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So if you'd like to just begin by saying your name and your current position.

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Yeah. Thank you. My name is Meghan Pandit.

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I am a professor. Am I going to Pandit? And I'm the chief medical officer at Oxford University Hospitals, NHS Foundation Trust.

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Thank you very much. And without giving me your entire life history, but starting from when you first got interested in medicine,

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can you just give me a sort of account of what brought you to where you are now?

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Gosh, yes. It seems such, such a long time that it's, you know, medical training, etc. goes on for.

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So I. My first consulting job was at a district general hospital that's too far away from me to go back a bit further than that.

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Oh, you want me to go back there? Just that. What got you interested in that?

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In medicine? Oh, well, what got interested in medicine is the human side of it.

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I wanted to help people.

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I wanted to be sure that the health care that was delivered to people was focussed around them, that they were the main stakeholders, as it were.

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And I was very taken by and those early days surgery.

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I wanted to use my hands to make people better.

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And that's what I wanted to do. And I did.

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I became a gynaecologist and an obstetrician, which was also a very nice mix because it has surgery and it has some medicine, as it were.

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So and the joy of delivering babies and actually the thrill and excitement of doing that when I was doing obstetrics,

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although, you know, there are some very hairy moments.

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It was it was about doing the right thing for the woman in front of me.

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And I think that was really important. And latterly I then took an interest in URO Gynaecology, which is very much focussed on women's health,

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the sort of incontinence and prolapse aspects which really, you know, many women feel that they can't speak up about it and don't seek treatment.

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And those, you know, back in the sort of late nineties when I started preparing to be a gynaecologist again, the focus in my mind was about women,

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about what impact childbirth has on women with regard to incontinence and prolapse, and how we can how we can improve women's women's quality of life.

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And I was very influenced by Professor John Delancy, who I worked with in Ann Arbour, Michigan, as his visiting lecturer.

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For a year. He has described the continents mechanism in women, and it was a fabulous opportunity to work with him and to understand the concerns,

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mechanisms and theories that underpinned his findings.

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So I was very much intrigued by that.

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And then I was a year ago an ecologist and an obstetrician in a district general hospital in England for nine years.

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But during that time I felt that we weren't really as a unit doing what I intended for women to have

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and for the satisfaction that patients should receive from a service that's being offered in the NHS.

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I also felt that we could do more to improve staff morale and also the outcomes for both from the point of view of clinical service,

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but also the education and training that we were offering. So I was brave.

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I put my hand up, said I wanted to lead the unit, and a very wise person said to me,

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Well, you haven't been consulting for long, so you should go and get some training.

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So all that was, was a week long course at the King's Fund.

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But nevertheless, I was with like minded people that was hospital management or that was on that was on leadership.

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And it just leadership how to be a clinical director was what it was called then I think it was in 2006 or seven, I can't remember exactly.

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And then I was interviewed and appointed as clinical director, and being a clinical director for a unit is a, you know, a relatively small budget.

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You are responsible for a smaller number of people as compared to what my current job is, obviously.

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But I was very fortunate to work with a newly appointed head of midwifery and a general manager for that unit.

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And we worked, you know, we just had the same aim, it turns out.

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And we worked very hard together as a team. We got lots of people on board and the outcomes and everything turned around gradually.

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So in three years time, I. I was no longer standing in front of the television apologising for some unfortunate mishap and sad case.

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And, you know, we were instead celebrating the wins that we were demonstrating, and that was really fulfilling.

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We're talking just after the report. The Ockenden report. Yes, yes.

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Yes, yes. So so that that was and then I was asked if I would be a divisional director for Women's and Children's.

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So that was a bigger budget, more people, more patients, a different scope.

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And I really enjoyed that. So this was alongside clinical work of course, and I just thought this is something that really motivates and inspires me.

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And I decided that I would undertake an MBA, which was again,

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not not a not very easy thing to have done because when I applied to the program at Oxford Brookes,

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they said, well, there haven't been many, hardly any doctors at all wanting to study and do an MBA.

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So and you are so busy as a divisional director with clinical practice, we are really worried that you may not be able to complete it.

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So you were doing it side by side? Yes. Yes. And I managed to convince them and I said, no, no, I really want to do this.

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And they accepted that. And within six months of that,

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I saw an advert in the journal Medical Journal for a Chief Medical Officer position at University Hospitals in Coventry, Coventry and Warwickshire.

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And I thought, okay, so this is really where I want my career to go as a medical leader.

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And, you know, and I'm a person that actually changes pathways, changes care for the better.

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And I applied and I got that job.

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And that was for me, it was like hitting a lottery because that was exactly what I wanted to do.

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I was travelling from Oxford, but. Or just outside from Oxford but or just outside Oxford.

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But it was it was something that I was passionate about.

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And, you know, when I started that role, there was a very steep learning curve,

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but I was surrounded by two or three individuals who really supported me and took me through that first,

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first year to understand what being a board director means.

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You know, how do you what is the governance and, you know, the interactions with with external agencies, regulators?

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Because by then and this is 2012, the role of the medical director had changed considerably from being a senior doctor

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who gives trust boards opinions about medical matters to being a very regulatory one,

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one that is responsible not just for the quality of care that's offered, but there was also a new regulation about appraisal and revalidation,

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and it was about being a responsible officer for the number of doctors.

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It was about responsibility for medical education and training and also for research and development alongside the whole of quality,

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which at that time I radzi had said, had to be sort of what was really about three domains.

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It's about safety, effectiveness, outcomes and patient experience.

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So I worked with again with the chief nurse and that's a very close relationship has to work well.

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And you know, I was a newcomer to that organisation in 2012, but when I left in December 2018, I very much felt like I was leaving home.

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It became a relationship where the organisation grew and changed.

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I grew,

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I learnt a lot and during that time I did several things like starting a master's course at Warwick University on health care operational management,

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because I felt that as doctors, nurses, pharmacists, physiotherapists, middle managers,

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we need to understand the theory that underpins everything we try to do.

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So this is having completed my MBA,

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I had learned so much that I felt it really is essential for people who manage health care to understand the basics of their of their practice.

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And then Warwick University agreed and that course started and I still teach on it, which is fantastic.

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And I am a chair. I have a chair at Warwick linked to that.

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I was also made a senior founding fellow of the Faculty of Medical Leadership and Management,

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and I did various other things linked to my role as Chief Medical Officer.

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And one of the other things that really influenced me was and my career was the partnership with Virginia Mason Institute and Medical Centre.

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This was something the previous Secretary of State for Health, Jeremy Hunt, did.

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He he created, he released some funding for five organisations in in the UK to learn.

