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From YouTube: CQC board meeting – March 2018
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A
Good
good
morning,
everybody
welcome
to
our
board
meeting,
which
this
month
is
in
Birmingham
in
our
office
in
Birmingham,
which
is
great,
can
I
particularly
welcome
first
of
all,
Kirsty,
who
has
joined
us
as
chief
operating
officer,
Kirsty,
Shaw,
extremely
welcome
and
then,
secondly,
mark
mark
Saxton
who's
joined
us
as
a
non-executive
director,
so
you're
both
extremely
welcome
I.
Don't
think
we
have
any
apologies,
so
we
can
deal
with
that.
A
Is
there
any
declaration
of
interest
that
anybody
needs
to
make
which
is
excellent?
We
then
have
the
minutes
of
the
21st
February
board
meeting.
They
are
true
and
accurate
record
of
everything
we
discussed
good.
Thank
you
very
much
indeed,
there's
nothing
on
the
action
log
that
has
not
been
completed,
which
is
really
good.
Is
there
anything
arising
from
the
minutes
that
were
not
otherwise
covered
on
the
action
log
or
otherwise,
on
the
agenda?
A
B
A
C
There's
rather
a
lot
in
this
a
significant
proportion,
these
for
information
on
this,
so
I'll
I'll
do
the
performance
material
with
with
colleagues
and
then
we'll
pause
during
that
and
then
I'll
take
the
rest
of
it
and
a
gallop.
So
when
what
you've
got
in
the
first
paragraph
and
the
Nexes,
the
performance
summary
for
January-
and
you
can
see
we're
trying
to
present
this
in
a
crisper
way,
so
you've
got
the
top
of
page
two.
C
C
Under
under
the
kpi's
under
what
we
would
hope
it
to
be
and
there's
an
analysis,
there
are
the
detail
of
the
work
that
is
taking
place
on
report,
timeliness,
safeguarding
reports
and
the
inspection
program
to
date.
I,
don't
think,
there's
anything
new
in
those
paragraphs
and
then
at
paragraph
two
we've
got
financial
performance
where
the
position
as
the
31st
of
January
is
laid
out
and
an
explanation
of
why
that
is
the
case.
I
suspect
the
questions
that
might
arise
we're
more
driven
by
the
performance
on
X,
which
has
a
much
more
detailed
breakdown.
C
This
is
a
summary
of
the
report
you
get
on
a
quarterly
basis,
but
as
the
key
headlines.
So
if
I
pause
their
picture
and
invite
questions
and
I'm
sure
my
colleagues
around
the
table
will
will
come
in
and
answer
specific
ones
which
are
coming
in
direct
and
if
it's
around
inspection
directorates-
and
it
says
anything
about
money,
kettle
pig.
D
B
Well,
it's
very
helpful
information
and,
as
always,
complex,
condensed
and
I
was
struck
by
the
maybe
I've
misunderstood.
But
the
apparent
rise
in
the
number
of
whistleblower
comment
and
notifications
to
us,
which
is
on
I,
won't
find
it.
C
B
B
Despite
the
fluctuation
there
is
an
overall
trend
towards
an
increased
number
of
notifications
and
I.
Suppose
that
surprised
me,
because
of
how
much
has
been
done
to
create
across
the
NHS
an
alternative
way
of
allowing
people
to
speak
up
through
the
Guardian
system
and
so
a
national
infrastructure.
If
you
like
a
national
message
about
the
importance
and
yet
we're
getting
more
more
cases
notified
to
us
or
more
people
coming
forward,
let
me
put
it
that
way:
do
it
understand
why
that
might
be.
C
With
the
NHS
it
might
want
to
come
in
social
care,
Andreea
might
want
to
come
in,
so
these
are
all
whistle
blowing.
This
is
right
across
the
piece,
I
think
what
you're
finding
this
is.
A
significant
proportion
of
these
relate
to
a
lot
of
social
care,
not
not
just
to
the
NHS,
whereas
to
your
point,
International
Guardian
rule
is
specifically
directed
the
NHS
acute
hospitals,
it's
not
yet
offered
in
terms
of
general
practice
or
in
relation
to
adult
social
care.
C
But
we
continue
to
do
work
to
understand
this.
I
I
still
worry
about
the
accuracy
of
the
figures
in
relation
to
our
these
old
people
who
are
employed
that
are
raising
concerns
in
relation
to
their
employment
and
the
quality
and
safety
of
their
employment,
and
are
the
old
whistle
blowing
cases
which
related
to
quality
and
safety
in
relation
to
what's
going
on.
C
So
we
continue
to
do
work
to
actually
understand
the
accuracy
of
the
figures
and
I
think
we
do
need
to
break
them
down
so
I
think
what
possibly
behind
your
question,
which
is:
where
are
they
from?
What
do
they
tell
us?
We
can
have
a
better
understanding
of
whether
this
is
more
people
expressing
concern
or
whether
this
is
more
reporting
coming
through
to
us,
and
these
figures
were
an
artifact
of
that
I.
Think
I
personally
think
this
is
more
reporting
coming
through
to
us,
but
I
think
the
truth
be
told.
D
D
We
are
trying
to
change
the
culture
of
the
NHS
yeah,
we're
trying
to
create
an
open
culture
in
which
whistleblowing
would
no
longer
be
necessary,
because
there's
so
much
transparency
we're
a
long
way
off
that
yet
and
I
think
the
work
that
the
National
Guardians
office
doing
and
the
work
that
we're
doing
is
encouraging
people
to
come
forward.
I
think
that's
right
and
proper
and
I
think
it's
gonna
be
quite
a
while
before
we
see
the
the
ink
proven
sin
culture
driving
down
the
numbers,
because
people
don't
know
they're
gonna
feel
they
need
to
I.
E
Well,
I
didn't
make
the
firstly
the
same
much
the
same
point,
which
is
that
I
think
riesen
umbers
is
probably
a
good
thing
rather
than
a
bad
thing
is
rather
like
complaints
and
more
contains
the
earth
of
all
learning.
