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International Women’s Day: Voices in health care – with Dame Jane Dacre, Dr Nikita Kanani and Dr Gabrielle Mathews Episode 29 of the Health Foundation podcast

Episode 29 |8 March 2023 |34 mins

About 1 mins to read

 

Today, women make up around half of all doctors and two-thirds of all medical students. So, has equality in health care finally been achieved? 

When International Women’s Day began in 1909, women were still barred from entering medical school. Today women make up a growing share of the medical workforce and students in the UK. Despite this considerable progress, research indicates that today women in health care are under-represented in leadership roles, are paid less than male colleagues on average, and still all too often encounter sexism and discrimination. 

To mark International Women’s Day 2023, we invited three female leaders at different stages of their careers in health care to reflect on the expectations, experiences and challenges that have shaped their professional journeys and what needs to happen to continue building a truly inclusive workforce.

To discuss, our chief executive Dr Jennifer Dixon is joined by:

  • Dame Jane Dacre, emeritus professor at UCL Medical School, chair of the Health and Social Care Select Committee’s expert panel and former president of the Royal College of Physicians

  • Dr Nikita Kanani, director of clinical integration at NHS England and deputy senior responsible officer for the NHS COVID-19 vaccination programme and a GP in south east London

  • Dr Gabrielle Mathews, NHS Assembly Member (NHS England) and a doctor at North Middlesex University Hospital NHS Trust.

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Jennifer Dixon: On 8 March, it is International Women's Day. This annual fixture started just over a century ago to mark women's contribution to society and push for equal political rights, and economic opportunity. Difficult to believe, but at that time, women were barred from entering medical school. But today, about half of doctors are women, as are two-thirds to three quarters of students entering medical school today. So, is the job really done? To mark International Women's Day this month, we focus on the position of women in medicine in 2023. We're doing this from the perspective of three women at different stages of their careers, early, mid, and late, and all of whom have been active in advancing women in medicine, and science.

I'm really pleased to be joined by Dr Gabrielle Mathews, who is a junior doctor at North Middlesex University Hospital NHS Trust, and a youth advisor to NHS England, amongst many other things. Dr Nikita Kanani, who is a mid-career doctor, and both director of clinical integration at NHS England, and a practising GP in south east London. And Dame Jane Dacre, who amongst many other things is emeritus professor at UCL Medical School, and formerly, of course, president of the Royal College of Physicians. Jane also led a college study of women in the medical workforce, and another on the gender pay gap. Welcome all. About half of doctors in the UK are women, and between two-thirds, and three quarters of students entering medical school today are women. It is the job done? Perhaps we can just start off with that, Gabby?

Gabrielle Mathews: I don't think to me that means that we've made any change on the position of women in medicine. Just because more women are coming into it doesn't mean that more ... and the data says aren't taking up leadership positions, or I guess have the space in their career to do what they want. I think to me, the measure of success is if you ask a woman in medicine what they're passionate about, and what they'd like to pursue, and they're able to do it, then I think we can say that we've been successful. And I don't think we're anywhere near that. And we're nowhere near where I think I'd like to be in terms of equality, and leadership positions, and in research funding distribution.

Jennifer Dixon: Thank you. Nikki, do you agree with that?

Nikita Kanani: When you said the numbers, I was heartened, because I remember my mum applying for medical school bravely as a migrant to this country in the '70s, and not getting in. And I love the fact that so many women are joining the profession, and I think for our patients, for our communities, having that breadth of diversity across all protected characteristics is hugely important. But as Gabby says, there's more to do. And there's some very fantastic role models in, and around our health service who will help us do that.

Jennifer Dixon: Thank you. And Jane, what's your perspective, later on in your career?

Jane Dacre: I think it's an awful lot better than it used to be. And so, I think that's quite an important point to note that we have come a long way. But I think that the structures of the NHS were set up for the 1950s male, and they haven't changed enough. And the gender pay gap, the fact that it's so wide, wider than any of the other elements of the public sector, suggests that we're not breaching equality in the way that maybe we should be. And I think that affects decision making in the NHS.

Jennifer Dixon: So, you're all saying that there's a lot more to do. The bald numbers don't really tell the story. And I'm just really interested in if you'd prioritise for me what you think the main areas are where there really is more work to do.

