In the UK, the NHS promises to provide healthcare based on need and free at the point of delivery – but we know that people from people from different socioeconomic backgrounds have very different outcomes.
Join us to explore experiences of health and disease, some thoughts of how technology can reduce or exacerbate health inequalities and some inspiration into how we might meet the challenges of reducing healthcare inequalities by partnering with the people most likely to benefit from interventions.
Hi everybody thanks for joining us we’ll just wait a few minutes for people to arrive and connections to be made properly we get started in a few minutes hi everybody thanks for joining us just wait For well it’s almost 3 minutes past 6 so I think I will make a start thank you very much for giving up your time this evening I hope it’s going to be what you expect and what you hope from this webinar so my name is Pria and I’m one
Of the co-executive directors of the equality trust uh the trust was set up in 2009 uh by two authors of the spirit level uh and another epidemiologist it was set up by Kate picket Richard will concern and Bill Kerry in 2009 following the publication of the spirit level and
That research found that uh inequalities harm everybody everybody in society so this evening we’ve brought you here together to kind of think about health inequalities and with the NHS in the UK being free at the point of delivery you know it might seem logical that we all have equal access to and
Experience of healthcare but this is far from the truth so in the London burrow that I living in haringay there is a 16year gap of healthy life expectancy between the richest and the poorest parts of that burough so for for men it’s 71 years in Highgate and 55 years
In the north of Tottenham and that’s from a 2019 report so you know while it might be tempting to blame individuals for their lifestyle choices and they know there’s not really enough time here this evening to go into the cycle of inequality and poverty and the impact
That this has on those choices tonight we want to consider the systemic issues at play and how many of these are both intersectional and cumulative so for example poor housing which contributes to poor air quality both indoor and outdoor air pollution and it also contributes a lack of green space and of
Course other space and I think France going to explore a little bit more about the systemic and uh drivers of poor health outcomes more in her talk but we also can’t ex ignore the biases within Healthcare we’re all too aware of the horrific and sometimes fatalist experiences of black and brown women in
Maternity care and the long and awful history of the overdiagnosis and overmedication of black people within the mental health care settings and sadly these biases are not restricted to humans a report published this week reveals biases within medical tools and devices for example those to use to measure oxygen levels and states that
These have almost certainly led to black and brown people experiencing poor heal Health set and our second guest tonight Dan will be sharing his report on AI and healthc Care exploring the vast potential for AI to do good and to maybe circumnavigate some of these biases but
The current reality being that well I’ll let Dan go on to speak to that and finally this evening we will look at democratizing and co-producing health priorities with the people who stand to benefit the most from interventions uh one of the three key principles of the structural inequalities Alliance of whom the
Equality trust is a member and we therefore integrate these um principles in our work is the principle of part participation the premise being that to change society’s structures we must first change change who designs it and that these and that those most affected by policy should be partners including
In the planning decision- making and in accountability so this evening we’re welcoming Hannah and Sally here to tell us about their co-produced priority setting project which we hope will spark some thoughts in all of us as to how we might incorporate this principle more or incorporate this principle differently
In our work going forward so I will let each of the speakers um introduce themselves so thank you very much for your time for being here for all of our speakers and all of our guests joining us to listen so we’ll start with Fran and I’m just getting my screen
Ready to share whilst talking um lovely to be here this evening um and really looking forward to hearing from the the others on the panel um so just to say brief bit about me so I’m Fran Darlington Pollock I am chief executive at greater Manchester M charity who are
An independent charity who believes homelessness has no place in the city region um but before that had a brief stint to save the children but um much longer stint as an academic so population Health geographer and during that time I wrote a book um which came
Out in 2022 which I’m going to talk a bit more on today um and I’m also former chair of the equality trust so that’s me um so inequality matters it really really matters for our health because of that it really matters for our Healthcare now 85 years ago or just over
That in fact so William beverage presented Parliament or or a committee of parliament with this report this very well read report from me um which was a radical blueprint for what rapidly became one of the most admired manifestations of the welfare state around the world and in that report he
Targets five giants that he saw a standing between a flourishing society and for that time the road to reconstruction in the aftermath of War so those five s were want disease ignorance squalor and idleness and um I wrote one of five books um with five other sets of authors um to kind of
Commemorate the the the beverage report 85 years after it been written now beverage called for a complete overhaul and not just peace reform of the social security system and he wanted it to be built on the principle of meaningful cooperation between the state and the individual A system that protected
Against and I’m quoting him now the interruption and destruction of earning power and for special expenditure arising at Birth marriage or death the idea was that the population would be able to have access to a whole range of benefits including things related to unemployment disability training and
Maternity so this was at all points of the life course including support through retirement with a pension provision and most importantly he established a National Health Service where care was provided free at the point of delivery and it was the first Universal medical system in the world I
Really really like talking about the NHS or the birth of the NHS when I’m sat right here because a mile and a half that way is chaff adrenal Hospital which was the very first NHS hospital opened by Anin Bon himself um so the NHS this was a landmark institution championed in
That blueprint and it’s been the focus of enduring but occasionally waning admiration of our British welfare state and there were a few things that are important to consider in the context of this discussion of inequalities in healthcare and the origins of the NHS so first when beverage submitted that
Report in November 1942 life expectancy at Birth for women was around 66 and for men it was around 60 for every a thousand births there were 52.9 deaths in the first 12 months of life so that’s uh the infant mortality rate at the same time fertility rate so the number of
Babies being born was really really low and beverage was amongst uh many who were pretty concerned about uh the risk of population decline something they were even more alarmed of because of the recent collapse of the British Empire they wanted children to be Bor and despite the fact that the Warriors had
Seen um the kind of raising of the status of women in the labor market that really rescinded in the aftermath of War and the expectations for the women of the country at the time um didn’t really extend beyond the kitchen or the nursery however when beverage was writing this
Report and he wasn’t aware of this at that time the numbers of babies being born was actually going up and we were soon to see the Advent of what’s now known as the baby boomer generation and this signals a really significant change in the size and structure of the
Population all all of this matters for the help of the population because it matters for the social structure it matters for the age and gender composition the economy and the politics of that Society now beverage wrote um that a revolutionary moment in the world’s history is a time for
Revolution and not for patching you can definitely see that was from what was going back on in um back in 1942 and and now um and two years ago when that book was published that I’m talking on today it’s it’s not only less true before I go
On to the next next slide I’m going to give you another quote and this quote was fundamental to the argument I’d put forward in the book um I should say though the book wasn’t particularly novel nor was anything I said in it but there is a kind of a need for continued
