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From YouTube: CQC Board Meeting - May 2020
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A
In
which
case,
let's,
let's,
let's
start
the
public
board
meeting
and
welcome
everybody
to
the
public
board
meeting
which
we
are
again
having
remotely
bar
bar
teams,
it's
Mental,
Health,
Awareness,
Week
and
I-
think
that's
an
important
event
in
any
year,
but
it's
particularly
important
I
think
in
the
the
current
coded
lockdown
period,
a
particularly
welcome
Beth
Matthews,
who
is
our
network
chair
joining
us
for
this
month's
meeting,
Beth
chairs
the
LGBTQ
class
network
and
Beth
you're
extremely
welcome.
There
are
no
apologies
for
absence
from
board
members,
but
Rebecca
is
not
with
us
today.
A
A
B
Support
framework,
please
thanks:
Peter
I'm
gonna
kick
off
with
some
sort
of
a
few
like
background
and
then
I'm
gonna
hand
over
to
Kate
to
talk
about
some
of
the
detail
and
then
particularly
around
the
experience
that
her
and
her
team
have
had
over.
The
last
couple
of
weeks
are
actually
using
the
emergency
support
framework.
So
and
I
guess
in
terms
of
what
is
the
emergency
support
framework
is
the
is
the
obvious
first
question,
and
it's
worth
noting
that,
since
the
start
of
the
pandemic,
we
have
stopped
routine
inspections
and
I
stress,
routine
inspections.
B
We
have
carried
on
contacting
providers
and
many
providers,
they'll
they'll
they'll
be
receiving
phone
calls
from
us
on
a
weekly
basis.
In
this,
in
cases
more
often
than
asked
we
have,
can
we
have
continued
to
assess
risk
remotely,
as
you
can
imagine
during
this
time
period,
that
the
normal
data
streams
that
were
used
to
seeing
continue?
Some
of
them
have
changed
and
been
amplified
and
so
forth,
but
the
normal
distance
and
rip
the
normal
data
streams.
Are
there
and
we'd
be
looking
at
those,
and
we've
also
been
receiving
information
directly
from
from
the
public.
B
They've
been
contacting
us
on
the
telephone
through
our
national
customer
service
center
and
you'll,
be
aware
that
we
have
continued
to
be
able
to
offer
a
full
service
from
the
NCSC
during
this
time
period
so
with
the
ntsc
colleagues
working
from
home.
So
and
we
know
that
the
shoppers
still
been
open.
If
you
will
for
the
public
to
to
contact
us
and
talk
to
us
and
of
course,
I'll
get
fit.
Give
feedback
on
care
service
which,
which
we
learned
some
time
ago,
has
enabled
people
to
contact
us
digitally.
B
So
the
lower
number
of
ways
the
public
can
talk
to
us
as
the
public.
That's
members
of
staff,
again,
we've
had
a
number
of
members
of
staff
talk
to
us
about
what
they're,
seeing
in
in
the
in
providers
and,
of
course,
patients
themselves
who
have
been
in
hospital.
Absolute,
come
out
of
hospital
and
of
course,
you
know
their
being
in
hospital.
These
days
doesn't
mean
you
cut
off
from
the
outside
world.
B
You
still
got
used
to
put
your
phones
and
tablets
and
so
forth,
so
the
people
can
contact
us
in
a
number
of
different
ways
and
have
continued
to
do.
Do
that
in
numbers
over
the
last
over
the
last
couple
of
months?
Well,
we've
been
in
lockdown
and
in
a
very
small
number
of
cases
we
have
actually
gone
out
and
and
looked
at
services.
In
some
cases
we
started
with
a
desktop
inspection.
B
We
didn't
want
our
teams
going
from
place
to
place
walking
kovat
into
into
environments
where
they
were
very
vulnerable
people
being
treated
or
were
living.
So
it's
not
always
been
a
very
difficult
balance,
but
that,
but
that
that's
what
we've
been
that's
what
we've
been
wrestling
with
over
the
last
last
few
weeks.
It's
also
worth
remembering,
of
course,
that
you
know
eight
weeks
ago.
B
B
What
we've
been
doing
during
this
time,
of
course,
is
doing
that
routine
regulatory
activity,
but
we
decided
that
we
wanted
to
make
that
more
structured
and
more
formalized
and
seeing
if
we
could
could
actually
make
some
changes
now,
which
would
help
us
evolve
into
a
new
way
of
regulating
in
the
future.
So
we
want
to
just
take
it.
Let's
take
advantage
of
the
fact
that
that
we
were
in
this
lockdown
period
and
think
quite
differently
and
I.
B
Think
one
of
the
one
of
the
biggest
biggest
changes
we've
made
is
to
introduce
this
emergency
support
framework
and
what
the
emergency
support
framework
does.
Is.
It
takes
a
structured
approach
to
assessing
the
safety
of
the
care
that
people
are
receiving,
particularly
with
a
focus
on
on
the
on
the
safety
in
the
context
of
Cobie
19.
B
Would
that
be
someone
from
from
NHS
England,
for
example?
Would
that
be
Phe?
Would
that
be
local
support
from
a
local
resilience
forum,
a
local
CCG
and
so
forth,
so,
depending
on
what
we
find
will
depend
on
on
who
we
call
upon
to
to
provide
that
support?
But
the
key
idea
is:
is
trying
to
roar
down
support
for
providers?
It's
not
not
indeed,
in
the
inspection
and
rating
business.
B
It
is
it
aside
from
looking
at
how
well
our
provider
is
coping
with
coded
19.
It
also
looks
at
some
very
specific
points,
or
things
like
Care
Act
easements,
for
example,
is
a
provider
in
an
area
where
they
they've
decided
that
they're
going
to
use
the
care-id
easements
that
are
available
to
in
some
areas
and
how
well
is
that
provider
coping
with
us,
and
it's
also
designed
to
look
at
people's
human
rights.
B
We're
conscious
that,
but
in
there
are
a
number
of
places
that
are
registered
with
us
were
human
rights
questions
would
Riley
come
up
all
of
the
time
and
in
closed
environments,
in
mental
health,
for
example,
but
in
in
in
an
in
an
area
like
a
care
home,
Human
Rights,
the
need
the
need
to
check
up
on
people's
human
rights
is
slightly
less
obvious,
but
I
think
we're
finding
at
obviously
as
care.
Homes
are
closed.
Environments
which
were
typically
open,
are
now
closed.
B
Then
this
human
rights
question
becomes
more
and
more
important
in
more
and
more
providers
and
again
the
ESF
seeks
to
it
seeks
to
make
sure
that's
being
considered.
Do
I
provide
us
the
tickly
environments,
where
they
haven't
necessarily
actively
considered
these
things
before,
and
it's
just
a
written
opportunity
for
us
to
remind
people.
They
need
to
think
carefully
about
how
people
get
consent
for
procedures
and
so
forth.
The
perhaps
hadn't
necessarily
been
something
they
thought
about
before
so
overall,
this
is
a
flexible.
B
It
is
a
digital
methodology
that
we
would
expect
to
evolve
rapidly
over
coming
weeks
and
as
restrictions
on
movements
change.
We
would
be
taking
this.
This
methodology
into
into
providers
in
a
very
direct
way
and
I
think
I
would
I
would
expect
that
that
that
we
will
be
doing
more
and
more
of
this
over
the
coming
over
coming
weeks.
B
And
you
know
we
are
talking
the
days
and
weeks
rather
than
rather
than
months,
where
we'll
be
going
in
and
and
then
and
the
tool
helped
us
to
target
that
work
so
that
we're
not
we're
not
we're
not
expecting
randomly,
but
where
we
are
carrying
out
assessments
of
providers
on
the
ground
in
the
way
that
we've
always
done.
We
might
report
on
them
slightly
differently,
of
course,
and
I
think
the
other
thing
that
the
the
the
emergency
support
framework
does.
C
Ian,
so
just
a
couple
of
extra
points
to
add
so
and
obviously
this
has
been
designed
at
Pace.
It's
had
a
really
good
engagement
from
our
inspectors
in
its
creation,
and
it
absolutely
does,
as
Ian
describes,
it
pulls
together
a
number
of
different,
intelligent
sources
into
a
single
suite
of
data
that
then
informs
that
inspectors
conversation
with
with
the
provider,
so
things
such
as
our
new
home
care
and
tracker
tool
where
we
are
asking
home
care
agencies
on
a
Monday
to
Friday,
to
report
to
us
about
issues
around
PPE,
workforce
testing,
etc.
C
All
of
that
data
is
informing
our
our
daily
conversations
and
with
providers,
so
we
went
live
in
adult
social
care
about
two
weeks
ago.
What
surprised
me
since
we've
gone
live
is
the
number
of
providers
who
have
proactively
contacted
us
as
an
organization
to
say
thank
you
for
that
supportive
conversation.
Thank
you
for
taking
action
on
the
back
of
that
discussion.
I
had
with
your
inspector,
so
there
has
been
a
notable
increase
in
feedback
we've
had
from
providers
telling
us
that
it
was
an
interaction
experience
that
they've
they've
really
welcomed.
C
I
just
wanted
to
share
with
you
as
well
in
the
last
week
or
so
I've
had
conversations
with
maybe
about
200
of
my
inspectors
to
find
out
how
they've
experienced
it
and
what
their
reflections
have
been
and
since
it's
gone,
live
and
if
I
may
I
just
wanted
to
give
you
a
quote
from
to
two
of
my
inspectors.
So
one
is
learn
a
spectacle
Karen
who
works
in
the
north
northwest
of
England.
So
she
said
not
routine
it
crossing
the
threshold
and
undertaking
routine
inspections
during
Coe
vid.
C
As
a
allowed
me
to
increase
the
monitoring
of
services
at
risk,
but
those
that
were
services
I've
made
calls
regularly.
The
cost
of
providers
have
been
supportive
and
I
believe.
Not
only
have
we
monitored
the
service,
but
we
supported
the
provider
to
resolve
issues
such
as
PPE
and
understanding
the
multiple
and
guidance
that
they've
been
receiving
and
trying
to
translate.
So
that
was
Karen's
reflection
and
then
Rajshri.
An
inspector
from
central
Midlands
central
East
Midlands,
said
to
me.
The
emergency
support
framework
calls
were
well
received
by
the
registered
manager.
C
We
reported
that
she
found
them
to
be
helpful
and
it
formalized
the
regular
calls
that
that
inspector
have
been
having
with
those
services
anyway.
She
said
that
through
these
course,
she'd
been
identifying
best
practice
from
conversations
with
the
providers.
So
just
to
give
you
a
couple
of
small
examples,
so
we
know
from
some
people
in
social
care.
The
impact
of
people
who
support
them
way
of
PPE
so
has
no
protective
equipment
has
been
quite
distressing.
C
So
they
establish
that
relationship
and
then
putting
the
face
mask
on
as
they
move
into
the
room
to
deliver
personal
care,
and
then
there
was
another
example
of
relatives
and
residents
event
a
sing-along
event
to
celebrate
the
the
day
that
they
did
by
assume,
and
this
service
also
regularly
has
relative
meetings
where
twenty
to
thirty
relatives
are
joining.
Powwow.
C
I
would
like
to
see
its
functionality
continue
and
develop,
and
there's
real
value
of
having
the
standard
ice
sentences
so
I'm
in
your
pack,
you
will
see
a
full
map,
I
kind
of
format,
of
what
the
emergency
support
framework
looks
like.
There
is
a
series
of
very
targeted
questions
that
our
inspectors
are
going
through
with
registered
managers.
The
calls
are
bearing
in
length,
some
of
them
are
taking
an
hour
an
hour
and
a
half.
They
are
working
their
way
through
these.
C
These
focus
conversations,
but
also
these
are
often
inspect
as
a
reporting
opportunities
for
register
managers
to
to
share
a
bit
about
the
burden
that
they
are
experiencing
with
coping
with.
You
know
events
that
they've
never
really
experienced
that
this
sort
of
scale
before
so
they
are
lengthy,
lengthy
conversations
that
lead
to
later
action
each
of
the
sentences.
The
standardized
sentences
generate
a
series
of
points
that
then
leads
us
to
form
of
a
view
about
whether
the
service
is
managing
or
requires
some
support.
C
And
it's
worth
saying
this
is
a
in
intelligence-led
process,
but
every
point
the
inspectors
judgment
can
overrule
it.
So
at
any
point,
if
the
inspector
needs
more
information
or
wants
to
understand
something
a
bit
further,
they
have
the
they
have
the
ability
and
to
do
that.
So
far,
we
have
initiated
1466
emergency
support
framework
conversations,
it's
a
higher
number
than
the
number
in
your
pack,
because
this
is
the
most
up-to-date
view
of
its
864
had
been
completed
and
that
provider
summary
that
was
in
your
pack
that
has
been
shared
shared
with
the
provider.
C
We
are
encouraging
the
providers
where
they
feel
it's
appropriate
to
share
that
information
with
their
local
authority
or
Clinical
Commissioning
group
in
the
spirit
of
transparency,
but
also
avoiding
duplication
of
a
local
authority
or
Clinical
Commissioning
group
asking
similar
questions
of
the
provider
and
that
we
are
in
terms
of
what
the
data
is
telling
us.
So
a
lot
of
that
will
come
out
in
the
insight
report
that
Chris
will
talk
about
shortly.
C
What
it
can
do
is
it
can
aggregate
up
the
information
that's
coming
out
of
the
ESF
to
a
kind
of
regional
level
or
a
local
authority
level,
and
the
way
that
we're
using
that
intelligence
is
that
is
then
informing
our
regional
conversations
about
risk.
So
we
are
able
to
say
we're
noting
an
emerging
picture
in
this
part
of
the
country
with
these
sorts
of
issues.
How
are
we
going
to
respond
system,
but
also
it
can
do
the
reverse.
C
So,
for
example,
if
a
part
of
the
country
starts
working
underneath
the
Care
Act
easements,
we
are
well
aware
of
that
and
we
may
choose
to
direct
our
efforts
about
where
we're
having
those
ESF
sessions
and
accordingly,
so
a
strong
start
in
terms
of
the
kind
of
functionality
and
the
feedback
we're
getting
from
providers.
I
do
want
to
make.
This
will
make
this
point
really.
C
Where
we've
been
concerned
about
the
services
ability
to
respond
to
and
requirements
which
we've
placed
on
them
and
in
those
circumstances,
we
will
be
crossing
their
threshold
and
we
will
be
undertaking
targeted
inspections
and,
as
I
said
at
the
beginning,
we
were
weighing
up
the
risk
of
our
staff
going
into
services
versus
the
risk
of
us
not
routinely
having
our
eyes
on.
What's
what's
going
on
in
those
services
in
person,
I
think
there's
at
risk
shifts
I
anticipate
this
number
of
targeted
inspections
increasing.
C
We
can
treat
now
as
we
go
forward
and
we
are
absolutely
set
up
as
an
organization
as
a
staff
team
to
have
groups
of
staff
that
are
ready
and
eager
and
willing
to
undertake
those
targeted
inspections.
And
there
are
other
groups
of
our
staff
that
will
be
supported
to
provide
those
small
remote
conversations
and
to
use
the
intelligence
there'll,
be
a
team
effort,
but
I
absolutely
anticipate
the
great
work
of
UNICEF
being
the
foundations,
but
are
starting
to
see
an
increasing
number
of
crossing
the
threshold
targeted
inspections
on
the
basis
of
risk.
C
A
Ok,
that's
that's
brilliant
only
and
thank
you
as
well-
and
it
just
seems
to
me
from
what
you've
both
been
saying,
that
this
is
not
only
a
great
response
to
the
Cova
crisis
and
the
right
response
to
to
what
we
do
in
the
crisis.
But
in
the
longer
term,
it's
a
way
to
enhance
our
monitoring
and
focus
better
our
inspection
and,
and
that's
a
really
exactly.
We
want
to
go
it's
links
with
our
strategies.
A
D
A
B
A
E
Please
thank
you.
Well,
first,
we
can
I
say
that
this
is
a
fantastic
new
development
in
a
very
short
period
of
time
and
I'm
really
pleased
to
see
that
priority
was
given
to
the
social
care
sector
for
deploying
it.
The
question
really
was
this
that
there's,
as
everyone
knows
of
anxiety,
expressed
in
some
quarters
about
decisions,
stop
crossing
the
threshold,
although
to
my
mind
it's
entirely
understandable
in
the
circumstances
of
this
emergency,
but
I
was
just
wondering
and
I
appreciate
what
you've
said
Kate
about.
We
will
begin
to
start
doing
that
again.
E
This
tool
is,
you
say,
is
intelligence
and
it's
of
course,
almost
entirely
as
I
understand
it.
Driven
by
information,
the
inspector
gets
over
the
telephone
from
the
care
home
provider
and
I
wonder
how
we
triangulate
that
information
I
mean.
Obviously
a
lot
of
it
will
be
accurately
there
and
there's
no
problem,
but
I
said,
would
sense
that
perhaps
their
homes
struggling
a
bit,
you
would
need
to
verify
that
and
I.
