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From YouTube: CQC board meeting - January 2021
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A
Ali
hassan
and
mark
chambers,
you're
all
extremely
welcome
as
members
of
the
board
sally
cheshire
is
also
a
new
member
of
our
board,
as
is
often
the
case
when
people
join
boards
with
fixed
engagements.
Sally
is
actually
chairing
another
meeting
somewhere
else
today,
so
it
can't
be
with
us
for
this
particular
meeting,
although
she
was
with
us
earlier
so
really
really
good
to
see
you
and
actually
did.
I
mention
you
ali.
If
I
didn't,
I
apologize.
Ali
hassan
is
also
with
us.
A
So
that's
that's
great,
so
I
hope
I've
not
missed
anybody
out
and
apart
from
sally,
we
have
no
apologies
for
absence.
Does
anybody
need
to
declare
any
interest?
That's
not
otherwise
on
the
list
of
interests,
excellent
and
then
that
takes
us
to
the
minutes
of
the
december
meeting
for
those
that
were
on
the
board
at
that
time.
Are
there
through
an
accurate
record
of
what
we
discussed?
A
Yes,
excellent?
Thank
you,
so
they
are
approved
for
the
first
time
that
I
can
remember.
In
the
five
years
I've
been
chained
the
ball.
There
is
absolutely
nothing
on
our
action
log,
but
that
does
not
mean
there's
not
lots
of
action.
It
just
means:
there's
nothing,
that's
come
forward
from
the
last
meeting.
Was
there
anything
arising,
that's
not
otherwise,
on
the
agenda
or
on
the
action
log
that
anybody
wanted
to
raise
peter.
B
Could
I
just
just
draw
people's
attention
to
page
five
parent
nineteen
reference
to
laying
of
our
accounts
just
again,
just
just
as
a
point
of
point
of
could
order
really,
we've
still
not
been
able
to
lay
our
accounts
from
20
19
20,
as
the
national
audit
office
have
not
been
able
to
obtain
the
assurances
they
need
from
the
local
government
pension
schemes
this.
This
relates
purely
to
issues
of
workload
on
local
government
auditors,
rather
than
anything
to
do
with
with
materiality.
B
As
far
as
we
are
aware.
So
this
is
a
copied
issue
rather
than
anything
else.
So
in
every
other
respect,
our
accounts
are
ready
to
lay,
but
I
just
wanted
to
sort
of
again
again
just
make
the
point
which
I
know
we've
been
making
in
in
previous
board
forward
reports
that
that
our
accounts
are
not
yet
laid,
but
they
are
ready
to
be
laid,
and
it
has
been
raised,
of
course,
with
the
nao
and
the
department
of
health
and
social
care
thanks
peter.
A
Thank
you,
it's
really
frustrating,
but
it
has
absolutely
no
impact
on
on
on
us.
I
mean
our
financial
position
is
not
impacted
by
this
delay.
It's
just
a
preceding
thing.
B
Peter
just
while
we've
been
on
the
call
this
morning,
I
think
we've
had
the
green
light
through
to
to
get
them
to
the
to
signing
off
in
certification.
So
hopefully
we
can
finally
get
that
progressed
and
update
the
board
next
month.
Oh
perfect,
good.
A
So
I
said
there
was
lots
of
things
going
on
even
there's
nothing
in
the
action
log
I
didn't
realize
chris,
you
were
actually
doing
that
as
well.
Perfect
good.
So
we
look
forward
to
a
different
story
next
next
month.
Perfect.
Thank
you
right
so
ian
should
we
move
then
on
to
the
executive
team
report.
Please
thanks.
B
Peter
so
this
month,
we've
decided
to
split
the
executive
team
report
into
two
parts.
Just
for
for
clarity
really,
I
think
I
want
to
spend
a
few
minutes
just
talking
with
the
board
around
our
priorities
at
the
moment
and
then
the
second.
The
second
part
of
the
report
will
be
other
things
that
are
are
not
related
to
priorities,
and
the
reason
I
wanted
to
do
this
is
because
in
this
way
is
because
I
think
we
want
to.
B
We
want
to
be
really
clear
about
what
we're
doing,
and
indeed
not
doing
as
as
during
the
next,
the
next
three
months.
So
really
what
we're!
What
we
want
to
do
is
to
say
quite
publicly
and
quite
clearly
that
are
around
what
our
priorities
are
for
for
the
first
quarter
of
calendar
year
2021.
B
I
want
to
begin
really
by,
though,
by
acknowledging
the
the
absolutely
superb
work,
that's
being
done
right
across
health
and
social
care,
whether
that's
people
that
have
been
coming
to
work
every
single
day
and
doing
a
fantastic
job,
and
not
really
being
seen
whether
it's
the
whether
it's
the
teams
that
are
working
on
vaccination
programs.
The
teams
that
are
running
intensive
care
units
and
so
forth,
and
the
teams
that
people
don't
often
talk
about
that
make
sure
that
patients
get
where
they
need
to
get
to
in
a
hospital
there's.
