NHS Winter Pressures

Shaun Bailey Excerpts

Monday 9th January 2023 Commons Chamber

[Mr Deputy Speaker (Sir Roger Gale)]

Finally, with the prize for patience, I call Shaun Bailey.

[Shaun Bailey (West Bromwich West) (Con)]

Thank you, Mr Deputy Speaker—I am last but I hope I am certainly not least. Some 700 beds are due to come online thanks to the Midland Metropolitan University Hospital and there is a new primary care centre in Wednesbury, so when my right hon. Friend’s Department delivers, we see the benefit. Clearly, however, that means nothing if we cannot get the processes right. The most pressing issue for my constituents during the winter has still been access to their GPs, as I am sure hon. Members on both sides of the House will agree. I welcome what he has said about the use of technology to ensure that people are seen, but fundamentally, people still want face-to-face appointments, because if they are digitally disconnected, they cannot access that technology. It is as simple as that. I ask him to commit—just after he commits to come to Wednesbury to see our new primary care centre—to work through his good offices with GP practices where there is best practice, particularly in the Black Country ICB, to ensure that we enable people who are digitally disconnected to access GPs.

[Steve Barclay]

We are working actively with the primary care community. Indeed, that was a key focus of the Prime Minister’s summit in No. 10 on Saturday and it is part of the work that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) is leading through the primary care recovery plan. Last year’s GP patient survey suggested that continuity of care and face-to-face appointments were extremely important for two fifths of patients, but that suggests that for three fifths—often younger patients—speed of access is more pertinent. Continuity of care is important for those with multiple conditions, particularly elderly patients.

Alongside that, my hon. Friend is right to raise the Midland Metropolitan University Hospital. Four years ago, when I visited as a Minister of State in the Department, it was near completion. As he knows, it has taken a significant amount of time since then to get to its opening, which is why we need to look at doing things differently when it comes to value for money. Looking at the hospital estate programme, nine of the last 10 hospitals were built over time and over spec, so we need to look at modular design, modern methods of construction, and standardisation, which deliver a 35% unit-on-unit reduction in cost and much quicker operational performance, and would enable us to get hospitals up and running earlier.

It is important to do things differently and the new hospital building programme is part of that. We have listened to the concerns of those on the frontline and today’s statement addresses the immediate issue of bed occupancy in hospitals and the pressure on emergency departments.

Midwives in the NHS

Shaun Bailey Excerpts

Monday 17th January 2022 Commons Chamber

[Siobhan Baillie]

It would be interesting to hear from the Minister on that. Midwives and some of the marchers have suggested talking about financial payments, but there also needs to be a culture shift. If we are asking midwives to do things that they desperately want to do, such as the continuity of care, but they do not have the staff teams to do them, they will feel as though they are failing. No money in the world will make that any better. Working together constantly and joined-up thinking are important to help that retention. I pay tribute to my hon. Friend’s mother.

I have some questions for the Minister. How many midwives are currently in training and recruitment? Why are babies not counted in the patient headcount to determine staff ratios? What measures, such as flexible working, are being considered to make the profession more attractive to those who have caring responsibilities or who are choosing a second career? Are we looking at salaries and financial support for students?

The issues that midwives face are incredibly complex, and as my hon. Friend the Member for Darlington (Peter Gibson) said, it is not just about staff. Midwives tell me that, without proper administrative support to reduce their huge non-clinical workload, they feel they are drowning in their jobs. The Association for Improvements in Maternity Services says that midwifery is a service that seems unable to support its own staff, including precious newly qualified members, with frequent reports of bullying. That is incredibly worrying. In England, that cultural problem was a key focus of the “Better Births” report in 2016, and it is an issue that the ongoing maternity transformation programme has been working to address.

The pandemic restrictions, which my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) mentioned, caused huge problems for mothers and partners. Mothers are now so scared that the restrictions will come back.

[Shaun Bailey (West Bromwich West) (Con)]

Further to the intervention from our right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), I am sure my hon. Friend will be aware that, contrary to NHS guidance, my own NHS trust, Sandwell and West Birmingham, stopped allowing birthing partners to be with expectant mothers. We managed to get that decision overturned, but just to re-emphasise the point, does my hon. Friend agree that birthing partners form an important partnership with midwives in ensuring that the safety of expectant mothers is paramount in the delivery process? I am sure she will expand on that later in her speech.

