 Right, hello everyone again, sorry I introduced myself a little bit prematurely. So in the UK we have something that's called Better Birth which came out a couple of years ago which I think you probably will all have heard of and it had seven arms to it and one of the arms was Continuity of Carer which is something that isn't really achieved in a big way across the UK which is a shame. Things are changing, there's been a lot of talk, there's change in the air and as a student midwife I can see in my own trust that they're shifting towards a more woman-centred and individualised care pathway which is hopefully going to include Continuity of Carer. So I can see that Vicki you're a lead maternity carer and you're a caseload midwife, that's really interesting. Where are you Vicki? Whereabouts? Okay so you're in New Zealand too so in New Zealand I suppose for a lot of us we look at New Zealand as the gold standard for giving women great continuity of care and that you take a lot of responsibility for women's care. Yes do you have a microphone on Vicki? If you go up to the red telephone singing at the top of the screen and go through the process you could get access to the speech. Yeah Vicki's going to do it I think and that should apply to all of you and then you can have a proper discussion it's very slow if you write it down in the chat room so have a go. Just click on the red telephone singing at the top there and choose instead of the headphones the mic and then you'll be able to talk. Is that working Vicki? Can you hear me now? Oh hello yes hi Vicki. How are you? All the way across the other side of the ocean? It's magic isn't it? This is amazing. Congratulations on your new job. Thank you I'm very excited. Yes fabulous oh you'll love it working with women is absolutely brilliant and I'll tell you if you can get a caseload job working with that continuity of care model it's just fantastic. Yes well I mean that is my that's my plan although the trust doesn't have a place at the moment but the government has said that they want at least 20% of women to have Continuity of Care by next year so they are going to have to start doing something about how we deliver care to women and I'm hoping it's going to go in a sort of Continuity of Care model way. I mean there's lots of there are lots of pockets in the UK of brilliant models that provide women with exactly you know caseload in care and it works but it's I don't know why it's not rolled out across the UK so how does it work in New Zealand? Well usually they go to their GP find out they're pregnant get a list of midwives some of them they know some of them they don't I've been in New Zealand for 20 years I'm Australian and it's definitely a better system than Australia and it's usually word of mouth so they just bring you up and then you start right from minute one and you look after them all the way through you do all their anti-native care organize all the blood tests the whole lot you do care planning where you plan how you they want a birth like usually we do home births water births in the hospital out of the hospital in intensive care if they need to so we can do high-risk patients as well and we do six weeks postnatal in their houses. Six weeks gosh very good and do they have scans how many scans do they have as standard in their pregnancy? It used to be two but now because of the grow programs it can be five. Right okay more intervention isn't it and so if a woman needs obstetric care does she see the obstetrician and also yes they can they do parallel care and so I can send for a consult just a one-off consult or they can actually be taken over by the obstetrician they have clinical responsibility of the obstetrician and then we do our primary midwifery which is the breastfeeding and the other measuring the funders and all of those visits and if they completely get taken over we still have that opportunity to be midwives supporting the secondary women that are taken over by the obstetrician. And do you work in teams to provide the care or do you just work alone? We work alone but we have there's about four midwives in this I only work in a very small hospital and we have the backup of another midwife so there's sort of four of us working loosely together if you have days off or but we're all workaholics. Oh yeah so you're always on call for your women? Yes yeah I think that's I think when you say caseloading to midwives some midwives in the UK they they think well that's going to be my entire life taken over and they worry about burnout and how they're going to cope but there are models in England where you're on call for 12 hours rather than 24 hours and you're in charge of your own off-duty so you're in control of the hours you work. If you have a good partner in New Zealand that can work very well where like I'm you know I go to Australia I'm going to Ruritanga this year and went to the midwives conference in last year in Canada and so you can get time off you just got to make sure you look after yourself from that point of view and have a good partner. Yeah I'm just reading Laura's comments I recently learned if you're working with midwives you share the same values yourself you can make it work yeah that's so true so Laura can you use your microphone can you talk to us Laura because you're a student in New Zealand aren't you that'd be really interesting can you do me. Hello hi welcome. Hi. So are you a first year did you say or third year? I am yes you're a first year so what's how does your training work so your midwives New Zealand midwives work in a quite different way in the UK so us midwives, student midwives in the UK we're based in hospitals and we get my particular course meant I case-loaded two women and that for me was like a like an epiphany I thought well this is how I want to work and I provided all the care for the women from start to finish like a no-brainer that there was best thing for the woman it was best thing for me but it doesn't work like that for everyone