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From YouTube: CQC board meeting - January 2022
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A
Welcome
everybody
to
the
january
2022
public
board
meeting
for
the
cqc.
A
We
have
one
apology
from
kirsty
shaw
who
is
ill,
otherwise
we
are
all
here,
I'd
like
to
welcome
as
a
as
a
guest
to
our
board
meeting
diane
horsley,
who
is
from
our
gender
equality
network
diane.
You
are
extremely
welcome
and
please
do
stick
your
hand
up
if
you,
if
you
want
to
contribute
at
any
time,
can
I
just
check
there
are
no
declarations
of
interest
that
anybody
needs
to
to
raise.
A
Okay,
thank
you
and
I
think
that
takes
us
straight
into
the
minutes
of
our
december
meeting.
Are
they
a
true
and
accurate
record
of
everything
we
discussed?
Yes,
thank
you.
A
Excellent
good,
we'll
take
we'll
take
that
as
approved
then,
which
takes
us
into
the
action
log
and
I
think,
there's
only
one
item
on
the
action
log
and
that's
not
due
yet
is
there
anything
else
arising
anybody
wants
to
raise
okay,
so
with
all
of
that,
let's
move
straight
on
to
the
first
item,
which
rosie
is
your
report
on
the
impact
of
our
regulation
on
providers
led
by
gps
of
an
ethnic
minority
background,
and
I
think
probably
I
need
to
welcome
a
couple
of
your
colleagues
as
well
for
this,
but
rosie.
B
Yes,
thank
you
very
much,
peter
and
good
morning.
Everyone
I'd
like
to
welcome
annabelle,
stigwood
and
aisha
ashmore,
who
have
been
have
done
a
fantastic
job
on
pulling
this
work
together
and
and
driving
this
work
over
the
last
year,
I'm
just
going
to
say
a
few
words
and
then
hand
over
to
annabelle
just
to
just
take
us
through
the
report.
B
So
the
first
thing
I
want
to
say
is
thank
you
to
the
royal
college
of
general
practitioners
for
raising
these
concerns
with
us
last
year,
and
also
for
all
of
the
organizations
that
have
been
involved
in
this
work.
We've
worked
across
the
system
with
all
organizations
working
in
primary
care,
and
we've
also
worked
with
many
experts
in
this
field
to
pull
on
lots
of
expertise
and
I'd
like
to
express
my
thanks
to
all
of
those
involved.
B
My
ambition
with
this
work
is
to
use
this
as
a
a
call
to
action
for
all
organizations
working
in
primary
care
to
work
together
to
address
these
going
forward.
I
think
they're
too
big
for
any
organization
to
address
on
their
own,
and
I
think
it's
vital
that
the
the
issues
that
have
been
outlined
in
this
report,
in
terms
of
inequalities
for
both
people
experiencing
care
and
people
working
within
primary
care
are
addressed
by
all
involved.
So
I'm
just
going
to
hand
over
to
annabelle
just
to
say
a
few
words
now.
Thank
you.
Annabelle.
C
Thank
you
rosie.
So,
throughout
this
work,
we've
consulted
with
our
colleagues
within
the
cqc,
including
our
working
group
and
inspector
reference
group.
We
have
consulted
with
an
external
advisory
group
made
of
practicing
gps,
many
of
whom
are
from
representative
organizations
such
as
bapio.
C
These
findings
are
reflected
in
our
recommendations
and
then
turning
to
single-handed
gps,
professional
isolation
and
support
in
our
survey
and
in
our
literature
review,
we
found
that
single-handed
practices
are
often
ethnic,
minority-led
being
single-handed
sometimes
means.
There's
less
time
and
resource
that
can
be
dedicated
towards
evidence
and
compliance
and
improvement,
and
often
these
practices
can
be
professionally
isolated.
C
C
C
We
know
that
there's
still
work
for
us
to
do
to
ensure
that
we
achieve
our
strategic
and
quality
objectives
and
deliver
our
core
purpose
to
ensure
that
we're
encouraging
practices
that
need
support
to
improve.
However,
the
research
has
identified.
The
action
is
required
beyond
the
cqc
to
address
concerns
relating
to
deprivation,
single-handed,
gps
and
the
support
available
to
those
practices.
C
Therefore,
we
have
continued
to
work
with
our
system
partners,
including
the
rcgp
gmc
nhs,
nhs,
eni
and
representative
groups,
to
ensure
that
the
findings
of
the
report
are
clearly
understood
to
facilitate
good
collaborative
working
across
the
system.
To
address
the
issues
we
have
identified,
the
engagement
teams
have
been
working
through
a
comprehensive
media
and
engagement
plan
to
make
sure
that
key
messages
are
delivered.
C
C
We
look
forward
to
progressing
the
findings
of
this
work
through
this
group
in
relation
to
the
recommendations
which
reflect
how
we
regulate.
Many
of
these
are
already
in
hand
specifically
around
how
we
can
focus
on
reducing
health
inequalities
through
systems
working
as
we
develop
the
single
assessment
framework,
as
well
as
how
we
collect
ethnicity
data
through
our
regulatory
platform,
the
governance
and
oversight
arrangements
for
the
overall
implementation
for
the
recommendations
has
been
identified,
and
today
we
are
asking
for
the
board
to
approve
this
report
for
publication.
A
So
annabelle,
I
I
think
it's
a
great
report
and
thank
you
and
all
your
colleagues
that
were
involved
in
in
producing
it.
I
think
we're
going
to
have
quite
a
few
comments
and
questions
robert.
Let's
start
with
you,.
D
Well,
thank
you
and
and
two
things.
Firstly,
this
is
a
great
and
informative
report
on
an
extremely
important
subject.
So
what
I'm
about
to
ask
isn't
intended
to
be
a
criticism
but
suggestions
of
what
we
do
now.
Really,
as
I
understand
it,
this
work
was
motivated
by
a
perception
on
the
part
of
ethnic
minority
doctors
and
other
providers
that
they
were
in
some
way
dealt
with
differently
by
cqc.
D
D
D
What
I'm
not
entirely
sure
I
see
in
this
report
and
wonder
what
work
we
can
do
is
to
be
questioning
ourselves
about
whether
there
is
something
about
the
impact
we
make
on
ethnic
minority
providers,
which
is
different
to
the
impact
we
make
on
our
non-ethnic
minority.
But
by
that
I
mean,
if
you
take,
for
instance,
a
minor,
a
minority.
Sorry
a
single-handed
practitioner,
single
gp,
who's
from
an
estimating
minority,
whether
somehow
or
another,
unconsciously
or
otherwise.
D
We
deal
with
them
differently
than
we
would
from
a
single-handed
white
gp
or
whether
that's.
What
is
the
belief
which
is
probably
more
likely
to
be
the
case
and
and
we
need,
I
think,
to
be
particularly
conscious
of
the
unconscious
effects
that
we
have
on
people
and
the
biases.
Otherwise
we
bring-
and
I
absolutely
understand
that
the
data
you
had
was
probably
not
sufficient
to
allow
one
to
get
into
that
in
any
depth.
A
That's
it
so
rosie
and
annabelle,
just
just
just
hold
on
to
that.
Let
me
bring
in
steven
and
then
sally
before
we're
coming
back
to
to
you,
stephen.
E
Thank
you
peter,
and
thank
you
very
much
to
rosie
to
and
about
colleagues.
It's
it's
a
really
interesting,
really
important
report.
E
The
the
bits
one
of
the
bits
in
it
that
struck
me
was
the
sense
that
many
of
the
gps
that
you've
been
working
with
here
want
help.
They
want
support,
they're
looking
for
support,
not
just
to
understand
cqc's
own
systems,
but
actually
more
broadly
sort
of
how
do
I
become
a
better
provider
of
gp
services
and
there's
a
bit
of
a
flavor
in
the
report
of
different
bodies
saying
well,
it's
not
us
gov,
I
mean
someone
else
should
be
providing
that
support,
so
who
should
be
providing
that
support?
E
F
Thanks
to
rosie
and
colleagues
for
a
report,
it's
always
good
to
highlight
where
we
could
do
better.
My
comment,
I
think,
follows
on
from
stevens
in
that
the
report
highlights
support
in
a
more
general
sense
and
perhaps
more
that
could
be
done,
secrecy
at
the
end
of
a
line.
F
Aren't
they
after
education
training,
doctor
representation
through
the
gmc
through
the
bma,
so
because
we
can't
influence
this
ourselves,
I'm
interested
into
what
our
response
will
be
and
how
we're
going
to
work
with
others
to
try
and
break
this
cycle
of
inequality,
as
one
of
my
colleagues
referred
to
before
it
isn't
just
about
the
support
now
on
inspection,
it's
about
the
whole
card
of
support
that
a
number
of
different
organizations
provide
to
doctors
from
an
ethnic
minority,
and
I
had
just
another
small
comment
really
about
single-handed
practices,
which
clearly
are
more
prevalent
here,
because,
although
we
don't
look
after
the
delivery
model
of
how
care
is
provided,
I
think
they've
been
attempts
over
many
years
actually
to
try
to
phase
out
single-handed
practices
and
build
them
into
a
network
or
build
them
into
collaborations
in
some
way,
shape
or
form.
B
Thank
you
peter,
and
those
three
points
we
could
spend
all
day
discussing.
I
think
actually
a
very,
very
good
point
so
to
robert's
point.
I
absolutely
agree.
This
is
a
a
very
highly
important
part
of
the
workforce
and
particularly
the
reflection
on
the
local
communities
and
working
with
local
communities
that
they
serve
and-
and
it
is
incredibly
important
this
I
think
what
you've
outlined
is
exactly
the
reason
we
need
to
get
our
data
collection
better
in
this
area,
and
I
think
we
need
to
do
that
across
the
system.
B
I
think
these
issues
that
we've
raised
in
the
report.
I
think
this
is
the
starting
point
of
us
of
work.
We
need
to
do
in
this
area
to
really
understand
this
better,
and
I
don't
think
we've
got
to
the
final
point
yet
in
our
understanding
as
to
whether
these
issues
are
just
related
to
ethnic
minority,
gps
or
whether
they
relate
to
a
wider
group
of
people.
B
Some
of
the
work
that
we've
done
in
the
literature
review
does
show
that
practices
working
in
areas
of
deprivation
do
have
a
a
different
set
of
problems
and
issues
than
areas
where
they're
practicing,
where
there's
less
deprivation.
B
But
I
think
we
do
need
to
understand
the
role
of
ethnicity
in
that
in
more
detail,
and
that
is
why
it's
imperative
for
us
and
and
other
organizations
to
look
at
how
we
collect
data
to
to
to
really
understand
this
in
more
detail
in
terms
of
stephen's
point
about
help
and
support
and
whose
role
it
is
to
support.
I
think
this
needs
to
be
everyone
working
across
primary
care
to
be
looking
at
what
their
role
is
in
dealing
with
the
issues
that
have
raised.
B
I
think
every
organization
should
take
responsibility
at
looking
at
what
their
their
own
processes
and
actions
are
and
how
they
can
improve
those
to
support
people
working
in
areas
of
deprivation
and
people
from
a
ethnic
minority
black
background.
B
I
think
there
is
a
key
role
here
for
integrated
care
systems.
I
think
integrated
care
systems
by
their
very
nature
need
to
be
understanding.
Their
population
needs
making
sure
their
workforce
delivers
good
care
for
their
populations,
and
I
think
that
all
providers
within
an
integrated
care
system
need
to
be
confident
that
when
they
need
help
and
support,
they
get
that
from
the
integrated
care
system,
and
we
know
from
the
work
around
the
invest,
care,
law
and
and
much
of
the
work.
B
That's
happened
previously
that
actually
people
who
live
in
areas
of
deprivation
often
need
more
care
and
support,
not
less,
and
so
that
needs
to
be
absolutely
factored
in.
B
In
terms
of
sally's
sally's
comments,
I
think
we
are
fortunate
to
be
working
with
nhs,
england
and
and
very
grateful
of
the
support
from
bola
alawabi
in
terms
of
the
her
role
in
as
a
as
in
equality's
lead,
and
she
has
agreed
to
chair
the
the
round
table
in
a
couple
of
weeks
time
to
look
at
the
next
steps,
and
I
think
at
that
stage
we
need
to
come
up
with
a
concrete
series
of
actions
that
are
going
to
and
priorities
across
the
primary
care
landscape
to
be
able
to
move
this
forward
forward
and,
finally,
just
to
comment
on
single-handed
practices.
