Why are current approaches for tackling obesity not working?

Why are current approaches for tackling obesity not working?

Bernardette McInally reflects on this public health challenge and why we need to focus on a whole systems approach. 


Obesity in Scotland is one of the highest among OECD countries. The risk of obesity is double for adults and children living in the most deprived areas.[ 1] The prevalence has not reduced in over a decade and the gap in inequalities continues to widen. Current approaches are clearly not working. We urgently need to shift mindsets, redesign the system, build partnerships, actively involve, and empower communities to reduce health inequalities and address obesity.  

So what’s going on?

Obesity is not just caused by an unhealthy diet and lack of exercise. It is driven by obesogenic environments. It is more difficult for the most disadvantaged to eat healthily and exercise. These inequalities have continued to widen even though this inequality has been widely understood and recognised for a long time [2][3] and have been exacerbated by the pandemic. 

Despite this recognition, health promotion initiatives continue to focus on getting people to change their behaviour. Just last summer, the UK Government announced the Better Health campaign to motivate people to lose weight and the announcement of a new office for Health Promotion still seems to focus on behaviour change campaigns. 

What needs to change? 

The narrative needs to change, moving away from the rhetoric that obesity is a lifestyle choice and the individual’s responsibility and ignoring the other drivers of obesityIt’s not that these initiatives have no impact but if the environment is not conducive to a healthier lifestyle than the effects are very limited, if not negligible.  

Obesity is a complex web of social, cultural, environmental, biological and psychological influences. This needs a collaborative and a systematic change including the government, local health services, environment, and the food industry. It is the government not individuals that change the food environment, the infrastructure and built environment, legislation and taxes, and control availability, accessibility, and affordability.  

A whole systems approach (WSA) is the way forward, or the obesity prevalence is unlikely to reduce

A WSA responds to complexity through an ongoing, dynamic and flexible way of working. It brings together stakeholders and communities to work together in recognising the opportunities for change. It draws on the local strengths, supports communities to create initiatives that are better and more effective by using their local assets. It engages stakeholders to develop a shared vision and actions to address obesity outside the ‘usual’ spheres of public health. Responsibility for action lies with everyone in the system working together in an integrated way to bring about long-term change.

How do we get there? 

This is not an overnight change but the longer we leave it the harder it becomes. PHE have talked about the importance of a WSA and have published guidance for local authorities to implement this approach. While the latest UK Government’s obesity strategy did not go further into taking this approach itselfthere are some welcoming measures targeting the obesogenic environment such as regulating food advertising and food promotions, and mandatory food labelling and calories displayed on menus. 

WSA is not just about prevention. Two thirds of the adult population is already affected by overweight or obesity. Obesity treatment needs to be part of the strategy. This is often missing with emphasis still placed on individual change and prevention, promoting stigma and discrimination against people living with obesity. More needs to be done in increasing access to weight management services across the country and mental health support and involving people living with obesity in the discussion. 

WSA needs to be community centred – actively involving community members in the design, delivery, and evaluation, use and build on community assets, focus on changing the wider determinants of poor health and develop collaborations with those most at risk 

One interesting example of change is the Scottish Government who have adopted a WSA to diet and weight. Work is under way with seven areas selected as ‘early adopters’ who are developing a local plan and activities for testing a WSA to diet and healthy weight.  

Rocket Science has experience in community-centred approaches which is central to WSA. We undertake research with communities to gain insight of their lives, needs and priorities. We are helping our clients to consider the social determinants of health and use a WSA to set their vision, develop organisational strategies and develop plans for changeThis includes helping organisations and partnerships to be responsive, manage change and transform their services through a flexible range of support.  

Bernadette is a Consultant in our Scotland office.  You can check out her profilehere or get with touch her on bernardette.mcinally@rocketsciencelab.co.uk.

[1] Scottish Government (2020) The Scottish Health Survey. 2019 edition. Volume 1. 

[2] Tackling Obesities: Future Choices. Government Office for Science 2007https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/287937/07-1184x-tackling-obesities-future-choices-report.pdf 

[3] Marmot, Michael. (2020). Health equity in England: The Marmot review 10 years on. BMJ. 368. m693. 10.1136/bmj.m693. 