B
Just
rain
is
just
a
fantastic
range
of
people
and
I
think
we,
as
the
regulator,
want
to
acknowledge
that
and
and-
and
I
think,
whilst
there
are
undoubtedly
I
think
grounds
for
optimism
with
an
accelerating
vaccination
program,
I
think
the
people
working
in
health
and
social
care
at
the
moment
have
been
under
sustained
pressure
for
for
well.
Over
a
year
there
was
a
busy
winter
that
rolled
straight
into
into
into
busy
covid
period,
so
people
will
have
been
you
know.
B
They've
been
been
working
incredibly
hard
for
14
15
months
now
and
that
that
takes
its
toll.
I
think
we
can
all
recognize
that
if
we
have
a
busy
day
or
a
busy
week,
then
it's
we
can
manage
that.
But
doing
that
for
for
months
on
end
has
been
has
been
hard
and
it's
been
hard
for
our
own
teams
as
well,
but
I
think
we
need
to
start.
I
think
our
discussion
this
morning
from
that.
B
From
that
perspective
and
all
the
way
through
the
pandemic,
we've
attempted
to
be
as
as
flexible
as
we
as
we
can
be
recognizing
the
the
fantastic
work
that's
going
on
in
the
health
and
social
care
system
and
balancing
that
with
our
duty
to
provide
the
public
with
assurance
around
the
safety
of
the
health
and
social
care
that
they've
got,
and
I
think
that
that
balance
of
respect
for
people
working
in
the
system
and
our
duties
around
the
public
has
been
something
which
has
dominated
our
thinking
right
from
the
very
start
of
the
pandemic.
B
So
we
paused
our
inspections,
as
you
recall,
right
at
the
start
of
the
pandemic,
but
we've
never
stopped
regulating
and
that
that
has
been
a
an
important
message.
All
the
way
through
we've
just
looked
for
different
ways
of
doing
that,
and
this
meant
that
we've
looked
for
different
ways.
Some
of
that's
about
increasing
the
amount
of
of
off-site
work
that
we
do
some
of
that's
about
the
work
that
we
do
do
on-site,
but
doing
that
in
different
ways,
and
some
of
that's
been
about
blending
those
two.
Those
two
approaches.
B
We,
of
course,
have
kept
our
our
approach
under
constant
review,
as
events
have
unfolded,
and
we
went
from
from
trying
to
try
to
use
our
existing
methodology
through
to
the
emergency
support
framework
through
to
our
transitional
methodology,
which
we
introduced
in
the
autumn
of
last
year,
and
and
as
and
as
as
part
of
that
constant
review
process.
We've
we've
been
reflecting
on
on
where
we
were.
The
the
health
and
social
care
sectors
are
right
at
the
moment
and,
of
course,
things
have
got.
B
I
got
incredibly
busy
over
the
last
few
months,
so
we've
decided
that
for
the
first
quarter
of
2021,
we'll
group
our
work
into
three
broad
categories
and
those
categories
are
aimed
at
either
adding
capacity
or
responding
to
risk
in
their
in
their
in
the
in
the
system,
so
either
adding
capacity
or
responding
to
risk
and,
as
there's
an
important
sort
of
like
headline
focus
for
the
work
that
we've
been
doing.
B
Our
work,
then,
is
in
three
categories,
which
is
proactive,
reactive
and
supportive.
So,
in
the
pro
proactive
is
all
about
planned
pieces
of
work
in
areas
such
as
infection,
prevention
and
control
or
areas
where
we
know
that
we
have
specific
risks,
specific
and
long-standing
risks.
The
reactive
work
is
is
about
exactly
that.
B
It's
about
reacting
to
information
that
we
have
have
from
the
public
or
from
people
that
work
in
services
and
and
the
aim
there
is
to
is
to
look
for
ways
to
bring
other
partners
in
to
support
services
which
are
struggling
to
highlight
those
areas
that
need
particular
support.
And
there
are
plenty
of
examples
of
us
doing
that,
and
the
third
category
of
work
is
is
what
I
describe
as
supportive
work
work
where
we're
working
with
other
agencies
and
other
organizations.
B
People
like
the
department
of
health
and
social
care,
nhs
in
england,
improvement
and
others,
so
that
we
can.
We
can
help
with
things
like
accelerating
the
vaccination
program
or
on
policy
development
in
areas
where
we
perhaps
have
a
unique
perspective
that
we
can
bring
to
the
table,
and
it
very
much
is
about
making
changes
as
we
go
and
responding
to
the
nature
of
of
the
particular
issues
of
the
day,
and
particularly
recognizing
that
the
health
and
social
care
system
at
a
macro
level
is
busy.
B
But
it
is
even
busier
in
certain
geographies
and
we've
seen
over
the
last
couple
of
weeks
particular
challenges
in
london.
But
of
course
you
know,
we'd
expect
that
over
the
next
few
years,
the
next
few
few
weeks,
rather
that
that
that
those
those
challenges
will
will
move
geographically
around
the
country,
as
as
things
begin
to
quiet
down
in
london.
B
So
I'm
going
to
ask
kate,
ted,
rosie
and
kirsty
in
that
order,
just
just
to
give
a
flavor
to
board
members
of
the
of
the
work
that
they're
doing
in
their
areas
to
to
support
this
agenda
of
pro
of
proactive,
reactive
and
supportive,
and
to
give
some
some
specific
examples,
and
I
think
that,
just
before
I,
before
I
hand
over
to
kate,
I
just
sort
of
make
the
point
that
this
sort
of
which
I
think
is
unspoken
in
some
respects.
