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Episode 32 with Blandine French
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Our last episode for a while... Max talks to Dr Blandine French, who not only found a problem (lack of knowledge in UK doctors about ADHD), she got up and did something about it!
She's remarkable, and you can find out all about her at https://ndlab.org.uk/
Bye for now!
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Transcript
00:00:05
Speaker
Hello!
Introduction and Farewell Tease
00:00:06
Speaker
Hello! Welcome to the ADHD Science Podcast. Welcome. I am Max Davey. I'm Tess Davey. And this is the last one for a bit, isn't it, Tess? Yeah, and we'll tell you why at the end of the episode. Ooh, no spoilers, although we've been talking about it for some time.
Interview with Blondine French Begins
00:00:21
Speaker
And it is September. um Right, this is, going to talk about the the interview that what I have done about a while ago, actually, about a while ago. That's how I basically...
00:00:35
Speaker
I interviewed Blondine French. um Great name. It's a fantastic name. And what nationality is she? French. French. Whoa. That's crazy. Uncanny.
ADHD Knowledge and Misconceptions in Primary Care
00:00:47
Speaker
She's amazing. So she basically, i mean, she'll explain herself better, but basically she's a researcher.
00:00:54
Speaker
And she looked at how much, a while ago, she looked at how much people in what we call in the UK primary care. In the US, it would be something like a family doctor, maybe.
00:01:06
Speaker
don't know why you're asking me. I don't know. you you know about American stuff. Do I? watch YouTube. I've never been there. And anyway, just for our US listeners, of which we have...
00:01:19
Speaker
some Hello. Hello, US listeners. And then obviously we have people in Singapore and I don't know what the Singaporean equivalent is. No, it's great. Anyway. You're our favourite. Your primary care people, how much they know about ADHD. Now, and what she, she talked a bit about that and the fact that, you know, when she did the research, it was a bit sketchy and people didn't really know what it was and they weren't really sure what it if it existed and whether it was just naughty children and, you know, whether girls could get it or not.
00:01:48
Speaker
Actually, we spent quite a lot of the time talking about how attitudes have evolved and improved in lots of ways and how we are on a journey, particularly this is quite a UK based interview, of course, but I think it kind of fits with global trends that we are on a journey with ADHD away from simple, this is nonsense, to...
00:02:13
Speaker
Well, this is this is this is the thing, but maybe we're over-diagnosing it or, you know, how on earth am I going to deal with all of these prescriptions? How is the system going to be able to cope with all of this?
00:02:24
Speaker
All of these more sophisticated questions. So that's what we really talked about. Yeah, it's a lot more questions and misconceptions, whereas before it was a lot of like denial.
00:02:36
Speaker
But have yeah I've noticed that people are getting more understanding about it, and I know that there's a lot of nonsense talk still online, and but i think things do you think things are getting better in terms of ADHD
Online Content and ADHD: Misinformation vs. Education
00:02:50
Speaker
acceptance?
00:02:50
Speaker
I think that when you talk about things we see online, you have to remember that it's very polarizing. Yeah. And that one day you'll scroll into a video that says everyone with ADHD is faking it. Yeah. And then the next day you'll scroll into a video that's a collection of teachers being educated about it. And they're like, oh, I never knew about this. I never knew about this.
00:03:08
Speaker
And that's great. And that's amazing. Yeah. um But you have to remember that that's all, that's just two ends of a very large scale. Yeah. And we don't really know what's going on in the middle because we never see the middle.
00:03:20
Speaker
Or if you're me, you never scroll on to any videos ever. Well, yeah. But you know what I mean. yeah that's the Those are the things that are going to get traction. It's very important to remain conscious of that. I mean, like I'm bad for it all the time. I mean, i I thought to myself for a long time that things were getting worse, and then I actually...
00:03:38
Speaker
stood back and I looked at it and I listened to like actual real people's experience and being on this podcast and stuff and I think it's getting a lot better yeah I think that's right because you want it to be so good and you sometimes feel like if there's any pushback it's things are getting worse and people are denying it all but I'm not sure and I find that negativity tends to get more traction in line as well Yeah, that is demonstrably true. yeah So shall we do the interview and let your mother into the house?
00:04:07
Speaker
Yes, I think you should cut that last bit out.
Blondine's Personal and Professional ADHD Experience
00:04:12
Speaker
Okay, so welcome to the plant, Blandine French. We're both laughing because it's taken us about half an hour to get everything sorted.
00:04:20
Speaker
um ah How are you? I'm okay. Thanks, Max. Great. Can do you introduce yourself to our listeners, please? So I'm Blondin French. I'm a postdoctoral researcher at the University of Nottingham, focusing on ADHD healthcare service research.
00:04:39
Speaker
So I've always worked in the ADHD field and as a researcher, but also I run support groups for parents and adults, who have, and but I had also ADHD and parents of children with extra needs.
00:04:56
Speaker
um I was diagnosed myself as a but with ADHD when I was an adult and both my children have ADHD and autism. So you you're steeped in the world.
00:05:09
Speaker
ah it's very Yeah, I mean, it's 24 seven. I go to work researching ADHD. I ah spend my spare time supporting people or helping as much as I can. at my kids' school or, you know, and and then during the night, I've got all the beautiful and sides of my ADHD family and the lack of sleep and everything else. yeah So, yeah, it's a very 24-hour thing me.
00:05:35
Speaker
Absolutely. live it. um And so...
Research on ADHD Knowledge Gaps
00:05:39
Speaker
We're going to talk about some of your work on ADHD knowledge and and barriers to to care in primary care, um by which for overseas listeners, I suppose we we kind of mean that the first level of healthcare, care the kind of community level of healthcare. care um And for UK listeners, that would be sort of your GP surgery.
00:06:00
Speaker
um Not everyone calls it primary kept primary care, of course. um So I suppose our first question, as always, and i'm afraid there's no test today to to come in and and and help.
00:06:11
Speaker
um Our first question as always is, um what was the question you were asking in your research? So the the the work on primary care was my PhD programme. And it was just trying to understand you um what what do primary care physicians know about ADHD.
00:06:31
Speaker
And this came actually from my own lived experience, spending years not being picked up um where a lot of sides had been there. and I was like, why did the GP not not pick it up? Why didn't see it in me for so many years?
00:06:47
Speaker
So really it stemmed from that, which is trying to understand what what knowledge they have about ADHD, how do they see it in their patients, how much do they understand about the diagnosis process, about the support around it.
