3 Selections of Candidates
We have considered what kinds of people put themselves forward as candidates, which potential voters actually took part in the election and who was eventually elected.
3.1 70 people sought election to the Board of NHS Dumfries and Galloway, 60 to the Board of NHS Fife. The ballot papers and candidate statements sent to electors were therefore unusually long.
3.2 Our survey of candidates, to which 83 candidates (64%) responded, suggests that the demographics of the candidates were fairly similar in both Boards (Fig. 3.1). The candidates were overwhelmingly between 41 and 60 (36% of the total) or 61 and 80 (51.8% of the total). Dumfries and Galloway had one candidate who was over eighty, one under 19, and one between 19 and 40; Fife had five candidates aged between 19 and 40 but none over 80 or aged less than 19.
3.3 Most candidates were long-established residents of their Health Board areas, with 88% reporting they had lived there for over five years. Our responses indicated 71.1% were male and 96% were white (which means two candidates did not give information and one, in Fife, was not white). Five candidates (6%) had a first language other than English. The geographical distribution of candidates is indicated on the map, figure 3.2. This figure is based on the addresses printed on the ballot paper and therefore includes all candidates and not only those who responded to surveys.
3.4 We interviewed every candidate who agreed to speak with us. While most were retired or semi-retired professionals or local politicians, applicants came from a range of different backgrounds.
3.5 There was a reasonably large group among the candidates who had sought appointment to public bodies before, or who had considered public appointments before but had recently retired and only now had enough free time to take a non-executive position. However, our interviews also suggested that many of the people who put their names forward would not have sought appointment to the Board through the traditional OCPAS-monitored procedure. Many candidates were unaware that non-executive positions on Health Boards were normally filled by public advertisement, and some believed that all members had to be invited to join Boards. A few were simply deterred by the current application system or believed they would stand no chance of being selected.
3.6 There was also variation in how candidates approached the elections. A few candidates, often those with experience in local politics, campaigned vigorously and used conventional tools such as pamphlets and door-to-door canvassing. However, most candidates did not campaign in this way and only a few reported receiving any support from political parties. The election was thus quite different from a local government election. Many candidates did not take any measures to encourage others to vote for them besides writing a candidate statement for the booklet and answering any questions posed to them by acquaintances. Many others encouraged people they already knew to vote for them, but did not contact other members of the public. These candidates typically expected support from people who already knew them personally or by reputation. As their addresses were printed on the ballot papers, some also expected support from residents in their area who would want to vote for a local candidate.
3.7 There were a few factors peculiar to Dumfries and Galloway. In particular, there was a perception in some rural areas that the Board intended to centralise services in the larger towns. Some candidates in rural areas of Dumfries and Galloway reported that opposition to centralisation motivated them. Candidates in rural areas were also concerned that elected members who lived in the town of Dumfries should not dominate the Board.
3.8 Although many candidates were vague on the details of what a non-executive does on a Board of Governance, most seemed to appreciate the need to compromise with other members and to accept collective decisions after discussion and possibly voting (while formal votes of Health Board members are rare, many interviewees did seem to believe that votes would occur periodically). Despite concerns among some Board personnel and stakeholders that Non-Executive Directors with single-issue agendas (for example, opponents of local hospital closures) might refuse to compromise and obstruct Board business if they disagreed with a policy, most candidates presented themselves as willing to compromise if they found themselves in a minority.
Patterns of voter turnout
3.9 We obtained records of voter turnout in these elections from the Returning Officers. In Dumfries and Galloway, 22.6% of eligible electors voted in the Health Board election (returning 26,516 ballots). In Fife turnout was 13.9% (with 39,761 ballots returned).
3.10 Official records include the postcodes of all eligible electors in the two Board areas. This enables us to check whether turnout was concentrated in particular postcode areas, and also to compare turnout in deprived postcodes with turnout in affluent areas.
3.11 The percentage of electors who returned their ballot papers did vary significantly in different postcode areas in Dumfries and Galloway, as shown in the map below (3.3).
3.12 There was no clear pattern in Fife, where turnout varied only within a 5% range between 10.6% in FK10 (around Kincardine) and 15.9% (around Elie).