But
I
I'm
gonna
say
anyway.
Is
that
this?
B
The
idea
that
we're
prioritizing
some
work
by
definition
means
we're
not
doing
other
work
and,
and
so
there
is.
There
is
inevitably
going
to
be
a
degree
of
risk
in
the
system
that
that
we
perhaps
aren't
able
to
see
we're
using
all
of
our
needs
to
look
for
that
risk.
But
I
think
we
have
to
recognize
that.
That's
the
place
that
we're
in
it
also
means
we're
explicitly
not
doing
certain
things
so
we're
not
doing
reviewing
of
ratings.
It
was
a
topic
that
we've
been
we've
been
thinking
about.
B
B
We're
also
going
to
do
less
of
our
transitional
methodology.
Less
of
our
contacting
people
proactively
we're
going
to
going
to
be
pausing
our
provider,
collaboration
review
program
and
pausing
our
provider
information
returns
in
adult
social
care.
B
We
will,
of
course,
continue
to
promote
I'll,
give
feedback
on
care
service,
to
gather
information
and,
of
course,
we'll
continue
to
to
publish
important
information
on
a
monthly
basis
and
you'll
see.
Our
inside
report
is
later
on
on
the
agenda
today,
and
we
will
continue
to
use
that
as
a
vehicle
to
talk
to
the
public
and
keep
the
public
up
to
date
in
terms
of
what
we're
seeing
in
terms
of
in
terms
of
data.
C
Thank
you
ian,
so
I'm
going
to
talk
about
what
we're
doing
in
adult
social
care
in
the
proactive
and
reactive
groups
of
work
that
ian
has
described
so,
firstly
in
proactive,
we
are
continuing
our
focus
on
infection
prevention,
control,
inspections
in
care
homes.
We've
done
a
vast
number
of.
D
C
Since
the
start
of
the
pandemic,
we
committed,
following
conversations
with
government,
to
increase
our
number
of
ipc
care
home
inspections
during
december
and
january
to
1
200.
we've
done
900
of
those
and
286
are
booked
in
for
the
end
of
january.
That
number
is
likely
to
increase
slightly
as
well
as
we
respond
to
risks
so
we're
on
track
on
delivering
our
increased
offer
around
ipc
inspectors
at
care
homes
and
we've
committed
going
forward
through
february
march
april
to
do
600
of
these.
C
In
each
of
those
months,
we
are
being
assisted
in
our
efforts
in
adult
social
care
by
43
inspectors
from
primary
medical
services
who
are
coming
across
to
help
with
these
efforts
as
well.
They
were
trained
last
week
and
they
have
started
inspecting
this
week,
so
big,
thank
you
to
rosie
and
all
those
colleagues
for
helping
us
with
that
work.
C
So
we
are
supporting
the
increase
in
capacity
in
the
system,
noting
the
significant
pressures
that
are
being
experienced
by
hospitals
at
the
moment
to
our
ongoing
rapid
response
to
potential
designation
schemes.
So
these
are
government
initiative
where,
if
people
have
been
tested
covered
positive
within
hospital
and
their
long-term
plan
of
discharge
is
to
a
care
home,
they
should
not
be
discharged
directly
into
a
care
home,
but
they
should
be
able
to
go
into
a
designated
setting
during
that
14-day
period.
C
Local
authorities
identify
these
potential
schemes.
The
information
gets
sent
to
us.
We
check
that
the
providers
aware
that
they've
been
nominated
and
we
go
out
and
inspect
within
48
hours
and
we
are
consistently
responding
to
those
requests
within
that
agreed
time
frame.
C
To
date,
135
designation
schemes
have
been
approved
and
we
are
ready
to
respond
to
potential
increased
demand
following
the
government's
announcement
about
insurance
two
evenings
ago,
and
we
are
also
looking
at
whether
we
can
support
around
increasing
capacity
to
enable
people
to
leave
hospital
in
a
timely
way
when
it
comes
to
re-rating
some
services.
So
many
commissioners
will
only
commission
new
packages
of
care
from
services
that
are
rated
good
or
outstanding.
C
We
are
going
to
be
looking
at
inadequate
or
requires
improvement,
home
care
providers
or
care
homes
where
there
is
some
evidence
to
suggest
if
we
were
to
go
out
and
be
raped,
that
rating
may
improve.
We
are
planning
on
going
out.
C
Those
inspections
re-rating,
where
appropriate
and
then
potentially
opening
up
capacity
for
new
services
that
commissioners
can
buy
care
from
and
therefore
help
people
to
leave
hospital
in
a
timely
way.
So
that's
some
of
the
stuff
we're
doing
in
the
practice
space
in
the
reactive
area,
we're
continuing
to
respond
to
risks.
So
a
large
number
of
our
inspections
are
triggered
by
risk
and
we
are
acutely
tuned
in
to
any
feedback
from
members
of
public
carers.
