Supporting the Delivery of COVID Vaccine in Wales: The Welsh Immunisation System

Supporting the Delivery of COVID Vaccine in Wales: The Welsh Immunisation System

DA

Dr. Anne Marie Cunningham

Associate Medical Director, Digital Health and Care Wales

Transcript

00:00:13

Congratulations again to Sade and Richard, I love that they have a video from their CEO, Luz Schuller, congratulating them on the work they've done showing that their work matters to people who matter. Incidentally. They are only the third talk to have achieved this joining American airlines and eBay. And by the way, if any of you have a technology story that your CEO appreciates and is willing to talk about it, please tell me about it. I have a conference that I'd love for you to tell your story yet. Okay. Here is a story behind the next talk. In January, I saw someone post something on Twitter who mentioned how the flow metrics described in Dr. Mick Kirsten's book, project to product explained how hugely valuable it was to minimize the separation between the quote technology and vaccination teams. So you can imagine that this caught my attention.

00:01:10

So I reached out to Dr. Anne Marie Cunningham to learn more about what she was referring to. And what I learned was absolutely amazing because she and her team of 15 people were instrumental in helping get whales to be one of the very fastest countries to get vaccinated, as well as having one of the highest percentage of the population being vaccinated. We all know how important this is for every society providing a critical capability for the most dire medical emergency and dire economic crisis in a hundred years, regaining any degree of normalcy is simply impossible without it. I thought of how incredible it would be to share her story here at DevOps enterprise. And I was so grateful that she said, yes, so Dr. Cunningham is a medical doctor, a general practitioner, but she is also has been an academic researcher as associate medical director for primary care for digital health and care Wales. She helps build software, which includes the scheduling system that support all child vaccination, which it turns out can be a huge part of the puzzle when you're trying to vaccinate entire population. So here to tell her amazing story of how this helped nearly get every citizen of Wales vaccinated is Dr. Cunningham.

00:02:28

Hello, I'm here today to talk to you about supporting the delivery of C vaccine in Wales, through the development of the Welsh immunization system. I grew up here in the mourns in Northern Ireland and studied medicine in Belfast and trained as a GP. You might know that as a family medicine doctor, uh, I then moved to Carter in Wales via Bristol, because I was considering retraining as a public health doctor. I changed my mind, but I am glad that I completed my master's in public health because I've always enjoyed working in health at a systems level, as well as working with individual patients for 20 years, I have worked as a GP in this village, in this south wheels, valleys, Geter, and alongside that, I have held various other roles for 13 years. I worked in the medical school as a, a researcher and an educator.

00:03:25

I was lead for the use of technology in the undergraduate curriculum, and then one of our statutory health boards as a primary care clinical director, it was named after an RM Bevin, the finder of the NHS before I joined digital health and car wheels, as the primary care clinical lead five years ago in this, in this post, I would call myself a clinical product owner for several, uh, products that we, that we work on. Uh, and by that, I mean that I work with our users, their stakeholders, and our development team alongside the product owners. But before this, I cut my teeth on digital health, by attending, and then running NHS hack days. These are two day hackathons, which bring together technologists, designers, clinicians, patients, and the public, uh, and these coincided with the, the start of the government digital service 10 years ago, it was a time whenever expectations were really being raised off public sector, uh, it, uh, and digital delivery and that applied in the, in the health sector as well.

00:04:38

So one of our strap lines for NHS hot day is geeks who love the NHS, but the other is making NHS it less bad. So given that when I took my role in digital health and car wheels, one of my friends said I had moved from being a Maverick to mainstream. Uh, but there's still some of the Maverick in there. So now I'm going to take you back to the summer of 2020. Springtime had been very hard. Everyone was exhausted with the changes that COVID had brought, particularly those working in health and care. I had been leading our primary care response in the organization, doing what we could to support staff who were changing the way that they worked at a, at an exponential rate and supporting data initiatives, such as our shield patient program will be used data clinical data about the population to try and identify those who were most likely to be vulnerable and so that they could get added, uh, support.

00:05:36

But unfortunately, thousands of people across the UK, uh, and in wheels had, had died from COVID including the most vulnerable living in car homes, uh, and, and the elderly. But by the end of June and Wales, we had had four days where there were no COVID deaths. We had survived the first wave of COVID, but we did expect a second wave to come. We just didn't know when still there was a sense of measured optimism about the UK government was starting to purchase millions of doses of vaccines, which were yet to be approved for use, but there was a belief that sooner or later there would be available. And the Welch government had asked the seven health boards in Wales who have a statutory obligation to plan for their population's health to start getting ready for the biggest vaccination program we were ever going to see against COVID.

