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From YouTube: CQC board meeting – March 2019
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A
Right,
unusually,
I'm
going
to
start
with
an
apology
that
we're
starting
this
this
meeting
late.
That
is
because
the
chair
stupidly
took
an
item
this
morning
that
should
have
been
this
afternoon,
so
we
running
a
little
little
late,
so
I
apologize
to
people
here
today
who
been
kept
waiting
entirely.
My
my
fault,
however,
can
I
also
with
an
apology,
say
that
we
have
a
very
full
agenda
and,
despite
having
taken
one
of
the
items
that
was
for
this
afternoon
this
morning,
there's
an
awful
lot
of
other
things
this
afternoon.
A
So
we
will
have
to
finish
the
meeting
on
time.
If
there
is
time
for
questions
from
the
public
and
I
know,
we've
got
two
or
three
questions
already
notified
to
us.
We'll
take
them
and
if
not
we'll
respond
to
those
questions
in
writing.
But
I'll
do
my
best.
The
board's
help
to
have
some
time
for
the
questions.
A
So
that's
that
is
any
declaration
of
interest.
Anybody
on
the
board
needs
to
make
very
good
that
takes
us
to
the
minutes
of
the
20th
of
February
meeting.
Are
they
true
and
accurate
record
of
all
we
discussed
and
that
case
I'll
take
them
as
approved.
There
was
one
item
on
the
action
log
which
has
been
completed
there.
Anything
else
arising
anybody
one
to
raise,
in
which
case
in
we
go
on
to
the
executive
report.
Please
thank.
B
You
Peter,
the
executive
report
covers
off
a
number
of
issues,
I
think
I
think
it's
first
to
say:
there's
good
performance.
Overall,
we
talked
last
month
about
about
increasing
month-on-month
performance
in
terms
of
particular
untimeliness
of
of
report,
writing,
which
is
one
of
those
headline
measures
that
people
set
great
store
by
and
I
think
talks
to
what
we
do
as
part
of
our
core
business
and
I.
Think,
what's
what's
slightly
hidden
in
some
of
the
numbers,
I
think
is
some
really
good
work
on
backlogs
I.
B
Think
what
we've
struggled
with
in
previous
in
previous
months
is
is
performance
which
has
been,
which
has
been
slightly
held
back
by
having
big
backlogs
and
the
backlogs
are
coming
down
as
well,
which
which,
which
I
think
is
a
really
positive
sign,
and
it's
a
really
a
great
testament
to
to
the
hard
work
that
a
number
of
my
colleagues
that
have
done
I.
Think
I'd
also
like
to
just
just
just
talk
about
the
effectiveness
of
going
back
to
the
same
locations
quickly
in
the
performance
report.
B
We
talked
about
going
back
to
adult
social
care
providers,
particularly
those
who
require
improvement
and
and
are
inadequate
and
I
want
to
just
give
assurance
that
that
we
are
looking
at
that
from
a
much
more
risk-based
approach.
So
those
that
are
our
most
risky
are
more
likely
to
have.
People
go
back
and
talk
to
them
can
I
just
invite
Debbie
just
to
touch
briefly
on
the
work
they're
doing
in
adult
social
care
in
that
space,
because
I
think
it
is
quite
an
important
point
that
we
don't
often
talk
about
Debbie,
yeah.
C
C
But
if
you
were
to
separate
the
data
a
year
to
date,
we
have
achieved
84
percent
of
return
inspections
within
KPI
of
90
percent
and
for
January
we've
actually
exceeded
the
KPI
of
93
percent
returns
to
inadequate
locations,
which
obviously
I
hope
will
assure
people
that
we
ensuring
that
those
services
that
are
most
at
risk
are
receiving
the
attention
that
them
that
they
require
in
relation
to
requires
improvement.
We
here
today
at
if
you
split
it
down
it's
56%
of
those
services
that
we
return
to.
C
C
The
majority
are
actually
improved
their
rating
to
God,
which
again,
hopefully
demonstrates
that
the
risk
assessment
model
that
we've
put
in
place
in
adult
social
care
is
actually
demonstrating
that
we
are
returning
to
those
services
at
the
right
time,
depending
on
the
risks
and
the
information
that
we
are
receiving.
So
I
think
that
our
insight,
information
and
our
assessment
of
risk
at
each
location
is
accurate.
C
I
expect
there
to
be
huge
improvements,
as
we
move
through
the
next
quarter
and
I'm
a
Seward
through
the
information
that,
after
that,
I
have
seen
that
all
those
services
that
we
haven't
quite
got
to
yet
are
in
the
process
of
being
inspected
and
will
be.
This
is
then
quite
an
inadequate,
requires
improvement
and
will
be
by
the
end
of
the
31st
of
March.
C
A
B
D
As
we
get
to
the
end
of
the
financial
year,
we
remain
on
track
to
complete
our
program
of
inspections.
You
may
remember:
we
set
the
target
of
getting
to
the
end
of
all
the
NHS
trust
inspection
juice
in
the
next
phase
methodology
by
June
of
this
year,
and
we
may
not
remain
on
track
to
deliver
that
and
as
we're
going
forward.
We're
assessing
the
next
phase
methodology,
particularly
the
world,
led
inspections
to
understand
how
we
can
continue.
D
Drive
improvement
in
that
process
and
board
is
well
aware
that
the
world
that
is
very
central
to
our
plans
for
spectrum
is
going
forward
in
terms
of
report
timeliness,
which
the
board
has
is
aware
that
we
are
below
KPI
on
we've
maintained
the
sustained
performance
that
we
the
improved
performance
that
we
developed
towards
the
end
of
last
year,
but
we
are
still
below
KPI.
We've
hit
the
target.
D
D
E
Thank
You
Ian,
so,
first
of
all
from
me,
an
update
on
our
preparatory
work
for
the
EU
exit.
When
this
report
was
written,
the
exit
date
was
still
the
29th
of
March.
It
remains
the
29th
of
March,
subject
to
parliamentary
process
and
potential
legislation.
Like
all
other
organisations,
we've
worked
hard
to
ensure
that
we
are
prepared
for
the
exid
a
both
internally
as
an
organization
and
in
terms
of
our
regulatory
role.
E
We've
tested
our
own
readiness
in
terms
of
our
staff,
our
processes,
our
legislation,
our
data
and
our
contracts
and
I've
identified
low
risk
for
all
of
those
issues.
So
our
confident
that
we're
good
to
play
some
also
very
pleased
to
say
that
we've
I
think
supported
our
own
staff,
who
are
you,
members
or
family
and
friends
from
the
U
in
that
process?
E
Well,
as
importantly,
we've
also
looked
at
what
this
means
for
our
role
is
the
independent
regulator
for
quality
in
health
and
social
care,
and
our
first
priority
is
always
also
during
this
time
will
remain
to
people
who
use
services
and
to
ensure
that
high
quality,
safe
care
is
being
delivered.
So
we
will
continue
to
monitor
inspected
services.
E
We
will
make
sure
that
any
issues
or
concerns
that
are
arising
during
this
time
will
be
raised
and
escalated
as
appropriately
as
part
of
that
we'll
be
working
very
closely
with
the
Department
of
Health
who's,
coordinating
the
wider
efforts
around
this,
and
we
will
respond
to
proportionately
and
also
flexibly
to
any
issues
that
might
arise
so
in
a
good
place.
As
far
as
are
there
any
questions
alone,.
E
Okay,
the
only
other
thing
that
I
wanted
to
mention.
There
is
a
number
of
parliamentary
activities.
I
wanted
you
to
be
aware
of
I'm
not
going
through
the
detail,
but
the
evidence
we
gave
to
the
karke
review
the
work
on
autism
by
the
old
parliamentary
group
and
the
way
we're
now
starting
to
brief
the
independent
group.
As
the
members
of
parliament
that
has
been
newly
established
Chris.
Do
you
want
to
summarize
on
the
publication's.
F
Certainly,
and
so
three
million
publications
to
bring
the
boards
bring
to
the
board's
attention.
The
first
one
is
a
comprehensive
review
of
independent
unbalances,
as
the
first
on
this
sector
has
been
formally
regulated
and
we've
shown
both
the
variation
with
good
practice
and
areas
of
concern
and
pleased.
We
had
a
good
response
from
both
the
providers
of
these
services
and
the
commissioners
of
those
services.
It's
very
clear.
This
is
an
important
sector
for
for
health
and
care
and
a
growing
sector
in
terms
of
people
moving
between
hospital
and
home.
So
we've
had
a
good
response.
F
Our
intention
is
to
continue
to
work
with
the
secretary
to
highlight
the
areas
of
concern
towards
particular
medicines
management,
but
also
to
show
what
is
possible.