B
I
think,
as
you
say,
sally
we're
not
in
the
position
as
the
cqc
to
say
how
care
should
be
delivered
and
the
model
of
care.
Having
said
that,
I
think
that
sometimes
being
a
single-handed
practice
does
bring
challenges
in
terms
of
offering
the
range
of
services.
B
It
brings
challenge
in
meeting
some
of
the
regulatory
requirements
from
providers
and-
and
I
think
it's
vital
that
eve-
if
single-handed
practices,
whether
they're
led
by
ethnic
minorities
or
or
non-ethnic,
minorities,
get
the
support
they
need
and
they
work
collaboratively
within
a
primary
care
network,
so
that
patients
get
good
care
whatever
practice
and
wherever
they
are
registered
in
the
country.
A
Thanks
rosie
mark
saxton.
G
Thank
you
chairman,
and
thanks
annabelle,
for
a
very
good
report
and
presentation,
and
I
this
is
a
question
for
both
you
and
rosie
annabelle.
G
I
share
my
colleagues
comments
so
far
and
the
points
they've
raised,
but
I
wonder
if
I
could
focus
on
another
area
that
came
out
of
the
report,
and
that
was
particularly
on
the
impact
of
the
cqc
inspection
on
individual
providers
and
we
talked
about
impact
on
mental
health
that
they
saw
the
inspection
as
threatening
that
there
was
an
impact
on
their
family
life
and
an
impact
on
physical
health.
G
I
mean
clearly
that's
a
a
narrative
that
we
have
to
react
to,
and
I
know
that
we
have
some
actions
to
address
that
going
forward.
But
a
cornerstone
of
our
strategy
is
to
reduce
health
inequalities
and
to
do
that
through
people
and
communities
through
improvement
through
safety
through
learning
and
smarter
regulations.
G
So
my
question
is:
can
we
not
find
a
way
to
reinforce
our
strategy
and
actions
from
us
to
to
to
ensure
that
the
strategy
moves
from
a
piece
of
paper
to
an
operational
initiative,
and
particularly
I'm
posing
that
question
around
that
we
do
that
alongside
the
actions
we've
said
in
the
report
that
we're
going
to
undertake
so
a
greater
focus
on
collaboration
on
engagement
on
understanding
context
and
on
improved
communications,
but
it
seems
to
me
that
this
is
a
broader
issue
that
I'm
referring
to,
which
is
about
our
strategy
and
people,
understanding
it
and
then
understanding
actions
in
relation
to
that
strategy.
B
Mark,
if,
if
I
can
start
with
that
and
then
ice
and
annabelle
might
want
to
add
to
to
the
answer
so,
firstly,
I
I
believe
regulation
should
be
constructive.
It
should
add
value,
it
should
be
proportionate
and
we
want
to
make
sure
that
our
our
regulatory
approaches
are
done
in
a
sensitive
manner,
so
that
actually
the
impact
that
we've
seen
in
this
report
is
is
minimized.
On
people
who
are
practicing.
B
I
think,
as
you
rightly
say,
there
is
a
huge
opportunity
for
us
to
use
our
our
plans
in
the
new
strategy
to
address
a
lot
of
these
issues
and
we
are
already
making
progress
in
those
areas.
B
So,
for
example,
I
think,
by
the
by
our
more
our
approach
about
monitoring
our
intelligence
driven
approach
where
we
we
can
do
things
without
actually
visiting
practices
as
much
that
that
will
help
by
us
looking
at
how
we
can
streamline
our
methodologies
and
make
sure
that
they
identify
risk
and
identify
what's
important,
but
to
patients
by
our
focus
on
improvement
and
and
making
sure
that
actually
what
we
do
drives
an
improvement
culture
across
practices.
B
All
of
those
things,
I
think,
will
will
very
much
help
in
this
matter,
and
we
know
that
there's
a
very
strong
link
between
staff,
well-being
and
and
how
they
feel
valued
and
patient
care
and
patient
safety.
So
we
absolutely
want
to
see
that
really
kind
of
good
culture
across
all
organizations.
B
That's
going
to
enable
to
deliver
care,
and
we
want
to
be
part
of
part
of
the
solution
there
in
terms
of
helping
organizations
to
drive
that
that
improvement
culture.
B
So
I
think
I
think,
in
answer
to
your
question,
we
are
that
there's
work
that
we
need
to
do
a
lot
of
work
in
that
area,
but
we
are
making
good
progress
and
it
absolutely
the
work.
The
recommendations
from
this
report
will
very
much
feed
into
the
the
overall
organizational
work
on
things
like
the
assessment
framework,
our
new
methodologies
and
our
new
processes.
A
Great
thanks,
rosie
mark
chambers.
H
Rosie
mentioned
the
the
this,
but
I
want
to
to
to
emphasize
the
point
that
she
that
that
she
raised
about
the
underlying
you
know
the
underlying
quality
and
and
breadth
of
data
that
was
available
to
the
the
team.
Here
I
you
know,
I
would
very
very
strongly
commend
annabelle
and
aisha
and
the
team
on
their
success
in
producing
an
insightful
and
actionable
report
when
it
would
have
been
easy
to
conclude
that
we
didn't
have
access
to
the
data
needed
to
get
this
this
this
quality
of
insight.
H
I
think
it's
a
really
important
call
to
arms
to
for,
for,
for
constructive
collaboration
way
beyond
the
the
cqc
to
ensure
that
we
all
have
access
to
better
data
to
drive
and
drive
the
improvement
that
I
hope
this
report
will
help
will
help
catalyze.
I
think
it's
a
great
piece
of
work,
great.
A
Thanks
mark
annabelle,
if
you
wanted
to
wanted
to
to
say
something.
C
I
was
just
reflecting
on
mark's
points
about
the
impact
of
cqc
inspectors
on
the
the
physical,
the
mental
health
and
the
family.
Life
of
of
ethnic
minority
led
gp
providers,
and
I
think
that
that
was
for
me
personally
throughout
this
work.
C
I
drew
on
my
experience
both
academically,
but
also
as
a
as
a
cqc
inspector,
and
it
really
did
emphasize
the
need
for
for
excellent
engagement
between
between
the
cqc
and
those
providers
that
we
regulate,
and
I
feel
confident
that
we
have
we've
reflected
those
findings
in
our
recommendations
to
make
sure
that
there's
better
engagement
with
inspection
teams
to
ensure
that
that
we
are
encouraging
improvement
across
across
those
providers.
I
Yeah
thanks
and
just
thank
you
colleagues
for
for
this
report.
It
has
been
really
interesting
following
the
work
you've
done
on
this,
and
I
think
it
raises
some
really
interesting
challenges
for
us.
At
cqc,
we've
made
health
inequalities,
one
of
the
key
things
that
we
want
to
focus
on
going
forward
in
our
strategy.
I
Absolutely
we
can't
have
high
quality
care
without
addressing
health
inequalities,
but
what
this
report
makes
absolutely
clear,
perhaps
with
great
clarity,
is
the
importance
of
actually
looking
at
the
equalities
within
the
workforce,
as
well
as
the
equalities
within
the
population
served
and
the
two
are
intrinsically
linked,
because
many
of
these
minority,
ethnic
gps
that
have
raised
concerns
are
providing
care
to
such
deprived
communities.
So
I
think,
bringing
together
that
approach
to
our
providers
and
approach
to
practitioners
and
providers
with
the
health
inequalities
agenda.
I
think,
is
very
important
part
of
this.
So
thank
you,
colleagues.
A
So
I
think
this
is
this
is
a
a
really
good
report
and
you've
heard
everybody
who's
spoken
say
that
so
what
I
would
like
to
do
is
get
the
board's
approval
that
we
we
published
this
report
and
we
do
so
immediately
after
after
this
meeting
there
are
clearly
some
follow-up
actions
for
us,
but
let's
get
this
report
published.
Okay,
thank
you,
aisha.
Thank
you.
You've.
You
you've
been
silent
behind
the
scenes,
but
you've
played
a
big
part
in
this.
I
know
and
annabelle.
A
Thank
you
very
much
as
well,
right
and
rosie.
Obviously
so,
let's,
let's
move
on
now,
colleagues
to
the
executive
team
report.
J
Ian
good
morning,
peter
good
morning,
colleagues,
so
I
just
wanted
just
a
couple:
just
raise
a
couple
of
things
before
handing
on
to
to
to
other
other
exec
team.
Colleagues.
First
thing:
I
just
want
to
advise
the
board
that,
as
accounting
officer
we
I
have
now
sent
the
annual
our
annual
accounts
to
the
comptroller
and
auditor
general.
J
Then
they
will
be.
They
will
be
laid
before
parliament,
we're
hoping
that
the
laying
will
take
place
tomorrow,
following
following
the
certification
from
the
comptroller
and
orders
the
general.
J
This
is
the
process
which
you
will
recall,
pre-pandemic
used
to
take
place
in
in
july
time,
but
it's
been
delayed
for
the
last
couple
of
years
because
of
the
the
linked
pieces
of
work,
around
audits
of
pension
schemes,
that
many
of
our
of
our
of
our
colleagues
are
are
in
my
to
be
frank
about
it,
I'm
expecting
this
sort
of
timetable
to
continue
for
at
least
the
next
year.
If
not,
if
not
longer,
I
think
the
linking
between
our
accounts
and
the
pension
scheme
accounts
remains
problematic.
J
It's
a
problem
that
is
shared
by
many
arms
length
bodies,
particularly
those
that
have
employees
in
the
local
government
pension
scheme,
which
is
what's
what's
causing
the
the
delay
in
in
the
process.
But
I
would
want
just
to
take
this
opportunity
to
publicly
thank
chris
usher
and
and
his
his
finance
team
for
the
for
the
hard
work
that's
gone
on
and
and
sally
and
her
and
her
group
of
non-exec
directors
as
part
of
acgc.
J
You
know
this
is
a
team
effort
to
get
to
get
what's
a
very
complex
piece
of
of
work
across
the
line,
and
I
just
like
to
say
thank
you
to
them
and
of
course,
colleagues
from
our
internal
auditors.
So
I
may
want
to
move
on
now
and
just
just
talk
about
executive
recruitment.
We've
been
through
a
process
to
recruit
a
new
national
director
for
of
healthwatch
england.
J
Healthwatch
england,
as
as,
as
you
know,
is,
is
one
of
our
is
one
of
our
companion
organizations
that
we
work
very
closely
with
and
we
are
responsible
for
recruiting
the
director
and
obviously
robert
robert
represents
healthwatch
on
on
this
board.
J
So
I'm
pleased
to
announce
that
we've
we've
recruited
luis
at
louise
ansari
as
the
national
director
louise
will
be
joining
healthwatch
at
the
beginning
of
february,
and
louise
joins
healthwatch
from
the
center
for
aging
better,
where
she's
been
the
director
of
communications
for
for
the
last
five
years,
so
peter.
That's
all
I've
got
to
to
say
before
I
can
I'm
happy
to
hand
on
to
to
kate.
Thank
you,
okay.
Thank
you.
K
Thank
you
and,
let's
say
good
morning,
all
gonna
talk
briefly
about
operational
priorities
and
then
I'm
going
to
focus
on
my
update
on
workforce
and
visiting
so
very
briefly
on
operational
priorities
in
adult
social
care.
I
just
wanted
to
remind
board
where
we
are
focusing
our
efforts
through
the
early
part
of
this
year.
We've
got
three
areas
of
focus,
so
the
first
one
is
as
you'd
expect
it's
responding
to
risk.
K
The
second
is
our
new
infection,
prevention
control,
plus
inspections,
our
focus
inspections
that
go
out
and
look
at
whether
we
are
assured
against
eight
areas
of
requirements
including
visiting
and
good
infection
prevention
control,
and
then
the
third
area
of
focus
is
around
activity
to
increase
capacity,
be
that
we
rating
a
provider
where
that
currently
requires
improvement
and
all
the
intelligence
tells
us.
If
we
went
back
out
and
inspected,
we
would
find
a
service
delivering
a
good
standard
of
care.
K
So
those
are
the
three
priority
areas
in
adult
social
care
and
tyson
will
give
you
a
little
flavor
about
the
volume
of
activity
when
he
gives
you
his
update.