You
can
have
the
question,
though
I
would
have
brassieres
the
research.
Oh,
the
pie
chart
Nick
next
to
it
nice
moment
for
this
before,
but
it
is
that
I'm
not
sure
with
digging
down
and
getting
information
about
exactly
the
point
Ted
is
made,
which
is
how
useful
the
information
is
to
us.
E
So
we
are
told
here
that
a
certain
percentage
has
triggered
a
well
brought
forward
to
review
and,
while
on
the
whole,
would
think
that
means
that's
a
really
useful
piece
of
information.
Then
there's
a
heat.
The
majority
attempts
this
pie
chart
with
no
seed
for
future
reviews
and
that's
what
goes
out
in
the
letters
most
the
time
we
try
if
I
were
a
whistleblower
that
had
summed
up
the
courage
to
say
something:
I
regard
it
as
important.
E
I
would
get
a
sense
event
to
climax
about
that
and
worry
about
what
that
really
meant
and
I
worry
as
a
board.
Member
what
it
really
means
here
so,
for
instance,
when
the
review
eventually
takes
place,
do
we
in
any
way
have
a
measure
of
the
extent
to
which
the
whistle
blaring
information
was
confirmed
so.
C
On
on
that,
so
when
we
received
the
information,
its
categorized
and
there's
a
priority,
categorization
were
priority.
One
is,
if
there's
a
risk
to
health
and
safety,
and
that
we'll
get
a
pretty
immediate
response
and,
at
the
other
end,
priority
4,
for
example,
might
relate
to
a
breach
of
an
environmental
regulation
where
others
have
already
been
notified
and
they'll
get
a
different.
C
So
we
continued
to
apply
that
approach
and
we're
currently
updating
the
guidance
to
all
inspectors
in
the
lessons
of
whistleblowing,
which
will
again
confirm
some
of
the
issues
around
what
action
needs
to
be
needs
to
be
taken.
So
I
think
this
is
something
that
term
receives
a
fair
bit
of
attention
at
a
senior
level.
C
In
terms
of
how
can
we
be
assured
that
we've
got
consistency
at
the
front
end
I
think,
which
is
behind
both
of
your
questions
and
pulling
out
the
data,
and
the
data
does
open
up
the
need
for
us
to
be
constantly
on
just
to
use
one
of
the
phrases
from
the
last
session
about
being
constantly
curious
about.
What
is
this
telling
us,
and
what
do?
What
do
we
know?
C
You
know:
we've
driven
inspections.
The
one
that
immediately
comes
to
my
mind
is
the
Marie
Stopes
international
inspections,
which
were
done
in
the
16
through
217,
which
were
driven
by
concerns
from
our
inspections
and
by
whistleblowers.
But
we
also
know
my
inbox
on
Roberts
and
all
yours
is
as
well
we'll
frequently
get
people
who
blown
the
whistle
who
feel
that
we've
not
listen
to
them
adequately.
We've
not
taken
the
appropriate
action
as
quickly
as
we
should
do,
and
we
actually
need
to
listen
to
both
of
those.
C
The
true
legal
definition
of
whistleblowing
all
parts
of
the
data
cleansing
that's
been
going
on
so
I,
wouldn't
want
to
come
over
as
being
in
any
way
shape
defensive
about
what
we're
doing,
but
I'd
also
want
to
be
clear
to
the
board
that
we
are
constantly
reviewing
the
approach
and
I
think
just
to
pay
tribute
to
the
national
freedom
speak
up.
Guardian,
Henrietta
Hughes,
who
I
think
has
done
a
fabulous
job
in
terms
of
setting
up
the
National
Guardians
office,
I.
C
Think
the
quality
of
the
work
between
inspectors
and
the
National
Guardians
office
about
exchange
to
make
sure
or
pick
you
know.
I
think
was
evident
when
Henriette
came
to
the
board
shadow
annual
conference
about
three
or
four
weeks
ago,
where
we
were
able
to
go
through
a
number
of
these
things.
I
was
able
to
say
a
few
words,
but
there
was
a
whole
dere
conference
where
we've
got
inspectors
really
who
were
present,
who
were
really
looking
at
how
we
work
with
a
national
Guardians
office
in
relation
to
their
role
and
responsibilities.
C
So
I
know
that,
in
terms
of
the
inspections,
it's
something
that
Ted's
team,
when
they're
out
in
the
hospital
is
a
big
component
of
the
inspection
methodology.
Because
that's
let's
face
it.
That's
where
a
lot
of
the
publicity
around
whistleblowing
comes
from
rather
than
in
care
homes,
where
the
volume
of
our
whistle
blocking
concerns
come
from.
C
That
needs
to
be
attended
to
as
well
and
at
one
level
our
worry
considerably
about
the
ones
that
come
in
from
adult
social
care,
because
they
are
more
closed
institutions
without
getting
into
the
sociology
of
all
of
this,
because
hospitals
are
pretty
public
places
with
lots
and
lots
of
people
going
in
and
out
every
day,
I'm,
not
sure
where
care
homes,
who
necessarily
is
public
with
that
degree
of
scrutiny
and
as
you
were,
sharing
with
us
about
your
personal
experiences
the
other
day.
So
yeah
I'm,
gonna
start
repeating
myself
and
we're
not
confessed
and
yeah.
F
F
I
was
going
to
say
the
same
thing
as
David,
which
is
that
very
often
we
are
the
people
that
they
would
want
to
turn
to,
because
if
you
are
working
in
a
small
care
home,
you
are
blowing
the
whistle
on
people
who
you
may
be
living
very
close
to
bumping
too
into
of
the
supermarket
it.
You
know
they
were
very
often
small
and
closed
environments
where
it
could
be
very
difficult
to
raise
your
concerns
within
that
environment
and
therefore
coming
to
us
is
very
important
and
I.
F
Do
think,
though,
that
we
it's
not
just
about
kind
of
immediately
going
out.