here so do you do lots of case-loading in your training in New Zealand? Yeah so part of first year we have five follow-through women that we follow right well not necessarily right through what we find at the start of the year and we follow them through their antenatal care their birth and their six weeks postnatal care so we do an assignment on that so we have to do five to six women a year in first year that we find ourselves and then second year we partner up with a community midwife and that's where we get our follow-through through that midwife and I think we have about the same amount I think it's about five or six women that we follow through as well and then I think third year it's fairly much the same but it's a it's a larger number of women that we follow through each year and that's in addition to all of our placements in the hospital gosh so you do five or six women each year yeah I think I think that's I think that's what it is I think we have to have a total of 40 it might even be more than that but it might be even a total of 40 um follow-throughs that we need to have by the time that we apply for registration at the end of third year and that's not just birth managing the birth that's actually providing the care from the start yeah it's actually um being part of that continued care and being from postnatal birth and um sorry internatal birth and the postnatal period so gosh so in the UK we have to get 40 births to qualify but that is literally just attending the woman at the birth in the hospital yeah I think I I think yeah I know we have to have about 42 qualify it might not be that many follow-throughs but we are encouraged throughout the entire degree to um there we go 25 oh sorry yeah yeah so we are encouraged for the whole whole degree to for um to do that continuity of care that's amazing so Linda what happens if the birth to be in uni for lectures uh I study almost um courses here in New Zealand we don't actually have to go and physically sit in lectures we do I live in Wellington and Targo is down on the South Island which um so I do all of my study from home and I have weekly group sessions at the hospital so all of our study is blended learning we do it online we do it face to face and we get together um every few months um to do intensive blocks so births come priority so if we do have a woman who's in a birth um that's top priority um doesn't matter if you're going to be on an online class or at an intensive um obviously except for exams um but birth if you have a woman who's going to give birth and you're on call from 37 weeks and she goes into labour you go type things that's um that sounds so sensible so we have to attend lectures I mean actually that the course could be delivered online thinking about it quite successfully a lot of our studying is self-directed anyway but um we aren't allowed to miss lectures for the birth which seems crazy with our we only caseload two women and we're only allowed to go to we're not allowed to go now on your leave and we're only allowed to go attend the birth if it's within um term time and we're on shift which um it's quite restrictive especially as we only caseload two women you think that you want to sort of prioritise that over everything else yeah absolutely I think they've done it really well here so and do you have a good um retention so once qualified do midwives tend to stay in the job in New Zealand do you know um I'm not sure if the exact statistic there's a lot of movement going on over here because even though we've got a great system it's not funded properly by the government so um I know that there is a big amount a lot of midwives leaving the profession at the moment just due to the stresses and because they're not getting paid what they what they should be being paid but I think there's a lot of passion coming through the course and I think the course destruction the way to keep that passion up while at the same time keeping us realistic about what we're getting ourselves into but um I think yeah we're lucky in terms of the system we've got we just need it to be funded properly so that midwives aren't burning out and not being paid a pittance you know so I think that's the um concern in the UK from a lot of midwives is that we're not paid very much and the expectations of caseloading mean that you're doing a lot more work for not very much money so are your government listening to you we hope so there's lots of marches going on at the moment well there were last week leading up to today um so all we can do is wait and hope and I think we've got about two weeks before we hear about the budget so we're all waiting with a big breath at the moment okay yeah and um Zaira is it Zaira or Zara can you use your microphone Zaira you're a third year student I think is that what it said just wondered what your experience had been of your training and having access to so many caseloading women you don't have a microphone okay um that's no problem you can type an answer if you don't mind um I just wondered your opinion so having gone through three years of caseloading have you coped with that training have you got to a point where you felt you couldn't cope or it's too much to do the pressure to caseload so many women over three years I'm just interested to understand what pressures are on your students having that kind of setup because from my point of view it sounds perfect but then I was thinking well there's quite a lot of women to actually caseload when you're still training yeah the assignments are a pressure aren't they so looking after the women is great but there are lots of assignments because it's I assume it's an honours degree in New Zealand like it is in the UK since 2009 it's been an honours degree so there is a lot of expectation on academic ability as well as the clinical aspect of the job but I have to say I feel as though everything I have learned has come from working on the job I mean obviously you have to do some academic aspects it's not honours in