So
if
it's
okay,
I'm
going
to
move
on
and
talk
about
workforce,
which
is
a
real
hot
topic,
particularly
in
adult
social
care.
At
the
moment,
at
the
back
of
your,
your
chief
exec
update
pack,
you'll
notice,
an
annex
which
provides
an
update
on
vacancies
within
the
care
home
sector.
K
So
through
our
provider,
information
returns
over
8
200
care
homes
have
given
us
this
data,
and
what
this
data
shows
is
that,
back
in
april
of
2021,
there
was
a
vacancy
rate
of
six
percent
within
care
homes
month
or
month.
We've
seen
that
number
increasing
to
december,
where
it
has
reached
11.5,
there's
a
kind
of
chart
and
a
breakdown
of
how
that
looks
regionally
in
your
pack
as
well.
K
But
I
want
to
really
flag
a
growing
picture
around
vacancy
rates
within
care
homes,
and
I
want
to
talk
a
little
bit
about
what
does
that?
Tell
us
about
the
kind
of
quality
and
the
impact
that
has
on
people
who
receive
services.
So
we've
developed
a
workforce
tool
which
we
are
using
on
all
of
our
infection,
prevention,
control
inspections,
but
also
every
time
we
have
a
monitoring
call
with
a
provider.
We
are
also
using
these
couple
of
questions
and
these
questions
are
asking
our
providers
what
impact,
if
any,
is
workforce.
K
We
have
had
these
questions
asked
of
328
services
so
far,
and
39
of
those
services
are
indicating
to
us
that
it
is
having
a
negative
impact
on
the
ability
for
them
to
provide
high
quality
care
and
each
one
of
those
instances.
We
will
be
following
up
with
the
provider
and
the
inspector
will
be
using
that,
along
with
a
wealth
of
other
data
and
information,
they
have
to
make
an
informed
decision
about
whether
there's
further
regulatory
work
they
need
to
do
with
that
provider.
K
So
a
kind
of
picture
of
providers
telling
us
that
workforce
is
having
an
impact
on
their
ability
to
to
deliver
high
quality
care.
In
addition
to
that,
we
require
providers
to
inform
us
of
events
that
may
stop
a
service,
there's
a
requirement
for
providers
to
do
that.
We've
been
keeping
a
really
close
eye
on
those
notifications,
with
a
focus
on
our
providers
telling
us
that
that
they
are
being
prevented
from
delivering
service
as
usual
as
a
result
of
workforce.
K
Now
we
tend
to
get
about
50
notifications
a
month
that
being
steady
and
throughout
the
year,
through
through
december,
mid
december,
up
to
mid
december,
we
saw
an
increase
in
those
numbers
doubling
and
again,
we've
seen
those
numbers
being
higher
than
usual
into
early
january
and
starting
to
see
them
move
back
now
towards
the
average,
but
again
keeping
a
really
close
eye
on
that
and
what
that's
telling
us
about
individual
providers
ability
to
deliver
care,
but
also
what
that
that
kind
of
tells
us
about
the
national
picture
as
well
and
then,
finally,
on
workforce.
K
So
we've
got
a
picture
of
increasing
vacancy
rates,
more
providers
than
usual
telling
us
it's
having
an
impact
on
quality
of
care,
we're
also
interested
in
what
that
tells
us
about
the
the
market.
So
we've
seen
a
pretty
steady,
steady
number
of
providers
deregistering
throughout
the
year
the
numbers
relatively
static.
K
Again
in
december,
we
started
to
see
an
increase
in
providers,
changing
their
registrations
and
providers
deciding
to
de-register
and
to
exit
the
market,
and
when
I
talk
about
changing
in
registration,
this
tends
to
be
where
providers
are
removing
the
nursing
element
of
the
care
they're
delivering
within
a
care
home
setting
so
moving
from
being
a
nursing
home
to
being
a
residential
care
home.
This
data's
pretty
hot
off
the
press.
K
So
again,
we
need
to
understand
what
that's
telling
us
providers
rarely
make
a
rapid
decision
to
exit
the
market
or
change
their
registration,
so
there's
more
work.
We
need
to
do
on
that
that
we
will
be
happy
to
update
board
on
when
we
come
back
in
february,
so
that's
workforce,
peter
I'm
happy
to
move
on
to
visiting
and
take
questions
at
the
end
or
to
pause
now.
What
would
work
best
for
you?
Why.
K
Okay,
so
I'm
visiting
I
wanted
to
start
off
by
reflecting
that
visiting,
has
been
an
incredibly
difficult
issue,
particularly
for
people
in
care
homes
and
their
families.
K
As
we've
highlighted
in
some
research
we've
published
today
on
the
day,
we
launch
our
because
we
all
care
campaign
with
housewatch
england
that
nearly
three-quarters
of
carers
report
a
deterioration
in
their
cared
for
mental
health.
As
a
result
of
all
the
changes,
that's
happened
through
lockdown
we've
launched
this
campaign,
inviting
people
to
tell
us
about
the
quality
of
their
care
because
hearing
about
people's
experiences
really
drives
our
regulatory
work
drives
our
activity
and
we're
keen
to
hear
about
families
and
people
who
live
in
care
homes.
K
Experiences
of
visiting
what
I'd
say
on
visiting
is:
most
providers
are
trying
to
do.
The
right
thing.
They've
got
an
incredibly
difficult
juggling
act
of
keeping
their
residents
safe
and
well,
while
supporting
their
mental
well-being
and
access
to
loved
ones
in
in
recent
weeks.
If
we
think
about
high
transmission
rates
in
the
community,
you
know
a
number
increasing
number
of
caregivers
with
outbreaks.
They
have
a
very
difficult
juggling
act
to
do.
K
We've
been
really
clear
that
cows
need
to
follow
government
guidance,
that
any
sort
of
blanket
visiting
bands
would
trigger
an
intervention,
a
kind
of
involvement
from
us,
and
we
continue
to
keep
a
really
close
eye
on
that.
All
of
our
ipc
plus
inspections
have
an
element
where
we
are
looking
at
visiting,
and
I
just
want
a
short
board
that
when
we
talk
about
visiting,
we
are
not
just
seeking
assurance
from
the
provider
we
are
going
back
to.
People
have
raised
concerns
with
us.
K
We
are
having
conversations
with
residents
we're
using
our
experts
by
experience
to
make
contact
with
families
and
with
people
who
are
in
care
as
and
when
needed.
So
visiting
is
an
issue
we
are
watching
very
closely
and
we
are
taking
action,
be
it
in
any
circumstance
where
people
are
concerned,
that
by
kim
isn't
following
government
guidance
and
that
could
be
a
a
call
to
the
complainant,
a
call
to
the
the
service
and
a
conversation
with
those
residents
to
seek
assurances.
A
Gosh
right
you've
got
off
lightly
there,
kate,
I
mean
I,
I
just
want
to
emphasize
what
you
just
said
about
the
the
the
difficulty
that
providers
have
been
trying
to
balance
safe
care
with
visiting
rights
which
are
which
are
so
incredibly
important,
so
that
that's
a
really
difficult
balance
for
people
understand
that
robert.
That
gave
you
time
to
put
your
hand
up.
D
Yes,
sorry,
I
was
gathering
a
thought.
It
always
takes
a
dog
time
just
about
the
workforce
issue
within
townhomes,
which
is
so
it's
very
important.
There
have
been
some
suggestions
from
the
care
home
sector
will
be
probably
slightly
tongue-in-cheek
made
that
I'm
not
sure
entirely.
Don't
you
see
that,
because
of
the
workforce
issues
cqc
are
imposing
a
burden
that
shouldn't
be
imposed
on
care
homes.
D
I
just
wonder
what
your
comment
was
on
that
sort
of
approach,
and
the
second
question
was
the
extent
to
which
you
we
can
tell
whether
the
rules
about
vaccination
are
having
an
effect
on
workforce
and
the
care
home
sector.
K
Thanks
robert,
so
as
as
board
knows,
the
issues
with
workforce
and
social
care
has
is
a
very,
very
long-standing
issue.
120
000
vacancies
before
the
pandemic
turnover
rates
up
to
37.38.
So
I
think
it's
hard
to
draw
a
link
between
any
one
change
and
workforce.
We
at
cqc
for
a
long
time,
have
been
calling
for
a
long-term
plan
for
adult
social
care,
a
plan
around
the
workforce
and
funding.
Obviously,
government
has
made
additional
money
available
to
social
care,
particularly
during
this
autumn,
which
we
welcome.
K
Our
comments
have
always
been.
We
want
to
see
that
money
flow
rapidly
through
to
front
line
to
to
through
to
care
workers,
to
kind
of
recognize
and
value
the
work
that
they
do
every
day
with
regard
to
burden
that
we're
placing
on
providers.
K
So
I
suppose
my
starting
point
is
we're
here
for
the
public,
we're
here
for
people
who
receive
health
and
social
care,
and
we
will
seek
assurances
in
a
way
that
is
as
least
demanding
as
possible,
but
we
need
to
be
assured
on
behalf
of
the
public
so
when,
for
example,
families
may
contact
us
about
concerns
about
how
a
local
care
home
is
managing
visiting,
we
will
speak
to
those
families.
We
will
speak
to
residents,
we'll
speak
to
the
provider
and
we'll
go
and
have
a
look
ourselves
in
person
if
needed.
K
D
Thank
you.
I
just
come
back
on
that.
I
fully
support
what
you
say,
and
it
strikes
me
that
actually,
in
these
current
times,
when
restrictions
are
whether
legitimately
or
not,
but
some
often
legitimately
placed
on
people's
access,
it's
even
more
important
that
cqc
is
keeping
a
close
eye
on.
What's
what's
going
on
within
institutions.
K
Yeah
we
we
I've,
seen
recent
recent
correspondence
from
a
couple
of
families
saying
you
know
you
are
my
eyes
and
ears
at
the
moment.
You
know
I'm
not
I'm
not
out
there.
As
often
as
I
want
to
be.
You
are
eyes
and
ears,
but
also
robert,
to
link
it
back
to
our
our
campaign.
You
know
people
who
receive
health
and
care
and
their
families
are
many
many
many
numbers
across
the
whole
country
and
they
will
be
seeing
things.
K
We
can't
be
everywhere
all
the
time
and
we
want
to
hear
what
people's
experiences
are
of
health
and
social
care,
be
it
good,
bad
or
mix.
So
a
little
plug
for
a
very
simple
online
form
to
give
us
feedback
about
the
quality
of
care
that
people
are
receiving
out
there
and
just
a
reminder
that
you
know
over
55
of
our
inspection
activity
is
triggered
and
informed
by
what
the
public
tells
us.
So
it
doesn't
sit
there.
It
is,
is
actively
used
and
and
acted
on.
K
So
so,
please
to
the
public
listening,
get
in
touch
and
tell
us
about
the
quality
of
care
you're
experiencing
out
there.
A
G
Thank
you,
chairman
kate.
Thanks
a
lot
just
to
come
back
to
workforce
again,
I
just
wonder
whether
there
is
any
vehicle
whereby
there
is
a
national
approach
to
recruitment
into
the
sector
and
if
so,
whether
you
can
give
us
some
insight
into
that.
And,
secondly,
whether
there
is
because
we
can
see
some
variants
in
in
the
recruitment
effectiveness
across
across
the
country,
whether
there's
some
opportunity
to
transfer
best
practice
within
the
sector
and
if
you've
had
some
insight
into
that.
Please.
K
Thank
you
mark
so,
and
the
government
earlier
on
in
the
pandemic
and
recently
have
led
a
national
recruitment
campaign
for
the
social
care
sector
called
made
with
care,
so
that
recruitment
campaign
is
out
there.
It's
raising
the
profile
and
it's
inviting
people
to
come
and
work
in
the
sector
that
makes
a
difference
to
people's
lives
every
day.
So
the
government
probably
best
place
to
give
an
update
on
the
impact
that
they're,
seeing
that
that's
having
on
on
the
numbers
of
people
coming
in
to
the
social
care
workforce.
K
Yes,
as
you
say,
in
terms
of
workforce
vacancies
there,
there
is
a
bit
of
a
variation
across
the
country
with
the
south.
Being
you
know
above
the
average
when
it
comes
to
vacancy
rates
and
in
care
homes.
When
we
go
out
and
we
look
at
workforce,
we
look
at
things
in
the
realm.