E
Just
wonder
how
you
and
your
inspectors
go
about
that
and
in
what
way
and
I
think
it
is
the
case
that
the
way
in
which
you
support
people
you
sense
to
be
in
trouble
is
a
form
of
regulation,
and
it
means
that
even
if
you're
not
crossing
the
threshold
or
other
people
are
not
crossing
the
Satori
and
the
residents
in
those
places
are
being
protected
by
the
support.
That's
being
given.
C
Thank
you.
Thank
you
a
bit
so
so
again
hearing
from
my
inspectors.
What
they've
said
is
because
they
are
not
spending
the
time
routinely
traveling
to
services.
They
are
spending
that
time
has
said,
having
much
more
frequent
conversations
with
local
authorities
with
clinical
commissioning
groups
with
advocacy
organizations.
So
this
is
absolutely
not
just
a
one-on-one
conversation
between
the
inspector
and
the
provider.
It's
using
all
that
kind
of
collective
knowledge.
We've
we've
been
hearing
some
examples
over
the
last
week,
where
surveys
that
HealthWatch
have
done
have
brought
back
themes.
C
C
So
it's
informing
our
conversation,
so
we've
got
whistleblowing
information,
safeguarding
information,
information
for
feedback
on
Claire
and
then
those
conversations
with
other
people
in
the
system
and
some
of
which
you
know
we're
hearing
examples
where
district
nurses
are
providing
really
good,
hands-on
care
into
services,
and
they
are
able
to
talk
to
us
about
their
observations
about
how
those
services
are
coping
so
we're
people
across
in
the
threshold.
We
are
absolutely
making
good
use
of
that
intelligence
as
well
to
help
us
have
that
complete
picture.
C
I
think
there
is
I
think
there
is
more
work
to
do
about
hearing
directly
from
people
with
lived
experience
about
their
care.
Where
they
are
maybe
unable
to
go
online
and
give
feedback
on
care,
so
we
are
starting
to
think
about
how
we
might
use
our
fantastic
expert
by
experience
resource
to
potentially
think
about
how
we
gather
some
of
that
information
directly
from
people
who
have
received
services
and
their
care,
their
families,
their
carers,
and
we
probably
want
to
come
back
and
update
the
board
on
that.
One.
B
Can
I
just
build
on
on
that
okay
points
as
well,
I
think
if
I
draw
people's
attention
to
page
18
of
the
diligent
pack,
why
things
page
four
of
the
slide?
There's
a
there's,
a
sort
of
master
inspectors,
portfolio
view
I,
think
it's
described
as
and
what
that
does.
Is
it's
a
summary
of
each
inspectors
portfolio.
It
shows
the
the
providers
it's
been
redacted
I
mean
the
blue
box.
As
you
can
this
you
can
see
on
the
papers,
but
there's
a
series
at
that.
B
So
when
the
inspector
is
looking
at
their
portfolio
in
on
a
Monday
morning
and
they're
deciding
which
calls
to
make,
they
have
got
access
in
one
place
to
the
entire
regulatory
history,
in
effect,
in
a
summarised
form,
they
can
dig
into
that
and
look
at
look
at
look
at
the
regulatory
history
on
CRM
and
so
forth.
So
so
does
it
does
give
the
inspect
as
a
real
sense
of
where
the
risk
my
lie.
B
Based
on
that
sense
of
risk,
they
can
then
decide
which
ones
they
do
in
which
order
and
in
fact,
whether
or
not
they
want
to
go
back
a
second
time,
I
think
it's
also
worth
touching
on
the
training
that
we
did.
I
know
you
know
I
expected
a
couple
of
inspectors
who
commented
on
the
fact
that
the
training
talked
about
how
we
question.
You
know
this.
B
This
idea
that
they
were
they
were
given
some
conversational
techniques
during
the
during
the
training
to
make
sure
that
they
can
start
to
draw
out
the
information
that
they
need,
but
I
think
as
Kate
as
Kay
said.
We
very
much
recognize
that
there's
an
awful
lot
of
information
we
can
get
from
the
intelligence
point
of
view,
but
the
fact
we're
in
The
Cove
in
lockdown
does
does
create
some
some
restrictions
on
what
we
can
do,
but
I'm
hopeful
that
we
can.
B
F
Yes,
look
it's
a
question
to
Kate.
Firstly,
thanks
very
much
indeed
for
explaining
that
process
well
and
the
intelligence
behind
the
but
I
wanted
to
just
look
at
two
sections
in
the
report,
which
was
staffing
arrangements
and
protections
from
abuse,
and
we
know
from
Walton
hall
that
these
two
are
very
closely
linked
in
in
toxic
cultures.
So
just
wondering
how
we
are
ensuring
the
ESF
flags
up
the
warning
signs
such
enclosed
open,
sights
such
as
high
agency
use
multiple
shift
patterns,
inadequate
line
management,
training,
high
turnover
of
substantive
staff
absence
rates.
C
Kate,
please
forgive
me,
there's
been
a
power
cut
so
and
so
thank
you
Mark
so,
and
we
obviously
have
that
suite
that
suite
of
data
and
those
of
the
services
that
we
have
prioritized
by
ESF
conversations
so
far,
I
think,
as
I
said
there
is.
There
is
some
really
helpful
information
that
those
conversations
will
give
us,
but
there
are
type
to
services,
types
of
environments
where
nothing
beats
crossing
the
threshold.
C
Nothing
quite
gives
us
the
information
that
we
need
when
we
go
out
and
we
do
a
short
observational
framework
piece
where
we
sit
down
and
we
just
observe
how
staff
are
working
with
the
people
they
support,
and
we
note
that
and
we
give
feedback
etc.
So
those
those
are
the
services
that
I
anticipate
are
starting
to
cross
the
threshold
with
more
I.
Don't
know
whether
Ted
wants
to
say
a
little
something
about
the
Mental
Health
Act
assessments
and
the
fact
that
we
have
continued
to
keep
those
crossing
the
threshold
inspectors
up
through
that
through
coatings.
D
Can
I
just
just
say
that
that
we're
looking
forward
to
started
roll
out
the
emotional
support
framework
in
hospitals
have
been
beginning
of
June
us
we're
trying
to
do
it
we'll
be
doing
it
in
selected,
sub
sectors
of
hospitals,
but
I
think
it's
very
important
to
emphasize
we're
not
waiting
for
that.
We've
got
many
other
sources
of
intelligence
that
we
have
continued
to
monitor
throughout
the
curve
of
epidemic,
give
feedback
on
cares
being
mentioned,
but
of
course,
we've
still
got
whistleblowing
and
we
put
out
a
message
board.
D
Members
will
remember
at
the
time
of
the
last
board,
emphasizing
importance
of
people
speaking
up
and,
of
course
we
have
monitor
serious
incidence
and
outcome
data
so
with
all
that
intelligence
and
that
will
drive
responsive
inspections
going
forward,
we've
already
done
some,
but
they
will
get
increasingly,
as
as
the
prevalence
of
Kovach
19
in
the
community
reduces
the
risk
of
doing
inspections
becomes
less.
We
will
be
looking
to
increase
our
responsive
inspections,
as
Kate
described
in
ASC
and
I.
D
Think
it's
important
to
emphasize
that
we
are
targeting
areas
where
we
feel
there
is
risk
and
we
will
go
in
and
cross
the
threshold
in
those
cases
in
terms
the
Mental
Health
Act.
To
answer
case
specific
point:
we
have
developed
a
new
way
of
reviewing
the
mental
health
act
using
some
desktop
and
and
remote
review
of
that.
That
is
actually
working
very
well.
D
G
Ted
so
could
I
could
I
ask
a
question.
Please
yeah.
Firstly,
I
mean
I,
think
it's
absolutely
right
that,
as
this
infection
risk
does
reduce
that
we
are
becoming
ever
more
active
in
crossing
the
threshold
and,
if
you
like,
shifting
the
balance
towards
our
full
regulatory
role,
because
I
think
that's
very,
very
important
to
people
in
this
time.
G
H
Perhaps
answer
that
one
Peter
at
least
and
so
so
so
absolutely
Liz.
That's
that's
the
intention.
Right
now.
We've
stood
something
up
at
incredible
pace
that
allows
us
to
gather
the
intelligence
that
we
have
to
enable
inspectors
to
me
good
risk
decisions
about
where
to
focus
their
attention.
That's
also
captured
in
a
structured
way,
so
we've
got
our
initial
Minimum
Viable
Product,
which
is
which
is
out
there
and
live
and
and
being
very
successful
and
will
continue
to
add
to
that.
F
So
particularly
addressing
Rosie
and
Ted
really
will
the
ESF
those
sectors
start
to
understand
whether
providers
are
beginning
to
pick
up
their
responsibilities
towards
non
co?
Work
which
is
going
to
be
important
and
I
minded
that
that,
in
terms
of
chronic
disease
may
increase
as
unemployment
increases,
will
we
be
looking
at
that
as
part
of
the
assessments,
so.
I
I.
Think
in
terms
of
the
between
care.
The
other
thing
to
mention
is
that
it
is
an
opportunity
for
us
to
capture
the
innovation.
That's
happening,
there's
lots
of
great
work
in
terms
of
what
practices
are
doing
in
terms
of
doing
long
term
management.
In
a
remote
way
for
examples
for
the
things
that
they
can
do,
immunizations
happening
out
in
car
parks
to
reduce
the
risk
of
babies
and
lost
it's
probably
not
a
long-term
solution.
I
D
D
Think
one
of
the
strong
drivers
of
that
is
going
to
be
really
good
infection
control
and
we
are
working
with
NHS
providers
across
the
board
to
make
sure
they
are
implemented
most
effective
if
infection
control
so
that
they
can
build
up
their
non
KB
capacity
as
quickly
as
possible,
as
so
I
think
this
is
very
much
a
focus
of
our
work
at
the
moment
and,
of
course,
as
we
introduce
the
initial
support
framework,
we
will
build
those
questions
into
it.
Thank.
A
You
good
so,
let's
move
on
I'm
not
going
to
try
and
summarize
the
discussion
have
just
had
other
than
to
say
I
think
there
are
some
very
strong
themes
that
come
out
that
will
recognize.
There
are
circumstances
where
crossing
the
threshold
is
essential.
I
think
we'll
recognize
that
we
are
a
regulator,
not
an
Inspectorate,
so
inspection
is
only
one
of
the
things
that
we
we
do
and
what
I
love
about
the
tool
that
has
been
developed
as
we
move
out
of
code
as
well
as
in
Cove.
A
It
is
that
it
enhances
our
monitoring
capability
and
capacity
and
I
think
that's
that's
a
really
important
development
as
we
as
we
move
on
our
regulatory
journey,
so
I
really
would,
as
I
said
at
the
start,
congratulate
everybody.
That's
got
us
to
this
point
and
look
forward
to
see
how
it
develops
in
the
future
with
that,
if
everybody's
happy,
let's,
let's
move
on,
if
we
can
in
and
Chris
to
the
insight
in,
do
you
want
to
introduce
this
or
do
you
want
to
go
straight
to
Chris.
J
To
Chris
Chris
as
you've
seen
from
the
previous
item
through
our
workers,
our
regulator
CQC,
is
developing
powerful
insight
that
helps
tell
the
story
about
what's
happening
to
health
and
care
at
the
moment
as
a
crisis
and
fall
we'll
continue
to
review
the
information
that
we
we
collect
from
others,
and
we
have
ourselves
about.
What's
the
impact
at
the
pandemic,
the
pandemic
on
people
who
use
services
and
also
those
that
provide
care.
J
The
purpose
of
the
report
which
I'm
going
to
introduce
today
is
to
make
that
available
that
data
that
we
collect
available
as
part
of
our
approach
activity,
so
that
we
can
build
a
clear
picture
of
the
impact
of
Ko
bid
at
19
they're,
offering
this
transparency.
We
hope
to
guide
decision
makers
now
and
inform
the
planning
for
the
future
and
by
regularly
updating
and
publishing
its
report.
We
want
to
show
what
is
changing
over
time
and
we'll
identify
improvements
that
are
visible
or
where
the
petitioner,
where
the
picture
is
potentially
deteriorating.
J
As
you
know,
those
often
the
nature,
a
natural
focus
on.
What's
not
working
what's
going
wrong
and
this
is
inevitable,
but
it
often
will
worry
service
users,
anyone
with
relatives
in
hospitals
or
in
a
care
home.
The
vast
majority
of
care
in
this
country,
as
we've
seen
from
some
of
our
early
work
in
the
SF,
is
still
being
delivered
well
by
dedicated
and
professional
staff.
Our
analysis
aims
to
offer
some
proportionality
and
balance
to
the
fast-changing
in
turbulent
period
and
we're
concerns
are
raised.
J
We
put
them
into
context
and
show
that
things
are
working
well
in
some
areas
that
we're
where
they're?
Not.
How
would
we
encourage
leaders,
both
national
and
local,
to
take
the
right
action
in
this
first
edition
of
the
packet
includes
information
on
outbreaks,
on
deaths,
on
testing
in
and
at
such
care,
PPE
in
care
in
home
care
and
the
wider
effects
of
code
read
on
social
care
on
the
social
care
system,
both
their
own
analysis
and
what
we've
gathered
from
our
rectory
activity.
J
Another
partnering
organization,
as
I
say,
the
document
is
designed
to
prompt
discussion
and
confirm
the
action
we
intend
to
take
as
a
regulator.
If
you,
okay,
that's
just
a
touch
on
a
few
of
the
themes
of
the
report
and
then
you'd
like
questions.
If
that's
okay,
this
please,
and
so
one
of
the
first
things,
was
around
the
significant
improvement.
J
Sharing
that
allows
care
settings
to
make
the
appropriate
assessment
of
risk
and
make
sure
residents
and
staff
are
safe.
We
are
investigating
a
number
of
cases
where
care
homes
have
told
us
that
this
has
not
occurred
and
we'll
take
action
where
appropriate
and
I
think
we
said
on
Monday.
We
have
we
our
ongoing
concerns
about
closed
environments,
partly
about
how
they're
managing
a
covert
situation
partly
about
how
we
ensure
that
they
continue
to
provide
safe
care
and,
as
we
discuss
with
the
JCH,
are
on
Monday.
J
We
intend
to
come
and
increase
our
inspection
activity
in
this
area
as
the
infection
rate
declines.
We
want
to
test
how
NHS
primary
care
and
I
don't
social
care
services
work
together
to
prioritize
the
reopening
of
care
for
non
COBE
patients.
We
want
to
be
clear
about
how
services
understand
the
risk
in
their
area
and
how
they
safely
improve
access
to
care
for
different
groups
and
going
forward
we'll
focus
on
other
key
topics.
J
We're
told
two
issues
around
social
care,
but
also
talking
about
other
issues
like
dentistry
and
how
that
can
be
opened
safely
to
provide
care.
We
will
use
examples
of
how
technology
is
changing
the
way
health
and
care
service
is
delivered
and
what
that
means
for
the
future
of
care.
I
hope,
colleagues
find
it
useful
and
say
that
this
is
a
first
first
edition.
We
aim
to
ensure
we
have
a
regular
drumbeat
of
this
communication.
Tell
informed
decisions
both
nationally
and
locally.
A
Thanks
Chris
I
think
it's
probably
important
just
to
recognize
that
the
slide
deck
is
data
up
to
the
8th
of
May
I.
Think
so.
Yeah
obviously
asked
the
cutoff
point
get
papers
to
the
board,
but
we
as
an
organization,
obviously
have
data
coming
in
on
a
daily
basis.
From
our
internal
point
of
view,
it's
more
up-to-date
than
this,
and
probably
other
thing
to
say,
is
this-
isn't
a
complete
suite
of
data
that
we
have
losses
that
stuff
that
we
we
want
to
put
into
this?
This
deck
is
really
good.
So
thank.
D
You
Ted
thank
you,
Peter
can
I
can
I
just
welcome
this.
This
report
I
think
it's
excellent
and
I
think
it
is
a
great
first
first
report
and
and
as
as
chris
says,
we'll
be
able
to
build
on
it
going
forward.
I
think
the
point
I
want
to
make
is
more
general
one
which
has
come
from
very
clear
out
of
the
Cova
Depa
technique,
and
that
is
the
importance.
D
Quality
board
where
next
meets
in
a
few
weeks
time
I
think
there's
a
real
opportunity
to
build
on
some
of
the
sharing
of
data
taking
place
during
the
Kovac
epidemic
to
build
up
to
really
transparent
a
system,
and
that
will
enhance
trust
in
the
system,
which
is
vitally
important,
but
it
also
mean
that
issues
do
not
get
hidden.
They
get
addressed
and
groupthink
is
challenged
and
I
think
that
is
really
really
excellent,
so
I
think
there's
a
real
positive.
We
can
draw
from
this
and
I
think
this
is
a
great
example
of
it.
Thanks.
A
F
Thank
you,
firstly,
Chris.
Thank
you
to
you
and
your
team
for
an
excellent
piece
of
work,
appreciate
it
because
I'll
just
briefly
endorse
what
Ted
just
said,
then
I
think
transparency,
all
organizations
in
the
data
they
have
that
facilitates
our
understanding
of
what's
going
on.
These
are
really
important.
People
have
a
moral
duty
to
do
that,
but
I
would
also
say
a
Kovach
duty
to
do
that.
But
until
we
get
that
transparency,
we
limit
the
trust
and
confidence
that
is
necessary
as
we
come
out
of
a
lockdown.