Scotland oh that's right that's that's those it's not honours here yes that's not going in so Linda what's the difference between an honours and not honours then is there less academics work to do well it's just um it's just a basic degree in Scotland yeah I wonder what the honours bit means though oh and and well it's taking it to the next level in the um whatever you call it sqa is the Scottish version the educational framework honours is like a it's an extra year isn't it taking it to dissertation level we don't do that here in Scotland although we do do a direct masters right so you can go on to a masters from that degree well no you can go straight into a masters without having done your midwifery first but that's just a we anomaly and it's nothing really anything to do with this yes we also don't have students having to get their uh get money and all that we still give them a bursary I think the struggle is if we went to honours it might become like you having to get your own money and not get a bursary so if you want to go down that but anyway that's like the side there yes it's because you said UK and it wasn't like UK sorry yeah you're right I think well Scotland leaves the way in most of these things doesn't it we need to look more to how Scotland are running their degree I think um definitely so direct entry in New Zealand Laura um do you mean you do three years training and then you enter into midwifery practice you do not a nurse first is that what you mean yeah that's right you're not you don't have to do um you don't have to do nursing before you go into it so I mean you can but you still have to go through the um the three years you can get um recognition of prior learning for some aspects but it's um it's still a three year degree that you need to do yeah and is there then much opportunity for going on and doing I mean do most midwives go straight into the job um I don't know the stats on it but I believe so and then we do have um I know a lot of my mentors and a lot of other people that have recently graduated you know they like to think about doing their masters it's something that I'd love to do because I eventually want to educate as well so yes Australia is hi terry Australia is direct entry you don't need a degree in nursing they have double degrees oh that's interesting so so how does that work terry you you is it longer to do a double degree so in Australia are you a are you a student midwife terry or are you a an educator can you turn your microphone on four years versus three years that's interesting sorry you are a I don't know how to turn it on so I think you can click on the phone at the top the icon and click on it and it should go red and that means that you can talk into the the um microphone on your laptop or computer uh is it working hello yes all right hi hi hi terry you lovely to speak to you so introduce yourself are you a student or a yes um I study part-time midwifery yeah in Australia and um in Australia you can either do nursing which is three-year degree and they also have I think they have honours as well um I'm sure they do um and all you can do midwifery uh and some some universities allow you to study nursing and midwifery part-time and some also offer double degrees um why you need that I'm going to doesn't offer the double degree so I would have to do two separate degrees um if I wanted to do both for instance um to be able to turn a health nurse you do you need a double degree and a master's um what's the maternity health nurse what do they do uh in New Zealand the New Zealanders will be familiar with a blanket nurse it's um the nurse that you see after you have your baby um it's like um when you bring the baby for home from the hospital and the community nurse will come and check up on the baby and then you have like the couple of weeks check and then the six months check and then the one year check etc right so it's like a health visitor I guess in the UK yeah yeah it must be like that um yeah so to be a paternal child health nurse I think that's what it's called you do need a double and you before you're accepted into masters if you wanted to go down that path you have to serve a certain amount of hours with the nursing and midwifery before you're eligible to do that master's okay that makes sense I think doesn't it to get some experience under your belt yes but otherwise you can just be a midwife or just be a nurse if you don't want to do the double degree okay and what's your experience of continuity of care right in Australia is that something that's on the agenda they uh it's um because I'm from New Zealand I'm used to the way um the nursing I'm sorry the midwifery is there whereas it's kind of like community nursing is in the midwives will deliver the babies within families and friends etc or you've got the midwives at the hospital in Australia it's not like that um you mainly use the midwives at the hospital um and they've just in Victoria where I am they've got a clinic here that um so one of the first to be approved for private midwifery where the midwives can um see you before like while you're pregnant and then go with each other hospital to have your baby and then afterwards they follow you up as well post birth so that's kind of like caseloading must be yeah but that's um relatively new in Australia that type um because this is my first year here um studying in uh in Australia here but um I know that Australia is a whole that's something they're working towards so they have that constant care because otherwise it's um every time we do see a midwife it's a different midwife so it's not the same midwife whereas in New Zealand you'll have that one nurse oh sorry one midwife the whole time so they know your case they know you but that's not how it works in Australia you get whoever is on when you go to your visit to the hospital so did you say that was a private a privately run system did you say it's private in Australia we have private and public in New Zealand they don't have public