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From YouTube: CQC board meeting – October 2017
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A
A
Are
there
any
interest
that
anybody
needs
to
declare
excellent
so
moving
swiftly?
Our
minutes
of
the
meeting
that
we
had
on
13th
of
September.
Are
they
a
true
and
accurate
record
of
everything
we
discussed
good?
Okay,
those
are
approved,
I.
Think,
the
first
time
since
I've
been
here,
there
isn't
nothing
on
the
action
log
we
are
so
efficient
and
up-to-date.
It
was
there
anything
arising
that
anybody
wanted
to
raise
that
isn't
otherwise
on
the
agenda
perfect.
So
we
go
straight
to
the
chief
executives.
B
C
David,
so
this
presents
the
figures
as
at
the
end
of
August.
So
in
the
month
of
August,
we
continue
to
understand
on
both
pay
and
non
pay,
bringing
the
cumulative
underspend
to
3.7
million.
We
do
have
a
shortfall
in
income,
a
hundred
thousand,
so
the
net
underspend
at
the
end
of
August
was
2.9
million.
The
Directorate
of
forecast
suggests
that
we
will
have
a
year-end
underspend
of
a
ten
point,
two
million,
although
the
current
burn
rates
would
suggest
a
higher
forecast
understand.
C
A
B
D
Well,
it
gives
me
the
chance
to
say
something
positive,
which
is
really
good
Liam
so
on
the
performance.
I
just
want
to
congratulate
publicly
my
teams
across
the
country,
because
the
average
days
to
publish
reports
has
dropped
considerably
to
28
days
and
we've
been
criticised
for
last
few
years
on
a
timeliness
of
publication.
Part
of
that
has
a
sort
of
rolling
figure
is
because
we
have
some
held
up
legally
and,
and
certainly
we,
we
had
a
problem
with
recruitment
in
some
areas.
We're
now
fully
recruited
to
all
of
our
inspector
places.
D
E
This
this
report
covers
the
time
when
we
started
inspections
under
the
next
phase
methodology
that
was
in
August,
and
that's
reflected
some
of
the
activity
figures
you
see
because
it's
not
in
the
middle
of
August.
So
it's
about
half
months
activity
there
and
that
has
been
progressing
well.
There's
more
detail
of
some
of
the
inspection
work
in
the
text
of
the
report
as
well
in
terms
of
report
terminus
which,
which
they
were
just
talking
about,
the
we've
been
making
progress
on
that
and
the
average
number
of
days
to
publications
is
now
falling.
E
F
Thank
you
just
a
few
things
to
highlight.
The
first
is
on
slide
3
looking
at
the
registration
processes
and
the
continued
improvement
that
we
have
there
of
completing
the
decisions
on
registration
within
50
days,
which
is
a
key
performance
indicator
target
and
I
think
that
the
continued
improvement
there
is
also
building
on
the
improvement
that
we've
seen
from
our
colleagues
in
NCSC
in
terms
of
passing
on
the
registration
applications
through
to
the
registration
team
to
deal
with
so
in
both
NCSE
and
in
registration.
F
The
next
slide
that
I
wanted
to
take
you
to
was
slide
6,
which
looks
at
the
productivity
and
the
activity
that
we've
got
there.
We
had
a
slight
dip
of
productivity
in
August,
and
that
was
largely
to
do
with
absences,
obviously
it's
the
height
of
summer
holidays
and
for
people
in
August,
and
we
are
not
in
the
position
that
steve
is
in
terms
of
having
all
vacancies
recruited
to
do.
F
Looking
at
the
forward
planning
for
our
recruitment,
also
trying
to
forward
plan
on
our
recruitment
so
that
where
we
know
that
people
are
intending
to
leave
because
of
retirement
dates,
coming
up
that
sort
of
thing
that
we
are
recruiting
ahead
of
time,
so
that
we
don't
have
huge
gaps
because,
of
course,
once
you've
got.
People
in
you've
got
to
train
them
as
well.
So
it's
not
like
people
and
start
on
the
first
day
able
to
pick
up
a
level
of
activity
and
that
their
colleagues
have
been
with
us
for
longer.
F
Can
the
recovery
plans
that
the
local
teams
have
been
developing
will
help
us
to
improve
our
position,
but
we're
still
very
anxious
about
that
towards
the
end
of
the
year,
and
we
don't
think
that
we'll
get
to
the
key
performance
indicator
target
of
90
percent
by
the
end
of
the
year.
Unfortunately,
but
I
do
again
have
to
say
that
the
teams
are
working
under
quite
considerable
pressure.
F
You
can
see
that
in
terms
of
the
increase
in
the
numbers
of
enforcement
actions
that
are
ongoing
and
the
activity
that
they're
undertaking
there,
so
people
are
working
extremely
hard.
But
it
is
a
worry
for
me
in
terms
of
how
well,
how
were
responding
to
the
timeliness
of
inspections,
because
what
we're
really
concentrating
on
is
responding
to
risk.
F
And
you
can
see
that
when
you
look
at
slide
7-
and
these
were
figures
that
we
reflected
in
the
state
of
care
report
last
week,
which
is
that
of
the
good
services
that
were
going
back
to
and
an
awful
lot
of
the
early
services
that
were
going
back
to
are
because
people
are
sharing
with
us
concerns
about
services.
So
we
are
responding
to
those.
But
you
can
see
that
23%
of
services
that
we've
gone
back
to
that
we'd
previously
rated
as
good,
are
deteriorating
20%
to
requires
improvement
and
3%
to
inadequate
and
I.
F
Think
that
you
know
the
the
message
that
we
shared
last
week
about
services
being
precarious,
is
really
reflected
in
that
and
is
something
that
we've
got
to
got
to
be
on
top
of
and
being
able
to
respond
to
people
highlighting
risk
to
us
and
again
on
on
report
writing,
which
is
worked
and
Steve
started
us
off
with.
We
continue
to
drop
the
average
number
of
days
and
we're
at
34
now
and
also
kind
of
keeping
ourselves
approaching
to
the
90
percent
key
performance
indicator
target
and
we're
at
86
percent.
A
So
there's
a
lot
of
positive
news
in
what
you've
just
said
and
and
I
echo
your
course
of
congratulations
to
your
your
people,
who
are
working
under
huge
pressure
and
delivering.
But
but
the
worry
which
you
said
is
is
around
staffing
levels
and
given
that
we
know
the
whole
sector
is
under
real
staffing
issues,
I
mean:
how
optimistic
can
we
be
about
getting
up
to
full
strength
and
staying
there?
Do
you
think.
F
We
are
having
a
positive
response
to
recruitment.
The
difficulty
for
us
is
keeping
pace
with
the
level
of
turnover
and
the
creep
meant
and
actually
making
sure
that
we're
running
sufficient
numbers
of
assessment
centers,
which
obviously
involve
inspection
managers
and
as
well
as
the
recruitment
teams
to
support.
F
So
it's
really
making
sure
that
we're
keeping
up
to
date
with
all
of
that,
we
do
have
some
particular
hotspots
of
of
worry,
which
is
in
the
south,
which
is
you,
coincidentally,
per,
perhaps
not
so,
coincidentally,
where
we
also
see
kind
of
significant
term
in
terms
of
recruitment
in
the
adult
social
care
sector
as
well.
But
it's
something
that
we
are.
F
You
know
trying
to
keep
on
top
of
and
working
with,
eiling's
team
and
the
people
Directorate
to
make
sure
that
we're
doing
that
as
proactively
as
we
possibly
can
team
are
also
looking
at
how
we
can
introduce
more
of
a
skill
mix
into
adult
social
care.
So
we
have
been
looking
at
the
introduction
of
assistant
inspector
posts
which
have
been
very
successfully
used
in
the
other
directorates,
and
we've
had
some
good
positive
responses
to
those
recruitments
as
well.
But
it's
just
relentless
really
in
terms
of
keeping
going
with
it.
D
Thanks
ed,
any
any
questions,
Steve
just
to
add
to
Andres
point
I
think
the
assistant
inspectors
pose,
including
in
the
medicines
management
team,
the
pharmacists
are
being
hugely
successful
and
Tiffa
I
met
with
the
senior
team
in
medicines.
Optimization
management
this
week
and
a
number
of
theirs
are
now
ready
to
become
inspectors
and
they're
applying
for
those
jobs
and
I
think
the
fact
we
took
that
initiative
has
been
really
good.
I
mean
we,
we
are
at
our
best
recruitment
and
we've
been.
D
G
Well,
thank
you
Peter.
So
it
is
a
great
note
to
end
on
to
to
actually
celebrate
the
fact
that
if
you
look
at
the
NCSC
performance,
where
actually
people
are
not
just
performing
against
targets,
they
had
previously
they're
actually
exceeding
the
performance
that
we
set
before
we
set
out
to
modernize
our
customer
service
center.
So
it
has
been
a
huge
team
effort.
I
think
Tracey
Forrester
has
done
an
amazing
leadership,
job
up
there
and
she's
playing
a
part
with
Andrea
in
the
reworking
of
registration.
