How can we improve the public’s view of the NHS?

Matthew Taylor

Hello and welcome to Health on the Line from the NHS Confederation, the organisation that represents members from across the health and care sector in England, Wales and Northern Ireland. Before we get into the detail of today's discussion, I just wanted to tell you about our EDI Professionals Conference on the 30th of April. Here at the Confed, we believe that support for equality, diversity and inclusion is key to improving the NHS in a whole range of areas.

And we know that many EDI professionals are now operating under difficult conditions in a very challenging political context. So at our conference on the 30th of April, we'll be joined by NHS England's Dr Navina Evans, the Race and Health Observatory's Professor Habib Naqvi, and the Department of Health and Social Care's Barry Missenden. So if you're interested in that, visit the events section of our website. Just put NHS Confed into your browser and it will take you there. So on to...

…today's conversation, which I think is going to be fascinating. We've just had the latest findings from the British Social Attitudes Survey, and it shows, deeply worryingly, that the British public are very unhappy with the NHS. Just one in five people, 21 per cent, said in 2024 that they were satisfied with the way the NHS runs. Nearly six in ten people, 59 per cent, said they were very or quite dissatisfied with the NHS.

And that's a sharp rise from the year before when the figure was 52 per cent. Overall, this is the highest level of dissatisfaction with the health service since the survey began, more than 40 years ago. So for many of us this may come as there's no surprise, but you know, it's very worrying, it's very disappointing. The question of course is what can be done about it? How can we improve the public's view of the NHS? What's driving this dissatisfaction?

Now I've got two fantastic people here to discuss this with me. One is Rachel Power; Rachel's CEO of the Patients Association, and Leonora Mary, who's director of communications for the Nuffield Trust. And Leonora is really the expert in this area. She's been involved with BSA for the past seven years and has led the analytical team working on this survey for the past three years. The Nuffield Trust, with the King's Fund, sponsors questions within the survey to measure and track public views about health. and care. 

So Rachel Leonora, welcome to Health On The Line. 

And Leonora, I'm going to start with you. We are, you know, we are clearly a long way away from those days standing in the street applauding the NHS during the pandemic. Tell us what you think is driving these worrying survey findings and what in particular stood out from what you've seen in the survey.

Leonora Merry

Thanks, Matthew. So, as you say, in some ways, not surprising, the field work for this survey took place in September and October last year. In fact, just a few days after Lord Darcy's report into the NHS and you'll remember the narrative around the NHS being broken. So it's hardly surprising in some ways to see that the British public reflect that or perhaps the government reflecting public attitudes themselves. 

I think what is really remarkable is how far this has fallen – just before the pandemic in 2019, satisfaction overall was at 60 per cent. There was a high point at the end of the last Labour government in 2010 of 70 per cent. That feels like a long, long way away from now. It seems extremely difficult to know how to get back from that. 

What's driving it? We ask a lot of different questions within the survey. There's absolutely loads that we could get into. The thing that consistently comes across is concern about accessing the NHS – waiting for GP appointments, A&E appointments and hospital care. And the A &E stuff is particularly interesting, we might come onto that, but there does seem to be a really clear story here, which is that getting into the service itself is very, as we know, very difficult. People are not happy with that. And that is a really fundamental part of the results we saw this week.

Matthew Taylor

So before I turn to Rachel, there's so many different aspects of this to talk about, but just in terms of understanding these findings, do you distinguish between people who have actually used the health service in the period of the survey and those people who might be getting their information kind of second hand or third hand?

Leonora Merry

It's a really good question. So this year we didn't ask that question, but we have done in previous years. Essentially this year we moved some questions around to make room for some new ones. The question about have you had contact with the NHS in the last 12 months? We've asked up until last year and the results don't really change that much. So we can quite confidently say that it ranges massively. Remember this is also a question we asked about social care. So people who've had contact with social care is about sort of 14 per cent ranging from about just over 80 per cent of people who've had contact with GP services. So it's really important to understand that this is not a patient experience survey. It doesn't tell us specific things about people's personal experience, but from that kind of range from 14 per cent in social care to 86 per cent of people having contact with GP, you can see that there will be people drawing on their own experience, or those of their loved ones as well in their responses.

Matthew Taylor

Yeah, and I want to come back to that in a second, but let's bring you in, Rachel. To what extent do these survey findings reflect the post bag of the Patients Association, as it were? Does this chime with what you hear day to day? And what particularly struck you about the findings?