We
do
indeed
have
experience
of
people
raising
concerns
with
us,
and
that
has
triggered
a
responsive,
very
quick
inspection
and
going
out
and
and
monitoring,
what's
happening
on
the
ground,
but
we
are
constantly
monitoring
these
services.
Every
single
adult
social
care
location
sits
on
the
portfolio
of
an
individual
inspector.
They
are
gathering
information
together
on
a
regular
basis.
F
This
is
part
of
that
building
up
the
picture
that
helps
us
to
ensure
that
we're
scheduling
inspections
correctly
and
that
when
we
go
out
on
inspection,
we're
asking
the
right
questions
and
we're
really
focusing
our
attention
in
the
right
way.
The
final
point
is,
and
I
welcome,
as
David
has
said,
we're
doing
this
additional
guidance
and
support
for
inspectors
to
help
them
to
do
the
right
thing,
and
part
of
that
is
about
the
response
that
we
make
to
the
whistleblower.
F
Sometimes
we
can't
make
a
response
to
the
whistleblower,
because
it's
anonymous
to
us
and
therefore
it's
difficult
for
us
to
do
that
and
closing
that
loop
can
be
difficult,
but
very
often
we
do
try
to
go
back
to
people.
But
increasingly
you
will
see
and
report
that
the
reason
why
we
have
undertaken
the
inspection
is
in
response
to
concerns
being
raised
with
us
and
I.
Think
that
that's
another
way
for
us
to
demonstrate
that
we
are
valuing
this
information
that
we're
taking
it
seriously
and
that
we
will
do
something
about
it.
Thanks.
B
B
You
know
the
there
is
a
danger
for
us
without
disputing
it.
I
just
wanted
caution
against
being
too
confident
of
it,
because
there
is
a
danger
that
we
fall
into
the
mists
of
culture
of
positive
news,
which
got
runs
around
national
organisations
at
times,
and-
and
so
you
know,
when
the
figures
are
going
up,
we
think
that's
good
and
when
they
start
coming
down
we'll
think
that's
good
as
well,
so
we
can't
lose
and
sometimes
the
figures
are
going
up
because
they
don't
forget.
When
are
we
talking
about
whistleblowing
figures?
B
We're
not
simply
talking
about
an
openness
in
the
system,
we're
talking
about
failed
openness
locally,
and
so
we
can't
be
too
happy
that
that's
the
situation,
though
we
might
welcome
the
fact
that
we,
our
role,
is
ending
being
so
recognized
and
responded
to
and
David
you're,
absolutely
right
that
my
concern
is
partly
about
social
care
so
and
and
care
homes
and
I'm
not
going
to
pursue
my
own
sort
of
personal
case
in
the
board
here.
But
but
just
in
care
homes
are,
as
you
say,
a
different
environment.
They
are
smaller,
they
more.
B
They
are
smaller
in
various
ways,
but
they're
small
in
terms
of
number
of
staff
they're
local.
The
adverse
news
that
way
Carol
might
generate,
has
a
greater
potentially
an
impact.
It
can
have
a
commercial
impact,
and
so
the
the
reluctance
I
was
just
at
times
for
Carol's
to
respond
to
legitimate
concerns
of
staff.
I
think
is,
you
know
there
is
an
incentive
not
to
respond,
and
in
my
own
case
the
the
handing
in
harassment
of
whistleblowers
was.
B
A
G
E
Could
I
could
I
just
ask
about
report
production
and
what
we
can
expect
in
terms
of
when
the
improvement
to
the
timeliness
of
report,
production
and
I
guess
tennis
is
particularly
aimed
at
hospitals.
But
I
was
as
well,
because
I've
just
point
out
that
this
is
something
which
has
been
a
problem
for
forever.
It
seems
that
I
think
we've
ever
hit
our
targets
on
report
production
there's
been
picked
up
by
P
AC
and
than
others
than
any
ownio
respect
and
in
the
commentary
that
we've
got
within
David's
report,
there's
a
bit
which
says
well.
E
Actually
we
brought
something
some
analysis
to
the
executive
team
in
January
and
we're
going
to
do
some
more
work
and
we
can
expect
something
to
come
back
to
the
executive
team
in
the
next
few
months
and
that
doesn't
sort
of
feel
to
me
like
we're,
really
getting
a
grip
of
it.
And
if
you
look
at
our
business
plan
for
next
year,
it
has
the
same
KPI
and
unless
we
do
something
about
it,
the
KPI
is
going
to
be
missing.
E
A
H
H
And
if
you
look
at
the
pms
graph,
we're
since
May
of
last
year,
26
days
and
we're
now
31
days,
and
that's
because
we've
introduced
a
lot
of
work,
looking
at
lean
methodology
working
on
each
step
in
the
process,
because
we
believe
it's
important.
Unfortunately,
KPI
is
about
10
months
behind
where
the
actual
action
is
okay,.
D
The
next
phase
inspection
at
the
time,
at
the
same
time
as
a
clue
from
the
backlog
from
independent
healthcare
inspections
which
have
been
taking
place.
The
the
lot
of
work
is
going
into
managing
the
process
of
next
phase
inspections
to
make
sure
they
are
coming
out
on
time.
We
are
getting
closer
to
it
all
the
time,
so
I
hope
this
is
going
to
turn
around
quite
radically
soon,
but
there
will
be
a
bit
of
a
backlog
in
urban
healthcare
which
will
keep
the
averages
down
what
you're,
seeing
in
the
in
the
KPI.
D
On
the
right
hand,
side
is
the
kind
of
long-term
situation
which
inevitably
takes
a
long
time
to
change,
because
it
is
data
over
a
very
long
period
and
I.
Think,
probably
and
and
John
mentioned
this
I-
think
at
the
last
board
meeting
we
probably
do
need
to
move
to
web
monitoring
this
through.
You
know
a
timely
process
of
Cystic
of
process
control,
rather
than
just
the
the
annual
KPI,
which
I,
don't
think,
is
really
very
helpful
in
that
we
can't
really
turn
that
around
in
short
order.
D
So
it's
very
difficult
to
demonstrate
the
progress
going
forward.