So
it
really
does
show
CQC
at
its
best.
A
Sure
that
you
had
absolutely
nothing
to
do
with
any
of
the
improvement
that's
taking
place,
but
just
in
case
you
did
can
I
just
just
can
I
just
thank
you
as
well
Eileen.
Having
said
all
that-
and
it
really
is
a
stunningly
good
performance,
but
there
are
a
couple
where
we're
still
not
hitting
the
KPIs
some
of
the
safeguarding
around
requiring
mandatory
action.
For
example,
we
are
we
confident
that
the
trajectory
continues
through
the
directories
coming
up.
Are
we
confident
that
it
continues
and
we
will
get
the
KPI
and.
G
I
am
very
confident
it
will
do,
but
around
safeguarding
and
mandatory
actions
in
particular-
and
this
is
where
CQC
for,
in
order
to
hit
the
KPI,
it
is
more
than
NCSC.
That
needs
to
do
something,
and
occasionally
is
the
recording,
once
they've
handed
it
on
to
an
inspector
call.
It
colleague
which
is
causing
that
particular
KPI
not
to
be
hit
so
I,
think
what
we're
looking
at
is
the
component
parts
of
those
actions
and
to
make
sure
that
everybody
is
actually
clear
about
what
they
need
to
do
so.
A
H
Imagine
quite
a
lot
of
those
are
in
the
adult
social
care
area,
and
you
will
see
them
they
in
the
minutes
of
the
ACCJC
meeting
that
we
had
an
update
from
Rebecca
on
this
there's
an
awful
lot
of
volume
that's
coming
through
in
the
enforcement's
area
and
it's
a
big
hopper
of
stuff
which
actually
then
has
to
be
triage
down
in
some
fashion.
To
get
to.
H
We
get
the
right
cases
through
to
the
actions
that
need
to
be
taken
as
quickly
as
possible,
and
so
that,
and
we
were
suggesting
nice.
If
you
see
there
is
something
that
Lois
isn't
here,
that
our
DC
might
look
at
the
proposals
around
that
to
make
sure
that
they're,
the
right
ones
and
force
perspective
around
there.
There
is
something
about
about
that
number
and
the
way
it's
impacting
upon
ASC
inspectors,
but.
A
I
Well,
just
to
sort
of
say
it
is
something
that
I've
begun
to
have
conversations
about
and
in
fact,
I
had
a
meeting
with
my
counterpart
at
HRC
yesterday,
and
we
were
talking
about
how
HSE
managed
their
sort
of
selection
criteria
and
that
there
are
some
key
differences.
But
there
are
also
things
that
I'm
sure
we
can
learn
so
I
think
there's
quite
a
lot
of
hopefully
fairly
rapid
progress.
F
Yes,
just
to
say
two
things:
one
one
is
that
rebecca
has
referred
to
the
enforcement
oversight
board,
which
is
led
by
Debi
West.
Air
2
is
one
of
the
deputy
chief
inspectors
in
adult
social
care,
but
she
takes
that
lead
across
the
whole
organization
and
they
they
are
looking
with
Rebecca
and
the
rest
of
the
legal
team
as
well
at
what
are
those
criteria,
making
sure
that
they're
fully
understood
and
that
we're
informing
the
training
and
support
that
inspectors
have
and
their
managers
have
because
they're
crucial
in
the
decision
making
process
for
this
as
well?
F
And
the
second
thing
to
say
is
that
I'm
equally
concerned
about
the
big
hopper
as
Paul
has
described
it
of
all
of
those
cases
sitting
there
and
people
worrying
away
at
them
and
collecting
more
evidence
and
checking
things
and,
and
actually
you
where
should
we
be
focusing
the
but
in
terms
of
these,
are
truly
going
to
be
cases
that
we
will
be
taking
forward
that
there
is
a
case
to
answer
and
that
we've
got
the
evidential
basis
to
do
that.
And
there
is
a
public
interest
tester
to
address
as
well.
F
So
one
of
the
things
that
we're
doing
within
adult
social
care
is
really
to
get
all
of
those
cases
reviewed
at
a
more
senior
level
to
absolutely
make
sure
that
we're
doing
the
right
thing
and
that
we're
taking
forward
the
cases
that
we
can
and
that
where
we
don't
have
the
basis
to
take
that
forward.
That
we've
got
a
good
rationale
and
explanation
as
to
why
not,
which
includes,
if
those
have
been
have
obviously
impacted
on
individuals,
and
we
have
contact
with
their
families
or
themselves,
then
that
we
would
be
talking
with
them
as
well.
B
The
state
of
hospices
report
quality
impairs
place,
reports
of
both
Sutton
and
Cornwall
local
systems.
Reviews
which
Steve
referred
to
in
the
earlier
meeting
are
all
referenced
and
I
think
make
a
significant
contribution
to
the
way
that
the
system
is
operating
as
distinct
from
what's
in
paragraphs
three,
which
is
a
brief
update
from
Ted's
team
in
relation
to
inspections
completed
on
trusts
since
the
last
meeting
I
don't
want
to
gloss
over
those
reports
and
in
the
spirit
of
paying
tribute
to
stuff
I,
just
like
to
do
this
to
the
editorial
staff.
B
B
This
is
the
first
opportunity,
I
think
for
the
board
to
consider
the
state
of
care
report,
since
we
published
it
last
week,
there's
a
brief
synopsis
of
what
we
said
and
the
last
paragraph
is
commenting
on
the
reception
that
it
got
from
stakeholders
and
journalists.
I
think
there
was
a
lot
of
support
for
it
both
on
the
day
and
then
subsequently,
I
think
in
terms
of
the
richness
of
the
document
and
the
richness
of
the
information
that
sits
behind
some
of
those
headline
messages.
B
It's
been
both
described
as
subversive
by
one
person
and
rich
by
the
other.
I'll
leave
you
to
work
out
where,
on
that
continuum,
you
want
to
sit
in
terms
of
the
volumes
of
information
in
there,
but
I
have
to
say
I
think
it
was
the
most
complete
report
that
we
published
over
the
past
five
years,
just
because
of
his
breadth
of
coverage
and
the
confidence
we
can
have
in
the
data
that
sat
in
that
and
a
big
congratulations
to
everybody
across
the
organization.
B
The
auditor
and
Comptroller
General
published
his
reports.
Commenting
that
were
an
improved
organisation.
Value
for
money
is
improving
and
if
we
continue
in
our
current
direction,
we
can
secure
further
improvements
and
he
flagged
a
conversation
we're
going
to
have
later
this
morning.
Colleagues,
in
relation
to
digital
systems
and
capability
and
intelligence,
driven
risk-based
approach
to
regulation
as
being
key
for
the
future,
so
I
think
it
was
affirming
that
he
reflected
the
direction
of
trouble.
That
we've
set
out
in
the
strategy
is
one
that
he
endorses.
B
My
personal
view
of
this
report
is
I
think
it
was
a
fair
assessments
of
where
we
are
rightly
congratulating
the
progress
we've
made
and
rightly
challenging
us
to
go
further
and
I.
Think
all
of
us
are
scrutinized
by
external
bodies,
and
we
do
this
to
others.
Want
the
reports
to
be
fair,
and
my
view
is
that
this
was
so
what
will
happen
next?
B
These
will
bring
back
a
response
to
the
recommendations
to
the
December
meeting
of
the
board
and
we'll
have
more
detailed
discussions,
audit
and
corporate
governance
committee
under
Paul's
chairmanship
on
the
progress
making
of
that
during
the
new
year.
It
may
well
be
that
we
have
a
Public,
Accounts,
Committee
hearing
I,
don't
know
whether
they'll
see
this
as
a
priority,
given
everything
else.
B
B
So
this
is
a
hot
topic
and
then
the
last
update
is
just
to
say
that
the
Bermuda
health
council,
which
is
going
to
be
the
body
that
regulates
health
and
care
services
in
Bermuda,
been
over
a
part
of
an
exchange
and
there's
been
a
training
program
provided
by
the
Academy
for
the
people
that
will
be
doing
their
inspections,
so
they
can
actually
benefit
from
the
experience
and
the
learning
that
we've
had
as
well.
So
that's
the
report,
pizza,
so
I
think
a
lots
of
positive
progress
in
them.
I
agree:
lots,
lots.
A
L
It
consists
of
the
five
national
statistics
that
CQC
produces
and
it's
part
of
a
survey
program
that
is
operated
across
th
and
NHS.
England
collecting
patients
experiences
on
a
range
of
care,
predominantly
here
at
CQC
around
acute
care,
but
that
also
includes
community
mental
health
services
as
well.
The
program
itself
is
based
on
a
highly
repeatable
and
robust
method,
which
allows
us
to
compare
organisations
and
areas
which
other
collections
around
patient
experience.
So
things
like
friends
and
family
test
or
individual
interviews
focus
groups
things
that
kept
kind
won't
easily
do
so.
