Transcript and Recording - Healthwatch Camden hosts online Q&A with Royal Free and UCLH
Full recording: Online Q&A event with Kate Slemeck, Chief Executive of the Royal Free Hospital and Marcel Levi, Chief Executive of University College Hospital.
Tuesday 4th August 2020, 5.30-6.30pm.
Saloni Thakrar: My name is Saloni Thakrar, chair of the board of Healthwatch Camden.
On behalf of Healthwatch Camden I would like to welcome you all to this event. It’s wonderful to have so many participants – we have around 400 people registered to join us.
Because we are such a large number I want to go over a few housekeeping rules which will help us make sure the meeting runs smoothly.
We ask that everyone except for the speakers stay on “mute” at all times. You will find that you are automatically muted. Apologies for this. We also ask that everyone except the presenters turn your video off. This helps improve your online connection and means we can all find and see the speakers and interpreters easily.
There is no “chat function” working for this meeting. This is because if everyone is messaging it can be distracting and, with so many people on the call, we just won’t be able to keep up. The meeting is being recorded so you can listen again if you miss anything. The recording will be sent to you automatically after the meeting. Also we will provide a full transcript on our website.
I would like to introduce our two British Sign Language interpreters – Colette and Russell. (Colette and Russell say “hello”.) If you are a BSL user you may wish to “pin” the interpreter so they stay large on your screen. Colette and Russell will swap every now and again.
You can follow @HealthwatchCam for live tweets throughout the meeting. Please tweet about the event - tag @HealthwatchCam and use the hashtag #askyourlocalhospital.
This is a question and answer session. Thanks to all of you who have sent us your questions. We have received hundreds and of course we cannot get to them all. So I am going to ask 20 questions based on those you have all sent in and I hope we’ll manage to cover many of the issues you have raised. We will also be sharing the full list of all your questions with the hospitals afterwards.
Here to answer the questions, I am delighted to introduce Kate Slemeck, Chief Executive of the Royal Free Hospital and Marcel Levi, Chief Executive of University College Hospital. Perhaps you would take a minute to introduce yourselves.
Kate Slemeck: Good evening my name is Kate Slemeck, Chief Executive of the Royal Free Hospital. It’s a pleasure to be here tonight we service a big proportion of Camden along with our colleagues at UCH and I’m looking forward to answering your questions.
Marcel Levi: My name is Marcel Levi I am the Chief Executive of UCH and I am also a consultant in acute medicine and haematology in the hospital. It’s fantastic you are all here and we are very happy to answer your questions. I’d like to thank you very much three times: first for your support in the intense difficult months we had in the Covid-19 peak, second for attending this meeting as there is information we’d like to share with you and third, for your patience as it takes a bit of time to get services back on line and I apologise for that on behalf of the UCLH and all the other hospitals in north central London.
And now I’ll start off with the first question.
Are the hospitals starting to do regular appointments again? When can we expect things to get moving and how long we will have to wait (what’s the backlog)?
Kate Slemeck: That’s a really good question and a question that lots of people are asking so it’s a good place to start. We are making good progress now in terms of appointments we are getting up to about 70% of activity that we were seeing before and of course we have started with the most urgent cases that during Covid were not able to come in and be seen and we are now broadening out the invites and hoping to get up to nearly 100 % in the next few weeks. Most of our appointments are being done virtually now, we have a mixed modality – so lots of people will be invited for virtual outpatient appointments which will mostly be done face to face (via video) so in this way you can actually see the team that you’d be seeing in the clinic and also we are now beginning to bring in people who need to be seen physically not just on screen. So that has now started as well. We are working hard across north London as a group of hospitals to step up activity in a safe way and in a consistent way across our different organisations. Safety is our highest priority. We’ve tried to start as quickly as possible but as safely as possible. An important part is reducing the numbers of people having to come into the hospitals so where possible we can do things remotely but obviously there are situations where people do need to come in and we are seeing that stepping up as well.
How can I be sure I won’t be at risk of Covid-19 infection if I come to a hospital appointment, or for a blood test, and what are the arrangements for A+E?
