Professor Rosemary Calder, Mitchell Institute

Rosemary Calder: And thanks to both Minister Hunt and Professor Shoemaker.

So what we've heard, is what the roadmap asks for, and the question for us now in the Ministers words, is to take it forward, to put it into play, to make it happen.

So the question is where to from here. We're going to move into an open discussion forum and, as I said earlier it’s hard for webinar participants to be engaged in an open discussion forum so we're bringing within, into the panel of commentators, three more members of the working groups and an expert to have a discussion with you as far as possible about ‘where to from here?’.

The panel of chairs is going to be joined by Lyn English, a member of the lived experience working group, an Equally Well Australia lived experience South Australian representative and co-chair of the lived experience advisory group of the South Australian Office of the Chief Psychiatrist.

Judy Bentley also a member of the lived experience working group as an advocate for mental health carers and ACT representative for Lived Experience Australia.

Victoria Palmer is director at the ALIVE National Centre for mental health research translation in the Department of General Practice at the University of Melbourne.

Before I ask each of you to introduce yourselves briefly and to speak very briefly on your perspective of this project and where to from here, might I add that in the list of recommendations that our chairs have talked about, there are also some very significant research proposals, that haven't discussed in detail and it's the research element that Victoria Palmer is going to bring into this discussion now. So Lyn would you like to introduce yourself please.

Lyn English: Hello Rosemary, It was me, was my name? sorry I thought you were talking Victoria. Lyn English and I’d like to acknowledge the traditional owners of the land, Kaurna people that I’m sitting on today in Adelaide and welcome everybody. I’m a fairly active consumer not only, I guess the committees or working groups that Rosemary mentioned, but I also am a South Australian consumer rep on the national level of Consumer Care Forum. Which has been, I guess, a very stimulating and interesting forum to be on because you have the privilege of representing consumers not only from your state but doing your best to speak up for people or taking on board the information and raising the issues that people speak to you about. And there is no doubt, both in my personal life and family members and people I’ve been very close to and the carers and family members I know, Physical health and mental health is huge. And the frustrations, the concerns, the stigma, discrimination that goes along with people with mental illness trying to access help if they have physical health problem and the lack of, I guess, acknowledgement of what they’re trying to say, is an ongoing frustration and I just want change, I just want us to do things differently, and we will talk more about that as we progress, thank you.

Rosemary Calder: Thank you Lynn. Judy would you like to introduce yourself please

Judy Bentley: Yes. Hi I'm Judy Bentley and I’ve been the principal carer for my, a family member, a son, who has been very seriously unwell for 20 years. He's just reached the age of 40. But I despair at how the difference between how well his mental health issues are being managed, but not inclusive of his physical health issues.

This is a project I've been thrilled to be part of, it's something I care about very deeply and been working on, like Lyn, we've worked collaboratively through the Forum, the national register. So many projects that we've worked on over the years, but we're not often seeing them carried through to fruition. And I think there are so many issues that have come up today that are really

 

important. We talk about nurse navigators and I would say, what about the support facilitators that we had in Partner’s in Recovery. But this isn't really an introduction, I guess. I live in the Ngunnawal lands in Canberra. Previously, public servant. Mainly in policy areas of Department of Health. Still working with the National Health and Medical Research Council as an observer, which I love. But yes, I would love to see the physical issues that my son is living with now as well treated or, together with his mental health issues and terrific to be involved.

Rosemary Calder: Thanks Judy. Victoria.

Victoria Palmer on Wurundjeri Land: Thanks Rosemary. Thanks Lyn and Judy and for everyone for coming together and having a really important conversation around what is just simply an unacceptable issue, isn't it. Just can't keep continuing. I'm delighted to be the director of the ALIVE National Centre for Mental Health Research Translation that Rosemary introduced and our focus is on implementation and translation in primary care in the community settings. So you raise that challenge of where to from here, Rosemary. I'm very glad it's not just my job to figure that out. It's a collective effort and, most importantly, I think we've heard earlier from Dave and others, the importance of the peer community and workforce and then I think that's one of our first steps is thinking through what's the role of peer workers and peer navigators and nurse navigators in this whole system. So it's exciting times and I guess in reflecting on where we might go and what we might start to think about I was curious to think about how much we know about the implementation leavers and strategies that we might need in that primary care setting. So we have a wonderful roadmap, we have an extensive policy and practice focus there, and I think some next steps are to think about where the leavers are in that whole setting. And Chris mentioned, you know let's keep doing some of the things that do work but I do want to flag, that there are some things that don't work as well, that we know well and there's some huge gaps in terms of being able to identify leads, we know that cardiovascular risk calculators, for example, underestimate risk. All of those things, that we do need those tailored tools and technologies and things available readily at hand to do this job well. So that would be some early, early comments Rosemary, I don't want to keep going on, without allowing our further conversation and dialogue too. So happy to speak more after others have had their turns.