L
In
effect,
they
move
generally
towards
a
greater
level
of
digital
communication
across
the
NHS
system,
means
that
email
addresses
are
more
routinely
collected
and
a
vision
of
a
2020
paperless
system
will
push
it
further
into
that
direction,
meaning
that
I
could,
instead
of
send
out
paper,
questionnaires,
reduce
the
costs
for
NHS
organisations,
put
back
through
a
digital
format
and
collect
the
information
quicker
and
much
cheaper
for
trusts.
So
switching
to
a
more
digital
system,
continuing
to
be
supported,
where
necessary,
with
paper
for
harder
to
reach
groups,
allows
us
to
do
that.
L
That's
a
bit
further
off,
but
it
would
certainly
come
within
the
the
period
in
which
this
contract
is
talking
about.
Then.
The
the
final
thing
is
that,
because
a
digital
system
is
inherently
more
flexible,
you
can
put
together
questionnaires
more
quickly
because
there
will
be
naturally
shorter
because
they
need
to
be
digital.
You
are
able
to
send
them
out
more
routinely
and
on
a
range
of
topics
that
we
currently
don't
cover,
because
they
are
not
increasing
the
cost
to
the
service
in
itself.
L
Well,
that
means
is:
is
that
we'll
be
able
to
revisit
the
the
actual
flow
of
that
data?
So
we
can
increase
it
potentially
towards
a
more
annual
cycle
to
help
us
in
the
next
phase,
but
also
we'll
be
able
to
undertake
pulse
checks
where
we
have
questions
that
we
want
to
be
able
to
understand
people's
experiences
about
rather
quickly.
So
the
basis
of
this
paper
is
to
continue
that
program
and
continue
its
development,
but
also
specifically
to
look
at
development
within
the
next
five
years.
In
those
three
areas.
A
H
Presentation
and
thank
you
and
clearly
persuades
me
that
we
need
to
continue
this
extremely
valuable
work.
One
note,
of
course
now,
which
I'm
sure
is
intended,
but
I
don't
see
mentioned,
is
that
well,
of
course,
the
majority
even
of
people
at
my
age
are
accessible
by
digital
means.
The
most
vulnerable
parts
of
our
population
tend
not
exactly.
If
we're
talking
about
the
patient
experience
of
the
elderly,
some
of
those
who
live,
you
can
obviously
deprive
circumstances
or
have
special
needs.
H
L
Is
the
program
so
I
absolutely
agree
with
you?
The
current
take
up
around
email
addresses
is
around
seventy
to
eighty
percent
and
that
obvious
reasons
continues
to
increase,
but
that
does
mean
in
particular
for
a
much
older
population.
That
email
address
is
just
simply
isn't
an
option.
For
now
we
wouldn't
switch
to
a
purely
digital
system.
L
We
would
need
to
leave
in
place
the
telephone
help
lines
to
allow
people
to
call
and
respond
over
the
phone
paper
methods
which
we
can
also
use
n
send
and
because
the
sample
data
collects
a
range
of
biographical
data
as
well
as
email
addresses,
we'll
be
able
to
target
those
where
they
need
to
be.
We
weren't
rushed
to
a
purely
digital
solution
straight
away.
We'd
need
to
leave
in
a
mixed-methods
until
then
Oh.
D
Steve
thank
sighs,
excellent
presentation
and
I
mean
the
papers
very
clear.
It's
just
to
highlight
an
issue
so
I'm
pleased
that
we're
looking
at
the
what
are
called
new
models,
our
care,
but
many
are
new
models-
would
care
their
existing
ones
slightly
differently
than
on
you
and
it's
to
clarify
that
NHS
England
managed
the
GP
patient
survey,
which
we
rely
on
quite
heavily
and
probably
don't
have
the
impact
on
its
development
that
we
probably
should
have
going
forward
with
that
being
based
in
one
organization
as
this
being
based
in
another.
D
It's
vitally
important
that
we
get
the
opportunity
to
talk
across
both
I'm
still
not
convinced
that
GP
surgeries
that
are
owned
by
a
hospital
don't
fall
within
NHS
England
patient
survey.
So
I'd
like
clarification,
some
time
on
that,
for
example,
Yeovil
hospital
will
have
1214
GP
surgeries.
The
other
surgeries
in
Yeovil
will
be
freestanding,
surgeries
or
or
organized
and
home
by
other
other
organizations.
D
It
would
be
extremely
useful
for
us
and
helpful
in
our
rating
for
these
same
questions
to
be
asked
of
both
groups
of
surgeries
so
that
we
can
compare
across
Yeovil,
let
alone
across
the
whole
of
England
and
so
I
support
the
paper,
but
at
the
anomaly
of
the
two
surveys
being
in
isolation
when
GP
surgeries
will
be
owned
by
and
run
by,
different
organizations
means
that
we're
still
behind
the
times
on
where
the
NHS
is
going.
Thank
you,
Steve.
A
I,
just
declaring
my
my
former
interest
in
in
Yeovil,
but
I'm,
not
sure
that
that
the
ownership
is
the
issue
that
these
are
not
primary
care
services
provided
with
within
the
acute
trust
and
in
in
quite
that
way,
I
mean
they
are
still
provided
through
a
GP
practice
which
is
on
a
contract.
So
why
would
they
not
be
in
there?
So.
D
I'm
highlighting
a
potential
anomaly,
but
in
a
bigger
anomaly,
in
that
some
surveys
we
lead
on
another
NHS
organisations
lead
on
others
and
if
they're
not
joined
up
when
you're
out
there.
As
we
talked
about
last
night,
when
we
were
talking
about,
for
example,
Dudley
and
and
Kent,
the
NHS
is
moving
faster
than
we
are
collectively
with
our
surveys
and
things,
and
we
just
need
to
make
sure
that
we
keep
on
top
of
it,
because
if
we're,
if
we're
not
going
to
look
at
similar
data
across
the
whole
of
the
NHS,
it's
very
difficult.
D
L
There
there
is
something
of
interest,
so
we
do
sit
on
the
boards
of
the
two
major
surveys
that
we
also
use.
So
the
GP
patient
survey
plus
the
your
staff
survey.
If
I
came
to
to
get
myself
on
the
ask
off
survey,
I'd
be
squeezing
myself
through
the
door.
I
can
assure
you
the
development
of
that.
Therefore
we
do
have
some
say
over,
but
we
don't
have
control
and
and
I
think
retaining
control
of
these
surveys
gives
us
a
greater
ability
to
develop
them
to
our
needs,
and
that
is
absolutely
a
point.
L
The
other
thing
which
I
think
is
true
is
that
the
GP
patient
survey
is
a
population
survey.
The
area
influence
we
could
therefore
have
is
the
reporting
out
so
the
population
in
those
areas
in
in
Yeovil
or
other,
where
the
service
models
are
slightly
different.
Their
view
is
still
being
collected,
but
the
reporting
is
done
at
a
GP
patient
level,
because
it's
done
the
GP
survey
and
if
we
could
influence
that
decision,
then
we
could
get
the
data
that
you're
looking
for
more
easily,
but
we
wouldn't
need
to
change
the
collections.
E
Yes,
just
strong
support
for
this
work.
I
think
these
surveys
have
been
really
very
valuable
to
us,
both
in
deciding
where
to
inspect
in
our
new
risk-based
methodology,
but
also
in
inspection
reports
and
they're.
Quoted
heavily
excuse
me
heavily
in
our
spectral
reports
as
a
reflection
of
the
patient
experience
and
services.
We
inspect
and
I
think
as
we
move
towards
a
more
annual
cycle
of
inspections,
I'm
very
keen
to
see
the
frequency
increase
and,
of
course,
the
the
digital
approach
that
you're
talking
about
will
help
us
do
that.
E
So
we
have
up-to-date
information,
because
some
of
these
some
of
these
reports
are
only
done
over
two
years
and
yet
who've
been
inspecting
every
year.
We
want
to
up-to-date
information,
so
I
strongly
support.
This
direction
of
travel
can
just
highlight
for
the
board,
but
yesterday
we
reported
the
latest
survey
on
emergency
departments
where
we
reported
the
responses
of
45,000
patients.
J
L
Absolutely
so
there
are
a
few
things
that
you
need
to
do.
You
need
to
revisit
the
websites
that
you
have
all
of
a
material
held
on.
You
need
to
also
revisit
the
way
that
it's
accessible.
So
no
one
really
uses
a
computer
anymore
to
fill
a
survey
in
they're
much
more
likely
to
use
a
tablet
or
your
phone,
so
we
would
need
to
revisit
those
decisions
as
well.
The
other
thing
that
is
absolutely
true-
and
we
all
need
to
get
this
right
across
the
system-
is
that
you
will
need
a
much
shorter
questionnaire.
L
I'd
love
you
to
fill
in
a
70
page
questionnaire
on
your
phone,
but
you're
not
going
to
do
it,
so
we
will
need
to
work
with
our
system
partners
to
work
out
whether
the
absolute
key
questions
that
we
need
to
be
asking
routinely
and
what
are
those
key
questions
that
we
want
to
be
using
on
a
pulse
base
to
work
out?
What
do
I
need
to
ask
in
winter,
for
example,
and
time
that,
but
there
is
a
technology
shift
that
needs
to
happen
over
that
period
and
we'll
be
looking
at
that
as
well.
