rewritten, so we’ve really got to very careful not to be put on a pedestal, when you know, this was how it started, I joined and others joined and then we had a movement and who would have ever thought that £750,000 would be raised over 13 years to have this splendid monument in the grounds of St Thomas’ Hospital. Mary Seacole overlooking the River Thames, overlooking the Houses of Parliament.

HM:   Yes, it’s brilliant and she’s marching isn’t she?

DEA:   Splendid and a Nurse, a Black Nurse, a mixed-race Nurse.

HM:   Actually so in both those examples, the Seacole statue and the sickle cell work, you talk about the opposition you faced and the barriers and that was something I wanted to ask you about was just about how you manage to remain so determined and resilient despite some of the obstacles and knock backs that you’ve faced when trying to achieve change, what gets you through?

DEA:   Some of the negative responses towards us about the Mary Seacole Statue appeal were absolutely vicious and we didn’t talk about it, it hurt a lot and I remember one night not being able to go to sleep and crying but what I gleaned from their attacks and their negativity and their opposition, what they didn’t realise was the more they did that, it’s just a small group but the more I viewed how they were attacking, the more it gave me the determination and I would talk to friends about it and I think there’s no doubt that we all need to learn to listen to our body and realise when we’re getting depressed, when we are getting too angry, your blood pressure’s going up, however it’s to know, who do you pick the phone up to? Who do you text? If you don’t do that, it just overwhelms you and you can give up, or you can get depressed and that’s not going to help you and it’s not going to help the campaign but you have to be constantly talking to yourself and trying to get yourself in balance and not be overwhelmed with the small but persistent and vociferous negativity that can happen.

HM:   So, it’s a very conscious effort that you have to make to stop your mind being distracted or hearing too heavily the minority negativity. So, in your memoirs you talk about anger and resentment, about some of the experiences that you had, but even though the words are there, the feeling of anger, the emotion of anger, I don’t feel as I’m reading your memoirs. You’re very, I guess my take would be, kind of, half glass full and positive and I just wonder how you do that? Is that a conscious thing too?

DEA:   Helen that is something that so many people have fed back in terms of that book. But people who know me, it’s made me reflect on, am I like that? I don’t really think too deeply, I just get on with stuff. What I now am more conscious of is, I do pick up when I’m feeling down, and I deliberately do something that will boost my spirit. Things like what helps me, music, helps me enormously, reading certain books anyway, comedy, sense of humour. I love really belly laughing television programmes, Derry Girls, I don’t know whether you ever saw the French comedy thing on Netflix, Call my Agent?

HM:   No but somebody has recommended it to me and now you have. I need to watch it.

DEA:   You need to watch it, I did live in France and I do like to keep my French up so there was the added bonus it’s in French, obviously subtitles. It’s just beautifully written, absolutely hilarious. Gradually I realised exercise was important, it took me a bit of time, friends, family and being aware of some people that you have to move around with but that they can create a sort of negative feeling in you, not deliberately but just being conscious of that. So, I’m aware now of things that will cheer me up and lift me out of the low moods and also not to be frightened of the fact that you have low moods. More importantly , what do you do to get out of them? And people have actually said, particularly after the memoirs came out, ‘How do you keep your positivity up, what helps you?’ I’m not being puritanical now but looking back, I don’t drink, I don’t smoke, given up with men, I think…

HM:   Is that the secret to a healthy life?

DEA:   I do value my friends, I really do and some of them are very, very patient with me and I love them for that. But bringing it closer to home, I’ve got a daughter, I’ve got a granddaughter I’ve got my flat, I feel safe in my flat particularly during all this Covid crisis and yes, I think I’m at peace with myself now, I’ve got a better balance in terms of life.

HM:   Yes, and there are some really good tips in there. Okay final question, if you could travel back in time and give one piece of advice to yourself as a young nurse starting her career and this is for the benefit of all those people listening who might be about to start their career as a nurse or have recently started, what would your advice be?

DEA:   My advice would be that I wouldn’t have been so shy and lacking in confidence about myself at the outset of my nursing career as a student. That blocked being able to converse with many people and benefit from their expertise, from their friendship and all that was due to I think we’d call it now low self-esteem. Looking back I wished I’d recognised that I was intelligent, that I had a sense of humour, that I was very curious about life, and also that my mixed heritage was not a negative issue that all of these are strengths now I realise, I didn’t realise then and I wished I had.

HM:   That’s good advice and actually sorry I have one more question, when you were talking about your work on sickle cell you said, it brought together the personal, professional and political, if somebody was asking you, where do I go with my career, how do I get energy for where to go, would that be a piece of advice, that you bring together those elements?

DEA:   I’m often asked that actually and one of the things I do say is, which aspect of your work do you really enjoy even though it might be really challenging? Which is the area of work where you suddenly find that energy that you haven’t found for a piece of work that you’re not really that interested in? Which part of your work would you really like to spend much more time on? Home in on that area because without realising it that was what I was doing. So, the area for me was improving the quality of care for the Black community. I found that was an area that I got a lot of energy with that. I think fortunately discovered that sickle cell was an area where I could work with others and use that anger, use that energy and really enjoy it absolutely. I think looking back at my younger self, I wish I was aware of that, I’d had such a sheltered upbringing that it took me longer. I think sometimes we haven’t got… why waste that time? Try and learn about this earlier on in your career possibly.

HM:   So, follow the energy. Well thank you so much Dame Elizabeth for joining me today and for being so generous with your time, I’ve learnt so much from you and I’m sure our listeners will too, thank you.

DEA:   Thank you very much Helen and I’ve thoroughly enjoyed our session.

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. You can also get in touch with us via Twitter either at The Kings Fund account or my account @Helenamacarena. Thanks as always to you for listening but also to our podcast team for this episode. Producer Ian Ford and Researcher Jonathon Homes as well as our colleague in our leadership division Mark Patterson. We hope you can join us next time.