We
look
at
how
people
are
on
boarded,
how
they're,
trained
and
and
the
quality
of
care
they're
delivering
to
people.
K
So
in
our
inspection
activity,
when
we
see
examples
of
best
practice,
obviously
we'd
be
really
keen
to
highlight
that
and
share
that,
so
that
other
other
providers
can
take
that
on
board
as
well.
Thanks
ian.
J
Wanted
to
come
in,
I
think,
just
to
build
on
on
that
point.
We've
talked
before
in
board
meetings
about
a
potential
role,
our
potential
role
for
looking
at
integrated
care
systems
and
that,
obviously,
as
you
know,
is
going
through
parliament
as
we
speak,
but
I
would
expect
one
of
the
the
key
things
on
the
agenda
for
an
integrated
care
system
is,
is
workforce
in
a
whole
area.
J
I
I
think
there
are
some
very
practical
problems
between
a
a
nhs
services
that
are
publicly
funded
versus
social
care
services,
which
are
largely
privately
funded
and
are
not
private
enterprises,
but
I
think
I
think
there
is
a
you
know.
There
is
a
useful
in
useful
place-based.
Conversation
for
individual
ics
is
to
look
at
a
workforce
in
the
round
to
look
for
local
solutions
to
some
of
these
problems,
and
indeed
do
some
of
the
sharing
of
knowledge
between
areas
that
you
were
talking
about
there
mark.
J
A
I
Did
we
come
to
you
next?
Thank
you,
peter,
and
just
to
follow
up
on
on
the
discussion
you've
just
been
having.
I
think
the
workforce
remains
one
of
the
key
risk
factors
across
the
health
services
that
we
regulate
and
that's
been
compounded
during
this
winter
by
absences
brought
about
by
kerbits.
I
So
so,
as
we
come
through
this
winter,
I
think
that's
one
of
the
lessons
we
need
to
take
forward
and
as
we
move
forward
as
a
regulator,
I
think
we
do
need
to
focus
on
the
support
for
the
workforce
and,
of
course,
that
plays
into
the
discussion
we
had
earlier
on
about
primary
medical
services
as
well.
As
colleagues
will
remember,
we
postponed
inspections
of
acute
trusts
and
some
community
trust
in
december
to
support
the
role
out
of
the
booster
program.
I
We
still,
we
still
have
not
reinstated
those
inspections,
although
we're
keeping
an
eye
on
progress
to
decide
whether
we
should
reinstate
those
inspections,
we've
cont,
we
continue
to
monitor
services
very
closely
and
we've
continued
to
inspect
mental
health
services
and
continue
to
do
mental
health
reviews
and
many
independent
health
services
as
well,
unless
they're
involved
in
the
booster
program.
I
remain
particularly
concerned
about
emergency
service
departments
and
ambulance
trusts.
They
continue
to
be
under
intense
pressure.
I
I
think
about
nearly
thirteen
thousand
were
waiting
more
than
12
hours
on
trolleys
in
emergency
departments
in
december,
after
a
decision
to
admit
before
they're
admitted
into
the
beds,
and
some
patients
were
waiting
way
longer
than
12
hours.
I
should
say
I
remember
that
12
hours
is
from
the
decision
to
admit
it's
not
from
the
time
they
arrive
at
the
emergency
department.
There
may
have
been
a
long
delay
before
the
decision
to
admit
there
may
have
been
a
long
delay
in
the
ambulance
before
they
got
into
the
emergency
department.
I
So
I
think
undoubtedly,
some
patients
are
suffering
really
very,
very
severe
delays
in
this
process
and
talking
to
frontline
clinicians
in
the
last
few
days.
It
is
clear
that
while
they
are
very
committed
to
providing
that
as
safe
care
as
possible,
despite
these
delays,
they
are
really
being
affected
by
seeing
some
of
the
the
patients
experience
that
they're
having
to
look
after-
and
I
you
know
again-
I've
paid
tribute
to
them
to
keep
things
going
under
the
most
difficult
circumstances.
I
It
has
really
been
a
pressure
on
staff
and
it's
really
having
an
impact
on
patients,
and
this
again
stresses
the
importance
of
urgent
emergency
care
pathways
being
redesigned
new
models
of
care
for
next
winter
and
again.
That
is
something
we
need
to.
We
need
to
focus
on
going
forward
in
our
regulatory
work
again,
the
pressures
on
emergency
care
is
having
knock-on
consequences
on
planned
and
elective
care.
B
Next,
yes,
please
peter.
Thank
you
very
much.
So
the
first
item
in
the
report
talks
about
the
work
that
our
medicines
team
are
doing
in
adult
social
care.
B
As
the
board
is
aware,
we
have
a
medicines
team
that
covers,
although
it
sits
in
primary
medical
services,
it
does
cover
all
of
the
different
sectors
that
we
regulate
across
the
cqc
and
they've
been
doing
some
great
work
to
look
at
how
we
can
improve
the
safety
of
medicine's
use
in,
in
particular,
in
adult
social
care,
and
so
the
report
outlines
the
work
they've
been
doing
there.
B
The
second
thing
I
just
want
to
talk
about
is
around
gp
practices
and
access.
As
the
board
is
aware,
we
discussed
at
a
previous
board
meeting
about
the
large
increase
we'd
had
from
from
people
using
services
and
particular
concerns
around
access
to
general
practice
and,
as
the
board
knows,
we
then
started
a
series
of
inspections
looking
at
access.
Specifically,
we
undertook
40
of
these
inspections
in
november
and
december,
and
we've
we've
currently
paused
them
for
the
due
to
the
vaccination
roll
out.
B
The
booster
program
that
had
happened
due
to
the
omicron
variant,
but
we
are
looking
at
how
we
can
restart
them
and
align
them
with
the
urgent
emergency
care
work,
given
the
vital
role
of
general
practice
in
the
urgent
emergency
care
pathway,
and
just
to
give
you
a
few
headlines
of
the
things
that
we
found
within
those
inspections,
none
of
the
reviews
of
the
locations
we
identified
any
current
issues
with
patient
access.
B
The
practices
we
were
visited
had
had
recognized
some
previous
problems,
but
had
taken
action
to
manage
them
and
improve
their
systems.
We
saw
a
lot
of
good
practice
in
the
practices
we
visited.
We
saw
practices
had
a
variety
of
ways
in
which
they'd
ensured
patients
who
were
vulnerable
or
digitally
excluded
were
supported
to
access
the
treatment
or
support
they
needed.
B
We
saw
a
rapid
increase
in
the
use
of
e-consultations
with
a
response
time
between
78
minutes,
which
I
think
is
is
is
very
impressive
to
up
to
48
hours,
which,
even
given
the
pressures
on
primary
care
at
the
moment,
I
think
is,
is
impressive
and
practices
had
re-structured
their
workload
and
appointed
extra
staff
to
be
able
to
deal
with
e-consultations.
B
We
find
a
small
number
of
should
recommendations
to
address,
for
example,
updating
practice
websites
to
look
at
reappointment,
appointment,
availabilities
and
practice
opening
times
and
some
issues
around
telephony
systems
and
reporting
in
telephony
systems.
I
think
one
of
the
key
things
we
found
is
that
practices
are
under
sustained
pressure.
B
We
found
staff
working
regularly
over
their
contracted
hours,
we
saw
staff
sickness
having
an
impact,
and
we
all
saw
the
so
saw
the
impact
of
the
isolation
self-isolation
on
practices.
B
So
I
think
just
to
reiterate,
ted's
ted's
point
there.
I
think
it
is
imperative
that
we
do
think
about
how
we
arrange
services
and
work
cross-system
to
look
at
new
models
of
care,
particularly
in
advance
of
next
winter,
but
I
know
that
the
pressure
is
still
very
sustained
and
very
high
on
all
of
our
sectors.
At
the
moment,
I
think
the
final
point
I
just
want
to
make
about
primary
care
is
that
there
is
a
significant
backlog
in
in
primary
care
services
as
well.
B
Now,
that's
not
quite
as
easy
to
to
quantify
as
with
waiting
lists
in
hospitals
or
some
of
the
other
services,
but
I
think
it
is
going
to
be
imperative
over
the
next
few
weeks
and
months
that
the
systems
really
understand
what
that
backlog
looks
like
in
their
primary
care
services
and
consider
how
they
address
those
going
forward.
Thank
you,
peter.
A
Oh,
thank
you
rosie,
I
mean
this
sort
of
next
stage
of
recovery
is,
is
just
so
important,
isn't
it
and,
and,
as
you
rightly
say,
it
is
looking
across
the
the
system
as
a
whole
to
be
able
to
do
that
right.
Nobody
else
wants
to
come
in
tyson.
L
Over
to
you,
thank
you.
Peter
kkk's
highlighted
the
work
we've
been
doing
since
the
last
board
on
on
our
plans
for
accelerating
adult
social
care
inspections
over
the
course
of
december
and
january.
So,
as
promised
in
my
in
my
written
report,
this
is
this
is
a
bit
of
an
update
before
I
give
the
update.
Can
I
thank
many
of
our
colleagues
so
many
of
our
colleagues
for
mobilizing
behind
this
priority,
not
just
from
adult
social
care,
but
also
from
primary
medical
services
and
and
the
hospitals
directorate.
L
It's
been
a
it's
been
a
great
cross-cqc
effort.
First,
on
designated
settings,
there
are
currently
48
services
who
are
operating
as
designated
settings.
We've
now
inspected,
all
of
those
and
those
will
provide
617
617
approved
beds
to
the
sector
on
inspection.
More
generally
across
adult
social
care.
We've
undertaken,
639
inspections
from
the
first
of
december
last
year
of
these
352
included
a
review
of
infection.
Protection
control
at
the
service
and
kate
talked
about
the
importance
of
the
these
types
of
inspections.
L
As
kate
said,
two
has
been
to
inspect
social
care
services,
where
we
believe
there
is
a
chance
that
in
doing
so,
additional
beds
would
be
added
to
the
sector,
what
we
call
improvement,
inspections
and
to
date,
we've
undertaken
18
of
those
improvement
inspections,
and
we
have
more
scheduled
for
the
rest
of
the
month
and,
more
generally
across
all
of
our
inspection
directorates
in
december
and
so
far
in
january.
L
Despite
the
decisions
we
took
before
christmas
to
change
our
operational
tempo,
which
ted
has
talked
about,
we
have
inspected
overall
867
services
of
which
442
442
were
in
relation
to
new
and
emerging
risk.
So,
although
there
has
been
the
christmas
new
year
period-
and
we
have
changed
our
operational
tempo
over
over
that
period
to
to
provide
support
to
the
vaccination
program,
there
has
been
a
lot
of
activity
underway
amongst
our
teams,
particularly
in
support
of
adult
social
care
and
particularly
in
response
to
risk.
L
I
think
the
plan
is,
for
chris
usher
to
update
the
board
more
generally
on
performance
peter,
but
that's
it
for
me
for
now.
A
It's
perhaps
tyson
the
the
appropriate
moment
for
the
board
just
to
to
acknowledge
the
huge
amount
of
work
that
our
colleagues
have
been
doing
right,
the
way
through
the
pandemic,
but
particularly
over
the
last
few
months-
and
I
mean
it's
been
exceptional
and
terrific.
A
M
Thanks
peter
yeah,
so
in
terms
of
performance
for
november
there's
a
few
areas
I'm
going
to
pull
out
and
talk
to,
I
thought
the
main
one
to
pull
out
was
regulated
activities.
We've
had
a
few
conversations
on
this
in
recent
months.
So
as
our
business
plan
as
per
business
plan,
we've
been
tracking
the
regulatory
activities
we've
undertaken
through
our
direct
monitoring
approach
and
inspections
for
the
year
to
date,
that
activity
is
16.5
of
regulated
services.
M
That's
at
the
service,
also,
where
we
receive
information
of
concern
through
safeguarding
whistleblowing
concerns
and
complaints.
We
have
regulatory
contact
with
those
services
if
you
factor
those
factoring
those
different
regulatory
approaches
in
means,
we've
actually
had
contact
with
67
of
services
this
year,
as
well
as
the
regulatory
contact
service
level.
We've
also
have
oversight
at
a
provider
level,
and
these
are
some
of
the
areas
that
I
think
you're
asking
around
in
the
last
board,
peter
so,
for
example,
in
hospitals,
inspectors
have
interactions
with
nhs
trusts
on
a
regular
basis.