Gabrielle Mathews: Firstly is in leadership. So, where are women leading both locally but nationally as well. Secondly, in specialties that are predominantly female. I think we as a system need to think more about how gender biases affect those specialties, and then take a wider look at how gender bias affects the majority of those women that are coming into medicine. And then, lastly, I think what Jane said about the system is really important. So, less than full-time being allowed across all specialty is really important, but there are so many other ways in which the system is so antiquated, so flexible working, and other ways that we can adjust for all the protected characteristics, as Nikki said.

Jennifer Dixon: And Nikki, what would you add to that?

Nikita Kanani: I mean Gabby is spot on. We've got a fantastic role model in our chief exec of the NHS, and I think that makes a difference. And I think that it's really important to see those role models in different parts, and at different levels of the organisation. The flexible working agenda, it's not a new thing. But I'm a GP. My ability to either drop the kids, and go in, or do a surgery early or late helps me do my other jobs as well. That means I'm going to stay in general practise longer, which is better for me, better for my patients, and better for the health service.

Jennifer Dixon: And how about you Jane? What would you think are the main areas to work on?

Jane Dacre: I think there are some specialties where there are still far too few women. They're usually surgical specialties, and I think they need to work on the culture to make their specialty more friendly to women, so that they want to be there. I think that's the main thing. But I actually, I want to make a plug for something which I think is under-recognised, and that is the pressures that there are on parents, and carers. Childcare is a complete nightmare. It is extremely difficult to hold down a job, and also have small children in nurseries. And the responsibility of that in society goes onto the women, and that just holds women back. There are so many women, not only in medicine but in other areas of professional life who give up, or go part-time, or forgo a promotion because they can't work out who's going to look after the kids. And not all NHS organisations have access to nursery places. It's paid for out of taxed income. So, it's ridiculously expensive, and it's just a huge barrier.

Jennifer Dixon: I mean, let's talk about childbirth and parenthood for a minute. I mean I was just looking at some figures from the NHS, and it's 18% of female doctors have at least one spell of maternity leave, which is quite low I thought actually. And a year after going on maternity leave, the proportion who aren't working full-time is 85%, which stays like that for five years after the birth of the child. I mean, there's huge variation as you're saying by specialty. Those with fewer women, the women tend to return full-time. It's interesting. And those with a lot of women, public health, and general practice, it's more like 75% go back full-time. So, obviously having children is a massive, massive thing. And you are saying that there's a lot more work that needs to be done to help with flexibility. Is that the main solution in that particular area, flexible work, or is there something more than that to try, and help encourage parents, but particularly women, back?

Jane Dacre: So, what you are describing is what my colleagues working on the gender pay gap would call the motherhood penalty. So, every time you have a baby, you get a kick in terms of your career, and it takes you far longer than it should do to catch up. I agree, flexibility is very helpful. But actually, the pay penalty is quite significant because you then can't afford to put your child in nursery. And it's not just about children. It's about caring responsibilities generally. So, we don't support or backfill women with caring responsibilities, and if we want a truly equal workforce, we need to think harder about how we do that.

Jennifer Dixon: It's not just maternity, as you say. It's caring. And everyone who's a parent knows how you've just got to drop something, because your child is ill, or at the nursery, there's a problem. Nikki, how flexible at the moment do you think general practice is to this kind of long tail of caring that's crucial?

Nikita Kanani: It's really challenging. We've seen some really good examples of where individuals who are working flexibly or need to work flexibly for a variety of reasons are able to make their sessions in a way that works for them. And actually, interestingly, I think that's often quite good for the patient population as well. So, I often do a later surgery because either the kids or work here at NHS England. And then actually patients will go, ‘Oh that's great, because I was able to be at work during the day, and then have the ability to speak to you later or at the weekend’. But I think as with anything, we've got some really great early adopters, but there is a way to go. And I really want us to, as you said, think about that shared care responsibility. I still get times where... I mean, the schools have learned now, because I've said where I'm the first person that's called again, again we can. I'm like, ‘You can call the other number on the form’. He's also able to answer a phone, and come, and collect the children or whatever. So, really being clear I think, with your teams, you support the working flexibility, support them, sharing parental care.

Jennifer Dixon: Again looking at surveys, there was another one I looked at. We looked at working patterns of doctors. After 10 years, 42% of women were working less than full-time but only 7% of men that there are also a lot of men at that point who will have kids, and many of whom have a growing interest in taking shared responsibility. So, is there any pressure coming from the men, Nikki, do you think, in trying to make things more flexible for them as well as women?