Rachel Power

Brilliant, thanks Matthew. I think it perfectly mirrors what patients tell us every day on our free phone helpline and through the various ways that we engage with patients. Patients are constantly describing to us their struggles to access care in a system that they feel doesn't listen to them as well as it did. And that's whether it's finding an NHS dentist, getting a timely GP appointment or navigating those hospital waiting lists.

People are feeling increasingly powerless in a system that they once trusted and accessing and that patient agency is definitely an issue that we need. 

I think what particularly struck me is seeing that this dissatisfaction was spread across all services, a growing sense among patients that we hear from that the system as a whole isn't working for them anymore.

Matthew Taylor

So we sometimes comfort ourselves when we see these statistics by saying that there's a contrast between how people answer questions about access and general satisfaction with what they say about the actual care that they receive. Leonora, is there still a kind of big difference there?

Leonora Merry

There is. So we see that about just over half, 51 per cent  of respondents say they're very or quite satisfied with the quality of NHS care and 24 per cent say they're very or quite dissatisfied. It's not great. Twenty-four per cent is still a significant amount of people, but there is definitely something going on there where you can surmise that once people do get into the system, it's not as sort of bleak as the findings overall as people would suggest.

We also see, and we've seen this over several years, concern about levels of staffing. So this year we asked people if they thought there were enough staff in the NHS and actually we had 72 per cent of people strongly disagreeing that there are enough staff in the NHS. So I think there are perceptions that aren't enough people, which is quite interesting because we know that have been quite significant increases in some areas of staffing.

So I think there's something about kind of, can't see the right people. Rachel mentioned dentistry. That's a really clear example of some of the issues that we're seeing where people just think, well, I can't get to see an NHS dentist. Of course there's not enough staff in the NHS.

Matthew Taylor

And Rachel, the danger is for those of us in the NHS that we read a survey like this and we're going to want to change. As someone said, the problem with politics is we've got the wrong public. We want to change the public rather than change the government. And I'm not wanting to suggest that these findings aren't powerful, but if you take one area like GP access, when you look at the actual statistics in terms of how long it is taking people to access GP, the proportion of people who do get an appointment on the same day, it doesn't look quite as bleak as this. 

Do you think that to an extent the public respond to what they read in the media rather than their direct experience? Or do you think that the statistics NHSE proudly tell us about access don't really reflect the reality on the ground?

Rachel Power

Both, but I think the real answer is that patients don't feel they're involved and that issues around kind of shared decision-making about where they're going to receive their service, how they're going to receive their service, because we do hear from patients that when they get to their healthcare professional, the relationship is good. 

And I think, in a way there are quick wins that we could focus on here around improving that basic communication and that administration process. So that patients are getting better information about appointments, clearer lectures, and more responsive ways to contact the system.

Matthew Taylor

Well, that's really interesting, Leonor. So that's the kind of distinction between the product and the kind of marketing and communication of the product. And I've kind of heard that talked about elsewhere. Do you think that quite a lot of this dissatisfaction is to do with failings that we've been reading about in other reports recently to do with kind of administration and communication?

Leonora Merry

I think that's almost certainly part of it. We did find that half of respondents in the survey agreed that the NHS does do a good job in communicating with patients about things like appointments and test results. But we know from other work, the King's Fund National Voices work recently, that people are experiencing a whole range of kind of fairly basic communication problems with the way they're interacting with the NHS. 

I would say, your question about the kind of the GP stats and how that compares, I think that the pandemic is a part of this. So our survey, you can see a real turning point with the pandemic. And let's not forget that some services, NHS dentistry being in the obvious one, did literally close their doors to patients. And it has really struggled to recover from that. I think there's obviously, most, and your members will know this very well, most health services were still running through the pandemic and doing their very best to continue to provide the care that people needed. 

But I think there has been a real perception that the NHS has failed to be available to people in the way that it was pre-pandemic, which I think, you look in the stats here and you can see that pandemic was a bit of a turning point.

Matthew Taylor

So Leonora, let's look at a couple of aspects of your sample. So first, I was really interested in the kind of age differences here. Older people are broadly more satisfied than younger people. We also know, don't we, that a lot of younger people are actually choosing, for example, when it comes to access to GP services, are actually choosing to go outside the health service. 

Give us a sense of what you think is happening in terms of the kind of age differentiation.

