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From YouTube: CQC board meeting - March 2021
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A
We
have
concerns
about
quality,
to
ensure
that
people
are
getting
safe
care,
so
those
are
cross-organizational
priorities,
but
also
asc
ones.
For
me,
and
thanks
ian,
I
think
I'm
handing
over
now
to
ted.
B
Thank
you,
kate,
and
thank
you
ian.
Can
I
just
just
cover
some
of
the
context
that
he
was
talking
about
from
my
perspective
as
well,
because
I
think
it
is
really
very
important.
These
have
been
exceptionally
different,
difficult
months
for
hospitals
over
the
last
quarter,
and
I
think
I
I
need
to
start
by
recognizing
the
enormously
important
good
work.
B
During
the
during
the
pandemic,
we
have
been
using
a
risk-based
approach
to
inspection,
which
we've
described
here
before,
and
we've
had
lots
of
very
positive
feedback
from
providers
about
the
way
that
our
inspection
and
reporting
and
other
interventions
has
been
supportive
in
helping
them
get
the
support.
They
need
all
the
resources
they
need
to
move
forward
and
improve
their
services,
and
just
as
ian
did
I
want
to
pay
tribute
to
staff
who've
raised
concerns
with
us.
B
I
think
it
shows
a
real
positive
cultural
move
within
the
system
where
this
is
putting
safety
first,
even
under
these
difficult
circumstances,
as
we
move
forward
into
the
past
the
second
wave
of
the
pandemic
into
what
I
hope
will
be
better
times
going
forward,
we
will
be
continuing
our
approach
based
on
risk
of
focusing
on
those
services
where
we
identify
risk
in
individual
services
or
those
services
where
we
know
they
are
high-risk
services
and-
and
we've
outlined
those
in
the
written
report.
B
I
won't
read
through
them
all
in
detail,
but
but
we
keep
that
under
constant
review
and
we
are
focusing
on
risk
and
we
can.
We
want
to
be
proportionate
in
this
regard,
not
to
add
extra
burden
to
services,
but
to
to
to
make
sure
that
we
are
focusing
on
risk
to
patients
and
taking
action,
often
supporting
services,
rather
than
enforcement
action
to
help
them
provide
continually
safe
care.
B
We're
also
going
to
be
focusing
on
recovery
and
has
highlighted
how
important
it
is
for
local
recovery
plans
to
take
into
account
the
needs
of
the
workforce
to
recover
from
what
has
been
a
very
difficult
time
for
many
of
them.
But
also
to
recover
the
services
for
staff,
who've
been
left
behind
and
we
want
to
work
with
our
system
partners,
but
also
with
individual
providers
to
support
them
in
developing
those
recovery
plans.
I
don't
think
a
one
one-size-fits-all
top-down
recovery
plan
is
the
way
forward.
B
I
I'm
very
keen
that
there
are
local
tailored
recovery
plans
developed
across
the
country,
and
I
think
the
focus
is
towards
ics's
and
system
working,
I
think,
is
a
great
move
in
that
direction.
B
One
of
the
things
that
that
providers
have
said
to
us,
so
this
is
both
nhs
trusts
and
independent
healthcare
is
that
some
of
them
have
ratings
which
they
believe
they
have
now
improved
on,
and
they
want
us
to
go
back
and
demonstrate
improvement
on
those
ratings.
So
as
we
go
forward
using
the
flexibility,
this
is
coming
out
of
our
current
consultation
on
our
on
ratings.
B
We
want
to
be
able
to
answer
their
their
requests
to
be
able
to
demonstrate
through
inspections,
whether
where
the
ratings
and
services
have
improved
and
we'll
be
developing
a
program
starting
in
april
to
do
that,
but
it
will
have
to
be
proportionate
and
we'll
be
using
a
risk,
brace
approach
as
well
in
that
respect,
to
try
and
make
sure
that
this
is
the
proportion
of
approach
and
just
to
stress,
we
are
not
going
back
to
the
pre-tamp
pandemic
model
of
inspections
that
we
had.
B
I
I
think
just
one
added
added
point
I
want
to
make
is
that
the
pandemic
is
still
not
yet
over.
We
still
live
in
uncertain
times
and
I
think
our
inspection
approach,
our
approach
to
supporting
colleagues
working
in
services
has
to
change
and
adapt,
depending
on
the
demands
going
forward
and
we're
very
much
alive
to
that.
So,
while
we
have
plans
in
place,
but
we
will
adapt
those
and
to
make
sure
that
we
take
a
proportionate
response
that
is
as
supportive
as
possible
of
services
that
are
continually
continuing
to
be
under
pressure.
C
Thank
you
ted.
Oh
sorry,
there's
necco,
it's
gone
now
so,
just
to
start
off
with.
C
Following
on
what
ted
was
saying,
I
just
want
to
pay
tribute
to
people
working
in
primary
care
at
the
moment,
because
I
think
that
they
are
still
under
enormous
pressure
and
we
need
to
recognize
the
pressure
that
primary
care
services
are
under
and
particularly,
I
think
we
ought
to
be
congratulating
them
on
the
massive
achievement
of
the
roll
out
of
the
vaccination
program,
much
of
which
has
happened
in
primary
care,
and
I
think
that
the
numbers
are
staggering.
C
I
think
in
terms
of
the
the
vaccines
that
have
been
undertaken
and
the
way
that
that's
been
that's
been
done
and
I
think
a
huge
recognition
for
people
in
in
every
sector,
but
particularly
in
primary
care
who
have
been
involved
in
that.
So
thank
you.
So
the
report
outlines
the
list
of
priorities
we
have
in
primary
medical
services
and
just
to
pull
out.
I
won't
go
through
that
list
in
detail,
but
to
pull
out
two
or
three
areas.
C
Firstly,
in
terms
of
gp
services,
as
I'm
saying,
we
recognize
that
they're
they
are
under
huge
pressure,
but
what
we've
noticed
over
the
last
few
months
in
our
programme
of
special
measures
in
inspections
is
that,
despite
those
pressures,
many
of
the
special
measures-
inspections
that
we've
done
have
shown
improvements
in
those
services.
C
We
have
now
heard
from
many
practices
who
requires
improvement,
have
a
rating
of
requires
improvement.
Who
have
said
we
would
like
to
be
reinspected.
We
have
made
the
improvements
necessary.
Please
come
back
and
and
re-rate
us,
and
so
we
feel
that
it's
important
firstly,
to
make
sure
that
those
improvements
have
happened
in
the
the
practices
that
are
requires
improvement,
but
also
to
recognize
the
work
that
the
practices
have
been
done
doing
in
those
practices
with
an
ri
rating.
So
we
will
be
resuming
an
inspection
program.
C
Looking
at
ri
practices,
we
will
be
continuing
to
also
follow
up
on
any
risk
and
inspecting
any
practices
that
we
have
risk.
As
with
ted,
we
will
be
looking
at
a
much
more
focused
inspection
response.
We
are
also
exploring
and
continuing
to
explore
how
we
use
technology
so
that
some
of
the
work
can
be
done
off-site
and
that
we
have
the
minimal
impact
that
we
can
on
busy
services.
C
C
I
think
many
of
us
have
been
concerned
about
what's
been
happening
with
children
and
young
people
with
special
educational
needs
and
disabilities
over
the
over
the
course
of
the
pandemic,
and
I'm
really
pleased
that
we
we're
working
very
closely
with
offstead
to
again
progress
that
programme
and
we
will
be
continuing
to
explore
and
develop
our
monitoring
approach
that
we
have
been
using
over
the
last
few
months
with
the
transitional
methodology
and,
in
particular,
we've
had
a
great
positive
response
from
the
dental
sector,
using
that
monitoring
approach,
very
positive
feedback
about
the
the
contact
with
inspectors,
the
support
and
the
signposting,
and-
and
we
will
be
continuing
to
to
use
that
across
all
of
the
sectors,
but
particularly
in
the
dental
sector
and
following
up
any
concerns
where
there's
a
risk
to
safety.
D
D
So
we've
done
quite
a
lot
of
work
to
support
some
of
the
step-down
facilities
and
to
support
opening
of
new
new
new
new
units,
and
things
like
that,
and
we
will
continue
to
do
that,
but
I'm
hoping,
as
hopefully
things
start
to
get
a
bit
better,
that
work
will
will
ease
down
over
the
coming
months.
D
So
we'll
continue
to
do
that
to
ensure
we're
able
to
provide
a
prompt
service,
we're
also
continuing
to
continuing
at
pace
with
our
transformation
and
improvement
of
our
registration
service,
so
that
people
who
are
using
our
services
get
both
an
efficient
and
a
timely
response
back
to
us,
and
we
are
continuing
to
invest
quite
heavily
in
that
to
drive
a
much
more
modern
transformation
of
that
service.
As
we
as
we
move
forward
over
the
coming
months.
E
Great,
thank
you
all.
Could
I
just
say
that
each
of
you
have
rightly
said
what
what
great
work
has
been
going
on
in
in
in
all
the
providers,
both
people
on
the
front
line
and
and
leadership.
I
I
just
like
to
take
this
opportunity
to
congratulate
our
people.
We've
had
tremendous
work
over
the
last
year
inspectors
putting
themselves
at
risk
of
of
harm.
E
We've
had
people
working
in
at
home
in
in
really
quite
difficult
conditions,
and
we've
had
some
real
leadership
challenges,
so
I
I
just
think
absolutely
right
to
congratulate
what
our
providers
are
doing,
but
I
think
we
should
congratulate
ourselves
as
well.
I
think
you've
all
done
a
fantastic
job
so
is
is
where
do
we
go
now?
We're
moving.
F
On
to
moving
on
to
the
rest
of
the
rest
of
the
of
the
report
yeah,
unless
anyone
has
got
any
particular
questions
or
comments
on
our
areas
of
priority,
I
think
kate's
covered
off
ipc
and
closed
cultures
in
in
her
section.
F
B
Fine
ted,
thank
you.
Thank
you
peter.
I
I
was
going
to
say
at
this
point
just
what
you
just
said
about
our
own
staff,
peter,
because
I
do
think
it
is
important.
I
I
have
to
say.
B
Certainly
staffing
in
my
directorate
and
across
cqc
have
demonstrated
real
commitment
both
to
our
purpose
and
values
during
this
very,
very
difficult
year
we've
been
through,
and
I
think
we
should
congratulate
them
on
on
their
dedication
to
to
the
work,
and
I
think
one
of
the
things
that
perhaps
the
outside
world
does
not
realize,
because
so
much
of
what
we
do
is
behind
the
scenes
is
how
much
a
difference
they
make
to
patients
and
service
users
on
a
daily
basis.
B
In
many
ways,
in
terms
of
in
terms
of
the
the
updates
are
on
the
in
the
report,
can
I
just
highlight
that
we
are
continuing
in
those
risk
areas
such
as
infection
prevention
and
control,
an
area
where
we
are
going
to
be
focusing
going
forward
is
maternity
services.
That's
mentioned
in
in
in
my
report.
We're
getting
increasing
concern
expressed
by
staff
in
maternity
services,
which
I
see
is
a
very
good
sign,
because
I
think
the
culture
within
maternity
services
is
beginning
to
change
and
I
get
a
real
sense.
B
It
is
beginning
to
change.
One
of
our
themes
going
forward
in
terms
of
our
strategic
in
terms
of
our
strategy
is
safety
through
learning,
and
that
is
all
about
driving
a
really
positive
safety
culture
and
I
think,
there's
a
real
opportunity
going
forward
using
our
regulation
working
with
partners
across
the
system
to
drive
a
really
really
positive
safety
culture
in
maternity
services,
which
I
think
can
be
transfer
transformative
for
women
and
children
in
those
services.