The
the
work
we're
doing
around
quality
improvement,
I
think
has
to
be
the
focus
on
getting
this
better
and
it
is
very
important.
We
direct
our
quality
improvement
initiative
starting
out
in
these
areas
of
difficult
performance
and
that's
what
we
determined
to
do
so.
A
The
risk
of
upsetting
colleagues
I
mean
I
I,
don't
think
in
with
great
respect
in
hospitals
where
they
are
large
and
complex.
We
will
actually
get
to
that
the
turnaround
time
that
I
think
is
necessary,
whatever
the
KPI
is,
while
we
are
essentially
a
a
pen
and
pencil
operation,
the
technology
that
we're
working
on
will
be
the
game
changer
and
that,
in
my
view,
when
we
get
that
in
place,
the
report
verb
all
will
come
up
much
more
quickly.
The
quality
assurance
around
that
will
be
much
much
much
easier
operation.
D
A
C
Do
we
want
to
change
this
KPI
and
we
did
it
again
for
the
business
plan
that
you'll
be
invited
to
agree
in
a
few
minutes
time
and
the
executive
team
were
consistent
and
decision
to
keep
the
KPI
where
he
was
so
that
becomes
our
public
declaration
of
the
target
we
should
be
working
to,
and
the
expectation
I
think
he's
at
the
board
and
members
of
the
public
is
that
we
should
be
working
towards
that.
I
was
asked
specifically
at
the
Public
Accounts
Committee,
because
this
was
a
big
thing
for
them.
C
C
So
that's
what
we're
on
the
record
of
saying,
within
an
agreed
target
of
I,
think
to
Steve's
point
about
a
role
in
average.
I.
Think
if
you
look
at
where
Andre
and
Steve
are
they're
going
to
head
that,
what
Steve's
working
is
where
there
is
a
backlog,
because
it's
a
rolling
average
that
keeps
that
going
so
I
think
we'll
get
there
and
you're
right.
The
challenge
is
going
to
come
from
a
mixture
of
improved
systems
and
productivity.
C
You
know
we're
going
to
start
distributing
laptops
which
will
go
to
inspectors
which
will
allow
them
to
have
a
tablet
that
they
can
write
on,
which
will
then
convert
into
scripts
I.
Think,
as
we
begin
to
make
sure
that
kind
of
technology,
the
productivity
improvements
will
be
considerable
as
it
works
its
way
through
I
think
Steve's,
point
about
end-to-end
processes
and
constantly
reviewing
those
own
brain
processes,
Israel
I,
think
summit,
Ed's
team,
a
proven
they
can
do.
C
B
C
The
karai,
Andrea
and
Teddy
both
gonna
have
to
work
very
very
hard
with
their
teams
over
this
next
12-month
period,
but
I
just
I
don't
want
to
prehab
the
next
discussion
Peter,
but
so
there
was
a
very
conscious
decision.
Second
to
propose
the
business
plans
at
the
board,
which
kept
it
at
90
percent.
C
A
C
On
thanks
for
that,
so
the
next
have
already
in
part
referred
to
the
Public
Accounts
Committee
report.
But
this
is
the
first
public
meeting
of
the
board
since
the
Public
Accounts
Committee
published
their
reports
on
the
9th
of
March
of
the
here
in
which
took
place
last
week
and
they're
reflected
on
the
progress
that
we
made.
C
They
referred
to
substantial
progress
which
built
on
what
the
Public
Accounts
Committee
talks
about
improved
significantly,
but
they
also
focus
quite
heavily
on
the
issue
that
you've
just
been
discussing,
which
is
report
timeliness,
amongst
other
things
and,
interestingly
enough
Louis
your
question
about
whistleblowing
about
what
impact
does
greater
recognition
have
if
we
get
more
work
coming
through
in
terms
of
how
we
plan
the
allocation
of
resources
to
make
sure
we've
got
sufficient
people
to
do
the
job.
We're
asking
people
to
do
as
well.
C
Public
publicity,
so
I
can't
resist
the
deliciousness
that
pointing
that
out
in
a
public
forum.
So
thank
you
very
much.
I
promise
I'll
behave,
gourds
July,
but
rather
importantly,
though,
in
the
Public
Accounts
Committee
report
was
the
attention
they're
brought
to
the
value
of
the
work
that
we
do
on
local
systems
reviews
and
this
important
issue
about
looking
at
the
system
as
a
whole.
C
Interestingly,
there
wants
us
to
report
back
by
virtue
of
a
letter
in
April
19,
which
hopefully
means
that
there
won't
be
another
nal
review
with
another
Public
Accounts
Committee
hearing
so
and
I
thought
that
was
a
significant
step
will
bring
forward
an
integrated
action
plan
which
will
bring
to
the
board,
which
combines
the
National
Audit.
Office
is
action
plan
and
our
response
to
the
National
Audit
Office
reports,
as
well
as
to
the
Public
Accounts
Committee
reports
and
that
will
go
to
polls
orbit
and
corporate
governance
committee
in
April.
C
Moving
on
competition
and
Markets
Authority
published
a
report
in
December
17,
hugely
important
report,
I'd
thought
Oh
an
axon
report
as
well
in
terms
of
its
content
and
the
quality
of
the
research
and
the
evidence
that
they're
brought
forward
and
they're
focused
on
capacity,
consumer
protection
and
consumer
information.
The
government
published
on
the
5th
of
March
their
response,
which
accepted
the
recommendations
in
principle
and
in
full
and
stated
that
significant.
C
Component
of
the
government's
response
will
be
captured
in
the
green
paper
and
I
think
this
was
talked
about
over
dinner
yesterday
evening,
but
the
secretary
said
yesterday
made
a
speech
on
the
seven
principles
that
would
support
a
green
paper
in
the
summer
and
I
think
you
can
see
in
that
speech.
Some
of
the
principles
that
were
flagged
by
the
CMA
in
in
their
report
so
I
think
a
pretty
significant.
A
pretty
significant
report
from
the
CMA
paragraph.
Five
is
about
the
care
cup
review.
This
is
a
review
that
dr.