Marcel Levi: I want to assure you that we are adhering to strictest infection control measures. So if you come to the hospital you will find it’s a different place. We have introduced all kinds of social distancing measures. There are separate entrances and exits. You’ll have to wear a mask you will find hand sanitiser everywhere. Staff are all wearing PPE. If you have to come for a procedure we will even test you for Covid-19 or ask you to self-isolate for a few days. We are intensifying the cleaning of the hospitals much more than we used to and we are doing staff testing. Many of our venues one hundred percent Covid free. Sites are really safe. We are separating the pathways very clearly. If you need to we really urge you to come to these sites they are really safe.
How can we be sure that hospital transport (ambulances, cab companies used by the hospitals etc) is safe and Covid-19 compliant?
Kate Slemeck: A bit like in hospitals things have changed and we have high expectations of our transport providers as well. Our hospital transport providers are fully compliant with current national infection and prevention control guidelines and there are measures in place to make sure patients are safe during the journey to and from hospital. So they will be wearing PPE, driver wearing a masks and patients will also be asked to wear a mask and it will be a socially distance journey with appropriate spacing in the vehicles. After each journey the vehicles are deep cleaned. We are also asking the same of cab providers too. There is often protection between the front and back of the cab. We have very strict regulations and approaches to hospital transport to make sure patients are transported as safely as possible.
Should I try to wait? I don’t think my condition is so urgent and I know the doctors and nurses are very busy treating Covid-19 patients. I don’t want to be a nuisance.
Marcel Levi: Let me tell you up front that our doctors and nurses are not busy treating Covid-19 patients. In the last week we had zero Covid-19 patients at UCH. We are there for you to help you, especially if you have an urgent case. All our clinicians triage all the waiting lists and all those patients where we think it’s urgent are getting and appointment. If you get an appointment, please come and do not wait as it may be detrimental to your health. It’s very important that you adhere to your appointment.
Kate Slemeck: Yes I just want to echo that from RFH. Our hospital is not full of Covid patients, we have very few Covid patients in the hospital and our pathways are very safe into care so we absolutely want to make sure you feel safe to come into hospital and to reassure people that the hospitals are a very different place to a few months ago.
I have breathing problems and anxiety about having things over my face. Will I be turned away from the hospital if I can’t wear a face covering?
Kate Slemeck: Obviously we want to encourage people to wear a face covering when they come onto the hospital site and when you arrive you will be asked to wear a covering but we know there are people who cannot tolerate this so there are things we can do to be respectful of that. It’s really helpful if you let us know in advance so we can arrange for you to come in a different route and put in support for you to get up into the clinical area and remain socially distanced from others. We can accommodate and be flexible for those for whom wearing a mask is not possible.
Marcel Levi: UCH is the same but we have our exemptions of people who do not have to wear a mask – children under 11 and people who rely on lip reading. Actually for people who are not comfortable wearing a mask it’s helpful if you indicate so that staff know.
When will partners be able to accompany women in childbirth and ante-natal scans and why this is still not allowed when restrictions elsewhere are easing – for example visits to care homes?
Marcel Levi: I have difficulty in understanding the question because throughout the pandemic even at the peak women have always been able to be accompanied in labour by one person. It could be their husband or another family member or any birthing partner. But only one because we have to take care of the safety of the other patients and our staff members. We are now extending that right to be accompanied to scans at 12 weeks and in the foetal assessment unit but we have to limit it to one person only.
Kate Slemeck: We are in the same position at the Royal Free. We actually have directory of prevention and infection control group across north central London so we all work together to try to make sure we are being consistent in our approach to implementing infection control and prevention across the hospitals and we too have always allowed a birthing partner. That has been more restrictive around the outpatient side of things. All these processes need to be under constant review as things are changing all the time we need to be flexible and safe.
My appointment was cancelled. I was told it would be rearranged. But I haven’t heard anything since. Should I keep waiting? How can I be sure I haven’t just fallen through the cracks?
Marcel Levi: If your appointment has been cancelled and you have been promised that another appointment will be made for you another please wait a few days. I do get emails from people who have been waiting only half a day and then send me an email – that’s really not helpful. Please give us a bit of time. But after a week or so you should have heard from us. The best advice I can give you is if you look at your appointment letter you will find an email address. Send us an email as that’s the best way for us to look into it and check if you have fallen through cracks. If you have difficulty using email then please try calling. But if you are able please email first or if everybody is calling our lines will over burdened and we cannot really respond to that.
Kate Slemeck: Royal Free – very similar. Be patient but if time is passing and you think you might have been forgotten then ring the number on the letter. If you cannot get through and cannot get satisfaction you can always go through our patient advice and liaison service. We are also working on a patient portal that we will be launching in August that will give people much more visibility and access to appointments and when their appointment is which will make life a bit easier. I appreciate that might not work for everyone but it will help for some.