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From Virginia Mason Medical Centre about how to improve quality.

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Yes. So what is the Virginia? It's a hospital. It's a it's in Seattle.

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It's a small hospital in Seattle. But what they did about 15 years ago now is they went to Toyota motor industry in Japan, learned about lean.

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And more importantly, they have demonstrated how to deliver lean in health care.

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What is lean?

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So lean management is about removing waste from everything and they have shown how removal of waste and there are several types of waste,

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how removal of waste improves efficiency and productivity, but it's also underpinned with the core principle underpinning this is respect for people.

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So it's the people on the shop floor who know the best way to improve and change the work so that we benefit patients.

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Those are all stakeholders. It might be somebody buying a car for Toyota.

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And and and we learned and while I was Coventry, we were one of those five trusts to partner with Virginia Mason Institute.

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So we learned from them and did several things.

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And, you know, I'll cut it short, but several workstreams and one of them was on safety in the work we did.

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And that allowed us to develop things like creating a patient safety response team, which we now do at Oxford as well.

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And that's about responding to harm incidents that may happen and in responding very regularly.

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Every 24 hours there are harm incidents recorded on systems and we are top you a team of five, six people, governance practitioners, nurses, doctors.

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We meet every morning at 8:00 and we go through those incidents and decide what level of investigation we should do.

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We make sure that duty of candour, which is apology, is offered to the patient and relatives and we make sure the area is safe.

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And we also support our staff so that people understand it's not about blame, it's not punitive.

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So those is just that's just one example. So that's I mean, that's an example of something that's reactive.

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Yeah, but it does it also does the method also introduce introduces sort of proactive.

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Absolutely. Because everybody is now aware of that,

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that there will be the chief medical officer or chief nurse or their team tomorrow morning that I can speak to.

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I'm really worried about this. People are not afraid of reporting.

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They are reporting every incident, you know, whatever the incident is.

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And there is a lot of learning. There is learning on the spot.

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There's learning on the day. And and that learning is disseminated more widely by use of safety huddles, for instance.

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So so there are a lot of changes that we were able to make and I was able to learn.

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And then in January 2019, I came to Oxford as chief medical officer, and a lot of work had to be done.

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That was very clear. And again, it's about being in a team, it's about being in a team to get the basics right.

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And this is a very big yes. So you're your chief medical officer across all the Oxford University Hospital?

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That's correct. That's correct. So we have how many hospitals, health care staff?

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Yeah. So Oxford University hospitals, it has a turnover of 1.3 billion.

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We have four hospital sites, we have circa 14,000 staff.

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And we, as you know, conduct services ranging from basic health care for people of Oxford,

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share if they fall ill or come to any to, you know, kidney and intestinal transplants.

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We have a very busy maternity unit of we deliver almost 7000 babies.

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We do complex neurosurgery, heart surgery. You know, anything other than a heart transplant or a liver transplant is done here.

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And we have the expertise,

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absolute expertise and commitment in this in this organisation and the partnership that we have in this organisation with universities in Oxford,

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Oxford University,

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Oxford Brookes University is something that we really have developed over the last few years and that has really stood us in very good stead.

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So, so yeah. So I'm here and my role is again, it involves patient safety, effectiveness of outcomes,

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medicines management, end of life care, research and development and medical, postgraduate training.

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And also that responsibility to make sure that the medical staff of it to practice so so all of that but also as I've said,

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the role has changed so much. So now it's changed further since I was first appointed to 2012 and CMO was the chief medical officer.

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So that will mean when you're previous. Yeah. Yeah. So I've been a CMO now for ten years.

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So in that ten years, it has changed. So, you know, I now work very much alongside other executives.

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So it's it's about being an executive director and providing assurance and accountable to the board.

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Yes. And the that is a chief executive. There is a chief executive.

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That's it. Next in line. So the chief executive has a team and that's how the work happens.

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That's how the organisation is run.

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So, you know, I work on productivity with with the chief operating officer, I work with the Chief People Officer in terms of workforce planning,

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in terms of personnel matters, I work with the Chief Financial Officer in terms of how do we allocate capital?

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You know, what do we procure? Is this the right thing?

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So there are so many different aspects to the role of a chief medical officer, and that's just internal.

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There's also the external work. So we now part of an integrated care system.

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The structure of the NHS has changed and so we belong to this system, integrated system that includes Buckinghamshire, Berkshire and Oxfordshire.

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So it's very much about working in collaboration rather than in competition.

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So, so that that is one. And then there are several external regulators on there.

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There's the Sikh, you see the NHS, England, there's, you know, several.

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So, so the work is endless, but it's actually the joy and the core of the work is, you know, why am I doing it?

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Well, I'm doing it for the patients. And if I keep that in mind every single time, then actually things are very clear.

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Mm hmm. So I'm just reading a little bit about what you've been doing.

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The phrase quality improvement come comes up, and you also just throw away,

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as we were talking earlier, that when you came to Oxford, there was a lot that needed doing.

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Can you give me some examples of the kinds of things, the kinds of changes that you've brought in, in the direction of quality improvement?

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Yes. So again, the key thing that I realised I needed to do was to work very closely with the chief nurse and be really be taught alike.

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And that's what that's what we did.

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So one of the first things we had to I was asked by the board and chief executive and the board is to reduce the number of never events.

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So never events harm incidents that should never happen because there are mechanisms in place to prevent them from happening on an average.

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You know, the whole hospital this size with this kind of complexity, you would expect maybe three or four and in a year.

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Classic examples. Yes, in a year. Classic examples of never events are the most commonly occurring in this country,

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are retained foreign body and something left behind after a corrective or a procedure and wrong site or wrong side surgery.

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And and there are others, you know, there are seven or eight types of environments, but those two are the most commonly occurring in in this country.

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And they continue to happen. So, you know, okay, so I was I was I was told that that is one of your objectives in the first year.

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And when I looked at when I looked at the the the picture in front of me,

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there had been eight I think the year or the year 18, 19, no years, 17, 18 and 18, 19,

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because that came before the end of the financial year 1819 there were 11 and a

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majority of them were one of these two region foreign body alongside procedure surgery.

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And then when, when I looked at, so what is the most important mitigating sort of factor to prevent that risk and that sort of event happening?

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It's compliance with the W.H.O. safe surgical checklist.

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This is a checklist rather like in the airline industry when the pilot sits in the in the

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cockpit and introduces himself to the team because they're all a new team every day,

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they're not the same team. Flying the same planes starts with who you are, what's your name?

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But it goes through very rigorously whether all the controls are in place.

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So that's very that's what the safe surgical checklist is.