Whistleblowers
around
poor
infection
prevention
control,
any
particular
concerns
about
excessive
staff
movement
between
care
settings.
C
When
we
get
that
information
in
we're
making
a
judgment
and
we're
going
out
and
inspecting
we're,
also
doing
reactive
inspections,
where
there
are
outbreaks
in
care
homes
where
we
have
concerns
about
the
spread
of
covid
and
we're
going
out
and
looking
at
practice
in
those
circumstances
and
then
a
topic
we
talked
about
a
lot
at
our
last
board
was
around
the
work
around
closed
cultures
and
our
commitment
to
absolutely
focusing
on
on
ensuring
that
we
are
responding
and
regulating
to
potential
close
cultures.
C
So
we
are
ready
to
respond
and
looking
at
work
through
the
next
couple
of
months,
particularly
about
inpatient
units
for
adults
with
learning
disabilities
and
autistic
people,
where
we
have
concerns
of
poor
quality
care
or
close
cultures.
So
we
will
be
responding
to
that
in
the
reactive
space
during
the
this
part
of
the
the
pandemic,
looking
at
it
potentially
being
the
programme
period,
a
programmed
set
of
work
when
we're
out
of
the
immediate
pressures
that
we're
under
and
as
with
other
colleagues
who
will
talk,
follow
me
in
the
supportive
area
myself,
my
leadership
team.
C
F
Thank
you
peter,
and
thank
you,
kate.
It's
really
an
issue
I
know
I've
raised
before,
but
it
links
what
you
were
saying
about:
infection
control
and
indeed
closed
cultures,
which
is
about
visiting
care
homes,
and
I
wonder
what
feedback,
if
at
all,
we
have
about
consistency
in
relation
to
allowing
visiting,
which
I
think
is
the
default
position,
albeit
with
careful
precautions
being
taken,
and
I
just
wonder
to
what
extent
you're
finding
that
an
over
defensive
attitude
towards
visiting
is
taking
place.
F
That's
first
question
the
second
is
and
what
we
do
we
do
about
that
and
and
secondly,
where
visiting
is
legitimately
being
restricted
or
indeed
stopped
altogether
we
are
in
effect,
are
we
not
adding
to
the
number
of
places
where
per
force,
not
through
the
fault
of
the
home?
There
is
a
closed
culture
and
I
just
wonder
how
we
keep
track
of
that
in
these
very
difficult
times.
If
we
are
and
whether
that's
it
is
possible,
we
just
have
to
accept
that's
part
of
the
increased
risk
in
relation
to
our
regulatory
activity.
C
Thank
you,
robert,
so
the
issue
around
visiting
and
the
incredibly
difficult
tightrope
the
registered
managers
are
walking
around
the
country
on
this,
I
think
is,
you
know,
reflects
they've
got
a
tough
job
anyway,
and
you
add
in
the
challenge
of
weighing
up
residents
mental
well-being
of
seeing
their
loved
ones
with
the
physical
risks,
the
residents
staff,
and
then
the
pressure
homes
are
feeding
very
rightly
from
families
who
are
you
know
their
desperation
has
grown
and
grown
and
grown
over
over
the
months
about
wanting
to
have
access
and
see
their
loved
ones.
C
So
it
is
it's
the
most
toughest
topic
we,
our
position
has
remained
the
same
throughout,
which
is
the
starting
point.
Is
we
want
to
see
providers
making
it
happen
wherever
it's
safe
to
do
so,
but
they
need
to
be
following
government
guidelines,
looking
at
advice
and
a
steer
from
their
local
directors
of
public
health,
and
there
is
a
wealth
of
examples
that
we've
shared.
C
Where
providers
are
doing
this
really
well,
we
have
been
really
clear
that
we
don't
expect
to
see
blanket
approaches
to
visiting
and
actually
a
very
a
very
blanket
approach
could
be
a
potential
sign
around
close
cultures,
and
that
may
be
the
very
trigger
for
us
to
want
to
go
out
and
have
a
look
at
a
service.
C
So
we
we
are
very
tuned
in
to
concerns
where
that
is
happening,
and
we
are
we,
where
appropriate,
will
be
responding
and
going
out
and
inspecting
to
have
a
look
at
what
that's
meaning
for
people
in
in
receipt
of
that
those
that
care.
But
it
is
it's
been
throughout
this.
It
has
been
an
incredibly
difficult
and
tightrope.
We
want
to
continue
seeing
a
kind
of
person-centered
approach
and
we
absolutely
don't
want
to
see
blanket
approaches
restricting
people
having
access
to
the
loved
ones
where
it's
safe
to
do
so.
D
You
peter
so
I'd
just
like
to
start
off
by
just
reiterating
some
of
the
things
that
ian
said
a
few
minutes
ago.
Hospital
services
are
under
extreme
pressure
at
the
moment,
brought
about
by
the
fact
we're
at
the
peak
of
this
wave
of
the
kerbic
pandemic,
together
with
the
winter
pressures,
and
this
time
of
year
is
the
time
of
peak
winter
pleasure
pressures
for
acute
hospital
services,
and
I
think
it's
really
important.
D
We
pay
tribute
to
the
enormously
powerful
work
going
on
at
the
front
line,
but
also
at
all
levels,
really
in
the
hospital
sector.
