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From YouTube: CQC Board Meeting – July 2016 (with subtitles)
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A
A
B
You
chairman,
there
was
a
measure
of
rising
at
HealthWatch
England.
We
were
talking
at
the
last
meeting.
We
had
an
update
on
HealthWatch
England
and
there
was
talk
about
a
document
called
a
common
intent.
B
State
common
statement
of
intent
and
I
was
sent
away
to
find
out
was
his
meant
to
be
coming
to
what
apparently
wasn't
meant
to
come
to
the
board
for
ratification,
but
just
in
case
you're
interested.
It
has
now
been
uploaded
onto
our
system.
So
if
four
members
would
like
to
see
it,
it
is
there
from
tavin
okay.
But
it's
not.
It
wasn't
for
formal
ratification
by
the
board.
A
A
E
A
E
E
A
F
A
A
F
A
Then
more
warrant
buying
me
the
Royal
College
of
Surgeons
on
the
Jew
and
I
think
that
that
does
not
entitle
you
to
do
surgery.
F
G
H
Morning,
everybody
so
there's
a
mixture
of
things
which
are
internally
facing
and
a
number
which
are
externally
facing
a
significant
number
of
being
to
the
board
before
so
I.
Think
colleagues
will
be
cited
on
this,
so
I'm
going
to
do
some
of
those
term
some
pace
and
not
dwell
on
them,
so
I'm
not
touch
on
performance
because,
as
a
first
courses,
performance
reports
is
the
next
item
on
the
agenda.
Adult
social
care
to
important
updates.
H
One
is
the
outcome
of
the
symposium
that
Andrea
and
her
team
led
on
car
horn
clauses,
urgent
care,
home
closures
involving
a
whole
range
of
organizations.
Nhs
England,
amongst
others,
has
now
been
concluded
and
a
document
which
sets
out
how
each
agency
will
act
if
that
action
is
necessary,
has
been
published
yesterday,
which
is
helpful
and
constructive,
and
it
should
ensure
a
much
more
coherent
approach
to
care
home
closures
where
that's
required,
for
whatever
reason
doesn't
just
have
to
be
for
regulatory
action
and
also
developing
some
work
for
to
support
people
who
make
a
complaint.
H
H
So
that's
an
important
development
which
will
check
those
I'll
not
touch
on
pms
and
hospitals,
which
is
about
performance.
Next
item
just
to
reflect
on
is
the
public
accounts
committee.
It
was
a
hearing
in
October
last
year
and
we
were
after
I
was
asked
if
I
would
write
to
the
public
accounts
committee
setting
out
our
program
in
terms
of
appointing
inspectors
and
analysts
and
the
impact
that
that
would
have
on
the
delivery
of
our
program.
H
That's
covered
again
in
the
performance
report
there
to
this
morning
and
the
letter
that
we
that
I
sent
on
the
19
to
July
to
make
heavier
as
Joe
the
Public
Accounts
committees
attached
to
this,
and
that
in
that
sense,
puts
out
into
the
public
domain
and
then
it's
absolutely
transparent
and
clear
what
we've
been
doing.
The
fact
that
we've
monitored
this
on
a
monthly
basis
at
this
board.
It
was
part
of
submission.
H
Last
night
we
had
David
is
the
current
chair
of
ofsted,
the
pre
board,
meeting
dinner
and
so
talked
a
lot
about
our
relationship
with
offset
around
children
services,
and
this
next
paragraph
paragraph
six
talked
about
some
work
that
Alan
warder
former
director
children
services.
Former
past
president
to
the
Association
director,
Children's
Services,
was
asked
to
do
by
the
previous
Secretary
of
State
for
Education
in
reviewing
children's
safe,
guarding
allen
has
now
concluded
that
publishes
report.
H
Governments
have
accepted
his
recommendations
and
there
is
a
bill
going
through
Parliament
on
children,
services
and
Social
Work,
the
children
and
Social
Work
bill,
which
will
pick
up
some
of
the
implications.
I
think
it's
been
heavily
and
ended
in
the
Lord,
we'll
go
back
in
deployment
in
the
next
session
into
the
house
Commons
in
the
next
session,
but
it
will
have
implications
for
the
work
that
we
were
talking
about
last
night.
The
work
that
Steve
and
his
team
leads
on
in
relation
to
children's
safeguarding
in
the
way
we
work
with
others.
H
H
With
the
five
questions
that
we
asked
relationships
are
constructive
and
that's
going
well
and
Malta
and
his
team
are
actively
involved
in
those
discussions
with
NHS
I
about
this
picture
and
I
had
meetings
with
chair
and
chief
executive
NHS
I
at
the
beginning
of
this
week.
So
we'll
continue
to
work
on
that
I
think
there
is
more
work
to
be
done
it
this
isn't
a
finished
or
settled
position,
but
it's
important
work.
H
When
this
report
was
drafted,
land
came
out
last
week
with
not
published.
It
had
not
been
published.
It's
not
that
we'd
not
published
it.
Hadn't
been
published,
the
action
to
strengthen
trusts
and
CCGs
financial
and
operational
performance
in
2016,
which
got
reported
as
financial
special
measures,
because
the
number
of
organisations,
hospital
trusts
and
CCGs
went
into
financial
special
measures.
H
That
material
is
now
in
the
public
domain
and
those
trusts
which
are
in
this
position
have
been
identified
and
that
work
will
continue.
So
I
just
wanted
to
let
the
board
know
that
again,
we'd
been
involved
in
those
discussions
in
anticipation
of
that
announcement
and
although
the
reason
why
these
organizations
were
placed
in
special
measures
was
due
to
finance
and
not
to
quality
issues,
it
was
important
that
we
were
closely
involved
in
the
finalization
of
that
guidance
and
the
decision.
So
our
annual
report
was
published
on
the
21st
of
July
to
Parliament.
H
H
Last
week
we
published
a
statement
of
intent
around
the
way,
we'd
involved
with
van
guides
and
new
models
of
care.
In
the
NHS-
and
it's
an
important
statement
to
make
at
this
particular
point
in
time,
because
what
we
were
saying,
it's
often
this
claim
that
regulation
gets
in
the
way
of
innovation
and
change,
and
we
wanted
to
make
sure.
H
What
we're
saying
through
this
is
we've
not
got
all
the
answers
for
how
we
will
regulate
some
of
these
new
models
of
care,
because
some
of
them
aren't
there
yet
by
definition,
but
the
listening
and
learning
is,
will
engage
with
them
and
be
alongside
the
molten.
Is
team
organized
a
workshop
internally.
H
Also,
last
week
there
before
we
launched
this
guidance
where
we
had
about
40
inspection
managers,
heads
of
inspection,
deputy
chief
inspectors,
all
of
whom
have
some
link
or
connection
with
some
of
the
new
models
of
care,
and
the
purpose
of
that
was
to
ensure
that
we've
got
consistent
approach
to
the
way
that
we
engage.
And
so
the
statement
of
intent
was
really
setting
out
the
principles
of
that
engagement.
So
quite
an
important
piece
of
work
on
our.
H
In
my
view,
because
what
we
wanted
to
avoid
is
in
one
part
of
England.
We
say
we
think
that's
a
really
good
idea
and
in
another
part
of
England
somebody's
proposing
to
do
something
similar
and
we
say
I'm,
not
sure
that
we
think
that
is
a
good
idea.
So
we
really
do
need
to
think
this
through
in
real
time,
and
that
should
be
consistent
in
the
way
that
we
move
forward.
H
H
Although
I
think
she's
beginning
to
make
contact
with
people
here
and
another's
to
take
on
that
role,
new
ministerial,
same
appointed,
which
we've
covered
and
that
will
be
known
about
through
other
routes
on
brexit
I
thought
it
was
important
that
we
just
remind
ourselves
as
an
organization
or
we've
got
over
a
hundred
European
nationals
who
are
employed
by
us
and
given
some
of
the
emotion
around
brexit
in
the
way
that
that
discussion
has
been
conducted.
One
of
the
things
that
we've
tried
to
do
and
I've
certainly
tried
to
do
in
my
messages.
H
Each
Friday
is
actually
say
these
are
valued
colleagues
who
are
other
place
in
the
organization,
particularly
in
the
context
of
some
of
the
debate,
which
is
taking
place
where
people
have
not
felt
valued
and
not
felt
that
they've
had
a
place.
So
it's
important.
We
continue
to
do
that.