So
I
think
there's
a
real
positive
developing
there,
but
much
work
to
do.
B
Thanks
ted,
I
think
good,
are
you
rosie.
E
C
Thank
you
and
there's
three
aspects
in
the
report
that
are
outlined.
The
first
is
just
to
ensure
the
border
aware
of
some
work,
we're
doing
with
offstead,
which
is
looking
at
how
we
develop
an
inspection
of
secure
schools
and
secure
schools
was
due
to
open
in
2022
and
and
we
are
working
collaboratively
with
offstead
to
to
look
at
how
we
how
we
approach
these
secure
schools.
The
second
item
is
a
progress
update
on
provider,
collaboration
reviews.
C
We
are
now
undertaking
our
field
work
in
cancer
and
learning
disabilities,
and
we
have
teams
on
sites
in
eight
systems
for
each
of
those
areas
undertaking
that
work.
We
will
be
talking
about
the
urgent
emergency
care
report
as
a
result
of
the
urgent
emergency
care
pcr
in
the
next
item,
but
that
is
all
going
very
well
and
then.
Finally,
the
dna
cpr
report
this,
as
hopefully
the
board
have
seen,
was
published
published
last
week.
C
I
think
it's
it's
a
really
important
report
and
it
was
a
huge
team
effort
to
be
able
to
to
get
to
that
stage.
So,
firstly,
thank
you
to
all
the
team
involved.
It
was
a
really
great
example
of
how
the
the
organization
different
parts
of
the
organization
come
together
around
a
very
important
area,
to
deliver
to
deliver
a
great
piece
of
work,
and
thank
you
also
to
robert
for
his
broad
support,
his
non-executive
support
into
the
work.
C
I
think
there's
some
really
important
messages
in
the
report
and
some
important
learning
we're
really
looking
forward
to
working
with
all
parties
to
make
sure
that
those
recommendations
are
progressed
and
that
the
improvements
that
need
so
desperately
needed
actually
happen.
Thank
you.
Peter.
E
Thank
you
rosie,
and
thanks
also
to
you
for
the
the
work
on
that
report.
So
it
was,
it
was
really
good
and
very
timely.
So
thank
you.
Kirsten.
D
Thank
you
peter,
so
just
a
quick
update
from
me
on
our
vaccination
program,
the
red,
the
regulation
of
that
we
are
continuing
to
make
really
good
progress
with
that
regulatory
oversight.
D
We
have
developed
a
risk-based
tool
to
to
to
doing
this,
our
vaccine,
our
vaccine
process,
and
we
have
now
sought
assurance
from
43
of
the
57
eligible
trusts
who
are
providing
the
mass
vaccine
sites.
So
far
we
haven't
found
anything
to
raise
alarm
and
that
which
is
good.
D
We're
also
continuing
to
monitor
the
work,
that's
being
done
in
the
pyromedical
services
through
our
current
risk-based
monitoring
activity
and
again,
we've
found
nothing
to
raise
any
concerns
about
we're,
also
continuing
to
work
with
nhsei,
to
support
the
vaccine
uptake
and
are
providing
any
feedback
or
intelligence
that
we
pick
up
through
our
monitoring
back
into
that
to
ensure
that
they
are.
They
are
they're,
well
informed
of
any
any
areas
that
we
we
find
on
the
ground.
So
that's
what
I
wanted
to
say.
Thank
you.
Peter.
E
Thank
you
kirsty.
You
want
something
on
the
performance
report
thirsty
or.
G
Highlights
to
run
through
in
terms
of
registration,
so,
as
you
mentioned
before,
continue
to
prioritize
registration
applications
to
help
support
the
system's
response
to
covert
in
terms
of
delivery.
Simple
applications
are
taken
on
average
20
days
to
process
with
complex
applications
taking
113
days
on
average,
to
complete,
in
terms
of
our
intelligence,
to
regulate
registered
services.
Our
performance
on
safeguarding
alerts
is
97
and
concerns
94
both
against
the
target
of
95
and,
as
previously
stated,
we
are
still
seeing
an
increase
in
whistleblowing
inquiries
coming
into
us.
G
So
both
safeguarding
and
whistleblowing
continue
to
be
key
source
of
intelligence,
with
55
of
inspections
that
are
triggered
by
risk.
A
result
of
receiving
information
of
concern
in
terms
of
our
reach
since
april,
and
up
until
the
9th
of
march
6217
locations
have
been
inspected
and
48
of
active
locations
have
had
either
an
inspection,
an
esf
call
or
a
tma
call
and
in
terms
of
equipping
our
organization
and
people
turnover
remains
stable
at
just
over
seven
percent,
sickness
tracking.
G
Well,
at
three
point:
two
percent
and
on
our
money,
our
revenue
budget
is
forecast
to
be
12.8
million
under
spent
for
the
year
with
the
capital
budget
now
forecast
to
be
1.7
million
under
spent
for
the
year.
E
That's
it
thanks
chris
mark
I'm
hoping
that
it's
a
another
nil
report
for
you
from
you
on
the
cyber
security.
H
It
is
absolutely
peter
nothing
to
report.
E
This
month
yeah,
how
long
may
that
continue?
Chris,
I
doubt
it's
an
an
ill
report
from
you
on
parliamentary
activity.
Unfortunately,
well.
I
Some
positive
conversations
happening,
we've
submitted
some
written
evidence
to
the
health
and
social
care
select
committee
on
a
couple
of
issues,
one
connected
to
the
inquiry
on
children,
young
people's
mental
health,
the
written
evidence
we've
given
here
outlines
our
approach
to
our
work
and
also
highlights
some
of
the
key
messages
from
our
are
we
listening
publication?
I
I
We
wrote
to
the
chair
regarding
that
to
indicate
our
support
for
and
our
the
guidance
around,
ensuring
that
there
was
access
for
people
from
their
family
members
and
how
we
were
supporting
that
communication
work
we're
doing
with
with
with
providers
just
to
confirm
that
we
are
both
being
very
clear
to
providers
that
they
must
provide
access
and
how
and
how
we
are
ourselves
assuring
ourselves
of
that
fact,
particularly
when
people
with
concerns
write
to
us
and
then
again
that
information
will
be
published
in
the
short
period
of
time,
but
they
were
the
main
two
for
me,
peter.
E
Great,
thank
you
and
thanks
everybody.
There's
a
huge
amount
of
ground
we've
just
covered
quite
quickly.
Stephen.
You
wanted
to
come
in
yeah
thanks.
J
J
How
does
this
one
actually
get
involved
and
developed
and
updated,
because
some
of
the
greens
in
it
will
last
calendar
year
the
reports
towards
the
end,
this
strategy
bit
hopefully
quite
soon-
can
be
updated
to
start
tracking?
Well,
how
does
how
does
success
in
delivering
the
strategy
work?
Could
you
just
help
me
understand
how
how
does
this
whole
dashboard
piece
get
updated?
J
How
often
do
you
sort
of
revisit
so,
which
are
the
indicators
that
really
matter
to
us
as
an
executive
that
we
want
to
keep
on
top
of,
and
we
want
to
know
how
it's
going.
G
Sure
yeah,
so
this
dashboard
will
cover
our
performance
for
this
financial
year.
We've
got
a
business
plan
that
sits
under
this
that
straddles
three
financial
years
and
I
and
the
work
we're
doing
at
the
minute
is
just
looking
at
how
we
evolve
this
going
into
the
next
financial
year.
G
Acknowledging
that
a
number
of
things
have
been
completed
are
live
now,
but
also
it's
not
capturing
some
of
the
work
that
we're
now
evolving
into
aligned
to
our
priorities
that
I
talked
to,
and
I
but
you'll
see
it's
not
actually
mentioned
in
the
dashboard.
So
that
is
the
work
we're
doing
to
just
take
some
of
the
areas
out,
but
also
bring
in
areas
that
we're
not
currently
tracking
in
terms
of
activities.
So
hopefully
you'll
see
that
in
the
new
financial
year.
E
Gosh
you've
covered
the
ground
really
really
well.
Executive
colleagues
nobody's
got
any
any
questions
so
we'll
seize
the
moment
and
and
and
move
on.
Chris,
do
you
want
to
introduce
the
the
insight
report.
I
Yes,
so
the
content
for
this
issue
of
the
insight
repo
report
focuses
on
the
challenges
in
delivering
urgent
emergency
care
that
come
that
send
partly
from
the
conversations
we
began
almost
a
year
ago,
with
a
with
a
group
of
clinicians
in
in
secondary
care
around
patient
first,
where
we
work
with
them
to
understand
more
effectively.
What
were
the
things
that
that
made
good
secondary
care
possible?
I
What
are
the
things
that
individuals
working
in
in
secondary
care
need
to
focus
on,
but
this
report
shares
a
wider
series
of
learning
from
urgent
merchant
does
not
just
happen
in
hospitals.
I
It
happens
right
the
way
through
the
system,
and
the
report
shares
some
overview
of
the
learning,
which
falls
into
sort
of
three
main
themes:
accessing
inequality,
safety
and
staff,
skills
and
governance
and
shared
planning,
and
we
wanted
to
to
give
this
report
to
a
aid
people's
thinking
around
how
systems
can
change
in
response
to
cobra,
to
support
kobe
recovery
and
also
to
give
some
sense
of
where
we
felt
there's
some
really
good
practice
and
all
where
we
felt
there's
some
really
strong
concerns,
rosie
and
ted.
I
I
wonder
if
you
would
like
to
talk
through
from
your
perspective,
some
of
the
key
findings
from
your
different
sectors.
Should
I
come.
B
In
first
then,
peter
is
that
all
right,
yeah,
of
course,
ted
okay,
thanks
chris
for
the
introduction
board.
Members
may
remember
that
in
the
winter
before
the
pandemic,
which
seems
a
long
time
ago
now,
but
it's
it.
We
were
really
concerned
about
urgency,
emergency
care
and
its
response
to
what
was
a
very
difficult
winter
so
going
into
2020.
We,
we
convened
a
group
of
specialist
advisors
from
emergency
departments
across
the
country
to
ask
them.
How
could
we
prepare
better
for
the
winter?
B
That's
just
gone
the
the
winter
2021
within
within
a
couple
of
months
that
was
rapidly
overtaken
by
the
the
pandemic.
It
was
very
clear
to
to
us
on
that
group
that
the
winter
2021
urgency
emergency
care
was
going
to
be
under
exceptional
pressure
because
of
the
combination
of
the
long-standing
issues
with
the
kovic
pandemic
on
that,
and
I
think
though,
we've
just
come
through.
It's
been
a
real
demonstration
of
that,
because
we've
had
the
second
wave
during
this
this
winter,
and
so
it
has
been
a
very
difficult
winter.
B
As
I
said
earlier,
on,
for
lots
of
services
providing
urgency,
emergency
care,
we've
been
out
inspecting
services.
During
that
time,
proportionately,
with
a
very
focused,
risk-based
methodology
and
we've
had
some
really
very
supportive
feedback
from
the
services
we've
inspected
around
how
we've
actually
helped
them
improve
their
care,
and
I
think
that's
really
important.
B
I'm
working
very
closely
with
frontline
clinicians.