00:06:59
Speaker
so So this was mainly what we're looking at, really understanding the knowledge um and <unk> potential gaps in in primary care knowledge on ADHD and trying to address it. So we co-developed with GPs a training program that was evaluated and implemented to see um if they did get the right training, if they did get you know um really tailored information on ADHD, what changed and how did it change their practice.
Training Program for GPs
00:07:29
Speaker
Okay. And so so it's almost a two stage things, what they know and therefore and then what we can do about what they know and what effect that has.
00:07:40
Speaker
So if you could take the first one, what, what, what was the current, I mean, obviously it's ah it was a few years ago, but I'm and reasonably confident, except in your area that it hasn't changed dramatically.
00:07:51
Speaker
um What was the finding in terms of the levels of knowledge and the barriers to to care that were existing before the interventions? So before the intervention, mainly the the thing that I took straight away was the the lack of training.
00:08:08
Speaker
So there is a lack of knowledge and misconceptions around ADHD within healthcare professions, but that stems from a lack of training. So ADHD, autism, neurodevelopmental conditions are not part of the compulsory curriculum for any healthcare professionals.
00:08:26
Speaker
So whether you're talking about a psychologist, a GP, an A&E person, you know, in the UK, it's not part of the compulsory training.
00:08:38
Speaker
So what this means is that all our healthcare professionals either would have had to go on an optional module or course, um or just start their clinical work without any evidence-based knowledge. So they pick up the knowledge from different bits and pieces.
00:08:56
Speaker
ah you know, either through colleagues or through articles they might see the media or... So it's really unreliable um yeah knowledge that they that they get.
00:09:10
Speaker
So for example, in a study that I did, over 250 GPs, so that was, when was that? 2019. So what, six years ago, only 26% of GPs had received any form of training on ADHD.
00:09:26
Speaker
So then you can see how misconceptions might develop, how you know the knowledge that they have is not necessari necessarily accurate or or up to date. um And that was the main findings.
00:09:37
Speaker
and there There is also an issue around the the complexity of ADHD
00:09:45
Speaker
diagnosis process and how you know it does take a long time that GPs don't necessarily have. There's loads of people involved. You need to involve the schools or, you know, the the patients, the secondary care services. So there's a lot of back and forth between loads of different um people that you know, they they don't necessarily have the time or it's it's quite complex.
00:10:08
Speaker
ah You have to follow up and you have to just keep and track of who's doing what. and And that was another barrier in education. in how well they can support the ADHD diagnosis process.
00:10:26
Speaker
Yeah, that last point is a really interesting one because I currently have just taken over as clinical lead in our local ADHD diagnostic service and and and where it really strikes me how much of the work is is just herding those cats, is getting all of the information from all of the different interested and and and relevant parties.
00:10:45
Speaker
into the right place in ah in a way that makes sense to the person who's actually making the assessment. It's a huge amount of work and it's very, very different to somebody coming, you know, were often with quite a complex um condition of themselves, you know, in themselves. It's not even as more and just not even like, oh, it's more complex than a, you know, than a twisted ankle or, or and you know, if somebody comes with a complex motor, musculoskeletal problem, that's No, that can be complex for a GP, but the all the information is within the person. They can ask them all, well, most of the information.
00:11:19
Speaker
it's that It's that additional, it's that need for external information and other and and multiple points of ah of um multiple points of information, multiple viewpoints that are makes ADHD particularly difficult and complex, I think in lots of ways, as as much as it is also a complex condition.
00:11:41
Speaker
Yeah, exactly. and And you just need one person to not to forget or to send it to the wrong person and then it just messes up everything. So if you imagine that an appointment is 10 minutes with your GP, but it might take 10 minutes to chase up the school reports or 10 minutes to figure out what is the new service that's been open for adults in the area or who do you need to send it to or what information was missing the first time you send the referral through and it's been bounced back or has this person filled up the phone properly? You know, these are all extra ah appointments. We want think about it that way that the GP has to do to, to kind of make it work. So it's extra resources, extra time. Um, you can't really plan it around. So this wasn't necessarily the the main thing, but it's definitely part of it or how, and, and every area is different as well. So,
00:12:38
Speaker
It's not like we could just give them a very easy answer and say, hey, you know what, when you have you know someone with a ADHD coming through with a child or an adult, this is what you need to do. Yeah, yeah and there's no consistency between areas of the country.
00:12:52
Speaker
Yeah.
Challenges in ADHD Diagnosis and GP Training
00:12:53
Speaker
whether As you said, with physical conditions, you need a blood test and then they need to refer to this service and that's it. it's maybe with a here it changes within depending on where you live, the post-court lottery that we all know about, but also even within the same place. like i've I've been living in Nottinghamshire for 10 years and I've seen three different services for the children. It's very hard to keep up, even even as a person working with them. I can't keep up with the way that services keep changing. so
00:13:25
Speaker
you know It is expected that how can all the GPs, all the teachers, everyone around keep up with the constant change around that? yeah It's hard. It's it's complex.
00:13:37
Speaker
It's very complex. The one thing I suppose, one thing I think listeners might be thinking is, yes, a lack of training would explain why if you come with a certain symptoms or are distressed in a particular way, that might explain why your GP doesn't immediately think of ADHD.
00:13:56
Speaker
But but the the experience of people is that sometimes is is of people going to surgeries and saying, I think I have ADHD and not getting anywhere.
00:14:07
Speaker
And I'm not sure, I think that would need a bit of explanation why that's due to a lack of training and ah or why that is actually. Because I think that's, I think people get that these are not specialists and that these people are not specialists and they might not go, aha, ADHD.
00:14:23
Speaker
But if you're told, I want an ADHD assessment, please, and then that is refused, that I think people find very, very difficult.
00:14:34
Speaker
Yeah, and that's a very tough one. I mean, I've been working within services. So I lead the Nottingham Neurodiversity Network.
00:14:45
Speaker
and For so the last two years, I've been working with services every week, every month, adult services, children's services. I've had a really strong sight into what's happening within the pathway, talking to the clinical leads and the service leads.
00:15:01
Speaker
And I have to say that there is a lot of, I don't know how to phrase it. There can be a lot of misconceptions about ADHD as well from a patient's point of view.
00:15:14
Speaker
Now, I know I've worked with adults for the last 13 years and with parents. We know that once you've been struggling for so many years and you find an answer, you want that diagnosis. There are some people that label that they mislabel it or that misunderstand it.
00:15:31
Speaker
You know, I have seen the other side of it, the flip side of it, where you have, you know, I've i've had mums at school coming to me. They know what I do. They know I'm an ADHD researcher. They know my children have got diagnosis.