C
C
C
What
do
they
cover
and
operation?
How
are
they
being
applied?
Fits
and
proper
person
regulations
were
waiting,
an
announcements
of
who
will
lead
that
review
in
terms
of
the
challenge
to
us
from
bill
care
cups
reports.
He
was
clear
that
we
failed
to
identify
the
extent
and
nature
of
the
problems
back
in
our
pre
2013
recommendations.
Rosa
Cooper,
who
was
the
MP,
championed
these
issues
and.
C
Interestingly,
going
back
to
the
earlier
conversation,
the
closed
culture
in
the
trust
and
as
a
consequence
of
those
staff
did
disclose
their
concerns
around
the
culture
and
the
way
that
people
were
treated.
We
then
took
enforcement
action
and
a
new
leadership
team
was
introduced
with
some
people
leaving.
C
So
whilst
we
didn't
get
underneath
the
skin
of
this
organization
in
those
early
inspections,
we
have
subsequently
and
of
course,
since
that
first
inspection,
we've
changed
where
we
inspect
and
it's
a
different
and
new
methodology,
which
is
more
rigorous
and,
as
I
say,
the
recommendations
which
are
directed
at
us
are
set
out
in
annex
2
to
this
report
today.
So
a
very
important
piece
of
work.
B
B
B
You're
right,
of
course,
it
relates
to
a
period
a
few
years
ago,
was
just
before
I
should
think
the
methodology
was
changed,
so
that
always
allows
us
to
say
something
which
is
I
think
is
genuinely
true,
which
is
that
it
is
less
likely
that
this
would.
This
would
be
missed
now.
I
think
we
have
to
be
able
to
reassure
people
at
our.
Our
new
methodology
would
pick
up
some
of
the
sort
of
flags
and
warning
signs
there
and
in
some
ways
the
interesting
bit
about
the
report
is,
of
course,
the
meat
of
the
report.
B
When
you
read
about
what
actually
happened
and
some
of
the
things
that
we
might
be
finding
and
and
the
requirement,
therefore,
on
us
to
put
together
the
this,
this
string
of
things
that
was
going
wrong
that
could
have
been
tied
together
at
the
time,
so
example
the
fact
that
it's
a
new
work,
there
was
a
new
board.
Actually
that
was
one
thing
new
and
they
built
very
specifically
said:
there's
a
new
and
inexperienced
board
that
provided
insufficient
challenge
to
the
top
of
the
organization.
B
So
in
terms
of
our
well
let
inspections
there
is
a
clear
message
about
what
we
were
there
to
it.
One
of
the
things
were
there
to
look
for,
and
the
bullying
of
course,
which
went,
went
unpunished
and
unreported
largely,
but
other
things
like
unrealistic,
cost-saving
targets.
You
know
that
was
us
that.
B
C
Lewis
I
think
I
think
this
to
people
come
out
with
immense
credit.
One
is
also
Cooper
for
championing
the
issue
and
doing
she's
done
her
job
as
an
MP
and
I
have
to
say,
and
as
invested,
he
knows
and
given
us
the
confidence
to
be
able
to
respond
to
what
she
raises
and
she
doesn't
always
do
it
in
the
most
comfortable
of
ways,
but
and
she's
absolutely
focused
on
the
quality
and
safety
of
services
and,
as
you
know,
she's
raised
the
issue
around
prison
health
as
well.
On
the
back
of
this,
but
I
think
bill.
C
But
in
terms
of
the
appreciation
that
inspectors
have
got
when
they
turn
up
on
a
you
know
a
wet
Tuesday
in
February
at
trust,
X
or
a
sunny
day
in
July
at
just
Y.
How
far
are
some
of
the
responses
which
you
flagged
in
bills
report
to
the
front
of
their
minds
when
they're
actually
carrying
out
the
inspections,
doing
the
interviews
looking
at
the
data
I?
Think
again,
it
goes
back
to
what
weight
we
give
to
concerns
which
are
raised
to
people
raised
by
people.
C
Sorry
and
I
think
we
shouldn't
be
complex,
and
this
was
the
old
methodology,
but
we
should
we
should
be
constantly
saying
to,
as
this
could
happen
again.
How
do
we
ensure
this
isn't
going
to
happen
again
rather
than
we've
changed
the
methodology?
Thank
God
for
that?
This
is
something
we
need
to
be
constantly
onto
and
I
think
we
have
given
this
a
profile
by
bringing
it
to
the
board
in
an
open
session
in
this
way
about
publishing
or
action
planning
relations.
C
So
what
what
bill
care
cap
has
said
in
his
report
is
just
one
way
of
doing
that,
and
of
course
it
is
why
there's
a
board
and
non-executive
directors
to
ensure
that
we
keep.
We
keep
true
to
this
and
so
I
think
by
combining
those
forces.
Well,
hopefully,
we
can
actually
do
justice
to
the
work
that
Rosa
Cooper
and
Bill
of
Dunkwa.
So.
D
Ted
and
then
Robert
and
I
mean
this
is
a
very
important
report
for
us
because,
as
you
say,
it
does
describe
how
we
fail
to
pick
up
these
problems
and
in
our
previous
methodology,
but
it
does
I
think
stress
the
importance
of
keeping
focus
on
leadership,
culture
in
organizations
and
that's
something
we've
learnt
over
the
last
four
years.
When
we've
been
doing
all
these
inspections
and
I
think
the
emphasis
we've
put
it
on
in
our
current
methodology
on
well.
There
is
absolutely
a
reflection
of
that
and
I
think
the
lesson
for
us
is.
E
Can't
tell
you
how
often
after
I
did
the
Mid
Staffordshire
report
I
was
asked
was
that
that
was
the
one.
In
fact,
it
was
always
a
leading
question,
usually
by
people
who
should
know
better.
It
wasn't.
That
was
a
one-off
and
I
continually
said.
No,
it
wasn't
because
look
at
the
key
review.
This
is
another
example.
