Transcript: Clackmannanshire and Stirling HSCP: Covid-19 response

Podcast Episode: Clackmannanshire and Stirling HSCP: Covid-19 response

What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

MD - Michelle Drumm
CW - Carolyn Wyllie

MD Carolyn Wyllie is Head of Community Health and Care at Clackmannan and Stirling Health and Social Care Partnership. On 18 June, we had a conversation with Carolyn about the partnerships’ response to Covid-19 and the interventions put in place to continue care and support in the crisis. This includes detail on the Forth Valley model.

MD So thanks a million for taking the time out to speak to me ‘cause I know you’ve got a busy schedule.

CW It’s absolutely fine. In fact, I’m probably in a good place today because we had our IJB yesterday and it was really positive actually despite everything that we have gone through, which was just lovely.

MD Good. Good. So there is quite a lot of positivity?

CW Absolutely. Absolutely, because as you know it has been challenging.

MD Can you just tell me firstly just your role at the partnership and maybe a bit about your background as well?

CW Yeah, sure. So I have been in post just over four months.

MD Oh right!

CW Yes. So I’m a qualified social worker. I qualified more years than I care to mention and have spent my career between Dumfries and Galloway, Scottish Borders and then laterally East Lothian Council, and then East Lothian Health and Social Care Partnership. So I’ve come from there into this post, so I was probably the level just below Head of Service in East Lothian, and quite a number of areas, adult support protection, adult services in the main. So coming here was a promoted post for me, a deliberate move for me, that I was ready for the next step. I understood the challenges locally of it being three constituent partners. We’ve got Stirling Council, Clack’s Council and the NHS. I’m never one to shy away from a challenge. I decided actually that there were definitely opportunities there, so I was successful in the recruitment and joined in February really, beginning of February, just as this all started kicking off, and in actual fact, in terms of my role, so my official title is Head of Community Health and Care, and that encompasses all the operational aspects of the Health and Social Care Partnership. So if you think about the national outcomes that we have, the nine national outcomes that we have, effectively my job is to make sure that they flow into the strategic priorities of the Health and Social Care Partnership, and then from that my objective I suppose is to make sure that we can evidence that we are achieving those priorities and ultimately can evaluate back into the national outcomes to demonstrate how we are making sure that services at the front end, for people who live in the communities, are benefitting from them, you know, care closer to home etcetera.

MD Could you just really quickly summarise the national outcomes?

CW So the national health and wellbeing outcomes are really what the integrated authorities should be striving for, and it is about people are able to look after and improve their own health and wellbeing, they’re of good health for longer, people including those with disabilities or long-term conditions are able to live as far as reasonable independence either at home or in the community, people who use services have positive experience and their dignity is respected, health and social care services are centred upon maintaining or improving the quality of life of people who use them. We’ll also have to make sure we have sight of reducing health inequalities, unpaid carers you can imagine is quite substantial and quite an important aspect of this as well, and that we are focussing on unpaid carers and supporting them to look after their own health and wellbeing and reduce any negative impact on their role. There’s a key point here about people who use services are safe and free from harm and people who work in health and social care feel that they’re engaged with the work that they do and they’re supported to improve, and resources are used effectively and efficiently from the provision and the delivery. So again that’s best value because it’s the public purse at the end of the day. We need to be accountable for how we’re spending that. So that’s a whistle-stop tour of what we should be about and our priorities kind of feed into that as well.

MD Yeah, so aspiring to quite a lot there. So tell me then, how did the services have to adapt then with the onset of the pandemic?