00:15:42
Speaker
And they say, oh, I think Leo is a bit ADHD. And I'm like, well, you can't be a bit ADHD. Well, I've been thinking about it for last. And I've known this child for three, four years now. I'm not a clinician.
00:15:54
Speaker
But... You know, the reason why they they put that label on this child would be like, oh, it's just been really misbehaving the last few months. And like, well, that's not well what ADHD is. That's not what ADHD is, right? So this is an instance, for example, at school. And this happens to me all the time. this These people that label it as children's behavior or their own behavior, because i work on it, I get a lot of that.
00:16:19
Speaker
Yeah. And I don't know, but I'm picturing, you know, if you're a GP, you you can't know straight away. Now, that doesn't mean that you need to refuse a referral, but there's a lot of people asking for referral when actually it's not ADHD. And it could be so much more complex. It could be um trauma. It could be crisis. You could be going through a very tough time.
00:16:42
Speaker
and And the GP... originally is not always able to tell the difference. Now that shouldn't mean that they should make a call on whether, you know, you should go through or not. That's not right.
00:16:55
Speaker
But I do empathize of how difficult it is have patients coming in and say, I have this, I have that. and Because the culture around diagnosis, your own problems is so big now.
00:17:13
Speaker
it's hard to trust, but I don't want this to sound like I'm saying lots of people make mistakes about what, what, what they're really struggling with. No, but I just traveling to balance, you know, it's hard to just, it it shouldn't be refusable. Otherwise you can't just trust everything a patient say either.
00:17:32
Speaker
And I think diagnose yourself and you can, you know, I don't know. and um Yeah. explaining right It is just... It's a challenging question, isn't it? It's challenging for me.
00:17:43
Speaker
Yeah. And you see 20 patients a day and how many of them would have looked up their symptoms and say, oh, I think this is it. I've got cancer. I've got this. but You can't just take their words for it.
00:17:55
Speaker
And you see that day and day and day and day and people who have been really struggling have Googled their symptoms, have made a conclusion rightly or wrongly about what they think they're struggling with.
00:18:07
Speaker
It's hard to just trust it. Now, but on the other hand, i also know patients who have been struggling for many years and i had crisis point and finally have the courage or the time or remember to go to the GP to get through the diagnosis process after years of struggling and then get sent back. And that's not right either. Like it it shouldn't work like that either. You can't just not send a referral through without any reason for it. You need to do it, gather some screening measures, to gather some evidence about yes or no, and make a decision on that, not a decision on um anything else.
00:18:47
Speaker
And I think um part of the problem is contained within the question, because if someone asks for an ADHD assessment, they're almost presuming that the only answer, the the question that they're answering is ADHD, yes or no.
00:19:00
Speaker
And I always slightly react against that. And I say, i'm i don't I don't lead an ADHD diagnostic um ah team. I lead a neurodevelopmental diagnostic team. And and so that's,
00:19:11
Speaker
It's still a little bit, have you got neurodevelopmental condition or not? but But still, um you know it has to be a rounded assessment. and And one of the big problems, I think, with the system is that there is services that just do ADHD, yes or no. and And there is a real question as to whether, well, okay, we could send you for this question to to answer this question, but is the is it the is it the most important question?
00:19:35
Speaker
And I think that is a valid thing for for for for a GP to come back and say, well, is it actually this the question is this the question that's the most important for you at this point? So that that kind of gives us the landscape of what what you found before you decided to intervene. So so what did what was the intervention and and what effect did that intervention have on the the landscape that you found?
Improvement through Online Training
00:19:59
Speaker
So the intervention was a ah training program, a 45 online program. training program on ADHD and the specific role of the GP within the ADHD care pathway.
00:20:11
Speaker
um It was co-developed with a team of 18 different GPs. It was reviewed by them. And and and really, because I wanted to make sure this was something they were happy to engage with, that there it was information that would change their practice, impact their practice.
00:20:27
Speaker
you know You could get a lot of, you know what is ADHD programs? There's a lot of the things out there. But it needed to change things. um So I worked for like eight months with GPs just developing constantly what, you know, what the format of the content, the structure of the program, what is important, what is not, how do they want it to be delivered? you know, is it in person? Is it face to face?
00:20:53
Speaker
I could talk. mean, as I'm sure you can see, but I could talk for three hours about ADHD, not engaged for three hours, know, on that. So how long did they have to be? um And basically they just wanted evidence-based information. What do I need to do in my practice?
00:21:07
Speaker
Yeah. And just, and just really tailoring the program towards that. Then we reviewed it and evaluated for a randomized control trial. So we had over 300 GPs, you know, half of them received the training, half of them didn't.
00:21:21
Speaker
And, um, And we we evaluated change of knowledge, ah confidence towards um dealing with ADHD in their practice, and then change in practice. Now, change in practice was a bit harder to gauge because ideally, you know, the ideal scenario would be you give someone a training program, you change their knowledge about but something, you go back um a year later and say, hey, since they've
00:21:52
Speaker
gain so much more knowledge, there is more accurate referrals, there are more referrals, but we couldn't gauge. That's yeah that's that's a v hard but it's it's Yeah, that's very hard, but it's very difficult to gauge you know quality of referrals or how many more referrals ah would have been made in that practice.
00:22:12
Speaker
And also my study finished in January 2020, just before the bid. so So gauging, and you know at the time, GPs had much more bigger priorities than thinking about, and you know, that those first six months of of the COVID pandemic were really hard on everyone.
00:22:31
Speaker
So i we just had to be pragmatic about it all. But I did interview GPs six months after they um took part in a study. to see what changed. And what we did see was, you know, they, I remember this one GP saying, as I was going through the training, I kept thinking, oh my God, this is my nephew, you know, little Henry does this.
00:22:52
Speaker
And as soon as I finished training, I told my sister to go straight on the reform pathway, because I never thought about that. And then, you know, another GP said, oh, well, what I didn't realize that I didn't know the services around here, especially for adults. And then I started looking into it. And so there was a brand new adult clinic that opened up six months before. So now when an adult comes through, know exactly where to refer them to.
00:23:14
Speaker
um So those are the kind of changes we captured in terms of um change in practice, but mainly what what what we noticed from it is a change in attitude. like I interviewed 50 GPs and all of them said, you know i had this really led this really strong stigma towards ADHD. I didn't realize how it affected girls.
00:23:39
Speaker
i didn andt you know I thought it was just a behavioral problem or a parenting problem. But now I'm lot more um understanding. I'm lot more understanding towards ADHD.
00:23:53
Speaker
um I'm a lot more willing to take on the referrals and to um send it through. I'm a lot more confident about what I need to do when someone with ADHD comes through.