Leadership
teams
as
well
in
making
sure
that
the
services
meet
the
demands
being
put
on
them
as
well
as
possible
under
very
difficult
circumstances,
and
I
think
it's
very
important.
We
start
by
understanding
that
and
everything
we're
doing
as
as
as
a
regulator
is
one
to
is
to
want
to
identify
safety
concerns
and
taking
action
where
we
find
them.
D
But
equally
trying
to
support
these
services
is
working
under
incred,
incredible
pressure
at
the
moment,
and
I
think
it's
important
that
we
we
are
doing
both
at
the
same
time,
and
I
just
paid
tribute
to
the
teams
that
I'm
working
with
that.
They
are
balancing
that
really
very
effectively
and
they
are
very
focused
on
providing
support,
but
equally
calling
out
safety
issues
as
and
when
they
find
them.
In
terms
of
proactive
approach.
D
Kate
was
just
outlining
the
work
that
asc
are
doing
on
building
capacity
within
the
social
care
sector
and
and
that
reiterates
the
importance
that
we've
we
we've
talked
of
many
times
before,
of
the
links
between
hospitals
and
the
health
care
system
and
the
social
care
system
and
coving.
If
anything
has
brought
that
to
the
fore
and
the
work
that
kate
and
her
teams
are
doing
in
freeing
up
capacity
and
social
in
social
in
the
social
care
system.
D
To
allow
hospitals
to
patients
to
be
discharged
from
hospital
is
enormously
important
in
freeing
up
some
of
the
pressures
on
hospitals,
so
so
that
that
that
has
been
really
valuable
over
the
last
few
weeks.
We're
also
supporting
hospitals
in
setting
up
new
facilities
such
as
nightingale
hospitals
and
other
facilities
where
patients
are
being
stepped
down,
so
they
can
be
discharged
into
those
facilities
as
well.
During
the
kobe
pandemic,
we're
continuing
our
reviews
under
the
mental
health
act.
The
board
will
be
aware.
D
We've
talked
before
about
the
virtual
approach
that
the
that
our
teams
have
developed,
which
has
been
very
successful
throughout
the
pandemic,
and
that
is
continuing
during
its
peak
of
the
can
pandemic,
and
we
will
be
continuing
that
going
forward
in
terms
of
reacting
to
risk.
We
are
monitoring
services
very
closely
and
we're
working
with
our
partners
in
nhs
england
improvement
to
make
sure
that
we
are
understand
the
risks
that
they
are
seeing
both
nationally
and
regionally.
D
We
are
analyzing
the
data
that
we
have
access
to
in
terms
of
performance
data,
so
we
can
see
where
trends
are
developing.
That
may
indicate
risks
we're
looking
at
safety
reports,
and
I
emphasized
in
a
public
statement
the
week
before
last
the
importance
of
staff
raising
concerns
and
reporting
safety
concerns
when
they
see
them,
despite
the
pressures
of
the
pandemic,
one
so
that
we
we
can
react
to
them.
D
But
equally,
it's
important
that
there's
honesty
about
the
problems
everyone's
facing
and
I
think
one
of
the
things
that's
really
important
is
that
we
tell
the
true
story
about
what's
going
on
in
the
front
line
the
nhs
and
I'm
very
pleased
that
staff
have
been
speaking
up
to
us
and
to
others
about
the
concerns
they've
been
finding.
I
think
that's
really
a
very
valuable
role.
We
are
listening
and
we
will
respond
to
concerns
as
arrays
with
us
where
concerns
are
raised
with
us.
D
We
initially
try
and
seek
assurance
from
the
provider
or
from
the
the
system
supporting
the
provider
to
avoid
doing
unnecessary
inspections.
But
when
necessary,
we
are
doing
inspections
in
response
to
risk
and
we're
taking
action
where
we
find
issues
that
that
the
the
safety
issues
in
providers
and
we're
continuing
that
reactive
inspection
going
forward
where
we
do
find
issues
we're
working
with
again
partners
such
as
nhs
improvement
to
make
sure
the
support
is
provided
to
those
services
so
that
they
can
drive
rapid
improvement.
D
We
are
focused
on
what
we
knew
were
already
risks,
and
we've
talked
already
about
infection
pressure
control,
we're
monitoring
that
very
closely
and
inspecting
where
necessary.
If
we
believe
there
is
evidence,
infection
prevention
control
is
putting
unnecessary
risks
in
services.
We're
monitoring
very
closely
the
performance
of
emergency
medicine
services,
emergency
departments
across
the
country.
These
at
this
time
of
the
year,
are
under
enormous
pressure
anyway,
and
we
have
talked
in
previous
years
of
our
concerns
about
the
pressure
in
terms
of
ambulance
delays
and
crowding
in
emergency
departments.
D
And,
of
course,
those
are
exacerbated
with
the
pressures
from
covid.
One
of
the
real
distinctions
between
this
peak
of
kobe,
compared
to
the
spring
peak,
is
that
emergency
department
attendances
have
gone
up
rather
than
down,
and
so
pressures
are
very
different
in
that
regard
going
forward,
and
we
monitor
that
carefully
and,
where
necessary,
we're
inspecting
emergency
departments
and
taking
action
where
they
need
to
improve
we're,
also,
of
course,
focused
on
other
known
risks.