CW Well, I suppose for me I joined and the pandemic happened four weeks later, so I was still learning what we already had and what was already in place here in Stirling and Clackmannanshire, and I think by the end of the week I had already identified a number of areas that we needed to either augment or improve or establish, and then the pandemic happened and I thought, “Well that’s put the kibosh on that”, but in actual fact what it did was accelerate some of those areas for me. It meant that I could very quickly implement change in response to the pandemic. What is it they say? “Out of every crisis you’ve got to see opportunity”? So that for me I have to say brought opportunity with it. So what we had to do very quickly was write a mobilisation plan. We had to take the directives that were coming down from Scottish Government, and at that point in March the directive was to ensure that the acute sector had the capacity to enable the bed capacity there for the surge that they were expecting. So in March that was our focus, empty the hospitals so as that basically we had capacity within the system to protect those or to enable those that were coming into acute services, and we did that very successfully. So every authority in Scotland was given a directive that they had to get to zero delays by say it was the 17th of April - I can’t remember the exact date - and our authority met that five days prior to that date, and that was quite an achievement here because the delays here I had noticed were always relatively high. So to go from a position where you were, you know, twenty, thirty recorded delays per month down to a position of zero was extremely challenging. How do we do that? How do we do that quickly? We worked with our local authorities. We worked with our Stirling and Clack’s authorities. We knew to create capacity in the acute sector we had to create capacity in the community. What we did was we opened up a care home that had previously been closed, a small ten-bedded unit, and then we brought online or prepared a second care home that had been closed, and I think that was a forty-bedded unit, and we thought, “We might not need them but they’re there. We’ve done it. We’ve done all the work that we require so as that should we have to open that because of a surge in the acute sector, we have the space”, because we also have Bellfield in this partnership, which is the Health and Social Care Village in Stirling. So there are 88 intermediate beds here. So we knew that we needed to make sure that the people that were in an intermediate bed had a medical diagnosis and reason for being there, and those other people waiting for care homes or waiting to go back home and waiting for a package of care could be looked after in a care setting in the community, as opposed to an intermediate or an acute bed.

MD Stirling Care Village is a very new initiative, isn’t it? That only opened I think in the last couple of years. Did that make a massive difference then to the provision of services in this period?

CW It made a difference to me in that everything is very much central here, so it made a difference in terms of that I was able to then if you like very quickly understand the dynamics and the resources here and then bring everybody together. So we opened up our mobilisation centre here, and until social distancing came in we ran a mobilisation centre in one of the rooms here, where every department was represented. So we had 28 desks if you like, so 28 representations of all the services from adult services to all the services in the village, and what we did was we worked together, we met twice a week and we identified what each other’s priorities were in terms of looking at what we could do. At that point in time I should say that staff were being redeployed, because staff were stood down in elective services. So we for instance received 43 ANPs into the village. It was great for us because we’d additional resources then to enable that faster rehab to get people back home, because we went to working seven days a week. So rather than the traditional Monday to Friday, we actually went to seven days a week.

MD How did staff respond to having to work seven days?

CW So it was their initiative. It was them that said, “We can do this”, and it wasn’t compulsory for anybody. It was voluntary and I think everybody volunteered. I don’t think there was anybody that didn’t volunteer. So they really pulled together and they were the ones from the bottom up that were coming out with the, “Why don’t we do this? Why don’t we do that? Have we thought that we could maybe do this a bit differently?” So it was just wonderful to see the richness coming from staff, and actually it was bottom up. It was very much bottom up because you had a new Head of Service who really didn’t understand all the resources and the dynamics totally, what everybody did and how that interacted and interlaced together. So you had the staff telling me and my leadership team - which was quite small at that point in time because again we had vacancies - you had them telling us how they felt that they could adapt their services. So that was really, really positive. So that was March and into April, then the direction changed obviously. The direction was that it appeared the acute services were not going to get the surge they had expected. So probably mid-April the focus then very much went to care homes, and it was about we have to think about the vulnerable older people because we can see that the pandemic, you know, we were watching what was happening in Europe and we could see that the pandemic, when it got into a care home it was very difficult to get it out.

MD Sure.

CW So the directive from Scottish Government then was about mobilising, with Public Health chairing that, multi-disciplinary approach and response in order to direct the next piece of work.

MD Mmmhmm. I don’t want to go into a blame game but do you think that services were a bit slow to think about care homes in this?

CW I have thought about this actually, Michelle, and I wouldn’t like to say slow. I think this pandemic caught everybody. We’d never been in anything like it before and I think that with the best will in the world you cannot think of everything if you’ve never experienced it before, and I think it was only when particularly Europe, particularly Spain if you think about it, and Italy, it was only when we started I think to hear the challenges that they were having that actually people started to think, “Well actually, maybe we’re focussing on the wrong area at this moment in time”, but that’s part of a pandemic response as well. It should be fluid. It should change according to the circumstances and the need. So I think that whilst you may be on one track, you know, my emergency planning hat on tells me that you may be on one track but you must be adaptable and creative to change very quickly. Hindsight as they say is a wonderful thing, and yes, in hindsight we look back and we reflect. Could we have focussed earlier? We probably could have. Is it, and as you say it’s not about the blame game, but could Scottish Government have directed us at an earlier stage? Well I think they were finding their feet as much as we were trying to find our feet and navigate our way through this.