I
think
we've
developed
a
very
supportive
approach
to
to
emergency
departments
going
forward
and
those
services
that
have
used
our
patient
first
guidance,
which
chris
just
mentioned,
have
found
it
really
very
helpful
in
driving
improvements
in
their
services.
B
The
problems
we
found
during
this
winter
are
outlined
in
in
the
insight
report
and
there
are
many
ways
similar
to
what
we
found
pre-covered.
So
the
basic
problems
haven't
changed.
There
have
been
some
changes
because,
of
course,
the
acuity
of
patients
with
kovid
has
gone
up.
The
numbers
actually
attending
nes
in
many
cases
are
down,
but
the
acuity
has
gone
up
and
there's
been
real
problems
in
cohorting
covet
and
non-coded
patients
to
try
and
maintain
good
levels
of
infection,
prevention
and
control.
B
So
in
some
senses
the
cues
that
we
were
worried
about
in
hospitals,
the
corridor
cues
of
patients
waiting
for
emergency
care
in
hospitals
have
transferred
this
last
winter
out
into
ambulance
weights
and
the
ambulance
weights
have
been
a
real
concern
during
this
winter
and
then
and
the
length
a
number
of
ambulance
waste
has
been
one
of
the
big
drivers
behind
our
inspection
approaches
going
forward.
The
solutions
for
this
lie
in
the
patient
first
document
as
a
start,
and
I
think
that's
still
something
we
can
build
on-
that
they
lie
within
the
emergency
departments
themselves.
B
To
some
extent,
they
lie
also
within
the
hospitals
on
how
well
the
hospital
supports
the
emergency
department,
but
they
also
lie
in
the
wider
system,
and
I
think
one
of
the
things
that
is
really
important
is
that
we're
presenting
this
together
with
the
provider
collaboration
review,
which
is
about
how
the
system
collaborates
and
I
think,
working
together.
What
we've
learned
from
our
inspections
of
emergency
departments
with
the
provider
collaboration
review.
We
need
to
think
forward
about
how
we're
going
to
approach
urgent
emergency
gear
going
forward
and
what
the
system
can
do
differently
so
I'll
hand.
C
Thank
you,
ted,
and
so
in
the
provider
collaboration
review.
This
is
our
second
providing
collaboration
review
report
and
I
think
one
thing
I'd
like
to
say
is
that
we
continue
to
work
on
the
methodology
and
we
continue
to
learn
every
time
we
do
a
set
of
these
provider
collaboration
reviews
about
how
we
really
understand,
what's
going
on
in
a
local
system
and
how
we
really
kind
of
get
understand
the
really
good
examples,
but
also
understand
the
areas
that
need
improvement.
C
The
second
area
is
about
shared
planning
and
system-wide
governance
and
leadership
across
the
system.
This
the
third
area,
is
around
ensuring
safety
of
staff
and
making
sure
that
that
health
and
care,
those
health
and
care
skills
across
the
providers
are
looked
at
to
system
level,
and
the
fourth
area
is
around
the
impact
of
digital
solutions
and
technologies
on
providers
and
services.
C
We
have
already
shared
some
examples
of
some
really
tangible
things
that
we
think
can
help
systems
and
those
examples
are
there's
a
link
to
those
in
the
report,
and
I
think
I
would
ask
systems
to
be
really
thinking
about
how
they
can
learn
from
these
examples
and
how
they
can
learn
from
the
areas
that
we've
looked
at
in
advance
of
the
any
future.
C
Spikes
in
demand
that
inevitably
will
come
as
we
go
through
the
year,
but
just
to
identify
the
the
the
kind
of
main
challenges
that
we've
seen.
Firstly,
is
such
reliance
on
relationships,
and
we
would
encourage
systems
to
really
look
at
their
relationships
within
their
systems
and
invest
in
those
relationships.
They
are
so
important
and
we
hear
time
and
time
again
about
how
those
relationships
are
so
important
to
meet
the
needs
of
the
local
populations.
C
Secondly,
is
about
information
sharing.
It
is
something
we've
raised
on
several
occasions
before,
but
that
importance
of
being
able
to
share
information.
It
came
up
in
the
dna
cpr
work,
we've
also
done,
which
is
is
very
much
linked
to
this,
but
people
being
able
to
understand
information
in
a
real
time
way
and
accelerate
that
work
is
really
important.
C
The
third
area
is
around
staffing
around
the
system.
When
we're
looking
at
staffing
across
the
system,
we
need
to
look
at
it
at
a
system
level.
There's
no
no
point
in
pinching
kind
of
different
members
of
the
staff
to
work
in
one
service.
If
it's
going
to
leave
another
service
short,
we
need
to
be
understanding
what
that
looks
like
right
across
all
of
the
system
and
to
be
able
to
enable
those
system-wide
plans
for
the
staffing.
C
The
other
thing
just
to
mention
about
staffing
is
that
we've
seen
some
brilliant
examples
of
where
actually
people
have
had
innovations
in
this.
In
this
area,
for
example,
dental
nurses,
particularly
in
the
first
lockdown
who
who
weren't
working,
who
then
went
to
support
the
local,
a
e
with
their
dental
problems,
for
example,
and
and
numerous
examples
where
actually
there's
been
some.
Some
really
great
innovation
around
that
inequality
is
a
key
factor
that
we've
been
looking
at
through
our
pcrs
and
we
found
variation
in
terms
of
how
much
people
have
been
understanding.
C
C
And
finally,
we've
seen
some
really
good
examples
of
where
places
have
used
technology
in
a
different
way
to
be
able
to
enable
good
care,
and
I
think
we
need
to
make
sure
that
technology
is
used
in
a
safe
way
in
an
appropriate
way,
and
that
makes
sure
that
no
one
is
disadvantaged
from
technology.
C
But
there
has
been
absolutely
no
doubt
that
there's
been
some
huge
positive
transformations
with
the
use
of
technology
across
the
system
and
we've
discussed
that
in
more
detail
in
the
report.
Thank
you,
peter.
E
Rosie
ted-
I
I
I
understand
why
or
how
it
is
that
we've
ended
up
with
a
lot
of
patients
being
held
in
ambulances
in
some
cases,
for
for
many
hours,
and
I
obviously
understand
how
that's
come
about,
but
but
but
equally
it
it's
a
really
bad
place
for
both
for
patients
to
be
held,
but
also
really
bad
for
the
population
elsewhere.
E
Who
might
be
waiting
for
an
ambulance
urgently
than
and
can't
get
it,
and
I
I
just
wonder
whether
there's
a
some
work
that
we
could
prompt
not
not
do
but
prompt
for
trusts
and
ambulance
services
over
the
summer
to
to
think
of
how
they
might
avoid
this
in
in
in
in
the
future.
E
It
really
is
bad,
isn't
it
what
what's
happened.
B
I
I
I
think
it
has
been
a
real
concern,
this
winter
and,
as
I
say
to
some
extent
because
of
the
infection,
prevention
and
control
concerns
within
the
hospital
patients
were
kept
outside
until
there
was
physical
space
for
them
in
the
appropriate
cohorted
area,
and
that
meant
they
were
looked
after
in
ambulances,
and
there
are
different
approaches
to
this.
Sometimes
in
some
trust,
we
found
that
looked
after
in
ambulances
by
the
ambulance
staff
and
the
trust
essentially
took
no
responsibility
for
them.
B
In
others,
the
trust
went
out
there
and
provided
support
in
the
ambulances,
it's
unsatisfactory
in
many
ways,
but
what
we're
looking
for
trust
that
actually
address
the
issue
in
front
of
them
and
the
mitigation
the
risk
for
individual
patients?
On
that
basis,
I
mean
clearly
if
a
patient
is
held
in
an
ambulance.
That
is,
it
is
not
good
for
the
patient,
but
it
is
not
good
for
the
ambulance
service
and
the
person
who's
waiting
for
that
ambulance
out
in
the
community
and
ambulance
services
have
been
under
tremendous
pressure
during
this
pandemic.
B
For
this
very
reason-
and
I
said
earlier
on
that
to
some
extent,
we
need
to
recognize
that
they
are
part
of
the
system
that
has
been
under
tremendous
pressure.
I
think
going
forward.
We
need
to
build
a
system
with
sufficient
capacity
and
resilience
that
can
cope
with
these
surges
in
demand,
and
that
means
there
must
be
some
of
the
flexibility
we've
seen
during
the
covet
pandemic
to
create
new
clinical
spaces
to
reflect
the
surges
in
demand.
B
We
need
to
build
that
into
our
daily
work
to
deal
with
surges
in
inactivity,
and
I
think
the
the
nhs
and
providers
have
demonstrated
they
can.
They
can
show
that
flexibility
where
necessary,
and
I
think
we
need
to
build
that
in
so
that
when
there
is
a
surge
in
demand
at
the
front
of
a
hospital,
the
the
default
position
isn't
to
leave
patients
with
ambulances
but
to
create
that
clinical
space
staff
safely
so
that
patients
will
be
looked
after
in
a
safer
space.
B
I
think
it
is
a
big
challenge,
though
I
mean
we
mustn't,
underestimate
the
formidable
challenges
that
the
services
have
faced
this
winter,
but
I
think
we
can
learn
from
it
and,
as
I
said
earlier
on,
I
think
a
lot
of
what
we
saw
in
this
winter.
While
it
was
different
because
of
kobe
did
reflect
the
problems
we've
seen
in
previous
winters
and
so
there's
a
long-term
issue
there.
We
need
to
need
to
talk
about
about
the
resilience
of
flexibility,
emergency
emergency
services,
dealing
with
searches
in
demand.
E
Thanks
ted
yeah,
I'm
not
unsympathetic
to
the
to
the
issues
people
have
faced.
I
just
think
it's
a
problem
that
we
need
to
try
and
see
addressed
other
questions
or
comments.
From
from
from
colleagues
stephen.
J
Thanks
peter
really
interesting
report.
Thank
you
very
much
indeed
the
the
particular
bit
that
caught
my
eye
was
page
47
in
the
set
that
I'm
looking
at.
We
saw
little
evidence
of
widespread
shared
strategies
at
whole
system
level.
J
Systems
didn't
always
feel
it
was
their
remit
to
plan
for
system-wide
staffing,
and
it
got
me
kind
of
thinking.
Well.
In
what
ways
do
these
group
of
people
and
providers
think
of
themselves
as
a
system
at
all
is?
Is
there
a
sort
of
underlying
problem
that
there
is
no
shared
understanding
of
what
the
system
is?
There's
a
there's,
a
group
of
people
and
a
group
of
providers
sort
of
working
together
more
or
less
effectively,
but
but
is
there
that
sort
of
secure
understanding
of
of
system
and
its
role
and
purpose
rosie?
You
want.
C
C
We
see
system-wide
strategies
around
people,
management
and
really
impressive
work,
that's
happening
where
people
are
working
together
and
the
other
thing
that
I
think
we
see
that's
impressive
is
where
you
can
see
that
thread
right
from
the
leadership
of
the
integrated
care
system
and
the
communication
rights
way
down
to
people
working
on
the
front
line,
and
everyone
understands
what's
going
on
across
the
system
and
and
what
the
challenges
are
and
how
they
play
a
part
in
that.
C
I
think,
at
the
other
end
of
the
spectrum
reduce
systems
where
enterprise
relationships
haven't
developed
and
people
working
on
the
front
line,
don't
understand
what's
happening
at
the
ics
level.