Evidence-based suicide prevention in the COVID-19 recovery

Evidence-based suicide prevention in the COVID-19 recovery

Jenny Paisley is a consultant in our Edinburgh office. Here, she writes about translating emerging evidence on the impact of COVID-19 on mental health in Scotland into a public health response which listens to the voices of those with lived experience, to ensure increasing mental ill health does not translate into a preventable rise in suicide.

What we know so far

Marginalised groups, such as those living in poverty and with long term physical and mental health conditions have experienced the greatest deterioration in their mental health and wellbeing since COVID-19 first emerged in the UK according to the Scottish Mental Health Tracker Study (SCOVID) [2]. This finding is also supported by a growing body of evidence on the mental health impacts of the pandemic, with more than 2,500 papers published on the subject of COVID-19 and mental health since March 2020. 

While there was an improvement in some mental health measures as we emerged from the first lockdown in Summer 2020, overall anxiety, depression and thoughts about suicide have all increased when compared with pre-COVID rates and there are alarming trends in suicidal ideation for particular demographic groups. The wave 2 SCOVID report [3], surveying people between July and August 2020 showed:

  • An increase in suicidal ideation in the Scottish population from 9.6% between May and June to 13.3% of respondents between July and August reporting thinking about taking their lives
  • 34.4% of men aged 18-29 reporting suicidal thoughts in wave 2, up from 21.5% in wave 1
  • People with pre-existing mental health conditions also reported higher suicidal ideation, with 36.7% reporting suicidal thoughts in wave 2 and 25.2% in wave 1
  • ONS statistics show that young people have borne the brunt of the impact of COVID-19 on the labour market, accounting for nearly two thirds of unemployment since the pandemic began [4]. Loss of employment, financial stressors and social isolation are all widely recognised risk factors for suicide.

There has been a demonstrable rise in suicidal ideation, but we do not yet have reliable data on the impact of the pandemic on suicide rates. Although there has been an increase in risk factors associated with suicide, suicide is preventable and a rise in suicide is not an unavoidable consequence of the pandemic.  Suicide prevention must be prioritised.

What do we need to do about it?

To ensure those experiencing poor mental health and at risk of suicide are not left behind in the recovery from COVID-19, we need higher investment for groups that have been marginalised during the pandemic to achieve equity through a combination of targeted and universal interventions. Emerging evidence on demographic groups experiencing worsening mental health and suicidal ideation must be rapidly translated into policy and investment. While there are a range of risk factors for suicide, policy makers need to act fast to acknowledge the known relationship between unemployment and suicide, as part of a holistic approach to suicide prevention strategy in the wake of Covid-19.

Public health responses to prevent suicide need to focus not only on formal mental health services, but on investment in community responses. We need a cross-sectoral response, with action on social determinants of mental ill health such as economic inequality, to address factors contributing to suicide risk.

Crucially, responses need to be shaped on the voices of those with lived experience. The National Suicide Prevention Leadership Group, formed in 2018, has a lived experience panel working closely with academic and professional experts to inform suicide prevention plans. Acknowledging that local people are experts in their own communities, the panel has been involved in the development of local suicide prevention plans.

The Suicide Prevention Action Plan in Scotland includes pilots of compassionate support for those in distress [5] and a suicide bereavement service, recognising that those bereaved by suicide are 65% more likely to die by suicide than those bereaved by natural causes [6]. Robust evidence on the effectiveness of these pilot services must be rapidly collected and shared, so that services that work can expand to reach the people who need them most.

Finally, voluntary sector services supporting those at risk of suicide are facing additional pressures due to the pandemic, with more people seeking help and support, and financial challenges meaning organisations are struggling to stay afloat. Elevated and sustained investment in Scotland’s third sector will be crucial to ensure it can play its  role in a national effort to prevent suicide.

Jenny is a Consultant in our Edinburgh office. Get in touch with her on jenny.paisley@rocketsciencelab.co.uk if you would like to find out more.

In the UK, Samaritans can be contacted on 116 123 or email jo@samaritans.org
Breathing Space is a free, confidential phone and web based service for people in Scotland experiencing low mood, depression or anxiety. They can be contacted on 0800 83 85 87.



