Sara Nelson, NHS asthma pioneer, Queen's nurse and digital app champion

In this episode of the "Up, Up and Away" podcast, hosted by Dom Burch with co-host Saira Arif, guest Sara Nelson, a nurse by background and a passionate advocate for asthma care, shares her extensive experience in transforming children and young people's health services through digital innovation. 

The episode sheds light on the evolution of asthma care, emphasising the importance of digital tools like the Digital Health Passport in managing the condition.

Sara discusses her journey from a nurse specialising in cardiothoracic care to becoming a pivotal figure in asthma management. Her work includes founding impactful initiatives like the "Ask About Asthma" campaign and the "Right Inhaler Image" campaigns, aiming to standardise asthma care and educate on proper inhaler use. Sara highlights the significance of these programmes: '#AskAboutAsthma campaign, is the importance of having an asthma action plan, ensuring people know how to use their inhalers and having annual reviews."

She reflects on the transformation in asthma care, noting the progress made in standardising treatments and the shift towards digital health solutions that empower patients to manage their conditions effectively. Sara proudly mentions the collaborative effort in London that led to the development of the National Asthma bundle of care, which was inspired by successful models in Finland. 

Sara highlights the importance of co-production in health app development, emphasising that involving patients in the design process ensures the tools meet their needs and improve self-management. And recalls first meeting Saira, "It was great to have you as one of the first people who used the asthma app, it really helped with some of that initial patient engagement,".

The conversation also covers broader issues of air quality and its impact on asthma, underlining the ongoing need for public health initiatives and education to reduce asthma triggers in the environment.

This episode serves as a powerful testament to the benefits of integrated, patient-centred care and the potential of digital tools to revolutionise healthcare for chronic conditions like asthma. Sara's insights and experiences provide valuable lessons on the importance of adaptability, collaboration, and innovation in healthcare.

For more information on the Digital Health Passport and to hear more insightful discussions on digital health, listeners can visit Digital Health Passport.

Transcript

Dom Burch: 0:09

Welcome back to The up and away podcast from digital health passport. This is the podcast where we get to speak to thought leaders from across the digital health sector. And I'm delighted this week to welcome Sara Nelson to the podcast alongside my co host, Saira Arif. Saira and Sara, welcome aboard.

Saira Arif: 0:29

Hello.

Sara Nelson: 0:30

Hi,

Dom Burch: 0:31

Sara, listen, it's an absolute delight to have you and I know you and we're going to talk about it later that you're approaching the end of a chapter of your life. But before we get there, I want to hear about what's gone before now. You're the joint head of children and young people's transformation and an NHS app ambassador, and you're a queen's nurse, which I want to find out more about. And of course, you're the founder of the ask about asthma and the right inhaler image campaigns. It sounds like you've packed an awful lot in.

Sara Nelson: 1:01

Thanks, Dom. It's really nice to meet you after so long, and it's great to be with you Saira, again, our paths have crossed a few times. So as you said, I'm, I've done quite a lot in my career. I am a nurse by background, I trained at the Westminster hospital some years ago. And I care to mention, I have worked within a sort of variety of innovative roles, both of them primary, secondary, and tertiary care. I actually spent about 30 years working within cardiothoracic X, I did my cardiothoracic course at the Bronx, and back in the 80s, and I was the first thoracic surgical assistant in the country as well. And I set up pre machine clinics for cardiac and thoracic patients. And then, along came Andrew Lansley and his magic wands, and moved me into the world of children and young people. And I've never looked back. You mentioned the work I've done during that time in healthy London partnership around the last London Asper programme, which is where I first came across Greg and Matt. Sadly, the London Haskell programme started out because we had seen a lot of variation of fragmentation and care in the Capitol and too many steps, unfortunately. So we decided that we needed to do something about it. And we developed a number of standards, these have since gone on to become the sort of National Asthma bundle of care, all of the elements of original standards were in there. But when we wrote the standards, we didn't want them to just be another document that sat on the, on the shelf for years, and gathered more dust. And we wanted to have some sort of real impact in the Capitol had been a lot of work done in Finland. And we wanted to emulate a similar model across the Capitol, but obviously didn't have the same capacity in terms of staff, and we have a lot more population than they have. So we tried to sort of develop tools that were actually would actually help people on the ground. And the first one of that was the asthma toolkit. And then as you mentioned, we then went on to set up the ask about asthma campaign, which this year in September will be its eighth year. And part of the ask for asthma campaign, is the importance of having an asthma action plan, ensuring people know how to use their inhalers and having annual reviews. And so, I do tend to like to try and think a little bit outside the box. And so my boss and I at the time, Tracy, PA, decided that one of the things that might help to manage patients to self manage their condition a little bit better would be to have an app. So hence that was how we started journey with with Greg and Matt and the development of the digital health passport. That's