These
are
all
people
that
make
a
contribution
to
the
organization
and
in
addition
to
that,
we
have
a
number
of
non-eu
nationals
who
also
work
here,
who
also
make
a
contribution
to
the
organization.
H
H
So
in
summary,
it's
been
a
busy
month
and
I
think
the
report
captures
a
lot
of
what
people
will
know
about
financial
special
measures
and
things
that
they
might
not
know
about
the
review,
their
children
and
Social
Work
bill.
But
if
I
could
ask
the
board
to
consider
the
item
on
delegations
Peter.
Thank
you.
Thanks.
F
I
can
see
that
they're
almost
all
these
are
our
operational
matters
and
therefore
it
seems
entirely
appropriate
I.
Just
wonder
and
I
whistle
questionable
knows
whether
there's
anything
in
this
list,
which
requires
a
decision
which
is
affect
the
use
of
our
own
resources
in
a
way
which
potentially
affects
our
strategy
or
business
plan
or
whatever,
in
a
way
which
we
ought
not
only
two
people
self.
F
H
There
is
a
bright
ideas
sentence
in
the
business
plan.
I
saw
in
anticipation
that
this
might
occur
so
I
think
what
we
did
in
this
year's
business
plan
is
set
in
the
priorities
under
voice.
I
think
he
was
martyred
that
we
would
have
the
capacity
to
do
some
section,
48
reviews
and
a
result
or
place
marker
in,
for
if
a
request
comes
through,
I
was
just
reflecting.
It
was
the
last
bank
holiday
August
that
I
was
approached
in
relation
to
the
debt
security
review,
so
I
think
this
is.
H
We
just
need
to
be
realistic
and
planned
that
that
might
be
an
ass
that
comes
through.
It
is
a
requirement
I
think
if
we
felt
that
this
was
something
that
was
a
challenge
to
the
resource
assumptions
that
we'd
made,
we
would
bring
it
to
the
board.
That's
the
income
from
in
consultation
with
the
in
consultation
with
is
whether
we
use
the
board
meets.
You
know
the
weekly
updates
I
think
it's
not
something
we'd
go
away
and
do
it
is
in
consultation
with
the
board.
It's
not
a
reserve
the
executive
to
make
our
decision
I.
H
Think
the
near
net
report.
We
use
section
48
powers
to
do
that.
So
I
think
this.
There
is
a
sense
that
we're
moving
away
from
some
of
the
big
set
pieces
where
we're
asked
to
do
something
and
actually
using
this
more
flexibly,
because
it
does
give
us
some
flexibility
to
look
at
commissioning
as
much
as
it
looks
at
provision
so
about
three
years
ago.
We
are
steep
undred,
do
a
review
of
section
48
and
he
said:
don't
use
this
as
part
of
an
escalation
tariff,
use
it
as
a
strategic
tool.
H
A
B
B
Is
that
a
direct
correlation,
as
in
you
know,
they're,
not
good,
on
money,
they're,
not
good
on
quality
or
they're
good
on
quality,
in
that
poor
on
Finance
I
would
just
be
interested
to
know
how
that
works,
and
the
other
one
was
about
the
new
models
of
care
just
to
say
that
HealthWatch
across
the
country
are
very
busy
trying
to
make
sure
best.
They
can
that
there's
a
really
strong
public
engagement
before,
during
and
after
the
SDP,
so
we're
working
very
hard
and
we're
grouping
together
so
that
we
match
theirs
stp
footprints.
H
Correlation
on,
we
can't
speak
on
CCGs
because
we
don't
hold
that
information
that
correlation
on
the
acute
trusts
borrowed
amidst
and
tunbridge
wells,
Norfolk
and
Norwich
north
bristol
the
answers.
Yes,
there
is
a
correlation
and
we've
done
the
analysis
which
looks
at
the
ratings
from
outstanding
through
to
inadequate
and
those
outstanding
trust
out,
smaller
debt
or
in
order
and
those
are
arrested,
a
niqab,
the
largest
proportion
of
debt.
G
Yeah,
as
it
happened,
Bart's
was
inadequate
than
the
other
four
were
requires
improvement,
but
the
issue
I
think
I
learnt
that
mortals
got
any
news
on
this
about
the
63
trusts
that
have
a
so-called
pay
growth
opportunity
or
effectively
are
being
asked
in
strengthening
financial
performance
and
accountability.
To
reduce
pay.
Do
we
know
about
those
63
yet
or
we
still
working
on
that
mortar?
I
Done
some
initial
analysis,
which
shows
that
overall,
the
pay
growth
opportunities
I
think
it's
cause
when
the
document
exists
both
for
trusts
across
that
would
exist
for
trust
across
the
spectrum.
So
there's
no
huge
and
difference
between
trust,
a
target
or
rated
requires
improvement
in
terms
of
how
much
pay
growth
opportunity
they
they
have.
That
differs
a
little
bit
for
inadequate
and
outstanding
trusts,
but
we
have
to
be
careful
because
of
the
smaller
number
of
trust
at
that
point
and
how
statistically
significant
that
would
be
it's
a
result.
A
F
Sorry,
Robert
I'm,
just
on
the
same
subject,
prompted
actually
by
the
phrase
paid
growth
opportunity
which,
if
I
understand
it
correctly,
is
the
exact
opposite
of
what
those
weren't
in
time
the
clearly
financially
challenged
institutions
of
which
we've
now
identity
they
have
been
identified,
will
be
under
considerable
pressure
to
produce
their
staffing
costs
and
at
a
time
when
we
seem
to
have
no
standard
by
which
to
measure
appropriate
staffing
levels
and
I
wondered
how
we,
in
conjunction
with
NHS
I,
were
proposing
to
deal
with
that.
I
know
that
Mike
worried.
F
If
he
were
here,
would
say
we
will
carry
on
measuring,
be
inspecting
to
the
same
standards
but
seems
to
me
we're
entering
exceptional
times.
Where
that
may
become
more
and
more
difficulties.
We
don't
have
a
standard
by
which
to
understand
whether
staffing
is
adequate
when
chief
executives
don't
have
a
measure
by
which
they
can
rebut
the
charge
that
their
deficit
is
due
to
over
staffing,
I.
A
As
I
was
saying
to
a
group
of
people
the
other
day,
you
know
we're
not
going
to
have
rating
inflation.
Now
it's
all
much
more
difficult,
we're
not
going
to
say
what
was
good
is
now
outstanding
or
something
like
that.
So
we
stick
to
our
nitin
and
hold
the
line,
but
that
is
going
to
put
providers
in
a
really
difficult
position
because
you're
absolutely
right.
A
The
pressure
on
now
is
to
this
to
reduce
staffing
at
a
time
when
demand
is
going
up,
so
I
ain't
really
difficult,
but
I
I'm,
absolutely
clear
and
say
chat
it
to
my
quite
a
bit
about
this
that
we
stay
exactly
where
we
are.
We
know
what
safe
is
like
and
that
that's
that's
how
we
continue
to
measure
it
I
think.
F
H
Yesterday
Polly
Toynbee
did
an
article
in
the
guardian,
which
prompted
me
to
write
a
letter
saying
we
will
continue
to
focus
on
quality.
She
might
accept
the
position
she's
doing,
but
our
job
is
to
focus
on
calls
and
Anna's
Peter
and
Mike
have
often
said
we're
not
operating
a
fixed
formula.
We're
actually
arriving
at
the
judgment,
and
the
key
issue
yesterday
is-
and
this
is
difficult
for
NHS
board.
But
this
is
why
boards
are
there
to
balance
the
requirements
and
the
demands
of
the
sources.
H
H
We
continue
to
work
in
a
way
that
boards
field
is
their
responsibility
and
they
can
set
that
action
so
because
they
are
ultimately
accountable
for
the
quality
and
safety
of
what's
offered
in
their
hospitals,
and
that's
why
the
redirects,
as
a
nurse
in
a
medical
directors
on
boards,
to
actually
provide
that
clinical
and
professional
advice,
as
well
as
a
financial
advice.
It
is
it
tough.
H
It
is
tough
an
hour,
don't
think
we
should
deny
that,
but
I
think
the
danger
is
we
start
losing
what
our
focus
is
and
why
we've
been
put
into
the
system
and
what
our
job
is,
so
that
what
we're
going
to
do
is
hold
on
to
what
our
role
is,
but
not
not
pretend
that
this
isn't
tricky
for
some
organizations.
