Introducing new Chief Medical Director, Dr Magnus Harrison
Newson Health has recently appointed a Chief Medical Director to ultimately help more women improve their health. In this episode, Dr Magnus Harrison shares a whistlestop tour through his professional life so far as a Consultant in Emergency Medicine via New Zealand, Australia, and Manchester and his experiences in leadership at Stoke on Trent in the wake of the Mid Staffordshire NHS Trust’s ‘adverse mortality’ investigation. Via Harvard, USA and India, Magnus then oversaw the merger of Burton upon Trent and Derby NHS Trusts before the hardest time of his career to date – the COVID 19 pandemic where 8 staff members from his organisation lost their lives.
Magnus discusses with Louise what he hopes to bring to the medical leadership and management of Newson Health and the key values that underpin his mission.
Magnus’s aims for his leadership at Newson Health:
- I will be humble and led by professional curiosity to learn how to help more women
- I aspire to be a compassionate leader, will listen to understand, empathise and ask how I can help
- Kindness is essential and should underpin all that we do.
Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence based information and advice about both the perimenopause and the menopause.
Dr Louise Newson [00:00:46] So today on the podcast, I’m really thrilled actually to introduce to you someone that I’ve known for a long time, nearly as long as I’ve known my husband, which is a very long time. So someone called Magnus Harrison. He’s a medical doctor and we first met in New Zealand in 1995, so many years ago. And life always goes in circles – a massive circle with myself and Magnus, and he’s now working with us, which is super, super exciting. So welcome, Magnus, to the podcast today.
Dr Magnus Harrison [00:01:15] Hello, Louise.
Dr Louise Newson [00:01:16] So tell us a bit about – I know a lot about you, some things that I might not reveal on the podcast today. But tell me a bit about you, because our medical backgrounds, I mean, we’re both medical doctors, but our medical backgrounds, even right from the start in ‘95 were very different weren’t they and they’ve carried on being very different. So if you wouldn’t mind describing a bit about where you’ve come from and what you’re doing, and then we can explain the full circle and why you’re here today.
Dr Magnus Harrison [00:01:41] I will do. So I’ll start a little bit before ’95, Louise. I’m a Newcastle Medical School graduate in ‘93 and always wanted to do emergency medicine. And I remember really clearly as a third year medical student, the medical registrar, working some sort of magic on a patient who came in with a low blood glucose, and on the end of a syringe, this patient just woke up and I thought, how fantastic. Get the diagnosis right, get the treatment right, and you make a difference straight away. So I was won on emergency medicine, more or less straight away, and I did a bit in the north east of England in Sunderland and South Shields, and then straight to New Zealand to be an emergency medicine registrar. And we actually met in the council offices of the New Zealand Medical Council where we were all trying to register and fortunately, we all had the right bits of paper and they signed it off to be able to work. Did a year there. Did almost a year in Sydney as well, shortly afterwards, again in emergency medicine, but always wanted to try and do research. There was very little research available in emergency medicine at that time and had a failed attempt initially in Stoke. And then I went to work at Manchester Royal Infirmary, which is probably one of the most formative periods of my career. It’s where we learnt about medical stats, it’s where I learnt about diagnostic statistics and ‘numbers needed to treat’, ‘numbers needed to harm’, and really set me up for my registrar training scheme in emergency medicine which was in the West Midlands, and I became a consultant in Stoke as a first consultant job. And this is where things all got a little bit interesting as six weeks in somebody said to me, ‘Do you fancy being clinical lead?’ And they hadn’t identified any particular talent or ability I had. They’d just identified that the other three had had a go and it was probably wise that I had a try.
Dr Louise Newson [00:03:26] That’s a huge job, isn’t it? I mean, Stoke is a big hospital, a big trauma centre, it’s not a small little DGH is it, it’s a big busy hospital.
Dr Magnus Harrison [00:03:35] Yeah, you’re absolutely right. Tertiary centre, medical school, that was quite rudimentary, embryonic almost at that time. But neurosurgery, cardiothoracic surgery, full on trauma. And at that point in time was one of the busiest emergency departments in the country. And we had 2.6 consultants – the point six was obviously not 60% of an individual, they just did 60% of a job. And there was a realisation that we needed a lead and I stepped in without really knowing what it was about, but absolutely loved it. Loved the interaction with people, loved being able to make a difference. And quite quickly after that I became Clinical Director of the emergency department and the acute medicine department, and that led me into working with the team Mid Staffs. And it was absolutely the time that Mid Staffs were having all their difficulties and that was probably one of the most challenging and yet probably one of the most rewarding times I’ve had, dealing with essentially an absolutely broken team as a result of what had gone on there.