A
A
H
Don't
again
routine
meeting
you
a
CGC
management
insurance,
the
this
is
the
process
by
which
management
looks
internally
and
does
peer
reviews
internally
on
our
processes
to
join,
assess
how
we're
doing-
and
we
use
a
similar
sort
of
process
of
rating
things
as
we
do
on
our
inspections
and
it's.
This
is
pretty
to
be
actually
a
very
good
process
of
being
transparent
about
what
we
do,
how
we're
doing
and
has
and
has
been
applied.
H
Well,
it's
been
looked
at
by
internal
audit
to
some
extent,
a
spindle
to
I,
say
through
peer
reviews
and
I
am
really
encouraged
by
how
positive
people
have
been
in
in
in
applying
this
and
honest
they've
been
applying
this,
it's
been
very
helpful
to
measure
and
it
gives
in
terms
of
directions
of
travel
and
and
so
on.
The
question
we
had
was
whether
this
needs
to
change
in
some
way
having
been
in
place
for
a
couple
of
years.
H
As
you
can
see,
we
looked
at
three
different
risks.
There
I
think
the
one
which
we
support
spent
more
time
on
was
the
IT
technology
systems
and
we've
got
about
the
presentation
coming
up
on
online
IT
and
systems
and
technology
and
digital
next,
and
we
also
inquire
into
the
areas
of
the
hopefully
culture
and
what
is
that
we
need
to
do
in
order
to
be
able
to
derive
the
high
performing
culture
more
into
the
organization.
I'm
very
much
focused
on
leadership
within
that
we
know
that
leadership
is
important
both
within
our
own
organization.
H
You
know
the
organization's
we
inspection
rate
and
I
think
that
the
stage
we're
at
now
is
actually
the
driving
leadership
down
into
the
organization.
It's
not
executive
leadership
team.
It's
actually,
then,
it's
sort
of
five
or
six
hundred
people
below
the
hats
in
a
sense
and
they're,
at
the
the
ASHRAE
disastrous
program
that
we
we've
gotten
and
how
that's
coming
through
so
I
think
a
CGC
were
encouraged
by
what
came
through
in
terms
of
how
we're
doing
that.
Obviously
it
seats
it.
This
is
a
hard
one.
H
This
is
a
kind
of
both
Education
and
Culture,
and
it's
something
which
needs
to
be
worked
out
in
in
detail
in
its
heart.
Yours
to
get
but
I
think
we've
got
progress
coming
there
we'll
see
the
results
of
that
over
the
next
year
and
we
looked
at
the
risk
around
essentially
market
oversight
and
we're
happy
that
that
risk
is
well
mitigated
internal
audit
progress.
Some
reports
issued
no
limited
assurance
opinions
in
there,
which
is
great
results
compared
to
where
we've
been
a
few
years
ago.
H
I
think
that
the
internal
moving
forward
and
nothing
particular
to
report
their
strategic
implementation
plan.
This
was
an
order
done
previously,
where
some
points
have
been
raised
about
what
we
were
doing
around
engagement
and
so
on,
and
that
engagement
internally.
That's
all
around
that
and
we
had
a
report
on
the
progress
on
dealing
with
those
the
voices
and
raised
which
was
good
pensions
governance.
We
could
spend
a
long
time
on
pensions
governance.
We
did
spend
a
long
time
on
pensions,
governance
within
the
a
CGC.
H
This
was
lot.
This
was
looking
at
those
of
our
staff,
who
are
members
of
pension
schemes
that
are,
that
are
local
authority
pension
schemes,
and
there
are
some
very
500
of
those
individual
says
quite
a
number.
The
majority
of
those
large
majority
of
those
are
in
the
Teesside
scheme
and
then
you've
got
about
15
other
schemes,
where
we
have
small
numbers
of
of
staff,
who
were
members
of
those
teams
that
it's
all
for
historic
reasons.
H
In
fact,
there
have
not
been
including
contributions
that
we've
made
it's
about
deficits
on
schemes
essentially,
and
how,
at
the
point
that
you,
your
last
person,
goes
out
the
door.
Suddenly,
the
deficit
falls
in
and
you
have
to
make
a
contribution
quite
quickly
as
a
result
of
that,
and
any
one
scheme
is
not
a
huge
amount
of
money,
add
them
all
together
and
there's
a
certain
amount
of
money.
That's
involved
in
that.
H
So
we
just
need
to
get
make
sure
that
we
understand
when
those
are
most
likely
to
fall
in,
and
that
depends
upon
people
retiring
off
and
rather
than
anything
else,
it
could
also
because
people
moved
elsewhere
and
that
we
are
lined
up
with
D
H.
In
terms
of
course,
D
H
have
the
ultimate
responsibility,
I
think,
because
they've,
given
us
guarantees
on
these
scheme
that
D
H
understand
when
those
those
amounts
can't
afford
it,
it's
not
huge
amounts
of
money,
British
citizens.
This
is
something
we
need
to
keep
under.
H
So
we
did
that
work
as
part
of
a
CGC
and
I
think
we
can
now
hand
that
responsibility
over
to
the
Finance
Committee
to
follow
through
there's
a
good
piece
of
work
done
by
some
external
folks
and
help
with
them
and
then
licorice
I.
Think
I
referred
to
the
point
where
she
really
talked
about
Indy
horse,
which
was
around
how
we
make
sure
that
we've
got
the
efficiency
in
the
processes
there.
A
Thank
you,
but
before
opening
it
up
multi,
you
might
like
just
to
get
a
message
to
Pete
and
Andrew
that
for
once
were
running
slightly
ahead
of
time
rather
than
behind
time,
which
will
shock
them.
But
it
would
be
good
if
they're
there
around
to
come
in.
Just
on
that
pension
point,
I
mean
that
the
the
the
the
what
you
said
at
the
end
is
the
really
important
issue.
Isn't
it
that
the
the
liabilities
ultimately
of
the
department's,
not
ours,
to
the
extent
that
there
are
liabilities,
the.
C
H
A
A
Right
so
we
have
an
interesting
pause.
Well,
not
only
is
Malta
God
yeah
he's
not
in
the
room
either.
So,
let's
you
want
to
do
this
all
on
your
own
and
then
we
might
wait
at
least
until
Malto
comes
back
bet,
penalties
for
running
ahead
of
time
for
the
board,
not
the
members
of
public
for
the
board
was
that
was
there
any
other
business
that
anybody
was
going
to
raise
under
the
any
other
business
section.
A
A
We
were
nearly
sending
other
others
out
to
look
for
you
mortar,
but
they
don't
know
it's
a
it's.
If
we
just
completely
shocked
you
by
being
ahead
of
time
rather
than
behind
I
know
who's
there
anyway,
you're
very
welcome
P
and
a
and
Andrew.
What
are
you
introducing
this,
or
is
it
straight
to
Pete
Pete
over
to.
M
You
thank
you
Peter.
Yes,
sir
thanks
for
inviting
us
back
for
this
session.
Really.
This
is
laying
out
the
the
top
level
strategic
objectives
that
we're
trying
to
achieve
that
our
digital
digitally
enabled
but
business
led
so
that
we
can
effect
change
in
the
CQC
to
become
more
efficient,
more
effective,
we've
laid
these
out.
M
Then
report
authoring
and
information
publications.
So,
in
that
space
it's
both
the
more
reports,
as
you
might
conceive
them
today.
So
how
do
we
make
sure
that
inspectors
can
create
reports
in
a
faster
turnaround
time
containing
the
right
information,
but
also
it's
about?
How
do
you
present
the
right
information
to
the
right
audience
at
the
right
time
in
the
right
way,
so
context
of
context,
sensitive
information
making
sure
it's
presented
for
the
people
that
are
going
to
use
it
in
the
way
that's
best
appropriate
for
them
to
consume
it?
M
So
that's
an
important
part
becoming
intelligence-led
or
extending
that
so
making
sure
that
we
are
using
the
right
information
to
inform
risk
to
manage
our
inspections,
to
manage
the
scheduling,
to
highlight
areas
of
concern
and
to
do
that
in
a
faster
turnaround
than
a
regular
cyclical
basis.
So
intelligence,
that's
critical,
and
then
we
have
some
core
service
design
pieces
about
the
technology
that
underpins
the
organization.
The
way
that
we
need
to
move
to
different
devices
and
fundamentally
change
the
way
that
our
our
people
operate
with
with
equipment.
M
They
would
expect
if
they
were
buying
it
themselves
at
home.
So
those
are
the
core
priority
areas.
We've
taken
a
bottom-up
approach
to
developing
a
plan
towards
this,
and
the
plan
we
put
forward
is
intentionally
aggressive.
Shall
we
say
in
terms
of
trying
to
do
everything
at
once,
not
to
say
that
we
will
do
everything
at
once,
but
to
make
sure
we
force
the
conversation
about?
Where
will
the
core
benefits
lie?
Which
pieces
will
make
the
most
impact
early?