People
don't
really
see,
haven't
really
looked
at
how
providers
work
together,
and
I
think
that
is
something
that
we
want
to
look
at,
how
we
develop
our
methodologies
and
our
work
in
this
area,
and
it's
certainly
pertinent
to
the
work
we've
discussed
around
the
white
paper,
because
I
think
it's,
I
think,
we're
moving
into
a
space,
especially
with
all
the
challenges.
C
The
health
and
care
system
face
that
actually
it's
imperative
providers
work
together.
It's
imperative
that
systems
work
together
against
these
challenges.
Otherwise,
patient
care
is
going
to
suffer
as
a
result.
The
the
only
final
thing
I've
mentioned
is
that
actually,
I
think
how
you
define
a
system
is,
is
a
really
interesting
question
and
one
of
the
things
that
we've
heard
through
our
provider
collaboration
reviews
is
some
of
the
some
parts
of
the
system
aren't
necessarily
very
integrated.
So,
for
example,
the
dental
sector
doesn't
necessarily,
although.
C
Is
an
integral
part
of
the
body
and
it
doesn't
particularly
integrated
into
the
wider
conversations,
despite
the
fact
that
often
people
with
dental
problems
can
end
up
in
a
e
or
in
general
practice
or
other
parts
of
the
system,
if
they're
not
managed
properly
so
so
yeah.
There
is
a
lot
that
we
need
to
nudge
and
encourage
from
our
end
in
the
system-wide
work,
but
I
think
there's
an
awful
lot
of
very
good
work
that
we
can
learn
from.
I
Chris,
do
you
want
to
add
to
that
just
just
to
quickly
say
that
the
points
well
made
stephen,
I
think
some
of
the
work
that
we
need
to
do
nationally
to
support.
I
This
is
how
we
develop
the
right
measures
of
what
we
ask
organizations
to
do
when
we
did
the
work
on
the
on
the
system
reviews
almost
three
years
ago
now
there
are
three
things
that
are
really
important:
having
a
common
vision
for
what
you're
trying
to
achieve
being
able
to
move
the
money
to
deliver
that
vision
and
having
some
measures
as
a
success
to
determine
that.
That's
that
being
done.
I
But
it
starts
from
a
premise
that
you
have
a
common
vision,
and
often
common
visions
depend
on
what
what
organization
and
what
organizations
are
asked
to
do
so
rose
is
absolutely
right.
The
ability
for
us
to
have
to
bring
the
vision
of
ics's
and
the
vision
of
social,
clear,
close
together
so
that
they
act
as
a
as
a
unifying
force
for
what
then
providers
do
in
a
local
area
is,
is,
I
think,
critical,
just
as
an
anecdote
to
that?
I
If
you
look
at
all
the
organization,
all
the
nhs
organizations
that
have
improved
their
a
e
performance
move
from
inadequate
to
good,
all
of
them
have
done
that
not
by
just
managing
flow
within
their
organization
or
doing
the
things
that
are
impatient
first,
but
a
lot
of
things
around
patient
first
about
their
engagement
with
wider
organizations,
good
conversations
with
primary
care
group
conversation
with
adult
social
care.
So
we
know
it's
critical.
I
It's
how
we,
as
national
partners,
try
to
provide
that
commonly
unifying
framework
that
allows
good
conversations
to
happen
locally
between
leaders
so
that
they
can
help
each
other.
Deliver
a
common
vision,
move
the
money
and
have
the
right
to
the
right
purpose
that
they
can
then
share
with
their
teams.
E
We
we
talk
of
systems
as
if
it's
a
single
homogeneous
system,
but
I
mean
certainly
in
my
experience
and
ted
and
rosie
you're
more
experienced
than
I
am.
You
can
find
places
where
you've
got
really
joined
up
pathways
in
in
some
areas
and
other
pathways
where,
where
the
system
really
doesn't
recognize
any
other
part
of
the
the
pathway,
so
it's
it's
quite
complex.
Isn't
it.
B
B
It's
called
mental
health
services
and
I
think,
during
the
pandemic,
one
of
the
things
we've
heard
repeatedly
from
emergency
departments
is
that
they've
seen
an
increased
number
of
people
with
acute
mental
health
problems
in
hospital
and
they
coming
into
the
emergency
department
and
they
have
increasingly
found
it
difficult
to
find
placements
for
those
individuals
moving
forward.
So
it's
it's
a
large
complex
web,
that
is
the
system
and
working
together
has
to
be
really
thoughtful
leadership,
bringing
all
elements
of
the
system
together
to
make
sure
it's
focused
on
the
needs
of
patients.
C
J
C
Come
in
there,
so
I
think
that
there
are
lots
of
pieces
work.
I
think
there
is
a
huge
development
piece
around
this
and
I
think
there
are
a
lot
of
pieces
work
all
already
in
train
both
within
the
cqc,
but
with
broader
organizations.
For
example,
the
national
quality
board
are
refreshing,
the
shared
view
of
quality,
which
I
think
is
a
a
really
important
piece
for
system-wide
working
going
forward.
C
There's
work
around
metrics
for
systems
going
on
with
multiple
parts
of
the
the
different
bodies
that
work
across
systems,
and
I
think
internally
at
the
cqc.
I
think
that
we've
we've
got
a
lot
of
learning
already.
We've
got
the
learning
from
the
local
system
reviews
the
provider
collaboration
reviews
have
been
a
a
good
way
of
looking
at.
Actually,
how
do
we
really
understand
population
groups?
How
do
we
look
at
pathways
of
care
and
are
we
continuing
to
develop
those
approaches?
I
think,
over
the
coming
few
months.
C
We
need
to
then
build
on
those
the
learning
that
we've
had
from
those
approaches
to
think
about.
How
does
that
then
put
us
in
the
best
position
possible
with
the
the
white
paper
proposals.
B
B
B
F
Thanks
peter,
I
think,
to
answer
you
know
to
have
another
go
at
steven's
question.
I
think
it's
a
really
important
question
around.
How
do
you
define
what
system
is
in
a
particular
particular
geography,
and
I
think
the
fact
that
the
secretary
of
state
has
been
quite
public
about
wanting
to
see
ratings
in
a
in
a
particular
system.
I
think,
by
definition
that
forces
a
debate
that
says
what
is
a
system?
How
do
you
define
it
for
the
purposes
of
rating?
F
So
I
think
I
think
I
know
people
have
got
different
views
on
on
whether
or
not
rating
in
a
rating
in
a
in
a
place
is
a
good
idea
or
not,
but
I,
but
I
do
think
that
it's
going
to
force
an
important
conversation,
that's
going
to
going
to
wash
through
some
of
these
some
of
these
questions,
because
I
think
my
sense
at
the
moment
is
the
white
paper
on
its
own
doesn't
define
the
system,
but
the
questions
that
it
asks
will
need
to
define
a
system
in
the
coming
in
the
coming
few
months.
E
Thank
you
ian
thanks,
stephen
anybody
else
want
to
come
in
on
the
report.
Mark
chambers.
K
A
quick
question
if
I
could,
on
the
on
the
inequalities
section
and
you
you've
highlighted
the
you
know
the
variation
in
in
focus
and
action,
but
but
the
report
also
highlights
quite
to
be
quite
surprising,
variation
in
the
in
the
in
the
data
that
underlying
data
that
is
available
to
to
have
that
focus
and
to
have
that
action.
Do
you
want
to
comment
a
bit
a
bit
on
that
right?.
C
Yeah,
certainly,
I
think
I
think
that
as
well.
There
is
quite
a
lot
of
variab
variation
in
the
data
that's
available
and
actually,
even
within
our
own
data,
that
we
have
at
cqc
to
be
able
to
look
at
some
of
the
inequalities,
and
I
know
that
that's
affect
the
work
that's
happening
with
with
registration
and
our
our
regulatory
platform
work.
C
I
think
we've
seen
some
really
examples,
so
I
think
primary
care
networks
give
us
a
real
opportunity
to
look
at
health
inequalities
and
to
really
look
at
how
they
work
within
their
local
communities,
with
all
aspects
of
that
local
community,
including
district
councils
councils,
faith
groups,
voluntary
sector
organizations
that
there
are
huge
opportunities
and
the
best
examples
we've
seen
are
where
the
those
different
groups
have
come
together
to
to
look
at
really
understanding
the
data
about
their
local
population
needs
and
being
able
to
to
plan
their
services
around
that.
C
Some
of
that
data,
as
you
say,
is,
is,
is
not
there
and
I
think
that's
something
we
need
to
understand,
and
certainly
I
think
again,
it
was
highlighted
with
our
recent
work
around
dna
cpr.
If
you
look
at
the
system,
oversight
and
assurance
of
dna
cpr
decisions,
which
again,
is
a
very
much
a
system
issue,
we
found
that
often
the
data
wasn't
available.
C
If
you
looked
at,
for
example,
the
number
of
people
with
learning
disabilities
with
the
dna
cpr,
and
I
think
we
need
to
make
sure
that
we
are
encouraging
systems
to
look
at
really
understanding
what
data
they
need
to
be
able
to
address
these
inequalities,
to
understand
them
and
address
them
fully.
E
Thanks
rosie
sally.
L
Yes,
thanks
peter,
I
wanted
to
commend
the
team
for
the
report.
First
of
all,
I
think
this
is
the
next
one
in
a
a
whole
series
of
insight
reports
that
we've
had
and
they
always
generate
an
immense
amount
of
conversation,
and
I
think,
touch
on
the
really
important
points
that
come
out
of
them
so
well
done
to
the
team.
L
My
question
was
a
bit
more
about
wider
definition
of
the
system
and
how
we
involve
adult
social
care,
because
I
think
in
all
the
years
I've
worked
in
health.
We've
talked
a
lot
about
ambulance
handovers
to
trusts,
and
that's
still
quite
an
important
point,
but
it's
one
we've
been
tackling
for
a
long
time.
L
The
reality
is
that
most
of
the
issues
within
systems
are
about
the
crossover
between
health
and
social
care,
particularly
for
older
people,
who
don't
have
a
very
clearly
defined
pathway,
but
might
touch
lots
of
points
and
move
from
one
back
in
the
pathway
forward.
Again
back
again,
and
I
I
was
conscious
that
kate
hadn't
commented
so
I
just
wondered
if
she'd
got
anything
to
say
about
this
particular
report
and
the
interaction
with
adult
social
care.
Thanks.
A
Skilled
staff,
but
also
how
joined
up
care
is
so
it's
absolutely
essential
that
people
experience,
joined
up
care
and,
as
colleagues
have
said,
our
our
system
reviews
three
years
ago
absolutely
put
the
blueprint
about
what
good
system
working
looks
like
you
know.
Chris
described
a
joint
vision,
called
budgets,
etc,
and
in
our
strategy
you
know
up
front
and
center
of
our
strategy.
Is
our
ambition
to
regulate
through
the
eyes
of
people
with
lift
experience.
A
So
we
are
absolutely
interested
in
someone
with
co-morbidities
how
health
and
social
care
comes
together
to
ensure
they
get
the
right
support,
and
that's
why
it's
absolutely
critical
when
we
think
about
integrated
care
systems
that
they're
not
narrow,
that
they're
much
broader
than
health,
that
they
do
include
social
care.
They
do
have.
You
know
workforce
plans
that
encapsulate
the
totality
of
the
workforce,
including
you
know,
volunteers,
the
much
broader
sector.
So
so
I'm
I'm
really
keen
for
integrated
care
systems
to
really
deliver
what
matters
to
people.
A
They
need
to
be
much
broader
than
house
they
need
to.