Rosemary Calder: Thanks Vicki and a very good launching pad I think for this discussion. Can I welcome back our chairs. And that Dave Peters, Malcolm Hopwood, Mark Morgan, David Castle and Chris Moy. We’re now going to have a discussion within the group, but also with you, the participants and I've been watching the questions-and-answers and in terms of levers in primary care as Vicki's referred to, one of the strongest running threads in the questions to date is the role of peer workers in primary care. Clearly, this has been the question from quite a number of consumers and carers who are participating today. We've heard through the discussion about the importance of peer support. I'd like to hear from some of the panellists and I know David Castle’s been engaging in the discussion with the question-and-answer forum. How can we take this forward? How can we take what will make a difference for consumers and carers into the system of change we're proposing in a way that builds the strength of support, reflects the evidence of what works, and build the evidence of what can work? Who would like to comment first? David.

 

 

David Castle: yeah, so I will comment first. First, I'm behind you all in terms of the time. It's getting to midnight here so I'm very alive and awake. Judy, I loved your… you really got it because that's exactly someone you love and you're seeing their mental health managed, but their physical health not and that just encapsulates everything we hear about. I love the idea of peer workers, and you

 

know we've had some such great successes on an individual level with it and I'm really trying to promulgate that here in this country as well. Although, and of course they’ve got quite a lot of peer workers, but gee the evidence base is slight, and that is our problem, you see. We've got to here use this opportunity, and I said this many times in our groups, we've got to use this opportunity to get the evidence base better and that's going in with an open mind, you know we shouldn't say, well, we have to prove they work because if they don’t, they don’t. But my gut feeling very strongly, is that they can do an enormous amount and my anecdotal evidence is it can be the pivot which really changes people's physical health trajectory and mental health trajectory as it happens. So that's where I'm at, but we need more evidence to get it in the budget.

Rosemary Calder: Thanks David and I can see a lot of nodding to that response, I think we probably answered those questions, as well as we are able. And Vicki it's a question for research, obviously, to build the evidence of what works. And how to embed peer support into primary care and mental and physical health care. Is that something you see is a potential agenda item for your Centre?

Victoria Palmer on Wurundjeri Land: yeah, most definitely Rosemary we've been working with many, many of the different lived experience communities, but I suppose with our lived experience lead Michelle Banfield who is involved with this project as well, which is fantastic. You know that is a conversation that needs to be had with peer workers in the room, as well, and people on the ground who bring that knowledge and expertise to the table, about how that might look. I know that, having been a researcher in the primary care space for 15 odd years, it's not an easy model to implement in terms of the busy general practice context. I wonder what whether Chris even might like to comment on that. You know how does this whole model look and feel? We all know why it's important in that regard, we’re all supportive of that, but then, how does it look and feel in practice and getting it in there on the day to day basis, on the ground, I think they're part of the questions that need to be answered too.

Rosemary Calder: And, yes.

Victoria Palmer on Wurundjeri Land: Chris has got his hand up.

Rosemary Calder: Over to Chris.

Chris Moy: I’m just going to say that, look, this is a really perfect time for all this to happen. So I'm part of the Primary Care Steering Group which is really looking at planning for the future. Crucial in all that. Our real problem, at the moment, is that General Practice is funded to be throughput. It's a conveyor belt in effect, and the incentive is to do that and we have to change the balance of that and to try and get it to do what we want it to do. So crucial to that, is a thing we're looking at, which is a thing called a voluntary patient registration or enrolment whatever you'd like to call it. Where essentially, you sign up to a particular practice that you have faith in. And that practice then has the ability…linked to that ability, is the ability to use a whole number of things like telehealth and things like linking to the Chronic Disease items. Maybe a few other things like extra funding for which we call the workforce centre payment for extra nursing and other staff, other allied health and also things like extra funding for say wound care or something like that. Now all of these things are… it's a critical part of this, just trying to pivot general practice away from just this conveyor belt type mentality to implement models of care like this which are really going to be far more important for people with chronic illnesses, where we're trying to implement something new that can get it into their radar. And to use data properly, and so you know if you've got a situation where somebody who's actually registered with a particular practice is then.. this practice is trying to change its model is willing to make the leap to implement a method of looking at the.. identifying the patients who