3.13 We also compared levels of turnout with postcodes' rankings on the Scottish Index of Multiple Deprivation (SIMD) (see Figure 3.4). This Index ranks clusters of postcodes according to their level of deprivation, from 1 (most deprived) to 6505 (least deprived) and is used by the Scottish Government in service targeting. In the graph below, deprivation ranking reduces from left to right. The leftmost bars represent turnout in postcodes which fell into the 500 most deprived clusters in Scotland, while the rightmost bars represent turnout in postcodes that fell in the 505 least-deprived clusters. The other bars represent turnout levels in postcodes falling into clusters ranked between the 501st and 1000th most deprived, 1001st and 1500th most-deprived, and so on. Blue bars give the turnout in Dumfries and Galloway; green bars the turnout in Fife. These figures ignore any postal votes that were sent to addresses outside the Health Board area.
3.14 In Fife there was no statistically significant relationship between the SIMD rank of a voter's postcode and likelihood of voting in the Health Board election. Voters in deprived areas did appear to be less likely to vote in Dumfries and Galloway, but SIMD rank was an extremely weak predictor of likelihood of voting. The fact that this relationship appeared probably reflects the fact that turnout was very much higher than average in a few of the affluent areas of Dumfries and Galloway rather than electors in deprived areas being unwilling to participate. In general, it does not appear that residents of deprived postcodes were less likely to return their ballot papers.
3.15 For comparison, the figure below (3.5) repeats the analysis for the 2010 General Election, using a random sample of 3000 electors in each Board area. While turnout overall was much higher in the General Election, the results for the Health Board do not suggest that there was a dramatically greater difference between deprived and affluent postcodes in the Health Board election.
Survey of elector results
3.16 Our survey of electors in Dumfries and Galloway and Fife provided us with substantial demographic information about those who chose to vote, and not to vote, in the Health Board elections. This goes beyond the information we were able to gather from official records, including information on gender, education and ethnicity. Because we found that there was a strong correlation between voting in the election and returning our survey, with voters much more likely to return surveys than non-voters, the figures reported here have been weighted to place increased emphasis on the responses given by non-voters.
3.17 Our analysis of this data indicates that age is by far the strongest predictor of whether an elector would turn out to vote in the Health Board election. Older electors, especially over-60s, were much more likely to return a valid ballot paper than younger electors in both Fife and Dumfries and Galloway. In keeping with the pattern in the Returning Officers' figures, presented above, we also found that those electors in Dumfries and Galloway who lived in certain postcode areas were significantly more likely to vote. We also asked about respondents' length of residence within the Board area, sex, state of health, disability, whether the respondent was a carer, and whether they had dependent children, but we did not find that any of these characteristics significantly influenced the odds of voting in the Health Board election.
3.18 Based on our weighted survey results, it seems that an elector aged between 60 and 80 was more than twice as likely to vote as an elector aged between 18 and 40.
Health Board versus general election
3.19 Our survey asked voters both about whether they turned out for the General Election held just before the Health Board election, as well as the Health Board poll itself. This allowed us to test whether the characteristics associated with not voting in the Health Board election simply cause people to be disengaged from politics, or whether some of these electors were particularly deterred by something about the Health Board election.
3.20 Turnout in the Health Board election was much lower than in the General. Only a few of our respondents had voted for the Health Board but not in the General Election, and that group of respondents was too small for us to be confident about generalising from their characteristics. We did have many respondents whose records show had voted in the General Election but not the Health Board election, and we were able to compare their characteristics with those of respondents who had voted in both.
3.21 Electors who voted in the General Election but abstained for the Health Board were likely to be under 60. Unsurprisingly given this age profile, they were also more likely to have dependent children, they were less likely to report that their lifestyles were "limited a lot" by disability, and on average they rated their health as better than respondents who voted in both elections. This reinforces our finding that older electors were particularly likely to vote in the Health Board election.
3.22 We already know that there are certain characteristics that make people less likely to vote in elections generally. Turnout in the Health Board elections was not only affected by these characteristics, but was much more heavily skewed towards older electors. Compared to respondents who had voted only in the General Election, respondents who reported that they had voted for the Health Board as well were more likely to be over 60 and had characteristics associated with being older.