M
A
M
A
If
I
hadn't
just
thanked
our
staff
with
through
in
response
to
tyson,
this
would
be
the
other
appropriate
moment
to
do
it.
I
mean
that's
a
that's
a
huge
amount
of
activity
and
a
really
important
activity.
So
thanks
chris.
M
Indeed-
and
I
think,
as
I
said-
I
mean
this-
reflects
that
for
our
going
forward
from
april,
we
just
need
to
really
reflect
the
breadth
of
work.
We're
doing
in
that
kpi.
Absolutely
yeah.
E
F
Oh,
that's
fine!
Thank
you,
peter,
and
thank
you
chris,
given
that
I
was
the
one
who
raised
that
point
at
the
last
board
meeting
because
it
was
14,
then
so
it's
already
increased,
but
it's
really
helpful
for
you
to
give
a
sense
of
how
much
work
we
do
behind
the
scenes
and
the
fact
that
two-thirds
of
the
people
we
regulate
have
had
contact
with
us
even
during
a
pandemic.
So
thank
you
for
all
of
that
detail.
F
I
just
thought
it
might
be
helpful
for
you
or
tyson
or
somebody
just
to
set
out
for
the
public.
What
happens
because
there's
another
detail
inside
the
report
which
talks
about
our
overall
interaction
with
providers,
but
our
specific
interaction
where
issues
of
concern
have
been
raised,
where
quite
a
significant
amount
of
those
people
who
we
go
to
see
are
then
rated
requires
improvement
or
inadequate.
F
Just
so,
people
don't
think
that
we
leave
it
there.
I
think
it
would
be
good
just
to
give
a
sense
of
what
happens
next
in
the
ex
in
the
inspection
cycle,
once
someone
has
been
given
a
requires,
improvement
or
worse
rating
and
the
fact
that
clearly,
we
don't
just
leave
that.
That's
probably
not
one
for
you
chris,
but
I
thought
it
might
just
be
helpful
to
give
that
broader
sense
of
not
only
how
many
people
we
have
contact
with,
but
what
we
then
do
proactively.
B
Thank
you
very
much
sally
and
a
really
important
point
because,
as
you
rightly
say,
when
we've
been
in
to
a
provider
that
is
struggling
and
gets
requires
improvement
or
an
inadequate
rating,
the
work
doesn't
stop
there.
Firstly,
all
of
the
recommendations
and
all
of
the
the
kind
of
concerns
we
have
about
those
practices
are
followed
up.
Those
providers
are
followed
up
depending
on
the.
B
The
level
of
concern
will
depend
on
the
time
scale
that
that
is,
but
certainly
any
particularly
any
enforcement
action
is,
is
followed
up
to
make
sure
that
the
improvements
have
occurred.
There's
also
a
wide
range
of
conversations,
usually
with
the
stake,
other
stakeholders.
B
So,
for
example,
in
general
practice,
we
would
be
working
closely
with
clinical
commissioning
groups
and
other
parties
to
make
sure
that
they
are
aware
of
the
issues
and
that
support
is
given
into
those
providers
as
well,
and
then
all
of
all
of
these
providers
that
are
particularly
the
inadequate
providers,
will
be
re-inspected,
while
all
of
the
requires
improvement
ones
will
be
as
well,
but
as
well
as
the
ongoing
monitoring,
there
will
be
a
further
inspection
to
to
make
sure
that
improvements
have
happened.
B
So
there
is
a
huge
amount
of
work
once
once.
We've
identified
concerns
in
a
provider
and
just
to
give
you
the
assurance
that
those
are
followed
up
and
we
continue
to
follow
them
up.
M
I
Well,
rose's
really
covered
it
all,
but
but
I
mean
sally
we,
the
the
rating,
is
not
the
end
of
the
story.
It's
the
beginning
of
the
story
in
many
ways,
because
it
triggers
enforcement
action,
it
triggers
monitoring
and
follow-up.
It
triggers
me
working
with
other
parts
of
the
system
to
give
support
to
the
provider
and
it
will
trigger
follow-up
inspections
against
a
very,
very
clear
timetable
during
which
we
expect
improvement
to
take
place.
So
I
think
inspection
triggers
the
regulatory
activity.
It
is
not
the
end
of
the
regulatory
activity.
A
Thanks
ted
and
kate,
you
were
nodding,
so
I
think
you
know
exactly
the
same
in
in
adult
social
care.
M
Yeah,
I
mean
just
plain
exactly
to
sally's
point:
I
mean
we
monitor
the
outcome
of
inspections
where
we've
inspected
due
to
risk
over
the
last
few
months.
We
have
noticed
this
is
starting
to
increase
in
some
reasons.
So,
for
example,
this
financial
year
56
of
risk
inspections
are
inadequate
or
requires
improvement,
but
in
certain
regions
we're
seeing
that
as
high
as
66
percent.
M
So
two
out
of
three
inspections
are
required
in
in
requires
improvement
or
adequate,
but
that
kind
of
a
something
that
we've
just
just
recently
started
to
see
as
a
trend,
so
we'll
explore
that
further
and
bring
that
to
board
next
month
and
provide
further
information
on
in
registration.
M
We've
got
continuing
good
trends,
so
simple,
a
normal
registration
applications
have
been
processed
in
13.2
and
11.4
reduction
respectively,
which
is
tracking
wealth
for
15
reduction
target
this
year,
and
also
in
just
in
terms
of
sheer
work.
We've
got
through
this
year.
Registration
colleagues
have
completed
and
processed
nearly
23
000
rep
registration
applications.
M
So
another
example
of
kind
of
the
the
workload
that
we
managed
to
get
through
as
an
organization
and
then
the
last
bit.
For
me,
just
in
terms
of
finances,
underspent,
year-to-date
with
nine
and
a
half
million
on
revenue,
this
forecast
is
unchanged
from
last
month,
we're
predicting
that
will
be
11.3
by
the
end
of
the
year
and
on
our
capital
budget
with
2.9
million
under
spent,
and
this
is
forecast
to
reduce
to
0.1
million
by
the
end
of
the
year.
So
nearly
on
budget
good.
Thank
you
chris.
M
It's
me
again,
but
yes,
just
yeah.
D
M
I'll
go
again
a
couple
of
bits
that
kirsty
would
normally
have
updated
on.
So
in
terms
of
our
mental
health
and
well-being
strategy.
The
july
pulsar,
a
pulse
survey,
evidenced
a
high
awareness
of
mental
health
and
well-being
resources,
but
lower
usage
than
we
expect
and
brought
out
inconsistencies
in
in
people
feeling
supported.
M
We
are
now
reviewing
our
pathway
to
our
resources
and
how
to
embed
more
effective
use,
we'll
review
the
outcomes
with
the
aim
of
agreeing
some
actions
for
implementation
early
in
the
financial
year
next
financial
year
on
talent,
we
have
32
colleagues
enrolled
to
start
their
level
three
or
level
five
management,
apprenticeships
and
we've
recently
had
three
candidates
join
us
as
part
of
our
first
digital
digital
graduate
programme
and
lastly,
on
our
people
pulse
survey
closed
on
the
7th
of
december.
The
survey
received
2211
responses,
which
is
73
participation.
M
Those
result
results
have
just
been
analyzed
and
working.
Their
way
through
internally
were
provided,
update
to
board
in
february
and
kpis
will
be
updated
accordingly.
That's
it
from
me.
G
Thanks
chairman
thanks
chris
for
that
report,
just
looking
at
the
people
plan,
I
mean
certainly
very
good
news
about
digital
graduate
recruitment
and
management.
Apprenticeships,
so
well
done
to
the
organization
in
moving
that
forward,
just
in
terms
of
the
well-being
pathway
that
you
refer
to
and
the
inconsistencies.
G
M
So
I
think
that's
that's
a
plan
for
later
in
the
year
with
regards
to
the
hr
systems.
It's
not
something
that
we're
actively
looking
to
procure
just
yet
we'll
revisit
that
later
in
the
year,
but
I'm
sure
this
would
form
part
of
the
plans
for
that
system
when
it
when
it
comes
on.
I
were
picking
that
up
later
in
the
financial
year
for
the
hr
system,.
G
Sorry,
chris,
I
thought
we
were
further
along
than
that,
but
certainly
then
my
point
is.
I
hope
that
we're
looking
at
a
system
whereby
we
can
track
those
pathways
effectively
and
efficiently
without
having
to
dig
through
loads
of
piles
of
paperwork.
M
G
A
I'm
sure
it
was
anyway,
okay,
thanks
chris,
very
much
and
thanks
for
stepping
into
the
breach
with
kirsty's
absence
mark
sutton,
I'm
hoping
we
get
a
new
cyber
security
risk
report
from.
N
You,
yes,
absolutely
peter,
just
a
short
update
on
this
from
me,
so
no
significant
informational
cyber
security
issues
to
report
in
the
last
month,
but
it
did
just
want
to
close
the
loop
on
the
the
global
security
vulnerability
that
was
raised
in
the
last
month.
N
This
is
known
as
apache
log
4j
and
just
let
you
know
that
we've
we've
completed
all
of
our
activity
at
review
and
remediation
work
that
was
needed
to
make
sure
that
cqc
were
protected,
but
I
think
probably
worth
noting
that
you
know,
as
as
we
know,
the
work
on
cybersecurity
never
ends,
and
our
ongoing
program
of
continuous
improvement
is
is
continuing
and
progressing
well,
and
that
includes
you
know
recently
reviewing
our
information
security
policies,
our
capability
of
our
security
operations
centre
and
we're
also
reviewing
and
updating
our
training
offering
for
the
organization
as
a
whole,
perfect
mark.
O
Yeah
three
quick
points
for
me.
The
first
in
the
report
you'll
see
this
this
week.
It
links
something
that
we've
said
in
the
mental
health.
That
report
we've
been
concerned
about
the
quality
of
ethnicity,
coding
from
mental
health
services,
and
we
found
substantially
very
important
patients
whose
ethnicity
is
not
recorded
or
not
known
or
not
stated.
O
It
varies
across
ics's
from
five
percent
to
around
about
one
in
three
in
some
areas.
Obviously,
we've
talked
earlier
on
about
the
importance
of
this
this.
This
recording
this
information.
O
It's
part
of
local
demography,
it's
part
of
us
as
understanding
how
services
need
to
respond
to
people
well,
poor,
recording
of
this
data
and
an
over
reliance
on
general
categorizations.
We
think
it's
a
real
problem,
so
we've
raised
this.
You
want
to
assure
the
board
we've
raised
this
concern
with
providers
and
with
other
organizations
responsible
for
both
the
completion
of
this
and
the
use
of
this
data
elsewhere
and
we'll
continue
to
to
reflect
what
we
said
in
state
of
care
in
a
mental
health
report
in
future
pieces
of
work.
O
The
second
area
again
something
already
mentioned
today,
the
because
we
all
care
campaign.
So
today
sees
the
return
and
the
the
launch
of
this
year's,
because
we
all
care
campaign
encouraging
people
to
speak
up
and
give
their
feedback
about
their
loved
ones
in
care,
and
obviously
people
have
different
experiences
of
care
and
we
want
to
make
sure
we
capture
all
those
to
support
our
regulation
of
services.
They'll
refer
back
to
what
we
said
earlier,
what
kate
said
in
their
interviews
this
morning?
O
This
is
this
information
that
is
used
well
to
describe
and
to
inform
how
we
see,
services
operating
and
the
campaign
itself
tries
to
target
groups
that
we
often
where
we
might
receive
fewer
fewer
bits
of
feedback
from
so
the
audiences
are
particularly
targeting
around
carers,
people
with
long-term
conditions,
people
aged
over
55
people
from
the
bme
background,
and
we
have
spikes
of
campaign
that
run
over
the
course
of
the
year.
O
Just
to
give
you
a
few,
a
few
stats
on
this
year's
campaign
we've
seen
a
remarkable
uplift
in
in
the
volume
of
information
we've
received,
a
62
increase
on
information.
We've
we've
reached
over
just
those
are
interested
in
sort
of
the
web
stats
on
this
we've
had
10.,
8
million
reaches
with
the
with
the,
because
we
won't
care
hashtag.