They
need
to
have
the
right
leaders
around
the
tables
that
are
people
live,
experienced,
families,
social
care
providers,
voluntary
sector
as
well
so
much
broader,
but
thanks
ali.
E
Great,
thank
you,
kate.
Thank
you.
Everybody
board.
We're
asked
to
formally
agree
that
the
report
should
be
published
at
the
end
of
the
meeting.
I'm
quite
sure
we
all
agree
that
don't
we
excellent
so
that
takes
us
on
to
welcoming
henrietta
hughes,
henrietta,
really
really
nice,
to
see
you
you're
gonna
present
the
national
guardian
annual
report.
So
should
I
just
hand
over
to
you
please.
M
Well,
thank
you
so
much
chair
and
I
wanted
to
start
off
by
just
reflecting
on
yesterday's
national
day
of
remembrance
and
thanking
everyone.
Who's
been
involved
in
the
pandemic.
M
All
of
those
who've
been
working
so
hard
to
keep
people
safe
and
particularly
thinking
about
freedom
to
speak
up
guardians
who've
been
supporting
their
colleagues
and
ensuring
that
they've
got
safe
channels
to
speak
up.
As
you
said,
our
annual
report
was
laid
before
parliament
last
week
and
I
just
wanted
to
just
think
of
some
highlights
in
that
and
then
obviously
have
time
for
questions
and
answers.
M
So
the
the
national
network
of
freedom
to
speak
up
guardians
is
continuing
to
grow
and
there's
now
over
600
guardians
in
more
than
400
organizations
across
england,
and
that
includes
all
the
trusts
and
foundation
trusts,
but
also
a
large
number
of
primary
care
organizations.
M
Independent
sector
providers,
hospices
and
many
of
the
national
bodies,
including
the
care
quality
commission
and
our
guardians,
have
been
listening
and
continued
to
listen
to
their
colleagues
and
handled
over
16
000
cases
in
the
last
financial
year
and
that
included
a
range
of
cases
related
to
patient
safety
around
25
or
23.
It
was,
and
36
of
cases
had
an
element
of
bullying
and
harassment.
M
During
the
first
wave
of
the
pandemic,
we
were
hearing
that
people
were
speaking
up
about
lots
of
different
subjects.
New
subjects,
including
the
availability
of
ppe,
fit
testing
risk
assessments,
and
we
asked
freedom
to
speak
up
guardians
about
their
experience.
M
And
initially
we
we
heard
that
people
were
speaking
up
to
guardians
around
these
matters
as
well,
and
I
was
very
grateful
to
the
chief
inspectors
with
whom
I
wrote
out
to
all
the
chief
executives
across
the
system
and
following
on
from
that,
we
saw
an
increase
in
the
percentage
of
guardians
who
felt
that
workers
in
their
organization
were
being
encouraged
to
speak
up.
M
If
involved
in
an
error
incident
or
near-miss
and
we've
seen
once
again
that
organizations
rated
highly
by
the
cqc
tend
to
have
more
positive
freedom
to
speak
up
index
scores
and
also
their
guardians
tend
to
have
more
positive
perceptions
about
the
speaking
up
cultures
within
them.
We've
got
a
new
question.
That's
come
into
this
year's
annual
staff
survey,
which
didn't
make
it
into
our
annual
report,
but
I
think
it's
worth
noting.
This
is
a
question
which
is
applicable
in
all
types
of
organizations
and
it's,
I
feel
safe,
to
speak
up
about
anything
in
my
organization.
M
This
is
the
first
time
this
question
has
been
included
and
nearly
66.6
percent
66.5
percent
of
people
who
answered
that
question
agreed
or
strongly
agreed.
Now,
there's
obviously
a
long
way
to
go
with
this,
but
I
see
this
is
a
foundation
from
which
we
can
build,
and
certainly
it
would
be
useful
to
be
able
to
share
that
question
with
non-health
providers
as
well.
Who've
often
asked
about
what
questions
they
can
use.
M
We've
continued
to
do
case
reviews
and
we
are
developing
a
new
case
review
process
so
that
we
can
hear
from
a
wider
range
of
workers
and
all
the
information
that
we
gather
from
the
speaking
up
data
and
the
index,
and
the
new
question
are
part
of
model
hospital,
so
that,
with
the
recommendations
that
we
make
and
the
information
that's
presented,
organizations
can
learn
from
each
other's
successes
and
we
continue
to
work
in
partnership
with
organizations
including
the
care
quality
commission,
where
we've
been
providing
training
to
cqc
inspectors
in
the
hospitals
directorate
and
updated
the
guidance
for
inspectors
as
well.
M
We
have
worked
with
health
education,
england
to
launch
a
package
of
training.
This
includes
speak
up,
training
for
all
workers,
listen
up,
training
for
all
managers
and
we're
developing
follow-up
training,
which
is
for
senior
leaders
so
that
they
know
about
how
to
foster
an
environment
where
people
feel
safe
to
speak
up
and
looking
to
the
future.
We're
going
to
be
looking
in
more
detail
at
detriment
and
thinking
about
what
people
are
fearful
about
when
they
speak
up
and
ways
that
we
can
help
to
mitigate
and
manage
that.
O
So
robert
well,
for
those
who
are
new
to
the
board,
they
may
not
know
that.
I
am
your
representative
on
a
henrietta's,
a
formidably
called
accountability
and
liaison
board,
which
in
fact
consists
of
two
people,
one
representing
cqc
and
one
nhs
england.
But
I'm
happy
to
tell
you
that
a
lifestyle
of
governance
is
really
all
that
henrietta
required.
O
The
the
progress
that
has
been
made
by
the
national
guardian
and
her
team
over
the
last
six
years
has
been
quite
formidable
from
a
standing
start
where,
frankly,
there
was
huge
skepticism
among
in
the
nhs
about
the
value
of
a
system
like
this,
and
I
think
one
of
the
reflections
I
would
have
is
that
it.
O
What
henrietta
and
her
team
have
been
able
to
accomplish
shows
the
value
of
not
putting
something
into
law
of
allowing
something
to
which
is
a
new
concept
to
develop
so
that
it
can
be
accepted
designed
into
the
system,
obviously
meeting
problems
and
then
addressing
them.
And
I
think
that
it
is
a
testimony
to
the
achieve
the
achievement
that
it's
not
only
within
the
nhs
and
our
field,
as
it
were,
that
this
concept
is
being
taken
up.
O
But
henrietta
runs
something
called
a
pan
sector
network
which
gathers
together
on
a
regular
basis,
people
from
entirely
disparate
industries,
the
oil
industry,
aviation,
even
banking.
Dare
I
say,
sport,
various
other
places,
all
of
whom
are
keen
to
share
ways
of
dealing
with
these
intractable
cultural
issues
around
encouraging
staff
to
to
speak
up.
O
I'd
just
like
to
obviously
henrietta
would
agree.
I
think
the
work
is
not
yet
complete
by
a
long
talk
and
there
are
I'm
afraid,
dark
corners
of
the
system
where
guardians
people
who
speak
up
are
still
treated
in
a
way
which
is
probably
unacceptable,
and
if
I
can
end
with
a
question
for
henrietta,
just
a
bold
one,
which
is
that
obviously,
the
primary
concern
is
to
allow
people
to
speak
up
and
to
ensure
they
don't
suffer
a
detriment.
But
I
wonder
whether
you
have
any
comment
on
what
happens
after
something
has
gone
wrong.
O
Often
and
for
instance,
an
alleged
whistleblower
complains
to
an
employment
tribunal,
and
the
matter
is
then
defended
to
the
nth
degree.
O
M
Well,
thank
you
very
much
and
I
think
you're
right
to
say
that
nobody's
got
this
100
right
and
the
more
that
we
can
learn
from
the
global
network
that
we
have
now
in
our
pan
sector
network.
The
more
that
we
can
share
that
learning
into
the
health
system
for
the
benefit
of
everyone.
M
I
mean
my
my
take
on
this
is
that
leadership
is
absolutely
fundamental
to
fostering
the
right
culture
in
the
first
place
and
also
to
be
able
to
respond
with
curiosity
rather
than
defensiveness
when
people
raise
matters
and
unfortunately,
that
does
still
appear
to
be
a
level
of
defensiveness,
which
is
is
really
unfortunate
when
there's
so
much
information
and
and
evidence
around
the
value
that
the
organizations
and
leaders
can
get
from
the
gift.
M
That
is
the
information
that
their
workforce
bring,
and
I
think
that
there's
something
about
how
this
forms
part
of
internal
governance
in
organizations,
but
every
single
aspect
of
leadership,
whether
that's
to
do
with
the
selection
of
leaders,
the
the
competency
framework
for
leaders,
the
annual
appraisal,
their
leadership
development
courses
and
also
how
this
fits
within
regulation
as
well.
M
So
that
organizations
who
are
able
to
cope
with
this
level
of
of
challenge
come
to
us
and
say
how
can
we
do
better,
whereas
the
ones
who
seem
to
be
struggling
more,
don't
have
the
headspace
to
be
able
to
make
those
improvements,
and
I
I
would
really
welcome
a
bigger
conversation
around
how
this
fits
into
leadership.
How
we
can
support
leaders
to
be
effective
and
how
this
can
be
recognized
and
rewarded
when
people
are
getting
it
right
as
much
as
there
can
be
ways
of
challenging
and
intervening
when
things
aren't
going
well,.
E
Great
great
answer,
thank
you
mark
chambers
you
wanted
to.
I
mean
thank.
K
You
well,
you
know
the
the
work
that
the
guardians
do
is
fantastic
and-
and
I
would
fully
endorse
robert's
observation
about
this.
The
value
of
this
is
not
as
a
compliance
exercise.
If
you
make,
if
you
make
this
a
a
a
a
a
discussion
of
a
leadership
level
about
how
you
meet
a
regulatory
requirement,
it's
the
wrong
answer.
K
The
the
the
value
of
the
cultural
value
of
having
a
strong
speak-up
culture
is
is,
is,
is
a
better
organization,
a
stronger
organization,
because
it's
one
where
you,
where
senior
leadership,
can
work
out
what's
going
on
and
get
an
early
warning
about
things
going
wrong
and
can
take
early
and
effective
and
effective
action.
But
I
just
wanted
to
comment
on.
You
know
a
few
external
things
that
that
worry
me
in
terms
of
coming.
You
know
their
confluence
in
in
our
space.
K
You
know
there
is
we've
seen
some
scary
external
scary
surveys
in
other
sectors
that
have
told
us
that
there's
been
a
really
sharp
increase
in
retaliation
rates
against
people
who
have
spoken
up
and
that's
enormously
worrying,
because
fear
and
futility
are
still
the
two
barriers,
the
two
biggest
barriers
to
people.
Speaking
out,
people
feeling
that
they
won't
be
listened
to
and
nothing
will
be
done,
but
also
feeling
that
it
will
it
will
be
damaging
to
to
their
careers
if
they
do
speak
up.
K
So
you
know
we're
seeing
in
other
sectors
a
big
increase
in
in
that
and,
of
course,
in
the
in
the
in
the
sectors
that
we
regulate.
We
see
people
under
immense
pressure.
K
You
know
levels
of
pressure
that
are
almost
unrecognizable
and
as
weak
as
skull
cells
are
almost
unmanageable
and-
and
you
know,
constant
pressure
leads
to
constant
pressure
to
to
compromise
standards.