From
the
same
time,
of
almost
exactly
the
same
pressures
producing
the
same
terrible
result
and
I
agree
that
we
should
not
be
complacent,
for
our
methods
have
changed.
E
These
things
are
more
likely
to
he
comes
before,
but
I
think
one
thing
perhaps
hasn't
been
mentioned.
It's
one
thing
to
for
this.
To
be
a
case,
studies
I
really
think
it
should
be,
if
only
because
little
Kirkup
managed
to
put
in
50
or
60
pages
what
it
took
me
three
three
volumes,
but
but
then
I
did
go
first,
didn't
I,
but
the
more
serious
point
is
that
it's
not
just
the
inspection.
A
lot
of
the
facts,
as
he
mentioned
here,
are
still
present
in
the
system.
E
Happily,
one
would
like
to
think
they're
being
managed
better
in
most
most
places,
but
actually
these
factors
mentioned
in
recommendation,
2,
plus
the
stories
behind
them.
It
seems
to
me,
are
very
valuable
indicators
to
what
our
intelligence
should
be
looking
at
in
terms
of
throwing
up
an
assessment
of
risk.
C
C
The
issue-
this
is
a
novel
service
and
a
great
deal
of
thought
has
been
given
by
registration
colleagues
about
what
are
the
implications
for
CQC
of
this
service
being
developed.
It's
effectively
a
service
where
people
recuperating
after
a
spittle
stay
got
to
stay
and
the
question
has
been
raised
is:
should
these
services
be
regulated,
but
on
the
basis
that
these
services
are
providing
accommodation,
they're
not
providing
care?
C
C
The
provider
has
been
quite
open
with
CQC
and
we
have
been
open
with
him
and,
as
you
can
see
from
this
paragraph,
we've
been
keeping
that
situation
under
review
and
if
those
services
do
expand,
the
service
offer
is
changed
and
there
is
the
offer
of
a
regulated
activity
as
defined
by
the
regulations.
Then
registration
would
be
considered.
C
C
How
long
a
Thor
--'tis
can
use
their
powers
to
look
at
care
rooms
if
that,
indeed,
is
something
that's
required,
but
the
important
bit
from
this
paragraph
Petrie's
just
to
provide
some
clarity
about
what
our
current
position
is
in
relation
to
whether
these
services
should
be
registered.
As
I
said,
there's
been
some
some
press
coverage
saying
that
we
should
be
registering
these
services.
C
A
Just
interruption:
I,
don't
I
think
this
is
exactly
the
right
approach
and
while
it
is
effectively
a
hotel
operation,
then
there
is
nothing
to
register.
But
your
point
about
monitoring
carefully
that
there
isn't
a
mission
creep,
that
suddenly
the
service
doesn't
change
into
effectively
being
a
care
provider
and
I
think
the
we
will
need
to
be
very
careful
to
make
sure
that
the
people
that
are
registered
that
are
using
this
service
are
very
clear.
What's
happening
and
we
haven't
got
something
different
to
me
in
a
year's
time,
but
it's
still
unregistered.
E
That's
one
thing,
but
if
it
goes
further
and
in
some
form
of
care
or
rehabilitation
is
being
offered
with,
that,
would
that
trigger
our
entrance
yeah
and
the
other
thing
is
even
if
that's
not
happy.
How
do
we
ensure
that
the
public
are
aware
of
the
difference,
see
what
I
mean
sense
of
somebody
else
might
be
providing,
for
instance,
the
care
in
that
room.
E
But
it
look
might
look
as
though
it's
all
under
one
envelope
when
in
fact
it
isn't
and
I
just
want
to
have
weather
in
a
position
to
cope
with
with
that,
because
all
those
things
can
be
happening,
but
around
an
apparently
provision
of
a
room
and
nothing
else
with
a,
but
in
cooperation
with
other
people.
It
all
becomes
the
same
thing.
Yeah.
C
And
this
is
why
this
is
an
importance
and
sensitive
issue
and
sits
at
the
board
today.
So
if
it
did
change
so
I
can't
remember
the
number
under
I
don't
know
the
uCam,
but
we've
got
a
large
number
of
supported
living
accommodations
which
effectively
adult
fostering
schemes
where
the
care
is
provided
is
defined
by
us
as
a
regulated
activity,
the
treatment
of
unsupportive
people
and
they
will
be
registered.
C
C
But
it's
why
it's
important
that
the
registration
team
continue
to
work
with
the
provider.
In
relation
to
this,
we
don't
think
the
provider
is
got
an
innovative
approach.
It
is
new,
it
is
different,
but
I
don't
think
that
providers
trying
to
game
the
system.
In
that
sense
he
wants
to
do
the
right
thing.
So
I
think
that's
important
and
I
think
really
does
undermine
underscore
sorry,
not
undermine
the
importance
of
at
that
point,
we're
having
discussions
with
providers
about
registration.
C
The
importance
of
that
conversation
that
discussion
going
on
to
make
sure
that
we
understand
what
the
offer
is
and
what
the
risks
are.
I
think
it's
your
point,
I
think.
If
this
is
what
you
meant
Robert
my
understanding,
rather
than
whether
you've
presented
it,
we
think
there
is
more
going
on
than
he's
being
offered
I'm,
not
saying
in
this
case
with
care
rooms,
then
the
registration
team.
C
There
was
significant
amounts
of
work
on
referrals
of
what
looked
to
be
unregistered
providers,
because
if
somebody
is
providing
regulated
activity
and
they're
not
registered
with
us,
they're
actually
breaking
the
law.
So
that
would
be
something
that
the
registration
team
would
today
with
a
view
to.
C
C
So
that's
broadly
where
we
are
I
think
what
we
need
to
do
as
we
begin
to
understand
what
this
particular
provider
is
offering
much
more
and
what
the
service
model
is
particularly
the
service
models.
There's
the
same
is
we
need
to
use
our
website
just
to
actually
make
sure
that
people
who
are
thinking
of
applying
to
us
to
register
can
be
to
be
clear
up
front
I
joined
Andrea
in
Birmingham,
he
was
Birmingham
was
no
last
week
for
the
registration
conference
and
I
was
fortunate
enough
to
be
able
to
spend
the
day.
