Professor Pam Enderby, president of the International Association of Communication and Science Disorders

Welcome to another RCSLT podcast. We have a very special guest on the show today, but before we get to that, I want to let you know that the RCSLT podcast should now be available on most of your favorite podcast apps, including Apple podcasts, Spotify, Google, Alexa, etc. But we will still be uploading to SoundCloud if you prefer to use that. We would really appreciate it if you could subscribe to the podcast and leave us a review. That helps other people find us and listen and discover new things, and in turn that means we can advocate for speech and language therapists in the UK and also abroad. For today's podcast, usual wanting to apply, COVID condition, so the sound is at best, so so. Our guest is Pam Indaby, Emeritus Professor of Community Rehabilitation at Sheffield University, which has also been chair of Community Rehabilitation, Head of the Department of Human Communication Sciences, and the first ever woman to serve as Dean of the University's Faculty of Medicine. She found time to supervise 30 doctoral these seeds, being principal investigator on 40 research projects, written 14 books and published over 250 journal articles. And if that isn't enough, Pam established the speech and language therapy research unit, which she still code our ex, and served as chair of our CSLT. She is one numerous awards, including an OBE in 2018, and is the new president of the International Association of Communication Sciences and Disorders. Still not feeling inadequate? In 1986, Pam was the lead applicant in the landmark case around equal pay, which went all the way to the European Court of Justice in Strasbourg, where luckily for SLTs up and down the land, Pam prevailed. I started by asking Pam how she became interested in speech and language therapy. Well, they didn't really attract me at all. I just didn't know what to do. And I went to a Convent Boarding School, and about the only thing that came out consistently on any of my reports is that she talks too much. And so people felt that I wanted to play to my strength. And I thought I'd go into teaching, but then get an interview for any of the colleges I tried for. So I went to apply for doing speech therapy, and again, didn't, I got turned down on so many interviews. But in the end, one offered me a place, and I thought I'd better go for something that looks as if it's vaguely interested in me. But it was finding somebody who was interested in me, rather than me finding something I was interested in. I didn't enjoy my training, but the need for speech therapy really grew on me, because during my training, my father had several strokes and lost his ability to speak. So that really sort of goaded me into taking the whole profession much more seriously. Right, it's fascinating. So you saying the nuns didn't say Dean of Medicine is what we think she should be? No, probably enough, no. They had two ambitions in that time. One was nursing, and the other one was being a good wife. And neither of those particularly appealed at that time. So it was really when your father had a stroke that you understood the importance of the profession. Yes, and I was so struck at that time at how awful speech and language therapy was, because my father was given books with teddy bears on to practice reading and things like this, and his intelligence hadn't been affected at all, and even if it had been giving a 54-year-old man a book of teddy bears was not really appropriate. And it just seemed to me extraordinary that a profession could be so bad in some ways, and it would take so little to make it more appropriate and helpful. When did SLT become so gendered as a profession? Well, it was virtually in the First World War and the Second World War, where a lot of women were drawn into the caring side of different professions, and they came out of the house really, and supported men and supported different roles, and the speech that started them, and it started as drawing from middle-class women that otherwise would have been in the home looking after their dear husbands. What do you think is the best and sort of most fundamental change that's happened in speech language therapy since you started and you had sort of slightly negative feelings about it at first? I did have negative feelings, and I certainly had negative feelings about my training, but I think the things that have changed are the evidence base, so the underpinning of what we were doing, and being nice was not sufficient, where there was that feeling early on that being nice to poor individuals who got disabilities and things, was the role of the therapist or the armina or whoever, and we suddenly went into being nice is not enough, we've got to know what we're doing, we should be able to extend people's lives and quality of life based on good scientific principles and theories. We must know what we can do, we must be very clear what we can't do, so it was that clarity that has come to the profession which I think is helpful, and we're still on that journey as our all professions, but I think the other thing is that over the years we've become much more person-centered, really looking at them as individuals and the role of communication plays in their lives and how we can help, so those sort of aspects. I then went on to ask Pam about this landmark case that she was involved in, and for those that don't know about it, I asked that she just give us a bit of an