3.23 The survey also revealed that, despite significant efforts by the Boards and Returning Officers to inform the local population about the Health Board Elections, many electors still felt ill informed about the elections. Table 3.1 shows responses to our survey question "How well-informed did you feel about the Health Board election?" It shows that many electors in both areas felt poorly informed, although electors in Fife tended to be less informed than their counterparts in Dumfries and Galloway.
|Dumfries and Galloway||Fife|
|"Not at all well informed"||27.1%||41.9%|
|"Not very well informed"||39%||39.8%|
|"Very well informed"||4.3%||1.4%|
3.24 Our survey form also offered respondents an opportunity to tell us why they had chosen to vote, or not to vote. When reviewing their responses we became aware that a significant proportion of non-voters were attributing their decision to limited information. We drew a random sample of 302 of the respondents to our survey who offered a reason for their not voting in the Health Board Election. Forty-six cited lack of information about the candidates, 6 lack of information about the role of Board members, and 48 a general lack of information about the election. Overall, a third of these voters attributed their decision not to vote to a lack of information. This suggests that electors' perception that they lacked information reduced the level of turnout. With regard to those who offered positive reasons for voting it seemed to come down to a feeling that that is simply what one should do i.e. it is a positive act of citizenship to vote and with these individuals this applied to both health board and general elections.
3.25 It is likely that the timing of the elections had a significant impact on the process. The closing date for candidate registration coincided with polling in the General Election. The election campaign took place against the background of post-General Election coalition negotiations. Proximity to the General Election affected candidates' experience. Several candidates who had past experience of campaigning for election mentioned that they had expected the first few days in which ballot papers were delivered would be the most fruitful for campaigning, but these coincided with the distraction of the General Election.
3.26 The coincidence between the Health Board and General Elections also raises counterfactual questions as to how campaigns for any future elections might differ if a rollout order is made. For example, while a few candidates did make use of political party labels there was relatively little activity by local branches of political parties in the Health Board elections. If this was partly a result of party members having focused their energies on the General Election campaign, it is possible that there could be greater mobilisation in any future elections. Therefore, while relatively few of the candidates campaigned as representatives of political parties this does not necessarily mean that the rules of the election discourage political parties from becoming involved. The relatively low level of partisan campaigning seems to have reflected inopportune timing of these elections from the point of view of party activists, coupled with self-restraint by political parties, which we cannot be certain would continue in the event of a national roll-out.
3.27 It is also possible that electors might be more available to digest information about future elections that did not coincide with a major national contest.
3.28 Electors were much less well informed about these elections than they were about the General Election. Comparing Table 3.1, derived from weighted responses to the question "How well-informed did you feel about the Health Board election?" with Table 3.2 shows the difference between the two elections. Voters felt much better informed about the General Election.
|Dumfries and Galloway||Fife|
|"Not at all well informed"||4.5%||6.2%|
|"Not very well informed"||17%||19.8%|
|"Very well informed"||16%||13.8%|
3.29 While this may not be surprising given that the General Election was a very high-profile contest, survey responses and interviews with a selection of respondents suggested that the level of public awareness was also much lower than local elections. Electors' feelings of being under-informed about the choice facing them clearly played a part in reducing the level of turnout, and it seems plausible that the General Election distracted attention from the Health Board.
16 and 17 year old voters
3.30 The inclusion of 16 and 17 year olds as potential candidates and voters was an innovative element of the pilots.
3.31 Residents who were under 18 on election day but whose 16th birthday *fell on or before the 30th of November 2009* were eligible to vote in the election, which closed on June 10th, provided that their names appeared on the electoral roll. This was the first opportunity for people in this age group to vote in Dumfries and Galloway and Fife. Under normal circumstances 16-17-year-olds can be added to the electoral roll in advance of their 18th birthday, but in practice many 16- and 17-year-olds do not have their names added well in advance of their 18th birthday. Despite the efforts made by the Returning Officers and their staff to encourage 16-17-year-olds to register before the Health Board election, it is possible that 16-17-year-olds were less likely to appear on the electoral roll than older residents. In Fife 4,484 16-17 year olds were registered while 2,421 were registered in Dumfries & Galloway.
3.32 Returning Officers' records showed that 12.9% of the 16-17-year-olds who were on the register in Dumfries and Galloway voted, with 312 ballots returned. Turnout among registered 16-17-year-olds in Fife was 7%, or 311 ballots. This means that those 16-17 year olds who were registered to vote were significantly less likely to vote than registered electors aged over 18.