[Siobhan Baillie]

I thank my hon. Friend for all the campaigning that he has done—as has my hon. Friend the Member for Rutland and Melton (Alicia Kearns), who is not in the Chamber this evening—and he is absolutely right. Birthing partners not only provide that immediate bond and that precious time with the baby; they provide support for the mother and support for the team, and have the important ability to spot what is going on. A mother who is taking quite a lot of gas and air might need someone else to have a couple of conversations when she cannot do so herself.

We are making changes in schools so that we do not see restrictions and closures again, and I think that if we are ever faced with the need to introduce further covid restrictions, we cannot do that in maternity services. The restrictions have had a knock-on impact on midwives as well: seven out of 10 RCM members have experienced abuse about visiting restrictions. That abuse may well have come from very worried and well-meaning people, but there is no doubt that it has contributed to their wish to leave their jobs.

The campaign group Pregnant Then Screwed did a great deal of work on this, and 98% of respondents to its survey said that the possibility of further covid restrictions on maternity services was causing them anxiety. There is enough for pregnant women to be worried about without their having to worry about that. Mothers reported rushing their hospital care during the pandemic, and seeking early discharge so that they could get home to be with their partners. As was mentioned earlier by my right hon. Friend the Member for South West Surrey, women-centred care is the ethos of midwifery. and continuity of carer is the national recommendation. It is the right approach, but at no stage have the current staffing levels and the impact of covid been taken into account to assess the viability of a new system. The vaccine mandate continues to cause concern, and the potential loss of more staff is adding to the pressure-cooker effect.

We in Stroud are hugely proud of the facilities that we have. In the past, Stroud constituents have come together and fought to save the maternity unit, and that fight was so strong that I do not think anyone would dare to try to close it down again. We have also recently instigated an important campaign to deal with mental health and birth trauma. Between 25% and 40% of women view their experience of giving birth as traumatic—I am probably in there somewhere—and one in four have experienced sexual abuse. Such issues often have a huge impact on fears for pregnancies and future births. The campaign and the dedicated mental health team that Gloucestershire is setting up will change perceptions and conversations surrounding birth from the off. Our minor injuries unit across the road from the maternity unit has received a welcome £2 million for refurbishment purposes. I was at the hospital recently for my scan, and it is really buzzing. Although I have raised some serious matters, I do not want expectant mums to be worried about the care that they will receive at Stroud or anywhere else, as professional maternity teams will look after all of them.

One midwife told me that midwives do not speak out because they are always trying to put the women in their charge at ease, but unfortunately it has reached the point at which they feel that they must do so, which is why they have sent me here today. That said, although a Minister will respond tonight, the issues raised are clearly not just for the Government to address. NHS trusts, their human resources teams, managers, and all of us as patients in society need to think about how we behave, how we use the NHS, and how we can improve it. Making the NHS a political football, claiming that more and more money is the only way to fix issues, or putting the NHS on a pedestal so that there can be no criticism or open scrutiny, will not help a single midwife in this great country. I believe that the men and women of our maternity services deserve better. They literally hold new life in their hands, along with all the hopes, dreams and responsibilities that come with that job.

I leave the final words to a midwife who told me:

“I love my job. I love supporting women and the team. But I too feel that maybe this is as far as I can go. I have never suffered with mental health concerns prior to this last year. Anxiety has crept into my normally happy life due to work issues.”

I think that that is quite a stark way in which to end the debate, and I genuinely think that we can do better. I look forward to hearing from the Minister, who I know cares deeply about this issue, and I am grateful for the time that I have been allowed tonight.

Health Incentives Scheme

Shaun Bailey Excerpts

Friday 22nd October 2021 Commons Chamber

[Maggie Throup]

My hon. Friend makes a very good point. Yes, we know that there is a lot of experience out there and we want to pull everything together to make sure that we have an effective pilot and know how we move forward from that to help people to get healthy, get fit and enjoy good lives.

[Shaun Bailey (West Bromwich West) (Con)]

Sometimes the risk of such schemes is that they become a little bit siloed. We have heard, in contributions from other Members, talk about co-operation. Can my hon. Friend reassure me that any insights will be used to inform the response across Government, and that she will ensure that we take a collaborative approach to ensure a long-term gain, not a short-term success?