MD You were saying the staff really responded really positively. Has there been any negative impact at all on staff do you think, or do you think it’s been mostly learning opportunities?

CW I think it’s been huge learning opportunities. I think the only negative I can remember, the only negative in the beginning was again the kind of mixed messages about PPE and the anxiety about PPE and about how do we protect staff and how do we protect patients, residents, clients, and I think that again because that was again a moving feast, and I hate to say it but there was a lot of, particularly with a political agenda, there was a lot of criticism, “If you say black I’ll say white”, and actually again it was everybody was trying to find their way through this quickly. It was a national pandemic, a national emergency, and unfortunately the resources in terms of the PPE equipment was in the beginning difficult, because people didn’t have the stock to send out. So in the beginning we were saying, “Well we have to be careful how we deploy our masks”, for instance - not face masks, face shields - “because we may have a limited supply of that, so who do we need to distribute them to? So we know we need to distribute them to anybody who’s doing an aerosol-generated procedure”, and that of course was I think quite difficult for others, particularly in public, because they were watching TV, they were seeing the news and they were seeing people gowned up with masks, visors, and so the assumption was that’s how you needed to look. If a carer was going in to help somebody get dressed in the morning that’s how they needed to look, and so there was a challenge there in terms of supply and demand. There was a challenge there in terms of protection, public perception, and there was a lot of versions of different guidance coming out from Scottish Government, Public Health etcetera, and it was getting quite confusing I think for staff on the ground. “Well what am I meant to be wearing? Do I wear nitrile gloves? Do I not wear? Can I wear ordinary gloves?”, and one question that came back to me I’ll never forget, one day I got a phone call from a Trade Union rep who said to me, “Your staff are wearing blue masks. They’re meant to be green.” So that was an example of actually it doesn’t matter what colour they are, it’s do they meet the standards, have they passed the assurance tests that they need to, and trying to say that to the union rep. The colour is irrelevant. Do they meet the standards that they should do so as that they are kind of waterproof I suppose, for want of a better word? So there was a lot of that, but that settled then and I have to say I think it’s much clearer now. We have good signage. We have discussions with staff. I think people are much, much clearer about what is required, when it’s required and where it’s required, but for about a period of two weeks to three weeks in the beginning that was quite precarious. That then caused anxiety amongst the staff, and that was difficult because you were trying to support the staff and you were trying to reassure them that never would we put them in a position of harm or risk, but at the same time the messages were unclear to us. So that was particularly challenging for us but since then I know I as a Head of Service am very mindful of how we support staff, because this is going to be ongoing for some significant time, and regardless of a pandemic my role as a Head of Service is to make sure I have an enthusiastic workforce. I’m not saying everybody comes to work every morning saying, “I would rather go to work than lie on a beach on holiday.” I’m not saying that at all. We all need to work but I want people to work for the partnership that actually don’t go home at night and say, “I don’t like my job.” I want them to go home at night and I want them to say, “What I did today made a difference. What I did today mattered.” We’ll all have good and bad days and so I need to look at that whether we’re in COVID or not.

MD Mmmhmm.

CW But one of the things that we have done is with the third sector and the independent sector we have set up a what we call - I’ve written it down actually - what we call a local resilience partnership meeting. A local resilience partnership. So that is going to be chaired by our Head of Strategic Improvement and she’s going to ensure that everybody’s represented on that board, and what happens then is we talk about how we support staff. We talk about what the challenges are for staff. We also not talk only about the challenges but how do we rejoice and acknowledge the hard work that staff have done?

MD Yeah.

CW And staff have - as you’ll know, you’ll see it everywhere - really gone beyond. We know that they’re going home after a twelve-hour shift and then making sure the elderly neighbour or etcetera are also fine.

MD And I guess it’s about forward thinking about staff wellbeing as well, so they’ve put a lot of time and energy into the now and how potentially will that impact them? How will they feel in say six months’ time? Will they feel a bit burnt out? So I suppose is there some forward planning and thinking around those situations?