So
that's
the
balance,
we're
trying
to
start
Robert,
but
it
it
is
a
difficult
one
to
strong,
and
you
know
we
do
get
complaints
from
trust.
H
A
Just
to
reinforce
that
I've
heard
both
ed
smith
and
and
and
Jim
Mackay
say
very
clearly
that
they
recognize
the
responsibility
for
running.
The
trust
is
with
the
trust
board.
So
exactly
you
know,
their
approach
is
exactly
the
same
as
ours.
We're
not
running
the
trust,
they're
not
running
the
trust.
We
have
our
responsibilities.
Nhs
I
have
theirs,
but
ultimately,
this
balance
is
going
to
be
run
by
them.
The
trust
board-
and
it's
really
tough
the
moment
really
tough.
A
I
So
I
think
there's
two
parts
of
the
question
you
raised.
One
is:
how
do
we
feed
it
into
our
risk
assessment
or
or
or
understanding?
The
first
thing
to
say
is
that
going
back
to
Peter's
point
of
the
complexity
of
factors,
because
there
is
not
once
you
look
at
an
individual
trust.
There
is
not
a
necessary
correlation
between
some
financial
situation
or
position
and
their
quality,
so
we
can't
use
it
as
predictive
factor,
for
example,
about
their
their
their
quality.
I
At
the
same
time,
of
course,
as
part
of
the
intelligent
monitoring
developing
inside
the
information
that
we
have
about
a
service,
including
the
through
conversations,
then
interest
improvement
and
their
ongoing
engagement
on
on
the
use
of
resources
and
Finance
will
feed
into
our
understanding.
In
the
pressure
that
raises,
but
I
expect
there
will
be
on
the
qualitative
side
of
information
rather
than
quantitative,
predictive,
predictable
indicators.
I
H
The
thing
that's
being
squeezed
at
the
minute
is
access,
so
I
think
the
so.
If
you've
seen
the
debate
in
the
press,
it's
about
a
any
times
growing
up
where
sometimes
going
up
so
interesting
in
terms
of
Roberts
question
about
this
balance
between
quality
and
finance,
one
can
visualize
this
as
a
triangle
between
quality
finance
and
access
and
I.
H
H
They're
not
predictive
of
themselves,
but
they
do
cause
the
questions
to
be
asked
and
I
think
we
need
to
be
alert
to
will
quality
suffer.
You
know
and
I
think
would
be
silly
to
deny
that
that
isn't
a
potential
risk,
but
at
the
minute
I
see
the
evidence
has
been
waiting
times
increase
in.
There
are
times
in
where
people
are
trying
to
hold
on
to
quality
and
doing
the
best
to
hold
on
to
quality
and
balance
money,
and
you
know
I,
don't
know
if
I
was
trying
to
run
a
trust
at
the
minute.
H
I
think
that's
the
balance.
I'd
be
trying
to
fly,
to
be
honest,
but
memories
are
the
public
and
politicians
in
particular
think
the
access
times
are
important.
So
I
think
you
know
that
it's
a
it's
a
very
finely
balanced
discussion
about
it,
but
I
think
we
do
need
to
take
this
into
account
in
the
way
that
we
do
it
and
a
lot
of
the
methodologies
it's
how
we
take
this
forward.
I
think
the
dilemma
for
realsies:
do
we
allow
for
it
being
a
tight
financial
environment?
H
H
We
have
something
called
fundamental
standards,
which
is
the
floor
below
which
they
should
not
fall
and
I
think
it
is
our
responsibility
to
apply
those
and
I
think
you
will
become
uncomfortable
for
us
over
the
next
two
to
three
years
holding
on
to
that
standard,
so
we
can't
ignore
the
money,
but
by
the
same
token,
we
are
here
to
ensure
people
get
access
to
good
quality
care
and
services,
don't
fall
below
standard
which
is
not
acceptable.
I
think
we
just
need
to
keep
saying
that
to
each
other
under
people
out
there.
G
But
David
I
think
you
know,
as
you
know,
I
have
I
wrote
to
you
and
Peter
and
mortar
with
not
with
my
own
feelings
on
this,
because
I
do
think
this
is
a
very.
This
is
a
fundamental
challenge.
For
us.
Part
of
the
problem
is
that
NHS
I
throws
around
our
name
relatively
indiscriminately
in
the
amex
on
table
growth
with,
as
Robert
says,
this
Orwellian
term
pay
growth
opportunity.
It
actually
says
NHS
improvements,
review
of
Pedro's
working
in
close
partnership
with
CQC
etc.
G
Well,
are
we
part
of
NHS
eyes
review
of
pay
growth,
or
are
they
using
CQC
to
make
this
review
of
paid
whether
feel
more
acceptable?
I,
don't
know
I
mean,
of
course
we
don't
see
their
documents
in
advance,
but
it
is
the
say
this
is
the
phrase
that's
used
at
the
beginning
of
the
annex
on
the
table
or
the
so-called
pay
growth
opportunity.
I.
A
A
A
So
I
think
the
important
thing
for
us
is
to
understand
what
each
trust
is
doing
and
you
know
clearly
if
they
are
slashing
and
burning
staff
numbers.
Then
what
is
that?
What
is
the
consequence
of
that
on
quality?
That
will
be
really
important
for
us
to
stand
so
I
think
it's
a
complex
area,
but
exactly
as
David
said
and
as
I
said,
you
know
I'll
brief.
Our
mandate
from
from
the
act
is
absolutely
clear.
I
Yeah
just
to
be
clear
in
the
understanding
Michael
you,
because
you
pointed
out
that
that
section,
so
the
analysis
of
the
pay
growth
opportunity
is
that
of
NHS
improvement.
So
we
haven't
been
involved
in
that,
and
quite
rightly
so.
The
reference
to
working
closely
with
CQC
is
about
how
and
the
work
that
then
and
it's
that
I
takes
forward
with
trust
to
happen
in
the
context
of
our
inspection
findings
and
our
views
of
where
trusts
are
and
quality.
A
H
A
H
So
I
think
first
up,
we've
got
the
performance
report
I'm
going
to
do
this
at
some
pace
and
I'm
not
going
to
present
the
annexes,
although
I
do
realize,
Clegg's
might
have
questions
on
the
Nexus
so
on
the
inspection
program
and
inspectors
in
post,
our
performance
on
inspectors
impulse
is
good
and
consequently
our
performance
in
delivering
on
the
inspection
program
continues.
I'm
not
going
to
present
the
detail.
It's
in
there.
Both
Andrea
and
Steve's
performance
continues
to
move
towards
delivering
the
completed
comprehensive
rating
inspection
program.
H
There
is
some
improvement
over
the
previous
quarter
of
over
eight
percent,
which
is
good.
Volumes
of
activity
are
high,
and
so
that's
a
significant
improvement
and
is
very
positive,
but
the
timeliness
is
still
on
the
target.
So
the
work
we
do
in
to
improve
registration
continues
to
be
important
and
a
priority
in
relation
to
did
all
services
that
we've
wretched,
inadequate
or
requires
improvement.
Improve
we've
set
out
the
performance
during
this
quarter
and
it's
currently
running
at
forty.
H
Seven
percent
in
adult
social
care
have
not
changed
on
reinspection,
but
forty
five
percent
have
of
the
four
trust
inspected.
None
of
them
had
chains
our
overall
rating
and
in
pms
45
of
a
total
61.
We
inspections
and
resulted
improvement.
So
a
mixed
picture
during
that
last
quarter
on
inspection
report
timeliness,
progress
is
being
made.
H
I
think
the
effort
that's
been
put
in
in
all
three
directorates
is
beginning
to
reap
some
improvements
and
some
reward,
but
there's
still
further
work
to
be
done,
and
the
significance
of
this
is
causing
the
gap
between
the
actual
inspection
itself
and
providing
the
report.
So
people
can
make
informed
choices
about
services
and
that's
why
that
particular
indicator
is
important
and
fair
amount
of
work
has
been
done.
I
think
we
had
a
full
discussion
at
the
mere
board
meeting.
H
If
memory
serves
me
correctly
about
services
which
had
been
where
there
were
concerns-
and
there
were
breaches
of
the
regulations
and
those
breaches
have
been
in
place
for
more
than
12
months
and
that
some
work
is
being
done
to
actually
cleanse
the
data,
we
think
some
of
that
is
due
to
out
of
their
data
and
there's
a
piece
of
work.
Remember.