00:24:04
Speaker
and And these were really nice things to observe. These were really nice things to observe. and It's not extremely sciencey. We didn't see, you know what, you started here, there was...
00:24:20
Speaker
10 referrals last year before you got a training and now a year later you've got 40 referrals. and But this is what we want to see. We want to see a change in attitude. We want to see a change of knowledge. I mean, the misconceptions and the knowledge just completely disappeared.
00:24:35
Speaker
Well, the misconception disappeared and the knowledge just increased but so much afterwards. So you wouldn't make those mistakes when people come to your practice of thinking, or maybe it's just the parents, or maybe it's just they're giving them too much sugar, they're overweight a little bit, so that's just because they're on a bad diet, or whatever those... Yeah, all of that nonsense.
00:24:54
Speaker
So, um yeah, that's what the training did. And and and you delivered the training you delivered the training yourself? Well, it's online, so it's an online program, it's like an online module, right?
00:25:05
Speaker
But it is by, I suppose, just just kind of thinking about it, the two questions that I and spring to mind are, have you managed to embed this locally, as in the people are coming through, becoming GPs, joining the area?
00:25:23
Speaker
do they Is that still something that is offered? So it's it's been very hard. So it's been five years now um since we finished i finished the project.
00:25:35
Speaker
So if we take COVID out, like maybe four years, we really could work on it. um There's been over 18,000 users. So we've we've had a lot of users and coming through. And I do a lot of training
Adoption Challenges in Healthcare Systems
00:25:49
Speaker
locally. So what I tend to do is I go to the local GP groups, I do a presentation, and then put the training forward for them to engage with.
00:25:59
Speaker
I'm quite active at disseminating the training. However, the issue with um healthcare training is that there's no topdown it's not a system.
00:26:14
Speaker
So you can't go, I mean, the training is accredited by the Royal College of GP. yeah But the way it works, it's not like, oh, it's accredited by the Royal College of GP and therefore every single GP in the UK will be... No, doctors don't like that sort of stuff.
00:26:29
Speaker
It's bottom up. So you have to speak to a you know ah clinical network that is very interesting and and they'll give it to their GPs. But it's still not compulsory. And and while... training on autism or ADHD or any neurodevelopmental conditions is not compulsory, then there is not an easy way to engage.
00:26:49
Speaker
You know, i can I can't force people to take it. I can't force clinical training to two you know to give give it to their um to their students.
00:27:01
Speaker
No, no, no. But 18,000 is a very big number and a very impressive number. Are those all GPs? Is it also other members of staff in primary care? No, and it's from all over the world as well. So um it's it's loads of different.
00:27:16
Speaker
and so but The majority are healthcare professionals. all that I would say about 60%, 70% are healthcare professionals. and The way the training was developed was that there's one module on understanding ADHD and one module on the role of primary care.
00:27:32
Speaker
And the reasoning behind that was that you could just do the first module in just understanding ADHD. And that would be for anyone interested in in understanding ADHD better. and then the second module was really what do GPs do in the UK? yeah And ah where do they sit within that that pathway?
00:27:50
Speaker
But that could also be useful for, for example, teachers or secondary care workers to really understand, you know, what to expect from a primary care person. Yeah, yeah, yeah, exactly. Within that pathway.
00:28:03
Speaker
So it's been a mix and ah that's not a bad thing because I think if everybody involved in that pathway would understand the different roles of everyone sitting within it, then um it just makes things clearer and better.
00:28:19
Speaker
and and people so So anyone from all over the world can join your training if they if they want to. So we'll put a link in the in the show notes for how people would look into that.
00:28:30
Speaker
And it's been translated in French and in Spanish as well. Okay, how on earth are they translating into French? That seems mysterious. but and the But the thing is because healthcare care provision is so different different countries. Oh, yes, sure, sure. There's a translation into systems as well as language. yeah Yes, so they it's it's a direct translation word for word rather than an adaptation to each system. So you know if you know If you're in Australia, it would be very different. So you would have the English training, the system would be different.
00:29:00
Speaker
And the same for the French. It's a French translation of the English system. And yeah the way things work is slightly different, but not different enough to um to make it unhelpful.
00:29:15
Speaker
Yeah, yeah, yeah, that might that makes sense. um So if you think about this work, I mean, how do you keep it up? mean, what's the future of this? Does it get bigger?
00:29:29
Speaker
are you it you know Is there a sort of vision for everyone being trained in this way? Or is that beyond even your energies?
00:29:41
Speaker
It's not beyond my energy, but it's beyond my capacity. Yeah. I mean, like if if giving it all my energy will make it happen, then I'm there. But and it's very hard because, and I've been working with teachers a lot, so I adapted a training for teachers.
00:29:58
Speaker
and and And those two systems, the education the healthcare system work very similarly in that there is no national curriculum. It's not a top-down, you know, what I was explaining earlier. Yeah. so it doesn't matter if I give it all my energy to make my way to the top. I can't seem to find a way that one person makes a decision and then it trickles down and then it is. become I would love it. There's a national curriculum for children, but not for teachers in in a funny way.
00:30:25
Speaker
No. So, i mean, I teach the teachers, every single teacher training that comes with Nottingham university now is being taught on ADHD because I'm, I'm doing it.
00:30:36
Speaker
But, um, e yeah so i i don't know what the way is to make these trainings and it's not just for autism it's for it's for sorry for idhd it's for autism and tics and dyspraxia yeah absolutely we like compulsory worked spend last five years trying to figure this out and i i can't find the way maybe i'm missing something but i've i've given it lot of energy um And I don't know what the answer is. I would love for it to become three, not necessarily my training, but any trainings hey training. So, But there aren't that many others that that are as adaptable. And
00:31:10
Speaker
um yeah, i I mean, there are obviously lots of lots of resources out there, but the the specificity that you've achieved, I think that's the that's the real achievement in a way.
00:31:21
Speaker
you know, specific to the audience. it'd be if it's used. Like, you know, I want people to use it. and i don't You know, I'm not getting paid for it. it It's free. It's, you know, it's it's out there. It's been evaluated. It's been tested.
00:31:34
Speaker
To just use it. But, yeah, it's it's very difficult to implement. Go on. go on Sorry. I do want to say, though, and when you were talking about what's next, what the future is,
00:31:46
Speaker
There has been a huge change since I've done my project five years ago, since I finished it. I mean, if I was to redo the training again, and and and the reason and why I'm not doing it again is because it's a matter of funding. i'm I'm being funded right now, i'm being paid to do a completely different project on economic cost of a diagnosed ADHD.