Discussion of this particular is actually only yesterday we had a report out from the World Health Organization saying pretty much the same thing in terms of gender inequalities Health outcomes Health Systems and and uh empowerment of women um so that quote it’s a quote from anoid sociologist specializing in peace and
Conflict studies and he called Johan galon and he said if a person died from tuberculosis in the 18th century it would be hard to conceive of this as violence since it might have been quite unavoidable but if he dies from it today despite all of the medical resources in
The world then violence is present so what is avoidable what’s avoidable death what’s avoidable illness what’s avoidable hardship or poverty or inequality at the moment these days there there quite a lot of avoidable all of these things so let’s focus in on health it’s pretty important to to
Pretty much everything we do and therefore it’s pretty important to everything we can do as a society and if I asked all of you right now to rate your health you’re going to consciously or subconsciously consider a few different things do you live with a chronic disease do you have acute an
Acute infection at the moment are you currently injured but you probably also whether you’re aware of it or not factored in conditions like where are you living and what sense of security uh and also the breadth of other things that might either enable maintain or disable your general well-being so
Health is very much more than the absence of disease um and this is an important conceptual discussion as it gives a space to look really critically at the health care system that beverage proposed relative to what we might propose and I suspect what’s going to be talked about later given how we evaluate
Our health and how broad an evaluation of Health we would actually make this is probably really different from the sorts of evaluations within more traditional biomedical conceptions of Health that framed the time that beverage was writing they would have been more likely to prioritize diagn prior prioritize diagnosing and treating the biologically
Deviant state of disease and that’ be probably at the expense of less tangible ailments and definitely at the expense of The Wider contexts that shape health for individuals and for populations but if we’re talking about inequality in the experience of healthcare we really do need to have a very social conception of
How and we need to capture everything that makes us whole sound or well so um I’m a quantitative academic I can’t help but give you a few graphs but there’s not many and there’s and they’re nice and simple so we’ll go here um and forgive me I’ve not actually updated
These um since the book but it’s pretty much the same and also aware that on screen this graph is really hard to read so the men the dark line at the bottom on the graph and it’s women on the top and this is showing life expectancy for
Birth um from birth at Birth sorry for men and women from 1842 right up to around 2020 that glitch that you’re seeing at the end here as I’m sure you can all understand is uh the impact of covid but the overall message you should be taking from these
Graphs or from this graph is that there was significant improvements to life expectancy for the population that came into force not only because of the NHS but also the wider provisions of the welfare state as they took effect so we had improvements in living conditions better Lifestyles and the medical
Advances that were coming in the postwar period as an engine for accelerating what then became a century long period of sustained annual improvements to life expectancy and as we can also see um the gains in life expectancy were mirrored in Falls in infant mortality rates so
Deaths to babies um um under the age of five this one is the problem is that when we reached that we reached a tail end of that sustained Improvement to life expectancy around this 2014 and at the same time we saw infant mortality rates begin to increase
And if our babies are dying more often in the first 12 months of life even if these incre increases are only small this is definitely the canary in the coal mine falling off its Purge and a really clear signal of something significantly wrong in our society more importantly it’s
Avoidable in 1996 Merl singer he was an anthropologist in the states and he spent some time looking at the health outcomes of people living in an inner city area of Connecticut and this area and this city was one of the poor poorest of cities in the United States
Um and it also had very high levels of crime but and this probably isn’t a surprise to anyone the poverty and those poor outcomes um across uh different societal outcomes were not evenly felt across the city and it was the Puerto Rican migrants there who suffered the
Most now singer argued that the reason this group suffered so much more than their African-American or white neighbors was because of the combined burden of the social economic environmental and political context of their lives this group not only enjoyed mutually reinforcing and co-occurring health problems such as substance abuse
Violence and AIDS but they were these these kind of Health occurring conditions co-occurring health conditions were Amplified for the Puerto Ricans because of the context in which they lived a perpetuating configuration of noxious social conditions noxious social conditions are lethal because of the social determinance of health and the uneven distributions of income
Wealth and power singer used the experien of the querto Ricans in the states to calling the term syndemic phenomenon that was absolutely applied to the experiences of covid for marginalized and minoritized definite groups in the UK by amongst others Professor CLA Bamber syndemics help us to make sense of uneven distributions of
Poor health when they’re exacerbated by the context of people’s lives if we are to allow which we should for a social model of Health we’re recognizing the social determinance of health so it’s the cumulative influence of things like the socioeconomic profile of where we’re born the schools we went to the sorts of
Houses we live in the amount we earned how polluted the air we breathe is all of these and other things are important for our health they shape our health how long we’ll live in good health and when we’ll die this is where the violence starts to creep in if we’re talking
About differences in the context of where people live or the schools they can access jobs houses Etc yes we’re talking about social determinants but we’re also talking about political determinants we’re talking about policy choices of investment or not or even of disinvestment we’re talking about avoidable hardship we’re talking about
Structural violence so syndemics are the lethal consequences of structural violence which can only be understood through contemporary biosocial and not by medical models of health and syndemics are going to be ever more common where polarized societies corrupt power and unequal chances are depressingly common syndemics and structural violence seem to explain a
Lot looking back then the fiscal response to the global financial crash of 2008 was um if you can remember you probably can was relatively modest tax increases and major public spending cuts um all with the intention to reduce the deficit and stimulate economic growth the deficit did fall a bit but economic
Growth didn’t materialize and the economy stagnated and we now have this sustained cost of living emergency so the widespread cuts that we saw to public spending led to significant reductions in Social Security unpicking and eroding a security net woven by beverage that had already begun to gape open Co hit socially and economically
Disadvantaged communities the hardest not because they didn’t follow the rules but because of the noxious social conditions they lived in already increased vulnerability to a range of chronic health conditions they had underlying health conditions was a phrase too commonly applied when reporting the latest daily death toll during covid and it’s never an
Acceptable excuse but particularly when the chances of having an underlying health condition are so unevenly and unjustly distributed linked to wider policy choices and uneven power distributions now I think the importance of place and politics inequalities in health is really clear in these next two figures first infant mortality rates by
Deprivation and you can see that generally the higher the level of area deprivation um as we go up here so 1 to 10 the the higher the rates of mortality or we can look at adolescent mortality rates in Scotland and we know that the highest rates are in South Asia I have
No idea how you say that so sorry if that’s wrong um and that’s one of the most deprived regions of Scotland and an area where nearly a quarter of children are living in poverty so we can look at these sorts of interactions between deprivation place and health with use of