H
H
Ws
said
who's,
the
deputy
chief
inspector
is
leading
our
work
across
the
organization
on
enforcement
is
also
going
to
look
at
this
in
much
the
same
way
that
Sally
did
last
time
and
I'll
be
looking
for
debbie
and
the
enforcement
oversight
board
to
be
bringing
some
work
to
the
executive
team
that
we
can
then
reveal
in
a
subsequent
performance
meetings.
The
issue
here
a
and
a
number
of
colleagues
and
colleagues
not
here
today
have
raised
this
in
the
past
is
what
does
this
say
about
our
impact?
H
If
services
have
been
outstanding
of
not
performing
to
the
level,
they
should
be
for
12
months
or
more.
What
are
we
doing
and
you
can
see
from
the
report?
A
significant
number
have
inspections
planned
or
by
this
next
period,
but
the
Sun
that
Dawn's
and
it's
likely
that
they're
the
ones
which
is
there's
an
anomaly
in
the
data
that
is
chasing
out,
but
we
do
need
to
make
sure
that
all
those
that
we
are
concerned
about
and
taking
action
about,
we
have
a
plan
for
and
we're
checking
that
plan
through
and
this
data
amenity
week.
H
I
can't
be
confident
in
advising
the
board
that
there's
a
plan
in
place
for
each
one
of
those,
so
we
need
to
make
sure
that
there
is,
or
that
there's
numbers
in
here
that
actually
have
some
active
work
going
on.
So
we
need
to
clear
this
up
beyond
any
ambiguity
which
is
in
in
this
report.
So
I
do
want
to
flag
that,
because
of
it's
an
important
issue.
H
The
one
that
resulted
in
the
prosecution
was
an
in-house
prosecution
from
Rebecca's
team
working
with
the
inspection
team.
In
the
lesson
to
that
which,
I
think
is
an
important
development
and
arises
as
a
result
of
the
investment
that
we've
made
in
the
legal
thing
in
terms
of
internal
assurance,
business
planning,
strategic
and
operational
risks-
I'm
not
looking
to
gloss
over
those
Peter,
but
I,
don't
intend
to
go
through
the
debt.
Is
the
bees
aren't
changing
greatly
from
one
month
to
the
next?
H
But
my
colleagues
will
be
happy
to
answer
any
questions
on
those
I'm
sure
and
if
I
do
the
financial
and
as
as
you
said,
that
carrots
here
as
well
there's
a
fuller
report
and
a
full
of
slide
deck
attached
to
this.
But
if
I
present
it
all
at
one
then
currently
at
end
of
june
we
were
1.7
million
underspent.
That's
three
percent
on
the
revenue
budget
and
two
million
and
dispense
against
net
expenditure
once
we've
factored
in
fees
and
depreciation.
H
F
D
Okay,
Joan
I
just
want
to
add
a
little
bit
of
detail
about
the
breaches
of
the
over
four
quarters,
because
we
take
this
very
seriously
and
we
only
have
in
pms,
which
is
GP,
dentistry,
111
at
bars,
etc,
etc.
We've
got
round
about
22,000
or
so
locations.
We've
only
got
192
who've
reached
over
the
year.
The
four
quarters
I
thought
it
might
be
helpful
just
to
tell
you
what
we're
doing
with
them,
because
it
has
been
a
concern.
We
know
every
single
one
of
them
in
detail
and
have
a
plan
for
everyone.
D
Forty-Nine
percent
of
those
have
already
have
an
inspection
date
scheduled,
which
leads
97
30
either
don't
exist
or
are
going
through
deregistration
issue.
So
it's
that's
one
of
the
data
issues
because
it
takes
a
while
to
get
them
off
the
register
and
deregistered
25
of
those
have
a
data
quality
issue
between
the
old
regulations
and
the
new
regulations,
but
we
know
exactly
what
they
are
and
that
doesn't
need
an
inspection.
It's
just
as
we
go
through
to
sort
out
some
detail,
and
that
means
we
have
22
left.
D
A
F
Robert,
antique
questions
really
were
one
on
independent
hospitals,
which
I
was
glad
to
see.
We
seem
to
be
making
progress
and
respected.
Mr,
I
don't
think
I
see
anything
here
about
what
the
outcomes
of
those
inspectors
are.
Is
that
because
we
haven't
reported
on
any
of
the
musical,
is
it
a
name
is
not
here?
So
we
probably
that's.
D
H
H
H
H
F
F
K
K
I
think
the
what
you
should
have
confidence
is
that
we
are
really
concerned
about
making
good
use
of
public
money,
so
we
are
questioning
what
we
do
and
making
good
decisions
about
traveling
about
using
rooms
and
about
sometimes
the
size
of
what
we
do.
So,
I
think,
is
really
having
a
tight
focus
on
how
we're
spending
what
we're
spending,
not
that
we're
not
using
our
resources
properly.
Robert,
no.
F
A
L
I,
don't
think
I
have
anything
further
to
add
really
other
than
to
say
that
I,
don't
think
we're
doing
anything
or
not
doing
anything
that
we
that
we
should
be
doing.
We've
had
a
tremendous
response
from
staff
in
terms
of
the
cost
savings
that
we
need
to
get
out.
People
have
really
kind
of
taken
on
board,
particularly
in
the
inspection
directorates,
who
need
to
travel.
L
We've
got
really
good
budget
holder
engagement,
we've
reduced
our
meeting
room
budget,
partly
because
of
the
move
to
151,
which
helps
we've
got
better
training
on
the
use
of
technology,
so
that
again
reduces
the
travel
and
subsistence.
So
it's
all
good
and
real
savings
that
are
coming
out
and
delighted
seller
can
be
a
bit
quicker
than
I'd
hoped.
Thank
you.
Thanks.
B
Not
a
terribly
heavy
point,
but
in
a
set
of
meeting
papers
which
are
for
a
public
board
when
I
read
the
sentence,
the
main
area
of
concern
remains
at
TNS
associated
with
SBA
usage
and
pms,
a
deep
tire
review
which
is
being
carried
out.
I
thought,
blimey,
I,
don't
know
what
that
means.
I,
just
wonder
whether
a
gentle
reminder
to
people
writing
these
papers,
that
not
everybody
speaks
at
store.
Shorthand
plain
English
should
be
wonderful,
I
think.
J
Think
it
just
one
small
point
of
clarification
against
us
is
in
the
public
papers,
where
we
talked
about
the
business
plan,
commitment
for
ASC
and
for
pms
for
the
complete
by
the
year.
I
think
I
business
plan
commitment
is
to
complete
the
inspections
by
the
end
of
the
year,
if
possible,
get
all
the
reports
out
by
that
time,
but
not
to
necessarily
good
all
the
reports
out,
and
we
do
so
here.
J
C
A
H
H
So
what
we're
doing
today
is
bringing
this
back
to
the
ball,
because
our
commitment
internally
to
you
as
a
board,
but
also
to
experts
by
experience,
that
we
would
do
a
lessons
learned
something
it
to
a
public
board
meeting
and
then
we
were
seen
to
be
transparent
and
learning
from
the
experience
that
had
arisen.
So
I'm
not
going
to
go
through
the
detail
of
this
report.
You
can
see
that
the
report
is
split
into
sections
on
procurement,
where
there's
an
analysis
of
what
the
key
issues
were.
H
Theirs
then,
lessons
on
terms
of
the
procurement
timetable.
The
way
that
the
evaluation
was
undertaken
in
this
issue,
about
whether
it
was
clear
about
payment
levels
was
part
of
that
evaluation,
how
we
managed
a
change
of
contracts
under
the
head
in
a
management
of
incumbent
suppliers
exit.
How
is
that
debt
we've
both
now
and
in
the
future,
how
we
communicated
to
those
people
who
are
experts
by
experience
that
were
the
subject
of
these
changes
and
then,
lastly,
how
did
we
deal
with
deployment
to
new
contracts
and
mobilization?
H
Management
resources
were
located
and
work
out
what
the
resorts
in
implications
will
be
for
the
service,
and
some
of
that
was
driven
by
the
fact
that
this
contract
had
been
extended
and
extended
and
extended
and
got
beyond
the
elasticity
of
what
could
be
extended.
So
there's
an
important
message
in
there
about
not
extending
contracts
and
doing
this
in
a
timely
way
and
I.
Think
mafic
Inc
is
being
relieved
by
Tristan
and
neck
coming
to
join
us
who've
done
much
of
the
bulk
of
this
work.