Saira Arif: 4:14

I think, when I first met you, Sarah, so I was in northwest London CCGs. And I was part of the digital transformation, digital innovation team. And I remember that was sort of my first step into digital health and I remember thinking about what was going on around within that digital footprint within northwest London and London itself. And I was trying to do a bit of like, you know, market analysis of you know, what are the tools are there what are the techniques and digital tech are there in in northwest London, and that's where I came across actually this this new app that they're talking about? You know, let me go upstairs to see what Sarah Nelson's doing and her team and Tracy fall. And I remember coming across Sarah and Tracy and the work that they were doing and it's sort of it was quite an initial phase at that time, off digital passport. So that's where I first met you. And I think that was one of my, I think the first encounters I had with Greg and Matt as well, some, I think it was a panel. And I remember thinking, wow, this is this is gonna grow. It looks like such a fantastic app at this stage. I can, I can see what you know what the future is gonna hold for this? And yes, great to be part of the team and kind of circle back around. And Sarah right now is all talking to her. So So yeah, absolutely

Sara Nelson: 5:23

It was great to have you as one of the first great. people who use the the asthma app, and really sort of helped with some of that that initial patient engagement. So because one of the things that was really key for us was to ensure that we had co-production as part of the development and iterations of the app. And you had a lot of experience with with patient engagement. And that's what we were tapping into. But to find out that you also had Asperger's and could become one of our users was was absolutely fabulous. And one of one of the other early users that was a really important one for us, was during the sort of like the development of our asthma programme. We have had Rosamund Kissi-Debrah as part of our, of our leadership group. So Robert, her son also became one of our early users, because as she known, Rosalind sadly lost her daughter to asthma at an early stage, and we've worked with her very closely since, because her daughter is the first person to have a quality on her death certificate.

Dom Burch: 6:35

Looking back, and when I heard you say, a minute ago, you were really keen to make sure that these documents, these plans you were pulling together didn't just sit on a shelf and gather dust. And it must be one of the frustrations of working in a sector where, you know, certainly with your experience, you can see what needs to happen. But turning that sort of tanker around, so that you start to make real progress. And here we are, you know, eight years on from ask about asthma. But the issue is still very much alive. But what are the things? What are the things that are the positives, because I think we can talk about some things that still need to happen in a moment. But what are the positives you take from the last decade, where things are beginning to change where the system is beginning to react or where, frankly, innovation is kind of getting through anyway?

Sara Nelson: 7:17

I think some of the positives have to be the fact that that it has a greater presence. It's, sadly, because of the large number of deaths. I mean, I think, in a report just this morning, they said that there are 12,000 deaths in the UK, and probably about 25 to 30 of those are children. And because of that, it's a strong why as to why we need to make some changes. And so the fact that the national team has picked this up as one of their programmes of work and have developed the National Assessment, bundle of care has got to be a positive. I think in London, the positives are that we've developed this sort of social movement of change across the Capitol. I'm not saying as you said that we've done it all we weren't far from from that. But we do have a number of projects. I mean, when I first started, I think there were only one or two asthma nurses in the Capitol. Now we've got a growing group, we have a WhatsApp group where they all communicate with each other. And there's about 85 people on that now. So that, for me is a real positive. I mean, obviously, I was a practice nurse at some stage. So I realised how important practice nurses and asthma nurses how key they are to sort of helping children and young people, well, and adults, obviously, with asthma. Because if we can get asthma control correct in primary care, then we would have less need for admissions to hospital and treatments in hospitals in tertiary care as well.

Dom Burch: 9:02

And sorry, we've seen it, haven't we? Well, we've worked with some respiratory nurses right down at the kind of GP level where you're explaining what an application can do. Or how Digital's can help a young person manage their own asthma, be aware of things like triggers, be able to track their symptoms, be able to even learn how to use their own inhaler properly, and actually working with experts on the ground, how they can onboard people and support them and show and demonstrate and just how key those in terms of getting traction, because you've just spoken to a couple Haven't you recently?