C
There
was
quite
a
lot
of
conversations
we
went
through
that
there
looking
at
the
various
bits
of
looking
at
the
way
that
we
register
any
service
that
applies
to
us,
but
the
table
that
I
sat
on
and
spent
pretty
much
most
of
the
morning
with
there
were
forecasts
on
what
our
pre
contacts
offer
is
to
people
who
were
considering
providing,
so
people
can
self-select
and
we
I
don't
think
we
do
enough
to
explain
what
people
need
to
get
in
place.
So
we
have
a
lot
coming
to
our
door
for
registration.
C
Of
people
who
aren't
quite
clear
and
then
the
fallout
rate
is
quite
high.
People
that
eventually
go
through
to
registration,
particularly
around
domiciliary
care,
so
something
like
I
I
used
to
work
for
Adamic,
axillary
care
agency
and
I'm
thinking
of
setting
up
my
own
business
will
be
a
frequent
call.
So
there's
be
a
single
person
who
wants
to
do
this
and
I've
given
no
thought
to
some
of
the
detailed
systems
and
processes
you
need
to
get
in
place
to
keep
people
safe.
C
So
that
takes
a
lot
of
time.
Peaches
often
referred
to
digital
and
I.
Think
in
the
also
pivot,
with
her
last
night,
Andrea's
slides
on
the
regulatory
Governance
Committee,
there
was
a
couple
of
those
colored
boxes
which
had
any
importance
to
developing
a
digital
offer
for
those
of
us
that
do
tax
returns
or
do
our
core
tax.
C
You
can't
go
on
to
the
next
box
and
complete
it
unless
you
finish
all
the
boxes.
We
haven't
yet
got
a
system
for
this,
so
we've
got
people
that
send
in
an
application
form
it's
not
complete,
so
we
send
it
back,
and
this
is
all
purpose
to
go
on
to
this
issue.
Do
then
send
it
in
again:
it's
still
not
right,
so
we
send
it
back
again
sort
of
streamline
this
process,
so
we
don't
have
to
do
any
of
that
is
really
what
the
objective
is
and
that's
what
people
they're
working
towards.
C
So
that's
the
end
that
people
are
working
to
and
the
first
stage
of
that
was
to
do
the
business
process,
mapping
to
make
sure
we've
got
the
cleanest
and
simplest
system,
and
that's
one
other
ways
will
route
out
people
who
were
applying
in
the
wrong
way
and
without
the
full
information
and
putting
our
information
up
from
so
that
that's
pretty
much
the
approach,
that's
being
second,
but
that's
probably
going
to
take
a
couple
of
years
to
get
through.
All
of
that
and
I
need
to
just.
C
So
the
gender
pay
gap
we've
already
had
something
on
this
I
think
this
is
good
news.
It
doesn't
mean
that
we
haven't
got
issues
that
we
need
to
address,
but
in
terms
of
recruitment
and
retention,
it's
a
big
part
of
the
offer.
I
want
to
draw
the
board's
attention
to
we're,
collaborating
with
a
mental
health
safety
improvement
program.
C
I'm
also
wanting
to
make
the
board
aware
that
we're
in
discussions
about
joining
the
a
defense
empire
recognition
scheme
and
the
Armed
Forces
covenant,
largely
on
the
back
of
the
work
that
Steve
and
his
team
have
done
with
the
Armed
Forces
in
relation
to
our
inspection
of
Defense
military
services,
staff
from
CQC
will
be
contribution
to
the
75th
anniversary
of
the
NHS
under
May.
At
the
70th
anniversary
of
the
National
Assistance
Act,
paragraph
11
is
just
an
opportunity
to
flag
the
work
we
did
on.
C
Recent
adverse
travel
were
because
of
the
severity
of
the
weather,
particularly
in
Newcastle,
the
Newcastle
officers
clause
and
the
consequences
out.
There's
two
issues
that
we're
looking
at
further.
One
is:
what
do
we
do
when
we
close
an
office
and
the
other
is
do
our
technology
systems?
Actually,
support
more
of.
C
G
That's
the
report
Peter
perfect.
Thank
you.
David
multi,
this
one
small
correction
to
be
made
at
the
bottom
of
page
9.
It
says
that
the
state
of
online
providers
of
primary
care
report
has
been
published.
That's
actually
out
to
you
on
Friday
this
week.
So
this
was
correct
at
the
writing
of
this
last
week,
but
the
scheduling
changed
so
expected,
rather
than
welcome
it.
Thank.
A
You
we
will,
we
will
welcome
the
expectation.
Thank
you
anything
anybody
wants
to
raise
on
David's
report.
We
haven't
covered
okay,
let's
move
on
to
the
business
plan.
We
have,
of
course,
looked
at
the
business
plan
in
its
various
earlier
drafts,
so
this
is
not
to
give
the
impression
that
a
quick
sign-off
is
we're
not
very
interested
in
all
the
work.
That's
behind
it.
I
don't
know
Kate
or
Walter,
who
wants
to
start
on
this
motor
I'm.
G
Freaky
start
so
I
commend
to
you
our
business
plan
for
2018-19,
which
is
the
public
commitment
of
what
we're
going
to
do
over
the
year
and
that
is
being
used
to
hold
us
account
with
the
Department
of
Health
and
Social
Care,
as
well
as
Parliament,
and
sets
out
our
performance
indicators
as
well.
This
year
sets
out
and
nine
priorities
a
particular
that
we're
working
towards,
in
particular,
including
to
investment
priority
areas
for
a
digital
development,
on
our
improve
implementing
a
quality
improvement
culture
internally
for
all
of
staff.
G
The
two
things
then
I
just
wanted
you
to
be
aware.