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It goes through, you know, is this the right patient?

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Have you checked the name Ban? Does the patient need any blood after surgery?

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Have you got the right equipment? All these sort of things. And compliance really needs to be 100%.

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And it wasn't. It was approximately 95%.

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So the checklist was in use, but not effectively. Not 100%.

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It was. You could argue whether it was effective or not when it was 95%.

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So you don't need a rocket scientist there to work out what needed to improve.

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So so, you know, we set about making it doing a few things.

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We started the patient safety response team, did it as a pilot initially because, you know,

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what I didn't want to do was, oh, here comes the new CMO, and she's just imposed a new process on us.

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So I convinced the the clinical leaders just to sort of try a pilot.

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And that's why there's a screen behind you, because until COVID hit, so from January 19, until COVID hit, that that meeting used to happen here.

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And I did it every single day unless I was away.

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And if I was away, people came in here, had that access to my office and they did it.

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And that was the commitment that had to be created. So the pilot went through and people really appreciated especially the support

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for staff because when we review these things we visit the ward and people said,

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yes, we really want to do it. So we started that. We started sending our safety messages.

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So every week we would send out a safety message on a Tuesday without fail.

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It has gone on every single day to the whole trust.

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And I'm just remind you, it's about learning a killer thing or saying this happened and if we've done this.

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It's about it's about a learning point from whatever has happened.

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Right. And not just. Bad things, good things as well.

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So it's about positive things as well as learning from home.

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And that's since we started sending that out.

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We created the notion of safety huddles, which became slightly later, but that's as a package of things around safety.

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And people started noticing this. People started what a safety huddle is,

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because I think I would come to that and people started noticing this and people started being open about reporting.

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Our reporting rates went up, our number of home incidents came down.

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And now, three years on, there is mostly 100% compliance with the checklist.

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And when there isn't, people are held to account because it's not a new thing, a safety huddle.

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We introduced safety huddles during COVID. Actually, we would be meeting to introduce them, but COVID gave us a perfect platform.

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It's about a multidisciplinary team.

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So a doctor, nurse, business student, you know, whoever a pharmacist on the ward coming together every morning to ask for basic questions.

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What went well yesterday? What did not go so well? What can we learn from it and do differently today to avoid it happening today?

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And are there any current risks in the environment in which we work that we need to take note of and mitigate?

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So that allows people to very quickly get the support for things if something is going wrong, and to identify good practice and celebrate it.

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And also if there is a negative thing to report it and look into it.

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So so that's a safety huddle. And it also is used to cascade information so that we don't people don't work in silos.

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So that's what we did. And, you know, all of this meant that there's a clear and obvious reduction in never events.

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The following year there were seven and the year after that there were two.

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But also we can demonstrate in our staff survey, the NHS staff survey, which happens every year.

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We can demonstrate a rise in response to questions such as Does your trust take your concerns about safety seriously?

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Are you given feedback? If you reported incidents, are you confident that your trust will investigate problems and learn from it?

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Which demonstrates objectively that that there has been a change in culture of safety in this organisation?

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And that's just one of the things we're going to talk about quality in such in terms of quality improvement.

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We set up a couple of consultants, approached me early on in 2019, spring of 2019,

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saying they're very keen to introduce learning across the organisation and quality improvement.

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And quality improvement is about the three domains of quality and how we improve them and there are tools and methods, so the methods might be asked.

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The five whys ask the question why? You know, somebody fell over.

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Why did they fall over? Well, they fell over because they slipped or why did they slip?

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You know, there was a patch on the floor. Well, why was there right back on the floor was a leaky tap.

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Why is there a leaky tub? You know, why has not been fixed.

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So you get to the root cause of why the patient fell by simply we're asking five boys and that's just one basic example.

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But so I along with a colleague who doesn't work here anymore, director of improvement, he was we said, yes, we would very much support you.

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So they started the key hub back in 2019, summer of 2019.

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And we've now taken a large cohort of staff through that QE hub.

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They've undertaken several projects,

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but it's really about being consistent in the messaging and making sure that all these projects are not just projects that tick a box,

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they actually lead to improvement and that improvement is spread across the organisation on a big scale.

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And one example is AQI project which has created a change is a flood water bus where there's a bus now goes

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along in Oxfordshire to to do phlebotomy blood tests for patients so they don't have to queue up here.

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So, you know, that's an example. But also I think the main thing that that I,

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I said during when COVID hit was I was asked the question because everything suddenly went to remote working.

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I was asked the question whether really we should continue patient safety response team at 8:00 in the morning.

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And I said, absolutely, yes. Absolutely, yes.

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Because that is the prime purpose. And there has to be a relentless focus on safety for patients and support for staff and.

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Did not stop.

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Which which, you know, which makes which gets people to understand that there might be a, you know, a storm outside or storm about to come inside.

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But we will still carry on doing the core business that we are meant to be here for.

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No, I mean, I think that's that's very interesting that what you've introduced is opportunities to reflect on practice.

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Yes. Which is often the first thing that goes out the window if you're very, very busy.

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That's right. But then that has negative. That's right.

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Yes. Yes. So you've mentioned it. You've brought Kogut up. So a question I'm just asking everybody is,

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can you remember when you first heard about the COVID pandemic and when you first realised

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this was actually going to be something that would be a major part of your role for a while?

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Yes, very much so. It was mid-February, late February.

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And the I think it was that first case that that that individual had returned from a skiing holiday.

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And we knew the first U.K. case.

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Yes. So you knew when you asked me, you know, because until then, I think we were all in oblivion,

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including some very senior people, that it's not going to come here.

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It's in China or it's in Italy. But but we knew when it was in Italy that it's going to be a matter of days, that it's going to be in England.

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But in those days, you know, we thought, okay, you know, two months, six weeks, how long is this going to last?

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And I work I'm responsible for infection prevention and control.

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And so I work with, you know, extraordinary people who are extremely clever and vigilant and have their own networks.

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And the director of Infection Prevention Control, who works very closely with me, said to me, this is coming here,

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and I'm getting a lot of questions from US staff as to what this is about and what will change and how have what sort of impact will it have on them?

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And I, I remember it was early March.

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We had a we used to have staff briefing in the lecture theatre, which is not too far away from here,

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but the CEO would lead that and about I think it has a capacity of around 150.

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And it used to be full and people would come forward and see things and ask questions, etc.

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And we had this staff briefing and and it was when the first came the cases in England had had come about and it

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was full and we needed to use both lecture theatres with a with a broadcast on All in one and live in the other.

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And there were many questions then that we did not have answers to.