[1] https://www.gov.scot/binaries/content/documents/govscot/publications/research-and-analysis/2020/10/scottish-covid-19-scovid-mental-health-tracker-study-wave-1-report2/documents/scottish-covid-19-scovid-mental-health-tracker-study-wave-1-report/scottish-covid-19-scovid-mental-health-tracker-study-wave-1-report/govscot%3Adocument/scottish-covid-19-scovid-mental-health-tracker-study-wave-1-report.pdf

[2] https://www.gov.scot/publications/scottish-covid-19-mental-health-tracker-study-wave-2-report/pages/7/

[3] The study authors note that this finding should be interpreted with caution due to small sample sizes

[4] https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/uklabourmarket/march2021

[5] https://www.dbi.scot/

[6] https://www.ucl.ac.uk/news/2016/jan/1-10-suicide-attempt-risk-among-friends-and-relatives-people-who-die-suicide

The Good Work and Care Conundrum

The Good Work and Care Conundrum

If I were to ask any council or employment and skills partnership about their employment and skills recovery plans, I bet all of them have referenced the importance of Good Work and the role of health and social care as a key sector for employment.  I know this because I have spent the last year supporting councils and researching recovery strategies to understand how places are responding to the employment and skills challenges. 

Can Good Work be achieved in the Care sector?

Pre-pandemic the health and social care sector played an important role in employment and skills strategies, in part due to the volume of vacancies, the need for care provision and the numbers of residents employed in the sector. In areas where there was nearly full employment recruiting into health and social care positions was difficult. When I worked on a sector strategy for health and social care back in 1998, the sector, although important, was considered then to be a poor relation compared to construction, technology, manufacturing and logistics in terms of focus for growth. I am not convinced that this view had changed much since. But Covid-19 has shone a light on the health and social care sector and brought its critical role and opportunities for employment recovery into sharp focus.

However, the sector has always struggled with recruitment and retention, and domiciliary care is a particular challenge. The 2019/20 research from Skills for Care [1] highlighted that there are over 50,000 vacancies in domiciliary care at any one time, vacancy rates were at 35% and 178,000 left the sector that year. 42% of the domiciliary care workforce are employed on zero-hours contracts rising to 56% for care workers. This picture has hardly changed in the past eight years. Although there have been moves to promote a Real Living Wage, pay still lags behind. A report by the Institute for Employment Studies for the Health Foundation on Covid-19, government policy and the sector highlighted the financial challenges faced by workers who have to go off sick and rely on Statutory Sick Pay [2]. Anecdotal evidence from a consultation we led into domiciliary care workers highlighted issues of over-working and not taking sick leave even though they had a health condition.

The issues are endemic and the precarity of work in care is not a new phenomenon.

We know that having flexibility around work can be really helpful. But I do think that the care sector, particularly domiciliary care, where 84% of carers are female, the workforce is ageing and 54% work part-time, we cannot ignore that reconciling the ambitions for Good Work, care commissioning and moving people into the sector as part of economic recovery is a big challenge for places. And an issue of inequality of ethnicity (in places, London has a high proportion of workers from ethnic minorities), gender, age, health and income.

So what can be done?

Although most domiciliary care workers are in the independent sector, local authorities have a role to play as commissioners of care. We have seen commitments to embedding the Real Living Wage into contracts in London and pay has increased. But this is one dimension to applying Good Work. Carers need better conditions and greater security of their income as we know that financial insecurity is a key contributing factor for impacting on mental health [3]. We also know that the hours carers work, shift work and lack of planning can add to carers stress in moving from client to client and not having sufficient time for self-care. The pay rates set by local authorities for domiciliary care are tight and do not have sufficient flex in them to provide the kind of employer support and help permanent workers get. This results in a vacuum of support for carers that probably need it most, especially as they are generally sole workers and have limited opportunity for socialising and meeting their co-workers.

The Scottish Government recently committed to a number of fair work measures for Scottish care workers including the Real Living Wage, improving the working conditions for staff, and giving staff an effective voice about workforce conditions. The challenge ahead in Scotland will be how to fulfil these promises within the already strained financial situation of the Health and Social Care Partnerships in Scotland who will be expected to implement these commitments. [4]

Since before the pandemic we have been wrestling with how to tackle this challenge and what could be the drivers for change. There is a business case to be made to make working conditions better to tackle the high staff turnover experienced in the sector and to ensure continuity of care for people, but this will cost money.  There is also a case to be made on in-work about ensuring the health of care workers and the support they need to manage their financial situation and stay out of poverty. Again this requires investment but with constrained public finances, fulfilling Good Work promises within the sector seem to be both unrealistic and undeliverable.