Saira Arif: 9:34

Yeah, that's right. There's a few master nurses that I spoke to, I think it was a northeast London region. And I mean, they're doing great work in sort of embedding the digital passport technology just in general, into the sort of touch points with the patients. So they're utilising the same routine that they would have in a asthma review, but sort of kind of started to integrate some of that tech solution into it. So here's a digital passport that can help you You know, look up inhaler techniques, the correct inhaler techniques, or, you know, if you want to start recording your symptoms over a period of time, this is how you can do it. And we're moving away from that paper based. I remember I used to get paper care plans and solutions and printouts of things from from Google Now. It's like, well, here's the app, everything that you need is in that one place. So yeah, we're seeing that kind of, in the in the frontline now, of asthma nurses actually doing that sort of really looking at those touch points that they have, and actually starting to embed the app into their everyday routine. So yeah, it's been brilliant. Yeah. And

Sara Nelson: 10:36

that's so so important, because improving medication adherence and avoiding asthma triggers, particularly things like air quality, dust, cats, dogs, etc. That mould, they're also important, and the app can sort of really help to get patients to think about that, look at what their risk factors are, and try and avoid it. And there's useful things to sort of think about, if the air quality is not great today, we I can take a different walk to school. And we don't want people avoiding going outside because the pollen count is high today. But we want them to continue to some leaders as an active life as possible. Because as a cardiovascular nurse, I seriously don't want people sitting at home and not getting out and exercising. And

Dom Burch: 11:24

you mentioned earlier about CO designing with young people or with patients who have a particular condition like asthma and the importance of doing that and figuring it out. And and oh, sorry, you were sharing something this morning on our WhatsApp or our Slack crypt, whatever, I lose track of which technology we're on half the time anyway, we were chatting earlier about it. And actually somebody who's neurodiverse and working with them to solve the issues that present for them as somebody that approaches the world in a completely different perspective than perhaps somebody might be neurotypical. But that CO design is so important, isn't it as we're developing solutions,

Sara Nelson: 11:58

the voice of young people is absolutely key and at the heart of everything that I do not just around asthma, but for all this sort of transformation that we do in the capsule. And we work very closely with young people to sort of CO produce any of the work that we we do. And so obviously, it was very key in terms of of the asthma work as well.

Dom Burch: 12:20

And one of the things that came up in our conversation when Sarah and I were chatting, and it was something Greg mentioned, right, we're in we're in a conversation with an ICB I'm not going to say which one I don't embarrass anybody, right? But they were talking about how they were trying to reach young people. And they tried this digital thing. But they found that in their part of the world is very difficult, because you know, we're talking about a lot of deprivation. And it was quite difficult to reach people and of digital, different languages and all the rest of it. And Greg made the point and he wasn't you made the point that added us don't find it hard. McDonald's don't find it hard. And tick tock definitely don't find it hard to engage young people. And that for me was like, isn't that the truth we sometimes talk about, it's very difficult to reach people they're hard to reach. But actually Saira made the point, we need to look in the mirror, if we're not reaching them, what could we be doing differently in order to engage them? Rather than just going? Well, it's teenagers, right?

Sara Nelson: 13:17

Yeah, they're not hard to reach, you just have to go to where they are. I mean, I know that makes the same the same sense with adults as well, you know, you need to sort of go to places where people hang out, it goes back to COVID, but also my work in the cardiac field, when we were trying to introduce health checks for people over over 40 You know, men don't come for checks. So you go to the pubs and you do the check in the pub, you know, sometimes we just have to think completely different. And so a lot of the work that we've been doing around models of child health care, and integrated child health care, we have talked to the, to the young people and gone to where they are, and we do in northeast London, they have an amazing service called Health spot, which is in a youth centre, in sort of Stratford area, we just need to think outside the box a little bit and span some boundaries. We get very hooked up on bringing people into the hospital. And that's not the way things should be nowadays. We need to sort of use more digital ways of reaching out to people and use the young people or who whichever community you are trying to work with. Talk to them and ask them what matters to them. And that you'll find that's a good starting point. What's

Dom Burch: 14:47

next what what else needs to happen so, you know, with your sort of vantage point, and and being involved so heavily in some of this development and leading on things like ask about asthma, and also to know your inhaler. because, you know, it was picking up even today on the news reports that have been out. And we're talking about this report from 10 years ago, and how 12,000 people have some needlessly died. And just the misinformation that's out there, or the fact that the media will fall into the trap of using the wrong inhaler in the imagery that and that, therefore, you're sort of actually sending out a message that's been reinforced that might not be helpful, because, well, let's just go there, right, just describe some of the issues when it comes to knowing which asthma inhaler you should be using regularly. And if you're using one too much, then that's probably masking over a problem that needs to be fixed today.