sorry I don't have private they only have uh public so you wouldn't need insurance to deliver your babies in a private hospital in New Zealand but in Australia you do have private hospitals um and public hospitals but what they've done is um I forgot what they're called I think they're my midwives I can't remember their name they're a private clinic but they have an arrangement with a public hospital so they can deliver your baby there even though you're going to them the whole time yeah okay so Laura's commented that Australia has pockets of private midwives that do case load but as a whole they don't yeah that sounds similar to the UK so here we you tend to have the same communities you tend to see the same community midwife um so all the antenatal care is given by the same midwife hope to be usually and also that same midwife can give you post-natal care after the birth but the lack of continuity lies in the fact that when you actually are having the baby you're going into hospital and it can be any one of whoever's on shift working on labor ward you wouldn't have met them before yeah and midwives are lovely and they're really good at building that bond and that rapport quickly with women to build up that relationship but how lovely to have to have the woman that's looked after you all through your antenatal to deliver your baby and I think that's what we're trying to work towards yeah but it's going to take a humongous effort and vision and change to alter how we work in the UK at the moment there's little pilots across the country which have worked but I'm just wondering how so if you think Australia want to the driving force in the UK is that the better birth thing said that it's safe for care if we have better continuity said coming from the government there's a massive push on safety and reducing still birth rate and inter-part of deaths and that sort of thing so and all of the evidence is showing that if you have continuity of care you improve outcomes for baby and month. They might say the midwife is familiar with everything like your history and just a just consistency they can notice stuff whereas if you're having to explain yourself every single time you might something may be missed you never know because you're just having to explain everything all the time and women get sick of repeating this story over and over and over again as well and yes you're obviously risking missing something so do you think it's on the agenda in Australia? It definitely is because I think when the Epping branch so I can't remember the name and I did it initially it was like a bit of a trial and it worked out successfully and I believe they began rolling it out a bit more I don't know if it was their franchise or whatever it was but I know it was extended a bit more so I think that is something that they are working towards in Australia. So Laura said that it's called My Midwives? Yeah My Midwives is the one and I think Laura if it's Laura from Epping I think that's her name I follow her on one of the pages that I'm on if she's the Laura that works for that company. Right. No that's not me I'm just here for Laura. No but I am Australian I moved from Australia a year and a bit ago to do my training here so. Oh right yeah. So Laura you're Australian and you're training in New Zealand and um yes yeah Harry you're a major citizen so I couldn't do my training in Australia. Okay so with what what were the drivers was it to do with how the New Zealand Midwives work Laura that made you want to train in New Zealand? Well my husband got an amazing job here so that was a big driving force and I'm used to start my training in Australia the year before last but um as it turned out you know the world works in weird ways and you know this is one of the best countries in the world to train as a midwife so yeah I just I'm very lucky to be training here absolutely yeah yeah so you made a good point about the fact that Australia doesn't support midwives as an autonomous profession. Yeah. Whereas in New Zealand they are so yeah in New Zealand are they so are midwives self-employed? Yes yes they are. Right whereas in Australia they're employed by a trust uh by a hospital yeah and there are midwives here that work at the hospital as well so yeah that's right when you come like in New Zealand at the moment there's a massive shortage so a lot of people have to rely on the hospital staff but it's it's a really bad shortage in New Zealand and people are struggling to find midwives so okay so there are some staff that work only in the hospital in New Zealand and they are employed by staff and they're not they don't have the autonomy autonomy okay that's really interesting they still are autonomous like they can still um prescribe and um within their scope and and that sort of thing but the the government yeah they're known as as an autonomous profession rather than having to work non-autonomously okay and so in New Zealand if a woman wants a home birth but she's high risk how do you manage that? I think it might vary I think it varies I'm not familiar with myself I know they have done it um but maybe Laura might know a bit more than she's in New Zealand. I think Vicki might know a bit more she's the qualified midwife in an autonomous part of New Zealand than I know does home birth so yeah so Vicki have you got any comments on high risk women are they allowed to make because choice is a big thing in the UK at the moment as well giving women choice for where they want to birth and following that up um is that the case in New Zealand? I would definitely send her maybe for an obstetric consult and um some midwives it depends on your experience and it depends on whether you live in the back of your living if you lived in Broken Hill or something like that I'd probably not do twins at home maybe not do breezes at home but but some midwives have that confidence and I mean I've delivered um like quite big BMI people down in um a primary unit um and was very successful but there's