Are there processes in place to support patients to manage symptoms while they wait for investigations or treatments that have been postponed?
Kate Slemeck: We are working across NCL to make sure we can restart services in priority order but if people have concerns about their condition in the meantime it’s really important they contact their GP or if they don’t have a GP then they contact NHS 111 and we can make sure through that process that they get the right advice and guidance. And then if there is a need for a more urgent appointment then the GP will let us know.
Marcel Levi: It’s difficult to answer specifically as it depends on the clinical situation but of course you can do things to relieve symptoms or any discomfort while waiting for an investigation or any further treatment. This is typically advice that should be given by your clinician – either the consultant or the nurse or by your GP. So if you are really uncomfortable and awaiting and appointment there is nothing wrong in asking what can I do in the meantime.
I had an appointment which was cancelled. I just got a message saying don’t come to the hospital. Why couldn’t I be given a telephone appointment?
Kate Slemeck: I am not sure when this happened – obviously I can’t see the detail. There has been a time when we were having to prioritise and contacting people to see even if we needed to see them virtually and obviously shifting people to virtual if possible and obviously we are seeing many more people in a virtual way than we used to. Now we are re-starting services that we had stepped down so I think this might have been something that happened at the beginning. At the height of Covid people were told not to come to the hospital and a number of appointments were cancelled but we are now in a different place and we are inviting people to be seen virtually where that’s appropriate and inviting people to come in where necessary.
Marcel Levi: Everything that we are doing now is relatively new. At UCH we see 20,000 patients a week so it’s huge numbers and the vast majority now by phone or video consultation and we are learning. If you think a remote appointment, a telephone appointment is the right answer for you then can ask for that and that’s actually easier for us to arrange.
Remote appointments are not always sufficient. For some things you need to be face to face. How are you deciding which appointments are appropriate for face to face and which can be remote and how can you be sure that a remote appointment is not putting our health at risk?
Marcel Levi: We are looking at it from the medical side and if we think this conversation can be done by telephone – so this is a consultation where we are discussing laboratory results or the effect of treatment it can be done by telephone and this can be helpful for patient too as it saves travel time and waiting in the waiting room. But there are of course things you need to see. Sometimes you need to examine a patient. Sometimes it might be a difficult conversation about a therapy choice or something that needs to be done face to face. And, taking it from the patient’s perspective, it may be that it’s something that the doctors think can be done virtually but the patient has another idea and that is also very valid. So it is absolutely normal during a telephone conversation to say doctor I would really love to see you to discuss this in person and we do now have the ability in all the hospitals to book face to face appointments so just say it and it and it can be realised.
Kate Slemeck: Royal Free are working in a very similar way.
I don’t feel safe leaving home and much prefer remote appointments while Covid infection is still a risk. Can there be a choice to continue with remote appointments for people who are vulnerable and shielding if we prefer?
Marcel Levi: Yes – simple answer – yes of course. I personally have many patients who are shielding and who don’t want to come in but who do value a conversation about their medical condition or what’s going on with their medication. And yes they can have telephone conversations and we will keep doing that in the next months and probably years.
Kate Slemeck: Yes virtual consultations are here to stay and some people prefer them. It saves travel and they are a good thing for many people. Sometimes people who are more vulnerable will need to come in because not everything can be done virtually so I just wanted to reiterate that we have put lots of measures in place to make sure that hospitals are safe and to make sure that vulnerable people are safe when they come in. We do not have hospitals full of Covid-19 patients and we do have very safe arrangements. It’s about a balance so if you do need to come in because your healthcare cannot be delivered virtually we do have a safe environment for you to come in to.
Saloni Thakrar: I have noticed that there are quite a few hands up. Unfortunately, due to the numbers and nature of this meeting I won’t be taking any questions live from participants. We will be sending all the questions that you sent us to the hospitals. I know it’s frustrating but I can’t open it up to the participants during this session.
If I don’t have access to the internet, can I still have a hospital appointment?
Kate Slemeck: Yes absolutely of course. We can use telephone appointments but also we can invite people to come in. If someone doesn’t have access to the internet and also doesn’t want to come in then we can use telephone. We have much better technology now – it’s one of the benefits of Covid – it has made us step into a new world with more ability like this (online meeting). We can still use telephones and we can still invite people to come in so it will not affect people’s ability to have an appointment.