Leonora Merry

Yeah, so there's always been something of a gap between, we just look at sort of working age to under 65 and under and over 65s in the BSA. There's always been a gap until last year actually, interesting where it converged. This year we see it coming out again, so we see that I think just 19 per cent of the under 65s satisfied compared to 27 per cent of the over 65s. That's almost certainly to do with having less contact with the NHS in some ways, but as you say perhaps something there in terms of changing generational attitudes.

We're going to come onto principles, I think, you know, what people think about the NHS founding principles and actually there's some quite interesting stuff there on the age differences, which isn't what you might think. So the age side of things is a really interesting one to explore and there's more we could do. So we could break it down by even smaller groups of respondents to look at that.

Matthew Taylor

And do you find that Rachel, do you find differences in age groups to different age groups contact you with different kinds of issues?

Rachel Power

Yes and no. I found that really interesting, that age difference. It was quite striking, wasn't it? Because in terms of sometimes what we might have heard, we would expect kind of a report to show lower satisfaction. But kind of reflecting on it, I think it's about the different relationships that older people may have built up with the NHS over time. And they've seen the NHS go through quite a lot of changes and they've seen it evolve over decades. And I think younger generations are expecting to have the same experience that they have in every other part of their lives and where digital access and responsiveness is completely the norm. 

But I think it makes it difficult for the NHS because I think both perspectives are really valid and what we need to do, as we need to do across the demographics, is to ensure that the NHS can effectively serve everyone across all age groups.

Leonora Merry

It's quite interesting because also we asked people what they think the priorities for reform should be; what do you the NHS should do? Obviously waiting times as we know is a huge issue and that generally does come top. 

But there's also a really interesting difference here which is that the 18- to 64-year-olds are much more likely to select improving mental health services as a priority for reform. Thirty-four per cent of them chose it as compared to 21 per cent of the over 65. So even in the kind of, it's not just about satisfaction, it's about what do they think are priorities for reform next. There are some age differences. So it's really interesting and worth keeping an eye on.

Matthew Taylor

Because I mean, it's not a simple distinction, but nevertheless one that does have some basis between those people who access care episodically that and that will tend to be younger people who will only reach out to the health service when they have a particular illness or they want to check something out and those people who will tend to be older, who will have a much more intensive relationship with the health and care system, particularly if they're in that large proportion of people with long-term multiple conditions. 

To what extent do you think that's kind of part of what's driving this, Leonor, is that young people are responding to that? As Rachel can imply, they're responding to the kind of clunkiness of the kind of episodic experience, whereas older people are expressing slightly higher satisfaction when, as it were, you have more of a relationship with the health system.

Leonora Merry

I think that's definitely part of that and the older group are also more concerned about waiting times. So we see 60 per cent of them want to improve waiting times as part one of their priorities, whereas 45 per cent of the under 65s do. So I think people will experience a health service in different ways and the more you're kind of encountering it at a particular period of life, that is going to colour your views. 

But we also have to remember that this is because it's not an experience survey, it's quite messy, right? So those respondents will also be affected by what they're seeing loved ones go through, what they're experiencing for their parents or for their children. So it's not as clear cut. I think if you were looking at an experience survey, then you could draw more of that kind of conclusion from it than the BSA, which is a public opinion survey.

Matthew Taylor 

That's obviously a really good point, that young people often reflect the experience of their loved ones.

Now, in politics, it's sometimes said that the place where you can have the most influence is where there is a kind of contradiction in public opinion. And so there's a conflict in how the public thinks. And that's a place where politics can really make a difference in its kind of narrative and helping people to understand. 

Now, of course, here we have now this ever bigger kind of paradox, which is that just as we see these pretty bleak figures on access and not brilliant figures on experience, people still cleave incredibly strongly to the NHS is founding principles, although that is also fraying a bit at the edges. 

So, Rachel, you first. What's your experience as you represent patients of this kind of contrast between people's love for the kind of idea of the NHS and their disillusionment with the actual experience of it.

Rachel Power 

Yeah, absolutely. And we hear that all the time through focus groups and through survey work that we do, that there is that kind of unwavering support for the NHS founding principles. And while patients are deeply frustrated with trying to access care, they still passionately believe in what the NHS stands for. Because like we said earlier in the podcast, when patients get through, finally get through that door, many are sharing very positive experiences about the care they receive from those dedicated healthcare professionals. 

So I think it's a little bit like we hear about the frustration and the faith. People haven't given up on the NHS whatsoever. They're asking for it to work in the way that it should with patients at the centre. And I think they want a system that lives up to that founding promise.