Some ideas for change

Despite this we think there are opportunities for changing the status quo. Our learning from delivering the Challenge Fund for the Work and Health Unit, tested innovations for supporting people with health conditions to remain in work. This highlighted that simple and low cost solutions such as advice for employers, providing wrap around support for people who needed financial help and getting early access to support were key to prevention.

Here are some ideas for how to bring Good Work and care work closer together.

Firstly, we need to take a place-based approach to understand the dynamics of the sector and how to respond. Our study, although small, highlighted that most care workers lived and worked in the same local authority meaning that reaching out to them and connecting them to existing support becomes easier. This includes both advice and guidance, mental health, financial and other in-work support.

Secondly, most Councils are supporting local businesses through grants, business advice and support. Targeting investment and tailoring support for care businesses would be a practical way of supporting them with their recruitment and retention.

Thirdly, we think that any local investment or strategy needs to be scrutinised through a Good Work Assessment Lens, where councils and their partners can use all of their levers such as commissioning, social value and other gifts to ensure that Good Work can be achieved in practice across all sectors and through all pathways.

Finally we think that levelling up also needs to focus on sectors where pay and conditions lag behind others. True change can only be achieved if there is the financial will and means to make it happen. Someone recently mentioned at an event on future work that they felt the care sector is broken, if this is the case then lets make that investment work better.

We are really interested in talking to others about how to bridge the gap between Good Work and other sectors where pay and conditions make it difficult to do, like self-employment. Please get in touch if you would like to know more.

Caroline Masundire is a Director of Rocket Science based in our London office. You can contact her at caroline.masundire@rocketsciencelab.co.uk

Access all areas: The role of advocates in supporting young people’s access to mental health services

Access all areas: The role of advocates in supporting young people’s access to mental health services

When seeking support for a mental health condition, young people are often required to navigate a complex system of statutory and voluntary sector services, with considerable waiting times. Barriers to finding out about and accessing relevant mental health services persist, often for those who need them the most. In this blog, Dina Papamichael outlines the potential to learn from existing advocacy models to improve young people’s awareness and take up of various health services.

While this turbulent year has prompted new concern around mental health, the mental health of young people in the UK was deteriorating before the pandemic – probable mental health conditions increased from 10.8% in 2017 to 16% in July 2020 across all age, sex, and ethnic groups [1]. Looking ahead, research from Young Minds has shown that 67% of young people believe that the pandemic will have a long-term negative effect on their mental health [2] . Against this backdrop, it is crucial that young people understand their rights and choices; and face open doors when seeking out support.

A bumpy road to help

The journey from identifying a need for mental health support to accessing appropriate care is often fraught with obstacles. Rocket Science’s recent research for Young Westminster Foundation has highlighted that a significant proportion of young people (43%) find it difficult to find out about mental health services, and an even higher proportion (47%) find it difficult to access services [3]. Even when young people are aware that support is out there, concerns around confidentiality, cost, stigma and waiting times can reduce willingness to engage.

 A wide range of providers and services exist to support young people’s mental health in the UK, including:

  • Local NHS Child and Adolescent Mental Health Services (CAMHS)

  • Voluntary sector services such as Relate or Off the Record

  • Private/independent sector counselling

  • Support provided within schools e.g. by Schools Mental Health Practitioners

  • Primary care – It is estimated that one third of GP appointments involve a mental health component [4]

While many young people can rely on a family member, teacher, or youth worker to help them understand and navigate options for support, this is far from universal. This means that young people can be left in crisis without feeling listened to or empowered to get help.

A need for advocacy

Advocates help young people to navigate complex service landscapes by listening to their needs, helping them to understand their options, accompanying them to appointments or acting on their behalf e.g. writing letters or making phone calls.