M
Those
the
core
points
really
and
then
there's
the
steer
from
the
for
them,
for
the
board
is
the
appetite
for
that
change.
The
prioritization
of
that
change
in
the
way
in
which
we
structure
and
implement
that
through
joint
of
joint
working
effectively
across
all
directorates,
because
it
is
a
cultural
change
and
a
new
way
of
working,
not
simply
a
technology
change,
so
it
needs
to
be
led
jointly
and
managed
effectively
and
coordinated.
Well,
so
those
I
think
I
look
for
the
core
pieces.
A
J
Sure
I
think
there's
a
lot
of
good
work.
That's
gone
into
this
paper,
having
had
conversations
with
you
know
and
repeat,
and
and
a
tremendous
amount
of
collaboration
throughout
the
organization
to
get
this.
This
paper
done,
but
just
a
frame
just
to
frame
the
conversation
and
use
my
weekend
hobby
of
looking
at
housing
estates,
I
think
I.
Think
the
the
the
pace
that
you're
going
to
move
that
is
is
ambitious
and
the
disruption
on
the
wider
CQC
organization
is
going
to
be
large,
because
this
is
not
just
a
technology
project.
J
They
would
realize
the
benefits
through
cash
flow,
which
would
allow
them
to
build
the
next
phase
of
the
housing
and
I
think
the
approach
we've
got
here
is
to
two
opposing
factors
is:
do
we
take
to
your
point?
P?
Do
we
take
one
set?
It
could
be
registration,
it
could
be
how
inspectors
use
mobile
first.
Do
we
take
one
set
of
that
and
say
we'll
complete
this
work?
J
At
the
same
time,
we
have
to
do
all
the
underlying
work
of
improving
our
data
collection,
normalizing
our
data
and
and
putting
data
science
at
it,
and
but
we
actually
realize
the
benefits
a
lot
earlier,
rather
than
trying
to
do
everything
which
will
disrupt
the
organization
hugely
in
in
one
year
and
really
realize
our
benefits
truly
in
the
next
two
to
three
years.
Well,
my
preference
would
be,
and
the
reason
for
the
preference
is
I
think
once
you've
built
something
early
on.
You
also
create
a
feedback
loop
and
through
that
feedback
loop.
J
You
start
learning
lessons
now
that
may
cause
you
to
pivot
your
strategy
in
years.
Three
to
four-
and
you
may
say,
although
intelligence
is
really
important
to
us,
I'm
just
using
this
as
an
example,
although
intelligence
is
really
important
and
data
science
machine
learning
with
the
areas
we're
going
to
go
to
right
now,
we've
decided
to
pivot
term
more
on
the
inspectors,
because
we
think
there's
a
greater
benefit
through
that
feedback
loop
that
we've
received
having
built
something
for
the
inspectors.
So
what
I'd
like
to
see
is
a
sort
of
slight
flip
of
of
this.
J
J
A
Stretch
your
your
housing
estate,
analogy
probably
too
far,
I
mean
I.
Actually
you
arrive,
a
house
building
will
arrive
at
the
the
end
point,
which
is
the
last
last
person
moving
into
the
last
built
house
at
about
the
same
time
under
either
approach.
It's
just
that
there
are
people
that
are
in
houses
much
earlier,
so
III
don't
see
this
necessarily
as
being
I
said,
I'm
sorry
over
using
your
analogy,
but
I
person
you
didn't
see.
A
J
Correct
I
mean
really
straight
to
the
analogy.
It
may
be
that
you
know
when
the
people
have
moved
into
the
initial
houses,
they
find
all
sorts
of
defects,
it
could
be
the
taps,
aren't
working
or
something,
and
the
important
thing
for
this
strategy
is
what
we
want
to
do
in
the
strategy
is:
remove
risk
as
early
as
possible
and
with
a
lot
of
traditional
approaches
of
Technology
projects.
J
The
risk
keeps
moving
further
and
further
down
and
you
only
receive
the
risk
when
you're
actually
doing
the
testing
right
at
the
end
and
what
I'm,
proposing
and
I
think
Pete,
Ellen
and
Andrew
were
also
aligned.
Is
that
we
recognize
a
lot
of
the
risks
earlier
on
and
and
then
we
stopped
mitigating
them,
and
although
it
will
look
slower
at
the
beginning,
the
velocity
will
increase
towards
the
end,
because
what
I've
realized
and
learned
a
lot
of
lessons
early
on
and
we'll
apply
those
lessons
to
the
remaining
houses.
J
So
it
will
slow
us
down
I
think
in
the
first
year
it
probably
will
slow
us
down,
but
then
subsequently,
as
I,
would
expect
to
see
an
increase
in
in
in
the
velocity
and
the
capability
of
the
team
to
deliver
what
they
need
to
there's
some
things
that
still
will
have
to
happen
on
a
more
enterprise.
So
it
may
be
that's
part
of
the
intelligence
side
where
we
are
still
collecting
and
normalizing
that
data.
H
At
the
same
time,
you've
got
to
stop
make
sure
that
if
you're
you're
you're
connecting
new
mains
or
whatever
or
new
roads,
that
you
aren't
stopping
people
getting
into
the
rest
of
your
housing
estate,
where
they're
still
living
and
working
essentially,
so
we
need
to
make
sure
we're
maintaining
what
we're
doing
elsewhere,
while
we're
developing
the
new
stuff.
So
I
think
I
think
some
important
points
in
getting
the
thinking
behind
that
absolutely
right
early
on,
because
it
becomes
hugely
expensive.
M
Loop
is
critical
here
and
the
feedback
loop
is
what
will
also
generate
the
internal
pull
from
the
inspectors
as
well,
because
that
will
understand
the
degree
to
which
we
are
making
their
lives
easier
and
better
and
the
way
that
that
is
impacting
others
as
well
and
what
doesn't
work
so
we
don't
replicate
it
3,000
times
and
we
test
it
and
improve
it
and
roll
it
out
and
a
subsidiary
critical
think.
The
integration
point
is
important
as
well,
but
that's
about
transition
planning
for
me.
M
So
there
are
some
services
where
we're
reliant
quite
heavily
at
the
moment.
So,
for
example,
serum
is
very
heavily
embedded
for
many
of
our
operational
processes
and
rather
than
taking
a
Big
Bang
approach
to
swapping
that
for
something
else
that
we
don't
fully
understand.
It's
going
to
be
about
carefully
planning
how
we
change
processes.
M
So
what
do
we
do
with
registration
to
pull
things
out
of
the
current
CRM
service
to
deliver
a
better
answer
to
people
by
way
of
example,
and
how
do
we
make
sure
that
new
services
integrate
back
into
often
old
views
of
the
world?
So
particularly
from
looking
at
the
intelligent
side
of
things
we're
aggregating
information
from
all
over
there?
The
system
we
need
to
make
sure
I
can
see
new
and
old
next
to
each
other
in
a
completely
reliable
and
consistent
fashion
that
feeds
everything
else.
M
We
do
so
I
agree
with
all
of
those
points,
and
it
is
about
for
me
that
that
collective
benefits
ownership
in
terms
of
why
are
we
doing
this?
If
that's
the
first
move,
why
we're
doing
to
the
first
place?
And
how
do
we
make
sure
we
measure
against
that?
Why,
early
and
often,
rather
than
at
the
end
of
a
long
program,.
E
Think
what
I
see
here
is
really
a
very
ambitious
program
which
I
think
is
necessary
and
we
should
aspire
to
deliver
and
we
need
to
decide
how
practically
to
do
that
as
quickly
as
possible,
but
clearly
as
quickly
as
possible,
because
I
think
it
will
make
a
real
difference
to
the
quality
of
our
regulation.
It
will
make
a
real
difference
to
our
productivity
as
a
regulator
and
I.
Think
it's
something
that
we
shouldn't
forget
is.
If
we
do
this
well,
it
will
reduce
the
burden
on
the
providers
we
regulate
and
I.
E
Think
that
really
is
very
important
that
we
need
to
understand
the
effect
we
have
on
providers
and
we
ask
for
lots
of
information
from
them
and
if
we
can
develop
a
digital
approach
that
will
extract
that
information
without
creating
burden
for
them.
I
think
they'll
be
extraordinary.
A
well
welcomed
by
the
system
so
I
think
as
real
opportunities
here
both
for
us
in
terms
of
the
way
we
work,
but
also
in
terms
of
the
effectiveness
and
efficiency
of
our
regulation.
Externally,
yeah.
G
G
Hear
the
chief
inspectors
talking
about
it
next
time,
but
at
the
same
time
I
wouldn't
want
that
then,
to
turn
into
some
sort
of
silo
thing,
because
we
need
to
have
a
digital
program
that
works
across
the
whole
organization.
But
my
question
is
we're
doing
all
this
for
the
end-user,
which
is
the
man
and
woman
in
the
street,
people
like
us.
What
are
you
going
to
do
to
involve
people
who
will
be
the
end
users
of
the
CQC
product
in
making
sure
that
our
digital
offering
works
for
them?.