00:06:30

So what we did know was that COVID was a devastating illness, and that vaccinations were going to be one of the ways that we were going to be able to stop people dying and get in very ill. Uh, but there were many things that we did not know when was the first vaccine going to be available, which vaccine would be approved first, how many doses of it would be needed? How long would the interval be between doses could vaccines be mixed and matched? How could different regimens be managed together? Who were the people who were going to be, uh, prioritized for the first available vaccines, uh, with, with knew it was going to be those with the highest risk of death. But at that time, some of the research hadn't been done to work out actually who those people were. So there was a lot, uh, that was really unknown, including where the vaccine would be delivered.

00:07:26

And that was really important because, uh, the usual vaccine campaigns that we have say, for example, getting your flu shot, go to your GP practice. So we thought that it was unlikely that these settings were actually going to work for some of these vaccines, because we knew that the, the properties of the vaccine did not lend themselves to that kind of delivery. So everything that we were taking for granted about our, our infrastructure for health was maybe not going to be available to us for this. So there was much uncertainty, but we knew that we needed to be able to maximize the flexibility of any software that was to be used to support the vaccination campaign. Uh, we would need to be able to identify and prioritize those cohorts. We would need to be able to call people for vaccination and then recall them whenever they needed a second dose, or they needed a booster.

00:08:20

And it was really imperative that the software could be used in any setting. So this, this meant that, uh, the good thing was that we had quite a lot of experience about all of this in our organization. For more than 20 years, we had been working and responsible for developing a child health system, uh, to be able to make sure that your children got vaccinated. So whenever they hit a certain age, you get a, an invite in the post when you needed your next one, it arrived. And that was a tremendous strength for us. It meant that when we were thinking, what was, what was, what were we going to do, where we going to go out and buy some software, even though we didn't know all of the requirements for it, or could we actually build software? It meant we really had a very big head start.

00:09:18

And a lot of that head start came down, uh, to my colleague, Jill, I'm going to mention now, and it, it meant our confidence, which I'm gonna explain to you why it was there. It meant that we were the only part of the UK to develop an in-house solution using an existing software team. And we knew that our timescales around that were less at that time than it actually was delivered within 16 weeks. Uh, and we thought that it was actually gonna take less, that we were gonna have less time in that. So it was, it was a tremendous kind of, uh, Hmm, very brave effort to actually commit ourselves to that. And the reason we did it, and the reason, uh, that there was that support was cause when, when, uh, the subgroup of the COVID vaccination board was considering, uh, the, the options, they knew about our background in this, and they knew Jill and Jill is my colleague who, unfortunately, can't be here today.

00:10:22

And to co present with me who was a product owner for the, for the product. Uh, she has 25 years or more experience in actually working and supporting mass immunization. She had worked on that child health system, PRI and it's for runners back to near the very start of all that work. And when the data, anybody results thought about this, they knew, uh, that Jill would be able to deliver. Jill had built and her teams had built many services, run them, operated them, fixed them. They were a stable team. Jill knew all of the team inside out. She knew what their strengths were, what their weaknesses were. There was very high trust amongst her team. And they were trusted by our organization and by our partners, they had empathy for their users because they supported them and they knew the challenges that they faced. And they could work in this like truly agile way, because Jill was comfortable with taking on the responsibility, uh, along, I, I did help her with this, with the, the, with of actually being, uh, making the decisions and prioritizing the backlog along with, with the stakeholders.

00:11:42

Uh, so all of that meant that Jill and the team were not just bringing technical knowledge to the vaccination program, but also knowledge of the business. In some ways, I would say that Jill knew more about how to run a mass vaccination campaign than the teams that were planning, uh, the campaign locally, for example, Jill foresaw that one of the really, really key elements to this was going to be these what we called system generated appointments. So that meant that you set up your clinic sessions, you had your cohort of thousands of people, and you pressed the button and you had populated all of those sessions. Uh, sometimes the health boards were not really thinking that they were gonna run the program that way, but Jill knew, and she was right because of the 7.2, 5 million vaccines that we have now given out in wheels to a population of 3.1 million.