F
So
I
would
encourage
those
who
have
difficulty
getting
to
that
point
that
they
reflect.
I
have
a
couple
of
questions
if
I
may
okay,
the
first
is
that
I'm
told
that
there
is
low
confidence
in
the
testing
system
is
being
applied
to
towns
in
a
way
that
gives
confidence
in
the
safety
of
residents,
which
is,
of
course,
part
of
our
purview
as
regulators.
What
is
your
view.
C
Thank
you,
John,
so
I
think
we
welcome
the
clarity
of
guidance
around
this
now,
so
the
guidance
is
now
there
should
be
whole
community
testing,
so
not
just
testing
of
symptomatic
residents,
but
testing
of
asymptomatic
residents
and
of
of
staff.
So
really
welcome
that.
That
is
the
the
guidance.
Welcome.
The
commitment
and
that's
been
made.
Testing
should
be
made
available
to
the
social
care
sector
in
its
entirety.
Obviously
prioritizing
care
homes
in
this.
C
We
have
not
firmly
handed
that
over
so
there's
now
a
government
portal
that
people
should
be
accessing
but,
as
we
say
in
our
report
that
we
published,
some
providers
are
still
reporting
challenges
about
getting
access
to
testing
in
a
timely
way.
So
so
this
is
still
if
this
is
this
is
not.
This
has
not
been
resolved.
This
is
still
an
issue
that
we're
hearing
from
our
providers.
C
F
You
and
my
second
question
brief:
the
pieces
are,
may
care
workers
have
done
an
incredible
job
they
as
heroic
as
exposed,
as
traumatized
as
other
people
in
the
system,
particularly
when
they've
had
several
people,
sadly
dying,
because
they
may
have
looked
after
for
a
long
time
and
added
to
that,
the
stress
and
impact
quite
often
going
back
to
a
low-income
home.
This
will
have
an
impact
on
their
mental
health.
What
support
is
available
to
them
to
assist
them
in
that
process?.
C
That
leads
these
colleagues
and,
to
my
hope,
is
that
going
forward
they
continue
to
have
they
establish
and
continue
to
have
the
recognition
and
reward
that
they
are
that
they
deserve
the
osteopath
support.
So
we
are
again
in
our
conversations
with
providers.
We
are
hearing
from
very
best
providers,
distressed,
registered
managers,
distressed
staff.
My
inspectors
have
often
reported
speaking
to
people,
do
work
in
care
in
you
know
in
tears,
describing
you
have
two
people
to
work
in
social,
carry
used
to
supporting
people
at
the
latter
stages
of
their
life
in
those
final
weeks
and
days.
C
C
They've
got
a
confidential
and
helpline
for
staff
and
during
ovid
that
was
initially
available
for
the
health
health
colleagues
and
my
understanding
is
as
of
the
15th
of
March
that
has
now
been
extended
out
to
social
care
workers
which
we'd
really
welcome,
and
what
we'd
really
encourage
is
at
any
point
when
there
are
new
initiatives
thought
about
for
their
health
workforce.
So
if
we
think
of
the
early
days
of
kovat
when
health
workers
were
supported
to
access
supermarkets
earlier
and
the
suite
of
other
support,
the
health
workers
offered
are
asked.
Is
there
any
point?
C
A
You
Kate
going
back
to
what
you
were
saying
in
answers
as
John's.
First
question:
I
own
a
board.
Colleagues
know
this,
but
it's
probably
worth
being
absolutely
clear
at
name
time
have
we
being
responsible
for
testing
nor
have
we
actually
done
the
testing?
What
we
were
doing
was
facilitating,
but
the
booking
of
tests
and
I,
you
know
I,
know,
there's
been
confusion,
so
I
think
it's
important
to
be
absolutely
clear.
What
we
all
are
all
was
and
what
our
role
was
not.
C
So
absolutely
so,
we
are
taking
every
opportunity
to
remind
people,
and
so
what
we
did
was
a
booking
function.
We
are
no
longer
doing
the
booking
function,
and
this
is
where
you
need
to
go
to
the
reason
why
we
talked
about
it
still
as
being
an
issue
in
our
insight
report,
its
inspected
still
having
regular
queries
from
providers.
There
still
seems
to
be
some
confusion
about
what
whether
we
have
an
ongoing
role
in
testing,
and
we
absolutely
don't
thank.
G
Thank
you
very
much.
Yes,
so
I,
like
others,
I,
think
the
transplant
point
is
hugely
important
and
I
think
it's
a
welcome
that
we're
going
public
everything
that
we
know
suitably
analyzed
in
these
weekly,
regular
briefing,
so
I
think
the
regular
insight
I
think.
That's
really
really
important,
and
but
I
just
wanted
to
pick
up
from
it's
a
go
about
how
maybe
initially
the
focus
was
on
the
NHS.
G
Then
it
moved
to
care
homes
and
I.
Just
think
one
of
the
purposes
of
transparency
and
benefits
of
it
is
that
we
can
highlight
other
groups
of
people
who
may
be
mainly
attention
that
not
written
in
the
same
level
and
I
just
like
to
mention,
subject
to
the
Mental
Health
Act
we're
doing
high
levels
of
deaths,
which
I
think
are
very
concerning,
particularly
if
people
are
composable
detained
somewhere
where
they
may
be
exposed
to
infection
and
they're
not
able
to
change.
G
You
know
they're
not
able
to
exercise
choice
themselves
to
do
something
about
that
has
also
obviously
applies
to
a
lot
of
people
in
care
homes
and
but
I
just
wondered
if
I
could
ask
in
relation
to
people
subject,
subject
to
the
Mental
Health
Act
I
know
it
says
in
the
document
that
we're
reviewing
data
to
understand
the
factors
more
and
see
what
actually
might
be
needed.
What
are
what
exactly
are
we
doing?
G
G
D
Part
of
the
work
we're
doing
on
infection
prevention
of
control.
That
applies
to
all
NHS
trusts,
including
mental
health
trusts
and
including
people
to
tend
into
Mental
Health
Act,
and
we
also
be
rolling
that
out
to
independent
providers
of
services
for
people
detained
at
the
Mental
Health
Act.
So
we
will
be
reviewing
the
quality
and
infection
prevention
and
control
arrangements
in
all
these
providers
going
forward
making
sure,
as
as
Chris
mentioned
a
while
ago,
that
they
are
complying
with
the
latest
guidance.
Major
England
on
that
and
I
think
that's.
D
That's
has
to
be
the
starting
point
to
make
sure
the
best
possible
infection
control
procedures
are
in
place
in
all
settings
for
all
patients,
regardless
of
their
reason
for
being
in
a
hospital
or
detained
and
I
think
that's
really
very
important
in
terms
of
the
the
specifics
issues
about
mental
health
act.
Of
course
we
published
this
data
and
again
that
just
feeds
into
the
issue
about
transparency,
that
this
is
data
we
knew
and
we
thought
should
be
made
input
into
the
public
domain.
D
So
the
edmonds
aware
of
it
and
as
a
promote
Kevin
Cleary,
wrote
to
all
the
mental
health
providers
just
to
highlight
the
issue
of
this
data
and
the
importance
or
infection
control
where
we
are
seeing
any
patterns
in
the
data.
We
are
going
to
go
in
look
at
specific
areas
and
we
are
following
up
with
warranty
providers
specific
issues
with
them
at
the
moment
as
part
of
our
regulatory
process
and,
of
course,
that
may
trigger
further
actions
such
as
inspections,
which
you
we
are.
E
I
Can
I
just
come
in
there
as
well
and
just
to
let
you
know,
the
the
safeguarding
group
across
the
CQC
is
doing
some
work.
Looking
at
specific
population
groups
who
may
be
vulnerable
as
well,
and
an
understanding
how
we
look
at
that
data
and
capture,
particularly
around
the
information
that's
coming
through
NCSE,
so
that
so
that
we
can
get
a
better
understanding
of
impacts
on
vulnerable
population
groups,
either.
F
Lock,
please,
yes,
I
wonder
if
I
could
just
build
on
John's
point
about
the
impact
on
care
staff
and
in
case
response
to
that,
we
already
use
our
national
voice
to
promote
Career
Pathways
sector
management
skills.
I
just
wondered
Kate,
particularly
if
you
felt
there
was
an
opportunity
for
us
to
be
using
our
voice
to
promote
a
occupational
health
infrastructure
for
social
care
providers,
especially
those
smaller
operators.
C
Thank
you
mark,
so
so
I
think
yeah.
So
when
I
think
about
our
role
in
terms
of
the
social
care
workforce,
I
think
we
have
an
important
role
to
play
in
terms
of
shining
a
spotlight
on
what
they
do.
So
we're
gonna
be
talking
Chris
in
the
coming
weeks
about
I
inviting
providers
to
tell
us
about
how
they've
responded
to
social
care
and
to
give
us
those.
We
were
life.
C
Think
it's
important
that
we
continue
to
do
that.
The
same.
There
has
been
moves
to
talk
about
how
so,
if
I'm,
wearing
my
care
badge
here
and
I've
been
wearing
it
them.
As
you
know,
for
about
a
year
in
the
last
few
weeks,
obviously,
the
government
has
been
promoting
the
care
badge
and
trying
to
encourage
the
of
an
identity
for
the
very
disparate
and
social
care
workforce
and
a
bad
sense
about
an
identity
that
also
gives
you
opportunities
and
similar
to
those
that
I'm
colleagues
have
in
the
NHS.
K
We've
got
lots
of
data
coming
through
from
at
the
moment
from
our
emergency
support
framework
things,
how
we're
putting
all
that
together
in
a
way
which
actually
starts
to
say
help
people
identify
what
the
issues
are.
That
leads
to
some
places,
getting
the
infection
and
others
not
getting
it,
and
perhaps
the
severity
within
a
particular
care
homes,
whether
it's
space
more
wider
than
a
home
or
not.
What?
What
are
we
learning
from
that
that
we
can
share
and
reinforce
the
defenses
if
you
like
around
those
that
haven't
had
it
yet.
C
So
so,
thank
you
so,
and
so
there
are
many.
There
are
many
factors
at
play.
So
Ted
was
talking
earlier
about
good
infection
control,
so
our
sectors
have
been
talking
a
lot
about
access
to
personal
protective
equipment
which
is
really
important,
but
that
is
a
component
of
having
good
infection
control
processes
in
place.
There
were
sometimes
particular
challenges
in
the
social
care
sector,
so
we
think
about
our
different
residential
and
nursing
buildings
around
the
country
that
may
be
small
or
old
buildings.
The
challenges
about
being
able
to
physically
space
people
out.
C
The
challenge
is
about
support
one
you
may
have
dementia
and,
as
a
result,
their
dementia
may
need
to
move
frequently
throughout
the
home
that
they
they
live
in
and
actually
to
be
restrained
and
restricted
to
a
part
of
the
the
the
home,
wouldn't
wouldn't
work
for
them.
So
there
are
many
many
challenges.
C
We
welcome
the
commitment
that
no
one
should
be
leaving
hospital
without
a
test,
and
those
test
results
known
so
that
a
care
home
when
accepting
a
new
person
into
the
service
can
do
so
fully
informed
about
what
their
needs
are
and
how
they
should
be
cared
for.
We
are
really
keen
I
think
when
we
think
about
the
insight
report
going
forward.
So
obviously
this
is
our
first
one,
but
to
talk
more
about
these
are
the
ingredients.
C
These
are
the
components
that
means
that
we're
seeing
the
right
outcomes
for
people,
so
whether
it's
testing
good
infection
control,
whether
it's
how
the
staff
are
working,
for
example,
how
the
local
health
community
is
supporting
that
that
service
I
think
we
will,
in
future
public
places
to
be
talking
more
as
well
about
what
good
looks
like
in
terms
of
support
supporting
services
to
not
get
infections
and
if
they
get
infections,
to
manage
it
in
as
a
contained
way
as
possible.
Just.
J
The
areas
of
focus,
which
is
the
last
section
in
the
report,
talks
about
the
the
areas
that
we
want
to
concentrate
on.
It
talks
very
much
to
what
case
just
said
in
terms
of
trying
to
understand
the
balance
between
people's
compliance
with
the
guidance
health
services
for
different
sectors,
work
together
and
how
people
respond
to
that.
The
challenges
around
around
training
and
support
and
I
think
one
of
the
things
the
challenges
of
these
documents
in
terms
is
to
you.
By
the
time
we
were
definitive
on
the
answer.
J
We
would
not
be
transparent
about
sharing
information
so
that
the
information
is
shared
deliberately
so
that
we
share
the
insight.
So
we
collectively
questions
can
be
asked
and
where,
as
a
reason
to
put
those
four
areas
of
focus,
it
won't
be
the
only
things
we
cover,
but
they
are
important.
Is
it
speaks
to
those
who
know
the
issues
that
we
think
some
of
the
data
raises
that
we
want
to
explore
again
and
I
think
in
future
editions,
as
well
as
our
own
voice.
J
I
I
just
come
in
as
well
so
I
just
wanted
to
say
in
terms
of
those
priority
areas,
I
think
that
the
system-wide
working
and
how
systems
have
worked
together
across
this
we've
seen
some
really
good
examples
of
system-wide
working.
We've
seen
some
examples
where
it's
not
worked
very
well,
particularly
between
health
and
care,
and
that
interface
and
I'm
really
keen
that
we
quite
quickly
understand
how
we
can
explore
that
in
more
detail
and
the
integrated
care
board
is
looking
at
that
at
the
moment.
B
I,
just
just
I
got
I
think
Paul
makes
a
makes
a
great
point
on
and
I
think
Chris
person
to
build
on
Krista's
answer.
There
are
some
things
that
we
are
CQC
can
can
can
interpret
from
this
information
and
those
things
that
we
as
CQC
can
do.
But
if
I
just
look,
for
example,
at
page
10
of
the
reports,
there's
a
line
graph
that
shows
numbers
of
outbreaks
per
thousand
population
and
I
think
it's
you
know,
there's
a.
B
You
know
so
in
some
respects
we
may
not
know
the
answer
in
detail
yet,
but
if
I
was
if
I
was
a
system
leader
in
one
of
the
other
regions,
I'd
be
picking
the
phone
up
to
the
people
in
the
northwest
to
understand
what
they
did.
I
think
that's
an
example
were
just
experinces
that
people
have
made
that
the
notion
of
just
exposing
the
data
means
people
can
draw
some
conclusions
really
really
quickly,
and
there
are
some
things.
B
You
know
it
can
be
really
exciting,
frankly
and
also
I
think
it's
always
important
as
we
go
through
these
sorts
of
things
to
make
sure
that
people
are
capturing
what
they're
doing,
because
if
you
know,
if
we
ask
the
people
in
the
northwest
in
six
months
time,
Watson
was
they
did
during
April.
They
probably
won't
be
able
to
remember
in
enough
detail
to
really
get
the
insight,
so
this
provokes
that
that
active
learning
as
well,
which
again
I
think,
is
a
core
part
of
our
purpose
around
providing
improvement.
So
thanks,
Bea
yeah.
Thank
you.
Please,.
E
Sir,
can
I
ask
a
question:
please
I
was
going
to
say
a
lot
about
transparency,
but
everyone
has
said
it
and
I
just
wish
to
endorse
it,
adding
that
everything
I
have
done
since
the
mid
staffs
inquiry
suggests
that
without
transparency,
bad
things
happen
and
therefore
I
would
encourage
everyone,
including
the
CQC,
to
continue
with
this
sort
of
exercise.
But
a
specific
question
about
our
insight,
which
of
course,
I
welcome.
E
Really
one
is
about
a
feedback
on
or
two
things,
one
is
feedback
from
care,
home
providers
and
others
about
how
helpful
or
otherwise,
the
guidance
they
have
received
in
relation
to
public
health
issues.
Well,
inevitably,
some
of
that
has
changed
sometimes
quite
rapidly,
but
it
seems
to
me
that
we
have
access
to
through
our
ECF
and
other
ways
to
providers
about
how
helpful
or
otherwise
the
guidance
is
and
whether
this
clarification
require
that's
the
first
question
and
the
second
one
is
whether
we
and
I
think
you
case.
E
You
alluded
to
this,
whether
there's
more,
we
could
do
in
relation
to
getting
feedback
from
both
staff,
but
perhaps
most
importantly
service
users
in
the
social
care
sector,
and
why
that's
useful?
It
seems
to
me,
apart
from
the
obvious
reasons,
is
that,
by
way
of
example,
has
had
some
feedback
that
domiciliary
service
users
have
been
afraid
to
continue
to
use
services
because
of
a
lack
of
PPE
from
available
to
the
people
coming
to
their
home.
Does
the
same
thing?
E
Actually,
we've
had
feedback
about
people
getting
for
non
Kovach,
related
treatment,
they're
afraid
to
do
so
because
of
a
feeling.
Staff
in
those
areas
have
not
been
using
PPE
and
I.
Just
wonder
whether
those
sort
of
issues
could
be
surfaced
by
us
through
some
of
the
the
contacts
that
we
have,
which
perhaps
others
would
find
more
difficult.
C
What
we
have
done
is
we
have
been
our
conversations
with
registered
managers.
Talk
them
through
supported
them,
answered
questions,
signposted
them,
but
I
I.