Matthew Taylor 

Yes, so Leonora, what's your view of this paradox between these elements of your survey?

Leonora Merry

So it's quite interesting, I remember we introduced these questions where we ask people about the three founding principles, NHS should be free of charge, available to everyone and primarily funded through taxes. And I thought, well, you we saw the very strong result that we see and then that's remained for the, I think we've done it for three years now remember being a little bit cynical thinking, well, of course, if you ask someone, do you want something that's going to take care of you when you're at your most vulnerable and it's free and it's available for everyone? Of course you're going to say yes, but actually I've become a bit less cynical about these questions because I think they're really useful to give us a sort of sense of, particularly when there are discussions and debates about let's move away from an NHS to a social insurance model, which we saw at the weekend, or the discussions we're having about how we fund public service. I think it's really useful get a sense that a reminder that the British public are not clamouring for a change in the model, they're not clamouring for a change in the way we fund it, they are just very despondent about the services they see. 

So, I think these principles questions now, I've put my cynicism to the side, I think they're quite interesting and quite useful, but as you say, we do see a significant drop in the proportion of people who definitely think the NHS should be available to everyone. So when you put probably and definitely together, we still have a high level of support for that, about 77 per cent, but those who definitely think it has now dropped, and that's particularly low among people who are supporters of the Reform Party.

Matthew Taylor 

Well, I was going to come to that because one of the other things that you have done in the survey for the first time, I think, is you focused in on Reform voters. How do their opinions significantly differ from the general public?

Leonora Merry 

Yeah, so we pulled them out essentially. We've tended to always analyse Labour, Lib Dem and Conservative and then other. We essentially pulled out Reform out of other, they are no longer other. And we find that in some areas there's real divergence. So I think I mentioned they're much more likely to be dissatisfied with the NHS. We also see perhaps unsurprisingly that Reform supporters are much more likely to think that the NHS doesn't spend its money efficiently. So much less likely to think that the NHS spends its money efficiently, but actually on waiting times they're like the rest of the sample, pretty concerned about them. And then in these principles, they're the ones that we see some divergence on. 

What is really interesting is that we ask whether the government spends too little money on the NHS or too much. And actually, although Reform voters are more likely to say that we spend far too much money on the NHS than others, still, a majority of Reform voters say that we spend about the right amount of money. So I think there's some really interesting findings in there. It's not as simple as you might think.

Matthew Taylor 

Let's turn from reform with a capital ‘R’ to reform with a lowercase ‘r’. And I'll start with you, Rachel. 

One of the challenges if you're a policymaker is that it isn't always the case that what you think and what the evidence suggests needs to be done is the same as what the public needs to be done.

One of the examples that always used to be given of this was that you asked the public the best way to tackle crime and they did always say get more police officers on the beat. But actually, that's probably not the most effective way to reduce crime, whatever its other kind of benefits. 

So if you're West Street and you're talking about your freeze shifts, you talk a lot to patients. What is the reform message that the public is willing to hear? What is it that they do believe? One is that the a politician should be emphasising if they want the public to give them a bit of time to turn things round.

Rachel Power 

From what we hear from patients right now, Matthew, is that those three shifts that the government are talking about have great potential. But I think what patients say time and time again is the success will depend on bringing people with them on that journey. So it's great that we're devising a long-term plan with the public, but the implementation of the plan with all the transitions they're going to have to go on between staff, with staffing and the department and NHSE.

There needs to be really clear communication and engagement with patients because it goes beyond kind of simply redirecting traffic. We need to empower patients with the knowledge of increasing awareness of other services and professionals. So I think it's around that kind of the health secretary talks a lot about power to the patient and that shouldn't be just around the developing plans. Like I say, well, we need to engage patients as active participants. And especially those, because I think the concern I have at the moment is those from marginalised communities whose voices are regularly not heard in the system. And while we're looking at those shifts, we need to make sure that we hear those voices and that we don't end up marginalising more people.

Matthew Taylor 

Yeah, absolutely. And also particularly with the kind of broader political context we're operating in. 

But, Leonora, let me ask you that question. I know that the ten-year plan consultation came up with some quite interesting perspectives on how the public view reform and some of the things that they care about. And, you know, it does seem, doesn't it, when we listen to our politicians, that they think it continues to be good for them to attack managers, to attack waste, you know, relatively soft targets.

Is that still right? Is that what the public is most willing to believe in or can ideas like shifting servers into community investing more in prevention, can those chime with the public as well?