3.33 In Dumfries & Galloway, the local authority's Youth Strategy Group had advised on communications efforts, with advertising concentrating on buses and local radio, and information sent to schools for their pupil intranet. In Fife, work with local youth groups (including the Big Shout and Members of the Scottish Youth Parliament) produced a DVD encouraging young electors to vote in the elections. Copies of the DVD were distributed to schools around Fife and played in cafeterias.
3.34 Across both Board areas, young people in the focus groups had very little awareness or understanding of the elections having taken place. No one in any of the groups said they had voted, and most had no recollection of hearing about the election. The only exceptions to this were some young people who were members of political parties, or whose parents worked in the NHS. Notably, this lack of awareness also extended to the existence and purpose of board of directors of the Health Board. Several young people stated that they assumed the Board was for doctors and nurses. Most young people expressed much more enthusiasm for voting in the General Election, and attributed this to knowing the purpose of the election, and the perceived greater importance of the issues at stake.
3.35 Young people found the booklet of candidate statements over-long and unappealing; several suggested that a photo of the candidate would be more engaging. When the discussion moved to better ways of getting information to young people, a strong preference was expressed for a face-to-face presentation in school. Focus group participants were enthusiastic users of the internet and social media but pointed out that they would need prior understanding of the election; some felt that information on an election would not appeal when using social media: "that's not what you go on Facebook for, is it?" (M, Fife).
3.36 The potential for 16 & 17 year olds to stand as candidates was surprising to focus group participants. Views were divided, with some young people feeling that their peers would lack the necessary life experience for the role, and other arguing that they would be able to represent young people's different priorities and perspectives. Most said they would not seriously consider standing, citing a lack of confidence, or worrying that they would lack necessary medical knowledge.
Elected member characteristics
3.37 We interviewed all of the elected members at least once, and asked them to complete a survey so we could gain background information on them. With a few exceptions, we were able to gather demographic information from all of the members who were initially elected. The new members who responded were all over 40, and 60% were over 60. However, none were over 80. All the new members who responded spoke Scots or English as their first language, all were White, and all had lived in the Board area for at least five years. Six men and four women were elected in Dumfries and Galloway, while six women and six men were elected in Fife. Of those who responded to our survey, in Dumfries and Galloway two elected members were carers and two were parents or guardians of dependent children. No members of NHS Fife fell into these categories.
3.38 The newly elected members who responded to our survey included several holders of advanced qualifications, as summarized in Table 3.3. The elected members tended to hold more advanced qualifications than the average for their local populations.
|Fife||Dumfries & Galloway||Total|
|No formal qualifications||1||0||1|
|Standard Grades/O- levels/School leaving certificate||0||1||1|
3.39 By way of comparison, the Office of the Commissioner for Public Appointments in Scotland (OCPAS) publishes a breakdown of the characteristics of people appointed to public bodies. OCPAS uses slightly different age categories than our survey, but by comparison their figures for 2010/11 show 57.8% of appointees were male, 96.6% were white, and 51% declared they were over 55 (with a further 25% aged between 46 and 55, 9% between 36 and 45 with only 3% under 35). The candidate pool was therefore more diverse than the OCPAS appointments.
3.40 One distinctive feature in NHS Fife was the election of members who had previously been appointed to sit on the Board as non-executives, and who were compelled to resign when the elections were announced. In order to meet the statutory objective of having a majority of the Boards elected, the Scottish Government ended some of the existing Non-Executive Directors' terms of office before their original termination dates. In Fife, three of those members contested the election and all were elected, while one member chose not to seek election. None of the non-executives in Dumfries and Galloway who were removed from the Board in this way chose to contest the election.
3.41 The elected candidates' statements often referred to professional background, in many cases including previous experience in some part of the NHS or in the English NHS, which was confirmed in interviews.
Induction of elected members
3.42 Elected members received two days of joint induction training at the Beardmore NHS Conference Centre in Clydebank, and the two Boards that received elected members each organised two days of local induction at their own sites. This induction differed from the normal induction process for new Board members insofar as new members typically arrive as individuals or as very small groups. Introducing new non-executives as large groups made these dedicated induction sessions feasible. A number of new members stated that they found these sessions helpful; some commented that it was valuable to meet other elected board members and some others noted that the volume of information could be overwhelming.