Think
providers
would
absolutely
say
that
there
was
a
succession
of
guidance
that
changed
along
with
the
science,
but
was
pretty
tricky
to
keep
to
keep
up
to
speed
with
with
regard
to
feedback,
was
stopped
so
and
I
was
gonna,
say
2:30,
but
so
I
was
talking
to
an
inspector
called
Lucy.
C
So
Lucy
is
a
Spectre
in
sorry,
East
she's
been
working
with
some
learning
disability
services
and
what
at
least
he
was
saying
was
and
prior
to
the
emergency
support
framework.
Joining
lucy
was
regularly
joining
zoom
meetings
with
staff
and
with
managers
across
the
service
and
to
observe
interactions.
They
have.
C
This
will
come
up
under
the
next
item
when
Stewart
Dene
joins
us
to
talk
about
market
oversight
issues
but
home
care
providers,
they've
absolutely
said
that
they
have
seen
a
reduction
in
people
choosing
not
to
receive
during
co
vid
for
a
variety
of
reasons.
The
number
one
reason
cited
is
a
fear
that
the
care
worker
would
be
bringing
potential
infection
into
the
home,
as
would
any
you
know,
as
would
any
person
might
get
he
coming
into
someone's
home
and
then
going
into
another
person's
home,
etc.
J
Just
answer
the
governance
point
so
and
Robert
it's
a
really
important
point.
We
one
of
the
things
we
try
to
do
is
to
embed
some
of
our
colleagues
in
partner
organizations
to
get
a
grip
on
the
guidance.
So,
for
example,
we've
we've
we've
lent
one
of
our
people
to
NHS
England.
So
when
we're
talking
a
bit
about
the
guidance,
did
he
put
on
axillary
care?
We
have
a
consistent
view,
we're
not
we're
not
presenting
disparate
views.
J
Anything
we've
done
in
response
to
the
feedback
from
providers
is
to
create
a
page
on
our
website
where
providers
and
go
for
information
about
all
the
badness
that
relates
to
them,
so
to
bring
other
organisations
guidance
into
one
place,
we're
working
with
their
and
with
the
HSE
around
a
sort
of
a
summary
of
that
guidance.
So
that
again
we
can
create
a
one
beep
I
think
the
point
is
well
made.
J
It's
been
a
painful
process,
but
getting
people
into
the
idea
of
testing
things
before
before
you
put
them
out
and
don't
assume
that
the
same
message
when
land
in
a
different
Center
has
been
something
I
think
is
a
positive
out
of
this.
So
it's
certainly
our
colleagues
now
feel
more
sure
that
they
can
send
information
to
us.
We
can
use
that
testing
process
and
we
can
get
better,
promote,
there's
a
long
way
to
go
and
I
think
there's
a
lot
more.
We
can
learn.
Peter
can
I
just.
D
Say
something
response
to
Robert
I
think
you
Charlie
right.
People
with
nonprofit
conditions
who
need
to
go
into
hospital
or
to
seek
care,
need
to
be
confident.
They
aren't
at
risk
of
infection
with
courage
by
seeking
that
care,
and
we
need
to
do
everything
possible
to
make
sure
that
they
are
confident.
Providers
need
to
make
sure
they've
got
really
good
infection
control
arrangements
in
place,
which
is
why
we
are
focusing
on
that
at
the
moment.
I
think
come
back
to
the
transparency
theme.
D
A
L
Always
helps
in
the
update
that
I
provided
to
board
in
March
this
year,
I
said
that
the
risk
that
c19
posed
to
the
sector
was
substantial.
Indeed,
the
types
of
challenges
the
c19
is
presenting
mean
that
they
will
be
felt
by
even
the
strongest
of
businesses
to
the
extent
that
they
remain
unfunded
to
effectively
understand
emerging
risk
market
oversights
continue
to
engage
extensively
with
the
providers
captured
by
the
scheme
and
then
feed
this
output
into
across
government's
thinking
and
discussions.
L
Admissions,
on
the
other
hand,
remain
depressed,
as
the
private
pay
market
has
collapsed
and
both
NHS
and
local
authority
referrals
remain
lower
than
what
would
normally
be
expected
for
this
time
of
year.
If
the
level
of
occupancy
reduction
were
to
occur,
so
this
is
the
forecast
continued
level
of
occupancy
reduction
were
to
occur.
Then
the
impact
on
profitability
would
be
profound,
as
this
is
before
factoring
in
the
impact
of
increased
costs
associated
with
PPE
and
staffing.
L
Turning
to
homecare,
the
volume
with
weekly
hours
is
typically
reduced
by
over
seven
percent
across
the
mob's
oversight
portfolio.
That's
driven
by
c19
infection
risk
concerns
where
individual
service
users
are
declining
visits
to
try
and
minimize
the
risk
of
c19
infection
entering
their
own
home
families
being
able
to
resume
or
increase
their
caring
responsibilities
and
reduce
commissioning
activity
by
sort
of
local
authorities
and,
to
a
certain
extent,
the
NHS,
given
that
homecare
operators
frequently
have
low
profit
margins
of
between
three
to
five
percent.
L
This
reduction
in
weekly
hours
adversely
impacts
profitability
and
again
this
is
before
the
impact
of
increased
costs
associated
with
TPA
and
staffing
a
considered
in
terms
of
increased
cost.
The
PPE
expenditure
is
driven
by
both
increased
usage,
as
well
as
substantially
higher
individual
unit
prices.
These
are
frequently
being
reported
as
over
three
times
higher
than
the
price
that
would
ordinarily
be
paid
hire.
L
Staff
costs
have
been
driven
by
increased
statutory,
sick
pay,
eligibility
higher
absenteeism,
self
isolation
and
shielding
absenteeism
typically
peaked
at
or
near
20
percent,
and
whilst
it
has
reduced,
it
still
remains
elevated
at
circa
temp
cent
market
over
mock
Davis
might
provide
a
responses
that
we
received
up
until
the
first
week
of
May
suggested
that
some
form
of
c19
support
had
been
offered
by
typically
sixty
percent
of
local
authorities.
However,
the
level
of
support
and
therefore
adequacy
was
variable
averaging
at
circa,
a
seven
percent
uplift.
L
The
same
responses
suggested
that
there
had
been
much
less
support
from
clinical
commissioning
groups
where
typically
less
than
ten
percent
had
made
an
offer.
The
provider
responds
to
the
uncertainty
that
seat
the
c19
pandemic
has
presented,
has
understandably
been
to
preserve
and
indeed
accumulate
cash.
This
is
frequently
been
seeking.
Additional
commissioner
supports
not
making
sheduled
pay-as-you-earn
in
national
insurance
payments
to
Her,
Majesty's,
Revenue
and
Customs,
as
well
as
securing
wider
stakeholder
support
from
owners,
lenders
and
landlords
as
appropriate
so
the
extent
the
Additional
Commissioner
support.
L
These
are
either
inadequate
to
maintain
short
term
liquidity
or
it's
insufficient
to
at
least
preserve
existing
profit
margins.
Thank
pasty
can
be
expected
to
leave
the
sector
with
the
consequential
impact
of
increased
uncertainty
for
people
using
services,
additional
costs
for
local
authorities
and
a
knock-on
impact
to
the
NHS.
Are
there
any
questions
so.
A
Just
picking
up
that
last
bit
that
you
were
saying,
it
seems
to
me
that
the
situation
doesn't
end
when
coded
ends
whenever
that
is
because
the
the
taxes
that
have
been
deferred,
the
loans
that
have
been
taken
out,
whatever
I,
still
got
to
be
met,
so
the
the
already
fragile
finances
of
the
sector
are
even
more
fragile
and,
and
that
extends
into
the
future
is
that
is
that
a
fair
summary?
That's.
L
The
the
key
thing
is
is
that
it
provides
a
window
for
it.
It
provides
a
window
for
additional
support
to
come
into
the
sector,
but
this
is
my
point
around
where,
if
that's,
if
the
level
of
that
support
is
an
adequate
to
sort
of
preserve
liquidity
or
maintain
existing
margins,
then
we
can
reasonably
expect
capacity
to
move
the
sector.
Thank
you.
Any.
L
We've
done
some
sort
of
provisional
analysis
based
on
the
bait,
based
on
a
broadly
10
percent.
So
if
it's
a
step
back,
we've
done
some
analysis
of
the
market
oversight
providers
that
equate
to
10
percent
of
the
CQC
registered
beds,
I've
sort
of
talked
to
the
average
occupancy
declining
a
being
circa
7%
and
the
forecast
occupancy
decline
across
those
providers
being
broadly
a
further
10
percent.
L
If
you
roll
that
sort
of
forward
and
calculate
the
occupancy
reduction-
and
you
then
assume
that
operators
flex
their
capacity
to
restore
equilibrium
which
is
broadly
considered
to
be
at
or
around
80
percent,
then
it
would
suggest
that
there
is
vulnerability
around
50,000
beds
there
or
there
abouts.
I
would
point
out,
however,
that
that
is
based
on
a
number
of
assumptions
from
the
current
information
that
is
being
provided
by
providers,
and
that
is
a
changing
landscape.
L
A
You
so
just
go
say
it's
also
important
just
to
keep
reminding
ourselves
to
it.
This
is
based
on
the
the
the
market
oversight,
absolute
leaders,
absolutely
mate.
You
may
get
different
responses
from
the
smaller
providers,
no
idea
whether
that
would
in
which
direction
that
would
be,
but
I
just
think
you
have
to
keep
reminding
ourselves
that
this
is.
This
is
based
on
the
larger
providers.
John.
You
will
not
have
McAllen.
A
A
Stuart
I
think
it's
really
helpful.
Thank
you
very
much
for
your
time.
Thank
the
team
for
the
work
they're
doing
and
oversee
along
with
many
other
things
where
you
know
we
need
to
be
really
closely
watching.
What's
going
on.
This
is
an
important
area.
So
thank
you.
Colleagues,
we
we
said
we'd
have
a
10
minute
break
at
this
moment.
I
said,
is
that
a
good
idea
allowed
John
to
go
and
feed
his
sheep
or
whatever,
and
should
we
start
again
at
midday?
Is
that
okay
effect?
Thank
you
all
sorry
about
that.
B
You
very
much
Peter,
thank
you,
I
think
I,
just
really.
As
always,
the
last
couple
of
meetings
that
they
meet
our
work
has
been
very
much
dominated
by
work
on
covert
19.
As
you
would
expect,
we
are
going
to
continue
with
the
high
tempo
of
management
meetings
with
these
regular
gold
and
silver
command
decision-making
structure
that
we
put
in
place
right
at
the
right
of
the
start,
and
that's
enabled
us
to
move
very
rapidly.
It's
enabled
us
to
make
some
some
changes
in
policy
and
approach
quite
quickly.
B
I
am,
however,
hoping
to
start
to
scale
this
back
a
little
by
the
end
of
this
of
this
calendar
month
and
I'm
hoping
the
next
time
we
meet
I'll
be
able
to
report
to
report
that
we're
in
a
more
sustained
on
a
more
sustainable
footing.
This
is
certainly
I.
Don't
expect
to
be
back
to
normal
in
a
month,
but
I
think
it.
There
is
something
about
getting
to
a
sustainable
footing.
You
know
many
many
colleagues
have
being
working
sort
of
continuously
now
for
a
couple
of
months
and
we
need
to.
B
So,
as
we
said
right
at
the
start,
our
our
activity
and
our
leadership
activity
has
always
been
tried
to
be
in
lockstep,
with
the
advice
that
we're
getting
from
government
and
from
public
health
England,
and
that
will
continue
to
be
the
case.
So
I
can
see
no
obvious
reason
for
us
to
diverge
significantly
from
that
there
isn't.
My
report
affection
on
testing
and
I
am
gonna
on
the
show,
merely
repeat
what
I
think
a
number
of
people
have
said
in
the
earlier
section
around
testing.
B
So,
as
I
reported
last
time,
we
we
were
able
to
offer
short-term
help
to
book
social
care
staff
into
Drive
in
testing
and
health
care
homes
or
the
test
kits
for
residents.
We
did
this
using
our
technology
and
our
people
in
our
NCSC
group.
We
have
now
stopped.
All
of
this
work
only
said
that
again
really
clearly,
so
there's
no
ambiguity
for
for
any
any
media
who
are
following
this.
B
This
meeting,
we
have
now
stopped
all
of
this
work
at
the
beginning
of
last
week,
as
the
government
have
launched
two
portals
to
enable
direct
booking
one
for
staff
and
one
for
one
for
residents
residents
testing
unconscious.
There
has
been
some
confusion
in
the
media
about
our
role,
but
for
absolute
clarity,
we
created
a
temporary
digital
booking
service,
supported
by
our
national
customer
service
center.
We
did
not
lead
the
process.
B
We
did
not
handle
the
results
in
any
way
at
any
time
during
that
process,
and
nor
did
we
provide
any
clinical
leadership
on
any
aspect
of
the
testing
process
and
I
appreciate.
I
am
slightly
flogging
this
point,
but
I
am
doing
that
very
deliberately
because
during
the
the
last
week,
I
think
we
have
had
a
number
of
questions:
the
titty
from
parliamentarians.
B
Now
we
are
aware,
though,
as
Chris
and
Kate,
in
particular
of
both
said,
is
that
we
are
still
getting
inbound
calls
from
providers
we're
still
getting
conversations
with
providers
when
we,
when
we
call
them-
and
they
are
asking
us
about
what
we're
doing
about
testing
and
asking
us
to
to
help
them
without
so
again
will
reflect
the
the
feedback
we
get
in.
The
insight
reports
as
Chris
said,
but
we're
not
going
to
be
physically
hands-on
with
testing.
B
We
feel
that
we
can
help
without
compromising
our
core
regulatory
role,
which
has
always
been
at
the
heart
of
what
we're
doing
so
I
think
in
the
next
period
we
are
going
to
continue
to
roll
out
the
ESF
in
the
way
that
we
described
earlier
on
the
agenda
and
we'll
be
reporting
on
the
results
in
public
over
through
our
insight
report.
Every
two
weeks
and
as
others
have
said,
I
would
expect
that
this
will
lead
to
more
on-site
activity.
B
There
will
be
a
small
number
of
cases,
but
I
think
I
think
the
public
should
be
assured
that
we
are
very
much
on
the
pitch
and
very
much
active
that,
albeit
slightly
limited
by
the
Kovach
position
at
the
moment,
but
we
are
very
much
in
the
game
in
terms
of
regulation,
so
so
I'm
going
to
pause
there
Peter
and
hand
over
to
Kate
with
an
exception.
Thank
you.
Okay,.
C
Thank
you
and
say:
for
the
other
side,
you
can't
update
a
huge
amount,
has
already
been
covered
in
board.
So
just
a
just
a
recap.
As
Ian
said,
we
temporarily
provided
some
support
around
testing,
we're
not
doing
that.
Now
we
spent
six
weeks
of
having
structured
conversations
with
providers.
While
we
worked
with
our
digital
team
and
our
policy
team
to
design
the
emergency
support
framework
that
went
live
in
adult
social
care.
C
In
addition
to
that,
we've
been
working
with
things
like
personal
and
local
government
to
understand
the
potential
impact
around
Care
Act
easements.
So
we
are
working
collaboratively
to
focus
some
of
our
efforts
to
understand
what
it
means
for
residents
of
those
parts
of
the
country
where
Care
Act
easements
have
been
switched
on
and
you've
just
heard
from
Stuart
Dean
about
the
enhance
work.
We've
been
doing
around
market
oversight
and
providers
that
fall
within
that
remit.
So
that's
what
we've
done
at
Kovach
and
Peter.
C
So
we've
published
our
findings
last
year
with
the
headlines
of,
in
the
absence
of
having
a
consistent
community
offer,
people
often
end
up
a
long
way
away
from
the
family
home,
not
having
the
best
outcomes
with
staff
who
don't
necessarily
have
the
right,
training
or
skills
in
an
environment
that
increases
the
stress,
behavior
and
without
an
unrelenting
focus
on
getting
those
people
back
to
their
normal,
normal
home,
their
normal
place
of
residence.
We've
worked
really
closely
with
an
expert.
C
C
So
we
anticipate
and
cranking
this
up
back
up
again
towards
the
end
of
summer
and
autumn
and
making
sure
that
lands
and
it
lands
with
actions
that
are
going
to
lead
to
delivery
because
families,
as
some
of
you
who
might
listen
to
the
Joint
Committee
on
human
rights
on
Monday,
we
had
two
amazing
mums
describe
their
experiences
of
their
adult
children,
who
are
in
assessment
of
treatment
units
for
families.
You
know
there
has
been
report
after
report
since
about
2007
and
there's
a
frustration
that
there
hasn't
been
enough
traction.
C
There
hasn't
been
enough
movement
on
this
agenda,
so
we
are
really
keen
when
our
restraint,
seclusion
and
segregation
final
report
arrives.
It
arrives
with
clear
deliverable
recommendations
with
the
right
people
need
to
deliver
those
owning
it
and
ready
to
go.
So
so
it's
not
being
forgotten
in
some
ways.
It's
the
complete
reverse.