We've
seen
a
number
of
organisations
that
they
were
initially
rated,
as
requires
improvement
or
inadequate
moving
to
good.
So
we
should.
We
should
talk
about
those
as
well.
The
second
review
this
happen
is,
then
our
follow
a
review
from
learning
from
deaths.
You
may
remember
the
the
conversation
we
had
with
a
number
of
parties
about
two
years
ago.
F
What
we
wanted
to
do
with
this
reporter
to
go
back
and
see
what
lessons
have
been
learned
since
our
first
review,
and
particularly
to
how
the
how
the
organisation's
adapted
its
culture
paralyzation,
has
attained
a
board
of
cultural
changes
that
were
that
were
necessary
in
order
to
make
sure
that
organisations
genuinely
learned
from
the
issues
that
happen.
Police,
say:
there's
been
a
good
response
to
that
and
good
support,
but
there's
still
some
issues.
F
We
were
very
clear
of
some
of
the
poor
culture
in
some
organizations
that
are
that
are
not
yet
capable
of
learning
from
the
mistakes
that
are
made
and
we
obviously
follow
them
up
with
those
individual
organisations.
But
this
is
an
opportunity
to
sort
of
say
what
has
happened
since
and
indeed
what
still
needs
to
happen,
not
just
at
local
level
but
at
national
level
as
well.
The
final
report
independent
doctor
what
you
out
tomorrow,
semolina
pentameter,
supports
our
first
on
this.
F
This
sectors
been
regulated
in
this
way
and
again
we
see
a
variation
from
very
good
performance
in
some
parts
of
this
sector
to
very
poor
and
whirring
performance.
Obviously,
we've
taken
action
in
terms
of
individual
organizations,
but
this
is
trying
to
work
with
the
sector
and
with
commissioners
and
with
individuals
so
that
they
understand
the
implications
of
off
poor
care
and
say
that
we
launched
tomorrow.
A
G
You
sorted
us
about
the
adult
social
care
inspection.
So,
first
of
all,
congratulations
on
predicting
the
question
that
you're
going
to
be
asked
about
it
because
the
figures
look
on
the
face
of
it.
The
prettiest
presented
here,
which
is
different
from
the
ones
you've
just
said.
Debbie
are
just
a
little
bit
concerning
because
the
this
is
about
inspecting
care.
Homes
that
have
been
previously
had
a
poor
rating
and
the
figure
we've
got
is
that
we're
in
the
in
the
charts
that
we've
been
given?
G
Is
that
we're
at
sixty
four
percent
overall
which
and
for
the
in
the
case
of
the
requires
improvement
and
inadequate
care
homes?
The
figure
is
I.
Think
it's
something
like
sixty
two
percent,
whereas
the
target
is
ninety
percent,
so
that's
very
substantially
below
now
you
giving
us
some
different
figures
that
are
which
you
know
it's
kind
of
hard
to
assimilate
a
different
set
of
figures
that
but
I.
G
So
it
doesn't
give
a
picture
of
overall
improvement
and
that's
not
to
say
that
what
you
said
isn't
right,
but
it's
it's
not
consistent
with.
What's
what
you've
presented
to
us
and
then
part
of
that
is
that
all
the
figures
are
based
on
this.
What
I
must
say
is
a
phenomenal
performance
by
social
care
inspectors
to
have
got
around
9800
locations
in
the
current
year.
So
that
is
a
tremendous
performance.
G
But
when
you
look
at
the
re-inspections
according
to
previous
rating,
it's
that's
about
seven
and
a
half
thousand,
so
that
must
leave
more
than
two
thousand
that
are
somewhere
else,
I'm
guessing
that
they
are
mainly
new
newly
registered
to
care
homes
and
if
we're
doing
well
we're
doing
well
on
the
re
inspections.
But
overall
the
figure
is
not
that
good.
G
C
Take
your
points
on
board
and
I
have
introduced
some
new
statistics
and
I
felt
it
was
important
to
introduce
those
new
statistics,
because
the
way
that
the
information
is
reported
in
the
performance
report
at
the
moment
is
very
much
putting
together.
The
requires
improvement
and
inadequate
locations
therefore,
are
spoken
to
the
performance
and
evaluation
team
and
going
forward,
and
the
report
will
read
it
differently.
C
I've,
looked
at
the
data
five
services
in
January,
where
we
were
out
of
the
KPI
for
inadequate
locations
and
out
of
those
five
two
of
them
were
in
enforcement.
One
of
them
was
a
registration
issue,
one
of
them.
We
had
to
change
the
dates
because
there
was
an
outbreak
of
infection
and
one
of
them
was
an
error
on
behalf
of
the
scheduling
that
that
was
an
error.
So
when
you
actually
break
it
down,
I
am
more
assured.
C
The
requires
improvement
locations
are
more
problematic
and
we
haven't
necessarily
been
getting
back
to
those
services
within
the
required
time
scales.
So
we've
looked
at
developing
some
principles
around
the
requires
improvement
and
we've
discussed
before
at
this
of
the
board.
The
scale
of
requires
improvement,
so
you
can
have
an
overall
rated
location
of
requires
improvement,
so
that
actually
has
two
good
key
questions.
Free
key
questions
requires
improvement
and
no
breaches,
and
then
you
can
have
a
service.
C
That's
related,
as
requires
improvement
with
five
key
questions,
requires
improvement,
breaches
and
warning
notices
where
we're
taking
enforcement
action
to
drag
that
improvement.
Those
are
the
services
that
we've
been
concentrating
on
for
a
return
to
inspection,
but
also
at
the
back
of
our
mind,
monitoring
the
other
services,
so
that
there
is
some
key
information
of
concern.
That's
coming
in
from
Intel
it
from
intelligence
sources.
Then
we
absolutely
escalate
and
bring
those
forward,
and
we
do
bring
a
number
of
inspections
forward.
C
The
data
is
also
showing
that
the
majority
are
actually
completed
within
that
four
to
six
week
period
of
the
KPI.
So
so
again,
we're
I
think
it
demonstrates
that
we
are
using
our
risk
assessment
model
in
the
right
way
and
return
to
those
services,
but
going
forward
I've
we've
developed
three
of
the
heads
of
inspection
who
are
actually
looking
at
the
of
inspections
for
quarter.
One
quarter,
two
of
the
new
financial
year,
the
presentation.
Yesterday
we
had
a
presentation
at
our
SLT
and
I
am
confident
that
we
have
now
got
a
clear
plan
in
place.
C
That
is,
support
in
those
areas
of
the
country,
for
example
central
region,
which
is
an
outlier
at
the
moment,
because
the
risk
profile
has
increased
so
central.
You
central
region
he's
no
receiving
support
from
North,
London
and
South,
and
also
the
additional
support
of
some
colleagues
from
PMS
as
second
inspectors
to
help
us
get
through
that
backlog
and
I'm,
confident
by
the
31st
of
March.
C
When
I
checked
some
of
the
system
issues
yesterday
that
those
services
that
fall
into
that
category
requires
the
improvement
where
we've
not
met
the
KPI
or
actually
the
inspection
is
taking
place
and
we're
about
to
publish
the
report
or
the
inspection
has
taken
place
and
the
certainly
rate
and
has
improved
to
to
good.
So
I've
personally
checked
some
of
that
information
out
and
that's
why
I'm
more
assured
Lewis
yeah.
G
D
G
Just
briefly,
first
off
thanks
very
much,
that's
probably
the
best
answer
to
my
relentless
questions
for
how
these
ratings
and
you
didn't
even
have
advanced
warning
of
the
question.
But
but
it
will
be
important
to
get
that
information,
though
it
sounds
like
yours
into
giving
us
that,
maybe
from
now,
and
because
there
are
still
some
questions
about
it,
I'm
not
going
to
list
them
all
that
people's
endurance
is
probably
reach
the
limit
for
the
data
talk,
and
but
there
are
some
questions
about
why
the
figures
are
much
higher
for
good
and
for
good
and
well.
G
The
few
outstanding
we
used
to
say
that
was
because
something
isn't
alert
about
them
and
therefore
we
were
going
out
to
see
them,
but
that
can't
be
true
of
four
and
a
half
thousand
locations
it
must.
We
must
actually
have
a
slight
imbalance
and
how
we're
pursuing
based
on
previous
rating
and
and
then
the
second
thing
is
this
other
group
who
are
not
in
the
previous
rating
group.
The
people
I
mentioned
earlier.
This
new
group
there's
about
two
and
half
thousand
of
them
by
my
calculation.
They
we
must
have
had
a.