Dr Louise Newson [00:04:36] Can you just explain for those that might not know about Mid Staffs.
Dr Magnus Harrison [00:04:39] Yeah, so Mid Staffs hospital was in Stafford and those who are a bit like you and me Louise, a bit longer in the tooth, will remember what went on at Mid Staffs but it was erm how to describe – because I’ve got lots of colleagues there who are bruised and battered by what went on there – they were recognised as having adverse mortality and for those that are going to scream at the podcast now I’m quite prepared to discuss the statistics around whether it was adverse or not but adverse mortality as a result of systemic failures within systems approached in Mids Staffs. And the emergency department were pilloried in the press. And I have two really good colleagues that worked there at the time. They’d both left by the time I was asked to help out there, and I led the emergency department in Mid Staffs as well as Stoke for a period. And just a broken team who actually all went to work every day, to do the right thing for the patients that are put in front of them. And I suppose what I learnt from that was the systems, the processes, the cultures all have to be lined up to actually be able to deliver care in the right way. And none of them went to work at any point in time to do a bad job. You know, it was hugely important and influential for me in my career and on the back of that, I applied for the Clinical Executive Fast Track Scheme, which the Secretary of State at the time, Jeremy Hunt, had put in place. And I essentially was sponsored to have a year more or less outside of the NHS. Got to go to Harvard to do a postgraduate course, ‘Reimagining Healthcare’. Worked with Baroness Cumberlege in the House of Lords. There were 50 of us on the programme, it wasn’t just me as an individual, don’t get that idea! Worked in the House of Lords, spent a bit of time working with EE the phone company, helping define their healthcare space, was asked to do their keynote speech. I was so far away from Steve Jobs and Tim Cook, it’s unbelievable. But we did their keynote health address. Got to go to India, went to India because India’s got a very different healthcare system to the UK and there’s private and essentially very little public provision. And I reviewed 12 healthcare systems over there to decide what we could potentially bring back and transport into the NHS. And on the back of that year, it was really obvious that I needed to do more to keep myself interested and I ended up as the Medical Director and Deputy Chief Executive at Queen’s Hospital in Burton upon Trent. If I’m going on, I apologise.
Dr Louise Newson [00:07:05] No it’s all very interesting and relevant actually.
Dr Magnus Harrison [00:07:07] What became obvious in Burton, and Burton was a small DGH, £160 million, 400-ish beds, three hospitals though in the South of Staffordshire. What became obvious really quickly was the population we served wasn’t big enough to allow physicians to specialise or surgeons to specialise. So it was a really general approach to medicine in the broadest sense and it was clinically unsustainable. Not clinically unsafe, although it had been recognised as a Keogh trust with adverse mortality, and went into special measures. We turned special measures around really quite quickly and I wouldn’t want to claim any responsibility for that, only for the ongoing plan that I had as a Medical Director. But it became really obvious quite quickly to me that we’re going to have to merge with a bigger organisation and that’s when the merger with Derby Teaching Hospitals started and I was one of the two SROs for the patient benefit case and the patient benefit case essentially is looking at a group of specialties and being able to describe the benefits for the populations that you represent. And it became really quite obvious, again, fairly – I say fairly quickly, it took 18 months to write it – but in six specialties that we’d picked, I could clearly define a benefit for the populations in Derby and the populations in Burton, and I could still do that now. I can still clinically evidence the impact of the merger positively, for that group of people. So the merger went through and it was – you know, when you look back on your career and there’s those times and, you know, the grin, and you just think, I’ve no idea how I am in this room having this conversation. So at that time, we had to go to the Competition Markets Authority, the CMA. And, you know, you hear of the CMA, I didn’t realise what they did. And I sat in front of a whole panel of health economists, lawyers, either contract law, then one of their team walked in and he said, I’m the Devil’s Advocate. And his job role was actually Devil’s Advocate in this panel, and I couldn’t believe it. So I was there with the Chief Exec. I was working to at the time, Gavin Boyle, and we both sat there and had to go through a whole patient benefit case with the CMA to prove there was no detriment to health and care as a consequence of the merger. So we weren’t decreasing competition and as a consequence decreasing the quality of care offered. And fortunately, we got through first time, so no second bites at the cherry. So we went in and we merged the… both Trusts on the 3rd of July 2018, and I became the Medical Director and Deputy Chief Exec. of the University Hospitals of Derby and Burton. Was Medical Director for three and a bit years there and then early this year, 2022, the Chief Exec. moved on and I became the interim Chief Exec. of UHDB. And I think right now that’s the pinnacle of my NHS career. So being able to have influence over the care and health of 1.2 million people, you know, what’s not to want about that? I say that and I say that rather glibly. And I’m looking back now through rose tinted spectacles because the last two and a half years as Medical Director in the COVID pandemic response was the hardest thing I’ve had to do in my career.