M
I
think
the
conversation
so
far
is
focused
on
the
narrower
set
of
users
in
terms
of
our
staff
and
those
in
providers
providing
information,
for
example,
there's
a
whole
of
the
fourth
point
I
made
about
improving.
This
is
making
sure
others
in
understand
our
information,
and
that's
probably
the
place.
We
would
start
with
that
function.
M
So
this
is
about
how
do
we
rethink
the
way
we
communicate
with
people
not
just
by
putting
PDFs
on
a
website
and
hoping
that
they
can
read
80
pages
and
interpret
it
and
actually
understanding
that
the
they
want
to
know
something
for
a
reason.
Perhaps
they
have
a
relative
and
they're
looking
for
a
care
home?
How
are
they
going
to
make
that
decision?
M
And
what
are
we
going
to
do
to
help
that
decision
in
that
constructive
manner,
and
that
does
come
back
to
understanding
them
as
people
and
not
them
in
and
out
in
the
abstract,
and
that
is
about
engagement
and
proper
conversations
and
user
testing
and
feedback
and
all
of
those
things
that
pura
was
talking
about.
But
with
a
different
and
wider
set
of
audience.
A
Yes,
so
it's
sorry,
Andrea
I
was
just
gonna
say
to
Jane
I
mean
just
to
give
notice.
I
was
actually
going
to
bring
the
chief
inspectors
in
because
there
is
a
point
that
you
made
Pete
right
at
the
front
and
Durer
repeated,
which
is
this
has
got
to
be
led
by
the
user
need
and
the
primary
user
is
our
inspection
people.
A
F
F
So
I
think
that
it
does
come
to
the
point
of
well
how
engaged
our
chief
inspectors,
senior
leadership
teams
and
the
registration
and
inspection
staff
in
in
the
process
and
from
two
areas
where
we
have
within
my
Directorate
being
very
directly
involved,
the
first
as
being
on
the
adult
social
care
provider.
Information
return
looking
to
make
that
a
digital
platform,
so
that
providers
can
engage
with
that.
And
yes,
we
would
be
expecting
them
to
update
that
on
an
annual
basis.
But
we
want
to
do
with
the
digital
way
of
doing.
F
This
is
make
this
as
useful
for
them
in
terms
of
being
the
vehicle
by
which
they
can
manage
their
own
Quality
Assurance
processes
update
when
they've
got
the
information
to
tell
us,
where
they've
improved
services
and
to
tell
us
of
changes
in
their
services
which
can
inform
our
inspection
and
kind
of
focus
as
well
as
timing,
and
that
has
been.
You
want
the
first
project
that
we've
been
getting
into,
where
there's
been
that
turnin
flowing
between
Pete's
team,
the
intelligence
team,
but
also
members
of
my
team
in
understanding
what
questions
do
we
want
to
ask?
F
How
do
we
want
to
ask
them?
How
does
that
manifest
itself
in
terms
of
the
that,
the
the
mechanism
by
which
there
are
still?
How
does
that
then
feed
into
the
information
that
inspectors
get
so
that
they
can
use
it
in
an
intelligent
and
informed
way
and
and
I
know,
and
this
hasn't
been
me-
that's
been
doing
it,
but
I
have
now
seen
some
of
the
end
product
of
it
and
it's
great
and
it
knew
we
had
a
really
good
demonstration.
F
A
few
weeks
ago
and
I
was
in
all,
could
it
do
this,
and
could
it
do
that?
And
actually
the
answer
was
yes,
which
not
normally
the
answer
that
I
get
when
I
ask
whether
things
can
can
happen
from
a
technology
point
of
view,
so
it
was
very,
very
encouraging,
but
the
reason
why
that
was
happening
was
because
we
had
had
a
lot
of
engagement
across
both
teams
and
the
second
area
that
we're
looking
at
this
is
around
registration
and
and
I
were
at
the
starting
point
on
registration.
E
Just
to
answer
your
question,
Peter
I
think
there's
no
doubt
that
our
frontline
staff
inspectors,
the
frontline
staff,
are
very
keen
to
see
digital
solutions
to
some
of
the
problems.
You
know
they
have
in
terms
of
their
day
to
day
work
load
and-
and
you
know
they
will
be
the
first
to
crap
for
that,
and
so
we
need
to
answer
that
question
for
them
and
part
of
that
has
to
be
to
get
them
fully
engaged
in
the
solutions.
But
but
it
isn't
just
asking
them:
how
can
they
do
what
they
do
now
better
with
digital?
E
It's
about
actually
asking:
what
can
they
do
differently
and
I?
Think
that's
the
real
challenge,
so
it's
so
I.
It
isn't
just
getting
them
to
lead
the
process.
It's
actually
engaging
you
in
the
process
and
if
you
like,
opening
up
the
possibilities
of
how
we
can
inspect
in
different
ways,
regulate
in
different
ways,
seek
information
from
trusts
and
communicate
them
with
them
in
different
ways
and
I.
Think
that's
a
really
exciting
thing
here
and
this
plan
is
laid
out
in
the
paper.
E
I
think
does
get
a
nice
balance
between
how
do
we
deal
with
some
of
our
current
IT
problems
and
make
them
easier
to
work
with,
but
equally,
how
do
we
open
up
the
possibilities
of
doing
things
very
differently
and
I
strongly
supported
that,
but
where
I've
worked
introduced,
IT
solutions
before
in
trusts,
the
key
thing
that
you
got
to
get
right
is
that
frontline
engagement
you,
you
can't
just
impose
an
IT
solution
on
on
people.
They
will
just
find
ways
of
working
around
it
if
they
are
involved
in
developing
the
way
of
doing
it.
Yeah.
D
That's
a
really
strong
point:
Steve
say
they
say
thank
you
and
I'm
and
I
welcome
Pete's
appointment
here,
because
we're
now
seeing
a
bit
of
energy
and
action
on
something
that
wish
I'd
been
talking
about
since
I
was
appointed.
This
is
actually
about
how
we
work
differently
it'll.
It
should
for
PMS
across
our
different
areas,
help
us
with
monitor
monitoring
providers
and
the
risk
management
so
that
we
inspect
what
we
need
to
rather
than
just
doing
things,
because
it's
on
on
a
router.
D
D
So
my
encouragement
has
been
all
along
to
be
ambitious
and
to
look
at
how
we
work
differently
and
the
key
people
for
me
are
the
inspectors
and
the
inspection
managers
who
monitor
portfolios
of
providers,
all
of
which
are
changing,
as
we
speak
number
of,
for
example,
in
one
small
part
of
what
I
do
general
practice,
the
numbers
have
decreased
over
the
last
six
months.
It
could
be
they
they
dramatically
reduce
as
providers
get
larger
and
more
complex.
So
we
have
to
be
agile.
D
The
as
far
as
it
directly
affecting
us
is
that
we've
got
to
think
all
the
digital
pick,
which
is
about
information
which
looks
as
though
we'll
be
at
alpha
testing
in
in
March
2018.
We
won't
really
be
able
to
change
what
we're
doing
on
the
ground,
probably
the
end
of
next
year,
October
according
to
this
paper.
D
That
means
workforce
implications
for
us,
because
we
were
planning
to
look
at
how
we
can
change
what
we're
doing
based
on
the
digital
offer,
the
longer
that
takes
the
more
staff
we
need
and
the
budget
in
a
way
because
it'll
be
about
how
we
we
we
do
things
very
differently.
So
we
need
to
be
ambitious
and
quick
with
this,
because
the
longer
we
take
the
less
likely
we
are
to
be
able
to
rationalize
what
we're
doing
and
move
to
the
monitor
function
as
well
as
I
would
like.
So.
A
D
A
N
Actually
the
information
that
comes
out
of
that
will
absolutely
help
us
improve
all
of
the
work
that
we
do
around
intelligence.
So,
while
there's
a
clearing
alien
intelligence
priority,
all
of
the
other
components
will
add
up
to
enabling
us,
within
the
intelligence
team,
to
do
better,
quicker,
more
quality
works
that
can
support
the
work
of
the
organization.
N
The
point
around
the
house
building
on
I
know
we
don't
to
go
there
when
you
feel
a
bit
and
one
of
the
pieces
that
we're
doing
quite
quickly
and
we're
trying
to
speed
up
between
the
work
that
we're
doing
is
put
in
that
platforms
in
places.
Some
of
that
pipe
work
to
make
sure
that
we've
got
all
of
our
data
in
one
place.
That
makes
it
easier
and
faster
for
us
to
deliver
outputs
to
the
rest
of
the
organization
so
that
we
can
make
more
timely,
more
consistent
decisions.
N
So
for
us
there
is
a
piece
around
getting
that
pipe
work
and
the
plumbing
done
as
quickly
as
we
can
to
allow
us
to
have
a
platform
to
build
from.
That's
not
so
we're
not
going
to
continue
to
doing
some.
The
data
science
work
and
other
pieces
that
we're
exploring
in
the
meantime,
but
my
focus
has
to
be
the
base
work
to
get.
Let's
get
us
to
a
place
where
we
can
support
all
of
the
parts
of
the
organization
more
effectively
good.