overview of what the case was about. Well of course it was called the work for equal value, whereas before the law had said you had to be paid the same, if you're doing the same job as a male, it suddenly a new clause came in which said that if a woman is doing work of equal value to a man, then you should be paid the same. And that was quite difficult because if you've got two different jobs, how do you know if they're of equal value? And one of the reasons why it went on for 14 years was this establishing what do we mean by equal value? Well I worked in a hospital where there was a pharmacist who was a male and a psychologist who was a male and we were able to look at what we did in each person did in those jobs. Fortunately I never fell out with my pharmacy and psychology friend and they felt passionately about this as well so we could work openly together and we had similar numbers of staff working, similar amount of research, similar amount of diagnostics, similar issues and similar responsibilities. We all had to go through an awful lot of job evaluation interviews and observations and it was at that point where it was decided that we were doing work of equal value to the hospital trust that we were employed in but there was a lot of contesting of that because it was clear that this would have a ripple effect on other jobs so it was quite hotly contested. I always felt that if we'd been able to sit down in a room with a cup of tea and a few sensible people, we should have been able to sort it out within a half a day rather than 14 years and several million pounds because one of the things that was holding people back is that they felt that if we did witness case we would have a lot of back pay and I never really felt that was appropriate. Really what we wanted to do was to evolve into having the same career structure as these more male dominated professions. At that time there wasn't a career structure there were two sometimes three grades but there wasn't a career structure so I was really pushing it to have a career structure and I think we could have settled very early on by saying okay historically women did not have a career structure for lots of different reasons and historically we've got to put that into the past and we should progress into all genders having similar career structures and opportunities. So for the for people that don't know you eventually lost in the UK courts before you went to the ECJ and how did you how did you feel when you lost in the UK courts at that moment and that had really been going on for a long time. I think I like your questions actually because one of the the press for all the time coming along and saying how do you feel now that you've lost or it's going on so long what a pressure and I was I kept totally disappointing them by saying well it's really interesting actually no I'm not stressed by it no I'm not I'm not cross they wanted it to have wrecked my marriage and you know really be able to have a really gloomy outlook on the whole thing but I was actually very intrigued by why it was going on and how it was affecting other cases that were being heard and I was also intrigued that people were getting very anti the case particularly London taxi drivers were very anti um women getting the same payers men for work of equal value and the numbers of times that I was tossed out of a taxi in London on the way to the court was was quite remarkable unbelievable and so did you you knew straight away you were going to go to the ECJ or did you have to sort of um the European court of justice yes um it was very we knew really from the outside it was very likely Pam went on to explain how after they prevailed in the ECJ the most significant benefit was that there was a career structure for SLTs um unfortunately for Pam she moved on to another job so she didn't get the benefit of back pay that her colleagues got though to be fair I don't think um that was uppermost in her mind but this was very important because it helped with retention in the field ambitious people were leaving to pursue other careers because there wasn't sufficient scope for progression but interestingly Pam has also said that an area of concern is the elimination of grade eight SLT jobs in certain trusts which undermines the profession and it's very important to remember how hard this was fought for and that we continue to advocate for a proper career structure that remains equivalent to other clinical disciplines I then went on to ask Pam how she got involved in academia well I wouldn't say I'm an academic actually um I would much prefer to say I'm a clinical academic and with a lower A than than the capital C um I've always wanted to do research as related to clinical practice to improve clinical practice and that is really my passion is to do research not for the necessary developing theory on its own which it can be I've it's sometimes being rude enough to call it cortical masturbation because you know the thinking can be really interesting for its own sake but I would prefer thinking to have a practical outcome and um there's so so many people in that we meet clinically and um um just generally where you think I'm sure that we could do make their lives a bit better if only we knew something about this or how to do that or how to reinvent force or encourage or whatever and so there are so many unanswered questions clinically and we have years and if not decades to examine this and therapy has changed so much in my clinical period and is going