Dr Louise Newson [00:10:18] I’m sure.
Dr Magnus Harrison [00:10:18] And for people that are not as close to this, we had eight staff members die as a consequence of COVID. Three consultants died from COVID in our organisation and as a Medical Director, you always, there’s always a level of unexpected events that occur when you work out what you’re going to do. But having three consultants die in a pandemic, you know, there’s nothing prepares you for that, nothing gets you ready. And then four other staff members, and we decided really early on into the pandemic that for everybody that died, we would have a minute’s silence at whichever particular hospital. We’d got five hospitals now in the Trust. And one of the consultants who died, it was a guy called Manjeet Singh Riyat. He was one of the A&E consultants in Derby and I’ve known Manjeet for years prior to being the Medical Director. And he was one of the original absolute godfathers of emergency medicine nationally. And seeing all the ambulances pull up outside. And they did it in such a way that they could all open the front doors out, so it looked like they’d got wings and they got the blue lights on, and we had the minute’s silence. I’m glad it was raining, I’m glad it was raining because everybody was crying. And it’s making me shiver now just even thinking about it. It was formative moments. But that takes us to sort of the tail end of the pandemic, which is where we are now. And me and you have been having this discussion about what could I bring, what would I offer Newson Health? And we sort of chatted and we danced around the handbags a bit. And then and you know, let’s not be shy about this, I went for the Chief Executive job, I didn’t get the Chief Executive job. And the timing just felt right for me to dip my toe into a very different arena. Somewhere where I am so far away from being a subject matter expert it’s untrue. But somewhere where 15 years of medical leadership and management could be exceptionally useful. But Louise, I’m only five days in so don’t judge me yet!
Dr Louise Newson [00:12:22] Ha ha! But I think it’s very interesting because when we both met in 1995 and somebody, if we’d gone to see a futurist, you know, someone with a crystal ball and said, ‘Right, in 2022, the two of you will be working together, you will be running a menopause clinic and you’ll be working with it’. We would just go, ‘no way. Absolutely no way’. And I’m not even interested in – I’m interested, of course but not as a specialty – in gynaecology. So women’s health is often grouped as a gynaecological specialty. So it wasn’t really my area of interest. I was always very scientific. I’d got a pathology degree as well as my medical degree. And you’re from A&E, you know, so why would you even think menopausal women go into A&E? And of course, how wrong were we? Because we know that menopause isn’t about women’s health in the respect of a gynaecological specialty. It’s a multi-system organ problem that affects every cell in our body. And there are lots of women that go into A&E and are misdiagnosed with various conditions, but that’s only a small part. We also, neither of us, wanted to work away from the NHS, you know, but we also, I know we’ve spoken about it before, we both qualified and we decided to do medicine because we wanted to make a difference to as many people as possible. And I know myself when I left the NHS a few years ago, as in stopped being an NHS GP, I was really sad about it and my husband kept saying, ‘but you’re going to make a bigger difference in bigger ways than you could do just in day to day seeing 30 or so patients, or 50 patients a day’. And it took me a lot to understand that. And it’s weird really, because when you left your A&E work, Paul my husband and I often said, ‘Well, why is Magnus doing management stuff? Because he’s such a talented doctor. He’s as cool as cucumber. He’d run the trauma unit, I can’t understand it’. And I think because we don’t know much, do we, about management, because we’re not trained in it as part of our undergraduate training, I didn’t really understand the enormity of what you’ve been doing over the years because, you know, I remember when you were going to America, we say, well, that’s nice. You know, didn’t really know what you were doing. But actually, we both want to make the biggest difference to the largest number of people. And also, we want to work with a team that’s dynamic, forward thinking, can make a difference and enjoy the journey and no journey is going to be smooth and there’s always going to be problems and there’s always going to be turbulence. But I think over the, maybe the last year, I have phoned you up with a couple of crisis calls to say, ‘Magnus, this is really big and I don’t know what to do’. And he would just laugh and say, ‘Yeah, it’s enormous, the more I think about the menopause, the more I realise it’s affecting my staff’. Do you remember? I remember you saying once, ‘Louise, a lot of my staff are either, as a nursing staff, are either your patients, they’re balance users, or sadly they’re giving up or reducing their hours because they’re menopausal’. And I think you’d started then to realise the enormity of what we’re trying to do here.