Healthare just as we can in terms of health outcomes for example this graph um is actually uh looking at vaccine uptake during covid-19 by area deprivation and the highest rates of vaccine uptake are this dotted line along the top which are in the least deprived areas and you can see that for
All age groups basically the more deprived area the lower the vaccine uptake this is structural violence this is avoidable ill health this is avoidable um death caused by by policy decisions explaining the structures that create this so beverage was the Catalyst of development of a revolutionary healthc care system but one that was
Focused on treatment rather than the prevention of ill health though once transformative to the health of the population the system that’s emerged hasn’t kept pace with the wider transformation of society beverage did not design a system for an aged or aging population or one that is ethnically
Diverse he didn’t design a system for a society that is persistently unequal and he didn’t design a system that’s been able to withstand the doctrine of neoliberal marketization that gives pracy to the market over the individual the NHS is the classic political Hot Potato a money pit that no politician
Really wants to touch but no politician can reasonably ignore since its creation we’ve had successive efforts to lower the bill and seen more and more emphasis on narratives which are derived from neoliberal individualism placing responsibility on the for health and poor health on the individual and the individual alone weigh into two heavy
Lose weight or pay for your services ignore the fact that your access to healthy nutritious affordable food varies according to your income ignore the fact that your time you have to cook the space you have to store Provisions also varies according to your income require more care in older life because
Of the toxic social structures you live in have not only made you iller earlier but also meant you earned less and therefore have less of a pension to support you in later life that’s a struggle struggling to get access to a medical professional for a non- urgent potentially developing potentially
Developing serious health or well-being problem fine if you go private if not good luck we haven’t built a resilient Health Care system and we haven’t invested one either and we’ve not even got close to developing a resilient sustainable social care system reforming Health and Social care isn’t a simple
Task but we definitely do need to do more than patchy reform because the existing model isn’t sustainable it doesn’t have the resources or capacity to address the increasingly complex health and well-being needs of a larger or older and more diverse population perhaps more urgently we have also
Become complicit in the struggles of the NHS we’re expecting what ails us to be really easily medically cured we want antibiotics for a cold or a cough so we’ welcomed a social model of Health but ignored the social determinants of good health we’re victims of our own success because the medical advances that
Bolstered and pushed those gates to life expectantly we expectancy we saw previously have created the space where we too often believe that a cure can only e be from prescribed pill so the silver bu bullet of medical intervention has led to a medicalization of society where we seek pharmaceutical
Intervention too quickly and this is largely driven by market forces and big farmer capitalizing on the desire for that magic Silver Bullet so the medicalization of life and Society is not only compromising the ability of the help and social social care system to meet demands but it’s also creating a
Dependency on Healthcare which is overlooking what could be resolved within our social support networks and better funded social care system so beverage’s Vision has definitely carried us as far as it can and the revolution it prompted is no longer sustainable in the face of demographic change or capable of addressing the structural
Inequalities of income wealth and power that can be so lethal for so many last moment here Galton talked about the Tendencies of societies to perpetuate patterns of inequality because of the nature of their hierarch hierarchical structure and what that then means for the social economic and political interactions within them this
Will he said continue unless deliberately and persistently prevented from doing so so is it now time for deliberate and persistent intervention inequality and structural violence can be and are so often ignored by any whose wealth income or self-esteem appears to buffer against it but to have that bit
More than your neighbor in a society of inequality is just that it’s not to flourish either as an individual or as a society um this has been a whirlwind tour of my brain and that book but just to conclude beverage created the NHS in his assumption B so I’ll conclude with
What I think our assumption b.2 should be this is one that recognizes the violent structures of society recognizes that we’re actually all complicit in this violent unless violence unless we’re persistently and deliberately doing something about it one that recognizes that health is socially and politically determined and that the
Perpetuation of toxic noxious social conditions because of structural violence will always worsen with lethal consequences the health outcomes of marginalized and minoritized groups in society one that recognizes that any Health and Social care system has to recognize all of this if it’s to do any effective preventative and Curative work so our
Assumption b.2 is premised on a care economy where care is community-led valued and reciprocal it’s premised on a society committed to dismantling structural inequalities of income wealth and power and it’s premised on acceptance that inequality is definitely not inevitable bran thank you so much recognize a lot of equality trust
Wording there really fantastic to see that it’s not stopped with your chairship so sorry to everybody I forgot to mention that we will have time for questions afterwards you can either pop them in the chat or just you know note them down and we can uh come to that
When all all three speakers have finished and you can turn your camera on and uh share your question then but thank you so much Fran really a lot to think about there a lot of you know historical and a lot of you know what we can do going forward so great great to
Hear from you thanks so much for giving your time today we’re going to move on to our second speaker now who um is Dan he is um I will’ll let him introduce himself Dan off you pop perfect thank you very much Priya and thank you very
Much fan as well I thought that was super super interesting right there we go hello everyone so and thank you as well um to everyone at tet and use your self prer for the invite tonight um so I’m Dan guest um I’m currently working as a policy and strategy project manager in
NHS England um where I focus on vaccinations and immunizations um I’m actually on the NHS graduate scheme which I started in 2022 and I previously sat in clinical policy mostly working on of long covid cases um I always have to pronounce the long properly because my black country
Accent I realize that a lot of people think I’m talking about my lungs um in November last year I was privileged enough to spend just over two months working with the equality Trust on a research piece into artificial intelligence and health inequalities which is what I’m going to be talking
Through today um it should be noted that this is not an exhaustive apparatus to examine the field but I’m hoping it’s to get some minds thinking um and some brains flow in so the context behind this piece was for it to be a baseline situational analysis into the relationship between the use of
Artificial intelligence with Healthcare and health inequalities so sense it’s not about finding Solutions but it’s to generate further points of discussion following the covid-19 pandemic response NHS England devised the core 20 plus5 approach to tackling Health inequalities so in this the core 20 are the 20% most deprived population and that’s as it’s
Identified in the index of multiple deprivation the plus populations are identified at a local level by local providers and they broadly cover those that share the protected characteristics within the equality act and those that are in those that are covered by inclusion Health the five represents the
Five key clinical areas which the NHS England Health inequality team have said that needs to be addressed most urgently so that’s maternity severe mental illness chronic respiratory disease early cancer diagnosis and hypertension case finding and good governance for all of this sits within a centralized team within NHS
England the origins of this report buil on the announcement of the AI diagnostic Fund in June 2023 so the AI diagnostic fund is a package of around 21 million pounds to enable The Accelerated roll out of AI Technologies across 64 NHS trusts in England the National Institute for
Health and Care research that’s the nihr would develop in tandem new inservice evaluations for the tools that are being deployed as the continues to be significant investment in this field it’s really important to understand the impacts that this has on equality much more widely because of the nature of the