[Maggie Throup]

I reassure my hon. Friend that we want to ensure that this is a long-term success. It is a pilot, so we cannot pre-determine the outcome. However, tackling obesity and the disparities that come with it are a No. 1 priority for the Prime Minister, and that goes across all Government Departments.

Covid-19 Vaccine Damage Bill

Shaun Bailey Excerpts

Friday 10th September 2021 Commons Chamber

[Sir Christopher Chope]

On the requirement that this House has made that all care workers in care homes should be vaccinated even if they have a genuine desire not to be—they may be fearful of the consequences, although consequences are seen in only a minority of cases—it should surely be for the judgment of each individual whether they will take the risk of having a vaccination or not. Obviously we know that, even if people are vaccinated, it does not mean that they are immune from covid-19, and it certainly does not mean that they are incapable of transmitting it to somebody else. Those issues need to be weighed up.

To go back to the hon. Gentleman’s challenge, he seems to be suggesting that those hapless families—10,000 of them, or maybe more—who have suffered real, serious damage as a result of doing the right thing should be left hanging around for years wondering whether they will be eligible for any compensation. That is totally the wrong message. The Government should be sending the message that, “If you do the right thing, you will be looked after by the Government if something goes wrong.” In a sense, that is what we do with the military covenant. People enter the armed forces of our country and, if something goes wrong, they expect the Government to look after them, and we do. We should be doing exactly the same for those who have suffered vaccine damage, instead of talking around the subject in the way that the Minister’s reply to the petition suggests is Government policy.

[Shaun Bailey (West Bromwich West) (Con)]

My hon. Friend is being generous with his time. I have been listening intently to what he has to say, but I am conscious of the narrative. How do we ensure that, on the one hand, people who suffer severe disablement as a result of the vaccines get that support and payment, but on the other hand, we do not create a culture of hesitancy where people do not uptake vaccines or, equally, do not produce vaccines because of the fear that they might cause mass severe side effects? I am conscious of hearing his views on that.

[Sir Christopher Chope]

I am trying to address that point. We cannot ignore the fact that there is fear out there about vaccination. We cannot suppress reports of coroners saying that somebody has died as a result of having a vaccination. I know from my own personal knowledge of people who have suffered—people who were in really good health and then had their first vaccine. I know of one person in particular who then had a stroke and was in hospital for some time with that, and then had severe heart problems and even had to be referred to Harefield Hospital. Those are not just anecdotes; those are facts known by people across the country.

The Government may not be too keen to promote that information, but failing to do that is actually counterproductive. Those facts are out there—we know that—so we need to say to people that if they are in that small minority of people who suffer those adverse consequences, we will look after them 100% without expecting them to get lawyers engaged and all the rest, which is agonising for their families and loved ones. That is what I think we owe them. We do that in a number of other fields for people who serve our country, and I would like to equate them to people who get vaccinated, do the right thing and act in the public interest.

By being vaccinated, we are collectively able to contribute to better public health for all. It is because people are doing it for the benefit of the state that the other side of the coin should be a guarantee that, if something goes wrong, the state will help them. It is the Government’s reluctance to deal with that part of the equation that is so distressing, because it feeds into people being vaccine-hesitant. If somebody comes to my surgery and says that they are nervous about having a vaccine for themselves or their children, I cannot say, “Well, don’t worry. If, in the most unlikely event, something goes wrong, you’ll be fully recompensed.” I cannot say that to them, but if I could, they might be more likely to take the risk. That is the issue.

Coronavirus

Shaun Bailey Excerpts

Wednesday 16th June 2021 Commons Chamber

[Shaun Bailey (West Bromwich West) (Con)]

Thank you, Madam Deputy Speaker. It is always a little bit trepidatious coming in at this stage of the debate.

The debate has been very finely balanced, and the difficulty is that after so many great contributions, one feels as though one is repeating oneself a bit. This is a difficult decision, and I do not envy the Government in the position that they find themselves in. We must tread a nuanced, balanced path, ensuring that we protect the most vulnerable while safeguarding those liberties that I am sure all of us in this House want to ensure that we and our constituents can enjoy.