C
We're
doing
around
closed
cultures,
so
there's
a
link
between
the
previous
item,
around
restraint,
seclusion
and
segregation,
and
this
so
we've
got
a
single
piece
of
work
now
that
has
brought
together
the
David
Noble
recommendations
and
the
professor
Glynnis
Murphy
part
one
recommendations
into
a
single
program
to
ensure
that
we've
got
really
good
oversight
about
what
what's
happening
with
every
and
every
aspect
of
that
work.
What
you're
seeing
your
board
report
is.
C
There
is
a
summary
of
what's
been
delivered,
there's
a
summary
of
what's
in
training
for
this
quarter
and
then
there's
a
forward
look
to
what
needs
to
happen
from
from
July
onwards,
there's
been
some
really
good
progress,
so
our
supporting
information
for
inspectors
has
been
really
well
received
and
was
enabling
inspectors
to
work
differently
when
they
were
identifying
closed
cultures
prior
to
inspecting
and
tailoring
their
approach
prior
to
Co
vyd.
There
are
other
areas
that
we
need
to
get
more
pace
on
and
we've
got
a
plan
a
plan
to
do
so.
C
It's
also
really
important
with
this
piece
of
work
that
we
as
well
as
saying
when
we've
completed
something
we
have
that
assurance.
So,
okay,
we've
completed
it.
What
does
that
mean
for
people
who
receive
services
for
providers
for
us?
So
you
will
note,
as
we
come
back
to
a
future
board
on
this
item,
there'll
be
increasing
focus
on
each
of
those
elements
on
the
kind
of
so
what
question
I
caved
on
that
what
has
been
the
improved
outcomes
for
people
as
a
result
of
it?
A
G
If
sorry,
yes,
yes
thanks.
Yes,
so
I.
G
Agree
absolutely
with
the
decision
to
postpone
the
final
report
on
restraint.
Segregation
seclusion
until
the
right
time
for
it
to
have
the
greatest
impact.
I
just
wondered
in
the
meantime
whether
we
have
ways
of
monitoring
and
keeping
a
handle
on
what's
happening
in
relation
to
restraint,
seclusion
segregation
are
we
able
to
identify
if
there
are
concerns
in
the
in
this
area?
Now
that
we
need
to
act
on,
and
this
may
relate
to
the
early
discussion
we
were
having
about
what
was
happening,
for
example,
in
mental
health
settings
and
other
such
environments.
D
Can
I
can
I
comment
about
that?
She's
has
a
right
because
so
to
answer
your
question
there,
there's
I
was
going
to
come
to
this
in
any
case
out
after
Kate's
explanation.
There
I
think
we're
very
conscious
that
the
solution
to
for
these
these
people
care
for
at
the
moment
in
assessment
of
treatment
units
for
learning
disabilities
and
autism
is
a
different
model
of
care
and
our
our
report
is
going
to
say
that
forcibly
and
so
many
other
reports
have
said
that
we've
got
to
make
this
really
count
for
those
individuals.
D
But
in
the
meantime
we
have
to
deal
with
the
risk
and
as
the
prevalence
of
carrot
90
is
diminishing,
then
I
think
it
opens
up
the
opportunity
for
us
to
revisit
these
services,
and
we
are
already
doing
that
and
Kevin
made
that
clear
at
the
at
the
Select
Committee
on
Monday.
So
I
think
it's
very
important
that
we
are
not
forgetting
about
the
current
risk
in
these
services
and
we
will
be
monitoring
all
the
in
the
indices
we
get
and
you're
talking
about
the
data
on
restraint
and
seclusion.
D
We
will
monitor
that,
but
also
of
course,
we
rely
heavily
on
staff
and
family
members
speaking
up
about
care
and,
and
we
love
that
will
drive
our
inspection
activity
going
forward.
So
we
will
be
monitoring
those
services
very
carefully
and
we'll
be
inspecting
and
we'll
be
taking
action,
and
remember
that
we
know
these
services
very
well,
because
we've
inspected
them.
We
reported
on
them.
We
know
where
the
high-risk
services
are
and
we
will
be
looking
at
those
very
carefully
going
forward
and.
G
Kind
of
just
one
quick
follow-up
does
that
apply
also
to
psychiatric
settings,
so
you've
talked
about
people
learning
disabilities
and
autistic
people
rightly,
and
we've
had
a
big
push
on
on
visiting
all
of
those,
but
I
just
wondered
about
you
know
if
levels
of
psychiatric
as
well
from
high
secured
to
kind
of
regular
in
person.
Indeed,.
D
D
To
your
report,
okay,
thank
you
for
that.
So
there's
detail
about
the
mental
health
report
and
infection
control
in
the
in
the
written
report.
I
would
go
through
it
again
because
of
touch
stories
already.
I
just
want
to
make
some
some
background
points.
I.
Think,
a
month
ago,
at
the
board
I
praised
the
acute
sector
for
the
way
it
had
responded
to
the
cogut
pandemic
and
increased
intensive
care
capacity
and
I
think
they
did
do
excellent
work
there.
But
of
course,
now
the
incidence
of
coverage
is
beginning
to
diminish
it
with
past
a
peak.
D
The
focus
is
very
much
on
restoring
the
services
for
people
who
are
whose
Trani
need
is
not
COBIT
have
got
other
medical
needs
and
I
think
that
is
a
real
priority
going
forward
and
we've
been
talking
to
providers
across
England
about
how
they
are
approaching
that
and
what
what
are
the
obstacles
for
them?
I've
already
touched
on
infection
control
as
one
of
the
key
elements
we
touched
on
that
earlier
on,
I
went
but
stressed
again,
but
we
have
a
very
strong
offense
on
infection
control
standards
going
forward,
because
that
is
a
key
enabler.
D
There
are
other
factors
that
that
will
affect
this
and,
and
providers
have
told
us
of
shortages-
are
some
key
anesthetic
drugs,
for
instance,
which
which
need
to
be
addressed
in
a
straight,
but
also
shortage
in
some
areas
of
P
equipment.
That's
been
driven
by
the
current
pandemic
and
those
are
being
dealt
with.
I.
Think
for
me,
a
real
concern
and
I've
been
talking
to
staff
from
emergency
bottoms
all
over
the
country
this
week
about
this,
that
there
is
a
real
concern.
D
The
board
will
know
that
that
attends
emergency
parts
has
diminished
quite
significantly
during
the
curve
in
epidemic.
That
is
slowly
beginning
to
increase
now,
which
is
good,
because
people
who
need
care
are
accessing
it,
but
the
emergency
departments
are
now
working
in
a
very
different
environment,
an
environment
at
which
patients
with
Covey's
are
mixing
with
patients
who
do
not
have
courage
and
they
need
to
protect
patients.
You
cross
infection.
D
D
For
instance,
patients
have
got
cancer
care
or
Sydney
elective
care
to
make
sure
they
are
prioritized
appropriately
and
people
who
need
care
are
getting
the
right
care
at
the
right
time
with
the
right
level
of
priority,
because
there
is
a
clearly
a
backlog
and
that
backlog
needs
to
be
cleared
in
a
way
that
puts
patients
needs.
First.
A
So
take
you
you
you,
you
you're
rightly
talking
about
that.
The
need
for
people
with
long
term
conditions
and
other
needs
to
be
able
to
access
care,
and
then
you
were
talking
about
the
system.
It
seems
to
me
that
the
system
here
is
both
the
the
acute
hospital,
but
it
is
also
primary
care
as
well
as
knit
and
it's
the
skin
under
there
to
working
really
well
together.
I.
D
Think
that's
right,
Rose,
even
though
they
all
have
have
comments
on
this
as
well
and
when
we
enter
but
I
should
say
there
has
been
some
really
positive:
science
really
carried
epidemic
about
different
parts
of
system
working
well
together,
not
universally,
and
that
there
are
still
clearly
barriers
between
different
parts
of
the
system,
but
actually
I.
Think
there's
been
really
strong
forward.
D
Node
movement
and
I
chair
a
regular
meeting
of
secondary
care
and
primary
care
clinicians
discussing
the
their
approaches
to
marriage
and
Cove
8:19,
and
it
is
really
good
to
see
that
various
integration
between
different
parts
of
the
service
at
the
moment.
So
there's
a
real
positive.
We
need
to
build
on,
and
so
many
people
are
saying
that
we
have
achieved
really
positive
things
in
Kovac
90.
We
need
to
build
on,
but
equally
I
think
it
has
demonstrated
some
of
the
problems
in
the
system
which
we've
been
talking
about
for
a
while
in
terms
of
integration.
D
Working
and
there's
none
there
are,
there-
are
plans
being
put
in
to
do
that,
so
there's
a
telephone
triage
service,
so
people
are
our
triage
before
they
go
to
any
and
where
possible,
they're
triaged
away
from
A&E,
but
if
they've,
if
they're,
possibly
coded
positive
or
if
they've
got
symptoms
of
carriage,
they
can
be
triage
to
an
area
where
they're
not
gonna
cross
infect
other
patients.
There
are
trials
were
like
going
on,
yes,
John
and
we'll
certainly
want
to
understand
good
practice
and
share
it
across
the
system.
F
Look
thanks,
chairman
said:
could
I
just
try
and
pull
together
a
couple
of
things
that
you've
been
referring
to
terms
of
us
transitioning
back
to
our
core
purpose
in
terms
of
hospitals,
restoring
services
and
perhaps
a
little
bit
of
the
new
norm
going
forward,
for
instance,
so
I've
heard
recently
that
hospital
based
geriatricians
want
to
extend
their
role
in
the
care
sector
by
using
tools
in
provider
premises
such
as
virtual
rewards,
telecare,
remote
MDT
and
being
involved
with
primary
care
and
community
geriatricians
in
case
conferences.
If
that
is
indeed
happening?
N
D
So,
yes,
absolutely
and
and
when
we
look
at
the
care
of
people
with
long
term
conditions
or
the
frail
elderly
I,
do
think
we
need
to
think
of
a
different
inspection
model,
because
we
need
to
look
at
the
care
as
its
received
by
the
patient,
rather
than
the
care
through
the
eyes
of
how
it's
provided
by
the
provider,
and
we
need
to
challenge
providers
right.
That's
really
integrated
care
and
I
think
there's
no
opportunities
there
of.
N
D
That
is
exactly
what
we're
talking
about
in
local
system
reviews
and
beyond
barriers.
But
again
this
has
given
new
impetus
to
that
and
I
think
there's
a
real
challenge
coming
out
of
the
curve
at
nineteen
epidemic.
How
do
we
move
our
inspection
approach
forward
to
take
into
account
the
fact
that
people
who
will
should
be
getting
and
I
hope
will
be
getting
more
integrated
care.
I
So
I
was
just
going
to
add
to
that,
because
I'm
really
really
keen
that
we
use
this
as
an
opportunity
to
understand
what
it
has
been
happening
in
systems
around
the
response
to
Kovach.
They
didn't
actually,
of
course,
for
the
proposal
was
coming
to
the
executive
team
later
today
or
or
early
tomorrow
around
how
we
could
do
some
rapid
work
to
really
understand
the
system.
Response
to
COBIT
I
think
we've
seen
some
great
practice
as
I
said
earlier,
of
people
working
in
a
different
way.
I
We've
certainly
seen
different
use
of
technology
in
terms
of
systems
working
together
and
all
sorts
of
innovations,
but
I
think
we've
also
seen
that
there
it
has
exposed
some
significant
issues
and
I
think
we
need
to
understand
how
a
regulator
we
can
support
the
system,
particularly
before
any
further
peak
or
any
kind
of
winter
pressures.
What
we
can
do
in
a
rapid
way
to
be
able
to
support
system
working
so
that
so
that
things
improve
in
a
rapid
time
scale.
So
Peter
I,
don't
know
if
you
want
sorry
I
care.
I
So,
and
the
next
thing
I
just
want
you
to
mention-
was
around
a
private
dentist.
You
may
have
seen
a
lot
in
the
media
over
the
last
week
or
so
about
what's
happening
in
private
dentistry
and
some
comments
in
the
media
about
what
we
are
and
what
we
are
not
doing
in
that
sector
and
I
just
want
to
absolutely
lay
it
out.
What
we.
I
We
have
been
asking
dental
providers
to
take,
do
consideration
of
the
seidio
communications
and
we
are
assessing
the
extent
to
which
these
dental
providers
are
actually
providing
safe
care,
in
line
with
the
guidance
that
public
health,
England
and
the
CDO
are
putting
out
and
I
think
the
things
that
Ted
has
been
talking
about
earlier.
Around
infection
prevention,
control
of
equally
important
in
any
of
the
settings
that
we
regulate
and
so
making
sure
that
people
aren't
at
risk
of
transmission,
particularly
in
dental
settings
where
there
is
aerosol
generating
procedures.
I
We
need
to
make
sure
that
guidance
is
being
followed
and
people
do
have
the
correct
equipment
and
a
CREP
a
correct
way
of
managing
patients.
So
I
just
wanted
to
clarify
that
we
are
working.
We're
sending
out
a
further
communication
out
to
dental
providers
today,
just
to
clarify
our
position
and
to
also
talk
about
the
work
we're
doing
with
the
emergency
support
framework
which
we
are
aiming
to
roll
out
in
dental
providers
in
the
coming
weeks,
and
so
that's
dentists
in
them
general
practice.
We
started
the
rollout
of
the
emergency
support
framework
on
Monday.
I
I
A
really
good
quality
care
and
we're
also
seeing
some
really
good
examples
of
how
innovation
is
being
used
for
some
of
the
more
routine
things
like
baby
vaccinations,
which
clearly
are
really
important.
What
we
don't
want
on
top
of
covert
is
an
outbreak
of
measles
or
an
outbreak
of
an
other
diseases,
because
people
haven't
been
able
to
access
their
care.
I
I
think
it
is,
can
be
really
important
for
us
to
understand
longer
term
what
the
implications
of
people
not
accessing
the
screening
and
not
accessing
some
of
that
long
term
conditions
care
is
going
to
be
and
we're
working
through
with
other
bodies.
How
we
understand
that
in
more
detail,
just
then
to
mention
the
front
of
thing
to
mention
with
their
battery
pieces.
I
They
are
having
a
series
of
calls
with
all
the
CCGs
this
week,
just
to
talk
about
the
emergency
support
framework,
but
also
an
Cape
steamer
joining
me
on
those
calls,
because
I
think
there
is
a
real
opportunity
to
look
at
the
support
in
to
care
homes
and
the
support
that
primary,
that
clinical
teams
in
CCGs
are
able
to
give
them,
and
so
we're
we're
we're
doing
a
kind
of
double
act.
Those
calls
which
are
going
down
well
at
the
moment-
and
the
final
thing
I
just
wanted
to
mention-
is
about
antibody
testing
in
independent
health.
I
So
we've
been
putting
out
very
clear
guidance
to
our
independent
health
providers
around
antibody
testing
and
up
to
quite
recently,
there
hasn't
been
any
tests
that
have
been
approved
and
we've
been
following.
The
advice
of
people
like
John
Newton.
With
this
as
some
of
the
people,
some
of
the
providers
providing
antibody
testing
are
in
ask
of
regulation,
there's
some
that
aren't
in
our
scope
of
regulation.
But
we
are.
I
It
so
I
think
it's
really
important
that
we
keep
following
up
those
messages
and
make
sure
that
providers
that
are
using
those
as
body
tests
are
doing
them
in
a
way.
That's
that's
safe
for
patients
and
the
final
sector.
I'm
sorry
I
wanted
to
just
mention
is
one
more
month
services.
One
more
month,
services
have
been
under
huge
pressure.
There's
been
enormous
changes
in
terms
of
how
they've
been
running
they've
been.
I
Let
me
look
at
the
other
services
that
wrap
around
that,
such
as
the
decoded
clinical
advice,
services
and
other
related
Urgent
Care
Services,
and
they
have
been
through
a
lot
of
change.
Our
teams
are
working
very
hard
to
understand
what
those
changes.
Look
like
I
understand
the
pressure
that
those
services
of
under
and
make
sure
that
we
understand
how
we
can
regulate
those
going
forward
and
work
is
going
on
with
the
ESF
in
that
Thanks.
A
It
just
it's
interesting.
Somebody
was
saying
earlier
that
it's
only
eight
weeks
since
we've
been
in
lockdown
fuels
like
you
know
lifetime,
but,
and
my
understanding
is
that
I
actively
oppose
and
a
lot
of,
if
I
can
call
it
routine
work
for
people
with
long
term
conditions,
but
also
for
dentists.
All
because
of
a
pause
for
eight
weeks
may
have
some
damage,
but
the
damage
gets
significantly
worse.
The
longer
the
longer
this
goes
goes
on,
so
it
does
seem
to
me.
There
is
a
real
priority
for
services
to
be
really
poor.
E
You
I
see
a
question:
yes
Robert,
please,
and
just
about
the
last
thing
she
was
talking
about
Tess
you
were
talking
about
testing.
Do
we
regulate
the
providers
of
who
are
selling
tests?
Antibody
tests
to
the
public,
I
mean
it's
not
just
they
provide
a
equipment
for
that
test
and
analyze
it.
Some
of
them
will
provide
online
consultations
with
doctors,
Nevada
I
think
that's
what
they
do.