 

required this. Inviting them to be a part of a systematic way of looking after them, which, you know, where we look at certain measures to and we monitor them and we provide consultations using the chronic disease item numbers to try and support them to improve their care. And I think most importantly, the incentive for general practice at that point would be, is if general practice are willing to make this leap that we actually then get the extra support of extra funding through the PIP, for example, just called the Practice Incentive Payment, but I think beyond that what would be wonderful for me is to be able to be have the support of some sort of service navigator who could actually help me and, most importantly those patients actually navigate and support them through the process and better still wouldn't it be great then to be able to trial these peer support type models. Begin in a group type system using the practice after hours have a meeting of like minds and use those a peer supports to really help guide individuals through this process but also be mentors to them and models to be able to be far more, let's just say, assertive I could put it. And I'm a GP telling patients that they need to be assertive sometimes. To stand up for what they want in terms of their health care. So, I think there is a great opportunity at the moment what's going on with changes, potential changes in primary care and what we're proposing today are not incredibly expensive new models that are going to be imposed and would get people's backs up, so I think it's a great opportunity, and all I can say is, I think we should be going for.

Rosemary Calder: Thanks Chris. Lyn, would you like to comment.

Lyn English: Yeah Rosemary, I have to say I have just completed my CERT 4 in mental health peer work, the only real, I guess, the nationally recognized qualification for peer workers in mental health sorry that's Mental Health CERT 4 in Peer Work. And I've been around Mental Health a long time.

I've been a nurse, I've done all sorts of things, I won't go on, my own journey’s about 38 years I still have a clinical team that are utilized personally to try to keep me on the straight and narrow. What I want to say is, in doing that course over 18 months I learned a lot. I knew a lot. I’ve been a peer worker. But I learned a lot and I learned the depth that those who are doing the training have to go to and the amount of work that's involved in actually doing that course, the amount of knowledge that you need to have was beyond what I expected. What I want to say is, I think we have a similar problem with peer workers and with the peer workforce. I'm going to use that term more broadly and that's about carer peer workers and consumer peer workers. We have a similar problem. There's a stigma because I'm identifying as a consumer or a carer. There is this stigma, that I won't be able to.. that I won’t either cope, I will decompensate and I won't be very well, so there is already, I think a bit of judgment about the peer workforce. Rather than looking at it as a profession, as a part of a multi D team. In some cases, as someone who has value in being able to bring, you know, expertise, skills, and knowledge into a GPs practice, for instance. And, and I think we are still coping that judgment, despite every state, is at the moment, every state and territory is doing work on the peer workforce, the national mental health condition, you know, is just about realease the guidelines for the peer workforce, there is so much work happening. Louise Byrne you know, Dr Louise Byrne from Queensland. I mean there is a lot of evidence, maybe not as much in Australia. Scotland, New Zealand, you know, some European countries. There's lots of evidence about the benefits of peer worker. Yes, there's a lot of anecdotal evidence. But once again, you know, those of us that talk about the peers that have made a difference, or that peer worker, or that lived experience person we came across that helped turn a corner for, it just gets ignored, it just gets.. we keep harping on about the fact that we want more involvement, we want to be listened to more, we want to be included more. But it doesn't seem to translate into practice, it doesn't seem to translate into any level of belief. If we're frustrated about the fact that we go to a doctor and we're not listen to and you know our symptoms, sometimes physical symptoms are ignored because they see that disease and not the person, they say the diagnosis and not person. I think we're having a similar frustration

 

with the role of the peer workforce that, I think, there's a desperate need to move things, change things and instigate reform from a whole different understanding, which is that lived experience perspective.

Rosemary Calder: Thanks Lyn, and Dave, you want to comment.