on changing which it should do so and so what do you think are currently the most interesting or promising areas of research in SLT? Well one of the things that one gets involved in in academia is doing randomized controlled trials and I've been quite a number in my time where you compare two forms of treatment to see which is most effective but one of the difficulties with that is that you have to select very carefully the clients that you put into a randomized controlled trial so if I'm doing research on aphasia which is a speech loss of speech of following a stroke then I would select people who were monolingual who did not have any other neurological condition who were able to access the facility I was getting to so I had resources to get to the clinic or to the research place if you go to a clinic you see people who've got several different conditions as well as their aphasia you see people who've got hearing loss as well as their aphasia you see people who speak with several languages so gathering information on everybody we see which led me into the work on outcome measurement has been very key because research tells you an awful lot in a very pure and important way and I wouldn't under state the importance of that but we don't know enough about what we do every day in which gives you the context right so you might find with carefully selected patients that this works but in the clinic with hundreds of patients you might find that it doesn't work quite so well but something else appears to be triggering that more complex caseload into improved quality of life so I do feel that we should in this decade be able to get information on everyone we see so we can look at variability across the country we can see why why does some places seem to do so much better than other places is it that they have more experienced staff or different structures in the community or better teaching practices at school or what is it is it social demographics we should be able to have that just by gathering data on everybody we see and already we're we're finding on the outcomes project led by RCSLT that some places get referrals much later in their condition than other places some places discharge much more quickly than other places some places do not get people with severe conditions they're only referred people with mild or moderate and other places you only get speech and language there if you can't speak at all really so the variation in our national health services enormous and learning from that should not be that difficult yeah and college has done an amazing job in that and that the data the route which is their database that they've started has now got data on more than 30,000 people who have had speech and language there be over the country well that's beginning to give us this information on what percentage of children really benefit who have gotten autism or what percentage of people with multiple stresses get referred and in what way do they benefit from that there's so many questions like that that we should be able to answer fairly straightforwardly and at a low cost doesn't need a multi-million research program it just needs the ability to collect the same data in the same way and do some analysis of it Big data is becoming increasingly important in healthcare tech companies have vast amounts of information about us about how much we move around what we eat what our habits are information about our mouse movements which could indicate neurological disorders we need to start thinking about the ethical implications of this information but also how a far more benevolent institution like the NHS can begin to use big data to drive efficiency and drive better outcomes for the UK we spoke about the IT systems and the NHS and how it's a problem that trusts use different systems that are talked to each other but this led into a more philosophical question about how the NHS should evolve in the future should there be more centralisation so for example the NHS purchases one system for the whole of England or should there be more devolution like Germany in which we federate the powers of the NHS oh I'm using this on the fence here actually yeah one of the I think that we need much stronger and stated governance centrally right to our federation because there's always different aspects that are going to affect care in different parts of the country according to other related issues but one of the things that would have been useful is if for example if one NHS trust has approved a particular piece of research to be undertaken there why does every single trust have to go through looking through slightly different forms filled in right by two or three committees to say yes in a few months time so when we're doing research we have to go to every trust and it very often to get agreement on them to do the same thing that's been approved in some areas right with the with the database that the college has set up some places have gone through their Coldecott Guardian and their governance procedures for entering the data and it took them two weeks some places it's taken 18 months and I would have thought that if it's gone through one or two and been approved why should it not be approved by other places so there are things where you feel yes this this does not require everybody to have a committee decision on it but there are some things to do with the provision of care where you feel local knowledge would suggest that it's going to be more appropriate and acceptable in to