Marcel Levi: The vast majority of our virtual appointments are actually on the telephone so video is relatively rare. Of course we can offer different types of appointments.
Video appointments can be really hard for a person with a Learning Disability. What are you doing to make online appointments easy for everyone?
Marcel Levi: It’s actually not only patients with a learning disability – I myself took 15 mins to get online to this simple zoom conference myself. It can be difficult for everyone. Of course if it is a video conference you can be accompanied and we can accommodate that a person accompanying can log in from a different location. So there are several solutions. If there is no practical solution for a patient who finds it difficult to do it by video then it’s better to do telephone or face to face.
Kate Slemeck: It’s about making sure that telephone or video isn’t the only offer. We have developed information leaflets to help guide people through the options and we’ve developed a video as well. But it is new for everyone and doesn’t suite everyone so it’s about finding the best way to communicate with each individual according to their needs.
Any chance of communication improving: first to reassure patients they have not been forgotten; second to avoid mishaps and misunderstandings about different types of appointment – face to face, telephone, video; and third to dispel confusion about new systems and procedures?
Kate Slemeck: This is all part of the new world order. We need to be better about how we share information on our website so people know what to expect. Also on an individual basis if people are feeling worried they should contact the hospital. We don’t want people to feel they can’t check in to see everything’s okay and also people can check in with their GP if they are worried about that connection with the hospital being lost. But I think also we need to think about what else we can do because we can see from these questions that there is a lot of anxiety about outpatient appointments and how we are offering them so I think we probably need to go away and think about what else we can do and maybe we can get some guidance from Healthwatch about what you think we can do as well.
Marcel Levi: Communication is of paramount importance. It is always difficult. We try to send out letters, emails etc and communicate through our website and call people if necessary but it is difficult because so many personal situations are very patient specific and it’s hard to make information on websites or in letters very specific. So please do email us - please use email if you can or get someone to help you with email. Emails do get answered, we monitor that very well in most cases, and it’s much better than calling which gets very congested and is difficult to deal with so try to get your information from the general sources such as the website but if you have specific questions please send us an email.
Many non-English speaking patients rely on family members or friends to translate for them. How is language support being provided if people have to come to hospital alone because of the Covid-safe arrangements?
Marcel Levi: If you need an interpreter and your family member is able and happy to provide that then that person is welcome to join you to support you in your outpatient appointment. But if you are admitted to hospital and need a procedure so it’s not possible to have a family member there all the time or sometimes there is no family member available to translate for you so normally we would use interpreter services. Those are still available to us but only by video or telephone. We will organise it if you need it and if you indicate to us that you will need that service. It’s not difficult to book. We can do it. The only exception is if there is a very urgent situation which requires immediate interpretation we will have an interpreter on site but otherwise it will be video or telephone.
Kate Slemeck: At the Royal Free we have a wide range of interpreting services with qualified interpreters and if you arrive you can request telephone interpretation on the spot. Face to face needs to be organised in advance ideally. We have sign language interpreters and quite an array of interpreting services that we can access quickly even in an emergency.
Face coverings make it hard for d/Deaf patients to lip-read. Can you make sure all hospital staff use clear masks and have d/Deaf awareness training?
Kate Slemeck: It’s been a real issue for patients who are hard of hearing or Deaf during Covid with people wearing masks I think it’s been very difficult. Lots of work is going on looking at clear masks and getting clear masks so people can see lips and mouths. We are really working on improving this because in the rush in the early stages of Covid-19 people who are hard of hearing or deaf struggled with all the PPE and everything not being able to see people’s faces and lips. We are looking at a range of options including clear masks and visual aids and writing things down and speech to text so we are looking at a range of options, a rounded approach to how we can support people through this period given the need to wear masks.
Marcel Levi: This is a fantastic example of how patients tell you how you need to improve because I did not think of this when we were in the middle of all this. We tried to source transparent face masks. They do exist but they are hard to get and we have very active procurement across NCL so we try to share across the different hospitals and it will probably get better but at the moment it is a problem as they are very scarce and we have to use alternative means to properly communicate with patients.
Saloni Thakrar: But in the meantime in the absence of clear masks what arrangements do you have in place?