K
I
think
the
third
thing
that
worries
me
is
that
you
know
we
we're
looking
over
a
system
where
microcultures
are,
you
know,
are
very
prevalent
and
you
know:
microcultures
are
particularly
difficult
if
you're
trying
to
drive
consistent
cultural
standards
so
yeah
and
reactor
I'm
pleased
to
see
that
you're
adding
new
measures
to
to
track
this
so
things
you
know,
measures
that
were
already
in
your
report
about
from
surveys
and
measures
that
are
in
your
that
that
are
in
there
about.
You
know
the
proportion
of
your
reports
that
are
anonymous.
K
M
Well,
thank
you
so
much.
The
first
thing
I
would
say,
is
we're
always
curious
about
what
it
is,
that's
causing
someone
to
be
anonymous
and
when
it
comes
to
freedom
to
speak
up
guardians,
this
is
not
the
only
speak
up
channel.
Clearly,
the
most
likely
thing
is
that
someone
will
talk
to
their
line
manager
if
they
want
to
raise
something.
M
The
work
through
the
navex
global
system,
the
res
the
research
by
kyle
welch,
showed
that
28
of
those
reports
were
anonymous
and
that's
more
of
a
sort
of
electronic
system
rather
than
a
human
being,
but
also,
we
recently
heard
from
speak
up
direct,
which
is
the
whistleblowing
helpline
that
86
of
their
calls
were
anonymous
and
people
were
withholding
their
phone
number.
M
So
I
think
it's
it's
really
interesting
to
say:
why
is
it
that
so
many
more
people
are
content
to
share
their
details
with
a
freedom
to
speak
up
guardian
than
in
other
equivalent
speaking
up
systems,
and-
and
I
think
that
it
really
shows
that
guardians
are
a
trusted
route
and
one
of
the
things
which
I
think
is
really
important
about.
E
Thanks
you
wanted
to
ask
something.
P
Thank
you.
Yes,
I
wanted
to
testify
to
how
scary
it
can
feel
to
speak
up
in
a
public
forum
being
a
non
ex.
You
know
not
not
a
a
visitor
to
the
to
the
board
today.
I
just
wanted
to
ask
henrietta
how
we
feel
we're
doing
in
terms
of
applying
that
lens
internally.
How
we
feel
our
own
freedom
to
speak
up
culture
is
is,
is
operating.
M
M
There
are
three
freedom
to
speak
up
guardians
who
form
part
of
our
national
non-provider
network
and
so
can
learn
and
share
from
all
of
the
the
learning
from
national
bodies,
and
one
of
the
things
I
was
really
pleased
about
is
that
when
we
had
october
speak
up
month
last
year,
which
was
looking
at
the
alphabet
of
speaking
up
where
people
were
able
to
share
hundreds
of
different
words,
that
meant
something
to
them
in
terms
of
speaking
up
listening
up
and
following
up
that
cqc
really
participated
in
that
in
a
really
positive
way.
M
So
so
my
feeling
is
that
I
think
up
until
you
know
we
had
our
first
freedom
to
speak
up
guardian
survey.
There
was
never
an
expectation
that
national
bodies
would
attend
to
their
own
speaking
up
cultures
in
the
same
way
that
we
were
asking
providers
to
do
it,
and
I
see
this
is
a
really
positive
step
on
the
whole
journey,
which
is
that
when
organizations
genuinely
listen
to
their
workforce,
that
they
can
get
that
gift
of
information
and
that
it
can
lead
to
learning
and
improvement.
M
E
Thanks
and
I
think
we
we
deco,
that
from
from
our
side
of
the
table
as
it
were,
mark
saxton
welcome
back.
Q
Thank
you
chairman
and
henrietta.
Thank
you
very
much
indeed
for
another
super
report
from
you.
I
took
a
couple
of
things
out
of
it.
I
just
want
to
comment
on
it
and
then
I
have
a
question.
I
think
it's
really
good
to
see
that
there's
a
focus
on
not
only
the
issue
that's
been
raised,
being
dealt
with,
but
then
expanding
the
learning
of
that
through
through
the
organizations
through
you
know,
training
and
and
applied
learning.
Q
That,
of
course,
is
is
going
to
be
a
way
that
you
get
to
some
consistency
and
improvement
in
the
way
that
that
people
are
managed-
and
you
know,
deliver
stronger
culture
and
and
stronger
leadership.
So
you
know
it's
really
good
to
see
that
focus
in
your
report.
Q
I
can't
say
I
went
into
all
your
reports,
but
I
did
go
into
the
data
one
and
picked
up
the
bullying
percentage
of
speak
up
events
and
then
sort
of
link
that
to
that
terrible
story
that
you
put
in
your
annual
report
about
the
bain
junior
doctor,
which
you
know
is,
is
is
a
salary
lesson
and
and
something
that
we
see
in
the
nhs
employees
survey
the
the
bullying
of
staff,
and
so
this
continues
to
be
an
issue
and
your
process
continues
to
shine
a
light
on
it
and
we
need
to.
Q
I
think
that
makes
sense,
but
I
wonder
whether
there's
not
an
opportunity
for
you
and
and
speaking
speak
up
guardians
as
we
move
to
more
system-led
approaches,
whether
there
isn't
an
opportunity
for
those
guardians
in
the
bigger
organizations
to
buddy
up
with
the
guardians
in
the
smaller
organizations
to
encourage
greater
confidence
and
capacity
to
speak
up.
So
just
wondered
whether
you
had
been
looking
at
that
as
an
organization.
M
M
Guardians
are
already
working
across
systems,
so,
whether
that's
dorset,
ics
or
bob
and
others
manchester
we've
got
guardians
working
really
closely
across
patient
pathways,
and
I
really
welcome
that
because,
as
a
gp,
I
know
that
it's
the
gaps
that
exist
between
the
organizations
and
I
caught
the
tail
end
of
the
previous
report
that
you
were
discussing
that
it's
those
gaps
that
make
all
the
difference.
Now
we
already
have
really
good
linkages,
for
example
with
the
guardians
in
the
ambulance
networks
and
the
providers
in
which
they're
they're
bringing
the
patients
and
delivering
care.
M
But
it's
also
really
important
that
we
we
work
across
primary
community
and
acute
sectors
with
mental
health
and,
for
example,
there
are
a
number
of
trusts
who
have
acquired
gp
practices
and
we're
particularly
interested
in
how
they
are
delivering
freedom
to
speak
up
into
those
primary
care
organizations.
M
So
as
the
landscape
of
the
nhs
evolves
and
continues
to
evolve,
we're
evolving
with
it
and
with
model
hospital,
there's
also
a
model
system,
and
that
will
help
to
support
data
in
terms
of
how
we
look
at
that
across
systems
and
with
our
regional
networks
and
the
sub-networks
that
exist
within
those
we're
really
interested
in
how
guardians
can
work
closely
together.
M
There
are
some
legal
aspects
around
who
you
can
speak
up
to,
and
we
want
to
make
sure
that
we
never
put
somebody
in
a
position
of
being
vulnerable,
that
they
happen
to
have
spoken
up
to
the
wrong
guardian
and
that
they
don't
then
get
the
protection
that
they
might
need
in
the
future.
But
I
think
that's
something
that
we
can
work
together
with
policy
in
terms
of
developing
the
the
correct
policy
wording
so
that
we
can
get
that
that
level
of
buddying
and
support
working
across
systems
in
the
future.
E
Thanks,
I'm
going
to
go
to
ted
and
then
sally
and
then
and
then
we'll
let
henrietta
get
on
with
the
rest
of
her
life
but
ted.
Yes,.
B
Well,
thank
you
henrietta
and
just
to
reflect
your
report.
I
think
we've
seen
real
progress
in
this
area
and
I
think
the
kobe
pandemic
has
been
a
great
example
of
seeing
the
progress
in
this
area,
and
I
I
I
I
as
I've
said
already
in
the
board.
I
really
greatly
welcome
the
fact
the
staff
have
been
speaking
more
freely
about
their
concerns
during
the
kirby
pandemic
and
I
think
that's
real
indication
of
the
way
we
need
to
go.
B
If
we're
going
to
drive
the
safety
agenda
that
we're
so
keen
to
drive,
I
think
your
freedom
speak
up.
Work
is
absolutely
central
to
the
safety
agenda,
creating
a
culture
where
people
openly
talk
about
problems
and
get
them
sorted
rather
than
keep
them
hidden.
I
think
is
going
to
be
so
important
going
forward
just
to
pay
a
big
thanks
for
the
support
you've
given
to
our
inspectors
in
developing
and
supporting
them
in
taking
the
steps
necessary
to
understand
this
agenda
better.
B
We
are
very
committed
to
building
it
into
our
well-led
framework
going
forward
and
we
think
it's
really
important
to
drive
this
agenda.
We
are,
as
you
know,
henrietta
in
some
ongoing
discussions
about
the
regulation
review
to
see
if
we
can
improve
the
way
that
freedom
speak
up
is
reflected
in
the
regulations
going
forward.
But,
as
I
have
said,
this
is
mostly
about
leadership
and
culture,
not
regulation,
and
I
totally
recognize
that
thanks
ted
sally.
L
Yes,
thank
you
peter
and
thanks
to
henrietta
for
both
the
report
and
congratulations
on
the
progress
that
you've
made.
I'm
I'm
really
struck
by
the
strap
line.
If
you
call
it
around,
listen
up,
speak
up,
listen
up
and
follow
up,
and
I
know
that
you've
got
ambition
around
follow-up
and
leadership,
and
I
just
wondered
whether
you
could
say
a
little
bit
more
about
that,
and
perhaps
you
and
robert
would
like
to
comment
on
anything
specific
that
cqc
could
do
to
help
you
with
that.
M
Well,
thank
you
very
much
and
yes,
absolutely
as
mark
was
saying
earlier,
you
know,
fear
and
futility,
and
the
futility
aspect
is
one
that
we
really
want
to
work
on,
as
well
as
the
fear
factor,
because
if
people
speak
up
and
it
doesn't
lead
to
change
or
they
never
find
out
about-
what's
happened,
then
there's
no.
You
know
there's
no
kind
of
sense
of
that.
M
This
has
made
a
difference,
but
we
know
from
the
hundred
voices
that
speaking
up
is
really
making
a
difference
in
organizations
in
a
really
positive
way,
and
when
it
comes
to
leadership,
I
mean
I
would
really
welcome
the
board
of
cqc
committing
to
undertake
the
training
that
we
are
developing
with
health
education,
england,
because
I
think
that
really
would
role
model
it
to
the
rest
of
the
system,
and
I
think
it's
quite
good
training
as
well.
M
I
mean
I,
wouldn't
I
wouldn't
impose
something
on
you
that
I
didn't
think
was
going
to
be
useful.
M
We
know
from
our
survey
that
of
guardians
that,
when
it
comes
to
detriment,
the
the
prime
kind
of
where
that
comes
from
is
from
managers,
and
so
if
managers
have
the
support
and
the
knowledge
and
the
skills
so
that
when
somebody
does
speak
up
to
them,
they
they
know
what
to
do
and
that
it
doesn't
feel
fearful
for
them
and
also
for
leaders.
It's
I
I
go
visit.
M
Lots
of
organizations
and
the
boards
are
really
enthusiastic
about
this,
but
it's
got
to
filter
all
the
way
through
the
organization
as
well,
and
when
it
comes
to
leadership,
leadership
is
is
something
where
that
we
work
in
partnership
with
many
organizations
on
this,
in
particular
nhs
england
improvement,
who
have
huge
amounts
of
resources
and
and
and
support
available
for
leaders
of
organizations
and
I'll.
Just
give
an
example
of
that,
which
is
the
nhs
leadership
academy.