00:12:46

Uh, we, over three quarters of those were delivered in our mass vaccination centers and they were, they were delivered and scheduled, met a lot of them apart from some at the very start through, uh, our application. It, I remember one of the days, uh, because we, we were going along to, to these tabletop exercises, virtual tabletop exercises. And that was where we were learning about what the health boards were planning to do, uh, with the program. Uh, so sometimes it would say, as Jill said, it was to glean what the requirements were, but actually a lot of the requirements were known, uh, to Jill and to the team. And so in a way, we were just checking in to make sure that what we were thinking was going to be needed was not going to break anything for the plans that the health boards were coming up for.

00:13:39

And after one of those sessions, Jill was saying, wouldn't it be useful? Do you think it would be useful if we built in a service where we could send people an SMS to remind them of their appointment? Because at that stage, uh, we were thinking, well, we'll generate all these appointments. And then the health boards might do a meal merge or something, and they'll send out these letters. And I said to Jill, well, look at the Gulf UK notify service. And, uh, she came back the next day and said, it's brilliant. We can integrate with this really easily, uh, get this set up, get all this, get all the SMS sent. And she said, but also they do a service where they send letters. So the old snail meal, uh, and that was important because many people, uh, certainly at the start, you know, we're going to need information about the vaccination campaign in a way to reassure them and getting your letter through in the post landing on your doorstep, telling you your vaccines here, and it's ready for you, uh, at a time also when there was lots of worry, I guess, about SMSs and things and where things scam and or people gotta charge you.

00:14:42

It was really reassuring for people to have that. So we went from actually scheduling, uh, all of these, these appointments, uh, and sending out altogether. Uh, I think about <laugh>, uh, 4 million letters have gone out through our service to people that was our last point last month. I think it's even up higher and 15 million text reminders have gone out through the service and the team, as I said, Jill knew the strengths of her team. So she was able to put some of the team actually on making sure that backend service worked for all of the health boards. So they would sometimes pick up on things like, uh, did you realize that you had set up that clinic and you hadn't actually scheduled anybody into it? So it was a full service that was being delivered along with the more technical aspects of actually having software that worked in any location.

00:15:34

And we feel that that's, that was been a tremendous, uh, strength for us. And I think it shows the vision of whenever you have people with really deep set of knowledge who are able to contribute and see sometimes the things that other people can't even see. So the Welsh immunize, this immunization system was born and it went into use. Uh, we didn't have time to do all of the testing and everything. And some of, some of the elements. Well, when we went, did some of the testing just before we went live, we picked up on some issues from some of our health boards, and I'd be honest. Some of our health boards did not think that we were gonna have this ready in time. They were setting in place other contingency measures to make sure that they would have ways of, of, of recording and, and, and managing.

00:16:20

And they, they, they just really couldn't believe it, that we could start and build something, uh, to be able to do this. But on that first day, on the 8th of December, this is, I was out in one of our vaccine centers in an iron Bevin health board, where I work as a GP, a leisure center that was now given over to working as a vaccination center. So you can see alongside there, some of the staff getting ready, this was just before they started, it started with a, but it was slow start, very sensibly. Uh, and, uh, they were there already to start recording the delivery that, that the vaccines that they were administering, um, and they actually became, that was one of the health boards. It was a little bit unsure about it, but they became one of our biggest supporters. Uh, this is how, how it looked just, I, I think I just, I don't know why I'd taken this photograph at the time, but it was income brand stadium there on that date.

00:17:19

It was a web based application. We were using 365 for authentication. It could be used anywhere a few days. Uh, a few days later, I went up to one of our smaller centers at a different health board where the staff were being in inducted into. There were some people who were sort of like a bit said, they were thinking, well, maybe we should just record the vaccines on paper. And I was actually going in and out with some of the other team sort of showing them how easy it was to record live into the application. And they all became converts and where they're going and managing to show, uh, others how to do it. And when I say every setting was used, this was a few weeks later, and this is outside court of city football stadium, where one of our clusters of GP practices had decided to try, uh, uh, and the, I don't say they cry.

00:18:08

They actually did use it having a drive-in clinic. So here is, uh, over the web, the, the, the team getting set up to be able to record this vaccine. It was a very cool day. It was just above freezing. Uh, and people were coming up in their cars and being jabbed and the vaccine recorded there then. So we felt tremendously glad and happy that we had succeeded in our plan of integrating scheduling with the recording of vaccines and a key element, uh, that came up, uh, as a requirement, not at the very start was that actually the tracks tracking of the vaccine stock. Uh, and that application, as I said, was used in every part, in every setting in wheels. So to give you a little bit more information about the tracking of the vaccine stock, we in wheels, you know, one at the start everywhere in the UK, the constraints around how fast you could go with a vaccination program, where, what staff you had, what buildings you had, what capacity you had, but more than anything, it was your vaccine stock.