00:32:09
Speaker
i don't I can't dedicate my working hours to redo the training, otherwise I would. But if I was to do the training again today, it would be very different. I've seen a huge increase in primary care knowledge.
00:32:21
Speaker
I think now the the acceptance around ADHD diagnosis and referral is much stronger. um GPs are much more open.
00:32:34
Speaker
There is a lot less refusal. it It does happen. There's still misconception. There's still some some issues. But there has been a shift in how primary care is involved now within the pathway, a shift in attitudes and and acceptance and lot more openness in in in ah working with services and with um service users on that.
00:33:02
Speaker
ah in ah it's It's very strange because when I started this project 10 years ago, it came from a place of a very strong lack of understanding, no knowledge and very strong misconception.
00:33:13
Speaker
And 10 years on, we it's not the same thing. Okay. and GPs needs are very different now or have moved forward. There's still a lot of needs, but they they're they're slightly, yeah. then What would you do differently if you were to rewrite the training today?
00:33:31
Speaker
Would start from a higher baseline, I suppose? No, actually, no, I wouldn't because I still think the lack of evidence-based training is there. but I would include things. So so what primary care is coming up to me with a lot is advice on shared care.
00:33:50
Speaker
So it's not so much now my advice was you know how to start a diagnosis and what to do, are understanding the pathway. Now, GPs kind of get that now, but what they're struggling with How do I do shared care? How confident to be with some of them the referrals or the prescription that they get from private providers? That's a huge issue.
00:34:11
Speaker
ah So that's the kind of support I give right now with primary care. And it is complex. It is very hard to understand. You get this prescription from a a person you never heard of, a company you never heard of, and you're supposed just take it on and and be okay with it. and and And the complexity around that, you know, do I, do I not?
00:34:31
Speaker
um So yes, private providers and shared care and right to choose. So those are three things that keep coming up now that I didn't touch on the training because at the time it wasn't.
00:34:42
Speaker
No, it wasn't a thing. And yeah, and And now these are what gypsies are most worried about. And again, rightly so, because I've seen some, I mean, I've seen some referrals, but some diagnosis reports being sent through where says this person has a DHD, plus can't done that. And there's no, there's no reports. There's no evidence thing. There's some pretty shocking stuff going on. How do you know that this is a,
00:35:08
Speaker
you know, how can you be sure that you're doing the right thing? You don't want to start prescribing something when you don't know what this person. So again, it's one of those things, it's balance again. and and And that's a massive thing right now in primary care.
00:35:21
Speaker
So definitely include that. I suppose while we're thinking about the future, the the interim report for the ADHD task force, which was commissioned by NHS England, came out recently.
The Role of Primary Care in ADHD Diagnosis
00:35:34
Speaker
And one of the one of the headlines was... basically more and more involvement of primary care and some people being diagnosed in primary care ah was the proposal.
00:35:46
Speaker
um What's your reaction to that? And what do you think that creates in terms of in terms of your training? And how is that going to change the way that you work with with with primary care?
00:36:00
Speaker
So i was actually um part of the task force. so I was part of writing. Disclaimer. I wasn't the one recommending that. To be fair, it wasn't like ah it was a a group decision from three different groups.
00:36:15
Speaker
And I do agree with the recommendation that wish we should involve primary care. and There is evidence that this could and make things a lot easier Well, there's a little bit of evidence. so So, for example, there is a clinic down in the southwest, can't remember exactly where, where there's one ADHD GP specialist that can start, you know, initiate, can start taturation, can, especially nurse, can do a lot of the the medication side of it with the taturation, with, you know, the the yearly reviews that take a lot of time on the services, don't need to be in specialist services. Once you're set up on me or medication, it
00:36:56
Speaker
it could be easily done by a nurse prescriber. him So there are things that I think the idea is that it working together. so not dumping everything on the primary care and the GP on people that not trained for it. And I know, but just thinking about how there are a lot of things that could be taken over by pharmacists or primary care um nurses, you know, like blood pressure should check or, yeah you know,
00:37:24
Speaker
So i think it's more joint working, but that works for, that's what I take from the report. And that that's what we were trying to put forward. You know, there's a lot of education could do to support, a lot of tech program could do to support and and how we can make it more of a holistic approach that people with the right skills or the right capacity can and take over without saying, well, like now,
00:37:53
Speaker
Everything's happening in primary care and all these GPs that, you know, don't know much will have to take on the whole diagnosis project, which is a ah very and difficult process, as we've talked about. Yeah, exactly. i think that that would cause some, I mean, I i i i think it's inevitable and I think it's if if it's done right, it could be fantastic.
00:38:14
Speaker
But if you just take it in isolation, i think it causes some alarm if you don't you know if you assume that they're not also going to massively increase, you know do the sorts of things that you've been doing in terms of increasing training and and changing misconceptions and so forth.
00:38:31
Speaker
um and And I think, yeah, if if you're right and things have moved on you know nationally, which I think they have to an extent, um then it shouldn't be ah particularly alarming to people that that that GPs are going to be more involved. Because the more they're involved, actually, the more understanding there's going to be and actually the better your ah your um service is going to be when you do turn up at your local surgery as an ADHD person.
00:39:03
Speaker
um it isn't it isn't sustainable for it to be super specialist forever. It just isn't. um No, it's not. It's a common condition. Yeah, and I think you've made a very good point where by um you know, you need to start with the training.
00:39:20
Speaker
How can you expect GPs to be specialized in a condition that they're not even trained about? Like, I think we're jumping your ahead. And I think it would be easy to jump ahead and say, okay, well, let's just, delegate these kind of tasks to primary care without having starting with the first thing like, okay, do you know what you're dealing with here?
00:39:38
Speaker
And, or or forcing, you know, what GPs have to learn very quickly, not necessarily on evidence-based and just being told, okay, well, is this how you do it? And that's it. and And for me, yeah, it always goes back to, let's just make compulsory training for everyone on this.
00:39:56
Speaker
And then you start from an evidence knowledge-based about what, how to deal and what, you know, it's easier to build up from your knowledge and say, okay, well, I know about this, this condition. This is how we've been dealing with, but then we're changing things slightly. Okay. Well, instead of is this happening here, it's happening with us.
00:40:11
Speaker
That's easy with a, Oh, hang on. Why don't you ask me to take on? Well, I know nothing about this. And I didn't even know the ins and outs of this condition in the first place. Um, so I think we need to be careful about.
00:40:25
Speaker
Yes, exactly. how How are we going about it? um Yeah, and and it's only an interim report and it's not final and it's you know that it's not very long either.