Report we thought it was best to focus specifically on one aspect of the healthc Care ecosystem and for that we decided on cardiovascular disease there’s many reasons reasons as why we decided to focus on CBD firstly cardiovascular diseases remain to be the biggest cause of death globally and one
In four deaths in England are attributed cardiovascular diseases it also has a higher than average um diagnostic error long-term health conditions um can be monitored by addressing topics such as CBD as well as viewing the challenges through a more intersectional lens one of the most important reasons that we
Looked at cvd is due to the level of socioeconomic disparities within cardiovascular disease and this covers nearly all aspects including initial research so for example women are still chronically underrepresented in chronic and cardiovascular research and that’s through implicit implicit sex biased inclusion criteria such as age limits body size limits and other
Cardiovascular indicators these sex biases go want to shape gender biases such as persistent inconsistencies in Risk detection and as a result women are less likely to be prescribed medication and at the higher risk of being misdiagnosed as a further Point people living in the most deprived areas of
England are four times more likely to die prematurely from cardiovascular disease and those in the least deprived it’s also the biggest factor in life expectancy gaps Within in the United Kingdom and another key reason why we’re looking at cardiovascular disease is because it’s been AI is being used
Widely within this disease area I’ve listed a few examples on the screen here such as Diagnostic Imaging and creating individual treatment plans and from the discussions that I’ve had with various people within the NHS and and outside it seems that the current direction of travel is much more towards the risk
Prevention and prediction and that’s to enable proactive policymaking decisions but what does this mean for inequalities whilst there is some movement towards utilizing AI to reduce Health inequalities these are currently quite Jagged and uneven for example there’s a big increase in using tele medicine in underserved communities and while this
Can help bridge geographical based inequality gaps um it doesn’t tackle the core socioeconomic disparities within this area area um and so an example of this is using wearable Technologies and that can help predict disease trajectory going into the future another key area that it’s been used in is to develop
Personalized risk models for individual patients but examples of this um particularly within risk prevention is often outside of the field of Health Care and within the field of Health Care it has quite mixed results there was a big um study in the United States that found the healthc care risk prevention algorithm
Demonstrated racial bias because it relied on faulty metrics for determining need and this was used in over 200 million patients in the USA so this algorithm was to try and help hospitals and insurance companies to identify which patients would benefit from highrisk Care Management Programs so
This was to try and get them to have more access to especially training nursing staff and to allocate extra Prim care visits for closer monitoring but the research found that while black patients tended to receive lower risk scores when they actually looked at the cohort black Co black patients were
26.3% higher um higher chance of having chronic illnesses so although they had a lower risk score this wasn’t reflected in the actual cohort and I think one of the one of this means is that we have to have robust evaluation mechanisms in in place so that leads us to asking the
Questions Where Do We Go From Here AI holds promise within the healthcare ecosystem and evaluating the effectiveness of AI necessitates proportional evidence standards and effective regulatory oversight an intersectional AI system is needed and by this we have to ask what are the right tasks for AI can AI really take on
The core tasks within Healthcare such as clinical risk prediction and Diagnostics we also need to reduce bias within the data interpretation most of the data in cvd seems to be based on bias sampling so where is the right evidence standard for II and this must ensure a clear demonstration of clinical
Effectiveness and finally I’ve written that Healthcare inequalities must pre ceed aii and what I mean here is that ultimately Health inequalities as a topic and as a scheme of work cannot be replaced by AI we need to examine integration approaches that support rather than replace healthc Care Professionals and
Healthcare inequality streams of work in the field moving forward it is crucial to anticipate and strategically address emerging Trends from the world of AI in particular particular with relation to cardiovascular disease this includes ensuring that developments focus on societal need rather than commercial opportunities and that AI governance is independently
Regulated so I hope this Whistle Stop tour has highlighted the intricate challenges and opportunities that are inherent in the integration of AI and machine learning technology whilst there is potential for AI to change the cardiovascular healthc care landscape careful consideration must be paid to the risks that may exacerbate Health inequalities resultingly organizations
And researchers must ask important questions to strenuously challenge AI developers in the field this will tests the reliability usability and adaptability of AI technology across social Landscapes so let’s leave it there for now but I hope it’s been interesting and hopefully there’s been some brains thinking about where we can
Shape I into the future as it’s certainly not going away thank you very much thanks so much Dan that was really interesting it was it was great to have you on board uh working alongside us developing that that report and it was really interesting all of our kind of
Check-ins and and conversations as we developed direction of it and it’s really great to see it come to fruition so thank you for coming this evening and sharing that with us I know you’ve moved on to a new job so that’s fantastic um oh our next two uh presenters this
Evening we’ve got Sally and Hannah and they uh I think I’ve mentioned earlier they worked on a co-produced uh project looking at Health Care priorities and they’re going to share some details of that project with us this evening so welcome Sally and Hannah you very much um I’ll just
Introduce myself first um I’m Sally I’m from a social Enterprise based in East Manchester in an area called gon for anyone that doesn’t know Manchester um and we’re a social Enterprise that Focus on health and wellbeing and I manager Community Center in I and I’m Hannah um and I am a public
Involvement and engagement specialist um I am an associate at an organization called voal and we connect people with research think we’ve got some slides I think they’re about to appear thank you thank you very much okay so um our project was called um Gorton Health matters um and this was
A community priority setting project um in East Manchester So today we’re going to quickly talk about who we are and the organizations that we are representing um we going to talk about our work um why we carried it out and um how we did it well also going to talk about the
Results um and then have a little bit of a reflective period um to think about um what we learned in the image here you can see um members of our Steering group um who were a working group and um advised and showed us what to do in the
Project um running a community Bing exercise was one of the first things that we did in the project I’m sorry that it’s so dark in my room um I’ve got a energy saving light bulb on and it doesn’t seem to worked at all today he next slide please thanks okay
So first up um I am a an associate at an organization B vocal vocal um has a vision of bringing people and health research together for everyone’s benefit they create opportunities for people to have a say um and find out about research um in Greater Manchester they’re specifically an organization
That works um in involvement and engagement rather than participation and what that means is they work in a way that you might be more familiar of as um co-production um than um uh kind of your your traditional engagement and healthy me Health Community is the organization that I’m
Representing um so we’re a social Enterprise as I mentioned before so we’ve been going for just over 10 years so we we’re we’re all about co-producing health and well-being services that Empower educate and Inspire for a happier healthy and longer life and what that means on the ground is we run
Different Community we work very close with partnership partner organizations and we run different projects like food projects um such as Community Growers which are social supermarkets H crisis food projects exercise classes courses to help people get into um employment uh volunteering opportunities um and lots of different things but our main thing