So
are
we
regulating
those,
because
I
imagine
that
these
are
new
sources
of
service,
as
it
were
so.
I
I
E
Reason
I
ask:
is
that
I
mean
some
of
these
others
and
that
rules
are
made
claims
with
regard
to
the
absence
of
false
positives
or
negatives,
whatever
it
is,
and
I'm
public
that
may
mean
someday
whether
what
they're
saying
is
correct
or
not,
and
I.
Just
wonder
if
anyone
actually
monitoring
that
to
see
whether
what
they're
saying
is
accurate.
I
Yes,
it
is
something
we're
working
with
the
MHRA
around,
but
there
have
been
a
variety
of
up
to
now
where
there's
been
all
sorts
of
antibody
tests
which
haven't
been
approved
and
haven't
been
felt
to
be
very
accurate.
We
have
had
a
clear
message
that
they
shouldn't
be
to
be
used
because
then
they're
not
accurate,
as
I
said,
the
situation
has
now
changed
with
these.
These
more
recent
tests,
which
are
being
rolled
Abney
and
HS,
that
that
are
felt
to
be
more
more
accurate,
but
it
is
something
we're
continually
working
on.
A
M
N
O
So
the
culture
inquiry
was
due
to
start
in
March
series
of
face-to-face
regional
workshops
and
which
were
aligned,
we'd
wind,
a
book
on
transformation
and
our
future
strategy
development.
However,
as
a
result
of
coded,
this
work
was
paused,
while
we
all
focused
on
more
immediate
priorities,
but
I
would
say
that
during
this
time,
we've
seen
the
organization
and
our
people
adapt
to
new
approaches,
different
ways
of
working
and
different
behaviours,
and
it
presents
with
us
an
opportunity
really
to
capture
the
positive
learning
from
our
response
to
the
pandemic.
O
So
we
redesigned
the
inquiry
so
that
we
were
able
to
deliver
this
virtually
and
we'll
be
running
a
series
of
online
workshops
for
colleagues
to
take
part
in
over
June
and
July,
and
the
outputs
of
these
workshops
will
continue
to
inform
the
development
of
the
people
plan,
but
also
critically,
the
transforming
our
organization
program
and
all
kind
of
future
strategy.
Development
work
and
we're
also
working
really
closely
with
our
evaluation
team
to
make
sure
that
we're
capturing
and
sharing
that
learning
from
our
cope
with
nineteen
respondents.
F
O
Question
because
I
think
it
is
quite
difficult
when
we
are
starting
to
use
the
inquiry
to
understand
how
we
work
now.
I
think
there
will
be
that
sense
of
blurring
but
kind
of
which
elements
of
those
behaviors
are
things
that
have
happened
from
before
and
things
that
are
new,
that
we
have
adapted
the
workshop,
where
we
are
trying
to
get
people
to
focus
on.
What's
changed
in
the
last
couple
of
months,
so
really
trying
to
hone
in
on
those
bits
that
I
have
our
new
behaviors
or
adapted
behaviors.
O
The
other
bit
of
supplementary
kind
of
insight
and
evidence
is,
through
the
poll
survey
we're
asking
a
free
tech
question
specifically
asking
people
to
identify
those
positive
things:
positive
changes
that
have
happened
as
a
result
of
our
response
to
Co
vid
that
we
would
like
to
retain
for
the
future.
So
hopefully,
if
that
gives
us
some
more
specific
stuff
around.
What's
changed
recently.
I
hope
that
helps.
G
Its
miss
here
could
I
just
ask
a
question:
I
mean
it's
great,
that
the
workshops
are
happening
virtually
so
that
colleagues
can
be
really
involved
in
this
process.
I
just
know
that
ham,
how
people
will
be
involved
in
drawing
the
confusions
if
you
like,
because
culture
is
notoriously
subject
to
different
perspectives
and
I,
just
wondered
how
that
the
process
is
going
to
pan
out
in
the
next
stages,
so
that
you
can
kind
of
draw
out
what
needs
to
happen
to
to
make
the
changes.
As
you
were
mentioning
yeah.
O
So
there's
probably
two
parts
to
that:
I
think
one
part
of
it
is
that,
through
the
workshops
themselves,
we
are
encouraging
those
people
that
take
part
in
the
workshop
to
take
the
information
or
the
insight
that
they've
gathered
as
a
mini
group
and
start
taking
action
on
it
almost
immediately
and
I.
Think
that
speaks
to
our
kind
of
view
of
culture
as
something
that
is
dynamic
and
constantly
changing,
so
that
doesn't
require
any
analysis
or
evaluation,
but
actually
by
revealing
some
of
those
ways
of
working.
O
O
There
is
still
some
work
for
us
to
understand
about
how
we
merge
both
our
analysis
of
the
culture
inquiry
workshop
along
with
any
other
bits
of,
in
fact,
that
we're
gathering
through
the
evaluation
work
and
be
careful,
rework
as
well,
so
that
we
can
develop
a
kind
of
coherent
picture
of
what
it
tells
us
about
today
and
what
we
need
to
ship
for
the
future.
But
crucially,
I
think
the
outputs
of
the
culture
inquiry
work
are
not
really
about
trying
to
say
whether
things
are
good
or
whether
they
are
bad
they're.
O
Simply
about
presenting
a
picture
of
how
things
are
at
the
moment
and
I
think
it
then
becomes
a
I,
think
I
think
you're
right
about
involving
other
people
and
the
wider
organization
in
their
almost
a
team-based
conversation
around.
What
do
we
do
with
this
information
now
that
we
have
it
and
what
are
the
aspects
of
culture
that
we
really
want
to
kind
of
highlight
for
the
future,
based
on
what
we've
learned
around
our
evaluation
of
the
kubrik
response.
O
A
A
N
P
Casey
yeah
just
a
quick
update
on
your
report
and
accounts
for
1920,
as
you
mentioned,
so
our
external
orders,
any
o
of
notified,
is
that
covered.
19
has
impacted
the
time
skills
by
which
local
government
pension
schemes
and
their
auditors
can
provide
valuation
and
assurance
on
our
pension
assets.
We
anticipate
the
delay
to
laying
our
accounts
before
Parliament
to
September.
We
usually
aim
to
lay
around
July
time.
So
it's
a
position,
that's
out
of
control,
both
CQC
and
in
any
other
one.
That's
one!
That's
manageable!.
J
So,
just
a
quick,
so
many
about
recent
activities
and
you'll
be
aware
that
would
be
responded
to
a
number
of
requests.
An
MP's
in
relation
to
our
activities
and
decoding
via
this
will
continue
alongside
the
parliamentary
questions
that
we've
been
responding
to.
We've
also
had
number
of
meetings
with
the
shadow
health
team
and
we've
set
up
meetings
with
the
stakeholders
in
the
relative,
relevant
committees
and
we've
been
updated.
J
Also
all
provide
we've
talked
about
earlier
on
in
our
in
this
this
meeting,
but
we
have
baited
all
stakeholders
on
our
first
Cobra
insight
report
and
from
the
feedback
would
already
have
you
know.
It
was
only
launched.
Yesterday,
there's
been
some
very
positive
feedback
from
range
of
stakeholders
and
the
fact
that
we've
got
the
information,
the
public
domain
we
will
be
giving.
J
With
that
in
mind,
we
are
close,
we'd
be
launching
our
next
peak
of
give
feedback
on
care
working
with
colleagues
in
HealthWatch
and
the
groups
that
represent
people
who
use
services.
This
time
also
trying
to
target
people
who
work
in
health
and
care
organizations
to
make
sure
hear
their
views,
and
indeed,
we've
already
seen
a
significant
rise
in
information
coming
from
both
service
users
and
also
from
people
who
work
in
services
and
that
information
has
already
triggered
a
number
of
responsive
inspections.
J
So
we
want
to
try
Niko's
a
little
further,
so
we
can
have
a
better
understanding
about
what
is
happening
across
health
and
care
and,
finally,
incentives
of
innovation.
We
remain
curious
about
what's
working
well
and
why,
as
a
systems
response
to
to
COBIT-
and
our
aim
is
to
share
some
of
that
innovation
and
good
practice
so
that
we
can
help
other
providers
and
other
local
systems
but
better,
but
also
that
we
can
use
that
in
our
annual
state
of
care
report
to
give
a
view
on
how
the
system
and
how
health
and
care
is
changing.
B
K
A
B
H
A
B
So
I'll
kick
off
and
just
say
a
few
words
that
this
is
the
end
of
year
performance
position,
I'll
say
a
few
words
by
way
of
context
and
then
I'll
hand
over
to
Kirsty
and
Chris
to
to
pick
up
the
detail.
But
I
think
that
the
thing
that
is
really
pleasing,
I
think
is:
we've
done
a
lot
of
work
this
year
to
focus
on
the
higher
risk,
services
and
I.
Think
we've
had
some
success.
B
But
I
think
I
heard
that
has
remained
a
challenge
and
I
think
most
in
part
of
that.
That's
probably
because
Hospital
reports
are
physically
bigger
and
Iran
more
more
data
sources
and
require
more
more
checking
than
the
smaller
reports.
If
I
look
at
registration,
I
think
I
think
we've
talked
a
lot
about
registration
now.
I
think
we
flagged
some
months
ago
that
we
knew
that
the
the
kpi's
we
went
into
the
beginning
of
the
year
with
would
struggle
a
little
bow
as
we
came
out
of
the
year.
Well,
that's
a
reflection,
I!
B
Think
of
their
of
the
work
that
the
kirstie
has
been
talking
about
around
the
change
where
it's
going
on
in
registration,
I'm
sure
we
can
talk
a
little
bit
more
about
that,
if
necessary,
but
I
think
that
is
a
that
is
going
to
be
a
transform
service
over
that
over
the
coming
year
and
you'll
see
those
numbers
change
quite
dramatically
main
terms
of
in
terms
of
in
terms
of
the
money
we
are.
We
finished
the
year
just
unspent
a
little
under
2
a
little
over
rather
2%
of
our
overall
revenue
turnover
annum.
B
Spend
on
capital
in
large
part.
I
think
this
is
driven
by
change
programs,
which
naturally
had
a
planned
back
endedness
to
them,
particularly
with
things
like
the
logistical
foundations
program
so
forth,
which
we
knew
were
going
to
have
a
lot
of
back-end
spend
towards
the
end
of
the
year
and
the
challenges
of
bringing
that
in
on
in
on
the
end
of
of
March,
but
I
think
I.
Think
I
would
draw
everyone's
attention.
The
fact
we've
been
through
a
major
set
of
transitions
this
year.
B
Sorry,
that's
Maya,
doorbell,
making
a
noise;
sorry
don't
have
a
comedy
doorbell
and
I
think
we
have
been
through
a
major
transitions,
particularly
in
technology
terms.
This
year
and
and
I
think
I
think
I'm
really
pleased
with
it.
With
the
efforts
the
team
have
gone
to
to
to
bring
the
budget
and
on
track
and
in
a
number
of
cases
we've
under
spent
on
planned
budgets.
I
think
it
is.
B
It
is
a
reflection
of
the
agile
approach
that
we've
taken
to
delivering
a
number
of
programs
where
we've
been
able
to
move
activity
forwards
and
backwards
and
I
think
we
was
made.
What
was
wanted
to
make
sure
that
that
that
if
we
had
to
move
away
from
our
plan
budget,
it
wasn't
under
spend
not
gonna
overspend
and
then
in
turn,
find
the
in
terms
of
people,
I,
think
turnover
and
sickness
have
all
come
in
within
the
expected
range
and
I
think
I'm
pleased
with
that
I
know.
B
We
had
some
challenges
earlier
on
in
the
year
around
around
the
the
people
survey,
but
further,
despite
that,
I
think
I
think
that
has
not
been
reflected
in
the
people
being
absent
from
work,
which
I
think
he's
a
really
important
point.
You
know
I
think
we
are
still
a
an
employer
that
seen
as
a
good
good
group
of
people
to
work
for,
and
it
that's
reflected
in
in
this-
and
those
people
numbers
so
and
I'm
going
to
pause
there
and
invite
Kirsty
and
Chris
just
to
add
a
little
more
color
to
what
I've
said.
N
Thanks
a
and
Chris
is
going
to
take
you
through
through
the
dashboard
and
also
the
the
caber
dashboard,
which
we
we
set
up.
I
think
we
may
have
said
last
last
month
that
we
at
the
start
of
the
code,
we
set
up
a
dashboard
to
track
our
activities.
A
crystal
talks
through
that
I
think
Ian's,
probably
discovered
off
most
of
what
I
was
going
to
say,
but
just
to
draw
attention
to
the
risk
register
as
well.
N
This
is
the
first
of
new
risk
register
with
the
with
the
amended
risks
and
we're
just
to
sort
of
show
that
we
are.
We
are
working
through
this
one
now
in
terms
of
allocating
actions
and
mitigation
measures
and
we'll
keep
you
posted
as
we
as
we
move
through
the
year
with
that
more
with
that
updated
risk
register
a
Chris.
Do
you
want
to
pick
up
and
take
people
through
the
the
detailed
the
performance
report?
Picking
out
some
highlights,
yeah.
P
I'll,
do
that
thanks
thanks,
Ian
cursory
so
going
through
the
pack
in
in
terms
of
the
the
slides
that
presented
the
main
area
really
focus
on.
First
will
be
registration,
which
is
slide
5
in
the
pack,
not
not
the
diligent
number
but
slide
5
in
the
pack,
and
they
know
the
story
this
year
was
the
the
registration
ended,
a
recovery
phase
in
November
I.
Think
at
that
point.
P
Five
thousand
nine
hundred
and
thirteen
applications
are
in
the
system
and
now
we're
at
the
position
where,
at
the
time
of
reporting
were
at
the
end
of
the
year
with
ninety
four
percent
were
complete.
With
six
percent
remain
and
I
think
a
lot
of
the
work
they
see
Madhu
and
his
for
an
understanding
activity
in
order
to
model
and
centrally
deliver
deliver
that
activity
and,
as
Ian
said,
we're
looking
to
implement
new
KPI,
so
reflect
our
work
and
registration
cases
in.
If
you
want
to
talk
to
the
detail
of
registration
order.
Well,.
N
It's
some
of
the
more
older
applications
in
the
system
to
enable
us
to
do
that
so
that
we
have
we,
we've
got
them
more
up
to
date,
backlog
now
and
I
think
you
can
see
that
we've
worked
through
most
of
that
backlog.
It
is
also
worth
registering
that
or
noting
in
registration,
there's
been
a
huge
amount
of
activity.
N
That's
come
in
as
a
result
of
okay,
big
changes,
and
we
are
working
through
that
quite
rapidly
now
to
to
a
nervous
to
respond
to
those
in
a
timely
and
efficient
fashion,
as
everyone
said,
I'm
I'm,
confident
that
next
year,
so
in
the
going
forward
that
registration
performance
but
will
markedly
increase
as
those
changes
that
we've
made
start
to
impact.
You.
K
Know
just
ask
a
question
there,
while
we're
all
not
right
that
particular
side
rather
than
yes,
please.
Thank
you.
Okay,
because
I
was
just
looking
at
how
that
red
line
is
diving
down
through
the
the
floor
and
I
understand
what
you're
saying
about
we're
going
around
use
new
processes,
but
in
terms
of
bringing
those
in
it's
going
to
take
a
little
while
to
get
all
of
them
in
we're,
starting
with
some
of
the
smaller
ones,
but
this
it.
When
can
we
see
we
expecting
this
line
recover
as
we're
in
recovery,
so.
N
This
is
new
application,
and
so
basically
what
was
happening
in
in
in
in
previous
times,
it
was
quite
a
lot
of
the
more
complex
applications.
What
we're
taking
a
long
time
to
resolve,
and
they
were
they
weren't,
being
moved
forward
at
paste
and
some
quicker
and
easier
ones
are
being
done
moving,
so
we've
been
brought
forward.
What
we've
got
now
is
a
different
approach
to
assessing
those
so
that
it
has
gone
down.
While
we
looked
at
the
process
and
the
backlog
and
sorting
all
that
out,
so
a
lot
of
stuff
got
held.
N
While
we
were
sorting
it
out,
we
were
lazing
with
the
providers
and
we
were
processing
the
urgent
ones
quicker,
but
those
less
urgent
ones
we
were
we
were
putting
on.
We
were,
we
were
putting
into
the
queue
in
order
to
enable
us
to
do
that.
I
think
that
line
would
have
all
start
to
go
up.
I
think
it's
been
impacted
quite
heavily
now
by
the
cave,
it'd
work
that
we've
been
doing
as
well,
because
we've
been
prioritizing
those
applications.
N
So
if
you
took
the
cable
feeds
out
of
the
system
and
we
look
forward
I'm,
anticipating
that
will
start
to
go
up
again
now
that
we
have
a
got
on
top
of
that
backlog
and
B
got
a
new
system
in
place
to
start
to
ensure
that
that
work
is
being
done
in
a
timely
fashion
and
we're
getting
through
them
at
a
pace.
I
think
off
the
top
of
my
head,
some
of
the
most
important.
N
P
S-See
hit
KPI
here
with
84%
of
services
within
the
wrote
in
frequency,
PMS
and
hospitals
were
just
slightly
below
target.