H
So
some
important
lessons
here
about
how
we
deal
with
the
procurement
time
scales
and
ensure
that
we're
not
trying
to
do
in
nine
months.
What
effectively
is
an
18-month
exercise
and
I
think
that
should
be
one
of
our
key
learning
points
that
we
check
out
of
this
about
the
importance
of
doing
this
in
good
time.
So
I
think
we
do
refer
to
a
register
of
our
contracts
which
allows
us
to
do
this.
H
So
these
things
don't
creep
up
on
us
and
we've
got
an
end
date
where
we're
then
forced
to
try
and
do
we
in
a
constant
period,
the
commercial
evaluation
and
payments
to
experts.
I
think
again,
one
of
the
key
lessons
is
about
how
we
deal
with
a
split
between
variable
and
fixed
costs
and
what
assumptions
are
made
around
volunteers
and
the
impact
of
this
on
variable
rates
and
I.
Think
that
would
allow
us
to
engage
in
a
different
way
where
there's
an
impact
on
pair
changes
and
the
broader
impact
on
volunteers.
H
An
important
issue
again,
a
pretty
important
lesson
about
impact
assessments
and
the
importance
to
do
an
impact
assessments,
upfront
and
being
really
clear
upfront
that
these
are
important
ways
of
actually
assessing
the
impact
of
the
decisions
that
were
are
being
considered
and
allow
a
full
understanding
of
the
requirements
and
potential
service
and
commercial
implications
up
front
impact.
Assessments
were
done
in
this,
but
I'm
not
sure
they
were
as
prominent
at
the
beginning
of
decision-making
process
and
again
a
lesson
I
think
for
the
executive
team
and
perhaps
the
board
about
as
needing
to
do
that.
H
Much
more
prominently
upfront,
and
that
also
turns
to
this
point
about
the
adequacy
of
resources.
For
this
we
have
strengthened
the
procurement
team
and
a
net,
but
I
think
it's
not
just
about
the
procurement
team.
It
is
about
making
sure
that
the
policy
ambition
is
clear
that
there's
appropriate
project
management
for
the
delivery
of
these
up
front
to
some
cheapy
impairments.
H
I
think
colleagues
were
in
the
board
meetings
when
this
contract
was
considered
north
at
2p
was
an
issue
about
the
to
be
applied
to
cheaply,
not
apply.
What
were
the
obligations
and
I
think
we've
now
already
made
changes
around
being
really
clear
in
our
contracts,
about
where
cheaper
sits
in
relation
to
this
and
how
they
should
be
dealt
with.
H
We
do
need
to
look
at
suppliers
exit
our
contracts,
I've
been
hitherto
had
exit
clauses
that
we
can
use.
So
if
you
remember
there
was
this
debate
about
who
said
what
to
whom
and
who
put
what
into
the
public
domain
and
actually
there's
more
that
we
can
do
to
ensure
that
we've
got
some
standard
provision
around
exit
clauses
and
again
that's
a
change
that
has
been
made.
That
will
build
in
I'm,
not
sure
that
communication,
either
by
the
contractors
or
by
CQC,
has
been
everything
it
should
have
been
doing
by
about
to
the
experts.
H
I
think
we
have
been
on
the
back
foot
and
clearly
there's
more
that
we
can
do,
but
also
part
of
the
discussions
that
we've
been
having
with
REM
ployees
about
how
can
they
be
more
engaged
and
more
proactive
in
relation
to
communication
with
experts
by
experience
still
on
the
timetabling
issue?
I
think
what
this
report
is
saying
and
the
conversations
that
we've
had
is
that
term.
H
We
do
need
to
allow
more
time
that
allows
the
supplier
of
the
services
that
were
contracting
forward
to
change
and
for
them
to
be
clear
about
what
the
impact
on
frontline
services
are.
It's
not
just
our
time
scales
that
we've
squeezed
it's
their
time
scales
as
well,
and
it's
an
important
issue
that
we
need
to
take
into
account
some
repeating
the
point
that
I've
already
made
so
I
think
what
we've
tried
to
do
here.
Peter
and
colleagues,
is
actually
have
a
pretty
open
and
transparent
analysis
of
what
the
issues
were
in
here
without
being
defensive.
H
If
we're
going
to
learn
from
this
I've
been
in
defensive
about
this,
isn't
the
way
to
actually
position,
I,
commend
and
Chris
for
the
work
that
they've
done
in
opening
up
these
issues
and
setting
this
out
and
I'm
grateful
to
Paul
I
think
we've
learned
a
lot
and
some
of
those
changes
have
been
made
around
changes
to
our
basic
contract
Annette
a
second
those
forward
and
I.
Think
this
issue
about
mobilisation
and
allowing
sufficient
time
and
giving
more
prominence
to
the
impact
assessments
are
actually
key.
Points
of
learning.
H
I
think
it
is
important
to
emphasize
other
experts
by
experience
are
an
important
part
of
our
operating
model.
Our
inspection
model,
the
ambition
that
we've
got
on
revive
and
the
contracts
are
at
an
end.
We
couldn't
have
continued
with
those
contracts,
as
they
were.
The
ambition
that
would
go
is
to
secure
a
better
value
from
those
contracts
and
I
think
we
should
be
clear
to
separate
what
their
ambition
walls
from
the
way
that
was
executed.
H
I,
don't
think
we
should
have
tall,
be
defensive
for
securing
better
value
from
these
contracts
and
actually
securing
that,
particularly
given
the
financial
position
we're
in,
but
the
improvement,
so
it
flagged
in
this
report.
I
think
will
help
us
to
make
sure
we
do
this
in
a
more
timely
way.
We
can
engage
people
communicate
with
people
better
and
give
people
a
chance
to
go
to
mobilization.
So
I
think
we
have
learned
lessons
from
this.
H
A
You
and
I
was
actually
going
to
thank
Kristen
a
net,
but
you've
already
done
it
so
I
went.
Thank
you
and
I
will
very
grateful
and
it's
really
important.
This
was
not.
The
whole
purpose
of
this
was
not
to
rerun
the
whole
experts
by
experience
issue
as
it
were,
but
was
to
learn
the
lessons
for
future
and
I
think
this
is
a
really
good
paper
that
will
help
us
enormously
a
lot
of
key
points
which
we
have
been
pulled
out
from
this.
Then
we
need
to
keep
in
mind
Paul.
J
A
F
Well,
firstly,
I
just
say
these
recommendations
of
wigan.
It's
encouraging
to
see
the
open
way
in
which
everyone
does
some
don't
go
with
this
just
get
moving
forward.
We
must
undo
value
our
experts
by
experience
that
quitting
our
values,
they're
part
of
our
team
and
their
people.
We
should
careful
so
I
just
wonder
in
terms
of
communication.
This
obviously
is
dealing
with
engagement
with
them
about
changes
and
contracts,
and
so
on
included,
that's
absolutely
right.
Do
we
have
a
process
for
engaging
with
experts
by
experience
generally
once
there
is?
M
Thank
you,
Robert.
We
do
and
there's
sort
of
two
parts
to
it,
there's
a
part
where
we
will
work
closely
with
Choi
support
or
employee
to
make
sure
we
share
the
communication
directly
with
the
experts
that
they
they
work
with
an
employee,
and
we
also
want
to
ensure
we
maintain
direct
dialogue
with
experts
ourselves,
so
we're
able
to
communicate
with
them
directly
because
you
say
that
very
much
part
of
our
team.
M
So
our
aim
is
to
do
both
the
lessons
that
we've
learned
in
that
regard,
our
to
make
sure
that
we
get
consistent
messages
out
early
about
things
as
they
begin
to
to
change.
So
we
one
of
the
conversations
that
we
had
to
employ
directly
was
about
having
a
weekly
update
or
four
experts
by
experience
that
came
out
from
us
that
we
would
also
make
sure
our
own
staff
are
aware
of
as
well.
M
So
as
a
link,
there
was
awesome
lot
of
the
ground
conversations
between
inspectors
and
experts,
so
I
wanted
to
make
sure
that
that
happens.
That's
now
in
place
and
running
well
and
I.
Think
that
that's
a
lesson
for
us
about
how
we
can
make
sure
that,
even
through
a
difficult
contracting
process,
there
are
people
that
work
with
us
and
we
need
to
make
sure
that
we
were
able
to
keep
that
line
of
communication.
Open.
Remember.