Is that we work with different organizations to co-produce together and then finally um we also were partnering with the James Lind Alliance lab so the James Lind Alliance lab is part of the JLA um which is a nonprofit making initiative that brings patients carers and clinicians together um in um priority setting Partnerships
The JLA um priority setting Partnerships or PSPs identify and prioritize unanswered questions um or evidence uncertainties that they agree are the most important so that health research funders are aware of the issues that matter most to the people who need to use the research in their
Everyday lives so the JLA lab is an experimental space for priority setting activities that don’t sit within that kind of very traditional methodological um way in which priority setting Partnerships are usually carried out and that’s where our projects sat at the jamund alliance because one of the
Things that we really wanted to do was push the boundaries on power sharing um and democratization within that methodology um and have a more participatory model so in terms of our work um this was a place-based piece of democratization um we worked in partnership with Gorton residents Community organizations and Primary Care
Servic to develop Health local health and well-being priorities um these weren’t research questions we specifically wanted to move away from it just being purely about research so these are priorities that can be used by the community as well as by health research to move away from an extractive
Model we hoped to learn what health and well-being topics residents felt were important so that we could improve the way we work for residents in Manchester so our aim was to generate a list of top 10 questions or areas that could firstly be shared with researchers in Manchester
And Beyond to develop research questions but secondly be used by project partners and others to develop projects set strategy and also apply for funding for our smaller Grassroots organizations that would struggle to get evidence-based um stuff in their funding normally so what is priority setting um so priority setting is a partnership
With the community that enables clinicians patients and care is to work together to identify and prioritize evidence uncertainty we’ve kind of gone over this but what I really wanted to be clear is that with a priority setting you um start from that foundational point and you set strategy and you make
Decisions based on the what the community have told you traditionally that was that’s in a research area we specifically wanted to broaden that out so that we weren’t just talking about one area of research we were talking about um community needs and why they help inequalities when we’re having those
Conversations um and so also what public involvement is um is um public involvement in research means research that is done with or by the public not to for or about them you may have heard of this as nothing about us without us um it’s a really foundational part of
Democratizing our services um it means and it’s been around since the 80s um it means that patients or other people with relevant experience contribute to how research is designed conducted and disseminated it does not refer to research participants taking part in a study and just to be really um clear
Here anything in terms of the nihr the National Institute of Health research has to have public involvement within a research project but not necessarily outside of that research project and within kind of strategic spaces and decision making spaces so why did we carry out this project Sally and I have actually been
Working in Partnership together for a couple of years now um we’ve done a number of different projects together including represent which was a transnational piece of research about um barriers to participation in early cancer detection research as part of that work we talked with our local
Community I also a g resident Myself by the way um about what was preventing people from taking part or being engaged in research and one of the big things was that they felt that coming to a community with a predefined idea a predefined research question was frustrating and actually there needed to
Be space that sat outside of the traditional research question cycle um for more involvement and not just engagement so there was a request for a pre-research phase um of public involvement um and also that Community experience often didn’t fit the boundaries of what researchers were researching um that residents often
Shared really really important stuff in these sessions um but uh they it didn’t fit into the Project’s objectives which led to frustration um really for everybody involved because you don’t want to come to a space and people share some really heavy stuff and there’s nothing that you can do within your
Research project so that’s kind of where this started from we also Drew from the work Dr Bridget Pratt who talks a lot about power sharing in priority setting models um and the thing that she kind of that really struck sticks with us is that um presence needs to have voice um
If you’re going to have involvement um and um voice must have influence so that influence must actually improve help I’m sorry that influence they must people must be able to actually make change um Within co-production within partici participation and involvement um and so we know um from evidence that people in
Rooms with influence and voice improve health research and improve health outcomes and so for us the question um the experimental part of our work was um how might we expand the scope of the conversation and also enhance the depth of our participatory approaches in the priority setting
Process I’ll pass over to S oh no sorry I won’t I forgot about this slide um so uh one of the things that we we had like um sorry we had five key points that we wanted to talk about in terms of the foundations of our project one of those
Was power sharing with each other and sharing power in the room um we’ve chosen this picture to show um that traditionally with a j in Alliance Workshop the final Workshop is run by members of the JLA um and the thing that we wanted to do was make sure that we
All came together as a community as our Steering group and led that Workshop collectively um so you can see here that um we were all working together and we all facilitated different rooms together the community leaders the residents um and also JLA members as well um we worked with brassroots organ
Organizations and groups so traditionally um in health research it’s very difficult to work with organizations that are Community groups don’t necessarily have the physical in infrastructure to to work with large organizations we’ve partnered with healthy me healthy communities intentionally um because they incubate smaller Grassroots groups um and in that
Way we could reach deeper into the community um um and to a much more diverse group of organizations doing really exciting really interesting things that Us in the health research world might not normally get to meet um we also wanted to make sure that this
Was a period of exchange um and so um the community were giving us so much advice on how to do really good in community engagement um and um the JLA also provided training um for upskilling in terms of facilitation of participatory models for the community um also one that um is really important
And just has to be said everyone has paid everybody that took part in in this piece of work was paid they were either paid an hourly rate um or they were um renumerated with gifts when we were talking about the people that were taking part in the surveys um just
Because we couldn’t work out how to get 200 um people through our systems um we also talked about sharing impact outputs and impact and what was really specific here is that sometimes involvement in projects can be um extractive when it comes to outputs because um we kind of set the idea of
The project and then the output is kind of what the organization or body wants so we really really wanted to make sure that our output was useful to our community organizations in terms of funding and prioritizing so one of the things that we kind of did slightly
Different to a traditional um PSP is that some of our top 10 are not unanswered research questions and they are in fact just really significant Community priorities that need um further funding but that’s part of sharing power and sharing outputs and impact Okay so I’m now going to speak
About H what did we do so how we how we carried the project out so we and the first step was we uh built a Steering group and in the first Steering group meeting we all worked together to identify partner organizations um to work with and engagement locations to carry out our
Outreach and the second uh the second uh part part of the project was we did our so we did the Outreach in two phases so we did our first phase of Outreach and we carried this out in 18 locations um so this was all as I mentioned decided