3.43 The introduction of elections not only changed the initial selection process, but also introduced a new mechanism for replacing elected non-executives who left the Board before their term of office expired. As all candidates in the election were rank-ordered according to the number of votes they received, when members who were initially elected needed to stand down it was possible to substitute candidates who had initially been unsuccessful. As vacancies arose, vacated seats were offered to the initially unsuccessful candidates who had received the largest numbers of votes in the elections.
3.44 Two elected members of NHS Fife and one elected member of NHS Dumfries and Galloway were obliged to resign from the Board by the end of 2011. Norma Wilson applied for, and was appointed to, a senior management post within NHS Fife that appeared on the list of excluded positions in the Health Board (Elections) Bill. Jayne Baxter and Alis Ballance were obliged to resign because they were nominated as candidates for the Scottish Parliament.
3.45 The succession procedure appears to have worked as planned. When the first member of NHS Fife resigned, the candidate who was ranked 13th in the election was able to take up the vacant position. With the next resignation, the candidate who had ranked 14th was able to take up the vacant seat. Similarly, the only resignation from NHS Dumfries and Galloway led to the candidate who had ranked 11th in the election results taking up the vacated seat.
3.46 The pilots did not encounter a scenario in which the candidate who was next in line was unable or unwilling to take up the post, or in which more than two elected members resigned. Such a scenario could potentially occur in future elections if a rollout order is made. The pilot gave us no information on how such a scenario would play out.
3.47 Two of these resignations from the Board were due to candidates for election to the Scottish Parliament being compelled to resign from the Health Board on submitting their candidacy. The prohibition on candidates for election serving on Health Boards did provoke some comments in a range of interviews.
3.48 Candidates for Parliamentary elections are required to sign a declaration at the time of lodging nomination papers stating that they are not disqualified from being a member of the Scottish Parliament. The Scottish Parliament (Disqualification) Order 2010 (S.I. 2010/2476) sets out many of the office holders who are disqualified, including "Chairman or any member, not being also an employee…of a Health Board…". Our understanding is that it has always been Scottish Government policy that Members of Parliament cannot sit on Health Boards, and that this extends to candidates for election to the Scottish Parliament. Any member nominated for election would need to resign from the Board before nominations were filed. This would apply to appointed and elected non-executives, and also to councillors nominated to the Boards. However, the policy had not been stringently enforced, leading some members to believe that they could stand for election to the Scottish Parliament and return to the Board if unsuccessful.
3.49 The Scottish Government's decision to tighten enforcement of this policy alongside the introduction of elections to Health Boards did put elected members who had committed to stand for election as representatives of political parties in a position that they found difficult. In effect, these members had to give up seats to which they had been elected. While this may have appeared in codes of governance, we found not all elected members were aware of the implications. We would recommend that implications of the policy be given a higher profile in the documentation issued to potential candidates.
3.50 In addition to the two electoral pilots two boards were invited to try recruiting and selecting non-executive members in a somewhat different way. These two initiatives became known as the alternative pilots. The two boards involved were Grampian and Lothian. As in the elected pilots, the number of Executive Directors was formally reduced to five. However, these pilots added only two additional Non-Executive Directors. Numerically, these pilots led to much less dramatic changes in the composition of the Boards, which would complicate any comparisons between the elected and alternative pilots.
3.51 In Grampian, the process for recruiting the two new members differed in that the vacancies were advertised more widely than in previous rounds, including a two-week advertising campaign on local radio, newspapers and distribution of flyers. The Health Board also took advantage of existing networks (such as voluntary sector bodies) to identify likely applicants, encouraged potential applicants who called the Communications office to apply if this seemed appropriate, and invited them to meet existing Board members to discuss the role.
3.52 In Lothian, the two members were recruited by very different methods. One of the new members was recruited by a mechanism similar to the Grampian pilot - a traditional competitive application open to all members of the public, but with a broader advertising strategy than in previous rounds and with possible candidates identified through voluntary sector networks. The other member was recruited from the office-bearers of Public Partnership Forums (PPFs). All office-bearers in the Lothian PPFs were invited to express interest in serving on the Board, and the selection panel chose from among those office-bearers who declared an interest using a conventional interview process.