But
if,
as
the
slide
7
you
can,
you
can
probably
see
there
that
that's
we've
seen
a
steadily
performance
increase
throughout
the
year
and
it's
it's
mainly
due
to
the
performance
at
the
start
of
the
year
that
that's
impacted
that
target
so
just
narrowly
missing
on
both
accounts
there.
So
if
anyone
has
any
questions
but
I'll
return
to
ratings.
A
I
Yes,
can
I
just
add
to
that
and
and
give
some
assurance
that
every
we've
been
tracking
this
on
a
weekly
basis
and
looking
all
of
the
reasons
why,
in
the
inadequate
racket,
they
were
missed
and
actually,
in
the
last
three
months
we
looked
and
all
of
the
reasons
we
missed
them
were
due
to
the
external
reasons
from
the
provider
such
as
bereavements
in
the
practice
or
other
things.
That
meant
that
they
negotiated
a
different
date
for
that,
rather
than
it
being
related
to
an
internal
factor
of
something
we
were
doing
or
not
doing.
P
D
P
And
just
moving
on
in
terms
of
safeguarding
on
which
is
slide.
10
concerns
continued
and
improvements
on
month,
ending
here
just
behind
target
in
93%
alerts
referred
within
KPI
hit
or
hit
the
hit
da
KPI
at
96%,
following
a
workshop
early
in
the
year
to
focus
on
performance
as
a
good
news
story.
There
slide
11
just
moving
on
to
reports
so
in
terms
of
reports
overall,
a
hips
and
were
published
within
KPI,
narrowly
missing
a
target
of
90s
90
percent.
The
Asin
PMS,
so
here
say
hit
target
an
outset.
P
Pms
were
above
target
93
percent
hospitals
as
we
reported,
or
were
54%
with
with
an
improving
position
or
at
the
end
of
the
year,
but
we've
as
mentioned
previously,
we've
a
Qi
initiative
underway
within
hospitals.
That's
still
under
way
and
still
progressing
again.
How
do
you
take
any
questions
or
pick
up
any
questions
about
our
reports?.
D
Just
drop
in
there
that
we've
with
the
suspension
of
routine
inspections,
of
course,
this
is
nameless
to
clear
the
backlog
and
the
backlog
is
virtually
cleared
and
within
a
middle
of
June
there.
All
the
reports
will
have
been
published
and
I
think
that
gives
us
a
great
opportunity
to
drive
the
quality
improvement
process
from
a
clean
sheet
when
we
resume
inspections,
so
I
think
there's
a
great
opportunity
here,
which
we
mustn't
miss.
P
The
last
bell
I
mean
as
covered
it
already,
but
we
the
financial
position
we
ended
the
year
with
a
pin
under
spend
slightly
above
the
2%
KPI
and
again,
as
Ian
referred
to,
is
the
predominantly
the
challenges
with
multi-year
change
programs
at
straddle
financial
years.
So
we've
taken
that
into
account
in
in
our
2021
budget.
But
that's
that's
the
highlights
from
the
poor
but
happy
for
anyone
to
pick
up
anything
within
within
the
wider
section.
N
Public
in
terms
of
the
change
report,
just
once
just
put
a
few
highlights
for
you
start
with
I-
think
it's
it's
good
to
note
that
delivery
progress
has
been
made
across
the
portfolio
despite
impacts
of
covered,
where
we've
had
issues
with
resourcing
being
pulled
away
to
support
covered
responses.
We
have
managed
to
protect,
protect
our
delivery
and
I
think
we've.
We
can
maintain
dasa
cadence
of
delivery
that
we
were
we
were
we
were
hoping
to
which,
which
is
which
is
great,
I,
think,
there's
three
reason:
three
programs
have
hit
their
critical
milestones
over
this
period.
N
Registration
transformation
program
has
launched
its
first
end-to-end
digital
service
in
private
beta.
That's
for
domiciliary
care
agencies
and
I'm
pleased
to
report.
We've
had
over
fifty
new
registrations
on
that
service
to
date
and
three
or
four
actual
full
applications
coming
through,
and
it's
working
really
well
so
I'm
hoping
that
we
will
be
able
to
get
the
applications
through
that
we
need
to
start
to
move
that
into
probably
be
at
the
right
time,
but
a
real,
real,
real,
positive
step
there,
Digital
foundations,
we've
had
some
key
contracts
that
we've
now
letting
I'll.
N
Let
mark
talk
a
little
bit
more
about
that
as
we
move
forward
and
also
regular
platform
is
moving
forwards
in
in
a
really
good
way.
We've
passed
the
internal
approvals
for
the
on
our
business
case
and
again
mark
will
update
you
on
some
technical
side
of
the
work
that's
gone
on
there
in
terms
of
code
I.
N
Think
it's
really
prescient
to
note
that
the
new
technology
that
we
have
been
working
on
over
the
last
year
or
so
has
really
enabled
us
to
deliver
at
pace
to
support
the
Kaiba
drous
panse,
both
through
the
work
that
we've
done
around
data
collection
and
also
in
the
development
of
the
emergency
support
framework.
I.
N
We
have
a
really
clear
delivery
plan
to
underpin
the
work
on
our
strategy
and
we're
launching
that
with
our
staff,
also
talking
about
how
that
also
fits
in
with
the
work
that
we
are
doing
to
transition
through
from
our
cobra
current
situation
through
into
recovery
and
out
the
other
side
into
business.
As
usual.
I
think
the
other
thing
to
note
this.
N
The
change
report
this
year
this
this
month
is
also
how
quickly
we
have
managed
to
move
our
entire
operation
out
from
a
a
office
or
from
a
hybrid
home-based
office
model
to
an
entirely
home-based
model,
and
our
colleagues
in
HR
and
facilities
have
been
working
really
hard
to
ensure
that
our
our
colleagues
have
a
have.
A
good
home
working
experience,
we've
provided
them
with
the
equipment
to
make
sure
they're
able
to
work
safely,
but
actually
also
supporting
them
through
both
their
well-being
and
and
also
through
supporting
their
managers
to
help
them
recognize.
N
Actually,
they
need
to
work
differently
and
major
teams
differently
in
a
home-based
environment
where
they
can't
see,
people
and
I
think
that's
worked
really
really
really
well
I,
hoping
that
the
response
that
we
get
to
our
pulse
survey-
that's
going
out
this
out
at
the
moment,
will
show
that
that
that
that
workers
has
been
well
received
in
terms
of
some
of
the
programs.
Just
a
highlight,
as
I
say,
the
transforming
our
organization
work
has
now
started.
This
is
aligned
to
our
strategy.
It's
a
tangible
delivery
plan
support
our
strategy.
N
As
we
move
forward
with
this
work,
we
are
now
commencing
the
the
to
be
state
and
we're
working
with
widespread
engagement
across
the
organization
and
with
why
the
stakeholders
to
start
to
look
at
how
we've
got
to
co.design
that
for
the
future,
thinking
about
some
of
the
things
that
we
want
to
do
to
ensure
that
we
are
a
responsive
regulator
both
now
and
in
the
future.
The
work
on
the
wreckage
platform.
N
We
are
working
to
select
our
business
partner
to
go
forward
into
implementation
and
Mark
will
talk
you
through
a
little
bit
about
that
in
a
bit
more
detail
and
our
registration
transformation
programs
have
said,
we
have
launched
our
new
service
that
the
other
element
of
registration
transformation
program
is
our
work.
We've
done
around
our
continuous
improvement.
We
have
struggled
a
bit
too
with
some
of
that
work,
because
one
of
the
areas
that
we
were
looking
at
driving
improvements
in
was
our
sale
and
transfer
piece
with
K
bid.
N
That
work
has
pretty
much
come
to
a
grinding
halt,
so
that
area
of
work
has
had
to
have
been
pause,
but
what
we've
done
is
brought
forward.
Some
of
our
improvement
work
that
was
on
our
backlog,
to
ensure
that
we
continue
to
drive
improvements
through
our
registration
transformation
program
in
terms
of
how
we
operate
today,
as
well
as
how
we
operate
in
the
future
improving
regulation.
Today,
work
is
looking
at
how
we
develop
how
we
improve
and
ask
that
change
in
our
project.
N
I
know
you
know
how
we
regulate
today,
ensuring
that
we
remain
aligned
to
the
change
in
health
and
social
care
sector.
There
are
a
number
of
projects
in
this
program.
The
coitus
for
that
program
at
the
moment
is
developing
our
approach
to
regulating
in
place
cultures,
which
Kate
talked
a
little
bit
about
earlier.
N
Our
Qi
capability
program
has
again
been
impacted
slightly
by
David,
as
we
were
hoping
to
start
to
run
our
silver
cohort.
That
has
recognizing
that
we're,
probably
gonna,
be
out
in
the
offices
for
quite
some
time
now.
What
we're
doing
is
looking
to
develop
some
online
training
support.
I
carried
a
particular
liability
in
particularly
putting
together
a
some
webinars
to
enable
a
silver
cohorts,
start
to
build
and
develop
capability,
and
we
also
have
our
bronze
cohort
or
our
bronze
online,
offering
available
to
start
to
build
the
Qi
so
understanding
across
the
wider
organization.
N
Our
people
plan,
which
is
our
overalls
of
a
holistic
plan
in
terms
of
addressing
our
work
around
our
people,
to
build
capability
in
capacity
across
the
organization
that
is
starting
to
take
shape.
Now,
we've
pulled
that,
together
into
a
into
a
tangible
program,
with
some
clear
benefits
and
deliverables
associated
with
that.
A
couple
of
things
just
to
highlight.
Through
that
work,
we
transitioned
into
a
new
payroll
provider,
which
was
Northumbria
healthcare.
N
N
This
one
will
has
got
questions
that
are
common
in
in
the
main
annual
survey
to
enable
us
to
track
performance
against
those
the
key
metrics,
but
also
we're
exploring
how
people
have
felt
around
the
carriage
response
and
also
checking
on
our
well-being
of
our
colleagues
there,
hopefully
we'll
be
able
to
have
some
headline
results
when
we
come
back
to
board
next
month
on
that
one
in
terms
of
building
our
leadership
capability.
This
is
a
key
tenant
of
our
people
plan.
N
We
have
been
doing
quite
a
lot
of
work
on
this
over
the
last
few
months
and
one
of
the
key
elements
of
that
one.
The
key
deliverables
has
been
success,
profiles
which
is
setting
out
the
behaviors
and
competencies
we
want
to
see
at
each
grade
in
an
or
in
the
organization,
to
really
start
to
provide
it
as
a
framework
for
the
future.
We
have
now
completed
this
work
in
in
draft
we've.
N
It's
been
a
quite
a
big
consultation
exercise
across
the
organization
with
lots
of
work
jobs
at
the
various
grades,
setting
out
what
they
see
as
the
key
behaviors
for
success
in
their
roles,
and
we've
now
brought
that,
together
into
into
a
set
of
a
set
of
draft
draft
profiles,
we're
now
starting
to
finalize
those
and
look
to
how
we
embed
those
into
the
organization
to
support
both
correct
allant
management
and
also
performance
management
going
across
the
organization
and
I.
Think
it'll
be
a
really
really
strong
plank
to
support
recruitment
and
ensure
our
recruitment
is.
H
Thanks
Jessie,
and
just
just
a
couple
of
additional
bits
to
what
you
discuss
so
and
on
digital
foundations,
we're
making
really
good
progress
on
some
very
core
activities
there,
so
we're
doing
a
significant
migration
of
our
applications
from
from
on-premise
infrastructure
in
silicon
to
modern
cloud
infrastructure.
That's
that's
progressing
very
well
and
we're
also
finalizing
that
work
to
transition
now
at
all,
rightie
support
services
to
our
turn
new
provider,
which
is
going
to
make
a
big
difference
to
to
our
dramatic
colleagues
and
that's
expected
to
go
live
and
during
the
next
month.
H
As
Kirsty
said
we're
now
in
the
final
stages
of
procuring
our
implementation
partner,
which
will
help
us
configure
the
new
Microsoft
Dynamics
platform
to
meet
our
regulatory
activities
and
and
we've
also
been
working
on
all
of
the
design
work.
That's
needed
our
house
isn't
and
to
be
process
design,
so
date,
data
designs
and
implementation
and
plans,
as
well
as
setting
up
our
teams
and
our
governance
as
well,
which
is
all
gone
very
well
and
I'll.
H
As
course,
he
said
that
technology
allows
us
to
deliver
services,
a
really
incredibly
accelerated
pace,
using
what
is
essentially
configurable
loko
platform
that
allows
us
to
meet
at
that
speed,
while
still
different.
In
the
secure
and
robust
solutions
that
are
scalable
and
performed
very
well
so
to
get
a
good
test
of
that
and
that
technology
for
us,
which
were
really
pleased
with.
A
D
F
F
Just
please
mark:
please
can
I
just
echo
what
John
said
there
and
impressive
from
Kirsty
thanks
for
a
really
full
report.
Justin
chose
the
people
plan,
I'm,
really
good
news
to
see
mental
health
advocates
being
put
in
place
and
trained
under
inflation
and
well-being.
So
some
well
done
for
that
and
great
to
see
some
of
these
sort
of
virtual
programs,
starting
we
heard
from
Karen
but,
as
you
mentioned,
grants
and
silver
Qi
programs
and
the
launch
of
ESF
using
new
training
and,
of
course,
the
pulse
survey.
N
We
want
to
look
at
that,
but
I
think
it's
about
our
broadband
and
our
capacity
to
pick
these
up
so
I've
been
having
conversations
with
both
Jill
and
Chris
about
what
a
what
a
future
integrated
HR
finance
system
might
look
like
and
how
we
might
to
build
that
in
the
future
at
some
point
to
to
enable
us
to
do
some
of
this
stuff.
Also
looking
at
where
we
can
automate
some
of
the
things-
and
there
is
quite
a
lot
of
new
technology
out
there-
that
we
can,
we
can
build
in
to
help
us
with
that.
N
We
are
just
starting.
The
robotics
piece
in
are
NCSE
Center
to
help
us
process.
Quite
a
lot
of
this
of
notification,
work
that
we
have
I
think
there
is
loads
of
opportunity
for
us
to
start
once.
We've
tested
our
toe
in
the
water
there
to
expand
that
work
both
into
into
the
HR
side
of
things,
to
really
make
sure
that
people
have
a
really
good
experience
and
a
quick
experience
where
we,
where
we
can,
where
we
can
do
that.
So
it's
definitely
something
on
our
agenda.
N
I
think
it's
probably
more
we're
pretty
full
up
with
the
people
plan
this
year.
If
you
look
at
the
breadth
of
what
we're
doing,
but
always
looking
ahead,
all
those
sort
of
things
that
I
think
we're
going
to
plan
in
for
for
next
year
to
enable
us
to
build
on
what
we've,
what
we've,
what
we've
done
over
this
period
of
time,
yeah.
F
Kirsty
thanks
I
wasn't
for
a
moment
suggesting
there
was
slack
in
the
organisation.
I
was
just
thinking
in
terms
of
recruitment
and
onboarding.
You
know
there
still
will
be
the
need
to
bring
people
in
and
in
an
environment
that
we're
in
now
then
clearly
recruiting
and
onboarding
a
critical
measures
for
us
to
have
some
success
in
that
area.
We.
N
Have
quite
a
lot
of
online
processes
already
that
may
be
slightly
slightly
clunky,
but
we
have
a
lot
in
that
space
at
week
we
can
do
and
the
moment
our
equipment
is
it's
pretty.
It's
pretty
small,
because
we've
caused
a
lot
of
it
through
the
cable,
but
we'll
start
it
we'll
get
it
back
up
and
running
again
and
and
it'll
work
quite
easily
remotely.
In
fact,
we
have
had
a
few
people
that
did
join
right,
the
beginning
of
caver.
N
B
Just
I
just
want
to
just
sort
of
add
my
thanks
to
my
executive
executive
team
colleagues
for
the
the
fantastic
work
that's
been
done
this
year,
I
think
nobody
skated
over
simple
things
like
a
new
payroll
system
or
a
completely
new
technical
architecture.
These
are
things
which
most
organizations
you
do
want.
You
wouldn't
do
them
all,
but
it
is
very
much
a
team
effort
and
I
think
I
think
the
way
we've
been
able
to
respond
to
Cove.
B
Think.
If
you
look
at
the
performance
across
the
year,
both
in
terms
of
operation,
performance
and
change,
I
think
there's
this
really
really
good
stuff.
There
there's
of
course,
things
that
we
still
want
to
to
improve
and
I
think
there's
a
collective
impatience
to
do
that,
but
I
think
I
think
it's
that
it
feels
like
a
good
end
of
year
and
a
set
of
numbers.
It's
my
it's
my
sense,
though.
Thank
you
thank.
A
You
so
we'll
have
a
pause
for
some
lunch
if
we
start
again
a
quarter
to
two,
which
is
the
scheduled
time
and
Mary
creature
and
colleagues
are
joining
us.
So
it's
about
a
five
minute,
less
than
advertised
break,
I.
Hope,
that's,
okay
and
see
you
all
in
25
minutes.
Thank
you
assume
we
are
so
can
I.
Can
we
restart?
Can
I
welcome
Mary
Creech
Mary?