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Did we have PPE? Yes. But, you know, there was this overwhelming concern that particularly a surgical colleague who said,

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I'm not going to operate, I'm simply not going to operate.

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You need to tell me how I'm going to protect myself and my colleagues.

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And, you know, it was not just that. It was this this was this dilemma of, okay, so very, very rapidly.

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We have to change our pathways. We have to change our front door, which is any we've got to care for COVID patients.

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We don't know how many there will be. So we've got to do we have to empty the John Ratcliffe building?

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Do we have to, you know, stop doing orthopaedic surgery at the Nuffield Orthopaedic Centre?

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What do we do with cancer surgery of the Churchill? What will happen at the Horton?

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What? It's a much smaller hospital. How are we going to make sure the resources are right?

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And what about those people who don't have COVID? You know, what about the people who have a heart attack?

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What about the people who have a poly trauma in a road traffic accident?

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How are we going to look after that? And at that point, we were told that the projections from NHS England,

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because NHS England went into a command and control structure and then it just England.

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And there were these suddenly there was a completely different meeting structure.

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There was a mushroom of meetings. It was it was just like, you know, some something overwhelming.

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And I was asked to be the chair of a COVID steering group for the organisation, and we had to come up with a plan.

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And the modelling from NHS England said that we'd have to double and double our ICU capacity and we have, we have,

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you know, we have adult critical care, we have neuro critical care, cardiac critical care and paediatric critical care.

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But you know, the numbers of beds that we had had to be doubled and doubled.

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So we were looking at something like creating a capacity for something like 100 over 120 ICU beds that were ventilated.

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Now, you know, we don't have that that many beds. And what that meant is I had to get people around me and we had to go through this

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rigorous mapping of which wards we would clear who would have to move from the building?

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Where would they go? Where would gastroenterology go? Where would, you know, cystic fibrosis services go?

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And and undoubtedly, you know, there has been a not such a good impact on some of the services that we had to move during COVID.

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We now know that there's an iceberg of of people that weren't treated, who didn't come forward for treatment at the time.

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We don't know where they are and who they are. That's in addition to the waiting list of people who are waiting for surgery.

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So so this was all very reactive. But, you know, the board took a very, very calm and measured approach to this.

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Everything went to remote working. We continued having our board meetings, the COVID steering group that I chaired met every day.

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We had the chief operating officer on and chief nursing officer on it, Chief People Officer on it,

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because we had to do a whole new piece of something we'd never done in this country, which is redeployment.

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So so we had to redeploy research staff and nurses.

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We had to redeploy junior doctors from one speciality to another because the need,

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the overwhelming need was in general medicine, in chest medicine, that's respiratory medicine and ICU.

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And the anaesthetists, they created a rota, a new rota to intubate patients with COVID and PPE.

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I mean, procurement of PPE. So we had several strands in the steering group.

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We had the clinical strand, of course, for COVID patients, for Non-covid patients, we had the infection prevention and control policies.

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We had the support for our own people, and we had procurement, which is PPE, we had medicines management, and we also had oxygen in that.

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So remember, there was a fear that we'd run out of oxygen at some point and we had to look at all of that.

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So looking back at it, you know, those days, one after the next one after the next, they just carried on and we worked really well together.

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And in the background we knew that there was a vaccine being developed not far away from this hospital.

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So what we had is we had 14,000 people with hope.

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We had 14,000 people who worked as a team. We had support from our partners, the charities, the universities, the other hospitals in the system.

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There was mutual aid and and we had no shortage of PPE in this organisation, not throughout the whole.

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Yeah, yeah. We've in fact offered mutual aid to all the other places.

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So. So it was from my personal point of view, if this had happened, if COVID had happened in February 2019,

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when it was a month since I'd arrived in this hospital as the CMO, I think that would have been not as effective.

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My, my, my steering and my presence as a CMO would have been less effective than it was because I'd been here for a year,

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just over a year, and people knew me. People knew my approach to things.

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People knew and had started to understand my decision making.

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And and, you know, I think that helped.

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And the safety culture. Correct. Being developed. Correct. And the consistency in that.

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So I think all of that meant that we were in there.

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I was certainly in a much better place.

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I didn't have a book in that cabinet which said Open page 65 and you will know how to manage a COVID pandemic, you know.

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No. So it was it was working and teamwork.

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It was about gathering and being surrounded by experts.

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There is no shortage of experts in this organisation.

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There's an expert in every clinical field and it was sitting with them and looking at the various guidance that came out from the centre,

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looking at whether we need to adopt or adapted, looking at what what you know,

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their opinion might be about any particular thing, for instance, resuscitation, etc.

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But the interesting how did you feel about the guidance that you were getting?

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Was it was it good on the whole? Like how flexible could you be in responding to it?

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So we couldn't be flexible initially.

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But I have to say that being the organisation that we are and being also part of the Shelford group, we could do a lot of influencing.

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We could do a lot of what influencing by listening to our people.

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So the Shelford group is a group of the ten biggest hospitals in the country and we had regular meetings.

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We still do have regular meetings with the national directors.

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So so that was a good forum. But the thing I was going to say was that being surrounded by experts was fantastic.

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And it meant that I.

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Could gather the information I needed from these experts to be able to make the holistic decision in a very logical and rational manner.

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So this was a very symbiotic relationship because was they were experts in their field.

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They had not necessarily made decisions for a whole huge groups of people populations.

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And I had the expertise from them to be able to make that decision because I was more used to making decisions.

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So so it worked really well.

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And, you know, we constantly maintain communication channels, not just within the organisation, but also across Oxfordshire.

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And we did lots of new things that were very important and done very well, like starting the COVID care at home service.

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And this and that has been a sequential change and improvement because, you know,

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we didn't in the end need those doubled and doubled bed capacity for COVID in the first wave.

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Because, you know, we were we were looking at we there was a ventilator sort of it was allocation from the centre.

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So depending on our beds, we were given numbers of ventilators.

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But you know, we were we were looking at prospects of actually ventilating COVID patients in theatres and recovery areas,

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which is not good in the end. We did use one recovery area in the second peak, but we didn't need to in the first week.

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We also had we developed Oxford developed the ethics proposal, the ethics guidance for for this for COVID during call that we use during COVID,

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which is certainly regional, if not national, nationally adopted.

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So a lot of things happened in that time.

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But I can tell you that working through the first peak was was almost thrilling, was almost coming out of it,

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was almost a sort of feeling of exhilaration where you felt, well, you're never going to experience that again in your life.

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And, you know, to do that in a way that has had a positive impact on people and we've done as best we can as a team to help our patients.

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And our staff was was very good.