The National Standards for the Provision of Children’s Advocacy Services define advocacy as follows: ‘Advocacy is about speaking up for children and young people. Advocacy is about empowering children and young people to make sure that their rights are respected and their views and wishes are heard at all times. Advocacy is about representing the views, wishes and needs of children and young people to decision-makers, and helping them to navigate the system.’ [5]

Examples of existing youth advocacy models within youth justice; mental health recovery settings and homelessness include:

  • Just for Kids Law – Youth Advocates work with young people to help them access legal support and other specialist services they need to resolve issues relating to e.g. housing; immigration and residency status; finance and social services

  • National Youth Advocacy Service – Advocates work within a variety of locked, rehabilitative, and residential mental health recovery settings within the Priory for children and adolescents to help them be actively involved in decisions that affect their care and treatment

  • Coram Voice – Homelessness Outreach Advocates help young people to move into safe housing and access the financial, housing and educational benefits which they are entitled to.

Alongside advocacy services, link workers with a strong knowledge of voluntary sector services are increasingly being used to signpost individuals in the community, reducing a reliance on GPs to keep up with a continuously evolving service landscape.

Learning from existing youth advocacy and link worker models can be used to inform local initiatives which put those most at risk of mental health issues, and least empowered to navigate the system at their core.

Making advocacy work for young people

Established principles for good advocacy services include building up young people’s personal power; working at the individual’s pace and following their instructions; earning trust and being there for a young person; learning from young people’s views to constantly improve [6]. Within a mental health context, it is important that advocacy services are:

Communicative – this includes reaching young people in spaces where they are comfortable and providing clarity on what the advocacy service can offer

  • Simple, equitable and easy to contact – addressing barriers to access and providing options for young people to reach out e.g. email, social media, call or webchat

  • Trauma informed – having an awareness of the prevalence of trauma amongst young people and minimising risks of re-traumatisation

  • Culturally informed – ensuring that young people feel understood and that the advocacy offer is tailored to their needs and experiences

  • Support the transition to adult services – Including young people between 18 – 25 to ensure no one falls through the crack during the transition to adult services

  • Picking up on specific service issues – such as missed appointments or where the level of support they receive isn’t right

Dina Papamichael is a Principal Consultant in our London Office. If you would like more information on our work or how we can help you please get in touch with dina.papamichael@rocketsciencelab.co.uk

Catching up with our digital progression in health and social care

Catching up with our digital progression in health and social care

The progression in the use of digital technologies to support virtual services in the health and social care sectors has been fast.


The Kings Fund {1} recently observed that the necessity to make services safe for patients and staff have provided organisations the single-minded focus needed to overcome prior hesitancy and disagreement related to digital technologies and forced organisations to put aside processes that had previously hindered the widespread adoption of digital technologies and virtual service models.

What have we seen?

The range of digital technologies available for the health and social care sector is mind boggling. I couldn’t possibly do them better justice than this article so I won’t try. Instead, I want to focus on the longer-term picture – the post covid world we are all hoping will be on the other side of summer – when we will finally have a chance to catch up with the digital progression, take a breather, and work out how we harness what we have learned!

Other commentators have observed that responses to covid have been local, those who had established technologies in play were able to roll them out more easily than those starting from scratch, and smaller organisations were able to adopt new processes and approaches quickly while larger organisations took longer to make decisions and roll out changes. This varied and localised approach reflects what we have been hearing from our clients – that what has worked is local organisations taking local steps to meet the needs of their local communities.

So how do we catch up with our own progress?

So, what happens when the pandemic dust settles? How do we learn which bits of the new systems and services we keep and which we say goodbye to? How do we refine what we have and use an evidenced based approach to inform its adoption and future development? It may feel like a long way off, but we are helping our clients now to plan for the following, so they have everything in place for when that breathing room finally arrives:

  • Working out what a mixed model will look like in the future – how can organisations balance the value and need for face-to-face interaction while harnessing the contribution that virtual services have to offer?
  • How do we overcome the digital exclusion elephant in the room with so many of the communities that services are desperately trying to reach are also those more likely to be digitally excluded it is clear that the response needs to be prioritised?
  • How do we bring back user-led design and service co-production into our organisations following a period of rapid change with little time and scope to consult and involve others?
  • How do we tackle the staff skills, training and resourcing implications of the new models of delivery we have set up, on top of the pre-existing staff shortages and resourcing pressures with an increasingly burned-out workforce?
  • How do we bring in robust data collection, monitoring and evaluation of the new technologies and service models to understand what works for who, in what context and why? We need to inform future service delivery using the invaluable learning during the pandemic.