The pandemic in my communities, in Sandwell, has been different, because we have not been able to work from home. The majority of my constituents have had to go out to work in the factories or in other places. They have had to be there. I want to dispel the notion that we can all carry on as normal—that we can all work from home. It just does not happen, I am afraid; it is just not reality. An important point that was raised by many hon. Members from both sides of the House this evening is that we must use the time that we will now have as a result of the regulations—because they will pass this evening—to ensure that we plan properly, to tackle the issues and the challenges that we are faced with in our NHS.

I want to talk about primary care, because that is a big thing for my constituents—no more so, at the moment, than in one of my communities, in Tividale, where my constituents struggle to get a GP appointment. One constituent who contacted me today had had to call the surgery 150 times to try and get in to see someone. It is not acceptable; it cannot carry on. I have had really positive discussions with the Minister and his team in the Department of Health, but we must find a solution. And we must use this time, not just on short-term matters, but to flesh out a long-term plan to deal with these issues, going forward. Because our NHS has done a fantastic job during this pandemic, now we must be sure that the issues that have come to light as a result of the situation we find ourselves in, are dealt with for the long term, so that the legacy of the pandemic is that we ensure that we pay back those NHS heroes who have saved so many people.

[Madam Deputy Speaker (Dame Rosie Winterton)]

As no. 49 has withdrawn, I call the shadow Minister, Justin Madders.

Covid-19

Shaun Bailey Excerpts

Tuesday 25th May 2021 Commons Chamber

[Nadhim Zahawi]

I know that the right hon. Gentleman is a passionate advocate for community pharmacies; he and I have discussed them in the past. I do not recognise his characterisation of the NHS team, who I absolutely know work every day with community pharmacies. I think that just over 500 community pharmacies and independent pharmacies are now part of the vaccine deployment. In phase 1, they have proved themselves to be excellent at reaching out and giving confidence to their communities and at getting people vaccinated; where primary care has decided not to carry on with phase 2, they have also stepped up to fill the gaps so that we keep going. I will absolutely look at the right hon. Gentleman’s constituency to see whether we can do more.

[Shaun Bailey (West Bromwich West) (Con)]

The record vaccine roll-out has absolutely vindicated the decision of my constituents in Wednesbury, Oldbury and Tipton to believe that this country can succeed in standing on its own two feet. Vaccination is going to form a really big part of our lives. What work is my hon. Friend doing to ensure that, as we continue our vaccination roll-out, we have the localised infrastructure to ensure that our great progress is not hindered?

[Nadhim Zahawi]

I absolutely agree with my hon. Friend. If the virus were designed to test liberal democracies, because the only way we could combat it was to withdraw people’s freedoms with the dreaded non-pharmaceutical interventions, the vaccine has played to the real strengths of the four nations that make up the peoples of these isles. We have had that Dunkirk spirit of coming together as 1,000 flotillas: the 80,000 volunteer vaccinators, the doctors, the nurses, the pharmacists and, of course, our armed forces and local government colleagues, who have stepped up not only to identify communities that we need to protect, but to find sites.

We are already making plans for the booster jab to be ready by September. I remind the House that the clinical decision has not yet been made, but when it is—whether that is in September, in October, in November or early in the new year—we will be ready to go. We are also planning how it will dovetail with our flu vaccination programme and seeing how we can increase the uptake in flu vaccination, because the worst of all worlds would be to do well against covid and then be hit by a heavy flu season in the autumn.

A Plan for the NHS and Social Care

Shaun Bailey Excerpts

Wednesday 19th May 2021 Commons Chamber

[Shaun Bailey (West Bromwich West) (Con)]

I start by congratulating the hon. Member for Airdrie and Shotts (Anum Qaisar-Javed) and by saying llongyfarchiadau mawr—massive congratulations—to my hon. Friend the Member for Aberconwy (Robin Millar). This has been an interesting debate. I have been here pretty much from the start, and it has been great to hear the breadth of the contributions we have heard today.