356
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But it was the second peak which was in the which came in the December, January, February of 2021, which was far worse because people were then tired.

357
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And and we just saw this coming and thought, I cannot believe this is happening again.

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And we, you know, we just about got the people who had moved from the job market building back into the building,

359
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but now they were all spread in the wrong place and having to say to them, were you going to have to move again?

360
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So we were asking a lot from of of people. And, you know, it was hard.

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But I think people understood the rules.

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People understood why things were happening as they were.

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And we did it. But I remember one one afternoon, I mean, the executives met every day led by the chief executive.

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And I remember one one day on a call the executive called, I said, I am waking up at two in the morning worrying about things like oxygen.

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How will you know, patient on bed six on such and such a ward, will they get the oxygen?

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Because where are we going to put our next patient? And nobody said anything.

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So I thought I said, you know, I pushed that.

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I said, so is that not happening to anyone else?

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And the chief executive said, You're very brave.

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You said, what people most people I think felt and worried about but perhaps didn't want to say it.

371
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And that was a good thing because it's demonstrating humility.

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It's actually something that, you know, is best discussed.

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So I literally was waking up at two in the morning worrying about it.

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But but since then, obviously, it then reduced again.

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And policies have changed now. And, you know, we as we sit here today, we have over 500 staff off with COVID.

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But the good thing is that the severity of the disease is lower because everybody is vaccinated as far as people have been.

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And the stress on the system remains because it's a different story now that, you know, we don't have the staff.

378
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But but we are we are getting through it.

379
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And there is a lot of pressure on urgent and emergency care and any which you might have read in the in the press.

380
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It's across the NHS. So things haven't, haven't gone back to whatever normal was.

381
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It's just a different healthcare system now. And that's going to take it is going to take a long time, in my opinion.

382
00:41:58,290 --> 00:42:09,529
Yeah. Yeah. So you said you got through the first pandemic reasonably, as you say, on a bit of a height, but you can't have been completely unscathed.

383
00:42:09,530 --> 00:42:12,590
I mean, did you did you lose colleagues during that wave?

384
00:42:14,300 --> 00:42:19,129
Yes, very sadly, we lost in during that wave.

385
00:42:19,130 --> 00:42:22,130
We lost full staff.

386
00:42:22,700 --> 00:42:29,809
Yeah, it was it was very sad. And, you know, we obviously have to investigate.

387
00:42:29,810 --> 00:42:40,220
And we carried out a thorough investigation about all of those and, you know, have communicated as far as we were allowed to with the families.

388
00:42:41,600 --> 00:42:44,209
And what were you able to do with staff who, you know,

389
00:42:44,210 --> 00:42:50,120
who were presumably aware that colleagues have been either very sick or in some cases, you know, sadly died?

390
00:42:50,990 --> 00:42:54,319
That must have raised their own levels of anxiety about coming. Oh, yes.

391
00:42:54,320 --> 00:43:01,309
I mean, there was a whole programme of risk assessments and we didn't know very much at the beginning of COVID.

392
00:43:01,310 --> 00:43:13,070
But by the summer or autumn summer, I think we pretty much knew that the risks of COVID were higher in ethnic minorities and and certain kind

393
00:43:13,070 --> 00:43:18,020
of predisposing conditions or comorbidities were predisposing conditions that increase their risks.

394
00:43:18,350 --> 00:43:25,549
So many people moved to homeworking they some people didn't come into who were vulnerable,

395
00:43:25,550 --> 00:43:32,510
identified subsequently as extremely vulnerable, clinically, didn't coming to work for a year and a half.

396
00:43:33,560 --> 00:43:39,470
And you know, so there was a whole programme of all those 14,000 people being risk assessed by their line managers.

397
00:43:39,950 --> 00:43:48,500
So that was done. And that was the one thing that was the best about this organisation was the staff testing.

398
00:43:49,460 --> 00:43:58,790
So we started staff testing for asymptomatic staff in May, one of the first hospitals to start staff testing.

399
00:43:59,120 --> 00:44:06,379
And that staff testing programme allowed us to develop infection prevention control policies because

400
00:44:06,380 --> 00:44:13,040
we knew then we knew within the first three months which group of people were at highest risk.

401
00:44:13,460 --> 00:44:17,990
So it wasn't the people in intensive care because they had the protective gear,

402
00:44:17,990 --> 00:44:25,280
it was actually the people on general wards where there was the unfiltered admissions right at the beginning,

403
00:44:25,280 --> 00:44:32,060
in January, February, when the testing of patients had not begun really unless they had some specific symptoms.

404
00:44:32,600 --> 00:44:35,120
And those were the staff that were more exposed.

405
00:44:35,420 --> 00:44:43,370
And yeah, and then we started to create our policies, we started to change the protection we offered based on where they were, etc.

406
00:44:44,300 --> 00:44:50,240
So, so, so the testing programme really helped us and it still continues.

407
00:44:50,240 --> 00:44:58,280
Of course, you know, we health care workers now do still have the facility to order the lateral flow tests from the government sites.

408
00:44:59,180 --> 00:45:06,680
And so people have to report in twice a week into our into our systems, their test results.

409
00:45:07,550 --> 00:45:13,190
And that will conduct testing of health care workers. That was a it was partly a research project as well.

410
00:45:13,190 --> 00:45:16,430
It wasn't when initially started with the yes.

411
00:45:16,460 --> 00:45:20,250
Data. Yes, well, that was in the latter. That was in the second wave.

412
00:45:20,250 --> 00:45:24,110
So that was supposed to be for everybody in the first week of May 2020.

413
00:45:25,010 --> 00:45:28,129
Yeah. So, so, so that, that was extraordinary.

414
00:45:28,130 --> 00:45:37,310
And then we opened our vaccine hub, I think 7th of December and we that was not the Oxford vaccine.

415
00:45:37,310 --> 00:45:40,640
That was the Pfizer that that was first released.

416
00:45:42,610 --> 00:45:51,590
And and then, of course, we were we were the first we gave the first phase of the first AstraZeneca vaccine as well in the same up.

417
00:45:52,580 --> 00:45:57,610
That was slightly later in in in early June.

418
00:45:57,830 --> 00:46:01,240
Yeah, it was in January. Yeah. Yeah.

419
00:46:01,760 --> 00:46:08,569
So I have the picture with my colleague Chief Nurse because I prescribed it to the first individual

420
00:46:08,570 --> 00:46:13,940
and she administered it because in those days we certainly did a doctor to prescribe it.

421
00:46:14,360 --> 00:46:19,530
So that was that was a very proud moment. This is an elderly lady was a gentleman.