00:19:14

And in wheels, we managed to have it that as soon as the vaccine arrived in wheels, it was only three days until it was into people's arms. And in, across the rest of the UK, that timeframe was about 10 days or more. And the other fact, the other thing that happened was that we had no or next to no vaccine wasted wastage. Uh, there was, um, tremendous tracking of, of the vaccine stock, every, uh, that it was being recorded into the system. It was being made available to the pharmacist across, they had complete confidence about word stock was and how it was being used. Uh, it was such a great success that they really do want to think about doing something similar, uh, for other vaccine pro programs as we're going forwards. And that flexibility, because we were building it ourselves, it had never been a requirement before you're doing a childhood set of immunizations.

00:20:07

You don't need to know exactly where the vaccine stock is. Uh, it's a plan program. You don't suddenly get a big rush off needing, uh, a lot of vaccines in one day to, to deliver to people. But here we were getting short life stock coming and it maybe needed to be used within a period of a few weeks. And there was complete confidence that we would be able to do that in wheels. And, and we did. So it wasn't just, um, of course the development team and the support team that were there. Uh, there were other teams that were really involved in this within our organization and across. So our information teams were essentially identifying the cohorts to be vaccinated. They built dashboards, which let, uh, the NHS and others know how they were getting on also made available the data, which could be then reused by others to make up their own, uh, ways of looking and slicing and dicing at the data.

00:21:01

Uh, and we're still doing that, uh, wave, just being, I was just working earlier on with our team, uh, where we were looking at people that are immunosuppressed and are due to get, uh, an extra spring booster vaccine. Uh, so we're still working, uh, through all of that. We know a little bit better what we're doing now, but, uh, all of that work is still going on. Uh, one of the key things that we did was to build vaccine payment for primary care. So I've mentioned already that while over three quarters of our vaccines were given in the mass vaccination centers, uh, that was for all kinds of reasons around the, the kind of vaccines that needed to be used and the suitability for smaller centers and, and stock and the volume that you needed to get through in the day to really make it sensible.

00:21:48

But when the AstraZeneca vaccine came on and was licensed in January of 2020, we were able to use the GP practices. And we knew that that was going to allow us to start going a lot faster. So we, we needed to, uh, we needed to make it really work for the GP practices because GP, it is very mature in the UK. People use the software for many years, they know what insight out, and they don't really like to use something else, but it was really important to us that everybody used the same application, because we felt that was the way to be most robust, over being able to know what was going on. So we built a little bit of a, a sweetener or a user need. We met the user need that the claims for the vaccination were built directly into the software. You could set it up at the story of your session and say, I am clearing for every vaccine that I give in this session.

00:22:43

And then we ran, uh, passed the information over to the people who paid them and it all happened seamlessly so that they got paid for the vaccines within a few weeks. It was something that we hadn't done before in our organization, but it worked really well. And I think it's a really good example of, uh, when Mike Bracken, uh, again from GDS talked, you know, about how the old way of doing things used to be to start with a policy, then go out and procure something and comes back in again. And does it meet your need? No, not really. So instead we were able to identify what the user need was here, that we really needed to make this easy for people to use, uh, and be able to Cleman was gonna be important. We then technically checked out, could we, how would we make that work?

00:23:32

We find out that we could, and then we managed to good agreement at the time this legislation was going through very fast to say that the policy was that it would happen and it would be recorded that way. And so it actually went into the enabling legislation to allow the primary care practice to do the delivery. So we managed to get it in the right order, starting with user need, then the technical, uh, uh, pros to be able to get that delivered. And then the policy as a sign off at the end. Uh, and along with that, uh, we were able to use our infrastructure across primary care, where we set up secure platforms to, to allow the GP practices, even to see the people that they had not claimed a vaccine, uh, payment on, uh, this. And we made it very easy to go into claim.

00:24:20

If you had missed a payment, you could just go back into a record and change it. It was all the one system. Uh, we did a already rolling reconciliation job done, uh, to systems using some other parts of the UK were a little bit more complicated than that. Uh, when I was talking to one of my colleagues about it in another part of the UK, he, he said, uh, cause I was, I was mentioning that this was really quite high press. You could actually go in and edit a vaccine, uh, the payment for a vaccine maybe that you had not actually delivered. Uh, but these are professionals. They're not going to do that. And if they did, we would know we'd have audit trails. We could have picked up something odd, but he, he said, well, if it all goes wrong, you might end up in Siberia, but luckily I'm still here in Cardiff and it didn't go wrong and trusting the, your users and the service and making things streamline for them really did pay off for us.