Dave Peters on Boonwurrung lands: Thank you Rosemary, look Chris you made some fantastic points about the opportunity that primary care can offer and I guess the state that we’re in with changing MBS item numbers and reform that's going on, just because of COVID possibly being a sort of a platform, through which to launch further changes and further reform. But I'm wondering there's, I guess, an issue that we're very aware of that broadly speaking, very generally, that the people with serious mental illness and other disabilities, probably have less financial resources to access health services and I guess my own personal experience of Bulk Billing in primary care is that the practices, where that is available, seem to, I guess, rely upon, you know, fast turnover or fast turnaround between patients as a way of compensating for offering that Bulk Billing service. So I guess, you know, I'm very lucky that I've found a regular GP that's been able to support me over the years and has been able to address ,sort of, my needs. But many people with serious mental illness or you know many people in the community don't have access to a regular GP at all and I'm wondering if you have any recommendations about how to help people see the value in investing in the relationship of the GP and to build, you know, I guess, how to support people to not just see the importance of but to actually find a GP they can build a relationship with.

Rosemary Calder: That is a really big challenge at the core of this, we do have recommendations about the support for general practice to be able to connect well with people with serious mental illness, with a strong focus on their physical health not their mental illness alone. So, Chris has talked about the extra payments that should be considered attached to this particular group of people.

We've talked about registers in general practice that will help make certain that people are connected strongly to their practice. But you use the term lucky to have a good GP, other members of the consumer and carer group have used that term too. How do we get past, how do we take the recommendations that all of the groups have worked on that say very clearly, this has to happen? How do we really achieve change in the shortest possible time? Around changing ‘luck’ into a system approach that reaches everybody who can be reached. Who would like to go first on that?

Chris Moy: Chris Moy here again. I'm going to say again that I think there is critical national work on this with this Primary Care Steering Group, and this work just fits beautifully in there. Getting back to what Dave said. Look, bottom line is there's several things, the first thing is, is that doctors are people in there that's…. it's a double-edged sword there. Sometimes you get along with them, sometimes you don't, you need to understand that. The second part of it, though, is that with respect to that, it's the critical part about the Primary Care Steering Group work to change this to a voluntary patient registration, is this idea that there is actually a reciprocal relationship, there's a clear relationship between the doctor and the patient. Rather than just a purely commercial relationship where you turn up for consultation, you go out and you get a service, and you move on. Because that's what we've got to get away from. That's what this is all about. It does need this continuity of care over a long period of time and some faith in the system. Now, in amongst that is, with a lot of that work, is actually trying to change the funding from this fee-for-service to funding which, number one gets directed to say other providers. That includes things like nurse navigators or social workers or others who can help assist our patients, you know, in a much more multi-D type sort of model of care. And I think the other thing is, if we can get that funding right, if a practice can show that they can do this and improve the health of individuals, then extra funding can go to these practices. They prove they actually improve the care of people not only stopping them ending up in

 

hospital, saving the health system a lot of money, but actually help their health. On an ongoing long- term basis. Well, I think, you know, extra funding should be going to that. We should be starting to think about switching and that's whole point of this Primary Care Steering Group. So, I'll say it again, that this work here is beautiful. Fits very nicely with where this Steering Group is heading and, ideally, I suspect, where the Government heading in the longer term.

Rosemary Calder: Thanks Chris. We’ve got a number of panellists who want to comment, can I go first to Mark Morgan, the other GP on this group.

Mark Morgan: Thank you. Look I’ll echo what Chris said, one of the things we discussed in the Microsystem Group is what about those people who do not have a GP, how do you get a warm handoff between specialty services in general practice if their isn’t GP or an affordable, accessible GP? And we looked at whether or not we could, as Chris suggested, provide funding but not in terms of single dollars, but in terms of access to the Community Mental Health Nurse working in, embedded in those practices in exchange for those practices putting their hand up to be an open door for people that can't find a suitable GP. And you start to get a win-win there. You start to get practices that have the support of an embedded person with social work skills, with the ability to connect to peer support working, ability to connect people to non-health services, what we call social prescribing. And to work closely with individual people to make sure that their health care is coordinated and timely and addresses physical needs with mental health needs simultaneously. So, access at a practice level to that Community mental health worker embedded in practice can start to get a virtuous loop going. And that's sort of model we looked at, rather than purely trying to pay for performance outcomes, which is something that has all sorts of unintended consequences. Thank you.

Rosemary Calder: Thanks Mark and I’m now going to go to Judy who hasn't had a hand up, and I know that she was about to speak. What has worked for your family?