O
We've
had
an
organic
growth
in
social
media
of
50.4
million
results
of
this
we've
had
over
half
a
million
elements
of
social
media
engagement
on
this
and
and
additional
to
that
we've
had
about
just
over
750
media
mentions
of
of
the
the
campaign
in
the
last
year,
and
the
the
other
thing
to
mention
as
well
is
that
this
is
it's
a
it's
a
good
campaign
there's
so
many
people
across
the.
O
For
a
pr
week
in
the
best
use
of
social
media
and
it's
up
against
private
sector
organizations
who
use
this,
it's
not
a
it's,
not
a
public
sector
campaign,
it's
a
it's
a
national,
it's
a
national
award,
so
I'm
really
proud
of
the
team
and
what
we've
achieved
with
that.
There
is
much
more
to
do
in
the
next.
In
the
next
campaign,
we've
got
a
number
of
areas
of
focus
for
this
year
for
this.
O
For
this
next
year,
starting
with
the
campaign
launch
today,
we're
going
to
focus
on
carers,
we're
going
to
focus
on
people
long-term
conditions,
we've
got
focus
on
their
55s.
We've
got
a
focus
on
people
with
learning
disabilities
and
I'm
hoping
that
we
can
continue
to
build
on
the
success
of
the
campaign
last
year.
Finally,
just
on
the
maternity
that
we've
got,
the
return
service
survey
coming
out
shortly,
just
to
give
the
board
an
early
bit
of
insight.
O
The
survey
online,
as
well
as
as
well
as
offline
and
we've
seen
a
substantial
increase
in
response
rate
generally
and
particularly
from
women
who
describe
themselves
as
asian,
asian,
british
or
or
muslim
those
those
response
rates
have,
in
some
cases,
almost
doubled,
which
I
think
suggests
that
the
new
methodology,
encouraging
women
from
different
demographics,
to
give
their
feedback
in
different
ways
is
having
an
impact
this
this,
the
actual
report
itself,
will
come
at
the
next
board
meeting,
but
I
wanted
to
give
colleagues
insurance
that
we
we
we've
made
some
improvements
in
the
way
that
we
we
target
people
from
different
groups
in
that
survey.
A
Great
thanks
chris
and
again
huge
volume
of
of
of
work
going
on
robert
francis.
D
Thank
you.
I
just
wanted
to
add
the
comment
from
a
health
watch
perspective
about
the
because
we
all
care
campaign
because
it's
been
a
part,
a
really
productive
partnership,
and
I
just
want
to
emphasize
how
vital
is
the
information
that's
been
coming
in
through
that
it
informs
not
just
cqc's
work,
but
also
ours
as
well,
and
I
think
the
two-pronged
approach
is
quite
useful
here
and
a
good
example
of
how
probably
healthwatch
and
cqc
could
can
complement
each
other.
O
Agree.
Robert
sorry,
I
should
have
mentioned
that
this
part
has
been
a
really
strong
partnership
between
healthwatch
and
and
cqc,
and
there's
been
a
number
of
organizations
that
provided
real
support,
but
I
think
the
partnership
that
we've
had
together
to
deliver
this
work
has
been
fantastic.
So
the
the
appraised
goes
equally
to
your
team
as
it
as
it
does,
as
it
does
mine
in
terms
of
what
we've
managed
to
achieve.
A
Great
thanks
robert
thanks
thanks
chris,
and
I
think
that
that
that's
the
end
of
the
et
report
so
can
I
can
I
thank
our
auditi
colleagues.
Can
I
now
welcome
merry
christ
who's
joined
us
and
kate?
I
expect
you
want
to
introduce
the
close
cultures
report.
K
Fabulous,
thank
you.
Everyone
welcome
mary,
so
this
is
the
last
in
a
series
of
updates
that
board
have
had
on
our
work
on
close
cultures,
and
this
is
a
kind
of
comprehensive
program.
That's
been
going
on
for
a
couple
of
years
now,
so
the
program
is
formally
drawing
to
a
close.
There
are
some
outstanding
actions
that
will
get
locked
into
other
programs
like
our
single
assessment
framework,
our
our
reg
reg
model,
etc,
and
we
will
continue
to
talk
with
board
about
the
ongoing
work
around
our
out
of
sight.
K
Who
cares
report
that
we
published,
maybe
18
months
ago
so
board
will
continue
to
hear
our
activity
as
a
result
of
close
cultures,
but
the
program
is
formally
drawing
to
a
close
now,
and
this
is
a
kind
of
a
a
chance
to
kind
of
reflect
on,
what's
been
achieved,
while
noting
there's
a
few
outstanding
things
that
will
be
taken
forward.
So
before
I
hand
over
to
mary,
if
I
can
just
say,
there's
been
a
huge
amount
of
colleagues
involved
in
this
work
from
across
the
organization.
K
But
it's
under
kind
of
mary's
leadership,
mary
managed
to
wrestle
a
huge
number
of
recommendations
from
david,
noble
and
from
glynis
murphy,
into
something,
with
a
really
concrete
plan
and
time
frames
and-
and
I
hope
board
would
agree
that
a
lot
has
been
delivered
while
recognizing
that
we
will
not
let
this
go,
because
this
is
one
of
the
most
important
things
we
need
to
do
to
be
an
effective
regulator.
So
it's
not
over,
but
it's
a
chance
to
hopefully
catch
our
breath
and
say
thanks
and
and
well
done
to
the
team.
P
Thank
you
very
much,
kate
and
good
afternoon
everyone.
So
the
paper
that
I
have
prepared
for
today
is
really,
as
kate
says,
a
sort
of
summary
of
our
ambitions,
our
achievements
and
pointers
to
the
way
ahead.
Thank
you
for
your
kind
words,
kate,
but
this
has
been
a
team
effort.
There's
been
a
lot
of
individual
and
collective
effort
right
across
the
organization
that
has
inspired
me
along
the
way.
P
So
it's
a
great
thing
to
be
part
of
there's
a
detail,
more
detailed
update
on
glenis
murphy's
recommendation
in
the
appendix
I.
I
won't
go
into
too
much
detail
on
that,
but
I
did
just
want
to
acknowledge
that
this
work
was
kicked
off
by
our
late
and
much-missed
colleague,
ursula
gallagher,
and
she
passed
it
on
to
me
in
about
spring
2020,
with
some
very
wise
words
which
have
stayed
with
me.
P
So
I
just
wanted
to
say
ursula's
name
in
this
meeting
to
acknowledge
that
she
she
kicked
it
off
so
underway
since
2019,
and
just
a
reminder
that
we're
talking
about
cultures,
where
there
is
a
higher
risk
of
poor
care
and
abuse.
P
But
we
know
that
what
we've
learned
through
this
and
the
advances
we've
made
are
applicable
right
across
all
the
services
that
we
regulate
and
we
know
there
are
other
places
where
close
culture
that
are
particularly
vulnerable
to
the
development
of
a
closed
culture.
Services
for
people
with
dementia
and
maternity
services
would
be
two
that
I
would
name.
P
So
our
ambition
was
to
be
more
aware
to
improve
our
ability
to
detect,
to
be
able
to
prevent
and
then
to
be
able
to
improve
and
where
improvement,
couldn't
happen
and
couldn't
be
sustained,
then
to
help
those
providers
off
the
pitch,
because
that's
what
we're
about
isn't
it?
The
second
page
of
my
paper
is
something
of
a
chronology
that
just
shows
that
way.
Back
in
2014
a
program
of
inspection
of
services
for
people
with
a
learning
disability
started
in
2018.
P
And,
coincidentally,
just
as
the
interim
report
on
that
published,
we
had
the
panorama
program
focusing
on
walton
hall,
so
on
the
back
of
that
swift
action
to
get
two
independent
reviews,
and
so
david
david,
noble
and
professor
guinness
murphy,
working
with
them
and
their
recommendations
have
really
formed
the
basis
of
our
our
whole
project.
P
But
the
key
part
of
the
whole
thing
taking
those
recommendations
as
the
framework
and
all
that
had
gone
before,
has
really
been
the
work
that
we've
done
with
our
internal
and
external
advisory
groups,
the
external
group
being
combined
of
providers.
Commissioners,
other
regulators,
but
chiefly
majority,
made
up
of
of
people
with
direct
experience
and
their
families
and
carers,
and
it
has
been
their
input
that
has
entirely
shaped
our
view
on
priorities,
the
ordering
of
our
our
actions
and
so
on.
P
We
had
the
pandemic
hit
during
all
this.
As
well-
and
we
know-
and
there's
a
reference
in
the
paper
to
the
other
report,
about
the
evidence
of
how
that
has
disproportionately
affected
people
with
a
learning
disability,
as
indeed
does
so
much
else,
so
we
focused
our
attention
for
improvement
on
four
key
areas
that
we
listed
here.
We
wanted
better
data
on
people's
experiences,
which,
and
chris
has
touched
on
some
of
the
work
in
that
area.
P
We
wanted
to
have
a
look
at
our
observation.
What
how
what
were
we
doing
to
look
at
culture?
We
wanted
to
look
at
training
all
the
reports
looking
at
this
had
referenced
better
support
for
inspectors,
so
you
know
we
didn't
just
want
inspectors
to
sit
there
and
a
whole
load
of
data
pour
over
their
heads.
We
needed
to
get
this
handled
in
a
way
that
would
help
identify
risk
that
would
help
us
predict
that
risk
and
put
early
morning
flags
up
and,
as
professor
murphy
noted,
we
were
seriously
lacking
in
research
in
this
area.
P
I
would
like
to
think
and
and
hope
I
have
conveyed
in
this
report,
that
our
understanding
our
approach,
our
readiness,
is
transformed
through
the
work
of
this
project.
The
impact
that
we're
having
is
improving,
but
it's
it's
never
going
to
be
done.
So
that's
still
a
work
in
progress.
P
We
have
such
so
much
better
on
our
intelligence,
collection
and
analysis,
and
at
the
end
of
last
year
we
launched
the
new
dashboard
with
a
set
of
indicators,
so
inspectors
can
see
which
services
are
triggering
the
the
factors
that
we
learned
through
walton
hall
and
other
work
that
that
we
need
to
be
concerned
about
and
also
the
absence
of
information,
so
that
that
is
much
that
so
as
an
inspectors
are
much
better
equipped
with
that
information
and
how
to
make
sense
of
it
and
obviously
we'll
be
evaluating
that
as
we
go
forward.
P
P
There
is
no
substitute
for
being
in
a
place
to
observe
how
care
is
is
given
how
people
are
experiencing
that
care
and
living
their
lives
and
important
factors
like
observing
how
staff
teach
talk
to
each
other.
Lack
of
courtesy
between
colleagues
in
a
service
is,
is
one
of
those
indicators
and
hard
to
see
that
from
a
set
of
minutes.
So
the
combination
of
this
enhanced
intelligence
and
on-site
presence
talking
to
people
receiving
the
service
talking
to
their
visitors,
talking
to
staff
working
in
that
service,
all
very
important.
P
Our
training
has
been
transformed
and
is
now
part
of
the
mandatory
offer
over
2000
colleagues
have
gone
through
that
training.
A
further
1400
have
gone
through
additional
training
about
how
to
how
to
be
a
great
regulator
in
a
service
where
people
who
autistic
people
are
receiving
a
service
and
over
70
of
our
staff
are
telling
us
of
their
increased
understanding
and
awareness
of
close
cultures.
P
So,
overall
we
are.
We
are
confident
that
we've
improved
our
ability
on
all
all
areas
of
our
ambition
and
the
fact
that
we
now
in
the
in
have
a
director
level
post
that
that
focuses
on
these
services
means
there's.
We
will
continue
to
have
oversight
of
the
agenda
and
its
mission
embed
it
and
keep
learning
and
extend
it
further.
We're
clear
the
work
the
work
doesn't
stop
here.
P
It's
always
going
to
be
a
priority
for
us,
but
as
we
reach
the
end
of
this
stage
of
the
project,
I
I
think
we
can
be
pleased
with
where
we've
got
to,
but
there's
no
resting
on
laurels.
There's,
there's
so
much
more
to
do
to
make
sure
it
lands
really
well
and
survives
and
thrives
in
in
the
next
stage
of
our
of
our
history.
E
Thank
you
peter,
and,
and
first
I
mean
huge,
huge
congratulations
to
mary
to
to
kate
and
the
team.
This
has
been
such
important
work
and
I
think
you
should
be
really
proud
of
of
this
report,
demonstrating
what
you've
achieved
through
through
the
work
that
you've
done
the
the
one
bit
I
wanted
to
pick
up.