certain other big BMI's that I certainly wouldn't do at home or in the hospital so I think in New Zealand there's a partnership model there the woman wants a certain thing and then the midwife um can actually work out whether they're actually confident enough to do that um and obviously I have good support in this area so um you know you can it's not you're not a failure when you come in from a home birth to a hospital um I mean I have them all booked in at the hospital anyway um and I would do certain ones that I'd really encourage um women to be at home and that's where you empower women to really enjoy their birth um process for the for the um their journey for that for that nine months that you're working with them so you can do high risks at home but um like you know previous seizures at home if you've only had one seizure then that's a little bit more dodgy where I'd probably do maybe a second after a second vaginal birth maybe I would do that depends on how far from my base hospital I would be as well that's really interesting and do you think um um how happy I mean it's difficult to gauge but are our midwives in New Zealand happy with the way they work so it sounds like it provides an amazing service for women and I'm sure the women love how you provide case loading but are the staff car coping um the midwifery population is divided like the Australian midwives we're just talking between the hospital midwives and your independent midwives and of course there's a bit of competition between the two but then there's also um great collegial support where when I come into the hospital they know exactly how I work I know how they work um you know like to me actually just being with the woman and whether I deliver that baby or not so the hospital midwife might do that if they end up with epidurals then I will stay with my women all the way through and um yeah but I think the increased acuity with the increasing gestational diabetes the hypertension the obesity uh increasing diabetes insulin and all that type of thing it's really putting a strain on the hospital midwives because there's they're delivering more in the secondary services whereas the primary units and the home births are getting less in number and you're getting to have to be a bit more game but you also work in partnership with women and if they really really are determined then sometimes that's part of it that they can um be determined uh to to birth wherever they want to really um as long as it's safe testing and how do students work with you so they caseload their own women do they also have you as a mentor so I think the students um like in first year they might do five weeks with a hospital and five weeks with an lmc the lmc being the community midwives and then the second year they would do again their practical stuff would be all the way so there's like you do a birth but then there's another continuity paper where they have to do an anti natal visit a delivery or birth or whatever you want to call it and then um your post natal visit so they're the continuity so teaching them that um if you meet the meet the woman when they're anti natal then they obviously birth better I'm in a lot of the girls that I have don't want epi drills and they don't want to go to the bigger centres and all that other thing so it's just fantastic that um and if I work with a student like their third year placement I think is about um 17 weeks is one of their continuity papers so then they have to do all my clinics all my post natals and the whole lot so they actually get a really good opportunity to meet the women all the way through and so they will know them so that's actually really really good that those students will know them it's pretty rough on a student to not get paid and to have to be working with me for 17 weeks because I'm pretty busy yeah but what an amazing experience and I mean although when I I only caseload two women and I managed to be I did the whole thing for both of us at the birth of both and it was a really incredible experience um come out and visit me in New Zealand for six months I'll I'll help you I'll learn a little bit gosh I would absolutely love to I have three boys and a husband and a dog um so I'd have to I'd have to try and convince them I don't think I could leave my house uh five sorry I've been given a five minute warning okay thanks Linda um I think my point is coming from a student perspective in the UK um caseloading for all of us you talked to any students that have or sorry not the UK England because I'm from England um speak to any students coming from England that have caseloaded it's been the best part of their degree they've loved it and then we get into our jobs and we don't work in that way anymore and it's so frustrating so there is a big push with Better Birth to try and implement um a system that works and that doesn't burn midwives out that does that and I just are there any tips anything I guess um you're really experienced um sorry was it Terry who was I talking to or Vicki is it Vicki um you're really experiencing it is there anything that you would change about the system the way it works in New Zealand to make it better for midwives um obviously to work with partners that are similar minded and similar that's where you know if you're working together I mean you know you always go somewhere with with your friend and um the midwives I work with um become good friends and I think that's the main thing is to support each other and all the way through so that's from a positive point of view and and also um working with the women empowering them knowing that you're making a difference with everything in the whole um yeah and just look after yourself as women I mean midwives are women we don't look after ourselves we've got three kids a cat and a dog and and we do everything but you know we've really got to look after ourselves and that's what midwives day is about I think yeah and have that support from each other and um build relationships