G
We
must
be
have
a
relatively
low
figure
on
hitting
the
KPI
for
that
group.
Now.
I
did
say
that
critically,
because
we've
been
looking
at
this
task
of
reinfection,
but
thinking
about
from
a
public
point
of
view,
knowing
that
there's
a
new
care
home
and
which
has
been
registered
but
not
yet
inspected
that
that's
an
understandable
situation,
but
not
one
that
can
go
on
for
too
long
and
I
think
that
that
becomes
a
next
challenge.
G
But
but
it's
it's
a
hugely
important
issue
because
of
the
change
ability
of
the
ratings
in
social
care,
I
would
say,
and
because
of
the
need
to
pick
up
on
the
the
the
new
and
the
inadequate,
and
if
we
could
have
the
kind
of
data
that
you've
been
outlining
there
in
future
as
a
routine.
That
would
be
really
helpful.
Thank.
C
You
can
I
just
come
back
on
the
new
registration,
so
the
new
registrations
going
forward
from
the
first
of
April
you've
got
your
new
billed
registrations
where
people
are
entirely
new
to
the
market
and
then
you've
got
your
new
registrations
where
it's
an
existing
provider.
That's
that's
coming
into
them,
and
it's
purchasing
that
particular
service.
So
going
forward
from
the
1st
of
April
those
providers
whereby
they
may
change
from
a
limited
from
a
mr.
and
mrs.
to
a
limited
company
or
another
provider.
C
Who's
already
registered
with
us
is
purchasing
a
care
home
that
those
ratings
will
continue.
So
we
won't
be
starting
from
a
blank,
a
blanket
approach
again:
it'll
be
the
new
new
registrations,
new
people
coming
into
the
market.
Where
will
will
she
will
be
more
assured
that
we
will
be
will
be
reporting
on
those
within
12
months
of
the
date
of
the
registration
and
obviously
sooner
if
information
of
concern
alerts
us
to
things
that
may
be
going
wrong,
and
we
need
to
get
out
that
great
Liz.
H
C
So
Chris
might
help
from
from
the
comms
point
of
view
and
I
think
it's
important
to
say
that
the
people
who
lived
in
mended
hopes
were
really
badly
failed
by
those
who
were
looking
after
them.
So
what
happened
Emily
is
is
that
in
May
2016
we
received
some
information
of
concern,
and
this
follows
on
from
the
conversation
we've
just
been
having
we
looked
at
the
information
of
concern
from
whistleblowers
and
we
inspected
straightaway.
C
Through
that
inspection
we
found
that
there
were
serious
concerns
and
a
number
of
abusive
practices
that
we
highlighted
as
part
of
the
inspection
report
when
we
rated
it
inadequate.
A
decision
at
the
time
was
also
taken
to
take
enforcement
action.
The
strongest
enforcement
action
possible,
which
was
a
notice
of
proposal
to
remove
the
location
from
the
National
Autistic
Society
portfolio,
the
National
Autistic
Society
decided
to
close
the
service.
C
So
the
impact
of
our
proposed
enforcement
action
have
the
right
outcome
for
those
people
and
those
people
were
moved
to
other
supported
environments
so
to
ensure
that
they
received
the
right
quality
care.
We
also
investigated
whether
we
could
prosecute
the
National
Autistic
Society
for
compete
for
failing
to
keep
people
safe,
but
we
were
not
able
to
do
so
because
of
insufficient
evidence,
and
that
was
the
same
with
the
police.
C
The
police
were
also
unable
to
carry
a
prosecution
because
of
insufficient
evidence,
which
meant
that
any
information
that
we
would
have
normally
shared
we
couldn't
because
it
wasn't
there
to
be
shared
at
the
end
of
the
day,
but
we
did
have.
We
did
have
evidence
whereby
abusive
practices
taken
place
in
relation
to
financial
abuse
and
we
did
pursue
that
and
we
were
successful
in
fixed
penalty
notice
of
four
thousand
pound
now
the
way
that
we
communicated,
obviously
the
information
in
2016-17.
C
F
The
evidence
that
we
need
to
gather
in
order
to
take
criminal
prosecution
as
a
police
investigation,
clear
to
a
precedent
over
hours
and
I,
think
the
speed
at
which
the
organization
was
closed
in
part
meant
the
information,
the
work
that
the
police
do
together
to
gather
the
information
it
would
lead
to
a
prosecution
didn't
take
place.
From
our
perspective,
it
was
important
that
we
then
use
the
other
evidence
that
we
do
have
detain
any
prosecutions
we
can.
We
can
do
we've
since
spoken
to
both
people
in
the
media,
I
know
and
elsewhere.
F
Who
raised
concerns
about
this,
but
I
think
there's
I
mean
put
the
really
important
point
in
this.
Is
that
we,
the
action
we
took,
meant
that
people
were
protected
quickly
and
that
the
organization
was
closed
and
then
the
rest
of
the
action
we
took.
We
used
all
the
available
evidence
to
take
the
prosecution's
that
we
could,
and
in
the
case
it
was
a
financial
prosecution,
was
accidents
that
we
had
available
and
I
think
that's
that's
the
important
part
part
to
bear.
F
We've
been
back
in
touch
with
Bob
Keeley
and
we've
also
been
in
touch
with
colleagues
in
The
Guardian,
who
wrote
the
initial
story,
and
they
understand
that
and
I
think
it's
in
some
times
about
reminding
people
as
we
did
on
social
media.
This
was
actually
about
closing
at
home.
That
was
that
was
unsafe
and
the
criminal
prosecutions
would
have
taken
months
anyway,
and
it
was
more
important.
It
was
to
make
sure
people
were
protected.
F
A
Might
also
just
be
worth
adding
that
the
the
fixed
penalty
notice,
the
four
thousand
pounds
that
I
am
right
in
saying
was
the
maximum
that
we
were
able
for
the
under
the
law
that
we
could
impose
for
what
it
was
we
were
able
to
prosecute
on.
Just
also
add
I
mean
I
I
I,
look
back
over
all
the
actions
that
we've
taken
at
the
time,
and
sometimes
when
you
do
that
you
think.
A
Well
with
hindsight,
you
know
we
should
be
done
that
or
we
could
have
done
something
different
and
in
this
particular
case
I
think
we
did
all
the
right
things
and
it's
not
one
of
those
cases.
When
I
look
back
and
think
oh
well,
it
could
have
been
better.
So
so
I
think
this
is
about
explaining,
rather
than
learning
ourselves
from
what
happened.
A
I
You
were
building
in
your
spread
strategy
right
from
the
beginning
and
the
outset
it
involved
people
from
finance
people
and
digital.
So
you
came
that
cross
sector
input.
The
results
were
demonstrating
a
median
in
report.
Writing
come
down
to
27
days,
the
factual,
a
cursory
dropped
mainly
now
around
two
days.
I
understand
there
was
co-production
of
some
of
the
elements
such
that
the
input
from
users
around
their
home
care
is
now
much
stronger.
The
quality
of
the
reports
was
higher
recognized
by
deep
sampling
and
they
didn't
stop
there.
I
They
rolled
it
out
webex's
using
these
people
in
all
the
geographies
to
get
it
there
and
have
built
on
that
structure
to
introduce
one
note
across
the
whole
thing
in
four
months.
This
is
truly
impressive.
Stuff
devi
and
you
know
there
was
clear
purpose:
clear
methods,
single
governing
team
colleague,
ownership,
things
done
with
people
not
to
them,
and
eighty
percent
of
transformation
is
involving
people,
not
the
method.
I
can
say
no
more
than
I
could
not
have
designed
and
delivered
it
better
myself.
So
well
done,
and
there
is
no
higher
praise
than
the
john
could.
J
But
rather
more
mundane
I
came
back
ready
to,
but
we
talked
a
lot
and
quite
rightly
about
the
timeliness
of
reports
and
inspections
being
important
to
look
at
the
higher
risk
cases.
I
do
understand
that,
but
when
we
consider
that
all
when
we
look
at
days
record
what
happens
to
the
people
rate,
it
requires
an
improvement.
Most
of
them
just
become
good
if
they
are
inspected
late.
The
public
and
indeed
the
provider,
is
being
deprived
of
knowledge.
C
Absolutely
key
and
critical,
because
people
who
use
services
are
people
who
are
choosing
services
for
their
loved
ones,
you're,
absolutely
right.
The
need
to
have
an
inaccurate
Retton
and
we
have
a
plan
in
place.
I
am
more
issuer
than
I.
Then
I
was
three
months
ago
and
we'll
we
will
we'll
movement
we're
monitoring
it
extremely
closely
extremely
closely.