Marcel Levi: In some situations you can use distance and you can use Perspex barriers so there are creative solutions. Also – not wearing a mask can in some situations be acceptable. They are not the holy grail.
Is there visible leadership in tackling racism wherever it exists across the hospital trusts? Is unconscious bias training part of hospital staff and medical training?
Marcel Levi: Good question and a very topical point. We do have a BAME advisory group that tells us how we have to change our practice and how we may have unconscious bias and how we can prevent it. We even have a BAME covid group because we all know that BAME staff are at greater risk and we need to make sure they can safely do their job without increased risk when working in the hospital. Yes we are trying to listen and do this in a comprehensive way – we do not want any inequality in the hospital but I think BAME get specific attention nowadays.
Kate Slemeck: We take a very strong position on this as well. We stand together with our black staff, minority ethnic staff, volunteers, patients and community against racism and hate crime. We are proud of the diversity of our staff – we are a very diverse workforce and that allows us to provide excellent care to our patients. Our senior leadership team do participate in unconscious bias training and staff receive it as part of training but that’s only one of many measures that are going to make a difference. We have a thriving BAME staff forum established in 2014 and they work with us to make sure we are reaching out in the right way and doing the right things across the board. We are committed to equality diversity and inclusion across the workforce and we have a number of initiatives in place to make sure we have a representative workforce or a workforce that looks like our local community. We have fair recruitment processes, equal pay for work of equal value, training and development opportunities for staff monitoring take up across our different ethnic groups of staff, making sure staff are free from any bullying and harassment at work and I can go on there is a lot of work going on in this space it’s very important for the NHS. It’s something we take very seriously and we stand firm with our staff to make sure we are providing care in a fair and equal environment and we are very aware of the issues and addressing them.
Are the hospitals offering additional support to local residents from the BAME and disability communities as part of the recovery pathway?
Kate Slemeck: We are taking many steps to support these communities. We are looking at equal access groups but we are bringing together a number of groups including Camden Disability Action, British Somali Community Centres, Voluntary Action Camden in the coming weeks and we want to get in touch with current members about this and we want to hear from people who would like to join the groups. Access to virtual appointments – we are very aware that not everyone has access to technology (we have talked a lot about this today) and we are looking at setting up drop in centres in the community where technology is available so that people can have their appointments virtually. There is work we do on supporting people with disabilities – we have a disability action group. And we are also looking at hospital passports for more vulnerable people who come in and out of hospital so that we know more about their condition so they get more continuity of care. We are putting more easier to read information on the website and discharge booklets so we are doing lots on communication as well. So there is a lot of work going on in this space but there is always more we can be doing. But I think there is more we need to do to connect up with our local communities to get this right.
Marcel Levi: Yes it’s not very different for UCH but I would like to add. Not just for BAME and disabled community but for everyone who had a Covid infection we are learning that some patients have a very severe or prolonged trajectory of complaints subsequently. It could be respiratory or musculoskeletal or severe fatigue or mental health complaints. We need to understand these and to support all these patients – not only those who were treated in hospital it could also be the result of a relatively moderate Covid infection that you experienced at home. So we are starting multi-disciplinary clinics where we look at these complaints and try to address them with physiotherapy or respiratory physicians or mental health support to support patients in the community. GPs can refer patients to these clinics.
Will we be able to volunteer at the hospitals again in the future?
Kate Slemeck: Some of our volunteers have come back. We have an enormous volunteer community at the Royal Free and they undertake a fantastic job supporting patients and staff and various services and we are beginning to step that back again. The arrangements are different and we are feeling more able to invite people back. We absolutely want to see our volunteers coming back. Something worth mentioning is that we are undertaking Covid risk assessments for all our staff and volunteers to just look at the individual risks associated to make sure we are not putting people at any risk in terms of the areas they work. I think we can see opportunities for our volunteers to come back.
Marcel Levi: It’s the same. We rely on volunteers almost everywhere in the hospital and they are slowly coming back but let’s not forget that even during the height of Covid we had a small army of volunteers in the hospital helping. We very much value our volunteers and we want to see them all back.
What will Covid-19 mean for the future of the NHS – both in terms of funding and priorities?
Marcel Levi: Covid-19 has clearly demonstrated that we need an NHS and that we do have an NHS that works properly and can really can step up and provide care for very sick patients if we need to. But we all realise that there are a lot of people who didn’t get care during Covid and there is this backlog and that’s the next challenge for the NHS. I am completely confident that we will get on top of this. We will need a little bit more funding to do all this but eventually it’s not up to use it’s up to other people to decide whether we will get the money to do our work properly.