I rise in support of the Queen’s Speech, but before I talk specifically about our health service and the NHS I want to talk about fundamental principles. What we saw in the communities I represent in Wednesbury, Oldbury and Tipton two weeks ago is that they back those principles. There are now nine Conservative councillors on Sandwell Council, the first elected in 10 years, which is proof that my communities in Wednesbury, Oldbury and Tipton are endorsing them. Indeed, in Tipton itself, my new adopted home, two out of the three seats are now held by Conservative councillors. I found it quite interesting that the Sandwell Labour group is now bringing in mentors for their councillors to teach them how to do things such as case work. To save a bit of time and money, I would just say that our group is happy to do that and give members of the Sandwell Labour group a bit of a hand if they need it.

This is a really important debate. I pay tribute to the fantastic NHS staff in my communities, to the people at Tipton Sports Academy who have been volunteering with mass vaccination for nearly three months now—I had the honour of volunteering there myself—and to the people at Portway Lifestyle Centre who have also been providing vaccinations.

When we talk about the breadth of the services we offer, social care is fundamental. In my communities, we estimate that roughly 16,000 people provide care in some form or other. It is vital that we get this right. I sit on the Public Accounts Committee alongside my hon. Friend the Member for North West Norfolk (James Wild); I will not go back over the challenges that he highlighted, because he has probably articulated them better than I could, but we have to solve them because they are ever present. I know from our conversations that my right hon. and hon. Friends on the Treasury Bench are aware of them, but now we must find solutions. I pay real tribute to the Sandwell Young Carers, who are truly inspirational in the work that they are doing—they are stepping up.

When we debate adult social care, we have to remember the role of the third sector, because it is quite often overlooked. I have had a lot of conversations with the third sector in Sandwell about adult social care, particularly in preparation for our Committee’s inquiry, and it sees the challenges articulated by my hon. Friend—they are absolutely the same for the third sector, the private sector and the public sector.

I want to focus today on primary care because it has been so prevalent an issue in my communities. I welcome the £1.5 billion that the Government rightly intend to place in primary care, but the key thing for my communities is being able to see a GP. Don’t get me wrong: the investment from the Government has been great—people are excited for the Midland Metropolitan Hospital to come online next year, and it is great to see it come through—but in my communities, particularly in areas such as Oakham in Tividale, people are struggling to see their GP. I have been inundated with correspondence on how we need to ensure that primary care investment works in the right way. I implore my hon. Friend the Minister to look into that. The investment is absolutely there, which is great to see; it is just about making sure that the delivery works.

Finally, may I pick up on a point made by my hon. Friend the Member for Devizes (Danny Kruger)? He was absolutely right that technology is great, but we will never eliminate the need for face-to-face appointments. There are people in my community who are digitally disconnected. They will not be able to have online appointments, so we have to ensure as we move forward that the balance is right.

DHSC Answers to Written Questions

Shaun Bailey Excerpts

Thursday 19th November 2020 Commons Chamber

[Edward Argar]

I am again grateful for the tone that the hon. Gentleman adopts. We have adopted in our recovery plan an attempt to deal with the oldest questions first, to try to get as up to date as we can. If he or the hon. Member for Central Ayrshire (Dr Whitford) lets me know the detail of that question, I will be happy to look into what he raises and to get that table to her.

[Shaun Bailey (West Bromwich West) (Con)]

No one could underestimate the challenges that the Department of Health and Social Care faces at the moment. I thank my hon. Friend for the way in which he has engaged with me and other colleagues during this time. However, there are clearly operational challenges as a result of this pandemic. My hon. Friend talked about the review that the Department is undertaking. Will he ensure that he shares the lessons learned from that not only with Members but across Government? We will have to look at being diverse in our operational structures, particularly within Government, to ensure that we expediently answer Members’ questions.

[Edward Argar]

I am happy to give my hon. Friend that assurance. Perhaps the best mechanism by which lessons learned can be shared will be through my written response—in due course—to and my appearance before the Procedure Committee, chaired by my right hon. Friend the Member for Staffordshire Moorlands (Karen Bradley). If appropriate, Mr Speaker, I will of course share that response with you and with the Leader and shadow Leader of the House.