Dr Magnus Harrison [00:15:25] So I think two bits to that, Louise. So this is where I’ve got to sort of clinically fess up to everybody and think there’s any number of women who are perimenopausal and menopausal who probably didn’t get the best deal from me when I was a clinician working in emergency departments. So how many people have I sent for 24 hour ECG tapes to try and work out what their tachycardia was, or even if there was a tachycardia there, I don’t know. How many women did I see with type two diabetes who were of the right age? And – you know, I know now because me and you have talked about it – and the impact of hormones, even on the acute presentations, should not in any way go unheralded in the future. But each step in my career, what I’ve done is changed the number of people, the population that I represent. And I’m very much you know, we can both remember those medical school interviews where you go in and you say something quite glib, ‘just want to make a difference’. It was quite glib, but I meant it then and I mean it now. And you know, if I was on call for trauma, I might see one patient in 8 hours as you make a diagnosis and pull all the right specialties in to build up a treatment plan. As you become a Medical Director, you represent the whole population that attends that particular hospital. As a Medical Director in a bigger organisation that gets bigger. So I’ve sort of gone from one patient potentially per shift to 300,000 when I was at Burton hospitals to over a million at Derby Teaching Hospitals. And listen, I’m going to quote a statistic now – I’ve only learnt this this week, thank you, Louise – so it moves from that 1.2 million to 1.2 billion, internationally. And the bit I particularly find exciting is the ambition we have, you have essentially, because it’s all down to you. And I’m here hoping to be part of that journey, is to make a difference to women everywhere. And it’s that equitable offer that we’re searching. We’re searching for that sweet spot where there’s an equitable offer for everybody so that we can look ahead and look to women who are beyond the traditional – I say beyond the menopause age. I don’t really mean that. Menopause goes on from when your hormones drop till the end of life. But the advantage we’ve got now is that with the right treatment and I’m not saying everybody should have HRT, but with the right treatment, we decrease cardiovascular problems, we decrease type two diabetes, decrease dementia, we stop the osteoporosis and that’s the bit we know about right now. And, you know, I remember me and you having a conversation during COVID about how many women did I see on our intensive care units who were on HRT. And I remember answering that question, having spoken to both sets of ITU consultants – zero. We didn’t find a single woman and that, you know, then you start thinking about the immune modulatory capability of estrogen. Louise, I’d never thought about that before. Never, never imagined it. And you know, the endothelial response to estrogens as well, I was never aware of this as a doctor.
Dr Louise Newson [00:18:34] Yeah.
Dr Magnus Harrison [00:18:34] But the impact we can potentially have now by getting it right, right now, nationally and internationally is huge.