B
Thank
you,
David
Thanks,
so
trying
draw
some
of
this
together.
I
think
what
we've
got
in
this
report
is
probably
the
clearest
statement
we've
had
ever
of
what
our
priorities
are.
So
I
think
the
work
that
the
team
have
done
is
really
boring,
that
fruit
and
I
think
what
the
boarder
invited
to
do
today
is
just
confirmed
back
to
the
team,
Peter,
Andrew
and
Helen,
that
these
are
the
priorities
we
want
to
go
forward
on.
I.
B
That
gives
us
some
sense
of
what
those
opportunities
are
to
set
this
forward,
as
well
as
some
of
the
investments
that
have
been
made
and
but
they
need
hardening
up
and
I
think
there
is
a
point
in
the
last
paragraph
of
the
report,
which
is
about
how
we
can
use
some
phase
in
in
opportunities.
I
think
Peter
was
reference
that,
in
his
introductory
comments,
so
actually
check
that
forward,
but
also
how
can
we
get
the
benefits
out
of
this
as
well?
B
B
Come
up
to
that.
That'd
have
been
a
clearer
sense
of
what
that
is,
because,
if
we're
going
to
make
investments,
we
need
to
understand
what
benefit
we're
going
to
get
back
from
it.
In
terms
of
the
advantages
it
will
give
to
the
organization
to
the
people
that
work
in
the
organization,
the
people
that
will
use
our
reports
and
so
on
and
so
forth.
B
So
what
will
happen
over
then
from
here
Peter
and
if
you're
prepared
to
confirm
these
priorities
this
afternoon,
is
that
this
work
will
now
be
taken
into
the
business
plan,
preparation
where
we
can
begin
to
set
specific
costs
against
some
of
these,
we're
obviously
not
going
to
do
that
in
a
public
session
just
yet
because
it's
a
commercial
issue
here,
if
we've
got
to
procure
just
two.
So
this
isn't
a
black
box.
But
this
is
a
commercially
sensitive
area
and
so
we're
ready
to
go
and
we'll
do
that
financial
planning.
B
B
1819
what
they
are,
but
if
those
benefits
accrue
in
1920
just
being
clearer
about
that,
as
we
have
to
prepare
business
cases,
we'll
have
to
have
some
discussion
with
the
d.edge.
We
need
to
be
clear
about
these
things
and
there's
no
point
in
saying:
oh
I
didn't
think
you
needed
to
get
that
we
ignore
the
last
bit
out.
So
we
need
to
do
the
work
now
as
part
of
that
so
effectively.
B
What
I'm
saying
Peter
is
that,
if
the
board
are
happy
with
the
statements
of
priorities
and
ambition
that
we've
got
here,
the
next
stage
of
this
is
to
put
a
costed
program
on
to
this.
A
part
of
that
custody
program
will
not
be
just
what
is
financially
available
to
us.
We
can
do
the
work
on
that
and,
as
I
say,
I
think
we
have
some
opportunities.
But
what
does
an
organization
are
we
capable
of
delivering
with
in
1819
I
think?
B
The
point
has
been
teased
out
in
this
conversation
that
this
isn't
just
about
competing
esteem
Speck.
What
these
programs,
or
get
a
procurement
through
a
net
and
care
team
to
get
this
in,
but
it
is
also
about.
We've
referred
to
inspectors:
I've
got
the
inspectors
that
are
available
to
do
the
work
on
this.
The
design
and
development
work.
B
Can
they
do
the
testing
once
we've
done
the
testing?
Can
they
do
the
feedback
so
actually
just
accepting?
This
is
a
whole
organization
program
which
will
require
the
engagements
of
the
whole
organization
causes
as
its
rather
think,
we'll
need
a
really
hard
conversation.
I
don't
mean
difficult.
We
just
need
a
realistic
conversation
about
who's.
Gonna
get
freed
up
to
do
what
over
what
time
scale,
because
we
can
have
all
the
ambition
to
go
quickly
in
the
world,
but
if
we
don't
have
the
people
involved,
that
needs
to
be
involved.
B
It
just
won't
fly
so
I
think
that's
the
next
stage
of
the
work.
So
this
period
between
now
and
I
think
there's
reports
coming
in
in
November
and
December.
I.
Think
for
the
December
report
to
the
board
is
where
the
costing
and
the
program
and
project
management
will
get
set
out.
So
personally,
I'm
very
pleased
for
the
work.
The
team
have
done.
B
I
think
we're
in
a
much
better
place
as
a
consequence,
and
we
now
need
just
to
push
this
in
to
turn
it
into
a
deliverable
plan
which
has
the
money,
the
capability
and
the
capacity
set
aside,
and
the
capacity
is
going
to
be
a
whole
organization
capacity.
Not
just
how
many
analysts
do
we
need
how
many
people
that
can
design
software
whatever
it
happens
to
be,
but
I
hope
you
can
agree
the
priorities
that
are
set
out
in
the
report
this
morning,
Robin
just
the
questions
really.
H
Don't
we
take
it
that
implied
in
what
you
just
sent
a
bit?
Is
that
order
in
which
these
priorities
I
didn't
the
person
started,
delivered
whatever
as
to
some
extent
and
a
very
big
extent,
to
be
determined
by
the
the
benefits
as
you've
described,
both
financial
and
others,
and
how
important
we
want
to
do
all
this
stuff
and
we've
got
a
period
of
time
within
which
we
want
to
do
it.
Some
of
it
might
turn
out
having
on
the
analysis
that
you're
suggesting
to
be
a
bit
more
important
than.
B
Others
come
in
on
this,
but
I
mean
broadly.
What
we're
saying
is
these
are
the
priorities
we
want
to
take
forward
and
I.
Think
just
to
the
point.
This
isn't:
the
executive
teams
or
the
senior
management
teams
set
the
priorities.
I
mean
Peter,
carried
out
a
pretty
extensive
consultation
exercise
right
across
the
organization
which
involved
all
levels
of
staff.
It
involve
every
single
individual,
but
certainly
the
exact
team
sat
in
workshops
where
Pete
run
us
through
a
prioritization
exercise
were
surprise.
Surprise.
B
We
have
slightly
different
approaches
to
this,
but
the
whole
purpose
of
the
exercise
was
to
distill
that
down
into
a
statement
of
priorities,
so
I
think
what
the
board
have
got
in
front
of
them
this
afternoon.
So
your
question
Robert,
is
a
clear
statement
of
priorities
which
are
presented
to
you
by
people
in
the
team,
but
as
endures
by
the
executive
team
and
certainly
as
chief
executive,
my
invitation
for
you
to
agree
these
priorities
is
because
all
that
work
sits
behind
it.
It's
not
we've
not
just
got
to
it.
B
I
think
the
issue
of
capacity
and
that's
money
and
people
is
really
going
to
be
the
gearing
of
the
speed
at
which
we
do
these.
It's
not
whether
we
do
these
I
think
what
we've
got
here
is
a
statement
process.
These
are
what
we
want
to
do.
The
issue
is:
is
it
time
or
money
that
regulates
how
quickly
we
can
do
some
of
these
I
think
I?
Think
there's
also
the
point
that
jurors,
making
and
Peter
also
referred
to,
which
is
the
way
that
we're
doing
this.
B
In
the
light
of
experience
of
how
we
do
some
of
these
first
buildings
on
the
build
inside,
we
might
actually
flex
the
design
on
of
the
second
buildings.
I
can't
keep
the
mess,
if
it
remember
so
it
might
be.
Instead
of
having
wood
cladding,
we
go
for
chow
I
live
in
some
detail,
so
we
have
Towe
cutting
on
the
buildings
in
the
light
of
that
experience,
yeah
so
I
think
there
is
a
bits
about.
B
This
will
be
an
iterative
process,
but
we
can't
keep
spinning
around
this
vortex
of
not
being
clear
about
what
our
priorities
are
and
not
having
a
delivery
plan,
because
we
can't
cost
it
get
the
benefits
out
or
identify,
and
what
this
does
is
it
bricks
through
I
think
the
circle
that
we've
been
in
over
the
past
two
to
three
years
saying
we
know
we
need
to
do
this,
but
what
is
it
we
do?
And
what
do
we
do?
First
and
I
think
what
we've
got
here
is
a
very
clear
statement
of
what
we
do.
B
First,
I
think
what
we
now
need
to
do
is
cost
it
that's
money,
but
also
the
capability.
We
need
the
people
skills
that
we
need
to
deliver.
This
we've
got
some
of
those
skills,
but
we
haven't
got
all
of
those
skills,
so
we're
going
to
have
to
bring
them
in
so
I.
Think.
The
stage
you're
in
now
is
is
to
go
to
that
one,
which
is
what
skill
do
we
need
to
deliver
these?
Can
we
then
go
out
and
procure
them
so
we've
got
them
available
to
us.