422
00:46:19,550 --> 00:46:22,860
Oh, it was a gentleman. The elderly lady was the first one to have it.

423
00:46:22,880 --> 00:46:26,130
And my previous trust was just Coventry. Oh that's it.

424
00:46:26,510 --> 00:46:31,970
Yeah. So, so yeah, that was amazing and extraordinary.

425
00:46:32,660 --> 00:46:41,450
But I, unfortunately, I had COVID back then in December 2020 and that was very difficult.

426
00:46:42,530 --> 00:46:52,309
I was unwell. But I mean, I was, I was that was before that before the vaccine.

427
00:46:52,310 --> 00:47:02,590
And I, I had. I started to feel marginally better by day seven or eight, but still very, very tired and muzzy headed.

428
00:47:03,040 --> 00:47:09,730
And on day ten I because in those days the isolation period was ten days.

429
00:47:10,240 --> 00:47:17,480
On day ten, I was communicating with my deputy and I said, Well, how's it going?

430
00:47:17,500 --> 00:47:32,980
Is everything all right? And she basically said to me that her words is sort of going slightly round and round in circles.

431
00:47:33,910 --> 00:47:40,270
And I thought, Ooh, I don't know what she means by that. And I brought myself into work on day 11.

432
00:47:41,230 --> 00:47:47,500
And, you know, I just thought, it's best I'm part of it.

433
00:47:48,280 --> 00:47:55,420
I wanted to be part of it. I wanted to help. I wanted to relieve the pressure on colleagues who had not had a break.

434
00:47:56,300 --> 00:48:00,520
And, yeah, just just dived straight back.

435
00:48:00,920 --> 00:48:03,670
The chairman said, you should really be at work. You should be resting.

436
00:48:03,970 --> 00:48:08,770
And I said, No, I think I've got over it and I'm going to work and continue working.

437
00:48:09,100 --> 00:48:14,920
So that was nice just to plunge straight back into it and work together with colleagues.

438
00:48:16,120 --> 00:48:21,280
But it was it was tough. It was tough. How long was it before you really felt you were over it?

439
00:48:22,240 --> 00:48:31,840
I think probably another week at most, yeah, probably another week at most.

440
00:48:32,260 --> 00:48:39,370
But, you know, so many people have now had COVID.

441
00:48:39,640 --> 00:48:45,370
And the sad thing is, I don't think we can predict who gets long COVID,

442
00:48:45,760 --> 00:48:55,570
but there is a lot of people and it's going to take a huge amount of resources to get these people better.

443
00:48:56,140 --> 00:49:00,580
We have started we started the Long-covid Clinic Long-covid service about a year ago.

444
00:49:00,580 --> 00:49:07,570
Now they've just come out with a book, That Team A Guide to Long COVID called Coping With Long COVID.

445
00:49:07,840 --> 00:49:18,590
And we've done some research witch trials which showed some lung changes in the lungs of people related to long COVID, too.

446
00:49:18,640 --> 00:49:26,530
So that then brings me to the extraordinary efforts and research that was led by the university and hospital teams.

447
00:49:27,550 --> 00:49:33,090
We recruited the first patient to the recovery trial, which showed us that steroids had a beneficial effect.

448
00:49:33,730 --> 00:49:40,750
You know what a fantastic thing. In the first wave, we didn't really know that it came towards the end of the first wave.

449
00:49:41,020 --> 00:49:43,509
So and that's just one trial.

450
00:49:43,510 --> 00:49:54,159
But there was just been so much enthusiasm and participation and research in this organisation that we've learned and our patients, I think,

451
00:49:54,160 --> 00:50:00,250
expect and accept and expect that if they come for care to Oxford University Hospitals,

452
00:50:00,250 --> 00:50:08,170
they will be involved in research because involvement in research has demonstrated really improved the quality of care we offer.

453
00:50:08,170 --> 00:50:13,480
And there's evidence that research active hospitals have lower mortality rates.

454
00:50:13,960 --> 00:50:21,310
So that is that is a good thing. We have to stop some of the research trials that are non-covid related because, you know,

455
00:50:21,310 --> 00:50:26,740
the researchers came in to do clinical work and we really could not bring patients into hospitals in

456
00:50:26,740 --> 00:50:31,450
that environment when they didn't when the research was not directly related to their treatment.

457
00:50:32,440 --> 00:50:35,980
So at the start of COVID, we were doing some 2000 clinical trials.

458
00:50:37,210 --> 00:50:45,220
Yes. Yes. And it's only now that we have back up to about 1600, but we are registering about 40 new trials a month now.

459
00:50:46,060 --> 00:50:51,280
So, you know, it is absolutely extraordinary.

460
00:50:51,970 --> 00:50:58,060
But now we have a mountain of work. We have to deal with waiting lists.

461
00:50:58,060 --> 00:51:00,640
We have to deal with pressures in the front door.

462
00:51:01,030 --> 00:51:09,010
And we are very obviously conscious of the health inequalities that became apparent and came to the fore during COVID.

463
00:51:09,970 --> 00:51:15,730
So we are working on that agenda as well in collaboration with the other providers in the system.

464
00:51:16,600 --> 00:51:22,390
So one thing I wanted to ask about was medical students because they stepped up, didn't they, to to help out?

465
00:51:22,810 --> 00:51:30,160
Absolutely. Fantastic effort, you know, and it makes me quite emotional because they were in their fifth year,

466
00:51:30,160 --> 00:51:33,790
finally, whatever they were, wherever they were, they all came to help.

467
00:51:34,240 --> 00:51:37,690
They helped with donning and doffing in ICU areas.

468
00:51:37,690 --> 00:51:42,069
They helped communicate with their relatives using iPads.

469
00:51:42,070 --> 00:51:45,250
You know, they helped do the testing.

470
00:51:45,250 --> 00:51:51,040
The entire testing service was supported by hepatology nurses and medical students.

471
00:51:51,340 --> 00:51:58,340
It was just amazing. Absolutely. Amazing. And, you know, I and what they I think they.

472
00:51:58,490 --> 00:52:03,020
Yeah. I was going to say I think that's what is it. I think they learned a lot through that.

473
00:52:03,020 --> 00:52:13,399
That's an experience they'll never get. They can see I was part of this but actually what they missed was the that the peer group being together,

474
00:52:13,400 --> 00:52:18,960
learning on the wards, being part of a hospital, you know, normal business and I think.

475
00:52:19,020 --> 00:52:26,310
And not not getting their tutorials I think that that's not that wasn't great so I but at least two years two cohorts miss.