Nikita Kanani: I really think we need to be talking about it more. I really want to see more of our male clinicians, and male leaders actually... Our exec director say, ‘Well actually, I did this with the kids’, or, ‘I'm going to take this time off’. Half term really is a quiet week at work because there are lots of people who are off with their children. The more we role model that, the more I think men will feel comfortable or more comfortable asking for the same opportunities to have time with their children. I mean somebody I was working with recently, I think it was the afternoon, and they'd put a meeting in. And he said, oh it's my daughter's… it was just before Christmas…. it's my daughter's nativity. But don't worry I will pop out, and dial in. I was like, absolutely not, absolutely not. Make sure you’ve got time by either side. Have a coffee, watch the nativity. When you're back on, let me know. So, we do need to keep talking about it, and creating those spaces.

Jennifer Dixon: So Gabby, I'm very interested in your generation, because you're obviously at the early stages of your career. What are you seeing amongst your colleagues, male and female, about the impending challenge of caring responsibilities?

Gabrielle Mathews: So I only started F1 in August, so I've literally six months into being a doctor. And I've been so shocked by how much everyone's thinking about this. Even in teaching sessions we've had, consultants have commented on how different, I guess our perspective is, looking at the work environments we're in, and our priorities by having leaders like Nikki, and other people that are kind of pushing those conversations, there is a lot more talk about going less than full-time early. And it is hard, I think, at my age to differentiate that from people thinking about families, and people thinking about their career, and non-clinical things to do. I think I'm still young enough where people aren't sure what their family life is going to look like or what they want from it. But there is definitely a sense that people want to be less than full-time, and that they want to explore other opportunities, and non-clinical positions, and that all of that together will allow them to have the family life that they want.

And I think, particularly for me as a young woman with a disability and long-term conditions, the space that I'm going to need in my career, if I want to be a clinician, and have a family, and do other things, I think peers around me are a lot more open to having that conversation, being really understanding to of course go 80% as soon as you can, and leave that space if you need it, or 60%. I'm often surprised when consultants, or I've seen college tutors for example, talking about their journey to doing it, and how far in their career they had that option is to me really surprising. Because I was even considering when I left med school trying to flexibly into F1 and F2 to create space for things I'm already doing.

Jennifer Dixon: I'm just really interested in what you've picked up amongst your male colleagues particularly. I mean, sure, everyone wants a portfolio. It's very nice to do that. But when some of that has to drop away for caring, I don't know what the attitudes are like. And do you get the sense that at this early stage, people are committed, men in particular, are more committed to caring as opposed to pursuing some other aspects of their career in a part-time way?

Gabrielle Mathews: Particularly from people my age, who are in relationships already, so starting to have these conversations, they're having the conversations really early. And I think it's almost because of our mothers. Because the generation of my mom was told that they could have everything, and they had to have portfolio careers, and have children without the flexibility that we are now afforded. So, I think as a woman, we are looking at that, and saying, absolutely not. We're going to share that burden of caring with our partners, and with the men our lives.

Jane Dacre: So can I just ... I think the rubber hits the road for women when they have children. And whilst I completely accept, and admire that sort of idealistic positivity, I think that the reality is that life becomes much more difficult for women when they have children. And the dates are about, for example, shared parental leave is really interesting. We tried to do some work looking at the uptake of shared parental leave, and we couldn't do it, because we didn't get the numbers, because not enough men are. So, when push comes to shove, and when people have children, these things don't happen. And I think there is an elephant in the room in relation to the NHS, which is the gaps in the workforce. Because it's really difficult to insist on your flexibility when there aren't enough people to run the shifts, and to run the system. So, although it would be fantastic if we could have this, we would really need a small oversupply of doctors to be able to pragmatically allow people to have flexible careers. And at the moment, that's just so far away from happening. I don't mean to be negative, but I think we have to be realistic.

Jennifer Dixon: Yes, indeed. And just there's a wider issue on the flexibility if you look at the wider workforce, and the extent to which there's a lot of economic inactivity, in part because people are leaving cause they have long-term conditions. And couple that with a labour shortage means that employers now want to be more flexible, and they have to be more flexible to attract, and keep people in at a time of high employment, and a labour shortage. So, I think the NHS is paradoxically going to have to think about this far more as we go into the future. Because that shortage is not going to stop any time soon, is it? I think what we've just been talking about is a needing more flexibility, and more space to pursue either caring or other things that people might want to do. What other aspects, domains of say gender dissonance there are which might be holding women back here?