Judy Bentley: Well, I would say today that it helps if you've got carers who can put their hands in their pockets and provide the money that the person they're caring for doesn't have to attend a GP or a physiotherapist or a dietitian or whatever. And there are not always carers available. But I know the cost to me over the last 20 years has been huge. There’s been physical costs, there’s been emotional costs, but it's the financial costs as well, so it's not easy. But I noticed Brenda Happell, and I would agree, there are so many things we're not learning from other programs. We had the Mental Health Nurse Incentive Programs, we had Mental Health Nurses embedded in GP practices, Partners in Recovery brought in the support facilitator method of supporting a person. My son needs somebody to help him navigate all these systems, he can't do it on his own. And I just think we've got to look back at what worked and how we can utilize those methods. It saved money. Partners in Recovery saved huge amounts of money for the Government. And it was simple, they didn't need.. support facilitators did not need to have, I suppose, academic qualifications. They could be grandmothers, they could be ex-teachers, whatever. Along with that peer support network, who I think needs support, extra support. But yeah, there's lots of people in the Community, we can call on for that facilitation role. I'll stop.

Rosemary Calder: Thanks Judy and I am noticing the Q-and-A, so thank you keep those coming, Are all centering around this issue. So, Malcolm to you. The maze of psychiatrists is not just a maze of psychiatrists. It’s a maze of mental and physical health care. We've heard about the programs that people feel strongly did make a difference. What would you want to do if you have the opportunity from a leadership position to say let's put this in place now?

 

 

Malcolm Hopwood: Well, I think it goes to what we put in the Roadmap, doesn't it Rosemary? And how it addresses the barriers that people are now describing. I think Chris and Mark have talked to some steps, would suggest in the Roadmap within a General Practice facility. We've talked a little in the roadmap about the cost barriers that Dave referred to. I think it's also important to think about this challenge at a broader population level. So, I talked to the SHIP study earlier. They told us there is a large group of people who receive their care for mental illness in the specialist sector, there's a large group they receive it solely in primary care and it probably underestimated the large group who currently don't receive any. And the barriers for them in accessing primary care and specialist care are going to be enormous. How does the roadmap ensure equity of access across all those groups is really important to think about. I think there's an interesting discussion to have about what might be the role of different components of an MDT (multidisciplinary team) and helping with that, including the Peer workforce in reducing that barrier. I think it's important to acknowledge those barriers include normal human behaviour. How many of us are good at looking after our physical health? And the impact of mental illness itself at times as well, so though they all contribute to that. I think it's really important that the Roadmap does contain that research component that you mentioned, with a call to the MRFF to look at funding research. What will help us to get people the care they need for their physical and mental health? What will the outcome of that be? and included, what will be the benefits for them, their family, and indeed the nation? I don't think we should underestimate that. We're only going to achieve that, through again, to bring from the Roadmap, that data linkage part. I think it's incredibly important. Because a number of the initiatives, people have described, fail. I kind of contend that ultimately part of the difficulty in getting ongoing support was demonstrating that high level data impact of those initiatives. We all knew they were good, we felt they were really positive, but could we demonstrate that, in a way that persuaded everyone? well, sadly, ultimately, the answer is kind of self-evident isn't it. That it didn't seem so. So, I think the roadmap does contain a number of things that are best seen as a package that will help solve some of these barriers. Won’t complete it, but will help begin to solve it.

Rosemary Calder: Thanks Malcolm. You’re absolutely right about the data. The groups all reflected strongly on the need to know and to measure what is done and how it's done and what it achieves and particularly to measure for the future, the narrowing of the gap, the staff divide that we've talked about, if we don't measure, it won't change. Vicki, can I ask you. You've had your hand up for the question and obviously you want to comment, and please do, but the question for you is we have an absence of evidence in a number of areas, the role of peer support workers in changing physical health outcomes. Lots of evidence about their engagement and supportive capabilities and outcomes, but not measuring a physical health improvement. A lack of evidence is a big issue, we have a lot of data we don't connect and clearly the Roadmap has made strong recommendations about how to do that well. What do you want to see done about bringing that to fruition?