A
Anything
else
on
the
performance
report,
because
you
could
I
just
just
just
may
not
be
for
now,
but
the
the
slide
on
the
rejection
rates
for
applications
and
registration.
That's
all
fine,
but
were
given
the
the
top
five
provider,
application,
rejection
reasons
and
they're
so
high
level
that
they're
really
meaningless.
As
far
as
I'm
concerned,
you
provide
a
section
or
location
section.
So
so
my
question
is
what
what,
if
anything,
are
we
doing
to
make
sure
that
providers
can
learn
from
where
all
the
mistakes
that
have
been
made
by
people
who
applied
before?
K
Around
our
quality
improvement,
so
we
I
think
we've
we've
done
some
analysis
on
and
why
why
we
have
these
problems?
We
have
a
very
complex
registration
process.
The
application
forms
aren't
great
and
the
guidance
around
it
isn't
isn't,
isn't
so
good
as
well.
So
we're
looking
at
all
of
that.
We're
also
looking
at
our
process
as
well
in
terms
of
how
we
can
lean
that
out
and
make
that
much
simpler
to
enable
people
to
to
get
it
right
first
time.
That's
because
that's
what
we
want
saves
money
all
around
for
everyone.
K
We
are
we're
testing
that
out
in
now
we're
in
we're
doing
it
for
the
add
and
remove
partner
one
and
also
the
council
registered
manager,
one
which
will
enable
us
to
test
out
the
process
lean
it
out
and
on
live
applications
and
make
sure
it's
working,
and
we
can
scale
that
into
live,
which
we're
we're
planning
on
doing
over
the
next
month
or
so
so.
I
think
this
that
we
recognize
that
I
think
part
is
a
registration
transformation
program
is
aimed
driving
this
forward
as
well.
K
So
our
minimal
Viable
Product
that
we're
looking
at
now
is
new
new
provider
applications
in
a
social
care
setting
and
by
by
it,
by
trying
to
drive
a
bi
driving
that
forward
in
a
much
more
in
a
much
simpler
user
driven
experience
type
way,
we
should
be
able
to
make
that
service
as
pain-free
as
possible,
so
people
do
get
it
right.
The
first
time,
that's
very.
A
K
Thank
you
so
I'm
just
going
to
give
you
a
quarterly
change
update
today,
there's
quite
a
lot
of
data
information
in
the
paper,
so
I'll
just
pull
forward
a
few
key.
The
key
key
areas
so
I
think
that
the
headline
around
our
change
and
improvement
portfolio
for
this
year,
so
we've
got
those
seven
projects
on
the
portfolio.
I
think
we're
seeing
a
generally
improving
picture
across
that
portfolio
and
terms
of
delivery
and
managing
the
risks
around
that
we're
also
doing
quite
a
lot
of
work
around
our
quality
improvement.
K
We
are
in
the
process
of
recruiting
a
partner
to
work
with
us
to
upskill.
The
organization
and
provide
for
support
to
a
number
of
projects
were
hoping
to
have
that
partner
finalized
through
the
procurement
process
and
in
working
with
us
during
April
of
those
so
Qi
initiatives.
We
are
doing
some
working
registration,
which
I
just
alluded
to
we're
doing
some
work
around
report.
Timing,
us
working
with
the
business
to
support
the
improvement,
and
that
can
be
seen
both
in
terms
of
improvement
in
a
report.
K
Timeliness
in
in
hospitals
and
as
the
word
that
you
Debbie
was
also
talking
about
we're.
Also
starting
to
look
at
how
we
can
drive
a
more
consistent
approach
across
the
organization
and
also
look
at
where,
when
partner
comes
in
how
we
can
upscale
our
capacity
and
capability
in
this
really
important
area,
one
of
the
areas
that
we've
been
really
focusing
on
over
the
last
12
months
is
improving
our
user
experience
and
really
starting
to
address.
K
Some
of
us
have
technical
debt
that
we
have
in
our
IT
services,
and
also
some
of
the
issues
that
we
have
around
just
to
have.
People
are
using
our
our
internal
staff
are
experiencing
the
using
and
using
their
IT
systems.
I
think
we've
started
to
roll
out
role
that
improved
kit.
So
we've
we've
rolled
Finnick
completed
the
rollout
now
of
the
new
laptops,
we're
starting
to
roll
out
smartphones
across
the
organization
as
well,
and
we've
done
quite
a
lot
of
work
to
improve
the
stability
of
our
systems
and
I've.
K
Just
seen
some
statistics
they're
showing
that
this
or
the
downtime
through
us
incidence
in
stable
platforms,
has
improved
now
by
about
50%,
so
we're
we're.
We
are
actually
starting
to
be
able
to
work
more
effectively
through
our
systems,
because
it's
better
we're
also
working
around
our
underpinning
architecture.
So
this
is.
This
is
a
sort
of
the
nuts
and
bolts
the
wiring.
If
you
want
the
supports
our
operation,
day-to-day
we've
got
some
work.
K
K
It
touches
every
single
point
of
the
organization
and
we're
starting
to
scope,
but
out
in
terms
of
what
it
needs
to
be
for
a
from
a
both
from
a
digital
solution,
but
actually
also
from
a
business
process,
so
that,
as
we
start
to
move
the
CRM
start
to
develop
the
replacement
for
that,
we,
our
business,
ready
to
take
that
on
board.
The
other
key
area
in
in
this
in
this
little
area
is
our
future
IT
services
program,
and
this
is
the
replacement
of
all
our
from
our
existing
contract,
which
is
currently
supplied
by
at
us.
K
We've
got
a
challenging
program
of
activity
there,
where
we're
looking
to
to
swap
out
for
one
provider
and
create
a
range
of
providers
and
under
an
integrated
service
there
we've
now
bought
in
the
resources
we
need
to
start
to
manage.
That
process
are
in
the
business
bit
the
currently
and
the
business
of
putting
together
the
the
business
case
to
support
that
support
that,
through
to
delivery.
A
K
Is
March
2020,
so
I
think
that
is
a
really
big
ask.
We
need
to
recognize
that
there's
a
huge
amount
of
work
to
do
in
a
relatively
short
space
of
time
that
what
we're
doing
currently
working
with
the
program
is
to
just
look
at
our
contingency
plans
around
how
we
might
want
to
do
a
phased
delivery.
If
we
can't
get
absolutely
everything
done
and
dusted
by
2010
March
2020,
but
we
are
looking.
We
are
that's
what
we're
working
to
but
recognize
that
it's
quite
a
steep
ask
registration.
K
Our
registration
program
is
a
multi-faceted
program
that
includes
service
redesigned
through
using
service
designed
Technic
techniques.
To
really
look
at
that
into
and
approach
to
to
how
we
are
delivering
our
registration.
It's
also
got
an
element
of
quality
improvement
in
there
and
also
an
organizational
design
and
people
work
strand.
We've
had
a
real
success
around
a
registration
program
recently
in
that
art
that
the
piece
of
work
we're
doing
under
our
service
design
team
is
the
has
been
in
alpha.
K
We
have
passed
our
GDS
assessment
to
move
that
into
into
private
beta,
and
that
is-
and
we
passed
it
first
time
with
with
flying
colors,
and
that
is
a
real
real
achievement
and
I
think
we
need
to
recognize
that
the
team
they
have
done
a
good
job
to
take
this
really
complex
area
and
and
and
get
that
through
this,
this
so
big
hoop
the
first
time
round
around
register
intelligence-led
approach
to
how
how
we're
becoming
more
intelligent
sled.
We
have
a
program
called
monitor.
K
K
On
the
people
front,
we
are
in
the
process
of
recruiting
a
new
people
director,
so
it
is
a
little
bit
sort
of
holding
the
fort
till
they
arrive.
We've
got
a
great
long
list
of
things
for
them
to
really
start
to
focus
in
on
key
areas,
for
us
are
around
our
workforce
strategy,
focusing
clearly
on
on
skills
that
we
need
to
now,
but
also
for
the
organization
in
the
future
and
our
attraction
and
retention
policy.
K
So
how
do
we
get
people
into
the
organization
that
have
the
skills
that
we
need
and
how
do
we
make
sure
we
keep
them
and
keep
them
up
skilled,
we're
also
doing
some
work
around
our
well-being.
We
recognize
that
well-being
was
an
issue
in
in
in
current
in
recent
staff,
surveys
and
ones
in
the
future,
so
we're
looking
about
equipping
giving
people
our
skills
to
cope
with
working
in
a
fast-paced,
modern
environment
at
an
individual
level,
but
also
we
have
a
program
in
place
now
to
support
teams
to
improve
the
overall
well-being
of
the
organization.