By the Steering group in terms of where where we were carrying out the Outreach and just some examples of where we carried it out was a local mosque um at two food projects that um that run here at the center and a local exercise group called afro fit
Um the next part was the theming of the issues so we um had a community representatives and They carried out the theming workshop to sort the questions into themes and the next part was we carried out uh the second phase of Outreach which was Community voting this was
Carried out in four locations and this included gon m Market which is a local Big Market which everyone in the community goes to so it was a really good way to engage with different people um and Al also at a project called gon Visual Arts which works with um adults with learning
Disabilities um and then the final part was our uh final Workshop um and this is where we identified the top 10 priorities um and this was through a consensus building workshop so this is the top 10 uh that the community uh decided on at the final
Workshop and just to mention as well in the photo is a picture of FIA so she’s a local resident that was part of the Steering group and one of the things that me and Hannah arranged was for the three facilitators at the final Workshop to be Community representatives there
Was FIA who’s a local resident and two other people called takala and IDU who are leaders of Grassroots groups and that was because we really wanted the final Workshop to be to be led uh by people that that represented the community so we’re just going to talk a little bit about what we
Learned um so we found um that community members um provided really important feedback in the theming workshop so um Hannah do you want to explain a little bit more about that so um one of the things that we found really useful was um and very important
Was to have um members of the public um carrying out the Thematic analysis with us traditionally that’s not somewhere where um you’d have involvement from the public within um these models um but it really really allowed for quite in-depth conversation about what was meant or shared um when
People were talking about the different things that were happening in Gorton and it really helped to reduce that kind of assumption or bias that you might have um when discussing um priorities because a lot of these statements are um kind of it’s quite limited information and so having somebody be able to contextualize
Or debate that and discuss that together was really really valuable in helping us to appropriately see and group and kind of write up these um priorities I’m sorry can we just go back to the thank you very much sorry just to mention as well is um we also found in
The project to opened up roots for support for those that might not have otherwise engaged so um we took on this Center a few years ago as an organization health meal communities and we’re still very much trying to do lots of Outreach and um engage people in the
Community um through this project we engage with lots of people who might not have done otherwise and a couple of examples of that is that um one of our outreaches at gon Market we um I had a conversation with someone who was looking into volunteering but they didn’t know where
To start or where to go to so I invited them to come along and have a conversation with us about doing it here and they’ve since trained up to be a volunteer and are regularly volunteering with us each week um and that’s hopefully in the long run going to lead them into
Employment and we also had someone come to one of the workshops who’ been struggling with quite a few things for quite a while and again wasn’t quite sure where to go and they came along to a workshop and then a few days later came in to have a quite a long
Conversation with us and where we were able to H refer them to quite specific support um and they said that they felt because they’d sort of buil the trust and felt listened to in the workshop that they’re able to then come in and have conversation with us about something quite
Sensitive and and just to link on from that as well is we have learned some um new sort of Outreach techniques which we haven’t carried out before and also locations that we haven’t thought of doing Outreach before so we’re going to use those going forward for further Outreach for our
Projects and finally we just wanted to say thank you to all of our absolutely amazing Partners um loads and loads of different organizations um enabled us to come together and do this work we got free a free market store got a market for a week um Southway housing gave us um free
Community rooms when we um couldn’t find anywhere else the library hosted us um Angels of Hope and women arise taught us how to um do one minute planks which we were surprised to have to do um and um gon Visual Arts um it was really lovely to share their final
Project um with them and share community in that way as well so thank you to everybody um that has made the project possible and it was a real Community effort and please do get in touch oh thank you so much both for sharing that and if and if we’ve got a
Bit of time extra at the end of the session you can be teaching us your one minute plank tips and te techniques so thank you very much to everybody for sharing your time and your um research with us today um if people have got questions please do put your hands up or
Put your cameras on or put some questions into the chat um I’m going to start the questions off I’ve got a couple of questions for Fran I thought what I would do Fran is give you both the questions that I’ve got now and you can think about them and work out which
One you’d like to answer first and meanwhile anybody again please do feel free to jump in it’s um great to hear from other people and get people to uh ask questions while we’ve got our speakers here they’re not always here together so Fran in your presentation uh you mentioned a
Revolution the needing to Kickstart things so I just wondered if you could give us any sense of how close we might be to this revolution in your opinion and maybe you know what’s what communities and people can do to kind of facilitate or shape the the revolution or what grows back after the
Revolution and uh you also um one of your graphs I think it was on the live expectancy graph you know you you mentioned there was a dip off there and you said of course that’s you know the um the impact of covid so I just wanted
To ask about you know what impacts and when we might expect to see the impacts of cost of inequality cost of austerity cost of living crisis you know what what might we see coming up on graphs in the future and when might we begin to see those impacts coming through
I’ll start with the second one it’s just because it’s there the in terms of the cost the impacts coming through we could look back so if you austerity started around 2010 and when did we start to see um the first stall in life expectancy and that started to happen in 2014 and
Then for women we actually started to see a reverse a few years later so and women were dying younger than their their their kind of like previous generations so that’s four years is showing the kind of real severe effects and austerity particularly hit women the hardest you know it was women who are
Working in part-time jobs in public sector they’re more likely to be on those contracts which means not only they the first ones to be kind of like well we could lose that but they also will be hit financially hardest by pay freezes um which were very common across
The public sector so there was this kind of double whammy on top of everything else that was already going on there so you will already be seeing it is the first simple answer and for example in the context of homelessness and rough sleeping we have seen huge increases in
The numbers of people rough sleeping um in the latest announcement that came out at the end of February and this is driven by the twin crisis of housing um of the failing welfare provision and problems around things like local housing allowance and also through very very avoidable um hardship caused by
Changes to Asylum policy so things play out in real time but then also you see that accumulated lag so we’re already seeing it and it’s probably going to get worse is the kind of um not very happy answer to the second question the first question how close are we to Revolution
Oh um I uh think quite close in some ways particularly if as should be communities do facilitate this and do argue for it the whole point for me of of of my argument in the book is structural violence and is that we are all complicit in it unless we do
Something about it because we keep just watching it happen even with all of the great work that’s happening from people in this room um this virtual room um it it’s still not enough to have kind of seen real change and I think the problem is that we just keep voting in the same
Sorts of people whatever party they’re a member of who are doing the same sorts of things there’s no co-production co-designer policy look at the kind of disaster behind Universal Credit for example so every time we just allow that to happen and don’t kind of turn around