The answers to these questions will look different for different organisations. We are helping our clients to work through these questions within the context that they are in operating in to identify pragmatic, proportionate, useful, and practical ideas, answers and plans. Central to this is helping organisations to learn from each other, reflect on the elements that they want to hold on tight to, and identify ways to overcome some of the challenges associated with rapid paced change under immense pressure and uncertainty.

{1} https://www.kingsfund.org.uk/blog/2021/02/rapid-digital-change-primary-care-covid-19-pandemic 

Clare Hammond is a Director in the Edinburgh Office and leads our Health and Social Care work across the UK. If you would like more information on our work or how we can help you please get in touch with clare.hammond@rocketsciencelab.co.uk

Domestic abuse and Covid-19 what next?

Domestic abuse and Covid-19 what next?

Covid-19 has had a direct impact on the rise of domestic abuse. Ciara Taylor summarises the issues, how Government has responded and what we need next to support survivors.


Since the UK-wide lockdown began in March 2020, there has been an increase in cases of domestic abuse. Domestic abuse charities such as Refuge and Solace Women’s Aid have reported an increase in demand for services; calls made to the Refuge national domestic abuse helpline increased by 66% over the last three weeks of May and visits to the Refuge website increased by 957% in the last two weeks of May. The rate of domestic abuse killings per week doubled in the first three weeks of lockdown; there were at least 16 suspected domestic abuse killings, four of which were children. Instructing people to stay at home has exacerbated existing problems of domestic abuse and in some cases has led to new perpetrators. As survivors cannot leave the home for extended periods of time it is more difficult for them to escape abuse.

To address this, the Government has:
1. Waived the stay at home rule for people experiencing domestic abuse.
2. Committed £76 million to support survivors of domestic abuse, sexual violence, vulnerable children and their families, and victims of modern slavery during the pandemic.
3. Raised awareness about domestic abuse through the daily coronavirus briefings including encouraging use of the silent ’55’ calls where individuals can call emergency services and press ‘55’ without speaking to alert that they are in danger.

Charities are providing the majority of frontline support for those experiencing domestic abuse. Face-to-face support has been shifted online through the use of emails, live chats and forums, whilst resources such as ‘survivor tips’ from Refuge and ‘how to cover your tracks online’ from Women’s Aid have been made available. Campaigns from organisations including Southall Black Sisters and Compassion in Politics have asked hotels to open up their rooms to those fleeing domestic abuse.

Changes to service delivery during COVID-19, alongside an increase in demand for these services brings several challenges. While organisations are unable to run in-person advice sessions, the provision of effective support relies on staff being equipped to work from home and service users having access to electronic devices and internet connectivity. Survivors face additional barriers to accessing help online as perpetrators of domestic abuse may closely monitor their use of the internet and they are unlikely to be able to speak freely over the phone for fear of being heard.

Building on the innovative and important work of the sector there are three key areas of intervention needed to support organisations supporting survivors of domestic abuse:

1. Invest in organisations to ensure they have the resources to respond to demand: Funders and commissioners must ensure that organisations and services have the resources that are required to respond to need and manage increased demand. The true scale of domestic abuse during this time and the impact it has had may not yet be realised; staying at home during lockdown has meant some survivors of domestic abuse have been unable to access support networks and as a result there may well be an increased caseload of people who look to access services post-lockdown. Resources might fund psychological support for staff as they experience an increased caseload and lack of face to face support themselves, and new homes/refuges for service users as survivors might have been cut off from other housing options due to COVID-19.

2. Recognise that domestic abuse is a complex issue which appears in many forms including economic abuse: Economic abuse is a form of domestic abuse that may consist of the control and restriction of the acquisition and use of money and economic resources. Typical financial advice services may not be suitable for those experiencing economic abuse and may put them at further risk. As such, advice services must implement a person-centred approach providing tailored financial advice to ensure that service users are kept safe.

3. Invest in longer term stability and support: As lockdown ends it is important to move from interim, crisis-response type support to a sustainable approach that guarantees maintained support of survivors through secure housing, secure income, psychological support. This will require greater coordination of resources and funding. The parliamentary Domestic Abuse Bill Committee met this week (04/05/20) to hear evidence from specialist domestic abuse organisations and survivors and to discuss the enhanced domestic abuse bill.

It is important to utilise this bill to deliver the reform needed by this sector.


Ciara is a Consultant at Rocket Science based in our London office.  You can check out her profile here.