K
K
L
Mark
Thank
You,
chairman
Kirstie
I
thought
in
the
reporter
on
people
that
the
development
of
reconnection
events
for
new
starters
in
first
house
was
a
really
great
initiative,
especially
when
we
look
it
up
of
hormuz
report
where
levers
for
avoidable
reasons
is
actually
increased
in
the
last
month.
So
I
just
think
that
the
ability
to
take
that
piece
of
work
and
try
to
show
the
evidence
of
that
impacting
on
our
turnover
rates
would
be
a
really
really
good
story
for
for
our
people.
Yes,.
K
I
agree
and
I
think,
particularly
in
the
way
in
which
we
work
as
an
organization
we're
a
dispersed
organization
60%
of
our
staff,
our
home
base.
So
particularly
as
we
get
new
people
in
it,
it's
really
important
that
we
make
sure
that
they
feel
connected
and
supported
across
that
not
just
when
they
start,
but
actually
over
the
first
12
months
and
on
was
throughout
the
organizer
throughout
their
life.
Their
working
life
in
the
organization,
so
I
totally
agree.
K
A
B
Really,
what
I'm
looking
for
today
is
just
to
ask
the
board
to
to
notice
the
progress
that
we've
made
on
the
business
plan.
I
think,
with
a
little
bit
more
work
to
do,
as
we
alluded
to
in
the
paper
around
around
presentation,
but
also
I
want
there's
a
there's,
a
meeting
of
the
board
subcommittee
that
sponsored
the
transformation
program
this
afternoon
as
well
and
again
it's
important.
We
hear
their
voices
properly
in
in
the
business
plan
as
well.
A
E
Thank
you
very
much,
Peter,
so
I'm
very
pleased
to
present
you
with
the
Equality
objectives
that
we're
proposing
for
the
next
two
years.
The
quality
objectives
for
CQC
is
something
that
we
doing
for
many
years
now
and
it's
very
important
work.
It's
not
just
part
of
obligation
on
the
Equality
sac
to
be
clear
about
what
our
objectives
are
around
equality
and
diversity,
but
it's
also
something
that
guides
and
frames
our
work
as
a
regulator
both
for
the
services
that
we
regulate
and
people
using
services,
as
well
as
for
our
own
staff.
E
There
are
all
about
how,
within
our
wider
approach,
whether
it's
registration,
whether
it's
the
inspection
and
monitoring
of
services,
whether
it's
an
independent
voice
or
how
we
work
our
own
colleagues
and
staff,
that
we
make
sure
we
pay
attention
properly
to
the
Equality
issues
that
we've
set
out
in
these
objectives
and
that
we
want
to
focus
on
over
the
next
two
years.
Liz
you've
been
involved
in
this
work,
quite
significantly,
for
which
I'm
very
grateful
with
with
colleagues.
It's
the
only
thing
you
want
to
add
and.
H
Yes,
I
think
that
I
think
there's
been
some
really
interesting
work
going
on
across
the
organization.
A
couple
of
things
I'd
point
to
one
is
that,
on
the
one
hand,
we
have
that
we
signed
off
recommendations
from
the
Roger
Klein's
report
at
the
board
earlier
this
year,
obviously
focusing
very
specifically
our
internally
on
colleagues
from
black
and
minority
ethnic
communities
and
the
recruitment
process
in
relation
to
race
equality.
H
We've
also
got
the
workplace
race,
equality
standard
already
in
in
place
and
the
workplace,
disability
equality
stone
for
going
live
in
April,
right
across
the
hill,
the
NHS
and
and
for
ourselves,
but
at
the
same
time,
was
focusing
on
those
kind
of
specific
issues.
I
think
there's
a
strong
emphasis
here
on
working
across
difference
and
recognising
the
intersection
of
a
lot
of
the
different
equalities
issues
and
working
intersection
later
coined
the
jargon
and
I
think
keeping
that
balance
right
is
important,
and
it
seems
to
me
that
we
are
doing
that.
H
M
G
Really,
thank
you
well,
I
think
is
very
important
piece
of
work
and
generally
pretty
good
I,
just
wonder
about
well
about
the
urgency
in
the
objectives.
So
the
two
things
about
the
the
outcomes
that
are
described,
one
I
think
as
you've
already
referred
to,
which
is
some
of
them.
Don't
look
very
measurable,
and
so
it's
it's
a
little
bit
odd.
To
have
outcomes.
Doesn't
that
you
can't
then
say
for
certain
whether
you've
met
them
or
not
so
I
think
you're
right
to
think
more
about
that.
G
G
So
I
would
like
us
to
have
achieved
more
in
the
next
year
than
what
most
of
the
outcomes
are
about,
which
is
this
issue
of
awareness
there's
an
exception
which
is
the
the
res
actually,
which
is
much
more
definite
than
one
there's
one
of
the
one
of
Jess's
about
the
really
the
workforce,
risk
quality
standard
and
it's
much
more
definite
and
much
more
specific.
And
maybe
that's
because
it's
already
in
the
system-
and
so
it's
a
bit
easier
to
be
clear
about
it
and
maybe
proneness
has
really
been
made
on
it.
G
E
The
on
the
urgency
I
think
this
is
so.
This
is
partly
a
recognition
that
what
we're
trying
to
contribute
here
is
a
significant
culture,
change
in
half
the
social
care
services,
so
even
where
there
are
clear
mandated
standards
or
expectations
set
through
the
Equality
Act
exam
or
the
accessible
information
standards,
for
example.
The
contribution
we
want
to
make
is
that,
where
we
can
we
talk
about
this,
we
look
at
it
as
part
of
our
inspection
and
we
change
that
culture
over
time.
E
That
means
I
believe
that
we're
not
going
to
see
a
change
where
everyone
will
do
this
in
the
way
that
we
would
like
to
see
it
within
12
month
time,
and
there
will
not
be
awareness
in
two
days
time,
because
we
know
from
all
experience
off
this
over
the
last
decades
that
it
takes
much
longer
to
achieve
that.
So
I
think
it's
it's
a
it's
a
recognition
of
the
role
that
we
play
in
the
contribution
we
make
to
it,
because
this
is
not
just
about
CQC.
E
This
is
about
our
contribution
that
we
make
and
the
others
playing
in
this
are
provide
us
and
their
leadership
and
their
staff.
Commissioners,
other
national
bodies,
the
public
and
their
voice
around
this,
the
Equality,
Commission
and
and
and
so
on,
and
so
on.
So
I'm
quite
happy
to
look
at
some
of
the
pace
of
this,
but
I'd
be
cautious
to
say
that
CQC
conceived
some
of
the
outcomes
that
we're
looking
for,
which
is
for
health
and
care
services
to
act
in
this
way,
could
be
something
that
we
could
say.
E
We
can
achieve
and
mend
aid
within
12
month
time,
because
don't
forget
what
we're
not
doing
here
is
to
set
ourselves
up
to
go
around
every
single
service
to
check
for
men
for
four
core
standards
and
expectations.
We're
trying
to
build
this
into
our
ongoing
approach
to
make
this
as
a
significant
cultural
driver
right
rather
than
something
where
we
are
acting
as
the
policeman
of
these
of
these
issues.
G
Just
briefly
come
back
I
just
would
would
ask
you
just
to
have
a
closer
look
at
the
wording
of
them,
because,
of
course,
it's
not
just
our
responsibility,
but
to
give
you
an
example,
the
outcomes
we
expect.
This
is
let
me
just
check
equal
access
to
care
and
equality
of
equality
of
outcomes,
actually
the
so
in
the
short,
come
short
term
leaders
and
providers
and
ICS
azar
aware
that
CQC
will
consider
their
role
in
tackling
inequalities.
G
Now,
how
long
does
it
take
for
the
leaders
to
become
aware
that
our
job,
so
we're
not
asking
for
a
major
change?
We're
asking
for
people
to
be
aware
that
we're
taking
this
seriously
providers
will
have
greater
awareness
of
their
role.
I
mean
that
shouldn't
take
a
year
to
get
anyway,
so
I,
just
your
answer:
Walter
sounded
slightly
hesitant
about
whether
this
was
possible
or
even
within
our
remit
and
I
think
it
is,
and
I
would
ask
you
to
look
more
closely
at
it.
N
A
J
Sorry,
yes,
I
wonder
whether
one
of
the
problems
with
that
conversation
is
that
these
objectives,
which
are
obviously
intended
to
be
common
expectations
in
regard
to
what
people
we
regulate,
do
and
what
we
do
internally,
but
I
just
in
the
ordering
of
this
just
in
relation
to
each
objective.