B
B
It's
a
slightly
frustrating
discussion
for
me
because
HealthWatch
is
about
engagement,
and
this
debate,
of
course,
is
about
procurement,
so
I,
just
to
put
the
thought
on
the
table
that,
when
we're
talking
about
engagement,
I
really
would
welcome
a
debate
on
engagement,
including
experts,
by
experience
in
the
future,
and
this
ball
table.
Okay,.
A
A
K
Matter
King
moment,
because
there
are
two
people
who
I
think
we'd
love
to
be
here
to
report
on
this,
but
let
me
begin-
and
hopefully
they
will
appear
very
shortly.
So
I
think
this
is
a
really
important
thing
for
the
board
to
see
and
it
sets
out
a
process
that
we
CQC
of
undertaken
for
a
number
of
years,
which
is
to
do
a
race
equality,
audit
of
ourselves
against
the
standard.
K
If
you
like,
and
we
publish
this
publicly
and
we
engage
primarily
with
NHS
organisations
to
look
at
how
we're
doing
and
what
you
see
set
out
here
is
how
CQC
is
reporting
against
the
standard
for
this
year
and
I
think
there's
some
pleasing
berries
of
progress.
I.
Think
just
as
importantly,
and
in
fact
perhaps
more
importantly,
for
me,
what
we
have
is
CQC
being
able
to
better
understand
issues
which
it
historically
has
had
not
not
had
data
available
to
understand
and
work
with,
and
that
really
is
to
the
credit
of
our
people.
K
Directorate
who've
been
absolutely
resolute
in
trying
to
get
to
good
data
to
work
with
and
to
our
race
equality
network
who
I
think
have
been
fantastic
in
saying.
We
want
to
work
as
colleagues
in
CQC
to
improve
the
experience
and
the
opportunities
for
people
who
are
colleagues
who
historically
have
not
always
felt
that
CQC
has
welcomed
or
encouraged
them
to
to
move
on
and
up
in
the
organization.
So
working
on
the
basis
that
everybody's
read,
the
report
is
I.
K
Think
it's
very
pleasing
things
in
here,
but
just
as
pleasing
is
our
level
of
understanding
of
what
we
know
and
what
we
know
we
have
to
work
with,
and
if
I
would
draw
attention
to
one
key
success
that
came
out
of
last
year's
and
report.
It
was
to
really
work
to
get
a
strong
mentoring
program
in
place.
If
Paul
Corrigan
were
here,
he
would
talk
about
the
way
that
he
helped
kick
that
off.
We
engage
with
an
external
party
and
we've
trained
people
internally,
their
mentors.
K
Some
people
around
this
table
are
mentors
and-
and
it
is
having
such
a
positive
impact
and
it
was
oversubscribed
we're
running
it
again.
It's
going
to
be
part
of
how
we
work
and
we
do
ring-fence
places
for
people
who
are
members
of
ren
and
or
who
would
be
members
of
bme
staff
so
that
they
can
seize
that
opportunity
and
we
give
them
every
encouragement
to
do
so
and
as
I
say
so
far.
The
report
back
on
that
has
been
fabulous.
K
A
A
B
K
That
so
CQC,
like
many
organizations,
has
had
dignity
at
work,
advisors
for
a
number
of
years
and
I
think
sometimes
initiatives
start
with
the
best
of
intentions
and
they
can
slightly
fade
into
the
wallpaper.
So
what
we
have
done
is
to
re-energize
that
and
we're
encouraging
more
people
to
become
dignity
of
work
advisors
and
that's
been
fantastic
in
reaching
out
to
people
and
saying,
would
you
like
to
become
ensuring
that
we
have
more
that
they
are
more
representative
and
that
we
are
training
and
supporting
them?
K
Because,
as
I
say,
this
is
an
initiative
that
started
a
few
years
ago
and
people
very
passionate
about
it,
and
there
is
now
very
good
leadership
for
it,
and
just
you
know
it
slightly
as
I
say,
fades
away,
but
really
re-energized
in
it.
People
are
getting
support,
there
are
more
of
them
and
and
I
think
it's
a
great
part
of
our
armory
in
terms
of
improving
Jane
right
across
the
board
in
terms
of
people
feeling
that
they
can
speak
up.
H
Did
I
think
a
couple
of
things
just
throughout
the
one
is
the
role
volunteers.
So
these
are
all
people
who
want
to
use
the
discretionary
effort
to
do
something
about
this
and
if
you're
in
any
of
our
offices,
you
see
somebody
with
a
green
lanyard
as
opposed
to
a
purple.
One
and
I
think
that
Flags
leur
the
dignity
at
work
champion
so
they're
the
kind
of
girl
to
people
in
relation
to
that
so
I'm
important.
This
might
be
mother
came.
H
K
May
I
makers
suggestions
are
unless
people
have
got
questions
and
don't
dig
too
far,
but
but
I
think
Farrah
who's.
A
member
of
the
race
equality
network
would
be
good
to
give
ferry
the
opportunity
just
to
give
two
or
three
highlights
about
how
she
feels
the
process
is
gone
because
she's
put
a
huge
amount
of
work
into
it
and
I
think
it'd
be
good
for
the
board
to
hear
and
recognize
that
so.
N
And
we've
recognized
that
there
are
definite
improvements
which
has
been
great
and
they
are
learning
points
that
we
have
to
work
through
for
next
year
and
we've
put
an
action
plan
together
and
some
of
the
highlights
of
those
include
and
developing
a
inclusion
plan,
a
diversity,
inclusion
plan
and
improving
our
monitoring
and
mentoring
and
our
data
monitoring,
for
example.
And
but
we
really
want
to
ensure
that
the
confidence
of
staff,
the
representation
and
staff
and
the
improvement
of
race
equality
across
the
organization
and
is
something
that
we're
focusing
on
I.
N
Think
that
that's
worked
really
well.
We
presented
this
to
our
res
external
advisory
group
on
monday
and
they're
very
pleased
to
see
it,
and
they
noted
that
we
were
leading
by
example,
which
was
really
great
and
and
they've
also
offered
to
help
us
with
effective
interventions
and
in
our
own
res
plan
for
next
year.
So
it's
positive
in
many
ways,
and
but
there
are
definite
improvements
in
learning
that
we
need
to
work
on
and
I
hope
that
we
can
be
back
next
year
to
tell
you
about
those
improvements.
You.
A
Will
be
promise
you
that
you
missed
most
of
the
discussion,
but
it
was
a
very
fulsome
introduction
from
from
Eileen
and
I
just
want
to
reiterate,
I
think
it's
a
really
good
rapport
and
really
good
work.
That's
been
done
and
I
think
as
a
board
were
very
supportive
and
grateful
to
you
for
what
you've
been
doing.
C
Andrea
there
was
just
dumb
33
points
that
I
just
wanted
to
make,
but
before
I
did
to
start
off
by
saying
thanks
to
everybody
for
the
work,
that's
gone
into
this,
and
thanks,
particularly
and
too
far
on
Rue
de
for
the
leadership
that
you've
shown
to
the
race
equality
network,
which
I
think
has
been
really
very
important.
For
us.
C
How
does
that
really
look
when
we
and
consider
the
publicly
facing
roles
that
people
have
and
because
I
think
that
we
we
can't
kind
of
assume
that
that's
a
good
indicator
when
we
do
know
the
where
people
are
in
the
organization?
So
actually
what
is
happening
and
to
be
any
staff
who
inspectors
going
into
places
and
potentially
facing
that
so
I
think
we've
got
a
bit
more
work
to
do
on
that,
and
that
was
that
was
accepted.
And
the
third
thing
was
just
to
widen.
C
C
That
follows
up
from
the
work
that
we
did
as
a
consequence
of
the
staff
survey
and
did
some
further
work
around
and
the
experiences
of
people
and
who
are
disabled
in
the
organization
and
really
looking
to
you
in
some
senses,
learn
from
a
good
work
that
we've
done
here
and
but
also
apply
that
across
to
thinking
about
the
experience
of
disabled
staff.
What
we
can
do
better
to
support
them
and
what
we
can
do
better
support
them
in
terms
of
their
progression
and
the
organization
and
with
Paul's
departure.
C
I've
taken
on
the
sponsorship
role
for
the
disability,
Network
and
looking
forward
to
working
both
with
race
equality
network,
but
also
our
LGBT
and
network,
who
have
offered
support
to
make
sure
that,
across
the
board,
we're
kind
of
considering
the
diversity
and
under
diverse
needs
of
all
of
our
staff.