CW So we have worked with our HR departments on that, precisely that, and what we’ve asked staff is in the beginning people were saying, “We’ll cancel our annual leave and we’ll do whatever we can”, and we were all going, “That’s great. Thank you very much.” However, after a few weeks we suddenly realised that we’re in this for the long-haul, and actually we didn’t want people to cancel annual leave. So we had to talk to HR and talk to our colleagues about this and say, “You need your holiday. You need your downtime”, myself included, management team etcetera, and it was about saying to them, “I understand you might want to cancel your fortnight ‘cause you can’t go off on your holiday, but actually could you make sure you take a week? Could you make sure you take some days?” So we needed to be aware of the needs of the service, we need to cover the service, we’re absolutely aware of that, but key to that is making sure that people do have downtime, and each manager is very conscious of that and I think that the staff wellbeing resilience is on my agenda, it’s a standing item on my agenda regardless of who I’m talking to and I think it will be forevermore. It’s certainly brought that home to me, that that needs to be up there.

MD Has this period then, you were talking about meeting up with the IJB yesterday, do you think this period has strengthened the integration of health and social care or has just posed more challenges to it?

CW No, I think it absolutely has strengthened it. Now I’m saying that because obviously I’m an incoming Head of Service and it is widely acknowledged that Clack and Stirling had some work to do around the implementation of integration. However, I think I’m quite amazed by how well that has gone and how accelerated that has been, and it was lovely to hear at the IJB yesterday our three Chief Execs acknowledging the work of the leadership team and all the staff behind that, about how we have really parachuted integration right into the centre of everything, but I think that nationally - and I say this because I’m part of a small cohort that’s chaired by Val de Souza about response and recovery - I think nationally there is now recognition that actually it’s the community where we maybe need to concentrate the resources on, and I speak from a personal reflection on this, Michelle, I think that there have been a lot of focus, or the majority of focus often goes into the acute services - quite rightly so, that’s where we save lives - but the infrastructure behind the acute is where people live. It’s about how do we prevent them getting into the acute and how do we get them out of the acute. I think that there’s a very much changing national picture about we need to make sure the acute is on par with the community and it’s not that way, it’s very much there, because actually I think what this has shown, and there’s been a number of initiatives here, is actually we can stop people going into the acute. How do we do that wellbeing agenda? How do we keep people healthy? How do we ensure that they’re for instance engaging in regular exercise so as that they’re healthy eating, they’re exercising, they’re not developing strokes, heart attacks, through not having the opportunity to access these areas? So there’s a lot of that I think that will move forward.

MD Has there been particular interventions you’ve brought in around prevention in this period that has helped to, as you say, lower the acute side of things?

CW Yes, and I’ve got some stats for you from the IJB yesterday, so a few things that we did, and I can go into each of them if you like. So the first thing that we did was I noticed that when I came here there wasn’t a hospital at home model. It was very much the admissions go through the acute and the pathway is into the acute and then down to the community hospital and then home, or acute home. I came from a background where we had step up step down beds, we had hospital at home if you like, that’s how it’s packaged, and also that kind of discharge to assess, getting people back home relatively quickly and assessing them in their own homes. I had started to have these discussions with our clinicians and our geriatricians and then COVID happened, and because of the need to if you like redistribute the staff and also the stand down of services, the geriatricians came to base themselves in the community, and by default it accelerated that discussion about a hospital at home model, and what happened there was almost overnight instead of people being directed through the acute we had people coming into Bellfield, which is in the Care Village if you like, into the intermediate care beds, and they would maybe have had a fall, and whilst they hadn’t broken anything, didn’t need surgery, they maybe weren’t functioning to their maximum potential, so needed a focussed period of rehab. So we brought them into the Bellfield, 48, 72 hours, and then brought them home again really quickly. By developing those new pathways, we actually - I’ve got the stats here - we avoided 58 people going into the acute sector. So this is only from I would say beginning of April. We had five stepped down, so five beds that were stepped down in total. So that’s 5 beds that were saved if you like. So 58 people were avoided admission, five beds in the Bellfield site, and 906 acute bed days were saved out of those 58 people, and 378 community hospital beds, so community integrated beds, were saved. So if that’s only really April and May stats, that’s an amazing piece of analysis. So we need to take that. We need to drive that forward.

MD Mmmhmm.