There
is
a
little
bit
of
potential
for
confusion
as
to
what
we're
expecting
other
people
to
do
and
what
we
are
going
to
do
and
because
they
well,
you
know
our
internal
expectations
or
sort
of
one
thing
we
have
completely
under
our
control.
J
What
we
expect
other
people
to
do
is
it's
like:
it's
not
different
in
terms
of
what
the
values
of
zone
behind
it,
but
actually
in
terms
of
the
mechanics
it
is
and
and
I
just
wonder
whether
the
ordering
of
it
could
be
just
a
little
clearer.
What's
about
the
external
environment
and
what's
about
us,
so
how
do
we
gain
we
influence
the
outside
and
how
we're
going
to
influence
ourselves.
A
A
Let's,
let's,
let's
move
in
that
direction
and
if
you
think
there
are
areas
where
we
can
move
with
more
pace
and
we
exceed
the
objectives,
that's
a
good
thing
to
have
done
yeah,
but
with
with
that,
are
we
happy
to
approve
the
objective
of
the
objectives
are
set
good.
Thank
you
right,
Imelda
well
done
for
getting
here
early
since
I
thought
we
were
going
to
be
late
and
clearly
the
communications
are
working
well.
Thank
you
now
me.
So
that's
good,
but
Rob
do
you
want
to
kick
yourself?
Thank
you.
Thank
you,
Peter.
Well,.
J
I
think
everyone
said
an
opportunity
to
read
what
was.
It
turns
out
to
be
quite
a
long
report,
but
I
think
that
somewhat
reflects
the
range
of
activity
that
HealthWatch
nationally
and
locally
actually
does
and
the
impact
that
it
can
make
I
don't
want
to
steal
the
melters
thunder,
but
underlying
all
this,
as
you
can
imagine,
is
a
huge
amount
of
work
both
by
the
office
here
and
volunteers.
Largely,
but
also
a
small
and
brave
army
of
paid
staff
around
the
country
are
doing
tremendous
work
and
I.
J
Think
that's
the
evidence,
pile
and
just
two
things.
I
can
pick
out
really
one
is
the
involvement
we've
had
nationally
in
the
long-term
plan,
not
only
in
informing
its
development,
but
also
now
having
been
commissioned
to
oversee
a
consultation
in
every
HealthWatch
in
the
country
in
relation
to
the
implementation
of
the
plan
and
I.
J
Think
it's
probably
the
first
time
that
the
people
of
this
country
have
been
given
that
sort
of
opportunity
to
be
involved
in
what
is,
after
all
their
service,
not
not
the
Department
of
Health
Service,
but
the
work
they
do,
which
sometimes
gets
criticized
I.
Think
because
it's
not
statistically
valid
in
the
sense
that
something
from
the
Office
of
National
Statistics
is
so
easy,
in
my
view,
extremely
valid.
Firstly,
a
very
large
number
of
people
contribute
to
this
work.
We've
got
over
eighty-five
thousand
voices
as
it
were,
into
informing
the
national
plan.
J
Four
hundred
and
thousand
people
as
reviews,
one
way
or
the
other
have
been
received
in
the
last
year,
and
it
brings
up
things
in
a
slightly
different
light
through
I.
Think
not
the
stories
that
people
tell
and
you've
seen
some
of
them
in
this
report
and
I
think
it's
the
impact
of
that
which
you
can
add
to
other
forms
of
information
which
can
truly
help
to
transform
the
way
which
services
are
delivered
and
I.
Just
like
to
pay
tribute
to
everyone
who
contributes
to
that
and
handover
dwell.
Melda.
O
Thank
you.
Thank
you
very
much.
Well,
as
Robert
said,
you
have
the
report
here
and
I
think
the
work
on
the
the
NHS
10-year
plan
has
been
a
bit
of
a
game
changer
for
HealthWatch
I
would
say
both
in
terms
of
I
feel
that
the
our
reporting
on
the
insight
from
the
public
has
really
improved
to
a
standard
that
we
can
with
confidence,
now
share
that
at
large
scale,
and
also,
very
specifically
so
within
that
85,000
there
were
750
homeless,
Street,
homeless,
people's
experience
of
using
GPS
or
or
a
and
E
departments.
O
So
it's
both
it's
both
global
and
specific
and
and
so
I
feel
like
we're.
In
a
the
best
position,
we've
ever
been
able
to
really
get
that
insight
properly
into
the
system
and
I
think
NHS,
England
and
other
organisations
National
Audit
Office
many
others
are
really
getting
to
understand.
The
value
of
that
insight
and
understanding
its
role
in
shaping
the
future
of
services.
So
on
that's,
go
I.
O
Think
I
think
we've
come
a
long
way
recently
to
to
really
be
able
to
deliver
that
we
are,
as
Robert
said,
we
are
in
the
process
of
running
engagement.
Events
in
every
part
of
the
country,
right
now
we
have
I
mean
the
team
had
just
been
fantastic.
It's
a
small
team
and
they
have
pulled
together
guidance
on
every
subject
matter.
You
could
imagine
to
help
run
any
event.
O
Anybody
could
imagine
in
any
part
of
the
country
and
and
of
our
152
local
healthwatch
150
will
be
taking
part
in
running
events
and
44
of
those
have
come
forward,
as
leads
for
their
area,
so
they're
working
very
directly
with
the
STP,
so
we're
completely
relevant
to
the
local
systems
and
structures
that
are
are
making
the
plans
for
the
future.
I
think
I
think
that
piece
of
work
is
actually
going
to
be
quite
a
game
changer,
for
how
HealthWatch
is
understood.
There
are
also
within
here
other
other
things.
I.
O
Think
we've
made
great
progress
on
in
the
last
quarter.
I
just
want
to
draw
your
attention
to
the
Reports
library
that
we've
now
launched
that's
on
our
websites.
We
have
around
2000
reports
on
there.
At
the
moment
we
will
have
the
whole
backlog
back
to
the
day.
We
were
set
up
on
on
our
reports,
library
by
by
early
summer,
May
June.
O
We
trialed
it
with
a
number
of
organizations,
including
CQC
National,
Audit,
Office,
Sky,
whole
range
of
people,
so
we've
got
some
really
great
feedback,
and-
and
it's
bit
proving
to
be
very,
very
popular
policy
work
goes
very
well
in
here.
We
talk
about
the
work
that
we
did
on
hospital
readmissions.
We
have
noticed
a
spike
in
readmissions.
We
noticed
that
that
this
was
not
been
analyzed
or
the
data
was
being
collected
by
NHS
Digital,
but
not
being
analyzed.
O
They
have
now
to
agree
to
start
analyzing
it
and
there's
sort
of
those
sorts
of
examples
are
happening
quite
frequently.
Now,
a
lot
of
work
that
we
did
on
oral
healthcare
in
care
homes,
along
with
CQC
that
now
is
become
mainstream,
so
I
think
we
can
really
see
the
impact
of
people
telling
us
things
and
then
getting
getting
a
response
that
is
sustainable.
O
The
I
think
one
of
the
other
big
changes
we've
had
in
the
last
quarter
has
been
the
quality
that
has
come
from
being
able
to
have
second
Munson
from
the
network
to
help
us
really
move
forward
on
things
like
making
a
difference.
Toolkit
you
know
an
impact
toolkit
on
setting
research
standards
so
that
real
sense
of
being
one
HealthWatch
and
does
working
together
has
really
come
a
long
way.
O
The
other
thing
that's
made
a
massive
difference
is
our
ability
to
to
give
grant
in
aid
to
local
HealthWatch,
to
carry
out
pieces
of
work
that
we
want
done
across
the
country,
but
can't
we
can't
mandate
local
HealthWatch
to
do
things
but
being
able
to
give
small
amounts
of
money
frees
up
their
capacity
to
help
us.
So
an
example
of
that
is
the
work
that
we're
doing
on
maternal
mental
health
and
on
young
people
and
mental
health
services.
O
As
well,
the
only
final
thing
I
want
to
say
is
I
apologize
for
the
length
of
the
report
and
I
had
flu
last
week
and
I
can
see
that
what
would
have
been
better
is
to
divide
it
into
two.
So
one
you
get
the
sort
of
an
insight
report
which
is
less
repetitive
and
one
is
what's
going
on
in
HealthWatch
and
if
that's
useful
to
you
I'll
do
that
for
the
future
meetings.
So.
O
I
Any
other
kind
of
just
endorse
that
I
really
enjoyed
reading.
This
did
you
and
it
gave
me
a
much
clearer
picture
and
I
heard
before
and
I'm
just
stunned
by
the
breadth
of
stuff
that
you
guys
do.