Kate Slemeck: A lot has changed as a result of Covid. We know how important our hospitals are in our local community. We have worked really effectively as a group of hospitals in our sector so we have all worked together and there are things that we are changing that I think will change for the future and strengthen our services across our patch. We are doing more things virtually and some of this is good for patients because people don’t have to travel as much as they did before and this can give us more options to work differently and safely. I think there is a lot of good change that has happened. There are lots of areas of cooperation that we will want to continue with going forward and ensuring we are continuing to offer safe services for our local community.
Saloni Thakrar: Is there anything you want to add?
Marcel Levi: There is one thing that is very close to my heart. I think hospitals did a good job with the Covid peak but there are lots of things we can improve. The thing that’s nagging me is whether we got it right with visiting rights for admitted patients to the hospital. I found it really hard to see patients on my wards who were very sick and could not get any visits from family members. Of course we had all sorts of creative solutions with telephones and ipads etc. But that’s not the same as having your loved one holding your hand. I think we need to have a discussion about whether we want to keep this visiting policy up if we have a next peak and I would value to hear from patients and families about what they think. For me this was one of the most difficult things in the past few months.
Kate Slemeck: Agree that this has been one of the most challenging things during the Covid period - people not being able to be with their loved ones. We have got much better at communicating through ipads with families and we found ways to be more structured with feedback to families about care and we were not very structured about that beforehand so we’ve had lots of positive feedback about that. Broadening out to the wider question, we have been through an enormous experience over the last months and none of us were prepared for it we have an element of preparation for a pandemic or event but we weren’t expecting what we have been through so we won’t have got everything right. There is lots of learning still to come about how we communicate and how we connect up better with our communities. I’d like to thank everyone for their patience with us as we come out the other side and step back up services safely not wanting to put our patients at risk and we always have a slight concern – you know – what’s the winter going to be like, is Covid going to step back up again we have to consider all those issues. Staff have been amazing we have to support staff to go and have a break and come back refreshed. Thanks to our local communities for being so supportive we got lots of support from communities through the pandemic we got lots of donations of food and things people have been amazing. It really helped carry us all through. But now we are in a rebuilding phase and we need to learn from what’s gone well and what we need to do better in the future. Thanks for the opportunity this evening to work through some of those issues.
Lastly, so many people have sent questions to Healthwatch Camden for this event - hundreds. We have tried our best to get to your questions. Many of you won’t have heard your own question but I hope you have heard answers that have captured something of what you want to know. Kate and Marcel, if people have questions and concerns or want clarifications, where should they look for answers?
Marcel Levi: Some of the information will be given on websites and public information channels but I admit probably people have looked there and didn’t get an answer to their question. It’s all about communication and so that we can try to make sure people understand what we are doing and that we are doing our best and we can’t do everything at the same time but that we haven’t forgotten about them. Everyone should get an answer. I would actually ask people to combine their questions – maybe Healthwatch can play a role there – and just send them to us and give us a bit of time and we can probably provide answers and send them back to Healthwatch and publish the answers on our website. We are keen to explain to people what we are doing and why we are doing it so questions are good. It is easier for us to answer general questions. If it’s very specific about you or your condition then it might be better that you address your GP or your consultant or the service you are under. But if it’s a general question about how the hospital is working we are very happy to spend some time in answering these questions.
Kate Slemeck: Yes agreed. And Healthwatch you have a role to help us this has been really good you all know the things people have been struggling with and we all share Camden as our local geography that we both serve. If there is anything we can work with you on to deal with the frequently asked questions that people are struggling with we are very happy to engage with that.
Saloni Thakrar: We are almost at the end of our meeting. Kate and Marcel, thank you so much for joining us this evening and answering our questions. I’d also like to extend deep gratitude to all your staff and volunteers at Royal Free and UCH for the care, dedication and support and commitment over the last few months
Thank you to all the participants who have joined this event this evening. I know I found it rather frustrating not to be able to see you or hear directly for you and I apologies for not being able to take your direct questions – it’s the nature of this meeting. Before I end the meeting I want to invite anyone who wishes to switch on your video cameras so that we can all wave goodbye. We will take a moment so we can all see each other and wave goodbye. I will now end the meeting.