00:40:36
Speaker
um It's not a detailed blueprint of how we're going to go forward. um So just, I mean, suppose moving on to our our third question, I'm just thinking about, sorry, I'm jumping ahead and thinking about the last one, which is going which is going to be um an event.
Future Aspirations for ADHD Recognition
00:40:53
Speaker
um
00:40:56
Speaker
What are the implications of your work around primary care training for people with ADHD? What does it mean to the person with ADHD listening to this? what what and should they Should they feel optimistic? Should they should they do anything specific about no suggesting your training? or what what What are the implications for the the community?
00:41:18
Speaker
I mean, if if anyone is struggling communicating with with primary care, then would definitely suggest using the training. i mean, whether the staff, you know, the healthcare professionals will actually engage with it or not. that No, sure. That's something we can control. But that that is what the training is for, to understand, to understand the nuances, to understand what they need to do, what they need to look for, what they need to ask.
00:41:41
Speaker
um And we know that this is what it's doing. So we we have seen a change of attitude and knowledge around it. and so So the difference for for all of us who are dealing with it is that, you know, the the hope is someone and like me that has been in and out of, you know, primary care services for depression for 10 years, and you know, in that antidepressants.
00:42:10
Speaker
Maybe the GP will just start to think, oh, hang on, there might be something more Something else is going on here. And this is the kind of information we are giving in a training. I was very lucky to have... um a female GP with ADHD who talked about ways like to have ADHD as a GP. She's one of the specialists that that did a lot of the videos to kind of talk about what you will see in your practice.
00:42:36
Speaker
You know, what does it look like in girls? What does it look like? Just the nuances of the things you can do practically within primary care to, to not miss those people or to, or to,
00:42:48
Speaker
yeah to pick them up much quicker, much earlier. um And I think that really helped in understanding what
00:42:59
Speaker
and and giving GPs confidence to to put this referral through much quicker um and much more confidently. So that's the impact it has on us.
00:43:10
Speaker
You know, you won't wait 10 years of going through four rounds of antidepressant for the GP to start thinking, oh, hang on. Or You won't have to just look up your symptoms and say, I think I have a DSG. I mean, that that's the the general hope. And and and I do think it has done that to a degree in ah really building the confidence in GPs to just pick it up in their inner patients. So that that's what I hope. it will have in the long term and and the feedback that we have got we just published a paper um the you know four years um follow-up of this and this is the feedback we we got you know gps are much more confident and much more um are putting through those referrals in in with better quality and um and quicker which is what why we want right we just absolutely the whole thing well actually it
00:44:04
Speaker
It's much more efficient. It wastes a lot of time, all this to-ing and fro-ing. is if Efficiency is actually, you know not only is it better for patients and smoother for patients, but it actually saves the system money. So actually, that accuracy of of referral and and smoothness of referral is it is a win-win for everybody. It's not it's not a zero-sum game, you if you see what I mean. you're not um You're not trying to kind of play things off or so trade things off.
00:44:28
Speaker
For the for for for our sort of fourth question, um i suppose... you know, the implications for, say, ah you know, a GP who's listening who hasn't been to your training would be please go to your training, course.
00:44:39
Speaker
But what about other professionals who work with people with ADHD, like teachers who are not in your area, or, you know, people who maybe be don't feel like this is right, this is right for them? but What would you say to them and as as ah as a result of all your work within ADHD training?
00:45:00
Speaker
That's a big question.
Tailoring ADHD Training for Various Audiences
00:45:05
Speaker
um I mean, as I said, the training has been developed in a way that and the first module is about understanding ADHD. It has got quite a strong evidence, medical stance to it, but anyone can do that one. Yeah, that's true. yeah So, you know, and we've we've had a lot of people engaging with it from loads of different professions, and even social workers or physios, you know, actually deliver training to some, um, physiotherapists, which is not something I straight away. yeah yeah yeah
00:45:39
Speaker
Um, I mean, for me, the key message of, of that work was that it's very important, important to tailor the training. So when I, I,
00:45:50
Speaker
adapted training for teachers. Teachers wanted something completely different. Yeah, they do. While GPs wanted online, quick, less than an hour. Teachers wanted a whole day training with case studies.
00:46:02
Speaker
They wanted to hear about the children really showing the different nuances in the classroom where the GPs when were more focused on evidence-based scientific facts. You know, what do I pick up?
00:46:12
Speaker
Yeah. so So the training are the same kind of core... information about what ADHD is, which we all know, but the way it's delivered, the way it's structured, the the information I included in either training is completely different. I need to adapt the the teacher training again with with a cohort of teachers to really make it that it's useful for them.
00:46:34
Speaker
The same way I did with GPs. And actually right now in talks, we're doing it for the police and for in for workers in prisons as well. And you can't just, I mean, maybe it's just because I've been doing it for so long, but you can't just take an online course and just say okay, well, this is, you know, you Google YouTube and just say, well, there's an ADHD program.
00:46:58
Speaker
um The importance of tailoring, there's just such, um the benefits of tailoring it to your audience is super strong, which means that in In the GP code I did, there was no, you know, everybody took part, everybody stayed, but, know, there was a lot of engagement where they have seen other people doing that where it drops off because it's not the right information, it's boring, it's whatever the reasons are. Yeah. um And that was a massive...
00:47:30
Speaker
um listen that I learned just the importance of really thinking about your audience about yeah what you're trying to change with whom and you can't just copy paste information from the internet and just hope that it will it will do it.
00:47:44
Speaker
yeah um And that takes ah that's a big but particularly if think about the teacher thing and and and that's a huge issue for you know the families I work with and and for the teachers that I know um that gap between what is sort of the reality of classroom life and managing a classroom and what we might but imagine as the ideal management of a child with ADHD within the school, that gap is really difficult to to bridge and it does require that really careful attention and respect and mutual respect as well.
00:48:18
Speaker
And that that is very difficult to to stick that on a webinar. It really it is very difficult. It is. But you know, like, for example, when when I did the co-production with the teachers, I included a few slides or a few pages on pathway. And you think, well, hang on, healthcare pathway has got nothing to do with education.
00:48:35
Speaker
But you need hard because once the teachers understand the steps, the children... Yeah, no, they do need to know. I mean, you can you can picture there's a lot of misunderstandings. So the GP might think, oh, hang on, the school will deal with that. Or the school might think, oh, the GP will deal with that. or yeah but Or they're getting support from, they've been referred, so they're getting support. But it doesn't work like that. When you get referred, you don't necessarily always get the support.