M
Freedom
to
speak
up
is
part
of
the
roslyn
franklin
training,
it's
part
of
the
aspiring
chief
exec
program
and
there's
a
desire
for
this
to
be
embedded
into
all
leadership
development.
So
we
can't
do
this
on
our
own.
You
probably
know
that
my
team
isn't
huge,
but
we
have
huge
ambitions
and
so
the
way
that
we're
going
to
be
able
to
deliver
that
is
through
working
with
others.
So
thank
you
very
much.
E
Robert
last
word
to
you,
then
we'll
move
on.
O
Well,
thank
you.
I
don't
often
get
that.
Do
I
well,
I
think
a
specific
answer
to
sally's
question
is
is,
firstly,
to
continue
developing
what
we
already
are
doing,
which
is
to
highlight
the
fact
that
when
we
that,
when
a
regulatory
intervention
or
an
inspection
is
due
to
people
speaking
up,
we
to
the
extent
possible.
O
But
the
second
thing
is
about,
I
think,
a
bit
a
bit
about
leadership
and
account
look
at
scrutiny
of
leadership
and
accountability,
and
so
taking
the
example
of
the
question.
I
asked
henrietta
about
the
conduct
of
some
trusts
or
leadership
in
relation
to
grievances
that
arise
out
of
speaking
up.
That's
gone
wrong
in
the
past.
There
tends
to
be
an
attitude.
Well,
that
was
in
the
past
will
now
treat
this
just
as
a
legalistic
issue,
rather
than
firstly
as
a
learning
experience
and
separately
actually
providing,
where
necessary,
recognition
to
the
individual.
O
Who
may
have
been
wrong
that
that
has
happened,
and
I
think
that
that's
partly
a
leadership
issue
which
could
be
scrutinized
through
inspect
the
inspection
and
oversight
process
at
the
extreme
end
of
the
scale.
There
is
the
use
of,
or
potential
use
of,
the
fit
and
proper
person
regulation,
which
we,
through
the
cart
review
and
so
on.
O
I
think
now
generally
agree
needs
revision
and
because
I
think
there
is
a
feeling
among
some
people,
I
talked
to
who've
been
at
the
wrong
end
of
all
this,
that
there
isn't
as
much
accountability
as
they
could
be
in
relation
to
the
really
bad
cases,
and
that
people
are
potentially
still
floating
around
the
system.
Who
have
a
record
about
this.
So
I'm
not
suggesting
for
a
moment.
Cqc
can
solve
all
those
problems
overnight,
but
it
does
seem
to
me
that's
an
area
where
we
we.
O
We
could
focus
a
little
more
on
to
see
if
we
can
provide
some
benefit
through
that.
E
Great
robert,
thank
you
henrietta.
First
of
all,
you
you,
you
issued
an
invitation
and
I
think
perhaps
ian,
and
I
could
talk
to
you
offline
about
how
we
how
we
progress
that.
Secondly,
let
me
just
say
it's
always
a
great
pleasure
to
have
you
at
our
board,
we'll
always
invoke
a
great
discussion
and
he
did
in
such
a
nice
way.
E
So
it's
it's
lovely,
but
I
think
it's
also
great
that,
as
robert
implied
in
his
first,
he
had
the
opening
and
closing
words
this
time
when
he
spoke
immediately
after
you.
If
you
look
at
the
first
annual
report
you
produced
and
you
look
at
the
the
most
recent
one,
the
the
progress
is
just
stunning.
It
really
is,
and-
and
I
I
just
want
to
congratulate
you
because
I
mean
this-
has
all
come
from
your
personal
drive
to
achieve
it.
M
Well,
thank
you
so
much
chad
and
the
thing
I
would
say,
is
yes,
there's
progress,
but
it's
such
a
huge,
huge
area
that
there's
still
a
huge
amount
to
do
so.
The
more
that
I
can
get
the
support
of
you,
your
board
and
the
entire
organization
to
help
drive
this
in
the
right
direction
is
what
the
system
really
needs.
E
You
have
it
and,
what's
we'll
see,
we'll
see
you
henrietta
somewhere
later
in
the
year,
I'm
sure
before
we
get
to
this
time
next
year,
with
the
with
the
next
annual
report,
so
we'll
see
you
midway
through
the
year,
I'm
sure.
Thank
you.
So
much
no
bless
you.
Thank
you
very
much
indeed,
and
that
takes
us
to
our
last
substantive
item
on
the
agenda,
which
is
the
healthwatch
england
quarterly
report.
Robert.
Are
you
going
to
introduce
it.
O
You're
getting
fed
up
with
my
voice
I'll,
be
quick
because
the
meld
has
been
sitting
there
patiently
now
for
for
some
time,
but
if
I
could
just
say
three
things:
firstly,
pay
tribute
to
imelda
and
the
healthwatch
england
team
for
the
brilliant
way,
they've
just
continued
business
as
usual
through
the
through
the
pandemic,
replacing
needless
to
say,
real
me,
physical
meetings
with
remote
ones,
supporting
the
network
of
local
health
watch
through
really
difficult
times
in
some
some
places
and
while
at
the
same
time
producing
as
you
will
see
from
imelda's
report,
really
impressive
work
in
relation
to
issues
arising
out
of
the
pandemic
and
getting
changed
as
a
result,
which
is
perhaps
the
most
important
thing.
O
I
just
like
to
that's
the
first
point.
The
second
point
is
that
you
will
see
that
our
committee
has
undertaken
a
refresh
of
our
strategy
and
the
fruits
of
that
are
seen
here
in
the
what
it
is,
in
effect,
our
business
plan,
and
we
have
recognized-
and
the
pandemic
has
highlighted
this-
that
there's
a
real
need
for
a
focus
on
health
inequalities
and
through
our
lens.
O
That
means
a
focus
on
seldom
heard
and
vulnerable
groups
in
different
communities,
because
healthwatch
being
present
in
in
every
local
local
authority
area
in
the
country
has
a
particular
skill
in
being
able
to
identify
such
groups
to
find
them
out
and
get
their
experiences
and
information
about
their
needs
and
feed
that
into
the
system.
And
we
believe
that,
although
it's
set
out
as
a
separate
strategic
objective
is
in
fact
something
which
is
going
to
inform
all
our
work.
So
anything
we
do
we'll
have
a
consideration
in
it
of
the
health
inequality
or
edi
perspective.
O
And
the
final
thing
to
mention
is
the
our
place
in
in
the
post-white
paper
world.
And
we
take
the
firm
view
with
which
I
hope
you
agree,
that
it
is
vital
that
healthwatch
has
a
presence
at
ics
level
in
the
new
new
environment.
O
And
there
is
a
very,
very
constructive
conversations
going
on
with
the
department
and
with
nhs
england
about
what
form
this
should
take.
But
it
does
require
a
recognition
that
our
scope
of
our
activities
would
increase
from
what
they
are
now
and
that
we
would
certainly
need
really
a
and
a
network
in
general.
Would
need
an
increased
resource
to
provide
the
service
at
ics
level
to
make
sure
that
local
voices
were
properly
taken
into
account
there,
and
also
just
as
importantly,
information
from
that
level
is
being
fed
back
to
the
public
locally.
O
And
so
there's
the
three
things
I
wanted
to
say
before
and
I
didn't
want
to
spoil
an
eldest
pitch
so
I'd
hand
over
to
her.
E
L
Well,
thank
you
peter.
I
always
feel
welcomed
at
these
meetings.
So
really
it's
completely
fine.
So
we,
what
you
got
from
us,
I'm
afraid,
is
a
very
long
document
which
I
didn't
expect
you
to
read
the
whole
thing,
but
this
time
of
year
we
as
a
sort
of
to
keep
you
informed
as
a
matter
of
transparency
in
the
public
domain.
L
We've
also
sent
you
our
business
plan
for
the
coming
year,
which
we're,
which
we've
done
a
lot
of
work
on
so
just
a
a
sort
of
reflection
back
on
the
last
few
months
and
and
I'll
just
pull
out
a
few
highlights
of
the
things
that
we've
focused
on
one
of
the
things
that
we've
really
focused
in
on
is
the
vaccine,
rollout
and,
and
we've
been
focusing
in
on
vaccine
rollout
in
a
number
of
ways.
L
We've
also
done
quite
a
lot
of
work
with
around,
particularly
some
groups
that
were
being
there
was
an
agreement
that
they
could
have
the
vaccination,
but
it
wasn't
getting
through
to
the
public.
It
wasn't
coming
out
in
messages
like,
for
example,
carers,
so
a
lot
of
work
on
vaccine
rollout,
getting
quality
information
out
to
people,
but
also
doing
work
on
vaccine
hesitancy
and
two
pieces
of
work
on
that.
The
first
piece
of
work
we
we
did
some
polling
and.
L
Black
caribbean,
black,
african
and
pakistani
people-
and
we
found
out
that
there
wasn't
a
huge
amount
of
hesitancy
about
the
vaccination,
but
there
was
a
great
deal
of
hesitancy
about
getting
to
vaccination
centers,
so
so
that
really
helped
in
working
out
how
we
can
then
help
roll
out
the
vaccine
and
the
next
piece
of
work.
L
We're
doing
is
a
much
more
in-depth
piece
of
work,
a
bit
more
like
ethnographic
work
with
the
nhs
race
observatory
on
really
unpicking
the
the
remainder
of
that
hesitancy
that
we
see
the
we've
done
quite
a
lot
of
work
on
the
program
where
we
were
involved
with
nhs
england
through
steve
powers,
pre
pandemic
on
on
work
around
a
e
and
what
the
public
needed
from
it.
L
And
one
of
the
things
that
the
public
talked
to
us
about
was
how
useful
it
would
be
if
they
could
pre-book
a
e
appointments
and
and
and
it
came
up
with
a
you
know,
back
with
a
lot
of
resistance
from
a
lot
of
places.
Actually,
in
the
pandemic,
we
moved
to
that
and
and
so
the
pre-booked
a
e
appointments.
L
There's
quite
a
lot
of
satisfaction
with
it.
People
are
there's
great
awareness
of
one
one
one,
but
not
such
great
awareness
of
the
of
the
ability
to
book
appointments
through
one
one
one-
and
I
I
think
this
is
one
of
those
change
management
things
that
nhs
really
needs
to
understand
more.
They
do
some
really
great
change
management,
but
they
they
that
bit
about
following
on
the
communication
to
the
public,
is
often
the
missing
step,
and
so
we
want
to
do
more
work
on
that.
L
Oh
we've
done
a
lot
of
work
and
I
know
it's
a
big
issue
for
you
too:
around
access
to
dentistry,
the
it's
the
biggest
issue.
That's
come
up,
but
it
was
a
big
issue
before
the
pandemic,
but
the
the
number
of
people
coming
to
us
saying
they
can't
get
a
dentist
has
gone
up
a
huge
amount.
I
think
it's
425
during
the
pandemic,
so
we're
working
with
a
range
of
people
on
how
people
can
get
better
access
to
to
dentistry
services.
L
Likewise,
and
just
this
week,
we've
published
a
report
on
people's
experience
of
trying
to
access
gp
surgery,
appointments
and
we've.
L
That
report
is
based
on
the
experiences
of
over
two
hundred
thousand
people
who
who've
talked
to
us
about
how
it's
been
for
them,
some
of
it
pre-pandemic
and
then
some
of
it
within
the
pandemic,
and
that's
a
piece
of
work
that
will
continue
into
next
year,
where
we're
going
to
work
in
partnership
with
the
general
practice
managers
association
to
look
at
some
of
the
pragmatic
solutions
to
the
problems
that
people
are
talking
to
us
about.