476
00:52:26,420 --> 00:52:32,749
Miss that but you know what they're going to be fantastic doctors because above all,

477
00:52:32,750 --> 00:52:40,520
they they they were able to demonstrate the basic human quality that every doctor, a nurse has and needs, which is compassion.

478
00:52:42,610 --> 00:52:56,980
So has the experience of of steering the hospital or hospitals through the pandemic increased your love of what you do?

479
00:52:57,910 --> 00:53:01,450
Has it has it made you yearn to go back to clinical work?

480
00:53:03,130 --> 00:53:08,800
No, it has. It has. Let's say I haven't been bored.

481
00:53:10,150 --> 00:53:14,559
And actually I have on reflection, I have learned a lot. I've learnt a huge amount.

482
00:53:14,560 --> 00:53:19,170
I've learnt how to cope with a pandemic, I've learned how to manage a response.

483
00:53:19,180 --> 00:53:22,540
I've learned how to do emergency planning.

484
00:53:22,570 --> 00:53:27,460
I've learned to appreciate and work in teams more than I ever did.

485
00:53:27,940 --> 00:53:31,089
And and, you know, it's been extraordinary.

486
00:53:31,090 --> 00:53:35,710
Absolutely extraordinary. So you think you'll be well prepared for the next pandemic?

487
00:53:36,610 --> 00:53:40,480
I don't think we could ever say such a thing because we don't know what it would be.

488
00:53:40,750 --> 00:53:45,760
But I hope that as a as a nation, as a nation, we are we are better prepared for it.

489
00:53:48,380 --> 00:53:54,650
Yes. I had the question here. So obviously, quality improvement has been very much your watchword.

490
00:53:55,310 --> 00:54:00,380
Was it able to keep that time in mind in the course of the pandemic that, as you say, was so unpredictable?

491
00:54:00,560 --> 00:54:04,430
Yeah, wave after wave and then, you know, sense of full security.

492
00:54:04,430 --> 00:54:10,969
And then suddenly we've got another of. Yeah, so so we were, we were absolutely constantly focussed on it.

493
00:54:10,970 --> 00:54:17,240
And I think the three things that took us through this pandemic in a successful way or you know,

494
00:54:17,240 --> 00:54:21,820
let's call it effective leadership and leadership by leadership, I use it in a general sense,

495
00:54:21,830 --> 00:54:29,060
leadership across the entire organisation by every person who is a leader was about the culture of the organisation,

496
00:54:29,750 --> 00:54:33,040
the partnership working and a clear strategic intent.

497
00:54:33,050 --> 00:54:42,710
We just released a strategic framework based on our people, our populations and our patients with compassion and excellence as our vision statement.

498
00:54:43,100 --> 00:54:47,420
And we knew that that was going to be a vaccine.

499
00:54:47,660 --> 00:54:52,280
And I think those three things are predominantly what took us through.

500
00:54:52,610 --> 00:54:56,209
And when I say culture, I think culture involves a couple of things.

501
00:54:56,210 --> 00:55:03,440
One is the relentless focus on patient and staff safety communication, consistent and clear communication.

502
00:55:03,440 --> 00:55:14,900
That's very important. And, you know, looking after staff, all the risk assessments, all the preparation for staff wellbeing, I think, you know,

503
00:55:14,930 --> 00:55:20,690
is extremely important and that sets the tone of the organisation and that's why we were able to get through it.

504
00:55:20,940 --> 00:55:30,860
Mm hmm. I wondered about your own wellbeing. Did you did you think did you feel that because you had this very clear mission that that supported

505
00:55:30,860 --> 00:55:35,419
your own wellbeing at a time when there was so much uncertainty and so many things that one could.

506
00:55:35,420 --> 00:55:40,190
Yeah. Made it so well. That was a difficult time.

507
00:55:40,220 --> 00:55:45,170
There were very difficult times, some very difficult times. I if you want to talk about them then.

508
00:55:45,350 --> 00:55:52,040
Well you know. Yeah. In terms of in terms of worrying, as I said to you, waking up at two in the morning, it's a novel thing.

509
00:55:52,040 --> 00:55:57,530
You know, I've been a CMO now for ten years. If somebody says to me, What keeps you awake at night?

510
00:55:57,740 --> 00:56:02,780
The answer is nothing. Nothing keeps you awake at night. When I go to bed, I know the job I've done.

511
00:56:02,780 --> 00:56:08,300
I know the job in hand. I know what's happening. It's very clear and I go to bed very happy and content.

512
00:56:10,100 --> 00:56:13,339
But this kept me awake. I was waking up at two in the morning.

513
00:56:13,340 --> 00:56:19,520
I've never experienced that before in my life and that meant I was very worried about something.

514
00:56:19,520 --> 00:56:23,210
I was very anxious about something, and I needed to do something about it.

515
00:56:23,540 --> 00:56:26,720
But the good thing was I have a lot of support.

516
00:56:27,020 --> 00:56:33,260
So my husband is also a doctor and and that's family support is very important.

517
00:56:34,400 --> 00:56:45,620
I have good friends and wider family who were able to, you know, just just normalise things in a different way.

518
00:56:46,250 --> 00:56:51,649
They appreciated what I was doing and also being part of the team.

519
00:56:51,650 --> 00:56:55,880
We came closer together as an executive team than we would ever have done.

520
00:56:56,330 --> 00:57:05,270
I think. I think that was that part of the working in the pandemic and the response brought us together, um, my own wellbeing.

521
00:57:05,270 --> 00:57:18,920
Therefore I think, you know, with the support I had got I've been able to look after myself and I've been looked after by my family very, very well.

522
00:57:19,250 --> 00:57:28,250
And of course, you know, the chief executive was very clear that people must take their holidays, even if it means you're going to sit at home.

523
00:57:28,910 --> 00:57:32,150
If you got a holiday coming up, you need to take your holidays switch off.

524
00:57:32,660 --> 00:57:40,730
So so we went if there was planned leave in the calendar, we were instructed to take our planned leave and we did that and that helped a lot.

525
00:57:41,690 --> 00:57:51,620
So so yes. And you know, when those when we were allowed those evenings to have up to six people in the garden, etc., I still remember, however,

526
00:57:51,620 --> 00:57:56,029
freezing it was with with heaters under the chair in the garden trying to have

527
00:57:56,030 --> 00:58:01,790
a socially distanced dinner for people simply because you get to sit outside,

528
00:58:02,600 --> 00:58:06,079
you know, and those moments of joy are really important.

529
00:58:06,080 --> 00:58:09,560
It just sort of distilled the important things in life.

530
00:58:10,550 --> 00:58:17,630
And I managed to pursue the things I like doing, which is cooking, cooking, different cuisines.