00:48:57
Speaker
Or the support will change depending on where you live or the support will. and your age or or whatever. So I think for them to understand exactly what's happening, yes, you did this form and you send the referral through and and this child is waiting for diagnosis or has a diagnosis, but this is what's happening around that. It gives some kind of accountability, but what they can do or not, or,
00:49:22
Speaker
or how to support the child while they're waiting for the more official support rather than thinking, oh, well, there you go, like now they're within the healthcare system, they're being they're being sorted. And vice versa.
00:49:34
Speaker
Yeah, exactly. Because a lot of healthcare professionals say, oh, it's okay, the school is is providing support while they're waiting. but But if the school doesn't understand, so yeah, that that conversation, I'm really unpicking knowledge based run around that ah has been really helpful.
00:49:51
Speaker
Because there are there are key ambiguities and um and and things that are unclear in the kind of whole guidance around how to, you know, whether you think of this as a special educational need, whether you think of this as a potential health condition.
00:50:05
Speaker
All those things don't quite gel, do they, in terms of policy between between health and education and actually social care as well. They don't they don't kind of they don't they don't use the same language and therefore people don't understand them in the same way.
00:50:18
Speaker
Yeah, and I think that's what we try to do ah in the report. It's just, I mean, it's really hard to interpret. The aim is not to say primary care needs to take on more, education needs to take on more, and let's just delegate everything to other services, but especially services.
00:50:35
Speaker
For me, that the the message from this report is let's have more joint holistic working together. you know, this is system where we all need to work together and we're not individuals in siloed.
00:50:48
Speaker
that um don't talk to each other because that that doesn't work. And we know that. So how can we do joint working um that doesn't impact each other in a negative way, but in a positive way and we support each other. And in Nottinghamshire, we have started doing that for the network that I live. We are really working well together in in making decisions together that makes life easier for each other rather than dumping.
00:51:17
Speaker
um Exactly. you know, responsibilities onto to another without. Because the dumping in the short term feels like it saves resources, but actually at the system level, it is very wasteful.
00:51:29
Speaker
Oh, it is in the long term. It's it's completely short sighted it doesn't work. It hasn't worked. Things have to change. I mean, the waiting list are not going anywhere. the demand is not going anywhere.
00:51:43
Speaker
There needs to be a change. I'm being open and about what I look like without just thinking, well, it's somebody else's problem. It's very important right now. I mean, the the way things are working right now in 2025, we need to get there.
00:52:00
Speaker
We need to involve everybody else differently.
Collaborative Approaches to ADHD Care
00:52:03
Speaker
um And that goes with training and that goes with joint working and that goes with communication. That goes with tailored thinking about what it means for everybody with involved within that.
00:52:14
Speaker
whether it's diagnosis pathway or the care pathway after diagnosis, what what does the support look like? What do these children, you know, how how does it work? and Children and adults.
00:52:26
Speaker
yeah Exactly. we I mean, this is all age stuff. this is we can't We can't discriminate. We can't just say this is ah children over there in a box and and and adults over there in a box. um Apart from anything else, it creates all sorts of cliff edges.
00:52:37
Speaker
um And we have this big problem with the the the eighty you know the cliff edge at 18 at the moment within our service, um which is we haven't got to grips with, it's fair to say. No, and um I mean, some places, i know, I think, um um might be wrong, but i think it's in Leicestershire, they started doing an all age pathway, which is great. A lot of places are trying about just not having that ah change at ageing and that you know moving from children to adult services. Yeah, it's very challenging to do, but it is the obvious solution um if you can actually pull it off. I'm be interested to know. I'll maybe look into that.
00:53:14
Speaker
So obviously we'll put a link to the interim report in in the in the show notes. um ah You've kind of alluded to it already and it's going to be, it's gonna it's it's it's quite a big question for you is is what what's next for you in terms of in terms of your research? and And it's also slightly a preview for a future ADHD science and podcast episode. But well what what's next for you what what what are
Economic Impact of Undiagnosed ADHD
00:53:39
Speaker
you? What are you looking into now?
00:53:41
Speaker
so I'm currently finishing a fellowship on the economic cost of undiagnosed ADHD and autism. And we're trying to show that you know deronga you me the the more costly it is in terms of societal costs, healthcare costs, personal costs.
00:54:01
Speaker
um And just really trying to and make an argument for why we need to prioritize um services and care and from an economic point of view. It's that hard-headed version which we have you have to bring to policymakers to the Department of Health. It has to be in that economic terms, doesn't it, and if in order to argue for more money?
00:54:27
Speaker
Yeah, unfortunately, yes. it it has to we It has to have a financial incentive. um So that's what I'm trying to do. So I'm currently analysing the data for the this survey that I did with 900 adults with lived experience. And and yes, we should have the results soon.
00:54:46
Speaker
Yeah, amazing. Working within, I mean, I've always worked in in access to care and care pathways. And I think right now it's trying to find, um I'm putting grants in and funding application through for finding ways to support services in in tackling this excessive demand and this, well, not excessive, this increased demand. Yeah, yeah, yeah.
00:55:10
Speaker
ah the increased funding that goes with it. and So a lot of the projects that we do is you know digital support either for families or for patients, for adults, or you know how can we automate things? How can we make the system better?
00:55:26
Speaker
now it's quite tricky because of all it changes within NHS England and the NHS in itself. it's The structure is completely changing at the moment. So it's very hard I think next couple of years are going to be a really tough to implement changes and two and to make a difference while while the restructure in terms of commissioning, in terms of NHS England, in terms of NHS as a whole is happening. It's very uncertain and um and therefore it's just hard to to
00:56:04
Speaker
it's just hard to implement changes. Yeah. Very. You get, I mean, it's, it's frustrating because we had sort of all these, all the Brexit years when you couldn't get anything changed or any um government to listen to anything. And now you've certainly finally emerged from that. And then you have all of this instead.
00:56:18
Speaker
Yeah. um And I mean, and, and this is some of the bias that we are finding with research, but with clinical care, like, so for example, um, in Nottinghamshire, the commissioners, it was in Nottingham, but now they're proposing that it's becoming a regional thing with Nottingham, Leicester, Derby.
00:56:37
Speaker
And I think this is going to happen within the next week before December. And that changes the decision making because when you look at just, to you know, a county compared to a region. Yeah, yeah. i mean, they're constantly reconfiguring. I get i like so lost.
00:56:51
Speaker
and and the And the service, I think, they you know, there's been talk i mean there's been talks of doing an all-age service. There's been talks of doing and you know, we have three different services right now in Nottinghamshire, putting an them all together. i mean, and and we don't know. and And those are just talks. There's not been any decisions or any any certain things. But if these things happen, you can imagine from a research point of view or from a clinical care point of view, when you say, okay, I'm going to work with Nottingham City about how can we make this different?