Leonora Merry 

I think they can. mean, in this survey, they don't come out terribly high on the list of priorities. So improving the health of the most disadvantaged, we have about 14 per cent of people picking that as one of their priorities, about a third for sort of prevention and public health. But I think in other surveys, they have done, you know, it sort of turns as with lots of polling and survey work, it depends how you ask the question. I think the thing in terms of reform that this survey really makes clear, and in some ways it's quite an obvious point, but it really kind of makes it very obvious, is that the government has a real dilemma because the very loud responses we hear about waiting times have to be dealt with. It's going to be really essential for the government to turn this around in order to get back and get a second term. These sorts of results we can't be seeing in the year before an election is.

Although, you know, this survey in some ways isn't surprising because they're called the NHS broken. It provides this baseline for us to say, okay, has the government made any progress? So tackling some of these issues, now actually dentistry being another one that is a really visible problem for the public is so important in order to get back in and do the longer and the harder job of the reform around the three shifts, because that's not something you can do as quickly as we need to see the change on these sorts of measures. 

So they have a real fine line to tread and I know that, but I think it's a really big kind of, it's going to be the real challenge for the Labour government is how to respond to that kind of waiting times challenge while also doing the longer-term reform.

Matthew Taylor 

That's absolutely right. And that's one of the things that we find ourselves saying a lot, which is, I use this cliche split-screen thinking, but somehow we have to meet that kind of immediate retail offer around access and waiting lists. But we have to do it in a way which speaks to the second screen, which is the fact that the fundamentally, the model of care we've got is not sustainable and we've got to change that model of care. And we have to try to be able to work in both those kind of domains at once. 

I'm going to ask you both one last question. It's a tough question, but I'm fascinated to hear your responses. 

Obviously we represent leaders across the service. Leaders listening to this conversation, reading the survey, thinking about what they can do to engage with their patients, their public, because it's not just about PR this. If people don't feel confidence in the health service, it genuinely affects their wellbeing. It makes people more reticent about coming forward because they're worried about... aches and pains they might have. So it really does matter to people. 

So starting with you, Rachel, if you're an NHS leader, you're reading this, you're listening to this, what's the one or two things that you think leaders on the ground can do to connect with the public and restore a bit of their hope and confidence?

Rachel Power 

So I think the communication, I think, is still an issue. So I think that's something leaders on the ground can definitely do. But I think it's about treating patients as true powers in the design of services. I think there's good evidence out there that shows that if patients are equal partners working with healthcare professionals and leaders, that satisfaction improves, even when resources are as constrained as they are properly.

So I think it's the right thing to do, but it's actually quite a practical way to move forward during one of our very challenging times for frontline leaders.

Matthew Taylor 

Yeah, I agree with that. And I think it's important to recognise that NHS staff and the families of NHS staff are a very large and significant group of people in a public survey. This is unusual, mostly when you do surveys about things, actual people who can provide the thing you're surveying is a tiny group. But in this, the views of NHS staff and their families and friends are a significant factor. 

So, people who work for an organisation, recognising how important it is and the way in which they treat and deal with patients, even when things are tough, that they can treat them with courtesy and kindness and empathy. These things really do make a difference. 

So Leonor, to you, I'm health service leader and I'm saying to you, well, look, I can't change this stuff at a national level, certainly not in the short term, but what can I do now to try to address people's concerns? What advice would you be giving?

Leonora Merry

So I'd probably reassure you from the work we've done on the BSA is that the public are fairly clear, if the finger of blame is being pointed at anyone, it's the kind of national government and the overall funding that is given to the health service. The public are pretty sympathetic towards staff. The results on quality of care indicate that actually they're, on the whole, satisfied with that. So it's not all as bleak as it sounds when you hear the kind of the headline.

I think it's really difficult for local leaders at the moment. It's really difficult, particularly in the context of, you know, changes and reorganisation and job cuts. One area that often is sort of overlooked because it's not the kind of the flashing blue light ambulance and A&E issue, but it's received such a huge amount of neglect and, you know, in policy terms is dentistry, but it's one that really matters to the public. And it's quite totemic, I think, in terms of it's an issue that appears in MPs' bags. Whenever we do any analysis on dentistry we get a lot more interest from kind of a much wider range of media because it's one of these kind of topics that people want to talk about and people have their own stories and it's sort of, it's become a bit emblematic of what's going wrong with the state that people can't even get into an NHS dentist. 