The
link
between
getting
a
report
and
getting
sustainable
policy
and
action
result
is,
is
just
truly
commendable.
So
thank
you
for
sharing
it
and
may
the
force
be
with
you.
K
G
G
And
what
was
good
about
it
was
the
the
breadth
of
personal
stories,
so
they
were
out
there
quite
diverse
in
lots
of
ways
and
but
a
couple
stood
out
for
me.
There
were
the
experiences
of
homeless
people
with
mental
health
problems
and
and
the
experience
of
people
trying
to
get
their
medication
from
their
local
pharmacy
and
it
was
a.
It
was
quite
an
interesting,
a
reminder
of
how
people's
experience
of
care,
no
matter,
how
good
our
staff
are
in
a
professional
sense
and
and
whether
we,
whether
policy
intentions,
are
enacted
and
nice
guidance
forward.
G
A
lot
of
people's
experience
of
health
care
is
actually
about
the
day-to-day
things
that
go
wrong
and
so
going
to
the
pharmacy
and
discovering
that
nobody's,
and
nobody
knows
their
what
their
prescription
ought
to
be
and
then
they'll
miss
out,
can't
get
their
medication
and
run
out
and
those,
and
so
as
they
were
there
really
quite
very
recognizable
and
quite
I.
Imagine
very
common
and
quite
powerful
stories
about
people's
care
being
adversely
affected
by,
in
one
sense,
quite
small
things
going
wrong.
G
So
I
did
wonder
where
this
goes,
since
it's
not
about
policy,
and
it's
not
about
nice,
going
it's
not
about
it's
not
really
about.
You
know
CQC
inspections
or
any
of
those
things
in
a
way,
and
it
could
be
I
suppose.
But
what
about
where?
It
goes
aware?
For
example,
if
we
take
the
prescription
problems
which,
as
I
say
as
a
day-to-day
problem,
actually
potentially
very
serious
for
some
people,
where
does
that
the
report?
Where
does
this
go
now
and
who
takes
responsibility
for
responding
to
it?.
O
That's
a
really
good
question
and
something
that
I
think
we're
still.
Oh
I
still
think
we're
not
having
maximum
impact
from
knowing
this
stuff,
so
there's
happens
on
a
number
of
different
levels.
So
it's
a
local
level.
They
will
report
that
into
their
CCG
and
they
will
say
this
is
what's
happening
in
our
local
area
at
a
at
a
national
level.
O
I
think
the
issue
about
medication
is
quite
interesting
because
that's
come
up
as
a
higher
issue
than
it
has
been
before,
and
so
what
we
will
do
is
make
sure
that
we
have
the
meeting
with
the
appropriate
people
within
the
Department
of
Health
and
Social
Care,
and
we
tell
them
about
the
trends
that
we're
seeing.
So
that's
the
if
you
like,
where
that's
the
real
challenge
in
for
us,
is
now
to
get
people
to
listen
and
make
changes
as
a
result,
so
I
teach
at
each
of
these
points.
J
Local
HealthWatch
and
they
have
a
varying
approaches
to
this,
but
they
are
a
very
valuable,
so
collecting
point
for
local
knowledge
about
general
practitioners,
who
perhaps
aren't
as
good
as
some
other
places
and
doing
things
for
a
particular
pinch
point
in
the
hospital
service,
and
they
do
in
the
good
ones.
They
will
have
immediate
access
or
on
a
regular
basis,
because
they
have
good
relationships
with
CCGs
and
often
with
providers
as
well
and
I.
Think
in
a
quiet
local
way,
they
can
get
things
done.
J
I
think
that
the
challenge
for
us
here
is
it
is
the
collation
of
the
information
in
a
way
which
has
impact
nationally
and
obviously
on
some
of
these
issues.
It's
going
to
be
easier
to
identify
what
that
is
than
others,
but
I
think
one
of
the
values
of
HealthWatch.
Is
that
because
we're
not
a
regulator
and
that
we're
sort
of
the
little
brother
of
the
big
regulator.
J
But
we
we
want
a
regulator
and-
and
that
gives
us
a
bit
of
the
freedom
to
exercise
a
bit
of
judgement
about
where
things
should
go
without
actually
having
to
go
through
formal
processes
and
I.
Think,
that's
probably
the
place
we
should
be
in,
but
certainly
there
will
be
occasions
when
we
shouldn't
do
feed
information
friendly
formally
to
CQC
or
possibly
to
the
GMC
or
other
regulators
and
I've
been
in
discussions
personally
with
whether
these
one
professional
regulator
about
how
we
can
enhance
that
process.
So.
L
I
echo
echo
that
I
thought
the
report
was
was
really
interesting,
I
enjoyed
reading
it.
It
made
me
think
that
at
the
Steve
Fields
sort
of
going-away
lecture
event,
we
had
a
presentation
from
a
primary
care
organization
that
had
set
up
an
outreach
team
to
specifically
support
homeless
in
their
their
community
and
I.
Wonder
whether
this
sort
of
report,
the
content
in
it,
is
perhaps
something
that
can
be
used
to
encourage
that
innovation
to
help
those
people
most
in
need.
O
L
D
Can
I
welcome
the
report
as
well
in
men,
Mulder
and
I
enjoyed
reading
it
and
I
think
the
juxtaposition
of
patients
stories
with
with
the
highlighting
the
concerns,
is
really
very
helpful
way
of
laying
it
out.
So
thank
you
for
that.
It
was
great.
The
couple
of
points
to
me.
One
is
the
emergency
readmissions.
Thank
you
for
getting
that
reinstated.
That
is
useful
information
which
we
can
use
so
I
think
that's
really
positive.
D
So
congratulations
on
that
can
I
also
highlight
that
the
concerns
you
that
you
raised
you
know
do
have
resonance
with
us
from
our
inspections.
You
know
and
I
hope
that
reflects
the
fact
we're
talking
well
with
you
locally
I
mean
particularly
the
concerns
about
their
knee,
the
the
concerns
about
mental
health
patients
and
their
knee,
which
lewis
is
referred
to
and
there's
also
issues
around
pediatrics
no
knee
and
those
are
both
big
features
of
our
reporting
on
A&E
over
the
last
winter.
D
O
You
I
completely
agree,
I,
think
we're
not
yet
maximizing
each
other's
knowledge
and
information
and
Chris
and
I
meet
regularly
with
our
teams
and
and
I
think,
with
a
long
way
to
go
to
sort
of
and
I
kick
through.
The
word
I've
always
used
is
hardwire
it
into
the
way
that
both
we
work
and
and
CQC
work.
At
the
moment,
it's
still
reliant
on
good
relationships,
rather
than
a
must-do
automatic
way
of
working,
so
I
think
we
will
keep
plugging
away
at
it.
F
F
A
So
a
milder
I
think
you
all
have
gathered
from
the
board
reaction
that
they
think
this
is
just
about.
Okay
and
seriously,
would
you
would
you
congratulate
past
the
board's,
congratulations
to
your
team
and
also
to
everybody
involved
in
the
local,
HealthWatch,
ISM
and
I
think
this
is.
This
is
really
a
super
step
up
in
in
what
we're
seeing
and
therefore,
presumably
the
performance
of
everybody.
So
great.
Thank
you
very
much
indeed,
and
thanks
for
thanks
Robert
as
well
right
board.
A
It
sir,
is
there
any
other
business
from
the
board
for
the
board
right,
so
that
ends
the
meeting
miraculously.
Having
said
we
were
having
started
late
and
said,
we
were
going
to
run
late
and
there
won't
be
time
for
questions.
We
have
got
time
for
questions
so
we're
in
good
we're
in
good
shape
and
I'm
going
to
take
a
we've
got
time
for
all
the
questions,
but
I
will
take
them
in
the
order
in
which
they
came
to
me
with
respect
so
David
I
gonna
start
with
you,
please
you're
on
the
list.
P
Thank
you
very
much.
Yeah
David
Hogarth
neighbor
Harrison
drums
wooden
made
a
veil
I
recently
looked
at
care
home
professional
latest
issue.
There
was
an
article
about
Wi-Fi
in
care
homes
and
they
said
that
there
have
been
two
reports
recently,
both
of
which
said
that
Wi-Fi,
the
existence
of
Wi-Fi
or
care
homes
was
extremely
important
to
prospective
users
of
prospective
residents
more
important,
not
surprisingly,
perhaps
and
sparse,
and
that
kind
of
thing
even
more
important
than
Gardens,
and
yet
only
one
in
five
care
homes
actually
have
any
Wi-Fi
in
it.
C
Quite
see
that
of
it,
that's
it's
a
really
good
question,
so
thank
you
for
raising
and
I
think
you'll
be
aware
that
we
are
actually
committed
for
our
strategy,
but
to
the
role
that
technology
and
innovation
can
play
can
play.