Covid-19

Shaun Bailey Excerpts

Wednesday 11th November 2020 Commons Chamber

[Shaun Bailey (West Bromwich West) (Con)]

I promise I will keep this brief. As is often the case in these debates, we come in having written one speech and end up giving another. I think we have heard some great contributions today. I want to start by paying tribute to the voluntary and community groups in my communities in Wednesbury, Oldbury and Tipton, who have absolutely risen to the challenge during these unprecedented times to support some of the most vulnerable in our community. Whether it has been delivering food, being on the end of the phone or just galvanising people together, they have been absolutely amazing. Let us face it: this is completely unprecedented. For many of us, if you had told us 12 months ago that this was going to happen, we would have looked at you with amazement. To be honest, if you had told me 12 months ago I was going to be here, I would have looked at you with amazement, but that is another story altogether.

The fact is that this is a difficult one. Last week was probably the first time in this House that I have been really torn, because we are having to find that balance with people’s liberties. Yes, the public health crisis is absolutely there; we can see it in the news and we can see it in the data. Every single person impacted by covid-19 is an individual and it is a tragedy when we see those deaths happen, but it is getting to a point where constituents come to me and say, “I haven’t seen my relatives in months,” “There is a choice as to whether I can go to my loved one’s funeral,” “I cannot go because the capacity is not there,” and “I cannot see my loved ones get married.” It is difficult. We have seen this technological renaissance through things like Zoom and Teams and people have been able to connect, but that does not replace physical human interaction at all.

The fact is that the Government’s economic response has been great, and that is what my constituents say to me. The Government have stepped up and given support to some of our most vulnerable communities through their economic response. I do not envy my colleagues on the Front Bench at all given the task ahead of them.

I am conscious of the need to keep my comments brief so that other colleagues can speak, so I shall just say this. Ultimately, as my hon. Friend the Member for Bracknell (James Sunderland) said, we are going to have to get to a point at which we live through a new normal, because when it comes to life, we can exist or we can live. The fact is that at the moment many of my constituents feel like they are just existing, and they want to start living again.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Shaun Bailey Excerpts

2nd reading & 2nd reading: House of Commons
Friday 16th October 2020 Commons Chamber

[Shaun Bailey (West Bromwich West) (Con)]

I have been taught that it is sometimes better to keep it short and sweet, keep them wanting more, so I will try to limit my comments to just a few. I start by thanking my hon. Friend the Member for Sevenoaks (Laura Trott), because her Bill demonstrates the reason why we are all here: to ensure that we protect some of the most vulnerable in our society and those who need our help.

I am conscious that at this point in the debate it is easy to be repetitious. I try to avoid being repetitious where possible, but I do want to pick up on some points raised. This is, at its core, about how we view ourselves. That point was well articulated by the hon. Member for West Ham (Ms Brown) when she said that it is about the individual inside and what we offer the world as people. Our physical presence should not be the core of what people see; it should be about who we are as people. That should be it, but unfortunately it is not.

When we look at the statistics, we see that women are disproportionately affected. I was fortunate to be brought up in a household of very strong women. My mum, who brought me up on her own, and her two sisters are strong, opinionated but fantastic women who absolutely gave me my life view. They taught me clearly that, at the end of the day, someone’s gender or what they look like should not matter. If they work hard, they should be able to achieve. I saw through their experiences that women are disproportionately affected, and it is absolutely wrong. That is not to discount, of course, that many man are affected. The figures I have seen show that about 40% of men are affected by botched botox and some of the image issues that come out of this. We absolutely must make sure that we get it right, and the Bill fills such an obvious gap. I think it was my hon. Friend the Member for Bosworth (Dr Evans) who asked—I may be wrong—why on earth this legislation is not already in place. It is beyond my comprehension.

This is not a controversial Bill. It is a common-sense Bill that fills a gap that should have been filled years ago. At its core, as many right hon. and hon. Members have articulated, it is about ensuring that we keep people safe and regulating a £2.75 billion industry. It is about ensuring that young people are protected and not pressured by what they see on TV. We have heard that in many fantastic and well articulated contributions.

I am acutely conscious that other Members want to speak, so I will round up my comments simply by saying that there are many more issues that are slightly outside the purview of the Bill that must be dealt with. My hon. Friend the Member for Sevenoaks absolutely must be commended, because the Bill is fantastic and is absolutely filling a gap that is there today, but today should only be the start. We must tackle those issues around how we view ourselves and the messages that we are sending young people about their place in society and what should be valued as important. It is incumbent on every single right hon. and hon. Member in this place to ensure that we carry forward the fight and say to people, “It is about who you are as a person, not what you look like.”