L
L
We
have
a
big
lead
at
the
moment
on
equality's
diversion
and
include
diversity
and
inclusion
issues,
particularly
working
with
the
network,
so
setting
up
action,
learning
sets
setting
up
black
workers
network
and
a
whole
host
of
things
to
really
get
that
work
moving,
and
it's
a
it's
a
very
top
priority
for
us
in
the
coming
year.
L
We're
also
undertaking
quite
a
big
I
mean
for
us
big
for
you,
tiny
digital
change
program,
because
we
just
we
believe
that
some
of
our
systems
and
processes
prevent
people
from
sharing
information
with
us
and
in
our
data
shows.
L
This
is
often
people
in
the
big
large
conobations,
the
healthwatch
in
the
league,
the
large
conurbations
that
aren't
sharing
as
much
with
us
and
that's
where
a
lot
of
the
seldom
heard
groups
are
so
we're
doing
a
big
piece
of
work
on
that
our
advice
and
information
service
has
really
stepped
up
in
the
last
couple
of
years.
L
It
was
a
priority
in
our
strategy
and
during
the
pandemic,
we've
seen
a
rise
of
720
in
people
accessing
our
advice
and
information
and
and
you'll
all
know
how
rapid
that
has
been
during
this
time.
You
know
the
guidance
on
visiting
care
homes,
the
guidance
on
shielding
the
you
know,
the
guidance
on
vaccinations
and
so
on.
It's
a
it's
a
rapidly
changing
situation,
but
I
think
our
team
have
done
really
well.
It's
a
small
team.
L
And
our
final
thing
just
to
say,
is
that
we've
had
a
really
good
year
in
terms
of
public
feedback
and
campaigns,
and
I
think
the
campaign
that
we've
worked
with
you
on
particularly
has
gone
very
well,
because
we
all
care.
It's
really
helped
informed
a
lot
of
the
insight
that
we've
been
able
to
share
with
all
the
stakeholders
that
are
relevant
to
healthwatch
england.
So
thank
you
very
much
for
your
time.
E
Thank
you
amelia.
I
think
I
said
this
to
you
before,
but
I
I
just
get
exhausted,
reading
what
you've
been
doing
and
how
you
feel,
because
you've
actually
had
to
go
and
do
it
it's
a
fantastic
volume
of
work
you
get
through
and
all
incredibly
important.
I
think
chris,
you
wanted
to
come
in.
I
Just
to
echo
melbourne's
thoughts
and
to
thank
her
and
her
team
for
the
work
that
we've
done
together
to
reach
people
across
the
country
to
make
sure
we
can
get
their
feedback
to
make
sure
we
can
act
on
it
and
make
sure
we
can
use
it
in
terms
of
our
regulation.
Her
team,
as
you
highly
say,
peter,
are
tirelessly
working
that
boat
at
the
national
level
and
also
at
a
local
level
as
well.
I
I
just
want
to
thank
her
and
the
team
for
her
continued
support
and
also
in
the
way
we
go
about
developing
campaigns
for
things
that
we
know
we
need
to
address
together.
So
I
think
I
just
wanted
to
echo
melbourne's
thoughts
and
to
offer
my
thanks
to
her
as
well.
Thank
you
thanks.
Chris
rosie.
C
Yes,
just
to
echo
that
imelda
we've
worked
very
closely,
particularly
over
the
last
few
months,
with
your
teams
around
particularly
around
gp
access,
but
also
around
dental
access
and
there's
some
great
collaborative
working
going
on,
which
is
really
adding
to
the
work
we're
doing
so.
Thank
you
very
much
for
that,
and
also
just
to
say.
I
thought
your
gp
access
report
was
was
great
and
highlighted
a
whole
range
of
issues
that
we
all
need
to
focus
on.
So
thank
you
very
much.
L
Thank
you
I'll
pass
that
back.
I've
just
come
from
a
morning
session
where
the
the
team
were
looking
back
at
the
highlights
of
the
year
that
we're
just
leaving-
and
I
felt
quite
emotional
at
the
end
of
it,
because
it
is
a
small
team
and
the
amount
of
stuff
and
the
the
the
drive.
That's
there
in
every
part
of
the
organization
is
amazing.
So
somebody
who
talks
about
the
digital
team,
it's
a
person,
it's
a
person
dealing
with
151
organizations
and
driving
change
through
that.
It's
it's
their
amazing
bunch.
E
Mark
saxton
you
wanted
to
pop
in.
Q
Q
You've
mentioned
that
in
terms
of
vaccine
hesitancy
and
transport
access,
as
we
come
to
terms
with
living
with
this
cove
experience
and
moving
forward
and
working
on
the
backlog
that
the
nhs
is
is
faced
with,
transport
again
is
going
to
be
an
issue,
and
I
wonder
whether
you
will
still
be
sending
finding
that
information
and
communicating
in
a
way
that's
had
such
a
big
impact
in
the
past.
L
So
it's
a
good
question
mark
the
the
work
on
nhs
england
you'll,
remember,
promised
a
review
after
we
published
our
findings
and
began
that
review,
but
actually
during
covid
rightly
it
became
about
how
do
you
provide
patient
transport
during
covid
and
now
they're
ready
to
start
doing
the
broader
piece
of
work-
and
I
have
a
meeting
next
week
with
nhs
england
about
how
they're
going
to
pick
that
up
and
take
it
forward.
L
But
we
also
take
it
into
any
of
the
conversations
we're
having
so
the
conversations
that
we've
been
having
about
the
40
new
or
review
reviewed
refurbished
hospitals,
transport.
Q
No
absolutely
good
to
hear
and
look
forward
to
hearing
progress
on
that
front
from
you.
Thank
you.
E
Great
anybody
else,
or
shall
we
let
milder,
go
and
get
back
to
her
busy
day
imelda.
Thank
you
very
much
again
for
for
coming,
but
thank
you
also
very
much
for
all
you
and
your
team.
Do.
I
think
it
really
isn't
it
a
very
important
contribution
to
health
and
social
care,
so
thank
you.
E
No
thank
you
any
other
business
from
anybody
on
the
board.
E
I
I
only
have
one
thing
to
say,
which
is
that
I've
just
been
told
that
the
live
streaming
failed
and
therefore
people
who
will
be
getting
to
to
hear
what
I'm
saying
will
have
seen
it
a
a
at
a
later
date.
But
I
I
just
want
to
apologize
to
everybody.
I
don't
know
what
the
technical
problem
was.
It
was
certainly
our
intention
to
have
it
live
streamed
and
it
was
all
set
up
for
that
happen.
So
apologies
and
hopefully
it'll
it'll,
work
next
time
properly.
E
So
if
there
is
no
other
business
from
the
board,
that
ends
the
board
meeting,
but
we
do
have
three
questions
from
the
public
and
we've
got
time
to
take
those.
So
let
me
start
with
two
questions
from
robin
pike.
The
first
is:
how
does
cqc
check
that
care
homes
that
should
register
do
in
fact
register?
There
are
some
suggestions
that
minor
organizational
changes
within
a
care
home
may
seem
to
remove
the
requirement
for
registration
kirsty.
Do
you
want
to
take
that?
One.
D
I
will
thank
you
peter,
so
I
think
there's
probably
two
scenarios
here.
One
is
that
a
service
that
is
unknown
to
us
is
unregistered,
so
we'd
only
know
about
a
care
home
that
is
not
registered
if
we
are
informed
by
the
public
or
others
through
through
our
intelligence.
D
D
So
if
it's
a
minor
organizational
change,
we
would
not
really
change
the
fact
that
a
care
home
needs
to
be
registered.
If
the
issue
is
regulated
activity
each,
for
instance,
accommodation
with
nursing
or
personal,
is
happening.
If
the
regulatory
activity
changes,
then
the
care
home
may
not
need
to
be
registered,
this
would
trigger
an
application
from
the
provider
to
vary
or
cancel
their
registration,
and
we
would
assess
this.
E
Thank
you
kirsty
and
then
the
second
question
I
think,
will
be
for
you
rosie
it's.
How
does
the
commission
monitor
patient
access
to
primary
medical
services
when
gp
staff
are
also
working
at
vaccination?
Centers.
C
Thank
you
peter,
so
we
have
a
variety
of
activities
that
help
monitor
this.
Firstly,
with
our
tma
activity,
our
monitoring
activity,
we
do
look
at
access
as
part
of
of
that
and
the
conversations
that
we
have
with
providers.
We
follow
up
any
concerns
that
we
hear
through
inquiries
or
follow
up
any
concerns.
We
hear
from
our
local
intelligence,
with
our
partnership
working
with
ccgs
and
local
health
watch
and
other
other
partners.
We
also
ask
about
access
on
all
of
our
inspection
activity
that
we
undertake.
E
Great,
thank
you
and
then
the
last
question
is
from
from
david
hogarth
and
he
says
in
the
march
care
home
professional
magazine,
kate
taroni.
So
I
guess
kate.
This
is
going
to
be
a
question
for
you
to
answer.
Kate
taroni
said
that,
where
intelligence
about
a
service
indicated
an
improvement,
an
inspection
could
be
held,
which,
if
positive,
could
lead
to
a
change
in
rating
and
additional
capacity
becoming
available
locally.
E
Does
the
cqc
accept
that
no
inspection
can
definitively
verify
information
of
concern,
alleging
possible
abuse
or
neglect
and
that
where
such
unverified
intelligence
is
held
either
the
information
will
be
checked
out
by
surveillance
or
moves
to
operate?
The
service
will
be
abandoned.
Do
you
want
to
have
a
go
at
that
one
kate?
I.
A
Would
say
thanks
peter,
so
I
I
think
we're
talking
about
and
two
different
things
here.
So
thank
you,
david
for
your
question.
As
I
mentioned
earlier
on
in
board,
it
is
a
priority
within
adult
social
care
in
the
cqc
to
go
out
and
reinspect
services
where
intelligence
says
that
they
may
be
currently
rated
as
an
adequate
ri,
but
actually
they've
improved
the
quality
of
care
and
information
from
local
authorities
and
clinical
commissioning
groups
back
that
up.
A
So
in
those
circumstances
we
would
go
out
if
we
found
the
service
to
be
good.
We
would
re-rate
and
therefore
open
up
capacity.
David's
question
I
think,
is
about
whether
our
inspection
activity
can
confirm
whether
there
is
concerns
about
the
quality
of
care
being
delivered.
I
absolutely
do
believe
our
inspection
activity
can
ascertain
if
people
are
receiving
poor
quality
care
and
where
we
find
that
is,
is
to
be
the
case.
A
We
can
obviously
take
appropriate
regulatory
action
and
also,
as
david
is
aware
and
as
border
aware,
we
are
continuing
to
explore
our
approach
to
how
we
use
surveillance
through
our
close
cultures
work
and
we
will
keep
board
and
the
public
updated
through
this
route.
E
Thank
you,
kate,
and
thank
you
everybody.
I
think
this
is
the
first
time
in
five
plus
years
of
chairing
the
board.
It
actually
finishes
at
precisely
the
moment
that
we
said
it
would
when
we
put
the
agenda
together,
which
is
quite
astonishing,
so
I'm
not
going
to
allow
any
other
business.
That
is
it
we'll
finish
and
just
thank
everybody
very
much
for
what's
been
a
very
good
morning's
work.
Thank
you.