We
continue
our
inspections,
mental
health
services.
D
If
we
find
problems
a
case
talked
about
closed
cultures,
and
we
are
likewise
focused
on
identifying
closed
cultures
and
inspecting,
where
necessary
and,
of
course,
I've
expressed
before
to
the
board
my
concerns
about
maternity
services,
and
we
are
monitoring
that
working
with
partners,
but
also
undertaking
inspections
where
necessary
in
terms
of
our
supportive
approach.
This
is
very
much
working
with
with
partners
in
nhs,
england
and
improvement
to
make
sure
that
we're
coordinating
our
approach.
D
One
of
the
things
we
really
focus
on
one
thing
providers
have
asked
us
to
do
is
to
reduce
the
information
demands
on
providers,
so
they're
not
getting
separate
requests
from
information
from
us
and
from
other
stakeholders
sort
of
nhs
england,
and
we
are
working
very
closely
with
nhs
england
improvement
on
that
to
try
and
make
sure
that
we
are
not
duplicating
requests
for
information
and
I'm
discussing
with
them
how
we
can
develop
further
transparency
so
that
all
our
communication,
all
their
communication
with
providers,
is
shared.
D
D
We
we
worked
with
nhs,
england
on
guidance
around
their
staffing,
which
was
released
at
the
end
of
last
week,
which
we
endorsed
and
and
and
assured
providers
that
we
that
that
guidance
was
something
that
we
would
be
taking
into
account
when
we're
inspecting
on
the
staffing
and
where
other
guidance
is
necessary.
We've
encouraged
danish
of
seeing
them
to
develop
it
and
to
involve
us
in
that
process
going
forward.
So
we
do
a
maximum.
We
can
to
support
services
going
forward
and
we'll
keep
focused
on
this
as
things
develop
over
the
next
few
weeks.
D
I
think
it
is
very
likely
the
pressure
on
hospitals
will
continue
for
several
more
weeks
yet,
despite
the
fact
that
we
may
at
least
in
some
parts
of
the
country
get
beyond
the
peak.
But
having
said
that,
the
pressures
are
very
high.
The
numbers
of
patients
we've
covered
in
hospitals
are
record
levels,
and
so
it
the
pressure,
will
continue
for
some
while.
G
Thanks
very
much
thanks
ted.
I
just
wanted
to
to
ask
about
one
area
of
risk
which
is
defilement
of
treatment,
surgery,
etc,
etc.
For
people
for
non-covered
people,
and
I
just
wondered
whether
we're
picking
up
you
know.
On
what
basis
are
these
decisions
being
made
fully
understand
the
difficult
decisions
that
services
have
to
make?
G
But
are
we
confident
that
a
that
these
decisions
are
being
made
so
the
fairly
and
sensibly
and
safely
as
possible?
And,
secondly,
that
people
have
sort
of
communication
if
they're
on
long
wait
long
waiting
times
like
that
and
they
may
have
worries
about
cancer
or
whatever
else.
D
Thank
you.
Listen,
I
think
that's
a
really
important
point.
I
should
say
that
when
we're
monitoring
risk,
we
monitor
risks
in
non-covert
and
curvature
services.
We're
not
we're
not
just
looking
at
coverage,
services
and
non-cobia.
Urgent
services
are
equally
a
focus
of
our
attention.
You
know
the
work
we
talk
about.
Emergency
medicine
affects
both
and
I
think
it's
important
we,
we
are
not
focused
people
on
campus
services.
I
am.
D
There
is
some
good
guidance
out
there
and
work
with
nhs
england
around
prioritization,
for
people
with
very
urgent
non-climate
conditions
and
talking
to
providers.
I
I
am
reasonably
confident
that
they
can
provide
that
the
care
within
a
timely
way.
I
think
there's
more
concern
about
people
with
less
urgent
conditions
and
there's
no
doubt
with
people
with
less
urgent
conditions
who
are
waiting
for
treatment.
D
There
is
a
big
backlog
developing
and
I
think
our
focus
going
forward-
and
this
is
what
this
is
work
we
need
to
do
with
providers
and
with
with
our
partners,
is
to
make
sure
that
those
patients
are
followed
up
effectively,
they're,
given
paths
of
escalation,
if
they
believe
their
condition
is
deteriorating
and
that
and
the
risk
is
monitored
as
the
system
catches
up
with
the
the
backlog
of
work
going
forward
post
the
pandemic.
D
H
Mark
saxton,
thank
you
chairman
thanks
ted,
really
good,
to
hear
from
you,
in
terms
of
us
continuing
to
monitor
safety
with
hospitals
who
are
reporting,
staffing,
oxygen
usage,
ambulance,
weights
and
bed
capacity,
challenges
good
to
hear
that
just
would
like
to
hear
from
you
if
we
could
about
the
challenges
facing
frontline
health
service
workers
in
terms
of
their
mental
health,
and
I
wonder
if
you
could
just
help
us
to
understand
how
we
will
continue
to
focus
on
this
area
in
in
our
well-led
key
lines
of
inquiry.