CW And that’s exactly what we’re doing. So our principal geriatrician, Dr Copeland, is leading on that work and looking at with myself and others about how we can augment our enhanced care at the moment. We’ve got an enhanced care team in the community, which is made up from ANPs, some rehab AHP support in there. How can we augment that team? How can we make sure it’s truly multi-disciplinary so as that we can pull people down from hospital to home really quickly, and also how can we avoid people going into the acute side as well, and that may be that when they come into Bellfield there’s a step up bed or actually they don’t go into a bed at all? So hospital at home isn’t my area of expertise because that’s to be driven by the clinician side, but obviously it’s really important from a multi-disciplinary aspect that everybody is involved there, that we’ve got AHPs, you’ve got the clinicians, you’ve got nursing staff and you’ve got social care staff as well, because some of that may be that they just need support for a couple of weeks to get their maximum functioning back up to full potential and then we can withdraw. That’s a huge area of us taking that forward.

MD Okay, and do you think there’s things that you’ve done that other partnerships around Scotland could also take and use?

CW So have you heard a lot of chat about the Forth Valley model for care homes?

MD I haven’t, no.

CW Right okay, and again I can’t take any credit for this. It was a work in progress if you like from Dr Williams and Dr Paul Baughan and the district nursing and myself. I had come from an authority that had a care home team, and I say that because my previous Chief Officer, if I took all the credit that’s not fair ‘cause it was in my previous employment as well. So we had a care home team and a multi-disciplinary care home team and what that was, was ANPs, social workers, and we basically at that point in time did a lot of the assessments and we did a lot of the support to care homes. So when this came around and we realised that there was support needed for care homes, in discussion with the consultants for Public Health we thought that the best approach would be to develop a multi-disciplinary team, and that that team would sit here in Stirling Care Village and they would support the care homes. So that team started off with 2 GPs, because they would support the COVID positive residents, ANPs that were if you like redeployed, three social workers and three social work assistants. In that team we have expertise about infection control and also we would link in with other professions on the periphery of that, which would be palliative care, third sector etcetera. So that team was set up within one week, and they’re core located so they’re based here across the road, and they all sit together and work together and what they then do is so the clinical side of it if you think about that, the GP side, if there is a COVID positive resident the clinicians in that team will oversee that person. They’ll go out to visit. So the GPs in the community would only see the other residents who weren’t COVID positive.

MD Okay.

CW So like if you needed to see a GP they’d call the practice, but if it was a COVID positive patient it would come into that team. The ANPs and the social workers in that team work side by side, so if the ANPs, the advanced nurse practitioners, were going out to the care homes to do a care assurance visit, then the social worker and the ANP would do that together because we want to minimise the footfall in these care homes, and they developed a care assurance tool and that care assurance tool really walks them round that care home looking at all the advice and directive that we’ve been given through Public Health Scotland about the cohorting, about simple things like making sure the chairs in the sitting room are two metres apart. So there’s lots of that as well, making sure that they have “just in case” medication. If somebody’s positive and we feel they could deteriorate, they may be asymptomatic but should they deteriorate and it’s three o’clock on a Saturday morning do we have “just in case” medication there readily available for staff to administer? So that came together really, really quickly and then every day, so since the 25th of April, every day seven days a week at four o’clock there was a public health call that’s chaired by one of the consultants in the Forth Valley Public Health team and one of the GPs - whoever’s on duty - myself and other representations from Falkirk Health and Social Care Partnership as well, we all dial into that. So we’re the strategic oversight team of that and we talk about the care homes in each of our patches, how many residents are positive, when was the next or when was the last care assurance visit, what was the outcomes of the care assurance visit, are we worried, have they actually displayed some really positive practice that we would want to promote with others, and also it was about standard and quality of care. It wasn’t just about management of the pandemic. It was also about quality and care, because you’ve got elderly residents at this point possibly isolating in their rooms, and that’s a long time for somebody to isolate. If they are confused or suffering from dementia, agitation, do we need to call in our CPNs in terms of supporting them? A big bit of the team as well was about supporting the care home staff. It wasn’t about going in and criticising. It was about going in and being a critical friend, but it wasn’t about criticising. It was about how can we support you, how are your staff, because unfortunately in the beginning some care homes had a significant amount of sickness, and on occasions we have had to put our own staff in to augment and support those care homes. So it was about working through all these challenges.

MD Mmmhmm.

CW Now what we’re doing at the moment is we’re evaluating that team, and in fact I think it’s tomorrow I think Paul’s presenting the work of the team on a national platform. So my objective now is that team has to continue. I need to now work out when we move on from COVID, when we move out of the emergency stage and we move much more back to normality, we’ve already talked across Forth Valley about how can we make this permanent, because I know from my previous experience that actually that model works, but this model here in Forth Valley was so much more than just support to the care homes. It was also the clinical intervention there as well.