with each other yeah so funding is a real issue isn't it it's a shame so do students in New Zealand or do you think it's your you cope any students out there what was that can you repeat just asking the students whether they feel as though they are treated fairly as students and that they cope with their workload with the way it runs with lots of case loading um I would say that we've been tremendously supported by the midwives I mean granted I've only been in it for five months but um I feel tremendously supported by the midwives that I've come across um because they know that there's problems facing the profession and they just you know they want to see it fixed as much as they want it fixed so um yeah there's there's I mean New Zealand's a very small country so I think I think there's a really good camaraderie here and I think students as a on a whole generally speaking are very supported by the midwives out there that makes all the difference doesn't it so you have good mentorship from do you have the same mentor all the way through no we change mentors but we do have weekly sessions with a midwife a registered midwife who is our main mentor for the first and second year and they're just incredible they're a huge support but um yeah like I said it's a small country so we are supported by the profession definitely that's great to hear and is that the same in Australia would you say Terry? Yes we um the way that university all of our lecturers and tutors and um they're all either qualified midwives or nursing because um we a lot of our classes are shared with other disciplines within the health science area um but yeah very very supportive even for placements and just everything I feel so far um that they do go out of their way to really help you learn and make it a really good experience so yeah I'm pretty happy with the mentorship over here. Do you have the same mentor for do you have continuity of mentor because that's another issue in the UK? We have a set person that for instance we have like the course coordinator like she's a midwife um and then we will have a separate person for placement and it's the same person um and then like the lecturer usually there's the main lecturer um and they'll have casual lecturers but overall we'll have the same lecturers or tutors throughout the whole course before the semester. That helps. Yeah exactly they become familiar with you as well so that also makes it easier. Great well I think we're almost done it's been I'm so thrilled that we've had um students and um midwives from right across the other side of the world it's just technology's amazing isn't it um and this is the lovely thing about the um International Day of the Midwife that we can all share our experiences and we can learn from each other. We've just had a new um person join us Lynn I think we're just finishing up but you probably hear this on here it can you can you listen in again Linda? Yeah and about an hour's time it will be um the recording will be on the website in the event. Oh great. But you've got a couple of minutes if Lynn has any burning questions. Yeah so where are you from Lynn? You can activate your mic by clicking on the red button. No questions you're just listening. Are you from the UK? So if anyone would like to share their Twitter handle or username I'd love to follow you and a big fan of um social media. So um writing a Twitter username in the chat box that'd be great if you are on Twitter. What's your um what's your campaign called? Get your tweet out or something. Get your tweet on. Oh there you go I was almost right I mentioned you yesterday at the thing I was doing down in England. Oh did you? Thank you. Yeah I got 110 more students following you which we would love wouldn't you? That'd be amazing yeah. Yeah I'm passionate about using social media to bring everyone together collaborate. Totally that's what my presentation was about yesterday. Really? Yeah when it was to a multi professional team as well so uh and it was all about how we should be using social media more to to record things like this um so that people not only those people who go to conferences who have to pay for them obviously um hear a presentation but you actually everybody has a chance to listen to the presentation so anyway sorry. Yeah get your tweet on. That's great but I think I've done this um any last minute um questions or anything before I kind of finish off this session with a couple of slides? No I want to thank everybody for coming as well because actually this has been a really good discussion and it makes me think that next year we maybe should have more of these instead of presentations you know like a a conversation between two people you know it's much more interesting than listening to sometimes than listening to one person giving a presentation you get a set of questions and then you can ask them and they give the same information but in a far more interactive interesting way I think so we should try that. Anybody fancied having a go next year just tell us. Yeah there you go so make sure you've got this in your diary for next year now and make sure you follow the blog or are on our mailing list or whatever so that you hear about us call put now call for abstracts and we could do something like that I think that would be fabulous as well as cafes but you won't be a student next year though will you Charly? I'll be a fully fledged midwife. You're on mute I'll mute you that's grand and did I hear that you've got a job already? Yes I've got a job where I wanted to work so I'm really really thrilled. Oh fabulous and I'm going to be on their case about caseloading. Quite right as well it's a big debate actually it's a big discussion up here in Scotland as well where people don't really fancy being on call all the time but they're not being very realistic about yes she can so I want to thank Charly anyway for being a fabulous facilitator in this student cafe and to all of you for coming and sharing in with this and I'll just move