You
could
just
talk
to
that.
D
Okay,
thank
you
mark
for
that.
The
the
front
line
staff
are
under
an
almost
pressure
at
the
moment
and,
for
instance,
in
intensive
care
units.
D
Traditionally,
you'd
have
one
intensive
care
nurse
per
bed
in
an
intensive
care
unit
that
is
being
stretched
in
current
gardens
up
to
one
in
two
one
in
three
one
in
four
in
some
cases
and
the
the
staff
coming
in
to
fill
the
gaps
are
not
intensive
care
specialists,
they're
working,
if
you
like
from
other
parts
of
the
hospital
to
support
the
intensive
care
nurse
who's,
leading
leading
the
team,
and
these
staff
are
not
used
to
working
in
that
environment.
D
So
for
these
staff,
I
think
working
in
intensive
care
dealing
with
patients
who
are
particularly
difficult
with
a
major
respiratory
demands
in
terms
of
their
care,
I
think,
is
really
challenging
for
them
as
individuals,
but
the
sheer
weight
of
work,
I
think,
is
challenging
for
everyone,
because
the
weight
of
work
is
relentless.
I've
heard
that
word
used
a
lot
recently
and
I
think
it
is
really
difficult
for
staff.
D
As
I
said
a
few
moments
ago,
this
is
going
to
go
on.
This
has
been
going
on
a
while,
and
this
will
continue
for
a
while.
So
this
is
this
goes
on
and
on
for
staff,
and
I
think
it
is
putting
enormous
pressure
on
their
sense
of
well-being
and
their
potential,
potentially
their
mental
health.
D
It's
going
to
have
to
be
an
important
part
going
forward
in
the
response
to
covid,
and
I
think
that
is
the
real
challenge:
we're
developing
a
new
well-led
assessment
framework,
as
you
know,
and
we're
going
to
build
well
staff
well-being
into
that
really
strongly,
and
the
culture
of
supporting
staff
into
that
really
very
strongly
and
they're
going
to
be
lots
of
elements
of
that.
D
One
of
the
things
that
I
think
is
really
important
in
this
is:
is
that
honesty
I
was
talking
about
a
few
minutes
ago
about
the
problems
at
the
front
line,
and
I
think
there
is
a
tendency,
sometimes
for
the
kind
of
external
communication
about
healthcare
to
be
very
positive
when
people
at
the
front
line
can
see
the
reality,
which
is
sometimes
quite
challenging,
and
I
think
that
that
disconnect
between
frontline
experience
of
health
care
and
the
the
kind
of
image
of
health
care
is,
I
think,
sometimes
very
difficult.
D
Frontline
staff
and
I
think
that
honesty,
giving
them
the
freedom
to
talk
about
the
things
they're
concerned
about
is
really
important
going
forward.
So
these
elements
of
culture
are
going
to
be
central
to
our
well-being
assessment
framework
going
forward
and
we're
building
them
into
our
transitional
monitoring,
app
approach
to
well
led,
which
will
be
developing
over
the
next
few
months.
So
I
some
assurance
to
you.
This
is
going
to
be
really
important
in
our
worldwide
assessments
mark
and
in
terms
of
the
safety
and
other
services.
D
As
I
said
to
this
a
few
moments
ago,
we
are
monitoring
safety
in
all
services,
not
just
covered
services,
and
it's
really
important
that
we
do
do
that.
I
think
one
of
the
differences
from
this
managing
this
peak
of
the
pandemic
compared
to
managing
the
previous
peak
of
the
pandemic
was
there's
been
much
more
focus
on
keeping
other
services
actively
going,
and
I
should
say
to
any
members
of
the
public
who
are
watching
this.
It
is
really
important
that
people
have
concerns
about
urgent
conditions,
do
seek
care
from
the
nhs.
D
The
nhs
is
very
much
open
to
them.
I
was
in
the
hospital
yesterday
and
they
were
talking
about
their
curvy
care,
but
they
were
also
talking
about
the
the
level
of
care
they
were
providing
for
people
with
other
conditions
and
how
much
they
were
focused
on
that
going
forward,
and
I
think
that
is
really
important
going
forward
that
people
recognize
that
care
is
available.
D
We
will
certainly
be
monitoring
risk
across
all
or
all
health
care
groups,
so
we
will
be
looking
at
risks
in
cancer
services
and
in
cardiac
services
and
in
stroke,
services,
real
services
as
well
to
make
sure
we
are
identifying
risks
in
all
those
services
as
they
develop
and
will
intervene
in
those
as
necessary.
A
Hear
thank
you.
Thanks
ted
rosie,
we'll
move
on
to
you
thanks.
I
Peter,
and
can
I
just
pick
up
a
couple
of
extra
points
with
liz's
liz
and
mark's
questions
there.
One
is
about
the
backlog
and
the
large
waiting
lists
that
is
only
going
to
be
tackled.
If
there's
a
system-wide
approach
to
it.
It's
not
a
not
just
a
hospital
problem.
The
impact
will
be
felt
right
across
the
system
and,
as
the
integration
board
has
started,
doing
some
work,
understanding
how
we
look
at
that,
and
particularly
the
primary
secondary
care
interface.