531
00:58:18,380 --> 00:58:26,300
I also wrote some poetry which I surprised myself, really surprised myself, but I wrote some poetry.

532
00:58:26,300 --> 00:58:32,930
It's all very basic. But it was it was very inspired by the events I wrote, the poetry about gowns.

533
00:58:32,930 --> 00:58:38,389
I wrote a poem about gowns. I wrote a poem about, you know, what will what will Summer look like?

534
00:58:38,390 --> 00:58:42,350
I wrote that in in February or March when COVID had just started.

535
00:58:42,650 --> 00:58:47,180
You know, it was very if I look back at it, it's very topical and it must have been my.

536
00:58:47,330 --> 00:58:54,770
Because, you know, that was going on in the back of my head in behind all this frenzy of activity that when I was,

537
00:58:55,400 --> 00:58:58,730
you know, lying in bed, I would come up with these poems.

538
00:58:59,210 --> 00:59:01,910
Well, I think I hope it's forgotten. I do.

539
00:59:02,990 --> 00:59:11,240
My colleagues on the project, when they listen to this, will be in touch with their very basic parts of creation picture.

540
00:59:11,270 --> 00:59:14,370
Yes. What happened? Yes. Yes. Yes.

541
00:59:15,050 --> 00:59:21,340
So what? When COVID is over, what do you want to do next?

542
00:59:21,350 --> 00:59:26,120
What's your next aim for your role here? So my aim.

543
00:59:26,360 --> 00:59:32,060
Well, you know, there's there's sort of usually the hard stuff and the soft stuff, isn't it?

544
00:59:32,450 --> 00:59:49,189
So so my aim is to really increase the engagement across the piece in this organisation so that isn't whatever little there might be offer them and,

545
00:59:49,190 --> 00:59:57,979
and us, you know, I want people to, people do the best, you know, 120% give their all to the patient in front of them.

546
00:59:57,980 --> 01:00:04,030
And I know that that's a fact, but I want people to not just look at that,

547
01:00:04,040 --> 01:00:11,480
I want people to have a sense that this is their organisation and the difference they make to the patient.

548
01:00:12,290 --> 01:00:16,970
You know, what difference can they make to the organisation to make it outstanding?

549
01:00:17,780 --> 01:00:22,700
It's exemplar in pockets. I want the whole thing to be outstanding.

550
01:00:22,700 --> 01:00:33,590
An exemplar where people say Oxford University Hospitals is the best internationally

551
01:00:34,390 --> 01:00:38,930
health care provider in the world and what are the barriers to achieving that?

552
01:00:38,930 --> 01:00:44,899
And I'm partly thinking about recruitment, retention, recruitment and retention workforce is a challenge.

553
01:00:44,900 --> 01:00:52,460
It's a massive challenge. And you know, I talked about our strategic framework and I talked about getting the basics right.

554
01:00:52,850 --> 01:00:59,270
So it's it's about it's about all that.

555
01:00:59,270 --> 01:01:03,889
It's about the pillars of great organisations are those things.

556
01:01:03,890 --> 01:01:09,200
It's about engaging with your staff, it's about and that's through communication, listening to them.

557
01:01:09,530 --> 01:01:15,920
It's about high qualities of research, high qualities of quality improvement in the organisation.

558
01:01:16,220 --> 01:01:23,210
And it's about really good infrastructures to enable clinicians to do the work they want to do.

559
01:01:24,200 --> 01:01:31,550
It's about collaborating with other centres, learning from the best, you know, without being arrogant about anything.

560
01:01:32,600 --> 01:01:41,179
It's about appreciating how sometimes in a resource constrained, you know,

561
01:01:41,180 --> 01:01:45,950
we don't have all the resources in the NHS when we have a constrained environment,

562
01:01:45,950 --> 01:01:51,769
how do we still deliver the best we can and how can we be efficient and productive so that we

563
01:01:51,770 --> 01:01:58,550
use the workforce that we have to deliver the care we have in the best possible way without,

564
01:01:58,580 --> 01:02:05,600
you know, without really sort of creating a financial imbalance that is impossible to manage.

565
01:02:05,620 --> 01:02:11,120
And I do think being part of an integrated care system will be helpful towards that.

566
01:02:11,120 --> 01:02:14,660
With it. Oh, goodness. Yet another reorganisation that we have to deal with.

567
01:02:15,380 --> 01:02:24,830
A bit of both. It is another reorganisation, but I think people are getting round to seeing that it can only be a good thing.

568
01:02:25,190 --> 01:02:32,149
And I think we have to force ourselves to think differently and behave differently because it's not just about saying yes across the table,

569
01:02:32,150 --> 01:02:36,140
it's actually going back to your organisation and implementing those changes.

570
01:02:38,190 --> 01:02:47,790
So I think this is the last question. So has the experience of going through the pandemic changed your attitude to your

571
01:02:47,790 --> 01:02:53,910
work and what has it brought up that you'd like to see change in the future?

572
01:02:56,720 --> 01:02:58,750
Has it changed my attitude to work?

573
01:03:04,730 --> 01:03:22,340
I think I'm probably more appreciative of different people's views and opinions, and it has reinforced the importance of working in a team.

574
01:03:25,580 --> 01:03:35,000
It has also taught me how important it is to not work in a silo, not just in an office,

575
01:03:35,000 --> 01:03:41,870
but in the organisation that you have to be open and honest with your partners and.

576
01:03:45,020 --> 01:03:50,690
Don't. Don't worry. And don't hold back. Because when you ask for help, people are there to give you help.

577
01:03:52,310 --> 01:03:59,840
I think that's really important. And supporting each other is critical.

578
01:04:00,170 --> 01:04:03,520
Absolutely critical. Um, so. So, yeah.

579
01:04:03,530 --> 01:04:06,709
Will it change the way I work? Well, I guess I will.

580
01:04:06,710 --> 01:04:13,580
Always taking to account all of these factors. Um, and, you know, um.

581
01:04:14,780 --> 01:04:25,690
I just hope that. We we are able to help people who obviously are scarred by their experiences.

582
01:04:26,740 --> 01:04:37,450
It is very sad about, you know, for all those families that have lost family members to COVID at various parts of of of this pandemic.

583
01:04:37,900 --> 01:04:42,630
And. You know, not not letting that happen again.

584
01:04:43,140 --> 01:04:50,940
And as far as it possible, is very important. And drug drug discovery, I mean, you know, how amazing is that?

585
01:04:51,330 --> 01:04:56,540
So never, never stop research. Lovely.

586
01:04:56,710 --> 01:04:57,580
Thank you very much.