And say why is that happening what is going on here we’re allowing it to just day there was that whole um view of build back better I thought that was a terrible terrible phrase CU build back better suggests just a stronger version of what we already were and we were
Already a complete mess so we needed to kind of build back completely different there hasn’t been the pivot that some would have wanted in the aftermath of covid but actually maybe we just need much more of the fundamental change um and I should carave out all of that with
I spoke um in quite positive terms about beverage um but let’s just temper that with actually he was misogynistic he was racist he was perpetuating a whole kind of set of structures that were problematic then and are even more problematic now um so the revolution
That he saw and not just on his own back there were plenty of other people including women who led to that but we do actually need some kind of revolutionary approach now and people like Hillary coton the the work that she’s done on this much more relational
Approach and kind of where you are putting people and communities at the center of it rather than kind of Institutions um probably the way forward thank you Fran and I noticed we saw I got very excited when I saw the Sue gray thing in the newspaper that she
Was you know wanting to bring in kind of citizens juries and then promptly 12 hours later that was whipped away again so thank you um of course if people got questions for Fran please either raise your hand you can put your questions in the chat box and we’ll we can come to
You I can read them out for you or you can put put your hand up and and turn your camera on and ask those questions yourself um maybe I’ll put some questions to you now Dan um in your in your presentation you talked about you know um the the issues with you know
Biased data that’s being given to these Ai and you know machine learning uh so have you got kind of ideas of you know how to prevent this happening again you know where is is the non-biased data already out there that we could be using and um it it felt in your presentation today
That we we concentrated a lot on you know the really negative parts of AI as they you know the potential harms you know are there any are there any examples of them working for good currently or you know where would you see that happening going forward or is it you know
Literally only a kind of Horror Story awaiting us and and build build up on that sometimes when I hear technology it just screams profit extraction and furthering inequality so you know have you got any kind of ideas of you know whether that’s true or whether it’s just
You know my my own bias coming into play there and you know what what can we do to kind of mitigate against that risk I suppose yeah thank you very much um I think most people when they think of new technology especially within Healthcare always think of about the commercial
Interests and I think there is definitely an element of that in the um iio diagnostic fund um but I’m hoping one of the themes that I think came through all three presentations was this idea of co-production and there is an excellent opportunity right now to have Pro um co-productive policym taking
Place that’s not to say it is occurring right now but I think there is the potential for it to occur um and one of the biggest elements of while they’ve put 21 million pounds into it um nihr are developing the evaluation Tools in tandem with the roll out um and
So I I agree that there was sort of focus there on the negative but that presents an incredible opportunity for those that if we can get into that space to develop um an II plan an evaluation plan that focuses on everybody in society and can be co-produced with
Everybody Society to really try and reduce some of those biases that are currently in the data in terms of whether there are examples of unbiased data I think that the sort of answer to that is pretty much no uh but I think you have to look at that holistic
Approach of how we can mitigate um mitigate data sets and a whole how do you reduce Biers and data sets more generally in society and I know that’s the discussions that we had quite a lot um in our catch-ups is that actually is this about taking a step back from AI
Taking a step back from Health inequalities and viewing everything much more holistically from a societal level and do we have to tackle um inequalities on a much higher level first before we can really tackle um Health inequalities um when we’re looking specifically at AI um I hope that sort of answer some of
The questions that you’ve put up there and there is incredible opportunities within AI as well within Healthcare and without um to put forward so I don’t want it to be all doom and gloom but you always have to evaluate do those positives outweigh the potential negatives that can come through and I
Think there was some excellent comments in the chat as well about the fear that it can exacerbate Health inequalities which it could definitely go down that path okay thank you very much Dan and to um Hannah and Sally um I think you know what you presented tonight certainly sparked a lot of
Interest in me and and potential of how we can be thinking more about incorporating co-produce kind of priority setting in the work that we do so you know if people have got that kind of spark you know en in in enlightened is that the right word ignited in them
You know you know what what might some of the next steps be and I just also wondered um just a very very specific honed in uh question about the project that that you ran uh was the voting the only way that you talked to people about setting the
Priorities from that long list of themes that you had had to reach your to reach that top 10 and you know have have you seen any impacts as yet to to the work that you’ve done in that priority setting so I’ll start um and um I will
First say no it wasn’t the only um way that we um engag with people in that second phase of Engagement um in fact all of the voting was done um in um like in spaces after conversations anyway um but we wanted to make sure that we
Worked with a diverse range of people so we basically prepared booklets we went out and we sat down we had um teas and coffees at Gorton Visual Arts um and sat down with memb of them talked through what was happening we also worked with adults with learning um disabilities to
Make sure that um everyone’s voice was included um and so in that sense we still engaged um through the gon Visual Arts artistic process but also having those conversations at the same time um it was always the same model in terms of the ending of the engagement Was the
Vote um but that’s because of the process but the ways in which we approach the voting change depending on the communities that we were engaging with thank you and and in terms of um like the effects it’s having already so we will be sharing our findings with all of the
Local partners that we work with um and I’ve already been looking at um like we apply funding regularly obviously with the type of organization we are and I’ve already been looking at you know information findings that we can um use to kind of help us with funding
Applications and it’s also in helping us to inform us of kind of what sort of work we need to be doing to be filling gaps in in what what what there isn’t in terms of support for people in the community for example um and I know some of the Grassroots organizations that
Have been involved have also been already using some of the um findings and discussions already in their own work yeah and we will be disseminating um all of this work through the clinical research Network I know that they want to take the findings to develop um some training for their engagement M teams
And also for their researchers so that they can think about how they’re better engaging with communities but also just so they can understand um gon a bit more when they come um with their appropriate um research projects for the area um and then I should also just say that we did
Finish this project um uh 14 days ago so um not much has happened since apart from kind of breathing and calming down the high it’s off the press yeah this is very very immediate finger on the [Laughter] PS much yeah oh your your final question
In terms of um what can people do if they’re interested in priority setting so this was a really big piece of priority setting um in terms of uh the funding that we needed to um gather for it but there’s lots of different ways of doing fun priority setting and there’s
Lots of different ways of democratizing your services there’s some incredible bits and pieces online um and the James and Alliance are always interested in talking to people I’m also very happy to have conversations with anybody should they want to do it but you know priority setting is just one thing there are
Citizens juries there’s liberative democracy there’s amazing Myriad Myriad of ways of engaging people in your decision-making processes thank you very much thanks Hannah and Sally a Dean you have your hand up I do um hi I do thank you um I just it hasn’t been mentioned I wanted