Sara Nelson: 15:37

Yeah, I mean, you're absolutely right. It's really essential that people use their preventer inhalers regularly, and only use the reliever inhalers as and when they when they do need them. And if they're using them more than three times a week, they really should be seeking some further advice because it should suggest that the inflammation in their lungs is not being dampened down enough. And they need to perhaps change their preventer inhalers.

Dom Burch: 16:08

What are the things you're most proud of, you know, talk to me about being a queen's nurse and some of the things that you have achieved because you must look back and you'll share the glory, I'm sure your teams and all the other people that were involved, but you must look back with a degree of pride that you're leaving this sector in a better place than when you found it. Yes, I

Sara Nelson: 16:26

am very proud of the fact that I received a queen's nurse award, the Queen's nursing award goes to people who have done a lot of work within the community sector working in primary care, etc. So that was a recognition of a lot of the previous work I've done in the cardiac field, but also in Medicare. But I think probably the thing I'm most proud of which was was the work during COVID Was I was part of an HS J award winning team to move to homeless off the streets of London to get them safe and into hotels. And it was a really sobering thing to to do. We worked with amazing voluntary sector partners, and many other partners like the GLA and the London councils and, you know, the whole of the health sector, and my amazing boss, Gemma Gilbert, I learned a lot from just that experience that can be taken into many, many aspects of care within the NHS. So that's probably that was probably one of my most proud moments, but I'm just proud, really, as well, of all the people that I've worked with along the way, because it's not just about me, it's a it's a real team effort. And you can't make change unless you bring people along with you together.

Dom Burch: 17:57

And let's talk about some of the unknowns then. Right. So air quality, let's take air quality example. I live in Bradford where air quality is, is terrible, you know. And so we've introduced a clear rate zone. And it's beginning to make little impact. Whereas in London, I've really noticed that and I'm sure things aren't where they need to be. But as a visitor to London, I've really noticed how much better the air quality is. And I'm speaking sorry, here is somebody with asthma, right? So yeah, I'm sure you're gonna say to me, Dom, you're talking bollocks. But it feels to me like the electric cars, the clear Arizona buses are moving, more cycling, things are beginning to move. But I bet they're not moving quickly enough.

Sara Nelson: 18:36

No, I'm sure Rosalind Kissy, Deborah would absolutely agree with you with you there. It is making a change. And you know, if we look back again to COVID That was probably the most the time when when the air quality was at its best. But sadly, I don't think people can put a link to return to those days and area at all. But yeah, there's still a lot of work to do. And it's in all our gifts to think about about how we can make small improvements and it's not always about the sort of big issues like Ulez etc. It's actually about what can you do within your own homes. There's a lot of indoor air pollution that we need to consider such as you know, candles, air fresheners, some a lot of the sort of canisters that we use in daily life they all add to issues of poor quality.

Saira Arif: 19:34

I've started using a salt lamp which I got from a salt cave that I went to in London and I think it's helping with the indoor because I have I have a cat so whilst I'm not allergic to cats, my triggers are normally dust. I find that the salt, the salt candles or the salt light lamps that have tends to do something to the air. I'm not sure how it works scientifically, but apparently that's one of those preventable altered and a two ways of sort of doing something indoors, I can kind of make some sort of progress with your with the ASPCA. So yeah, starting to learn new new things.

Sara Nelson: 20:08

Yeah, I don't know the evidence on that. But I do know that visiting. A lot of my family live in Germany and I went to a thought cave in Germany many years ago with my father, where they literally had sort of beds in many years ago, almost to sort of go and lie on these beds within the salt cave to improve poofer their lung conditions. Yeah.