MD Yeah.

CW So how do we do that? How do we augment that and build on that?

MD Yep sure, and do you think other health and social care partnerships will have done things quite differently, or whether your model is particularly unique?

CW I don’t know is the answer to that, Michelle, unfortunately. I’m not actually that sure what other partnerships are doing, however I do know that our Chief Execs and our Director of Public Health, I do know that there’s been a lot of interest in the Forth Valley model, and the consultant on the strategic call last week said that there was an MP in Westminster that apparently said to Mr Johnson, “Why can’t everybody follow the Forth Valley model?”

MD Right, okay.

CW So there we are. Our claim to fame!

MD It’s good feedback to get.

CW Yes.

MD Yeah. There might be people in some of the other partnerships who are interested to hear more about what you’ve been doing.

CW Absolutely, and that’s some of the work that Paul’s been doing. Forgive me, off the top of my head I cannot remember the forum that he’s speaking on tomorrow. So he’s got the slideshow etcetera, which shows pictures of the team all side by side, and what the principles behind the team were, how do we evaluate. We had a session last week and we actually said, “We’ve missed a bit of a trick here because we became so reactive and we just moved forward, said this is what we need to do, this is how we’ll do it, and we forgot to evaluate bits of it or capture information right from the beginning.” So we probably were slow to capture some of our data. For instance, we know how many times the clinical staff have gone out because it’s recorded in note, but actually we don’t know how many times the social work staff have gone out because they were going out generically for the care home, not for individual residents. So we had a session last week about what data do we need to capture and how can we provide that quantitative and qualitative analyses so we’ve got data but we can also give you the detail behind that.

MD Just to finish, Carolyn, you spoke a little bit about evaluation there but what would be the key learning for you, from starting your post I know having to go straight into the pandemic, what would be the key learning over this period for you so far?

CW I think probably for me is have confidence. I came into the partnership obviously and I think in that first week that I called all the Heads together, all the operational lead managers together, I didn’t know them. I didn’t know their services. I was really worried about getting it wrong. I was a new Head of Service, brand new in post. I didn’t understand the make-up. I was aware of the challenges before, and here we are with a pandemic, and in actual fact I think on reflection what I did was I flipped back into operational mode. I flipped back into when I was probably more of an operational manager and just took it from there to say, “Well this is what I would do if I was in your service”, etcetera, and talking to people and actually hearing their stories as well about what we do. I think I learned from that I needed to have a bit more confidence in myself, but equally as well I put if you like myself in the hands of the staff. There were nights that I would say, “I hope everything’s going to be okay. I hope I’m not going to have a momentous fall”, and it’s not about me personally, and that sounds strange. It’s not about me personally because actually I’m representing an organisation, so if I fall the organisation falls because we have a corporate responsibility here, and a lot of the work of the partnerships and particularly the NHS etcetera, especially the care home stuff, so much of it has been played out in the public domain. So if I got it wrong it would very much be played out in the public domain, or let’s not say got it wrong, but I didn’t get it right. I think there is a difference between getting it wrong. You don’t have to get it wrong but you don’t have to get it right the first time either, ‘cause sometimes you have to do trial and error.

MD Mmmhmm.

CW So I think that reflecting back I think I have so much more confidence now than I did before about me as an individual and about some of the decision making and acceptance that I’m in this position and I have to accept that I need others as well. It’s not about me. I need a really kind of robust team. So the confidence thing is a big thing. I think that’s for me the learning there, and learning to accept that other people will sometimes have to tell you what you need to know. They’ll have to tell you how they think it should play out and you have to accept that. You have to put your trust in them. What we’re now trying to do is manage the pandemic but at the same time bring some of our oversight of our other strategic priorities to front, or to the fore I should say, and it’s about how can we make sure that we use our experience over the last twelve weeks to move some of that forward, and again it isn’t always about money. People will say, “Well we can’t do that ‘cause we’ve not got any money.” Well actually, can we? We move things around. Can we? How much money would we actually need to make to do things differently? It’s about imagination and invention as well.

MD Carolyn, we’ll leave it there if that’s okay?

CW That’s fine.

MD I’d like to thank you very much for taking the time out to speak to me about the partnership.

CW You’re welcome.

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