Victoria Palmer on Wurundjeri Land: yeah like to think that the national Center, Rosemary, does present an opportunity on all those fronts. Particularly bringing the data together, and not duplicating and replicating what already exists and identifying those gaps and I think that's where those implementation leavers, that I was talking about are pretty important. You know, I think it's fairly apparent to everyone that our Centre has a very deep commitment to lived experience and a very deep commitment to supporting peer models going forward. And so, we're very happy to have conversations with people who bring models that we can look at and gather that evidence and again use that digital platform and space that will be coming. To gather it and bring it all together as a nation and work collectively with Equally Well and Being Equally Well. And I think that segues into

 

what I wanted to comment on too finally Rosemary is, and you know we talked a little bit about those Microsystems and the importance of looking at Microsystems and service delivery systems. But I think part of the conversation about the importance of the peer workforce as well, is linked in with the understanding that we're all part of our own Microsystems. And often the two Microsystems of service delivery don't necessarily match up with what's going on, on the ground, and I'm sure Judy and Lyn would feel equally the same. And what we're all about in the National Centre and in the work that we've been doing around tailored care and assertive cardiac care and all of the co-produced interventions that we've been trialling at the moment for heart health in this space. Is starting from the microsystem of the person first and what they're looking for, and I think that way we identify when there are gaps in not having a GP, for example. And we're starting from that whole person perspective and going outward. And I think that's probably something that, it's a really subtle reorientation of the healthcare system. It's not that there's not support for that or that we don't value that in primary care or that ‘generalism’ isn't a good fit with that, it is. It's a great and fantastic place to address this issue and to connect up with all the other sectors as Malcolm has pointed out and as David has pointed out. But there is a slight reorientation needed in how we, you know, develop our programs, and implement them to have that fit. That would be my perspective. Thank you for letting me have a moment at the end there.

Rosemary Calder: And thank you for that. Now, in the questions, we've got a number of questions that talk about the role of the workforce, and particularly the potential role of the Navigator as either a Nurse, Community Mental Health Nurse or Social Worker. A range of options. And we have talked in the roadmap, about the need to build workforce capability without cannibalizing other areas of healthcare need. But they’ve also talked in the questions about some of the connections that needs to be navigated. And one question I’ve noticed is about the loss of the Partnerships in Recovery Program and the migration of some of the people who worked in that program to the NDIS and the lack of connection back between what they're now doing, and what they once did. The Roadmap hasn't talked particularly to those external connections. Given that it's focus was on the front lines of care, particularly the role of Primary Care. But what the panel like to reflect on what we talked through, which was how to build better connections to all the resources that are needed.

What can we say should now be considered as part of the implementation of the Roadmap to reduce fragmentation, build the capacity to use the resources that are there to be used, who would like to comment? Judy and then David Castle.

Judy Bentley: I would just like to say it needs a national commitment. To start with and then leading through we sort of bring forward programs which work and then somehow, they get lost. But this is something that's been going on for too long. It's causing loss of productivity, it's a financial cost to all levels of government. But we've got to carry it through. There's got to be a commitment. We start at the top, we include everyone who's involved and we carry it through. We don't keep it going for three years, “look at works”, but we move on to something else. I'd love to see this…I don't want to do another 20 years of caring for somebody that I think will probably die before I do and yep just it's got to be a national commitment at every level.

Rosemary Calder: Thanks Judy and a brief comment from David.

 

 

David Castle: yeah I think you know we spoke a lot about supporting people, but maybe we haven't talked enough at this forum at least about actually empowering people. So, you know models which actually say, our aim is to empower you as the still point in your turning world. For you to understand what your rights are broadly in terms of your mental health, as well as your physical

 

health. As well as give them the knowledge and the wherewithal to be able to negotiate this and ask the questions. And you know so many people with mental health problems and carers feel hugely disempowered by services which are too complex, which are shifting all the time. I always joke, rather badly Judy, about if your program actually wins an award, that'll probably be shut down because that seems to be the way it happens in Australia. And it is a crying shame. But to my mind, the only real answer is to empower people themselves.

Rosemary Calder: Thanks David. And thank you all. That was a really good discussion. We’ve had a lot of questions. I tried to scoop them into groups to ask the panellists to respond to those groups. We will do more if we can, after the session. And can I now hand on to Russell Roberts, from Equally Well Australia, who will talk about the future challenges. We've delivered the roadmap, all of us, and thank you all for your part. The roadmap now needs to be implemented, and it needs to be implemented with all our support. Russell.