You
are
going
to
give
us
some
reflections
on
your
time
as
our
speaker,
Guardian,
which
has
come
to
an
end,
can
I
also
welcome.
A
Q
Okay,
thank
you.
Thank
you
very
much
for
the
invitation
to
share
my
reflections,
iPhone
sort
of
rounded
them
down
to
seven
key
reflections
and
once
I've
gone
through,
there
might
be
very
pleased
to
hand
over
to
Carolyn
Julianne
uma
to
introduce
themselves
to
you
ahead
of
bringing
the
six
months
report
to
you
next
month.
So
number
one
on
my
list
is
the
reflection
that
we
really
believe
in
speaking
up,
but
we
don't
always
live
up
to
our
expectations.
Q
Q
We
know
research,
though,
that
we're
brave
us
speaking
up
for
others
than
we
are
for
ourselves
necessarily,
but
as
a
guardian
to
be
in
a
place
where
speak
up
is
respected,
encouraged
and
nurtured
is
really
very
special
and
I
I
doesn't
always
mean
I've
got
the
outcome.
I
was
hoping
for
an
behalf
of
others,
but
it
has
been
a
very
supportive
place
to
be.
My
second
reflection
is
that
speaking
up
is
relational
and
that,
just
like
all
good
relationships,
it
needs
to
be
worked
on
and
nurtured.
Q
It's
not
enough
to
be
a
nice
person
and
a
great
listener.
We
have
to
actively
invite
people
to
speak
up
to
us,
and
then
we
have
to
respond
well
when
they
accept
that
invitation
and
I.
Think
we've
made
some
really
good
progress
on
this
there's
a
phrase
now
in
CQC
about
disagreeing
well,
which
I
think
is
a
great
thing.
Q
We've
learnt
it's
about
understanding
how
scary
we
are
about
sending
shutup
signals
that
can
range
from
body
language,
expressions
that
show
impatience,
or
indeed
a
diary
so
busy
that
no
one
can
see
when
they
could
possibly
get
a
moment
with
you
and
we've
had
some
really
good
leadership.
Conversations
about
that
and
I've
seen
habits,
change
and
I.
Q
Q
My
next
reflection
is
the
guiding
lights
that
have
really
made
a
difference
and
I've
not
been
sure
on
inspiring
people
around
me.
So
everyone
from
Sir,
Robert,
Frances
Henrietta
Hughes,
is
our
national
Guardian.
Professor
Megan
Reese,
the
many
Guardians
I
have
encountered
on
Hospital
inspections
and
the
people
I've
worked
with
in
CQC,
so
whether
it's
been
helped
with
understanding
where
they
started
the
high
stakes.
Q
What
good
looks
like
what
to
avoid
and
feeling
part
of
a
bigger
movement
as
that
status
felt
really
special
next
on
my
list
would
be
the
star
for
quality
networks
and
recognizing
and
reflecting
on
the
part
they've
paid
played.
We've
recognized.
We've
got
a
shared
agenda
that
wasn't
always
obvious
from
the
start,
but
it
certainly
is
now
and
I'd
include
the
star
forum
and
trade
unions
in
that
group.
Q
Network
so
I'm
very
grateful
to
them
for
them,
but
for
their
support,
ambassador
have
had
a
real
impact,
would
be
my
next
reflection,
I've
been
blown
away
by
this
group
of
people
and
I
think
individually
in
colour
actively
they're
really
having
impact.
Now
some
of
the
individual
speak
up
stories
that
we
heard
from
people
on
the
ambassador.
Training
was
so
humbling
and
inspiring,
and
some
of
those
experiences
brought
people
directly
from
provider
organizations
to
search
out
regulators
to
be
part
of
it.
So
we've
got
within
our
within
our
own
organization.
We
have
some
amazing
stories.
Q
My
final
sort
of
reflection
is
that
we
have
moved
the
dial.
I've
got
a
phrase
about
when
in
doubt,
look
at
the
data
and
in
my
very
first
appearance
aboard
and
answering
the
question
about
how
we
would
judge
success.
I
mailed,
my
colors
to
the
people,
survey,
mast
and,
specifically
the
question
that
says:
I
think
it's
safe
to
challenge
the
way
things
are
done
in
CQC.
So
when
I
started,
that
was
42%
and
it's
stuck
at
42%
for
the
next
couple
of
years.
Q
But
in
our
last
survey
it
was
the
second-most
improved
school
and
we
increased
by
6%
to
47%.
Obviously
that
isn't
where
we
want
to
land
and
within
that
there's
a
huge
variety
of
experiences
for
people
in
different
parts
of
the
organization.
But
but
it's
a
really
significant
improvement
and
it's
it's
been
hard
one,
so
that
that's
that
is
my
gallop
through
them,
but
to
allow
some
time
for
questions.
But
that
is
the
some
of
my
reflections.
It's
been
a
huge
honor
to
hold
the
post
and
I.
Q
A
Mary
I
think
it's
our
thanks
to
you,
because
I
think
you've
done
this
on
top
of
having
an
incredibly
large
day
job
as
it
were,
and
you've,
given
a
huge
tie-in
and
direction
and
impetus
to
aasaiya
eyelining
were
all
incredibly
grateful
to
you.
Okay
can
I
just
ask
you
to
amplify
your
your
first
comment,
which
was
that
we
believe
in
in
speaking
up,
but
we
don't
always
deliver
it.
I
think
all
words
to
that
effect.
You
said
yes,.
D
Q
I
I've
got
sort
of
two
sources
for
that.
One
would
be
the
research
that
we
participated
in
part
of
Megan
Reese's
international
research,
where
the
results
that
came
up
was
so
average
that
she
actually
doubted
them
and
had
the
data
rechecked.
And
when
we
discussed
those
aboard
there
was
some
disappointment
that
thinking
that,
in
our
role
as
our
regulator,
we
might
actually
have
been
better
than
this
and,
in
fact,
as
a
regulator
when
I
think
of
the
community
that
I
work
with
there
is
no
lack
of
bravery
in
speaking
out
on
behalf
of
others.
Q
But
when
it
comes
to
internally,
the
research
showed
that
we
were
solidly
average,
which
just
means
that
all
the
barriers
that
exist
in
every
organization
exist
for
us
as
well,
and
it
is
a
case
of
having
things
in
place
and
habits
to
go
along
with
the
with
the
policies
that
we
have
so
I.
Think
that
was
a
bit
of
a
wake-up
call
for
me
and
for
others
that
actually
we
have
got
room
to
move.
There's
also
I.
Suppose
the
very
human
side
of
this
that
I
think
people
are
very
deliberately
trying
to
get
this
right.
Q
But
you
know
it's
the
then
Megan
Reese
talks
about
this.
She
says
about
you
know
as
leaders.
We
might
get
this
right
98
times
out
of
a
hundred,
but
the
couple
of
times
we
don't
get
it
right
is
what
people
will
notice
and
is
what's
talked
about
at
the
watercooler,
so
I
think
we're
good
in
CQC
at
recognizing
that
we
are
human
and
I.
Think
with
this
is
never
going
to
be
perfect.
I
would
point
to
something
I
said:
did
it
further
down
around
learning
to
disagree?
Well
and
be
eight
beings?
Q
F
Yes,
I'd
love
to
ask
you
a
question
to
Mary.
Please
Mary
thanks
very
much
for
this
report.
I'm
very
interested
in
your
point
about
communication
and
I
must
put
up
my
hand.
That's
like
sometimes
sent
an
email
that
I
shouldn't
have
sent
I
take
that
on
board.
But
on
a
serious
note,
have
you
noticed
a
spike
in.
Q
We
haven't
had
a
spike,
in
fact,
the
other
way
it's
become
quieter.
There
has
been
an
active
discussion
of
speaker
on
some
of
the
rules.
Staff
calls
which
has
been
good.
We
definitely
alert
through
it.
Looking
externally
for
staff
in
provider,
organizations
speaking
up
I
am
in
fact
aware
of
a
number
of
cases
at
the
moment
where
people
have
actively
put
the
things
they
want
to
say
on
hold
recognizing
how
busy
everybody
is
at
the
moment
and
how
there
are
bigger
fish
to
fry.
That
they're
saying.
F
Q
E
Just
to
thank
Mary
for
tremendous
work
and
a
couple
of
reflections
of
my
own
one
is
that
I
love.
The
phrase
disagree
well,
and
it
seems
to
me
at
the
heart
of
the
freedom
to
speak
up
is
the
necessity
for
all
of
us
to
learn
that
there's
nothing
wrong
in
disagreeing
with
each
other.
What
is
wrong
is
suppressing
or
someone
else
that
wants
to
say
not
listening
to
them,
and
that
can
happen
at
both
intentionally
and
unintentionally
and
I.
E
As
we
are
seeking
to
do
in
order
that
we
can
exemplify
to
the
world,
we
regulate
that
it
is
possible
to
do
this
because
I'm
not
sure
everyone
believes
it
is,
but
the
health
service
generally
I
think
is
getting
better
and
the
final
reflection
is
a
game
it
comes
out
of.
What
Mary
is
saying.
Is
that,
like
with
everything
else,
we
do?
You
do
need
patients,
probably
more
patients
than
I
really
have
frankly.
R
R
That
I
was
going
to
be
very
curious
as
to
whether
and
I
know
you
cover
more
than
bullying,
but
whether
instances
of
bullying
and
harassment
we're
going
to
go
up
or
going
to
go
down
during
lockdown,
whether
people
being
physically
removed
from
a
situation
would
ease
it
or
whether
interaction
being
of
team's
virtual
interaction
in
a
way
that
is
less
witness
about
and
then
office
interaction
is,
would
actually
increase
it.
So
I
will
be
interested.
A
Thanks
Beth
can
I
just
point
Mary
or
the
three
new
Guardian,
so
it's
a
good
at
colors,
broaden
out
cuz
cuz
I.
What
I
was
going
to
say
was
I
think
it's
really
interesting
for
an
organization
that
has
a
very
large
part
of
its
people
working
permanently
as
home
workers
to
understand
what,
as
what
we've
learned
through
the
lock
down,
both
good
things
and
bad
things
so
Mary
and
Auntie.
If
you
would
like
to
best
comment
but
for
broaden
it
out,
if
that's
appropriate,.
Q
Q
The
gratifying
thing
from
that
was
just
what
a
difference
it
made
and
the
number
of
anonymous
comments
fell
off,
fell
off
a
cliff
really
and
there's
only
just
a
few
left.
We
also
invited
Henrietta
to
be
part
of
those
calls
and
she
reinforced
how
important
it
was
just
to
say
what
you're
thinking
and
feeling
so
I
think
where
it
has
shown
to
be
an
emerging
issue.
It
has
been
addressed
head-on,
but
I
think
they'll
be
lots,
fuller
of
learning
for
all
of
us
about
positively
and
less
positively
around
this
period,
and
we
can.
Q
A
S
Actually,
that
I
was
caring
for
at
the
time
economists
echo
Sir
Robert
Francis
what
he
was
going
to
say,
I've
written
down
here
about
us
being
the
regulator
and
about
was
having
exemplary
speak
up
policy
that
basically
we
can
be
proud
of,
and
that
can
be
replicated.
So.
Thank
you
very
much.
Don't
think
you
thank
you
for
volunteering.
T
Thank
you
how
everybody
I'm
Carolyn
Jenkinson
I'm,
one
of
the
heads
of
inspection
in
the
hospital's,
Directorate
and
I,
am
covered
the
London
and
acute
sector
of
the
Directorate
and
and
I'm.
You
know
like
him,
my
other
two
colleagues
I'm
really
proud
to
have
been
appointed
as
a
guardian
and
but
I.
Let
you
into
a
little
secret.
One
of
the
reasons
that
I
applied
for
the
post
was
because
I
wanted
to
get
a
little
bit
more
exposure
to
the
board.
T
Hopefully,
if
that's
ok
with
you,
Peter
and
and
I'm
not
look
forward
to
working
with
you
a
lot
more
I
think
I
I
also
am
in
a
privileged
position,
because,
obviously,
as
a
head
of
inspection
in
hospitals
and
I
get
to,
as
you
know,
my
day,
job
go
and
look
at
how
boards
function
and
look
at
and
how
speak
up
works
within
an
HS
trust.
So
I've
seen
some
great
things
and
I've
seen
some
not-so-great
things
so.
U
You
Peter
and
thank
you
everyone
for
inviting
me
to
the
board,
like,
like
the
others,
I'm
really
really
excited
to
be
part
of
the
show
why
I
was
interested
in
this
is
as
Australia.
That
perhaps
is
a
few
months
old
I
joined
the
Leadership
Academy
for
a
leadership
training
course
and
buckler's
actually
directed
low
at
British
commandos,
to
make
candidates
and
I
wasn't
really
looking
for
anything
particular
in
diversity.
I
was
really
only
looking
at
general
leadership,
but
that
I
heard
during
the
cold
show.
My
fellow
you
know
workshop.
U
The
colleagues
was
really
an
eye-opener
to
the
kind
of
discrimination
and
the
kind
of
problems
that
I've,
HS
and
Brad
got
me
really
interested
in
understanding
why
people
are
finding
it
difficult
to
speak
up
and
I
always
thought.
Cqc
was
a
was
a
wonderful
organization
in
terms
of
the
way
big
policies
have
had
in
plays
in
terms
of
the
way
we
look
after
our
people
and
ensure
that
base
that
our
support
really
for
everyone,
but
then,
like
Murray
I,
started
to
go
back
and
look
at
some
of
our
staff.
U
Several
assaults
and
just
realized
that,
while
we've
got
the
policies,
some
of
our
staff,
perhaps
don't
perceive
us
living
up
to
those
policies
as
well
as
we
could
and
which
is
why
I
really
thought
you
know
if
there
was
anything
that
I'm
learning
from
what
I'm
doing
they're,
not
really
like
to
contribute
to
that.
So
all
I'm,
looking
forward
to
looking
with
everyone
with
my
colleagues,
my
other
two
colleagues,
as
well
as
everyone
in
the
boat
great.
A
Thank
you
so
Larry
volunteered
that
you'd
be
back
in
a
month's
time
with
a
reporter,
and
if
that's
all
three
of
you
or
just
you
very,
very
write
that
whenever
we
will
see
more
of
all
of
you
over
the
coming
months
and
anything
you
need
from
any
of
us,
you
just
have
to
say
because
going
back
to
Mary's
opening
statement,
we
really
do
believe
in
speak
up
and
if
we're
not
always
living
up
to
it,
then
we
need
to
work
out
how
to
to
do
better.
So,
thank
you
more
very
much
and
Mary.
A
So
that
takes
us
I
think
just
to
any
other
business,
so
if
there
is
any
other
business
from
the
board,
so
the
end
the
formal
board
meeting.
At
that
point,
we
do
have
one
question
from
a
member
of
the
public
Robyn
Pike,
which
I
will
read
out
because
it's
it's
relatively
short,
I
understand.
The
CTC
currently
has
a
role
in
facilitating
access
to
independent
hospitals
by
NHS
patients
for
their
elective
surgery,
homeless,
access
work.
Will
it
require
authorization
by
local
commissioners
and
I
think
probably
take
you're
the
best
person
to
answer.
D
That,
yes,
thank
you
Peter,
said
so.
First
of
all,
can
I
just
start
off
by
saying
that
independent
hospitals
have
been
really
very,
very
positive
that
what
they've
done
in
supporting
the
NHS
response,
Kerry
to
being
really
very
positive
and
I,
want
to
congratulate
them
on
lots
of
very
good
work.
They've
been
doing,
they
are
essentially
providing
support
for
the
non
covert
services.
D
That's
a
generalization
because
different
different
hospitals
are
doing
different
things,
but
essentially
they're
providing
a
sports
non-current
services,
and
if
you
think
about
some
of
the
issues
we're
talking
about
earlier
on,
it's
an
infection
control
there's
a
real
opportunity
for
those
those
hospitals
to
be
the
encoded
free
environments.
Where
elective
procedures
cannot
be
undertaken,
all
cancer
care
can
be
provided
so
I
think
they
are
going
to
be
extremely
important
in
the
recovery
and
I'm
very
grateful
for
the
work
they've
done
speaking
to
the
independent
health
riders
anti-ages
providers.
They
are
generally
paired
together.
D
So
the
local
hospital
and
depend
hospitals
are
paired
to
the
local
NHS
trusts
and
patients
who
are
been
referred
to
carefully.
They
just
trust,
will
be
transferred
seamlessly
to
the
independent
Hospital,
where
necessary.
Sometimes
that
would
be
the
independent
Hospital
providing
care.
Sometimes
the
NHS
trust
will
be
providing
care
within
the
independent
Hospital,
so
it's
gonna
be
different
depending
on
the
care
provided
and
the
local
arrangements.
So
the
access
for
any
patient
is
through
the
normal
referral
to
their
NHS
trust.
D
The
NHS
trusts
will
manage
the
process
to
make
sure
they
get
the
care
they
should.
They
should
get
in
the
appropriate
environment,
and
this.
This
is
one
of
the
things.
Of
course.
We,
as
the
regulator,
are
going
to
be
monitoring
very
carefully
to
make
sure
that,
as
we
discussed
earlier
on
that,
people
who
need
care
for
non
Co
conditions
are
getting
the
right
priority.