be done slightly differently here rather than there so that's why I'm sitting on the fence I'm thinking much clearer guidance and agreement for many of the managerial approaches but the ability to do some in different interpretation according to local circumstances particularly perhaps on a clinical pathway would seem appropriate it's also fascinating and I realize I'm taking up too much time we've got to we've got to move through through such a number of topic areas and on to the main one which is of course congratulations you are the new president of the International Association of Communication and Science Disorders so firstly it's had a name change I wonder if you could just talk us through that a bit what what what did it used to be called the International Association of Logopedics and Phoniatrics I often said if you can say it you really really don't need us because it's a very complicated sort of phrasing it is an organisation that goes back 97 years and was set up by Phoniatricians I'm going to really interrupt Pam here because after we finish she dropped me an email to say that she wasn't satisfied with the answer here but more importantly we hadn't taken time to reflect on the huge impact of communication disorders on people's lives because this really speaks to her passion for the profession the organisation and why the work is so important yes well I think we've all experienced a time in our lives or several times possible every day when we think oh I wish would I'd phrase that differently or I could have answered that question better I could have asked that person something in a more coherent way they frequently the words that we want to use don't come out in the order or even the right words don't come out or perhaps even with the right stress and we can find that very frustrating personally because we feel that it reflects our personality in a way that perhaps we didn't want it to be reflected or we didn't show our standing or our interest or whatever in the right way now if we experience that occasionally how difficult would it be if you were experiencing it all the time every time you opened your mouth you felt that's not me I'm not coming across as I'd like but it doesn't show that I've got a sense of humour or it doesn't show that I understand and people with speech language communication disorders have a part of their essence of their personality suppressed so that they cannot be who they wish to be which I think must be one of the most frustrating disorders because you can't a person outside can't see that they can't perceive that frustration they can't perceive that that individual is different to how they're coming across so speech language communication disorders really takes away your personality link with other people in your environment now for children the difficulty with developing speech is a frequent in about 10% of children of young age say under the age of seven they will have difficulty making friends because they may not be able to use the words to express the games that they wanted to play etc or their personality or to reject something or to accept something in the right way so it will have an impact upon the way they develop friendships it will have a way of a developed an impact on the way that they have difficulty in expressing themselves more broadly and developing their own character and confidence it will affect the way that they engage with education it will affect the way that they can express themselves in the family and get their position in that family established so it affects everything from day one that they have this difficulty Pam returned to the impact that her father Stroke's had on her views on the importance of communication and the first stroke affected him physically but his mates would still come and take him out to the pub and push him in the wheelchair and he could go to work and everything yes it was frustrating but it was only after his third stroke when he was in his young 50s that suddenly the friendship groups broke because they were embarrassed about the difficulty he was suddenly having with speaking and they felt they didn't want to push him into the position of making efforts to speak when it's he didn't need to make the effort they thought it might hurt him they didn't know how to cope when they didn't understand him did they pretend to understand him or did they try and get him to say it again say it again say it again so the friendship groups broke he wasn't taken to the football he wasn't taken to the pub and suddenly his world got a lot smaller now he thought used to his physical disability and so had many people around him but he never got used to that difficulty of not being able to express his position on things his humor his sarcasm his personality etc and I think communication is so fundamental and we just take it for granted until we meet a lot of people with these challenges because it's so interesting what you say you've you've just brought back a memory of a documentary that I saw a few years ago an incredible documentary that followed some children with with various kinds of disability and there was a kid who was quite severely autistic and he had a lot of behavioral issues and eventually they got him to a specialist who taught him to use a he was he was he was completely non-verbal who taught him to use a speak and spell and the first thing he said was I'm not stupid and it was this and I mean and everyone sort of burst into tears it was absolutely he'd had nine