Dr Louise Newson [00:18:43] It’s absolutely huge. And I think what’s, because it’s so huge, it’s quite scary. And when things are scary, people often withdraw and don’t do it and I think that’s what’s happened the last 20 years, actually. There is a bit of gender inequality, there’s a lot of sexist ageism, but actually I’m really interested in healthy ageing and a lot of people think about ageing as just a few wrinkles. We’re always going to get that as we age. That’s fine, but it’s about the accelerated ageing that leads to diseases, the inflammation and I think, you know, having the immune system as healthy as possible, we know with the pandemic how important it was. But we also need to know, you know, number one killer is cardiovascular disease and dementia in women globally. And we need to look at other inflammatory conditions. And actually even clinical depression, Parkinson’s disease, dementia, are thought of to be inflammatory conditions. If our immune system isn’t primed well it doesn’t work well, it fights against us and all these cytokines, these chemicals are produced, they accelerate the way we age. And we talk a lot now, don’t we, about sort of fragility and how healthy we can be until the time we die. And the problem is, after the menopause, for a lot of women, their health decelerates really, it gets older a lot quicker and therefore there’s a bigger drain on the economy. And you only need to look at one in two women who have osteoporosis after the menopause, one in three have osteoporotic hip fractures. I was told that the mortality from an osteoporotic hip fracture was 20% after a year. But a professor of orthopaedics told me yesterday it’s 25%. I can’t think of, you know, most cancers, 25% of people don’t die after a year of diagnosis. I know this is really depressing for the podcast but actually osteoporosis is never on the front page of a magazine or newspaper. People think more about breast cancer, but far less women have breast cancer and far less women die from breast cancer, which is wonderful. But we have to look at the diseases that are affecting our ability to work. And also what’s really affecting the NHS at the minute is social care. We know there aren’t enough people who are working in social care and in nursing homes, residential homes. A lot of the women that do work in these places are menopausal. We know at least 10% of women who are menopausal give up their jobs, a lot more want to reduce their hours and don’t go for promotion. So they’re not being cared for by the right people. But we also know, and I would love to know at a more national level, but I know we did a survey from our patients. Rebecca Lewis did one on her patients, just an audit, just trying to see how many patients we had in nursing homes, residential homes, care homes, sheltered accommodation who were on HRT. And you can imagine it’s the same number as the number in intensive care on HRT – zero. That does not mean HRT keeps you out of these places. But actually HRT, we know, builds muscle strength, builds bone strength, helps improve cognition, helps stamina. So a lot of women we see who are older on HRT, they are doing their shopping every day, they’re independent. Some of them are still working in their seventies and eighties. And that’s really important for their individual quality of life, for sure. But it’s more important when you think about social care. So there’s also some debate and I’ve been talking to a Professor this morning from Liverpool about the ethics of denying treatment that’s evidence based. And why is it that we’re denying treatment that could help people get back to work and function better and be healthier? Especially women from areas of social deprivation who we know are neglected more. And this I know is an area that’s really close to your heart, isn’t it?
Dr Magnus Harrison [00:22:32] So I think there’s – heck there’s quite a lot in there.
Dr Louise Newson [00:22:36] Ha ha there is!
Dr Magnus Harrison [00:22:36] to talk about. But I think to leave the patriarchal male view of medicine to one side. If you just think about osteoporosis in menopausal women, why haven’t we really ever thought about what the cause of that is? So we treat it almost as a symptom. And, you know, I’m sure your orthopaedic colleague tells you that bisphosphonates just make bones, yeah increases the density, but they’re more brittle and more difficult to work with. So we rather glibly treat osteoporosis. Now don’t worry, we’ve got that covered. Yet in actual fact, nobody thought, why is this actually happening? So that was one thing that resonated from what you just said. I think the social care issue at the moment is massive. And, you know, how many more people would we have working in social care if they were on the right hormones and felt able to work? Who knows? Probably a significant number would be my guess on that. But the health inequalities and again, I hate to bring it back to COVID, but if we look at COVID data nationally and you are one of the population that is suffering from the multiple indices of deprivation, your likely outcome from COVID was far, far worse than it would have been for other groups. And I’ve got this really concerning worry that those groups, if they’re not treated for the menopause in the right way, will also suffer more deleterious health outcomes. I have no doubt. And I think the conjuring act, the trick, the sleight of hand that we need to pull now is how we in Newson Health look at treating more and more people in the most efficient, effective, responsive and equitable way possible.