00:25:16

So, as I was saying that we, yeah, we built in the, the claims to be able to, to, to do that and to be instantly corrected a real strength for us. Uh, we had the dashboards. Um, we also had our business change team involved in with our service desk and our primary care teams supporting the onboarding of thousands of users, thousands of them, because we also made available, uh, elements of the, the GP records. So that in the, within the software, there was an integration. So you could see if somebody had a flu vaccination recently, if they had any allergies, uh, it meant that we needed to go through, uh, ensuring that people had completed their IG training. They also were gonna be able to get access to the vaccination record of everybody in wheels. So we, we went through all of that and really had tremendous support from our teams in actually the onboard with the users and also the support with some of their needs as they were going, uh, going on, uh, I mentioned that I'm making it sound like GPS are a particularly tricky bunch, but anybody that's from the UK and has worked in the health sector would know that that is sometimes, uh, perceived as being a, a particular issue.

00:26:27

Uh, it's not really, it's just that, uh, they are very proficient in their use of it and they, they kind of know what they, what they like and what works for them. So I had identified that when we were, when we were doing this, uh, bringing on board, all of the GP users, we were going to need to suddenly we're moving from working with seven organizations, the health boards to now 400 GP practices who are gonna be involved in the delivery. And although we were gonna run webinars, we, we had to bring them on board very quickly. Because again, this was day to day. You did not know when the vaccine was gonna come live, that it could be used in that setting and go live with it. So over one weekend, myself, and one of our business change team organized, uh, we did just like a, you know, recording a screen share of how you could use the system very short to the point.

00:27:18

This is what your receptionist will do. This is what you will do as a vaccinator. This is how you view in an edit record. Uh, one of the things, and it did take, this was a few weeks until we'd identified. This was that at the time when we built it originally, you were, you were going through and you had to select yourself as a vaccinator, uh, nearly every time, every time whenever you were giving the vaccine, uh, we should have got that fixed earlier. Um, but I knew that it was gonna be a big, a big issue with the GP, uh, with the GP users. So we were, I was recording this video, uh, and I just done it. And we were, we were getting ready to go out in, live with it whenever Jill messaged me. And she said, oh, we've just fixed that.

00:28:00

Now we've just, you know, done another release, we've fixed it. So that actually you can default and, uh, choose you, choose yourself as a vaccinator it'll persist for the, the user per user procession. So that will speed things up. So I just had to add a little note onto my, onto my video before it w it was picked up by practices the next morning, uh, this, as you can see is actually a Facebook group. Uh, I had started this Facebook group when I, when I started in digital health and care wheels, uh, by the time, uh, that was, we were the start of COVID. I had 100 members in it, but because I was doing so much interaction with people, uh, and letting them know about things that were happening and what was going on, uh, across different elements of all the programs they were involved in and answering queries, uh, uh, although there were many other channels that people could use were up night to having like over 650 people in the group and still more people coming in and joining all the time.

00:28:57

So that's been a real success, uh, for us as well. But I wanna tell you about one of the challenges, uh, that's there, this is a, a slide that my friend, Matt, uh, commissioned for a different talk that he was giving you, can't buy a box of interoperability as you can't buy, uh, a bottle of, or a jar of DevOps either, uh, that we know we do know that integrations within healthcare can be, can be difficult and can be challenging. And I use this as an example of how that is very clearly evident. We needed to send back the vaccine record to the GP system. The GP system is perceived as being the lifelong record for a citizen. And, uh, although we had a permanent record within our system, which was accessible by anybody that needed to, to, to use it, uh, across all of wheels.

00:29:50

We also wanted to have a record, uh, within the GP system as well. So with one of our suppliers, we, uh, were in, we had got as far as February, so we'd been vaccinating the I for two months, and we wanted to get data back into the GP record. So we talked to them and they said, in three weeks, you will be able to send a message, uh, through a new standard fire, fast healthcare, interoperability resources. Uh, we will be able to receive that message, and it will be deliverable within three weeks. So the other alternative, which was to kind of BU them over our CSV file every evening, which is actually what we did with the other supplier, uh, they said, no, don't do that. Let's wait three weeks, and this will be ready for you. Now, given this was one of the top priorities for everyone.