And
I.
A
Think
it
was
at
the
last
board
meeting
I
was
making
the
comment
about
trying
to
have
as
greater
diversity
on
this
board
as
possible
as
new
opportunities
to
bring
new
directors
on
to
the
border
eyes,
but
also
recognizing
there
were
certain
skills
that
were
needed.
There
were
a
lot
of
different
angles
to
diversity,
so
just
had
to
see
how
far
and
how
fast
we
can
get
brad,
you
think
all
forms
of
diversity
add
great
value,
so
we
do
need
to
focus
on
that
anything.
Anybody
wants
to
add
or
ask
robert.
F
Well,
firstly,
can
I
join
in
the
general
congratulation
on
what
looks
very
good
police
work
seems
to
me
that
the
one
of
the
huge
values
of
the
figures
is
not
the
figures
in
themselves,
and
you
could.
We
can
argue
about
five
cent
or
percentage
the
fact
of
getting
people
talking
about
these
things
unusually
actually
in
these,
these
systems
does
actually
mean
that
eventually,
things
will
happen,
which
is
a
the
actual.
Often
talking
leads
two
nothing
but
I.
Think
here
of
talking
is
really
valuable,
but
it's
in
that
context
is
just
probably
by
a
comment.
F
I'll
you
made
about
dignity
at
work,
champions
as
being
part
of
freedom
speak
up.
We
know
at
least
my
work
seems
to
suggest
that
BM
e
employees
generally
and
I'll
talk
about
this
organization
suffer
worse
in
terms
of
the
ability
to
be
able
to
speak
up,
they
get
into
more
trouble
for
their
doing
so
and
I
wonder
whether
how
we're
in
importing
leads
and
freedom
to
speak
up
agenda
into
what
the
dignity
of
work
champions
do
with
a
particular
reference
here.
Obviously,
to
bear
me,
staff
I
mean.
K
Advisors
who
come
from
the
bme
community
and
I,
think
Farrah
will
say,
but
we've
had
people
volunteer
and
so
that
that
whole
network
is
strengthening,
and
so
it's
just
more
representative
of
who
we
are
and
I
think
that
that's
the
first
step
and
actually
talking
about
it,
as
you
say,
I,
think
it's
absolutely
critical.
So
we
are
talking
about
it.
K
We
are
strengthening
that
Network,
giving
people
support
and
we'll
be
continuing
to
communicate
outwards
into
the
organization
about
the
role
and
importance
and
what
the
dignity
of
work
advisors,
role
is
and
in
parallel
will
shortly
be
announcing,
and
David
will
be
coming
back
to
talk
about
the
fact
that
CQC
will
have
its
own
speak
up
guardian.
So
it's
knitting
all
of
that
together,
so
that
we
are
promoting
the
fact
that
we
do
want
people
to
I.
K
N
Those
issues
in
terms
of
freedom
to
speak
up
as
something
that
we
are
aware
of
and
that
we
have
discussed
and
that
we
are
looking
at
at
implementing
in
our
action
plan.
We've
had
conversations
and
I
take
your
point
that
talking
by
itself,
isn't
enough,
but
we
think
that
we
have
engaged
in
a
way
that
we
have
tangible
outcomes
over
the
year
in
terms
of
turning
that
into
some
kind
of
reality.
N
It's
very
important
that
our
staff
feel
confident
and
be
any
stuff
for
all
staff,
and
we
hope
that
by
understanding
what
some
of
those
barriers
are,
although
that
we
can
extend
that
learning
as
well
as
andrea,
saying
it
across
all
groups.
So
it's
definitely
something
that
we
are
focusing
on
the
very
aware
of
that
and
issues
of
openness
and
transparency
in
terms
of
and
how
people
are
able
to
move
forward.
A
O
Yes,
I
think
we
discussed
this
in
private
session
at
the
last
board
meeting
and
we
took
away
in
action
to
do
some
further
work
on
the
terms
of
reference
of
the
Finance
Committee,
which
have
now
been
tidied
up
and
we've
put
together
terms
of
reference
of
the
people
and
values
committee
which
sweep
up
those
matters
which
seemed
to
the
establishment
of
the
remuneration
committee.
We
didn't
want
to
lose,
but
we've
recognized
that
we
might
want
to
have
the
people
in
values
committee
just
meeting
flexibly
and
sort
of
a
line.
It
really
with
the
the
remco.
O
A
I
think
that
that
is
exactly
that
now
you
would
look
to
this
comprehensively
and
we've
got
all
the
committee's
with
no
overlaps
or
gaps,
which
is
what
we
need.
So
I
certainly
think
when
a
good
place
is
everybody
happy
to
improve
the
terms
of
reference,
great
Thank,
You
Rebecca
for
dinos,
actually
quite
a
hover,
20
insert
TV,
etc.
Thank
you
for
that
and
anybody
else
that
was
involved
with
you
any
other
business.
P
P
We
can
have
that
by
email,
later
public
engagement,
the
last
time
what
I
was
going
to
ask
was
that
you're,
all
here
and
members
of
public
I
mean
David
and
I
can
get
here,
because
we
were
in
London
but
getting
members
of
the
public
for
parity
of
access
to
all
to
be
able
to
get
to
London
nine
o'clock
start
for
one
member
who
comes
here
occasionally
is
153
pounds
return
train
journey.
There
is
no
NHS
improvement,
although
wherever
else
about
they
do
actually
did
their
board
meeting
at
one
o'clock.
P
So
we're
not
saying
one
o'clock,
but
is
there
any
chance
you
could
do?
It
may
be
a
little
bit
later
that
it
would
give
a
parity
of
access
to
anybody
wanting
to
come
from
a
couple
of
hours
away,
that
they
could
buy
a
cheap
with
rail
return
to
get
to
the
meeting,
so
they
actually
have
access,
but
they
don't
really
have
us
and
that,
if,
like
you
know
a
lot
of
whistleblowers,
as
you
well
know
we're
out
of
work,
they
never
get
work
again.
P
So
they
don't
have
any
money,
and
if
there
was
any
way
for
expenses
for
anybody
to
repeat
some
expenses,
if
they
were
far
outside
London
that
they'd
actually
have
it
would
give
them
access
to
the
meeting
where
the
meeting
to
be
a
bit
later.
That
would
be
really
helpful
and
parative
access
should
really
be
for
a
64
million.
People
should
be
a
real
issue
for
you
so
and
dignity
at
work.
P
It
would
be
really
nice
for
dignity
for
patients,
and
we
should
be
lovely
and
and
just
on
your
point,
roberts
patients
do
suffer
repercussions
as
I
well
know,
and
and
many
whistleblowers
know.
So
if
any
care
or
a
family
member
or
friend
makes
any
kind
of
complaint
or
concern
raised
any
kind
of
concern
guaranteed
without
doubt,
every
single
time,
patients
are
for
repercussions.
P
So
I've
spoken
to
carers
as
a
member
of
the
advisory
panel,
I
sobota
carers,
all
over
the
country
in
different
sections
and
every
single
time
is
come
to
the
point
where
actually
we
had
to
tell
them
not
to
complain
and
that
if
they
wanted
to
complain
to
find
a
safe
route
around
us
either
do
it
through
an
advocacy.
Do
it
anonymously
make
sure
the
data
was
anonymized,
make
sure
that
the
patient
themselves
wasn't
wasn't
set
out
that
it
was
a
general
thing,
because
if
you
say
it,
patients
are
moved
far
away.
P
Carers
and
family
and
friends
are
blogging.
All
these
things
happen.
That
happens
a
lot
and
they're
moved
quite
far
away
so
that
the
care
is
blocked
from
going
to
see
them
isn't
allowed
in
to
see
them
stories
are
made
up.
It's
a
really
really
serious
issue
so
for
anybody
out
there
if
you're,
going
to
make
a
complaint
for
the
gods
sake
for
your
care
of
the
patients
are
looking
after,
do
not
make
it
complaint
without
using
an
advocate
and
use
it
an
anonymizer,
otherwise
grossly
in
danger
and
part
of
the
res
thing.
P
Just
fourth,
maybe
just
an
idea.
The
unconscious
bias
hasn't
been
discussed
so
for
the
bme
south
or
is
really
an
unconscious
bias
that
isn't
really
being
openly
discussed.
So
I
know
as
myself
being
an
Irish
person
making
a
complaint.