years of just of just the most enormous unspeakable frustration at the world and and yeah when you're talking about about the kids and about your father is you it's so right I mean it's so devastating it is devastating your story has reminded me of the story of a young man who had severe disaster which is slaring of speech and he was retelling an event that had happened to him he had gone into a new town and wanted to know where the library was so he asked a couple of passersby do you know where the library is but they distorted speech and a couple of them said to him why does someone like you want to know where a library is oh my god yeah and another person said you must take more water with it so as immediately it thought to be drunk so he's either thought to be dashed or drunk every time he opens his mouth so just completely distorts your relationship so I wonder if you can if you can then talk to the work of of the organization that you are now the president of fine yes I'd be happy to the International Association of Communication Sciences and Disorders which was formerly known as the International Association of Lovapédics and Phoniatrics was established in 1924 by a doctor a male pro shall who specialized in phoniatrics and this was a specialty and there's still a specialty in many countries where doctors are interested in communication disorders and he established it because he was very aware that the way that different countries support treat assess people with communication disorders were very different and that was back in 1924 they still are the way that the public attends to people with different disabilities it's very different in each country and we can learn from each country because there are ways that some countries handle some disorders better than we do and that is faster so this organization which is international has the international view to facilitate better understanding by sharing knowledge and care of all those with communication and now of course we're not only sharing communication but also swallowing disorders many people who have motor problems with their speech will have problems with swallowing so it's a natural family to look at this and one of the things that I've been very interested in is that there are many countries that have less developed health services possibly related to financial situation of that country and we can support professionals working in those countries by offering resources by facilitating symposia by providing information and networking all of us together so that we actually share the best ways of doing things for a broad range of people with needs but I would hate you to think that it's a one way process I have learned from other countries, underserved countries, just as much as I've learned from developed countries. Is that some of them? They have to be hungry to interrupt you. Is that because they have to sometimes if you're underdeveloped you have to be quite innovative with the limited courses right? Jack you've just put your finger on it exactly. Places that have few speech and language therapists have to work a lot with other care workers and we should perhaps be doing more of that but in addition they work with families and community workers is often quite strong. That doesn't mean that we don't need the expertise and the specialisms but we kind of were not careful only looking at becoming more and more specialist rather than looking more broadly at the general community helping to understand and to facilitate the lives of people with communication to saw orders. We spoke a lot about the vastly different levels of access that people from around the world have to clinicians and services as well as the vastly different attitudes towards communication disorders. There are still countries that actually you are put into an institution if you are a child of the age of 10 and you cannot speak. What do we do about those sorts of situations? That's a question that keeps me awake in life. What do we do? Well the first thing is to ensure that we have materials to assist people to do their local lobbying. We do national lobbying through the World Health Organization or any other organizations that can assist. We provide information to those who are interested in a particular country to support their activities. We ensure that we promote days to, for example, the Hearing Awareness Day is supported now internationally to quite a long time for that to be the case. There are now international autism days as well, supporting those providing the materials to small countries as well as large. There are so many small countries that have maybe one to three people interested in communication disorders. Those people need support. We have a conference every three years. We can, being mostly interested in communication, spend days talking about something that's perhaps we should have solved into us, but that's the problem with our professions, I think, is that we value communication almost too much to have that be the case. If I'm an SLT, a locally SLT here working at, I don't know, guys in Tommy's or something, obviously the college is an a member. How do I get involved? If it also keeps me up at night, the fact that a kid is being institutionalized because it can't speak? Well, there are so many things we need to do, and I'm early in my presidency, so I've still got a few years to try and meet some of these ambitions. But I really wish that every speech and language therapist in the UK had heard of our