So I think that kind of thinking about how there's different parts of the system working together and you know, the commissioning of dentistry is going to be a really important one for the future.

Matthew Taylor 

That's a really important point. And I was looking at some statistics the other day, remarkable about the proportion of children who go to A&E and who have a kind of oral health dentistry problem. 

Well, Leonora, Rachel, this has been a fascinating, somewhat sobering conversation. Will you both come back this time last [sic] year and hopefully reflect on a slightly more positive survey?

Leonora Merry 

Absolutely, hope so.

Rachel Power 

Hope I will come back next year.

Matthew Taylor 

Thank you both. 

That just leaves me to introduce our latest Leader in Six interview, which this time is from sunny Cornwall, where I spoke to Steve Williamson, who is the chief executive of the Royal Cornwall Foundation Trust. 

First question, what's the biggest challenge you're facing right now?

Steve Williamson 

I think the combination of the demand pressures facing the NHS right across the country and delivering those to safety within the financial environment that we have, it is a really very, very significant challenge.

Matthew Taylor 

Yeah, and we've been talking about that this morning. What innovation most excites you in the trust at the moment?

Steve Williamson 

I think the things that stand out for me, I guess, are the opportunities to utilise digital technology to assist in the transformations already underway, to manage that demand and build on some of the fantastic performance we've seen. I think you've seen a little bit of some of our elective transformations this morning in our enhanced prerogative care facilities and applying care units. They've been instrumental in enabling us to be forecasting one of the best selected performances in the country. So it's amazing to see those kind of things progressing.

Matthew Taylor 

Yeah, was fantastic seeing the E-pop team. If you were head of, king of the NHS for one day, what's the one thing that you would do?

Steve Williamson 

I think our national colleagues are trying to do this, the more we can empower local decision-making in the interests of local communities and local patients, I think the better. And there's been a really positive direction towards that. You've seen some of the innovation that teams are taking forward, the more we can empower them, I think, to accelerate and deliver that the more opportunity we have to move forward. 

There are some kind of structural aspects that have to be considered at a national level. When the scale of the transformation that the NHS is facing is at such a level, then there are some things that centrally can probably only be done there in terms of creating the environment to enable those changes to go forward at the fastest possible pace, whether that's structural support for system reconfiguration workforce change that those sorts of things or whether it's a planning environment to enable the changes that best support local care being able to move forward at the maximum pace.

Matthew Taylor 

So tell us something about yourself Steve that's nothing to do with your job. Something interesting.

Steve Williamson 

I am a hockey player. I play for Truro Hockey Club. Not a very good hockey player, but that's part of my switching off from work.

Matthew Taylor 

I thought hockey’s quite a violent game, isn't it? Aren't you worried about, is your chair maybe worried about you ringing in and saying you got terrible injury?

Steve Williamson 

I have not had the experience of a terrible injury. I have been tested on minor injury units services after a hockey ball and they were fantastic. I didn't know who I was. Their care was amazing. A great bulletin to look online and see where the short waiting times are in our network of my injury units across Cornwall and the Isles. So we'd go there, get timely care, not put any pressure on our emergency departments and yeah, really good.

Matthew Taylor 

Pretty good. Brilliant. Can you share with us a leader that you admire, maybe in the health service, maybe more broadly? You're not allowed to say Jim Mackie.

Steve Williamson 

We've got some amazing clinicians in our organisation that are driving forward change and transformation and you'll have met maybe a couple of them as you're out and about across in our organisation. So when I look at the likes of Toby, our associate medical director for urgent and emergency care, passionate about driving forward change and the best interests of patients is amazing to see.

Difficult to draw out one individual, but I'm struck every single day as chief executive that the passion, the innovation, the determination from colleagues in our organisation to drive forward change. I'm equally struck by the innovation determination in other parts of health and care system.

Matthew Taylor 

And finally Steve, share with us a bit of content, be a box set, might be a podcast, might be a book, something that you've enjoyed recently that you think other people would enjoy too.

Steve Williamson 

Yeah, I've been reading a book, Fit in the Clouds, which is an outdoor book setting a context of challenge and how obstacles and challenges can be overcome, which is clearly nothing to do with it. Yeah, Fit in the Clouds. So I found that really interesting, exciting and gives a different context. But when we think about the challenges and the opportunities facing the NHS, an interesting book.

Matthew Taylor

I can't think of anything more relevant to NHS bosses than to look about climbing mountains. Thanks so much, Steve.

Steve Williamson 

Thank you.