It
certainly
seemed
to
be
a
lot
worse
where
I
white,
an
English
as
opposed
to
Irish-
and
you
know
all
those
type
of
unconscious
buyers
had
lived
in
it.
Thank
you
very
much
have
a
lovely
summer
and
we'll
see
you
again
in
to
tell
you.
A
D
A
D
A
P
P
D
A
H
It's
kind
of
absurd.
It's
arriving
kind
of
pick
up
on
the
unconscious
bias
point,
so
we've
had
a
pretty
comprehensive
training
program
and
unconscious
bias,
which
think
something
like
sixty
percent
of
our
inspection
staff
have
been
through.
So
whilst
it
wasn't
mentioned
a
key
issue
about
the
rest
quality
standard,
we
apply
that
standard
when
we
inspect.
So
what
that
was
about
is
that
we
need
to
apply
it
for
ourselves,
but
unconscious
bias.
P
H
Q
Garza
I'm
the
coordinator
of
the
friending
charity
that
visits
usually
older
people
in
care
homes
and
in
their
own
homes.
So
we
come
into
quite
a
lot
of.
We
have
quite
a
long
experience
of
care
quality
and
we
have
come
across
ourselves
quite
a
lot
of
abuse
and
neglect,
which
is
which
has
led
to
why
I'm
I'm
here
I
have
had
since
the
last
meeting.
Q
I
have
a
particular
interest
in
this,
because
I
question,
in
my
mind,
is
whether
this
is
something
which
prevents
the
CQC
from
taking
more
effective
action
about
the
issue
which
concerns
me
and
this
issue
is
that
whenever
a
scandal
breaks
in
the
press
or
anywhere
else,
it
isn't
normally
or
really
hardly
ever,
because
the
CQC
has
discovered
it
or
because
somebody
has
come
to
the
CQC
and
told
them
about
it.
Oh,
and
also,
if
you
look
back
as
I
did
do
when
I
collected
42
examples
of
this.
Q
Q
Q
If
there
had
been
a
camera,
they
would
have
been
discovered
earlier
and
there
are
some
people
who
would
be
alive
now
if
that
had
happened,
but
I
don't
think
that,
in
fact
cameras
is
the
area
where
CQC
has
the
most
influence.
You
can
only
say
that
you
perhaps
you
could
say
that
you
liked
cameras
a
bit
better
than
you
have,
but
you
can't
spend
a
lot
of
time
putting
in
cameras,
but
I
would
like
to
see
this.
He
could
see
taking
this
a
little
more
seriously
and
regarding
this
as
more
urgent
than
they
do.
Q
I've
been
told-
and
I
will
agree
that
it
is
there
at
some
very
high
level
in
the
strategy,
but
things
take
a
long
time
to
come
down
from
the
stratosphere
and
I.
I
I'd
like
to
see
you.
While
you
are
debating
this
I,
these
things
are
happening.
People's
thought
people
are
being
called
names,
people
are
being
abused,
people
are
being
neglected,
their
dolls
are
being
tortured
in,
as
in
ashbourne
court,
as
in
their
hair,
is
being
pulled
in
the
middle
of
the
night.
Q
Q
That's
all
I
really
want
to
say
and
I've
been
told
that
the
board
has
decided
that
the
pace
that
you're
going
at
is
the
right
pace
that
you
don't
really
want
to
encourage
cameras.
I,
just
don't
feel
you
ought
to
be
leaving
it
in
this
kind
of
at
this
stage
and
without
doing
something
more
quickly.
All
these
people
are
dropping
below
those
fundamental
centers
that
you
say,
David
that
you
are
maintaining
every
single
one
of
those
care
homes
that
I
list,
even
by
my
report
and
I,
was
just
hoping
them
do
something
about
it.
A
David,
thank
you.
As
you
rightly
said,
you
and
you
and
I've,
had
various
conversations
since
the
last
board
on
various
matters.
I
just
like
to
pick
up
a
couple
of
points,
then
I
might
pass
counter
if
to
say
that
first
I'm
really
disappointed.
You
don't
think
we're
taking
this
seriously
enough,
because
I
absolutely
assure
you
every
one
of
us
around
this
table
and
I'll
staff.
Take
this
really
seriously.
A
This
is
why
we're
here
and
it's
the
question
of
pace
is
not
because
we
think
we
can
do
this
in
a
leisurely
fashion
and
I've
never
tried
to
suggest
that
what
I've
said
is
that
putting
a
new
technology
which
is
part
of
the
strategy
can't
be
done
overnight.
That's
that's
a
separate
issue
from
whether
we
will
do
everything
we
can
to
get
as
far
as
we
can
in
stamping
out
all
forms
of
abuse,
whether
they're
in
homes
or
anywhere
else.
A
That's
what
we're
here
to
do
so
I
I,
don't
want
you
to
go
away
with
the
with
the
impression
that
either
I
or
my
colleagues
don't
take
this
really
seriously,
because
we
do,
then
the
question
is
well.
What
more
can
we
do?
That's
what
the
discussion
you
and
I've
been
having
around
cameras
and
other
things
is
about,
and
so
we
may
have
differences
of
view
about
aspects
of
what
we
could
do,
but
it's
not
because
we
don't
take
this
really
seriously
because
I
absolutely
assure
you
we
do
Andrea.
Do
you
want
to
say
something
and.
C
Yes,
thank
you
and
the
first
to
reiterate
term
Peter
in
in
response
to
David's
comments
that
we
do
take
it
seriously.
I
start
to
take
it
seriously.
I
take
it
seriously
and
we
do
respond
to
the
issues
that
are
raised
with
us
and
you
can
see
in
the
performance
report
the
increase
in
the
level
of
enforcement
that
we're
taking
as
a
consequence
of
that.
C
We
do
see
a
huge
percentage
of
good
stuff
across
the
country
trying
to
do
a
good
job,
but
sometimes
they
are
not
supported
by
the
provider
by
the
system
within
which
they
are
working
and
and
I.
Think,
what's
important
for
us
is
the
regulator
to
do
is
to
be
absolutely
clear,
as
we
are
in
the
fundamental
standards
and
also
in
our
characteristics
and
the
key
lines
of
inquiry
that
we
pursue
on
inspections,
absolutely
clear
about
what
we
are
expecting
providers
to
be
doing
and
how
we're
expecting
them
to
be
to
be
doing.
C
That
reporting
on
that
as
we
find
it
and
I
think
that
our
new
way
of
inspecting,
which
is
not
just
taking
that
snapshot
on
the
day,
but
also
thinking
about
all
of
the
intelligence
and
the
information
that
we
have
about
service,
to
reach
our
judgment
and
then
rating
that
and
being
very
transparent
about
that
and
holding
providers
to
account
where
we
do
find
that
they
are
failing.
As
we
have
discussed
ever
since
I
came
in
to
post
I,
think
I
think
it
were
at
the
very
first
meeting
that
I
ever
came
to
David.
C
Even
before
I
came
into
the
job
you
we
were
never
ever
going
to
stop
absolutely
everything
happening
in
25,000,
different
locations,
twenty
or
thousand
primary
medical
services
locations
and
all
of
the
hospitals
across
the
NHS
and
independent
hospitals.
I
wish
it
were
so,
but
we
need
to
make
sure
that
we
are
giving
people
the
confidence
to
share
information
with
us.
That's
we're
giving
people
a
confidence
that,
if
they
raise
those
concerns
with
providers
and
that
they
can
do
so
without
fear
of
reprisals.
C
That
is
the
reason
why,
as
as
David
reported
in
the
chief
executives
report
were
doing
the
work
on
making
sure
that
providers
are
clear
about
our
expectations
of
how
they
respond
to
people
who
are
raising
concerns
because
the
signs
there
there
is
a
real
concern
that
actually
there
will
be
repercussions,
and
that
should
not
be
the
case.
So
I
think
there
were
a
variety
of
things
that
we're
doing
that
we're
trying
to
do,
and
we
can
always
improve.
I
know
that
I
can
rely
upon
you
too
and
pushes
along
that
path.
C
David,
and
one
of
the
particular
issues
that
we
are
discussing
within
the
team
at
the
moment,
is
how
we
look
at
the
question
of
whether
a
service
is
caring.
What
more
we
can
do
to
get
under
the
skin
of
that
in
a
in
a
better
way,
so
that
we
can
actually
reflect
on
that.
Better,
both
in
our
reports,
but
also
in
the
expectations
that
we
set,
the
providers.