organisation, which they haven't. The vast majority do not know that we exist, but also to look upon it as a philanthropic organisation, because one of the things we would very much like to do is to sponsor a speech and language therapist from a low income country to come to conferences, or to be able to sponsor being able to send their materials, etc. So we want to actually make sure that people see this as a philanthropic organisation, a charity which we can help them roll out what they feel passionate about to people who have not got the services or facilities that we take for granted here. But in addition, we have 14 committees, each one specialising in the different areas. So we have a committee that works on stammering and fluency disorders, one on a phasier, one on child speech disorders, one on child language disorders, one on autism, etc. We've got 14 of these. They all are mans on the committee, by people from different countries, so that we have no more than two people on a committee from the same country. That is a terrific opportunity for people to meet like-minded and interested individuals from other countries in their area of interest. And you can't believe how much one learns from chatting to people in different countries, because of the ways they provide care, with the restrictions as well as the freedoms that they have as clinicians, etc. There's not a meeting that I don't go to that I think. We've never thought of that. Why haven't we thought of trying that over here? Why are they doing that? Why do you spend so much time on that particular approach, etc., etc.? It broadens your mind and keeps your thinking going. And sometimes, it's what's interesting, it makes me think, why am I doing what I'm doing? Because somebody says, well, why'd you do it like that? Now, I can't respond because we all do it like that forever. You can't say that. So you're thinking, why do you do it in that way? So we strongly encourage all of our listeners to have a look at the website. And if you can, please do join. It's a great philanthropic cause that truly support life-changing interventions. And at the same time, you can get exposure to lots of different techniques and thinking from around the world. So it's a great CPD opportunity as well. Pam mentioned that they are trying to find ways to lower their membership fee so that more people from around the world can join. The next conference is scheduled to take place in Auckland, New Zealand in 2022, if you fancy a trip to Idle Roa, the land of the Long White Cloud. There are also three regional symposia every year, the details of which can be found on the website. The website address is in the show notes. So please do have a look. I then ask Pam what she thinks the future of SLT is. About 25 years, I've been involved in research related to computerised therapy for people with aphasia following stroke, people with slurred speech, dysarthria, and children with certain language and speech disorders. And I've always been convinced, even from when do many people remember the BBC computer, which was the size of a desk? Yes, I've seen it. I don't have one. You're probably too young to remember it. Anyway, we did start doing research with this of saying, surely we know one thing about speech therapy that practices desperately important, intensive, repeated practice, to change learned behaviour into a new learned behaviour. So that if somebody has learned to speak in a way that is less intelligible, they unlearn that and learn how to speak in a more intelligible, more fluent or whatever way. And so practice is desperately important, but practice is also unbelievably boring very frequently. So by using computers to develop different ways of getting the person to practice and keeping their interest is really valuable. And in some of the research we've done, we found that patients actually prefer to do their practice on the computer than with a face-to-face therapist, because one they feel they're taking the valuable therapist's time, so they don't want to practice too much, because they feel they're absorbing your time. But the other thing is, is that it becomes a little bit boring to both the therapist and the patient to keep on going on. And we often change the exercise prematurely. Right. So if you can do a computer game where you're doing version of the same behaviours, but getting different rewards or different stimuli, that should make a big difference. And most of the research related to computerised therapy is very positive. It's positive because it helps people to maintain doing the practice for as long as they need to, but also it's positive because people will practice several times a day. And they're never going to see a speech in language therapists several times a day. So I think the use and value of computers with known for a long time, but we haven't been using them as much as we should until COVID came along. And suddenly, people are doing much more online. And actually downloading apps and games for different children and adults to do at home. And so it's given us a bit of a pick-up the arse, I think, in saying this technology is already there. We've known that it's effective, the research has shown it's effective, the majority of patients, not everyone, the majority of patients do like using it, but we're not adopting it. We haven't changed our behaviour to accommodate to it. And I think we have now. So I think that's really good news. Can I just tell you about something that recently happens to