3.53 The Grampian pilot attracted 90 applicants for the two posts, a much higher number than such vacancies usually attract (the previous appointment round had attracted seven applicants). Not all of these applicants chose to give demographic information with their application, but of those who did 51 self-identified as White and four were from Mixed, Black or Asian backgrounds. There were 34 men and 24 women. The age profile of the applicants who gave this information is summarized in Table 3.4.
|Number of applicants||1||6||4||8||18||10||7|
3.54 For the open competition, NHS Lothian attracted 30 applicants. Again, not all applicants chose to provide demographic information. Of those who did, all were White, and there were 12 men and seven women. The age profile of the applicants who gave this information is summarized in Table 3.5.
|Number of applicants||0||1||3||5||8||1|
3.55 Eighteen office-bearers in Lothian PPFs expressed an interest in joining the Board; no demographic data was available from this selection.
3.56 We also conducted our own survey of applicants to Grampian and of members of the public who applied to Lothian's second (open) position. This survey received 26 responses from Grampian and 18 from Lothian, a rate that may have been reduced by the considerable time that elapsed between this survey and the deadline for applications. Our survey asked for information that is not gathered during the normal demographic monitoring of applicants. This asked about applicants' level of education, whether they considered themselves to be disabled, whether they were carers of adults or children, and whether English (or Scots) was their first language. We also asked if they had applied to join a Board of governance before.
3.57 This survey revealed further diversity among the applicants. Three applicants to NHS Grampian and two applicants to NHS Lothian self-identified as disabled, while five applicants to Grampian and two to Lothian were carers. One applicant for each Board reported that English (or Scots) was not their first language, while four applicants to each had dependent children.
3.58 With two exceptions in Grampian, all respondents had lived in the Board area for at least 5 years. Similarly, with a few exceptions respondents tended to rate their health as good (Table 3.6)
|Very Good||10 (38.5%)||9 (50%)|
|Good||12 (46.2%)||7 (38.9%)|
|Fair||2 (7.7%)||1 (5.6%)|
|Very bad||0||1 (5.6%)|
3.59 In both cases, most applicants held degrees. The educational qualifications of the respondents are summarized in Table 3.7.
|No formal||1 (3.8%)||0|
|Standard Grades or similar||1 (3.8%)||1 (5.6%)|
|Highers or similar||3 (11.5%)||0|
|College qualifications||1 (3.8%)||1 (5.6%)|
|University degree||11 (42.3%)||7 (38.9%)|
|Postgraduate||8 (30.8%)||9 (50%)|
|(no response)||1 (3.8%)|
3.60 Responses to our survey suggested one notable difference between the Boards: respondents who applied to NHS Lothian were significantly more likely to have applied (or been invited) to join Boards of governance before than were applicants to NHS Grampian. Fourteen of the 18 respondents from Lothian (78%) had applied to Boards of other organisations before this application, as opposed to only 10 of 26 respondents from Grampian.
3.61 It is worth remembering that neither the demographic monitoring as part of the application process nor our survey had a 100% response rate.
3.62 Thus, the alternative pilots do appear to have contributed to some increased diversity at the application stage. However, it is important to remember that selection from among these applicants continued to be made using a conventional OCPAS-approved method, based on a long application form and a competency-based interview. The alternative pilots formally changed only the process by which applicants were encouraged to submit forms to the Scottish Government and OCPAS for scrutiny. After that point selection progressed as normal, although the selection criteria for these appointments were weighted towards ability to provide a generalist perspective on the Boards' activities rather than possession of any specific technical knowledge (e.g. of finance or human resource management). In this respect the alternative pilots were very different from the elections. Elections recruited far greater numbers of potential non-executives and effectively bypassed the selection process normally put in place by the Scottish Government and OCPAS. If these methods were to be rolled out across Scotland, the conventional selection process would still shape the composition of new non-executive cohorts even if the size and diversity of the applicant pool were increased. The question of whether it would be possible or desirable to alter the Scottish Government and OCPAS selection process for non-executives technically falls outside the remit of this report. However there is clearly scope to do this should Ministers and Parliament decide that that would improve the appointment process.
Induction of alternative pilot appointees
3.63 The pilot appointees in both Grampian and Lothian received tailored induction and training similar to any standard appointed non-executive, delivered by the relevant Board. Due to the different timescales of these pilots, they were not present at the Beardmore induction sessions for elected members.
Email: Fiona Hodgkiss
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