Jane Dacre: I suppose I've been around for long enough to have experienced more abhorrent behaviour. And one of the things that's quite interesting is that people now know there are certain things that they shouldn't say, and what that does is drives the behaviour underground. So, I don't think it gets rid of it. So, throughout my career, every so often, I've had somebody say something or do something that just felt completely unacceptable. And if you then stand up, and say something about it, then you are actually regarded negatively. So, you have to be really careful about how you deal with it.

Jennifer Dixon: Are you able to give an example? I mean, is this rank sexism?

Jane Dacre: Sometimes I said, ‘Oops,’ and was told by a male senior colleague that oops was a sign of female incompetence. That's a fairly mild example. When I was vice president of the Royal College of Physicians, and was stepping down, this was a time when there had been I think only one female president, and only two or three female vice presidents, and a very senior neurologist said to me, ‘But surely, my dear, hadn't there been enough of you already?’ So, there are those kinds of put downs that happen quite frequently to women. And you just brush it off. You wobble a bit, and then you carry on. I can remember being pregnant, and I was still finishing my thesis, and I was told by one of my educational supervisors that I needed to choose, that, ‘You can't possibly be a woman, and have a clinical job, and finish your thesis. You've just got to give something up, and have your babies.’ But those sorts of comments just slip out.

Jennifer Dixon: Still?

Jane Dacre: And yes, they do. They do. And what happens is that they're under the radar.

Jennifer Dixon: Thank you. Is that your experience, Nikki, and Gabby?

Nikita Kanani: Yeah, and sadly I've heard it from other women as well. I mean, I do think it's getting better. But I was on maternity leave with number two, and I came to still at a flexible working on a panel. And a very senior woman took me aside afterwards, and said, "You're going to have to choose your children or your career. And we talk about the fact that this is ... It's not a work-life balance. It's chaos. We have to talk about that, but it's not always going to be easy, and you can't neatly bucket up work and life. And actually, I was really struck years ago about the concept of undefended leadership, and authentic leadership. And bringing your whole self appropriately to work and being your whole self in the spaces you occupy to me is a really important part of how I lead.

This morning, I had to do something at my daughter's school before I came in. That creates opportunities for other people. That creates better role modelling. And this concept of having it all is just really outdated. It's about defining the things that are important to you, and then understanding... It's that lovely analogy of juggling balls. We're all juggling loads of balls, and you can let some of the balls drop if they're the plastic ones, or the rubber ones, you know that bounce up. You've just got to figure out which are glass balls that you don't want to lose. So, you do need to talk about it. Creating ways to do that juggling in a safe way, protecting those glass balls means that more people will stay in our service in different parts of our service for longer as well.

Jennifer Dixon: And Gabby, you're probably listening to all this with horror but probably recognition.

Gabrielle Mathews: I'll give you one example which was .. And I recognise what Nikki was saying, there was actually a female consultant recently who we were on ward a round. And she said, ‘I'm going to ask you a question you're not going to like’. And I thought, ‘This will of course be some horrible physiology about this really complex patient we've just seen.’ And then, she said, ‘Have you gained weight since you started this job?’ And I don't even know why I responded. And then, later, I was talking to one of my registrars, who's a man. And I recounted it. And he said, ‘Yeah, of course, what would a woman... What else would a woman say to another woman to tear her down?’ He was obviously joking, but almost directly articulating what the situation was as really disappointing. And that's just one example.

But I also think I've been lucky, and this is going to sound really bizarre, by how people regard me as a young Indian woman, and how they won't... often don't see that as a threat. So, in policy spaces, it allows me to challenge, and discuss, and play into some of their expectations of me, and then use the space that they've created to challenge. But that's because I have a supportive environment, and mentors around me. So, when bad things happen or I face challenges, I've had the space to reflect on that, and it not to be a huge push down or for me to go away, and decide that I shouldn't have been in that space, and my voice wasn't valuable.

And I also think having... So, my background is as a children and young people's health advocate, and having been able to start in my early teens advocating for others, and being told that my voice, and their experience has mattered, coming into then medical school, and now into the workplace, and into the NHS... having been told that, and trained to advocate for others, and be really principle and value led in how I see myself, and being told repeatedly that no matter my position you can be a leader in that space is very different. So I recognise it's really hard, but I think I've been really, really lucky to have certain tools to be in environments that are impossible, and go away, and cry about it, and have someone's talk to, and support me in that.