Saira Arif: 20:31

So I think they say something about if you think about when you're on the beach, and you're walking along the ocean coastline, or whatever, the salt within the water and the air, it's why you feel good, like you know, and I actually it's funny because if I do go to beach, I actually feel like I can breathe a bit clearer, which is kind of weird because there is sands there is things in the air, but for some reason salty water or anything salty around me, it's actually quite good for for breathing, apparently. So yeah. Again, I don't know the evidence behind it. But I'm trying to learn alternative ways of sort of monitoring my asthma and keeping it at bay. And I mean, being in Dubai right now. For me, I really have to make sure I'm looking at the air quality alert because the air here is a very different to the UK. You know, we have sandstorms which is something you can't see. But sometimes you know, the sand is quite prevalent in the air. And there's so many different things that one has to do. But I don't think no one's talking about air quality, right? Only right now over here like we are in the UK. So that's something I'm trying to bring over here to try and get, you know, asthma advocacy up at its best. So yeah, I like

Dom Burch: 21:35

to think Syrah is like our international lead over there and Dubai. You just got that whole sort of corner of the earth to conquer. So Krakow Krakow. So you talked about being in Germany there, what what's next for you said, what, what are you planning? Next? What are the untapped ambitions that you still got? And actually, is that outside of health? Are you planning to do something completely different? Or? Or do you think it will always sort of be like this beckoning call that you'll always get dragged back toward it

Sara Nelson: 22:05

knows I am sort of retiring shortly, but who knows what the future will hold? I hope some of it will be spending more time with my family and my new or not so new grandson now, and definitely trying to get in some travel. So maybe I'll be coming out to see you. Saira, please, please do most welcome. Think in terms of the future around us. And for asthma. It's, it's potentially exciting, the NHS is sort of moving into a sort of phase of, of taking a much more quality improvement approach. So we will use this in our and our work to sort of continue to, to challenge and make change. But there's also lots of new technologies and new drugs on the horizon. And then whether you like it or not, AI is on the horizon as well. And we need to sort of consider how we can best use that to its most potential positive effect, it would be good to see if we could use AI to actually to benefit asthmatics, so looking at taking sort of data from from things like the Apple or from from care records, to actually sort of manage help them to manage their their risk factors more more effectively, providing alerts etc.

Dom Burch: 23:33

I can use I mean, like, clearly the whole health system is under a you know, huge strain, whether that's from just resourcing from the budgets, all the rest of it, right. But we are moving towards an era where people are going to have more control over their own health in the sense of knowing their own health know, being more aware of their own conditions, their symptoms, having the tools and the technologies that allow them to be better informed, and, and gradually moving towards this notion, whether it's, you know, diabetes, or sickle cell, or all these other things that if you are able to be well informed, well educated, and to use all of the technologies out there. And then for that, to also be plugged in at a very personal level to you as a human and the health system been able to talk to that data and understand that data, and better address your emergency if you end up at the back of an a&e. And, you know, I was imagine Greg being at the back of an a&e and, and another stranger coming in on a stretcher. And in the future, being able to better address who is that person on what are their individual needs? And what is their condition and what are their symptoms? And actually what we already know, because the system kind of knows this stuff, but it's just sort of dotted around in scraps of paper or, you know, on an old PC that won't load because it's, you know, 1986 or whatever, you know,

Sara Nelson: 24:55

yeah, I mean, we've seen huge strides since 1980. One when I first started nursing, when when the patient came into ame, you'd have to make hundreds of phone calls to find out anything about them. The least nowadays, when somebody gets in an ambulance or when they pitch up at a&e, you've at least got the summary care record for them. And there is of limited information, it's not perfect. I would like to see, the day when the records are fully integrated. We're moving that way in London, because we've now got the development of the universal care plan, which will hopefully help us a lot. And my vision originally for the digital health passport, which I mentioned earlier, was the fact that I wanted something that connected across the pathway. So basically, when when the child was born, they automatically got a health record from from the mother through something like the E red book. And this seamlessly morphed at the age of five into something like the digital health passport that the mother had, or the the carer had control of, until that age transition, when the young person began to take on more ownership for that for that app. And then when they go off to school like my son did, my youngest son, who had always been very healthy compared to the other two. So when he went off to university in Southampton, I got this panicked phone call to say, had he had his immunizations and what what health problems that he had in his life he had no, he couldn't answer the questions had he had his app in his hand, with all that information that had been tracked right the way through his lifetime, then that would have been very useful. And we now see in a way, most of that is now within the NHS app. And I'm looking forward to that point when other apps have access through the NHS login, so that patients can actually choose which apps can help self manage whatever condition that they've actually got. So I think we are moving in that direction. But I think the trouble is, with any change, it always takes a long time, it's that we have to take slow, steady steps.