00:30:38

It was a top priorities for those suppliers. It was a top priority for us, for, for everybody to make that work. But that service did not actually go live until August. So it was many months longer than we expected it to be. And it shows, I think the, the challenges of whenever we, you know, we did, we had, we had everything working well within what we'd built and what we were working with, but when we started working with others, the challenges increase. Um, but you still have to work through it, but you, you just have to take that on board and, and, uh, give, give the time for that and keep the commitment to keep it going. And don't give up. Uh, we also, the other, some with the other one interoperability video, which is more successful, it has been sending our vaccine data over to NHS digital, to the NHS COVID pass.

00:31:28

And that's been, that's been really successful and has helped people be able to prove that they've been vaccinated so that they're able to a, uh, keep, uh, using services when they were going out. Not so much. No thank goodness because, uh, we're um, uh, we've got the, we've got the vaccines and, uh, we have treatments as well. So the, the cover pass has less some, some utility, but it was a tremendous success for get helping people feel that things were, were getting back to normal. So overall, what did this mean for us and for wheels? Well, we were at, uh, in, at a, at a point in time in may, uh, 2020, although this was, uh, reported there in 2021, but in may, uh, 2020, we were at, no, sorry, it's may 21 at May, 2021. We were at the top in the world for having the, the, the most of our population had actually been vaccinated.

00:32:29

Uh, we were 10% of 10% of more people in Wales had been vaccinated than in other parts of the UK and Israel, which had got off to a flying start and was one of the fastest vaccinators. We were even had managed to surpass and get past them. And it was not just us that delivered that, but we supported it. We were part of it. Uh, we had, and we continued to talk about having a real team wheels approach to this. Uh, I, when I think of team wheels and I think of the vaccination program, it's important to point out how really we manage to be so central to the delivery and how we manage to stay so tightly aligned with the vaccination program's needs. And that was because I'll be honest at the very start. There were a few meetings that took place without having a digital team there, but we made our voices heard, and we were so instrumental to the delivery that Jill and myself for well over a year, uh, were attending every single operational meeting off the team that we're delivering the vaccine program.

00:33:36

So there is the digital contributors. We were there with all the health boards that were doing the delivery with the pharmacist teams that were managing the stock, uh, with all of the operational elements. And that was where my original tweet had came, uh, that, that Jane had picked up on about how narrowing, I feel very, truly that the narrowing between the business and the it and that that's making, allowing us to get to fast flow was really keen. And that, uh, was cause of the colleagues and the teams that we work with. And because I'm very sure of, of Jill our product owner, who was, who, who was able to inspire that confidence and speak authoratively and confidently and take responsibility, uh, with her team who she knew so well, as we were going, uh, through this. So Jayna said to me, you should tell people how they should reach out to you if they want to contact you and, and be able to, you know, give some support.

00:34:33

Uh, now, uh, there are lots of challenges that we have going on a RH bite. Uh, one of our challenges that I'm really looking at a lot, I'm trying to think about is how we think about demand for, for primary care and how we manage that. And, and, and, uh, look at it, analyze it, be able to pick it up and really seem this way. So I'm, I'm doing some thinking about that. If you want to reach out to me, the other two things I'm going to ask you for are that I, I'm still involved in doing NHS hack days in these events. We're hoping to get going again, uh, very soon. Uh, and I would love if you would reach out to me if you're interested in sponsoring us or, or helping with this, us for this, because I think it's a fantastic way of allowing people to understand more about the health tech space, to meet people with real problems and work and work on them, and to give them the, the confidence to actually go and move into the sector and learn, uh, and for clinicians and people like me to feel confident enough to go and take on more rules as well.

00:35:32

And alongside that, I am also in our professional membership organization, the faculty of clinical informatics, and, uh, within that, uh, we, we, we started this body a few years ago and it's to really support people like me who have a clinical registration who are taking on a digital health role and being able to contribute to that. And we are interested in cane to think about how we can work with partners that are interested in he health tech space, uh, in actually supporting what we do. So if you're interested in any of those do get, reach out and contact me, uh, you can, that's my, my, my Twitter hand, I'm coming. Um, I've opened DMS, please let me know, but thank you so much for, for letting me, um, come here and speak to you about this. I, I feel that for myself, this is going to be the thing that I am most going to be most proud of in my professional career. I'm pretty six years now qualified as a doctor, but I think being able to contribute to the vaccination campaign in such a way where we know that when we got faster and we vaccinated people faster, as soon as those people received a vaccination, their chance of dying from COVID was reduced by 80%.

00:36:48

And that's something that is always going to stay with me and with our team. Thank you.