And I think I want other women to have that, to have people telling them that how you differentiate the glass from the rubber balls or to challenge them early on to think about when it's going to get harder later on. Because people have sat me down about my long-term condition, and working, and asking me how I've managed managing it or about family. And obviously, I have often not wanted to hear it. But them pushing me, it's been really powerful. So, that network around you when you're going into medicine is important.

Jennifer Dixon: I was reading something from the WHO Gender Equity Hub, which was a report, and it had this phrase in it which said that, ‘In health care, women deliver, but men lead’. And you are all female leaders. When you consider women's position in leadership, and what might be holding them back, apart from the space to care, what else do you think is needed to be done to help?

Jane Dacre There are all sorts of things, but just listening to the conversation so far, one of the things that the three women, well, all four of us really on this call, have is the confidence to be able to speak out, and not all women have that. And because of the knocks of life, quite a number of women, women in medicine, women everywhere, feel that they have the Imposter Syndrome, and they don't have the confidence to speak out where necessary. They undervalue their academic achievement. So, there is something about, I think, empowering people to be able to do it. Having said that, I'm quite a fan of what's been described as the flagpole style of leadership, which is that if you are able to be at the top of the flagpole, and see the enemy coming off the horizon, to use a military analogy, and you can slide down, and also see what's going on in the grass, you probably are better at your job.

Jennifer Dixon: So Nikki, you're in position as leader, would you agree with Jane beyond what we talked about?

Nikita Kanani: I was really hearted to hear Gabby talk about going into policy spaces and being heard. I still find myself in rooms that are very white male heavy, and it still takes me a moment to remember that I've got something to add. Occasionally, I'll change what I’m saying or how I'm saying it, because I want to use language that reflects the people in the room as opposed to the language that feels comfortable to me, and that brings a different perspective and viewpoint of course. And I'll have to check myself, and kind of go, ‘Hold on a sec. I'm here for a reason. I'm here to bring my, usually, clinical female Asian mum perspective. And it needs to be in this room because this room doesn't have most of those other perspectives around the table.’ And if we are leading, designing, strategy, policy, whatever we are doing in different parts of our world, we do need to build to bring that.

So, I think the other thing apart from flexible working is our colleagues as allies. And I have some great allies that will look around a room, and go, ‘Hold on a second. Nikki, can you come in here?’ whatever it is. And that makes a huge difference. So, then, I think when other people do that, male or female, create that space, it means not only can you contribute, but you can create space for others. I think it was Chadwick Boseman, and he said that thing about, ‘Everything you fight for is not for you, it's for those who come after you’. So, I really value the opportunity to get around that table to create that space, and then make sure that people get to use it, too.

Jennifer Dixon: I think that's so well put actually. Because I think all of us around Jane's generation probably feel as if we've been slightly pulled out of shape, because we had to, in order to be heard. Because there's a kind of almost a cognition wavelength. If you're not on that, you have to adapt to that to be even heard. But in being pulled out of shape, you're not putting forward your different perspective, which is a loss, isn't it? So Gabby, I'm rather hoping that your generation isn't going to be pulled out of shape so much, and presumably doesn't want to be, and has recognised this already.

Gabrielle Mathews: I think we definitely have, but I think there's a long way to go. And I think one of them is working on psychological safety for people as they're working. The incivility we've discussed in the workplace, and the way leadership currently works is there isn't a linear path into leadership in the health system. Loads of people have to self-select. There isn't a model by which people put you forward. You're self-selecting, and you're often stepping away from clinical work, which can be really frowned upon. So, there isn't a way for us to tap women that we think are amazing, and push them forward.

And Liz Wiseman talks about this balance between stretch, and safety, so leaders creating the space where you can stretch yourself but still feels safe to challenge yourself. And I think if we don't see that in teams, we're not going to allow women to stretch, and then have the opportunity to fail or find out that actually they absolutely hate being in a managerial position, and they want to be back with patients. Or a lot of people talk about leading clinical practice because they feel like they'll make a bigger difference elsewhere. But being able to say, ‘Absolutely that's not how it felt,’ and come backwards.

And then, I think power and design, to me, is really important, and with my background as an advocate, how we can think about designing the systems in which we work. So, I have, a lot of the time, found myself in very traditional boards engaging how you have to, and learning the tools of how to have your voice heard. So, saying a specific phrase, and then making sure that it's minuted at the next meeting, and writing down exactly what you wrote. And then at the next meeting saying, ‘Sorry, I think that was missed’. And then, being able to tie that. So, I think having to teach yourself how to be in those settings, I don't think it's a bad thing. I think it's always powerful to be able to adapt to new environments, but we do need to think about how we design the systems by which we lead.