Dr Louise Newson [00:24:27] Yeah. And I think, you know, we’ve got the ability to do it. So it’s very interesting, you know, running a private clinic, everyone thinks it’s about treating people with money and it’s not actually. And, you know, having the clinic now has enabled us to give a lot of money for research, for education, towards balance app, helping people globally as well. But, you know, we’ve only been going for four years, so there’s a lot more we can do. And having people like you hopefully that we can use and abuse, but also be part of this exciting team to transform health going forwards is going to be really exciting. So I’m very, very pleased that you agreed to come on board, Magnus, and you’ve nearly completed your first week, and I managed to detract you from your work to record the podcast. So I think there’s short term plans, there’s long term plans, there’s a lot we can do. And I think the biggest thing is just having your enthusiasm, knowledge and skills that will really help work at pace to make a difference.
Dr Magnus Harrison [00:25:31] So the first thing is thank you, kind words, and just to absolutely reassure you. If I thought for any second that you weren’t motivated by making a difference to the patients you represent, you know, we’d have still been chatting, but it wouldn’t have been on your podcast. So I’m here completely for that. And, you know, detractors may suggest that it’s a private clinic. It is a private clinic, but we’re quite an altruistic organisation and I’ve seen that already within the first week, from a research, from an education perspective, and what the plans are going forward for how we invest wisely but invest wisely for the entirety of the population we represent.
Dr Louise Newson [00:26:14] So I’m looking forward to getting you back – I was going to joke and say in a week’s time to see what we’ve achieved, but maybe I’ll give you a bit longer – to see, because I think it’s very important to show the world and hopefully some of this conversation to our listeners, how much we are doing behind the scenes. And I’m not very good at singing my own praises and my blowing my own trumpet because it’s a team work. It’s not me that’s doing all of this. But actually the bigger the team, the stronger we are, the more powerful we are, and the more that we can do. And I think that’s really important. And, you know, I’ve talked a lot before in the podcast about my detractors and people that are bullying and trying to stop me. But it’s not about me anymore, actually. It’s about us. It’s about us as a team helping women who need the help. And so we’re not going to stop. We’re here to stay. So I’m very grateful, Magnus. But before we go, I would just like to put you on the spot and ask you for three tips. And I’m going to ask you for three ways that you personally think that you can bring to our organisation to improve the global health of women, because that’s our mission.
Dr Magnus Harrison [00:27:27] So you and I both know that nothing teaches humility like medicine does, and I have lost more £10 bets on diagnoses than I care to remember. So I think the first thing for me, I will be humble and I’ll be humble because we don’t know all the answers all the time. And it sort of links in to a professional curiosity is being humble. You know, if we look back through history of medicine, we got a bunch of stuff wrong. So let’s not perpetuate that. Let’s all be professionally curious and humble and try and think in the right way about what we’re doing. That’s my number one. My number two – and for anybody that’s watched anything by Michael West, whether it’s in person or on YouTube – I absolutely aspire to be a compassionate leader. What do I mean by that? Compassionate leadership is listening with absolute fascination to people to understand their particular issue, whether that’s in a clinic setting for our clinicians, or whether it’s as I manage and lead in the organisation, I will listen to understand so I can empathise in the right way and then ask a question around what can I do to help. What is my role in providing an intelligent solution to each particular issue? So being humble, I’ll be compassionate. And then my third one, and again, we talk about values a lot, but one of the behaviours that sits behind most values in any healthcare setting is kindness. And I think kindness is absolutely essential. It’s kindness in spirit. It’s kindness in thought. It’s kindness in actions and deeds. But it’s kindness in time as well. So giving of our time and for any Newson Health employees that are listening to this or anybody else for that matter, if I’m not behaving in those ways, if I’m not demonstrating the humility, the compassion and the kindness. You’ve got to call me out on it. I want to hear from you.
Dr Louise Newson [00:29:33] Brilliant I love it. And I’m very pleased that you’re on board working with us, because those three values are so important, not just in the clinic, not just in menopause care, in everything that we do. And I instill these values a lot in my children as well. And I think you can’t measure kindness. We can’t do research on kindness. It’s not part of our job description. But it’s so important because kind people make the days go better. I think that’s so key so I’m very grateful, Magnus. I’m not going to keep any longer because I would like you to go back and do some work. Thank you so much for your time today. It’s been really enlightening and I’ve learnt quite a lot about you, which has been wonderful, so thank you.
Dr Magnus Harrison [00:30:14] Thank you.
Dr Louise Newson [00:30:17] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.