To mention agism as another source of um Health inequalities um where we’ve highlighted I’m from the center for aging better so we’ve highlighted it in a number of things we have our big um our big campaign going on which I hope you’ve all seen and we have the harms of
Ages in paper on the website um so both through self- agism the way people limit themselves and overt actual you know ages practices and um and lack of practices so just want to I just want to put that into the mix as another as another source of of Health inequalities in later
Life can I just add in so in the book that we in the report from beverage he has um the problem of age as a section in it and he’s just kind of arguing around all people get older and and how do we resource this and then in the book
What I I talk about a lot about that internal agism and how this we um things like say baby boomers I refer to Baby Boomers in in the in the talk and then you see cards kind of ridiculing Boomers or kind of ridiculing old age particularly women we kind of kind of
Make a joke out of old age and this is just a really um passive version of something that’s really Insidious in how we kind of get to a point where you’re 65 and over and suddenly that’s it you are grouped as a single homogeneous group who is dependent on a population
Even the way we talk about them in demography is the dependency ratio so we’ve kind of set it up to be a real problem right through the life course and then if you go back to the kind of cumulative impact and the fact that people who are in more Soom so
Economically disadvantaged situations are going to have higher costs in the life course that they haven’t been able to recoup because of the kind of the the impact on them then an aging population is a really significant issue that no government has fully recognized even though it was completely um kind of
Forecastable based on what the population is doing but again it’s a really really important one to look at an agency yeah well we could I could talk we could talk about it for for ages um I mean one of the things we’ve got because we’re evaluating the campaign
I’ve got this all this Baseline data so we’ve been looking at it and we see that people in lower socioeconomic um people who are struggling are much more likely to experience of experienced agism than those who are much a much larger proportion those are very well of say
Know they’ve never experienced it so you see real intersectionality there also which is just sort of exacerbating you know everything just gets magnified and exacerbated thank you thank you ad and I haven’t seen your research actually so maybe if you could pass that over to me you know at some
Point that would be fantastic to see it absolutely will yes please uh and please distribute it I will uh so has anybody got any more questions or any questions for our guests I mean I I can I’ve got a pie in the sky Wishful dream one while
We’re all here and we’ve got these experts around the room but I don’t want to hog hog the floor so if anybody’s got questions please do um save my doorbell and the dog going crazy but maybe I just thought uh you know in the inter room we could think about you know
We have got a general election coming up do do do the any of our panelists have any ideas of you know what’s what we could be asking of you know the next incoming governments in order to kind of address some of these Health inequalities we’ve seen and and even
Reverse them maybe should we start with should we start with you Fran I think to a large extent we do need to completely reform Health and Social care that is fit for the population that we have now and that we are kind of expecting to have so that is
Um for all ages um and for all um backgrounds cultures ethnicities we should also so really really call for for my active investment in the Health and Social care Workforce because that’s a kind of huge huge area where just seem to ignore it and actually whenever we’ve got acute
Health for health Workforce shortages they have historically just recruited overseas but then the policy environment at the moment doesn’t really allow for that either so there’s kind of really strange short-term views which kind of attach to election Cycles as opposed to attach to actually the lifespan of a
Hering population so it’s if we could shift policy to think longterm rather than in a four five year cycle and really call for all manifestos to be looking at that and committing to it which is difficult because obviously as soon as the budget changes they just do something different anyway um but I
Think that we should be holding them to account for that more routinely than we do because we we also get caught up in those election cycles and what did they say last time and they didn’t do that or they’ve moved to this rather than being like actually hold this um allow for the
Budget to change recognize that it’s going to and give us something that is actually sustainable thank you Fran Dan did you want to add anything on I mean I’m there’s not too much to add from my side I think I completely agree with Fran and being in NHS England I can’t speak too
Widely but we do see that it’s based on five year Cycles um and particularly up to an election with this general election coming up I know there’s lots of talks about which projects can go ahead which projects can’t um particularly when we have that standstill period where uh we can’t
Publish any new policy um and it does have a big effect on the way that NHS England operates um and I think a longer term view as Fran was saying if all parties could agree to something like that would be excellent yeah thank you Canan Sally any final words I didn’t hear the
Question fully because there a bit of a problem with the sound laptop sorry I was also turning my mute on as soon as possible because my doorbell okay got the general just all I would say so just you know we’ve got a general election coming up and you know
Obviously Health inequalities are you know a huge issue have you got any kind of thoughts of what we could be campaigning or asking of our incoming governments to help kind of address or even reverse the situation of Health inequalities as they stand um it’s hard
Thing the job but what I would say is um certainly working in uh the area we work in in the type of work we are in the center um it’s this area is particularly high level of deprivation um and you can really feel the the kind of complex
Needs even over the last few years that um people are just struggling with lots of different things and the needs are very complex and often it feels like the third sector is is filling in those gaps because there’s been so many Cuts there’s been so many things going on so the need is
Increasing but the support is decreasing and uh ourselves and lots of the organizations we work with is um we’re very stretched and we yeah we can just really feel it because we’re we’re in the sector that filling in the gaps that’s an unsustainable model thank you and Hannah did you have
Anything you want to add yeah it’s the thing I’ve been saying and I think thing that lots of us have been saying for years decades um we need to move away from the deficit model Fran you touched on it um earlier but stop thinking about people as individuals that need blaming
Um and start thinking about relational empathetic long-term Services where people can feel safe and trusted to talk about those the complexity of their needs one of the things that came up the most um often within our piece of work was um conversations about GP surgeries and a huge number of people talked about
A GP who had worked um uh for 30 years in a practice um and had recently retired and the impact of losing that relationship with their GP had on their health and their well-being was enormous and it was numerous numbers of people that gave us that feedback and so yeah I
Think long-term relationships um with services that care really really important and that can only happen with more funding yep thank you very much well in the absence of questions from our audience we seem to have done really well for time so I’d like to thank all of our speakers for giving up
Their time to us this evening and sharing their incredible research and experience and you know knowledge and um research from their books and and stuff like that we’ve going to put some in the chat we’ve got uh Dan’s uh report on Ai and Healthcare that you can have a
Lookout uh download from our website and we would really really appreciate if you can please uh fill in a feedback form it really helps us at the equality trust with you know planning for our future webinars to kind of think about what topics people are finding interesting
And you know concerns that they have coming up that we might be able to kind of find speakers to think about and discuss uh with uh all of you guys so thank you very much for your time we really enjoyed everybody and learned a lot from uh spending time here and and
And listening to everybody and and seeing their work so thank you very much and good evening thanks bye thank you very much