We
also
acknowledge
that
access
to
Wi-Fi
is
a
commonplace
for
most
people
and
why
shouldn't
it
be
for
people
moving
into
or
living
in
care
homes.
C
However,
we
haven't
got
the
legal
powers
to
require
care
homes
to
provide
internet
access,
but
we
do
through
our
assessment
framework
and
in
particular
the
key
question
on
responsive,
ask
the
questions
that
you've
just
asked
David
and
we
will
report
on
them
on
our
inspection
report
in
our
inspection
reports,
even
more
so
going
forward,
because
we're
actually
trained
these
are
actually
seeing
some
of
that
innovation
now
and
the
benefits
that
Wi-Fi
can
have
in
care
homes.
So
thank
you
for
raising
and
to
help
encourage
the
improvements
as
well
and
drive
it
forward.
C
D
We
apply
them
in
exactly
the
same
way.
We
apply
them
everywhere
else.
I
mean
our
framework
is
consistent,
regardless
of
the
service
we're
inspecting
so
I
I'll
answer
any
specific
issues
you
have
around
it,
but
but
the
key
lines
of
inquiry
are
used
in
exactly
the
same
way
for
each
specialist
service.
We
will
have
some
prompts
to
help
the
inspector
understand
the
evidence
behind
each
key
life
inquiry,
but
the
key
laddering
inquiry
stays
exactly
the
same.
D
Indeed-
and
that
is
the
subject
of
a
thematic
review
which
we
want
to
take
at
the
moment
that
will
produce
an
interim
report
in
May,
which
I
think
is
going
to
be
very
important:
I,
don't
apprehend.
What's
what
we're
going
to
say
there
and
then
a
substantive
report
early
in
2020,
so
I
think
we
are
looking
at
that,
because
I
think
others
have
raised
concerns
about
it
and
certainly
some
of
our
inspections.
We
found
concerns
about
individuals
and
we
now
look
at
our
national
basis
and
part
of
the
imagined
review.
D
A
R
Hello,
I'm
Martin
Russell,
member
of
the
public,
with
an
interest
in
patient
safety.
Just
to
put
my
question
in
context
context
being
the
the
learning
from
deaths
review
program
I
know
that
just
this
week
there's
been
a
report
by
the
CQC
to
update
the
progress
and
the
outcome
of
that.
My
understanding
is
that
it
is
culture,
change
and
leadership.
That
is
absolutely
key.
R
Learning
from
deaths,
not
the
most
pleasant
of
subjects
but
I'm
just
having
having
having
attended
the
board
meeting
I'm
hearing
that
culture
change
is
and
when
well,
ladies,
is
an
emphasis
throughout
the
whole
of
the
CQC,
with
its
regulation,
combined
with
the
use
of
movement
to
business
intelligence,
as
one
would
expect
not
necessarily
artificial
intelligence
but
business
intelligence.
So
what
my
question
is
and
having
read
the
report
of
the
the
progress
of
learning
from
deaths,
which
is
talking
about
it
being
a
quantity,
qualitative
issue
as
opposed
to
a
quantitative
issue,
culture
change
leadership.
R
R
Sorry,
quantitative
measurement
of
the
culture
within
trust
springboard
for
the
question
is
I
read,
for
example,
in
the
news
it
was
across
all
of
the
national
newspapers,
despite
the
current
negotiations
about
the
culture
of
bullying
in
the
NHS,
where
there
was
quantitative
work
by
Freedom
of
Information
rating
trusts
that
70
trusts
by
the
number
of
formal
complaints
that
staff
have
made
about
bullying
and
harassment.
So
that
might
be
one
even
avenue
of.
R
Quantitative
work,
and
also
the
other
thing
I,
was
interested
well
just
to
touch
on
that
at
a
previous
board
meeting.
There's
a
lot
of
discussion
about
whistle
blowing
whistle
blowing
is
a
very,
very
complex
subject.
It
doesn't
do
it.
The
the
is
perhaps
wrong
to
refer
to
as
business
intelligence,
but
I
know
that
you
get
about
8,000
reports
of
concerns
raised
per
annum
is
that
are
those
concerns
broken
down
as
intelligence,
for
example,
by
Ward,
so
that
that
information
can
be
used
to
build
up
a
picture?
D
D
It's
a
it's
a
gratitude
to
you
and
I.
Think
you
raised
some
really
very
interesting
questions.
I
I'm,
not
sure
I
can
answer
at
all.
Culture
is
something
there
are
measurements
that
we
use.
I
would
not
argue
that
that
we
we
can
measure
it
precisely
across
the
board,
but
we
use
particularly
the
staff
survey
and
there's
been
a
recent
staff
survey
published
for
the
whole
of
the
NHS,
and
we
have
identified
that
some
elements
of
staff
survey
are
strong
predictors
of
the
quality
of
care
that
patients
experience
so
staffs.
D
The
experience
of
working
in
an
organisation
is
really
very
important
in
terms
of
the
their
ability
to
provide
high-quality
care
and
that's
around
issues
such
as
engagement,
but
also
issues
such
about
as
race,
equality
standards,
where
we
find
that
those
trusts
with
who
score
poorly
on
race.
Equality
are
often
the
trust
that
have
the
culture
that
delivers
poor
quality
care
as
well,
so
that
there's
there's
a
kind
of
sense
of
we.
If
you
look
at
staffs
experience
of
working
in
an
organisation
that
can
predict
quality
and
I,
think
that's
a
an
important
insight.
D
That's
come
out
of
our
inspections
and
it
drives
a
lot
of
our
work
around
well
led.
So
in
terms
of
well
led
I
mean
clearly,
we
spend
a
lot
of
time
talking
to
staff
and
talking
so
hearing
their
stories,
not
just
about
you
know
looking
at
data,
but
the
data
very
much
informs
that
and
some
of
the
data
I've
looked
at
formatting
forms
a
well
there
if
I
can
come
back
to
the
whistleblowing
and
every
whistleblowing.
A
story
that
comes
to
us
is
looked
at
by
the
inspectors
who
are
looking
after
all,
regulating
that
organization.
D
Sometimes
it
will
lead
to
us
asking
questions.
Sometimes
it
will
lead
to
us
taking
actions
such
as
doing
an
inspection
or
focused
inspection,
and
sometimes
it
will
inform
our
inspections,
and
some
of
our
sessions
are
heavily
driven
by
whistleblowing
stories
that
tell
us
there
are
cultural
problems
in
an
organization
and
then
we
go
and
look
for
those
problems
and
try
and
try,
try
and
draw
them
out
to
reflect
on
the
quality
of
care
in
that
organization
and,
of
course,
the
inspector.
D
If
it's
about
a
specific
ward,
we
will
go
and
have
a
look
at
that
ward.
So
to
come
back
to
your
point,
we
drill
down
in
you
know.
So
if
a
member
of
staff
says
I'm,
not
I'm
unhappy
with
the
safety
of
care
of
on
the
ward
I
work,
we
all
want
to
go
and
have
a
look
at
that
board
as
part
of
our
inspection.
So
I'm
not
sure
if
that's
answered
the
totality
for
question
yeah
just.
R
Intrigued
is
it.
We
talked
about
culture,
but
culture,
I
presume,
is
across
a
whole
trust,
but
can
you
have
pockets
of
good
care
and
pockets
of
bad
care
within
one
particular
trust,
but
then
it
is
a
complex.
It
is
more
verges.
There's
such
an
emphasis
on
it's
a
complex
area
and
emphasis
on
culture,
but
they
could
be
trust.
I'm,
presuming
that
could
have
a
poor
culture
yet
have
good
care
in
some
parts
of
it.
I
can.
D
Think
of
one
trust,
I,
remember
that
that
came
out
very
poorly,
but
had
one
service
that
was
outstanding
and
when
you
went
to
look
at
that
outstanding
service,
essentially
what
the
leadership
did
was
to
protect
the
service
from
the
culture
of
the
whole
trust
around
it
and
secure
that.
So
you
can
have
macro
cultures
within
the
trust.
It
isn't
a
uniform
culture.
D
It's
perfectly
possible
to
have
really
poor
care
in
one
ward
and
then
just
down
the
corridor,
another
Ward
providing
very
good
care
and
that
that
is
the
local
leadership
and
leadership
at
all
levels
of
an
organized
@drive,
squawk,
good
quality
care,
not
just
in
the
boardroom,
but
also
you
know,
middle
management
and
the
clinical
leadership
at
the
front
line
that
are
really
important
in
driving
high
quality
care.
So.