Saira Arif: 27:24

I think my main question, which I think you've kind of answered there already was really like, what's your hope for the future of healthcare, not just asthma, but just healthcare in general? Given that, you know, we all know how fragmented it can be. And I know we're moving towards more of an integrated care sort of setup. But do you have any sort of hopes ambitions, or I guess, recommendations that you'd like to sort of share, just in general for health care, not just asthma,

Sara Nelson: 27:52

I think my hope for the future is obviously having a much more joined up, integrated system, that will be the first one. But actually, I'd really like us to focus much more on prevention. If we if we spent more time and money investing in young people, and across the pathway, other people sort of basically on preventative aspects of care, then we will hopefully prevent the sort of ill health in later life, investing in children in, in both education and in this sort of environment around them. And ensuring we think about equity is going to really make a difference. We saw so much in COVID, and learn so much in COVID, about the inequalities that exist across the Capitol. And we now need to sort of make sure that we actually address that, so that we've got a much brighter future. Many people will be sick of me saying that a third of our population, our children and young people, but they're 100% of our future. And so if we invest some time, money and energy into making their lives, the best that they can be, that will help us get to a long way to sort of preventing some of the long term conditions in the future. Yeah,

Saira Arif: 29:19

absolutely. Yes.

Dom Burch: 29:20

That's such a nice way to end the podcast. I almost don't want to ask you any more questions, but because I'm not gonna get tired of hearing that. I mean, that's such a powerful thing. So it's, you know, it's a third of who we are, but 100% of the future absolutely bang on. And what was coming up for me was just this notion that it's so important that we invest in order to save and it just seems this really strange situation where we're putting all of the money into the sort of the problem at the end rather than solving it further down the down the chain, obviously got world Aspen Day coming up in in a couple of weeks time. In fact, we'll probably put this podcast out in and around world asthma day. I mean, it's a good moment in time, isn't it just to draw attention to some of the issues? Yeah, So

Sara Nelson: 30:00

the National Review of asthma deaths as obviously 10. This year, it was a very useful document to hang this work of, sadly, we haven't managed to sort of achieve all the recommendations that have been outlined in that document. So we've got a lot, a lot of work to do. From our perspective, in London, we've obviously got our article about as a campaign coming up, but again, the ninth of September. And so we will continue to work with our partners and to raise awareness of this condition, because people don't realise they think that asthma is a really common condition. But they don't realise that it does actually, sadly, cause death, if it's not taken as seriously as it should be. And we also need to sort of think about the partners that we need to bring on board in the journey, we've worked really hard to take a very whole systems approach in London, including sort of schools and pharmacists, community pharmacists, etc. In as well as the sort of traditional primary, secondary and tertiary care clinicians. Or more recently, we've worked very closely with sort of public health teams as well around air quality, and obviously damp and mould and other triggers. So I think it's a good time to use and read as a period of reflection to look at what we have managed to achieve, but also to think about what are we going to do in the next 10 years to make a big difference to the Capitol. So

Dom Burch: 31:38

it's been lovely talking to Great to see you. And I'm a bit gutted, actually, that I'm only getting to meet you now. And you're closing off, you know, about to go off on retirement. So, so give us a little sprinkle what what's on this sort of to do list when you hang up your NHS pass and you go into work for the last time, what you know, are you going to be doing the garden or you're going to travel the world what's on the list?

Sara Nelson: 32:01

Everything probably, definitely, definitely need to tackle that garden that's got seriously out of control since COVID, because it's just laughable, spending more time with the family. I would like to revisit my very bad German because all my relatives speak fantastic English. I'd like to pick up that and I probably ought to sign up for a photography course because my husband bought me a really nice camera for a lot last year, which I still don't quite know how to use properly. Probably got to learn how to do that so that I can take lots of pictures when I go off on on my travels when you come to Dubai. When I come to Dubai, yeah.

Dom Burch: 32:48

Brilliant. Well listen Sarah Nelson, thank you so much for coming on plaid we grabbed you before you went off on your gardening leave and your ventures around the world but it's been an absolute pleasure catching up. Thank you so much for coming on to the Up up and away podcast.

Sara Nelson: 33:00

Thank you very much and I look forward to seeing how the digital health passport progresses are

Saira Arif: 33:07

Thank you Sarah.

Sara Nelson: 33:08

Lovely to see you again Centre at Sarah.

Dom Burch: 33:21

You've been listening to the Up up and away podcast with me DOM Burch and Syrah RF if you're interested in becoming a guest on the podcast, please get in touch and if you'd like to find out more information about digital health passport, then you can just use your favourite search engine or go to digital health passport.co