There's
some
final
refinements
before
the
final
report
is
published
on
some
of
the
delivery
dates
following
the
discussion
today,
which
is
underway
and
then,
finally,
that
the
subcommittee
of
the
board
considered
the
risk
tolerance
statement
and
risks
set
out
in
the
report
and
made
some
changes
to
the
tolerance
for
risk,
particularly
the
developmental
phases
around
digital
services,
as
well
as
some
of
the
exploratory
analysis,
but
also
being
clear
that
that
risk
reduces,
as
we
make
those
systems
and
analysis
operational
on
a
wider
scale.
F
At
the
end
of
1718,
we
will
have
achieved
our
and
original
spending
review
target
for
the
end
of
the
spending
review
period
of
270
million,
which
is
two
years
out
of
target.
But
we
have
set
our
budget
for
next
year
at
223
million
to
allow
us
to
invest
and
to
bring
costs
down
further
and
introduce
efficiencies
in
future
years.
So
that's
all
built
into
the
budget
in
the
business
plan.
So.
F
F
A
Good
so
as
I
say
we,
this
is
not
the
first
time
the
board
has
seen
any
of
this,
but
is
there
anything
anybody
wants
to
raise
excellent,
so
we
can
agree
the
business
plan
and
budget
as
as
presented
and
absolutely
we've
noted
noted
the
work
of
the
Audion
corporate
governance
committee
and
that
thank
you
right.
Luis
I
apologize,
I
wasn't
at
the
OGC
last
night,
I
was
in
London
with
our
intelligence
away
day,
which
was
really
interesting,
but
that
and
a
couple
of
other
things
meant
I
didn't
get
back
in
time.
B
This
is
a
summary
of
what
you
missed.
We
had
two
topics
for
discussion.
Mainly
one
was
about
CQC's
role
as
prosecutor
as
well
as
regulator,
and
how
these
two
might
fit
together.
I
suppose
it's
fair
to
say
this
was
this.
Is
we
had
a
very
good
presentation,
very
good
discussion,
but
it
did
still
work
in
progress,
and
so
there
will
be
further
discussions
about
it
at
that.
That's
the
Attar,
GC
and
I.
B
B
The
the
the
second
topic
was
a
presentation
of
adult
social
care.
So,
as
you
know,
we
have
a
rotation
of
of
presentations
from
different
different
sectors
within
CQC
this
without
all
Social
Care
Stern,
and
we
had
a
very
full
presentation
about
progress
in
adult
social
care.
It
I
just
wonder
if
I
can
just
select
one
or
two
of
the
things
that
you
said.
B
B
The
concern
for
CQC
itself
and
for
the
social
care,
a
bit
of
CQC
is
perhaps
more
about
not
more,
but
it
is
equally
about
responding
to
concerns
how
we
identify
where
risks
are
in
the
system,
how
we
respond
to
particular
incidents
and
then
how
we
use
our
enforcement
powers.
So
there's
more
about
how
we
do
our
job
well
and,
of
course,
all
that
sits
alongside
the
public
concern
and
the
public
concern
is
poor
care
and
so
and
not
only
that,
but
how,
because
of
poor
care
in
the
system?
B
A
A
I
Yeah
I'm
David
Hogarth
I'm,
the
coordinator
of
a
small
befriend
in
charity,
which
brings
us
into
contact
quite
a
lot
with
registerable
care
of
all
sorts.
They,
as
you
say,
the
question
I
asked
was
really
asked
us
by
Sir
Robert.
It
was
about
the
pie
chart
about
whistleblowing
but
I
and
also
well
answered
by
Sir
David
and
by
by
Andrea,
but
I
think.
I
The
point
you
were
making
I
think
was
how
whistleblowers
who
are
doing
something
very,
very
brave,
usually
particularly
in
care
homes,
need
perhaps
a
little
more
than
just
to
be
told
something
is
being
put
on
file
and
that's
a
very
good
point.
But
the
other
thing
is
I.
Think
that
andrea
has
very
often
said
when
a
case
arises
where
CQC
has
said
that
some
some
care
home
is
good
and
then
there's
some
awful
abuse
is
discovered
by
panorama
or
something
like
that.
I
Andrea
very
often
says:
well,
there
is
just
so
much
we
can
do
which
I
take
to
mean.
Is
there
is
just
so
much
that
inspecting
can
achieve,
because,
frankly,
you
are
not
there
all
the
time,
and
these
things
usually
happen
when
you're
not
there
and
so
the
result
of
gap
in
your
knowledge
about
everything
that
you
expect,
and
it
seems
to
me
that
whistleblowing
is
desperately
important,
because
that
is
the
only
way
of
filling
up
this
gap.
I
A
David,
thank
you.
I
would
take
a
slightly
different
view
on
one
aspect
of
what
you
said
in
any
one
aspect,
which
is
that
anything
whistleblowing
is
the
only
thing
that
is
available
to
us.
I
think
it's
really
really
important.
I,
don't
disagree
with
anything
that
you
really
is
central
to
what
you
were
saying,
but
I
think
there
are
lots
of
other
things
we
need
to
do.
Our
strategies
you
know
is
to
be
intelligence-led.
A
There
are
cameras,
I,
don't
know
why
you
never
thought
of
that
mention
it
before
and
though
there
are
lots
that
there
are
lots
of
things
we
need
information.
We
want
to
be
intelligence-led
it's
at
the
heart
of
our
strategy.
Whistleblowing
is
just
a
part,
a
really
important
part,
but
it's
just
a
part
of
what
we
need,
but
thank
you
for
raising
it.
I
think
with
that
miraculous
speeding
up
towards
the
end
of
David's
report,
I
think
that
brings
to
an
end
the
meeting.
So
we
are
only
6
minutes
late,
which
isn't
too
bad.
A
F
A
I
forget
it's
absolutely
here,
but
thank
you
just
in
case
I
had
but
I
hadn't
Kate
you
looked
after
our
finances
brilliantly.
Well,
the
fact
that
you
delivered
are
our
target.
I
mean
they
may
have
had
a
bit
of
help.
Some
other
people
into
this,
but
they're
on
your
watch.
We've
hit
our
target
two
years
early,
which
is
fantastic,
and
all
I
can
say,
is
that
the
mo
DS
gain
is
absolutely
our
loss.