It's
it's
recommendation,
six,
which
is
page
90
of
the
pack,
and
it's
the
one
about
registration,
because
I
was
very
struck
by
what
you
were
saying
mary.
That
kind
of
a
lot
of
this
is
about
things.
E
You
can
only
pick
up
through
observation
through
being
there
through
getting
the
feel
of
the
place
and
kind
of
by
definition.
You
can't
do
that
at
the
point
of
registration,
so
I'm
interested
in
kind
of.
Are
you
confident
that
you
can
head
off
at
the
pass
people
seeking
new
provider
registration
who
might
become
closed
cultures?
P
Yes,
indeed,
but
through
the
particular
lens
of
learning
disability
services,
there
are
established
principles
around
models
of
care
that
we
have
ourselves
set
out.
So
we
are
talking
about
places
where
people
are
going
to
live
home,
that
their
home,
so
any
provider
coming
forward
with
what
looks
like
a
traditional
hospital
model.
P
You
know
high
numbers
of
beds,
people
shoved
together-
that
that
isn't
what
we
want.
So
there's
conversations
and
education
at
that
stage,
but
we
have
gone
to
the
wire
with
some
services
and
we
have
refused
and
we've
we've
had
other
providers
where
it
hasn't
got
to
that
final
stage.
But
they've
backed
down
reassessed
changed
their
plans,
but
it
is
an
area
that
we'll
always
need
to
watch.
P
There
is
we're
noticing,
a
trend
of
some
providers
getting
registered,
not
appearing
to
be
a
service
for
people
with
learning
disabilities,
then
seeking
to
add
it
later
so
and
that
that's
a
trickier
area
legally
for
us,
but
our
debbie,
even
over
my
colleague,
who
is
focused
entirely
on
on
services
for
people
with
a
learning
disability,
is
on
to
that
and
working
with
registrations
to
try
and
call
well
what
I
call
sneaking
around
the
back
we'd
much.
Rather
that
people
were
absolutely
clear
and
open
about
what
services
they're
intending
to
provide.
P
A
Thanks
mark
something.
N
Thank
you.
I
just
wanted
to
come
in
and
reinforce
a
bit
of
what
you
said
there
mary
about
the
closed
culture
of
ball,
which
is
the
dashboard
which
was
delivered
recently.
N
N
Great
thanks,
belinda.
Q
I've
got
a
couple
of
questions,
so
the
first
one
is
really
what
risks
do
you
think
there's
to
the
project
as
it
winds
down,
and
the
second
question
is
the
bespoke
dashboard
for
learning
disabilities
and
autism.
We've
already
mentioned
that
you
know
close
cultures
can
exist
in
dementia
care
and
maternity
services
and
whether
it's
similar
dashboard
bespoke
dashboard
could
be
created
for
those
services
as
well.
P
Mary,
I
did
thank
you-
I
was
just
mark,
can't
see,
but
I'm
looking
at
him
with
a
second
question
but
anyway,
so
the
risks
well,
as
with
all
closure
of
projects,
there's
a
risk
of
that
loss
of
attention
and
focus.
P
But
we
do
have
the
project
disciplines
which
require
owners
and
safe
landings
for
things
still
in
progress,
but
I
think
going
forward.
The
keeper
of
the
keys
in
my
head
is
definitely
the
regulatory
leadership
function.
There's
a
director
post
in
there
focused
on
services
for
people
learning
disabilities.
So
I
think
that
will
be
the
place
and
I
think
there's
some
work
to
do
to
think
about
how
best
to
continue
to
roll
this
out,
to
widen
it
across
sectors
and
so
on.
P
But
the
lessons
from
closed
cultures
are
very
well
understood
in
the
development
of
the
regulatory
model.
People
from
those
teams
have
been
sat
on
the
close
cultures
board
and
it's
it's
been
working
sort
of
going
along
step.
You
know
hand
in
hand
as
it
were
really,
rather
than
a
separate
piece
of
work,
which
is
good.
I
think
the
concept
of
silence
services
is
something
we
increasingly
understand.
We
need
to
build
that
in
as
well.
P
We
know
we're
progressing
our
our
preparations
for
surveillance,
so
there
are
still
some
some
big
meaty
pieces
of
work,
the
research
that
we
have
commissioned.
This
is
glenn
glynis,
murphy,
saying
there's
not
a
lot
of
research.
I've
reported
before
that.
P
Our
research
and
evaluation
committee
proposed
research
to
the
department
of
health
which
has
been
commissioned
and
there's
a
unit
underway
working
on
that,
as
we
speak,
made
up
of
a
collaboration
of
the
universities
of
oxford
kent
and
the
london
school
of
tropical
medicine,
so
that
they
they
will
continue
to
engage
with
us
and
as
that
research
commences,
that
will
keep
it
in
the
forefront
of
cqc's,
mind
and
attention,
and
I've
mentioned
already
the
aspiration
to
to
expand
it.
P
There's
also,
I
think
what
we
haven't
given
particular
focus
to,
but
recognizing
who's
after
me
on
the
agenda
is
the
connection
with
freedom
to
speak
up,
because
a
strong
speak-up
culture
is
one
of
the
best
preventative
measures
for
for
against
the
risk
of
a
close
culture
developing.
So
as
we
continue
to
look
at
that.
R
P
Our
assessment
framework
going
forward
there's
a
synergy
to
some
of
this,
which
will
help
it
and
I'd
also
say
we
need
to
stress
test
everything.
We
do
designing
our
organization,
our
own
policies
and
procedures
and
the
way
we
go
about
our
regulatory
role.
We
need
to
stress
test
it
test
it
against
the
lessons
we've
learned
through
glynic
smurfy
and
david
noble,
to
make
sure
that
we're
as
much
guarding
you
know
we're
leading
by
example,
as
we
always
aspire
to
do.
So.
P
That's
a
long
answer
to
your
question,
but
I
hope
that
covers
the
points
in
terms
of
when
we
might
further
the
dashboard
to
other
services.
I
think
that
would
require
a
new
workup
of
an
ask
and
we'd
have
to
get
in
the
queue
with
other
things
on
the
development
of
the
reg
platform.
But
just
what
I
know
if
that
works
so
far
is
going
to
make
it
so
much
easier
to
avoid
rabbit
holes
down
which
information
can
disappear.
P
A
Thanks
mary
sally.
F
Thanks
peter
and
thanks
mary
to
you
and
your
team,
for
I
know
such
an
extensive
piece
of
work
over
a
long
time,
we've
seen
it
two
or
three
times
at
audit
as
well
reporting
back.
So
I
know
how
much
hard
work's
gone
into
the
recommendations.
F
I
think
you
and
belinda
may
well
have
covered
the
point
I
wanted
to
make
which
is
not
is
about
not
necessarily
winding
this
project
down,
but
thinking
about
what
we've
learned
and
how
we
can
apply
it
elsewhere
in
cqc,
because
there'll
be
other
areas
of
practice.
Right
now,
belinda
mentioned
dementia
and
maternity
services,
but
our
review
of
mental
health
act.
A
So
I
think
that's
that's
quite
a
good
point
to
end
on
sally.
You
think
that
oh
I
was,
I
thought
something
else
was
trying
to
come
in
yeah
I
I
was
right
mark
you
wanted
a
chambers
just
quickly
outside
wind,
it
up
yeah,
sorry
to
to
to
come.
H
In
right
at
the
end,
but
it
was,
it
was
just
to
reinforce
those
messages
about.
H
You
know
the
the
importance
of
speak
up
and
to
emphasize,
and
perhaps
a
quick
call
out,
for
you
know
that
for
the
national
guardian
on
this,
who
has
who
recognizes
that
there
are
best
practices
and
learnings
way
beyond
our
sector
that
that
are
worth
drawing
on.
You
know
lots
of
there's
a
vast
amount
of
work
out
there
on
culture
and
what
influences
culture.
There
are
many
sophisticated
corporates
that
are
using
behavioral
psychologists
to
help
nudge
and
influence
their
their
culture
work.
H
I
think
the
national
guardian
does
a
great
job
of
tapping
into
this
through
their
pan
sector
network,
but
you
know
we.
We
simply
need
to
have
the
the
same
desire
to
learn
from
the
widest
possible
group
of
sectors
that
that
we
can
so
a
quick
call
out
for
that.
A
So
the
national
guardian
is
in
the
meeting
and
will
have
heard
all
of
that
and
we'll
we'll
respond
or
not
she
wishes.
But
I
I
was
just
gonna
get
again
to
say
mary.
I
think
where,
where
where,
where
sally
got
us
was
to
say
that
there's
a
lot
of
work
that
needs
to
go
on
and
we
need
to
make
sure-
and
you
were
saying
this
yourself-
we
need
to
make
sure
the
various
actions
get
properly
embedded
in
in
in
work
streams
that
continue
and
the
board
will
want
to.
A
You
know
see
it
coming
back
at
some
point,
and
you
said
the
work
is
never
done.
That
may
be
true,
but
I
think
we
need
to
definitely
see
lots
of
progress
as
we
go
along
one
thing
which
I
think
is
done
and
I'd
like
the
board
to
agree.
A
I
think
we
can
say
that
we
have
actioned
all
the
actions
that
come
out
of
both
david
noble's
initial
report
and
then
the
two
reports
from
from
guinness,
that's
not
to
say
that
that
there
is
more
work
to
to
be
done,
but
the
actual
specific
recommendations
have
been
actioned.
A
So
we
can
sort
of
say
that
positively
close
down
the
reports,
but
then
there's
lots
of
work
activity,
work
streams
that
are
embedded
in
ongoing
work
streams
that
this
board
will
want
to
keep
an
eye
on,
and
excuse
me
I
I
just
at
this
moment
mary,
your
job's,
not
done
but
mary.
Thank
you
very
much
for
the
work
you
have
been
doing
and
I'm
very
glad
you
mentioned
ursula's
name
in
this
board
at
the
start,
because,
as
you
say,
she
she
kicked
this
off.
A
Excuse
me,
but
mary.
Thank
you
very
much
indeed.
Thank
you.
Thanks
bye.
Excuse
me
so
jane
you've
been
you.
You
you've
been
mentioned,
your
your
your!
Your
reputation
precedes
you,
but
as
a
result,
but
I
particularly
want
to
welcome
dr
j
jane
gigi
clark,
who
is
the
new
national
guardian?
A
R
Thank
you
very
much
chair
and
thank
you,
colleagues.
It
is
an
absolute
privilege
to
be
appointed
as
the
national
guardian
and
I'm
following
in
in
in
footsteps,
which
I
hope
I
can
live
up
to
for
those
of
you
who
don't
know
me
know
my
background.
I'm
a
nurse
by
background.
In
fact,
hearing
ursula's
name
mentioned
ursula
was
two
years
ahead
of
me
at
university.
R
So
I
knew
her
well
and
you
know:
we've
kept
in
contact
over
the
years
and
so
to
hear
that
today
was
was
was
very
heartwarming
and
she
did
so
much
good.
I
think
as
well
just
hearing
that
discussion
absolutely
mark.
As
you
said,
the
plan
sector
network
is
really
key
and
absolutely
one
of
my
commitments
will
be
to
continue
to
engage
with
the
pan
sector
network
to
bring
that
learning
back
into
what
we
do
within
the
nhs
and
obviously
as
we
go
into
social
care.
R
But
more
of
that
in
a
moment
I've
been
given
about
a
10-minute
slot
with
you
and
I
won't
take
it
all
up
just
in
case
you
have
some
questions
today,
but
I
will
be
coming
regularly
to
board.
So
this
is
not
the
only
opportunity,
and
I
shall
look
forward
very
much
to
engaging
with
you
on
this
important
agenda,
because
I
know
how
supportive
the
cqc
is
of
this
agenda
so
as
a
registered
nurse
and
a
senior
leader
in
healthcare
and
as
a
freedom
to
speak
up
guardian
myself
in
a
previous
existence.
R
This
agenda
is
obviously
absolutely
key
to
to
what
I
do
and
why
I
wanted
to
become
the
next
national
guardian.
What
I'm
going
to
do
is
just
speak
very
briefly
about
a
bit
of
background
in
case
there
is
anybody
on
the
call
today
either
members
of
the
public
or
anyone
who
wants
a
very
short
reminder
of
what
the
national
guardian
and
the
national
guardian
office
does
then
talk
a
bit
about
our
current
priorities
and
then
a
bit
of
a
further
future
look
so
in
three
short
parts.