B
What
we
can't
tell
you
at
the
minute
is:
how
much
will
it
all
costs
and
over
what
period
of
time
we
do
that
and
that's
the
work
they'll
get
done
between
now
and
December,
so
we
should
be
back
in
a
private
session
at
the
board
in
December
into
January,
saying
you
supported
these
priorities
in
October
and
the
work
we've
done
subsequently
is
this,
and
what
we
now
know
is
this
is
what
this
will
cost
us,
and
this
is
the
skill
that
we
need.
We
might
not
have
all
the
clearances
we
need
through
d-h.
B
That
will
be
another
thing
that
we
need
to
go
through,
but
being
clear
about.
What
we
want
to
do
is
the
first
stage
of
this
and
I
personally,
I.
Don't
think
we've
been
at
this
stage
before
of
having
the
clarity
that
we've
got
so
I
thought
I
feel
very
confident
about
where
we
are,
but
we
are
at
the
beginning
of
this
not.
A
So
David
I
haven't
heard
anybody
suggest
these
are
not
the
right
priorities.
So
unless
anybody
wants
to
say
that
now
I
think
you
have
bored
agreement
that
these
are
other
priorities.
I
think
there's
been
a
lot
of
useful
discussion
around
the
next
steps
and
the
the
the
route
map
that
we
will
follow
to
deliver
all
of
the
priorities.
A
As
you
said
Robert,
this
is
something
we
want
to
deliver
in
its
entirety
over
time,
so
I
think
that's
probably
as
far
as
we
can
go
today,
but
a
lot
of
work
to
be
done
over
the
next
couple
of
months
and
to
come
back
to
the
board.
But
but
thank
you
all
three
of
you
and
your
teams
behind
you
for
getting
us
to
this
stage
because,
as
David
says,
I
think
we're
a
better
place
than
certainly
since
I've
been
here.
We've
we've
been
so
great.
Thank
you
very
much
indeed
Eileen.
A
I
mean
we
said
earlier,
you're
sort
of
leaving
us
on
a
high
in
terms
of
the
areas
of
your
responsibilities
where
the
performance
is
being
great,
but
what
people
don't
necessarily
see
is
the
huge
amount
of
support
that
you've
certainly
give
it
to
me
since
I've
been
here
which
I
really
value
and
the
work
that
you
do
and
have
done
both
sort
of
up
front,
but
also
behind
the
scenes
to
deliver
the
organization
to
where
we
need
to
be
so.
Thank
you
and
I
wish
you
every
success.
A
A
Right
so
I
need
to
tell
everybody.
We
have
a
very
hard
finish
at
12:40
because
board
you
need
to
be
in
the
let's
get
this
right
in
the
orange
area,
which
is
the
bit
behind
the
reception
at
12:45.
So
you
have
your
duties,
don't
finish
when
the
board
meeting
comes
to
an
end,
just
in
case
you
thought
did
so
that's
the
orange
area,
which
is
the
the
orange
quadrants,
give
it
its
proper
title,
which
is
behind
the
reception,
which
leaves
us
only
a
few
minutes
for
questions.
A
O
O
A
new
system
has
ent
in
the
grazing
road,
it
has
neurology
in
Queen
Square,
and
it
has
urology
in
Westland
Street
now,
I
think
each
of
these
three
departments
is
located
in
Victorian
buildings
and
if
the
hospital
were
to
be
inspected
on
three
core
services,
where
this
is
comprehensive
or
focused
and
those
core
services
were
all
located
in
the
new
modern
building,
it
would
not
give
an
accurate
view
of
the
whole
Hospital
trust.
So
how
are
inspections
for
larger
hospitals.
E
The
second
time
we
did
go
to
Western
Street,
so
just
to
reassure
you,
we
have
those
areas
in
our
sites
and
we
will
go
and
inspect
any
area
where
we
believe
there's
a
risk
and
a
need
for
us
to
look
at
it
in
very
big
hospitals.
We
obviously
can't
go
into
every
ward
in
every
building,
they're
just
too
big
for
us
to
do
that,
and
it
would
take
too
long.
So
it
is
very
much
a
risk
assess
a
basis
and
we
do
look
at
these
state
risk.
E
So
you
mentioned
Victorian
hospitals
and
it's
not
just
about
Victoria
Falls,
often
which
were
very
well
built
in
their
time,
but
are
outdated
and
I.
Think
what
we
challenge
hospitals
to
is
not
how
old
is
your
building,
but
are
you?
Are
you
using
it
effectively
and
have
you
adapted
it?
Are
you
maintaining
it
effectively
for
for
the
benefit
of
patients?
And
if
you
look
at
our
reports,
we've
been
very
critical
of
some
hospitals
and
take
an
action
against
them
where
they
have
old
buildings,
not
all
Victorian
but
old
buildings.
E
They
haven't
maintained
to
a
satisfactory
standard.
They
haven't
adapted
for
that.
For
that,
for
the
needs
of
modern
the
needs
of
modern
medicine
and
the
current
patient
population
and
we've
told
them
to
take
action
and
there's
been
some
significant
improvements
in
those
buildings,
I
think
we
do
look
at
every
hospital
comprehensively
across
the
board
and
take
an
assessment
to
where
the
risks
lie
in
that
organization
and
that's
based
on
the
data.
We've
just
been
talking
about
how
I
look
at
data,
and
we
want
to
improve
that.
E
But
it's
also
based
very
much
on
what
patients
tell
us
about
their
experiences,
and
we
talk
about
patient
surveys
earlier
on
and
what
staff
tell
us
and
I
think
if
we
hear
that
there
are
problems
in
a
particular
area
because
of
the
estates,
we
will
go
in
and
have
a
look
at
that
area,
regardless
of
the
clinical
service.
So
our
core
clinical
services
are
now
allow
us
to
go
and
look
anywhere
in
terms
of
where
we
perceive
there
may
be
a
risk.
E
A
P
I'm
Jade,
Taylor
and
I'm
here
in
a
personal
capacity
in
my
own
time,
I
have
a
day
off
today,
really
want
to
keep
the
house
building
metaphor
going
because
it
it
made
my
heart
sing.
Having
once
built
a
house
and
I
must
say
in
terms
of
the
fact
that
you
want
to
progress
this
very
quickly
when
I
was
building
a
house,
I
had
a
slight
hiccup
because
had
to
spend
thirty
thousand
pounds
more
on
building
the
foundations
10
metres
deeper
than
they
needed
to
be.
The
house
is
I
believe
still
standing.
The
house
further
up.
P
I'll
go
into
my
substantive
question,
but
this
is
with
regard
to
an
article
which
was
in
the
mail
on
Sunday
on
the
3rd
of
September
this
year,
and
it
was
talking
about
disturbing
parallels
with
the
mid
staff
scandal
and
it
was
an
article
by
Professor,
Brian,
Jarmon
and
I'll.
Just
read
out
something
at
the
bottom
very
quickly.
Ten
years
ago,
professor
Sabri
and
Jarmon
sent
a
series
of
mortality
alerts
to
health
bosses
about
what
was
then
a
little-known
part
of
the
NHS
in
the
middle
of
England.
It's
named
Mid
Staffordshire,
NHS
Trust.
P
P
When
we
published
that
the
Department
of
Health
insisted
that
people
take
no
notice
of
our
data,
professor
Jarmon
recalled
last
week.
We
asked
them.
Why
not,
but
we
never
got
a
proper
explanation,
but
he
and
his
team
were
onto
something
something
big
and
soon
afterwards.
Personal
reports
of
the
shocking
care
that
patients
at
Stafford
Hospital
had
received
started
emerging
adding
to
the
death-rate
data.
The
reports
led
an
investigation
by
the
Health
Care
Commission,
the
watchdog.
At
the
time.
P
A
Jade,
if
we
hadn't
run
out
of
time,
I
would
have
invited
Ted,
in
particular
the
three
chief
inspectors
to
comment,
but
I
would
hope.
If
bran
was
sitting
in
this
room
now,
he
would
not
have
the
the
worry.
Oh,
that
he's
allegedly
said
to
have
had
in
that
that
newspaper
cutting
we've
just
spent
most
of
the
morning
talking
about
how
we
use
intelligence.
A
A
A
E
But,
but
just
to
just
to
reassure
you
briefly,
because
it's
a
big
subject
and
I
can't
cover
it
all
in
just
in
just
a
few
minutes,
but
we
we
look
regularly
at
mortality
data
across
a
range
of
a
range
of
mortality,
data
for
all
NHS
trusts,
and
we
will
be
in
contact
with
them.
If
we
see
any
outliers
at
all,
it
isn't
just
shimmy
shimmy,
it's
just
one
element
of
data.
E
We
look
at
a
whole
range
of
other
data
and
we
look
at
shimmy,
but
this
there's
a
whole
host
of
other
data
out
there,
which
we
monitor
continuously
and
if
any
Trust
has
an
outlier
for
mortality
for
any
particular
condition.
We
will
contact
the
trust
and
ask
them
to
investigate
and
look
very
carefully
at
their
investigation
of
it.
And
if
we're
not
happy,
we
will
inspect
them
and
we
have
done
so
so
there.
You
know
there
isn't
a
sense
that
we're
ignored
mortality
data,
but
actually
mortality
data
is
not
more
than
just
the
shimmy
data.