me, which I think is a great illustration. I had a small, I would say, a walt on my head that needed the dermatologist to look at it. And they said, oh, yes, that's just a basil ganglia thing. And so stick this cream on it. And I'll see you in a few weeks time. Well, a few weeks time came just timed in with COVID starting. Right. So she rang me. And I would have had to travel to the hospital. It would have taken me about an hour. I would probably got there early to not make the apology. That would have been probably another half an hour. She would have seen me for a bit in an hour, but it would have been a good morning. Was she rang me? She said, just take a picture. And well, I can't see anything. Is it raised? No. Is it? Have you got any scarring? No. Is it red? No. She said, well, I can discharge you. 56 seconds. That's amazing. 56 seconds for her to see and to have a chat easily with me. She said, if anything like that comes back again, go see your GP. Now, if I had gone to see her, she wouldn't have felt comfortable in having a look and sort of kicking me out the door in 56 seconds because she would have known that I traveled. I've waited. So she would have had to pad out the time somehow. Yeah. And why don't we ring parents before seeing a child to get some of the background to create a bit of a relationship, to perhaps observe a bit of play through the video. There's so much more that we could do, which would be less disruptive to the client and their family and much more efficient for us. I don't know if you have an assessment of obviously the NHS has done an absolutely sterling job, but the government somewhat less so, or do you have any thoughts on that? Well, I would hate to have been in their position. Yeah. You know, new government with something that's that's hit them. And previous governments perhaps hadn't done as much with the warnings about pandemics. I'm not sure that anyone could have done that much more. Really? Because they've had to change their minds as new data comes out. And also, of course, no two scientists will necessarily agree 100% of the time. Yeah. You get two two scientists, two public health clinicians, and you have four views. And they're all good, arguable views. Right. There's no one truth in this. And so, I think it's, you know, I have quite a deal of something whilst still remaining irritated. I still have some degree of sympathy with regards to how the heck do you lead a country when there are so many different scientific ways forward that have got good arguments to support them. True. I've got two last questions for you in our last minute. You received an OBE. Does that mean you met the Queen? I met William. Oh, right. And how was that? It was wonderful. It's terrifying. It's absolutely terrifying. And I wish I hadn't chosen that hat. But putting that to one side, it is unbelievably intimidating. And you feel all the time, a complete fraud, because you're meeting other people who are getting there on us. We've done fantastic things like defused bombs, and stimulating the women's individual professions. And great, interesting people who think, oh God, they've done so much more. But William was lovely. He's much taller than I thought. Right. And but he engaged in conversation and I kept on thinking, William, there's a lot of people behind me. He is sure that we should shut up and you could get on with the job. Apparently, there has to reduce the numbers of people going through when he's giving out the honours, because he does chat, whereas the others have been doing it for longer and have got the art to talking appropriately, but quite quickly getting rid of the person. So it was a wonderful occasion. And I did feel that imposter syndrome, but and I wish I hadn't worn that hat. Everyone, we're going to frantically Google pictures of you. No, please do not. And all I can say was a hat done by a person setting up in the military business in Sheffield. And I wanted to encourage her, but perhaps I shouldn't have done that occasion. We're definitely going to look into that. And then our final question is obviously we are, we're still living in semi lockdown. I suppose not total lockdown like it was in April, but do you have, for those of us that are still working at home and not venturing out an awful lot, a recommendation of a TV series, or a film, or a book, or a podcast, or anything that you've discovered during lockdown that you think is worth taking a look at? Well, the book that I read recently, which is a real page turner, was called Three Hours. Right. And I can't remember the author, but it was absolutely a brilliant book and it's a page turner. And you learn a lot very easily. It's not a book that you read to learn things, but almost by chance you learn quite a lot about immigration, etc. And I never watched broad church before this situation. I've never seen it. And I've loved it. I really have loved it. So that brings us to the end of today's podcast, a big thanks to Pam for her time. So the documentary I was talking about is called Far From The Tree. It's based on an award-winning book. I got some of the details wrong, including the boy's words, which were in fact, I'm trying, I'm smart. I challenge you to watch that and not shed a tear. Pam's book Three Hours is by Rosamond Abton. There's a lovely article in the Guardian about an SLT at Guy's in St Thomas's Trust, in which we are reminded to keep safe, but also look out for our well-being and that of our colleagues. This is a marathon. Until next time.