R
Substantial
progress
has
been
made
to
embed
freedom
to
speak
up
into
a
range
of
our
systems
and
processes
across
the
health
sector
and
the
freedom
to
speak
up
guardian
network
has
grown
in
both
number
and
diversity.
In
a
way,
maybe
we
couldn't
have
originally
predicted,
since
the
last
update
that
dr
henrietta
hughes
brought
to
board
back
in
june
last
year.
R
There
are
now
over
800
guardians
in
over
500
different
organizations
and
they've
handled
more
than
50
000
cases,
amplifying
the
voices
of
those
who
might
not
otherwise
be
heard,
and
around
half
of
the
network
still
supports
nhs
trusts.
But
you
may
be
interested
to
know
that
over
40
percent
support
other
providers
than
nhs
trusts
and
10
supporting
organizations
such
as
arms
length
bodies
like
yourselves
as
the
cqc
nhs
england,
health,
education,
england,
etc,
and
we
have
training,
support
and
guidance,
and
this
thriving
network
of
peer-to-peer
support
for
our
freedom
to
speak
up.
R
Guardians
and
workers
have
spoken
up
about
a
range
of
issues,
including
patient
safety,
worker
safety,
bullying
and
harassment,
as
well
as
improvements
to
services
as
well,
and
workers
are
utilizing
the
support
of
their
guardians
and
providing
really
positive
feedback
over
55
000
cases
that
have
been
handling
and
over
80
people
who
come
and
bring
an
issue
to
a
guardian
say
they
would
use
that
service
again.
So
that
is
a
great
position
to
be
landing
in
this
role
in,
however,
there
is
still
as
as
as
mary
said
previously,
with
the
work
that
she's
been
doing.
R
This
will
never
be
complete.
There
is
so
much
more
to
do
just
want
to
do
a
quick
shout
out
regarding
speak
up
month
back
in
october
every
year
we
have
a
freedom
to
speak
up
month,
and
I
just
want
to
call
out
to
the
support
from
cqc
leaders
to
that
we've
had
a
big
awareness
raising
process
which
included
workshops
mark
you,
you
hosted
a
a
live
event.
R
Thank
you
very
very
much
indeed,
many
of
you
as
leaders
took
speak
up
pledges,
which
is
a
really
key
part
of
the
campaign
and
we
actually
had
over
over
6
000
people
completing
the
training
during
that
month
and
many
many
pledges
that
were
made,
including
from
much
many
of
our
senior
leaders.
So
thank
you
for
that
and
we'll
be
looking
again
to
that
this
coming
year,
but
for
the
immediate
future,
we're
working
very
closely
with
nhs,
england
and
improvement
on
revising
the
freedom
to
speak
up
guidance.
R
That's
out
in
the
nhs
at
the
moment,
there's
going
to
be
a
new
policy
and
there's
going
to
be
new
universal
guidance
and
that's
important
for
one
of
our
challenges
for
ourselves.
R
R
But
this
new
guidance
may
cause
a
quite
a
big
draw
on
our
resources,
as
people
want
to
look
at
how
they
can
implement
this
important
role
as
such,
we're
looking
at
how
we
can
strengthen
and
make
our
training
more,
that
less
less
face-to-face
and
more
virtual,
so
that
we
can
increase
what
we
can
offer
to
to
people
who
want
to
come
forward
within
those
sectors.
R
But
alongside
that,
I've
met
with
our
three
chief
inspectors
in
cqc
and
thank
you
for
your
warm
welcome
and
we're
looking
at
how
we
can
ensure
that
speak
up.
Culture
and
behaviors
is
embedded
in
the
new
regulatory
platform.
So
that's
a
key
point
of
work
at
the
moment
and
also
we
continue
to
support
freedom
speak
up
guardians
as
a
key
part
of
our
office's
function,
because
we
know
that
not
all
guardians
are
supported
well
by
their
individual
leadership
teams
and
that's
an
issue
of
of
great
importance
for
us.
R
It's
a
complex
role
in
order
for
workers
to
be
heard
for
that
message
to
get
back
to
those
who've
got
the
the
power
and
the
authority
to
to
change
things
that
need
changing.
That's
really
key
that
they're
listened
and
acted
on
we're
also
currently
looking
at
how
we
change
our
case
review
mechanism.
I
won't
go
into
the
detail
today.
R
Maybe
when
I
come
back
next
time,
I'll
give
you
a
bit
more
information,
but
we're
moving
to
a
system
rather
than
doing
speak
up
reviews
where,
where
people
feel
that
the
the
systems
they've
gone
through
for
for
the
matters
they've
raised,
haven't
worked
well.
Moving
from
that
that
way
of
working
to
a
new
way
of
working,
we'll
be
looking
more
at
at
case
reviews,
rather
than
so.
R
So
forgive
me
also
really
excitingly
we're
working
with
health,
education,
england
for
our
training
and
we're
about
to
launch
the
third
and
final
module
which
will
be
speak
up
for
leaders,
and
I
will
be
encouraging
when
it's
launched
in
march,
the
board
cqc
board
to
undertake
that
training
as
role
modeling,
as
well
as
for
your
own
information,
but
role.
Modelling
for
other
arms
length
bodies
and
then
looking
at
the
longer
term.
R
We
have
a
strategic
framework
which
you
may
well
be
aware
of
that
was
published
at
the
end
of
last
year,
setting
out
our
vision
for
how
we're
going
to
go
about
our
work
and
it's
in
four
pillars.
We're
going
to
be
looking
at
workers.
How
we
champion
and
support
our
workers
to
to
speak
up,
we're
going
to
be
looking
more
at
how
we
support
and
enhance
the
guardian
role
and
we're
going
to
be
looking
at
leadership
very
much
looking
at
what
supports
and
encourages
leadership
and
those
culture,
changes
that
have
to
happen.
R
If
we're
going
to
see
good,
speak
up
culture
and
also
the
wider
healthcare
system,
and
how
we
support
healthcare
system
alignment
and
accountability.
And
that's
key
in
my
introductory
meetings
with
senior
leaders.
My
commitment
is
to
lead
the
implementation
of
that
framework.
That's
going
to
underpin
all
our
work
as
an
office,
and
we
have
a
commitment,
a
very
strong
commitment
to
reducing
the
current
variability
that
we
see
in
both
the
implementation
of
the
guardian
role
and
in
how
leaders
listen
up
and
follow
up
on
matters.
R
So
that's
something
that
you'll
hear
me
talk
about
in
the
future.
We've
also
got
high
ambitions
for
the
national
bodies
to
do
more,
to
deliver
a
consistent
and
high
quality
response
to
workers
who
speak
up
to
them.
So
we
have
workers
that
speak
up
to
yourselves
to
nhs
england
to
the
regulatory
professional
bodies,
and
we
have
a
a
sort
of
a
very
firm
commitment
through
those
organizations
in
a
speak
up.
R
And
finally,
I'm
going
to
close
on
the
the
fantastic
news
that
the
government
has
committed
to
working
with
our
office
to
explore.
Not
if
but
how
freedom
speak
up.
Guardians
can
be
implemented
in
social
care
and
very
much.
This
will
be
a
program
of
work
that
we'll
be
undertaking
with
social
care,
not
to
social
care,
I'm
very
aware
of
having
worked
alongside
social
care
as
a
as
a
health
professional
that
actually
it's
about
taking.
R
Yes,
we've
got
our
learning
experience,
but
how
can
that
be
translated
into
practice
and
kate,
teroni
and
her
team
have
already
been
very,
very
helpful
in
initial
discussions,
we're
looking
currently
with
department,
health
and
social
care,
how
that
funding
will
be
given
to
us
and
then
our
program
of
work
that
hopefully
will
start
in
the
new
financial
year.
So
that's
all
I
wanted
to
say
today
by
way
of
introduction,
I'm
happy
to
take
any
questions
if
you
have
time,
if
not
you'll
see
me
very
shortly
on
a
regular
on
a
regular
slot.
Thank
you,
chair.
A
Oh
jane,
thank
you.
That
was
a
terrific
tour
of
force
for
a
couple
of
weeks.
In
the
role
I
mean,
I
just
that's
very
impressive,
thank
you
very
much
and
we
will
definitely
be
seeing
you,
as
I
said
earlier,
I
hope
actually
in
person,
rather
than
on
the
screen
at
a
future
meeting,
we'll
obviously
discuss
with
you
the
timetabling,
for
that
is
there
anything
anybody
wants
to
to
to
to
quickly
say
or
shall
we
let
jane
go
for
the
moment.
A
I
think
I
think
jane
don't
take
silence
as
as
a
lack
of
enthusiasm
with
robert
on
our
board.
You
know
that
we
will
always
be
hugely
enthusiastic
and
supportive
for
you
and
your
office
so
but
but
for
now.
Thank
you
very
much
indeed
and,
as
I
said
a
minute
ago,
we'll
see
you
in
person
at
a
future
board
meeting
very
soon.
Thank
you.
Thank
you.
Yeah.
A
So
that
takes
us
to
any
other
business
and
and
for
once
I
I
have
a
piece
of
any
other
business.
Just
as
the
meeting
was
starting,
the
secretary
of
state
announced
his
preferred
candidate
to
succeed
me
as
cqc
chair
and
that
person
is
ian
dilks.
Many
of
us
know
ian.
He
was
the
chair
of
nhs
resolution
until
last
year
worked
very
closely
with
us
and
in
that
role,
and
I
I
have
to
say
personally,
I'm
absolutely
thrilled
with
with
the
appointment.
A
I
think
it'd
be
really
really
good
for
cqc.
It
is
still
subject
to
confirmation
by
select
committee
hearing,
which
I
don't
think,
we've
actually
got
a
date
for
yet,
but
hopefully
we'll
be
in
in
early
february,
and
then
he
will
take
over
when
my
term
finishes
at
the
end
of
march,
so
really
really
exciting
and
a
good
development.
So
that
was
my
bit
of
any
other
business.
Does
anybody
else
have
any
other
business?
They
want
to
raise?
A
Okay,
so
that
is
the
end
of
the
the
formal
meeting.
I
had
two
questions
from
robin
pike:
the
member
of
the
public.
The
first
robbing
was
about
visiting
rights
and
care
homes,
and
I
think
kate
really
has
fully
discussed
that
earlier
in
the
meeting.
So
I
think
we'll
take
your
your
question
as
if
it
were
already
answered.
The
second
question
was
how
is
cqc
improving
accessibility
to
its
data
via
the
website,
and
I
think
chris
this
has
to
be
one
for
you.
O
Yes,
thank
you
peter
thanks
for
the
question,
so
we're
currently
developing
an
upgrade
to
our
website,
which
is
expected
to
launch
the
first
phase
of
it
in
in
april
this
year.
O
We've
put
accessibility
at
the
heart
of
that
work
and
we're
working
with
colleagues
from
the
from
marx
team
in
a
digital
team,
and
also
colleagues
who
use
both
the
website
and
the
intranet
and
people
who
use
services
and
particulars
who
use
assistive
technology
to
try
and
make
sure
that
the
information
that
we
place
there
is
effective
and
meets
our
needs.
O
There
are
ten
standards
that
we're
trying
to
put
in
place
for
web
publications
around
reading
age,
around
tone
of
voice,
around
length
structure,
image,
use
of
color
linking
styles,
the
style
guide,
generally
use
of
tables
and
design,
all
of
which
are
designed
to
make
sure
that
our
information
is,
is
accessible
to
people
who
use
services
accessible
to
providers
and
accessible
to
to
why
the
people
responsible
for
improvements
in
health
and
care
prior
to
the
launch
of
the
site
will
be
subject
to
a
full
accessibility
audit
by
an
external
organization.
O
There
will
also
be
some
improvements
over
time
so
later
in
the
year,
linked
to
our
new
regulatory
model,
we'll
no
longer
use
pds
as
our
primary
source
of
public
of
publishing
inspector
reports,
we'll
still
enable
people
to
print
and
use
that
information.
But
we
want
to
make
sure
that
our
information
to
inspectors
and
to
people
use
services
and
to
others
is
accessible,
no
matter
whether
you're,
using
whether
you've
got
a
sensory
or
physical
impairment
or,
if
you're,
going
to
use
a
mobile
or
desktop,
or
indeed
an
alexa
device.