00:57:20
Speaker
And then a year later, there's no more Nottingham City. So Nottinghamshire thing. everyone's moved. and yeah Exactly. like and and and and And even for the staff, it's very disorientating for everyone. So it's it's very hard to make any concrete healthcare service plan in terms of research principally when it's a constantly changing environment. And as I say, you know the last five years have been, we've we've seen a lot of changes about ADHD care.
00:57:51
Speaker
I mean, increase in in in demands has just been unparalleled. compared to when I started my my project. so You have to keep evolving and a lot of people and places, organizations don't have them the capacity to keep evolving. No, no, the increase in in demand for ADHD is, I mean, it's it's extraordinary.
00:58:15
Speaker
It's hard to think of another condition where it's it's been so rapid in proportionate terms. um And and and um you know and we haven't we have not managed it well, but but equally we've got to manage.
00:58:29
Speaker
I keep thinking what one the answers will be, but, you know, I've worked with the adult services for 13 years and and this, please don't quote me on that because this is just an example and and it will have changed. But the last time, you know, we talked about it, there were over 6,000 adults waiting for a referral, but then you only have the staff to do, you know,
00:58:53
Speaker
a few hundreds. I wouldn't say, you know, exactly. But even if let's say, you know, there's there's enough staffing to do a thousand referrals, there's still 6,000 on a waiting list. So how do you deal with that? I mean, it's not like, you know, you can't manage it. You haven't been able to manage it well.
00:59:10
Speaker
How do you deal with that? You can't increase the staffing sixfold in every single services in the UK. Even if there was unlimited resources, if money was no option,
00:59:22
Speaker
There is not enough trained psychologists to do that. You know, i know it it's a for big puzzle. It's a huge puzzle. Yeah. And I don't know what the answer is. And and so I'm not going to do menggluda. I don't have any signs because I am a patient. um My kids have been on the waiting list for 30 months since reception is just about to go to year three.
00:59:44
Speaker
And we still don't have an official diagnosis. I've got to play it by this because, but, I want this as much as everybody else, but I also can see the side of you're fighting fires and and and the clinicians and the healthcare professionals are dealing with something that they can't deal with.
01:00:00
Speaker
Exactly. There's no answers. It's not like, oh yeah, it's just very sad. So I think that completes our questions.
01:00:14
Speaker
um was there Was there anything else you wanted to say before we um before we sort of close out? um People presumably can contact you via the training platform and if they want if they're and interested in the training. Is there any other way that they can kind of contact you or or talk to you about this stuff?
01:00:33
Speaker
No, I think I finished on a more positive note. I mean, ah it these things do make ah change.
Personal Motivation and Incremental Change
01:00:40
Speaker
the the The work that IDHK does, the research that we do, we we all have the same goal, which is to make things better in whatever capacity we have.
01:00:51
Speaker
I hope what you got from this podcast is, yes, this is my job and I'm i'm a researcher, but I'm really driven. I've got really strong personal interest in making things better for the future the kids, for myself.
01:01:04
Speaker
and So please, and anyone contact me in any way if you want me to come and train, you know, your workforce, your whatever. I'm always happy to have ah because that's what I got into the job for, you know, like this is what, and maybe, maybe this is not the answer, but if we cheap at it little by little, you know, like, and we do one little bit here, one little bit here, maybe we'll,
01:01:27
Speaker
it's all part of the bigger change. If we can't go do a top down and do a bottom up, as much as we can, we have chip away at the mountain. and yeah there's And it's going to take ages, but its it doesn't mean it's not worth doing.
01:01:41
Speaker
But you know what? That's what sometimes when I get a bit done, I'm like, Oh my God, this is, you know, we're never going to go anywhere. But then on the other hand, I say, you know what? If I train one GP that's going to spend the rest of his career making,
01:01:55
Speaker
life better for even just 10 patients over the next 20 years, then that's worth it. i don't care. If if one adult doesn't have to go through what I had to go through, if one child doesn't have to go through what my ma children had to go through, then I'm okay with that.
01:02:08
Speaker
a You know, why if it's only 10 families in the whole of the UK in the next 20 years, then it's still 10 families the out is that are better off. So exact I'm all okay with that. That's a great way to end it. Thank you so much. Because I was getting a bit down before.
01:02:22
Speaker
um Well, you will come back. um we have have the down bit just you don't love We're on a break for a couple of months, but I will be back in touch and we will um will well we'll get back on and hopefully we'll have Tess next time ah to join in the chat. But Blondie and French, thank you so much. Such an inspiring um ah
Episode Conclusion and Tess's Future Plans
01:02:42
Speaker
interview. Thank you so much.
01:02:43
Speaker
No worries.
01:02:46
Speaker
Okay, so that was Blondine, a force of nature. Thank you, Blondine. um So, this is the last episode for a bit, Tess. Yes, because I'm going to an undisclosed place and you'll never guess where.
01:03:00
Speaker
And does it begin with you? end in... And end in why? Yes, it does. Yeah. Oh, it's fine. I'll have a great time. I just think it's unsustainable to record a podcast with three people on an online call. I think that will just you never work. we will try to do episodes when you're back.
01:03:19
Speaker
Yes. And you are planning to come back every so often. Every now and then. Every now and then. and I will try and gather up some interviews while you're away and then we'll talk about the interviews and...
01:03:31
Speaker
Yeah. That's the plan. Cool. I might be restricted to exclusively intro outros. Although it's kind of been like that already. it's kind of been that for a while. But it's all right. I don't mind it. But yeah, I might have forced you to listen to the interviews in the future.
01:03:45
Speaker
No! My secret's out. I do sometimes. You do sometimes listen to I'll listen to this one. Yeah. i want to know about what makes Blundie such a force of nature. She is a force. Yeah.
01:03:57
Speaker
Many things. Many things make her a force of nature. Great. Um, Well, I think she just just doesn't stop. She's just unbelievable. She's one of the most unbelievably busy point people I've ever met.
01:04:08
Speaker
Perseverance. Yeah, perseverance. Drive. Yeah. All things that I am increasingly lacking. Hence the very, very, very long periods between episodes of this podcast. You can blame that on me if you want.
01:04:22
Speaker
Anyway, good luck to Tess. I'm sure everyone wishes Tess good luck. Good luck to Dad coping with me leaving. I know, I'm sad. But yeah, we will be going to do that and we will see you all at some point.
01:04:35
Speaker
At Christmas. ah Yes, we'll do a Christmas special, definitely. yeah Alright, bye! i Merry Christmas.