And I think finally, how we educate and teach about leadership is really important. Because I am often in spaces where I am years behind reading literature or understanding policy, and reading things without context. But having been able to work with people who've taught me about quality improvement, or strategy, or different frameworks, just having the ability to think in those spaces without that years of context is really powerful. But not everyone has access to training, and you can't ... Your biggest gap is you don't know what you don't know. And until we are able to direct people to ways to educate themselves that are leadership focused, they won't find a way to it. So yeah, but I think my biggest one is design. In designing all these new systems, and in implementing all these huge policy visions, we need to make sure that we're doing it with those that will be impacted by it, whether that's clinicians or patients in the public.

Jennifer Dixon: Yes. That's almost a good way to round this off, because my last question was really about making progress. And I'm going to ask all of each of you what needs to happen, what you plan to do to make things better, also for those coming behind, including men, as well as other women.

Jane Dacre: Its almost become my passion to try and do that now, because I'm reaching the end of my career. And I think there are three things. One is to use the data that's there. Because Jennifer, you've presented some really interesting examples of where there's data that tells you something that you might think but not really know. So, promoting those data sets that actually show what the situation is, I think is very helpful for the future. Another is to always support people. Don't turn into the person that undermines other women or other men or anybody else. So, always find the good in people, and find a way of supporting them. And then, to promote the good news stories, because there are some, and what we need to do is just to get them rolled out. We're in a lot better position now at the end of my career than I was at the beginning where it was just expected that I would either have children or have a career. And I've been very fortunate to have had both. So, we just need to be positive about that, and carry on moving forward.

Jennifer Dixon: Thank you. And Nikki?

Nikita Kanani: Our responsibility to build strong networks, and particularly as women, particularly as brown women. So, I have quite a lot of different groups of people that I lean on, I hope I also look after. We look after each other, and it's a real mix of different sorts of backgrounds, experiences, and that is so important. And always, whenever I talk about being a female Asian leader, I come back to the fact that I've had a tribe in one way or another for a very long time, and different tribes for different things, mixed gender, mixed backgrounds. And that has been incredibly powerful, because on my darkest worst days, they are the people that will check in with you. And when you've had a great day, they're often the people that can celebrate with you, and help remind you of the stuff that you've done well. Also, having people around you is hugely important, and ties so much to Jane's point about being kind and compassionate in everything that we do.

Jennifer Dixon: Thank you, well put. And Gabby, I'll give the last word to you.

Gabrielle Mathews: I'd agree with Jane, the evidence base. But I also think being able to formalise how we talk about design, because there are so many different fields, and areas in which people are really early on in thinking, and also really advanced in thinking about how we design systems. And to me, it almost feels like, I guess when Jane was leading work on medical education, looking at that field, and where it started to where it is now, I kind of feel like we're at the start of engagement, and system design thinking in a similar way. So, I think I personally want to really commit to thinking about how we can find people who are doing that research, and getting it put into academic literature, so we can build better systems around us.

I think the idea of luck readiness, which is a career development term of how you can be ready for opportunities that will come to you is really important. And then lastly, that being remaining value led. So, for me as an individual, what is it? Why do I want to do medicine? Why did anyone that's in the NHS want to work in the NHS? And keeping that story. And I think being proud enough to say when I'm taking a leadership position or when I'm taking a task, because of a personal motivator, and when it's actually because I think I could do a really good job at it, and encouraging people around me to articulate their value in spaces. Because it's very easy for us to, I think, hide behind values that maybe aren't our own or behind overall visions, and forget where our values, and where we are in it.

Jennifer Dixon: I think that's an incredible thoughtful place to end. I think you've all given food to thought here, particularly the need to be open, and expansive, and supportive, and horizontal, rather than imitating what has gone before. And there's no doubt that these sorts of discussions I think are happening in the world of work everywhere, not just medicine, are they? And it's all the healthier for it. I think that's a very thoughtful set of observations. I hope you all agree. So, thank you very, very much to Gabby, to Niki, and to Jane for their contributions today. More information in the show notes as ever, so please check those out. Next month, we are going to be looking closely at the promise or otherwise of artificial intelligence in health care, should we be techno ecstatic or techno pessimistic? So, join us next month for that very interesting discussion with two very knowledgeable guests. A big thank you to Kate and Leo from the Health Foundation, to Paddy at Malt Productions. And it's goodbye from me, Jennifer Dixon.

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