I
So
that's
something
that
we're
very
much
attuned
to
and
very
much
looking
at
as
a
system-wide
issue
and
the
recovery
of
those
within
the
waiting
list
and
recovery
of
that
will
need
to
be
tackled
at
an
ics
level
and
a
system-wide
level
if
real
progress
is
going
to
be
made,
and
the
other
thing
just
mark's
point
about
staff
well-being
is
that
we
have
picked
up
a
huge
amount
of
really
great
innovation
in
our
provider.
I
Collaboration
review
in
terms
of
how
systems
are
supporting
the
well-being
of
their
staff
and
what
they've
put
in
place,
and
certainly
some
of
that
was
in
our
state
of
care
report
with
the
last
set
of
provider.
Collaboration
reviews
and
with
the
urgent
emergency
care
reviews
again,
we
have
picked
up
some
really
great
practice
which
we
will
be
sharing
with
our
education.
Emergency
care,
pcr
report,
so
so
systems
are,
are
finding
innovative
ways
to
actually
look
at
supporting
staff
well-being,
which
is
fantastic.
I
I
Gps
are
having
to
deal
with
both
increasing
demand,
with
the
normal
winter
pressures,
plus
seeing
people
with
covid
and
the
after
effects
of
long
covered
and
other
problems,
plus
an
increase
in
mental
health
problems
due
to
the
effects
of
the
pandemic,
and
on
top
of
that
they
are
also
successfully
rolling
out
the
the
primary
care
vaccination
program
and
doing
a
fantastic
job
with
that.
I
So
I
just
want
to
say
thank
you
to
all
my
colleagues
working
in
general
practice
at
the
moment,
because
I
think
it's
a
very
challenging
time,
but
they
are
absolutely
doing
great
things,
particularly
around
vaccinations,
so
we
are
taking
a
risk-based
approach
in
general
practice.
We
are
only
inspecting
where
there
is
very
high
risk
and
we
are
doing
as
much
as
possible
of
that
off-site
and
we
can
access
clinical
records.
We
can
access
a
whole
variety
of
things
off-site
and
we
want
to
minimize
the
impact
that
we
have.
I
We
are
also
following
monitoring
areas
of
high-risk
breaches,
areas
of
concern
and
doing
that
in
conjunction
with
partners
such
as
clinical
commissioning
groups
working
with
local
health
watch
and
other
partners
as
well,
which
gives
us
a
huge
amount
of
information
in
terms
of
the
primary
care
vaccination
program.
We're
not
planning
an
inspection
program,
but
we
will
be
following
up
risks
with
the
vaccination
program.
Primary
care,
as
you're
aware,
are
used
to
running
vaccination
programs
and
they
do.
I
The
flu
vaccination
program
is
very
different
in
lots
of
ways,
but
there
are
lots
of
similarities.
So
it
is
something
that
our
teams
are
very
used
to.
Looking
for
and
looking
at
how
vaccination
programs
are
are
delivered.
So
so
that's
something
we
will
be
following
up
in
dentists,
we're
following
an
inspection
inspection
program
only
where
we
identify
significant
risks.
I
The
tma
approach
has
been
welcomed
by
dentists
and
felt
to
be
supportive
and
helpful
in
terms
of
sign
posting
to
guidance
and
and
other
things,
and
we
are
particularly
focusing
around
access
and
sedation
in
dental
providers
access,
because
we
know
that
there
is
a
huge
backlog
again
of
dental
treatment
as
a
result
of
the
pandemic
on
sedation,
because
that's
a
high
risk
area
in
in
dental
practice.
I
In
independent
health
care.
We
are
looking
at
particularly
high
risk
providers
and
also
providers
where
we've
never
inspected
them,
because
we,
we
are
unaware
of
the
risks
in
those
providers.
So
those
are
our
priorities
in
that
area
and
inspecting
where
we
find
high
risk
we're
taking
a
proactive
approach
with
our
sexual
assault.
I
Referral
centers
with
our
health
and
justice
team,
because
there's
been
concerns
about
the
hidden
sexual
abuse
and
increasing
during
the
pandemic,
and
we
want
to
make
sure
that
people
get
good
care
with
that
and
we're
also
working
closely
in
a
reactive
way,
with
her
majesties
and
speculative
prisons
around
prisons
and
making
sure
that
we
are
monitoring
what's
happening
in
those
and
taking
action
as
necessary.
I
And,
finally,
just
to
mention
we're.
Taking
a
proactive
approach
with
send
visits,
the
special
educational
need
visits
with
ofsted,
because
we
are
very
conscious
that
children,
young
people
with
special
educational
needs
and
disabilities
there
has
been
concerns
about
their
care
during
the
pandemic,
and
we
we've
wanted
to
make
sure
that
they
continue
to
get
good
care
and
we're
also
continuing
to
inspect
children's
residential
care.
I
Sorry.
My
final
point
is
around
provided
collaboration
reviews
which
are
really
looking
at
how
we
can
find
and
pick
up
the
good
practice
and
share
the
learning
around
covid.
We
have
decided,
due
to
the
high
level
of
pressure
in
the
system
to
postpone
our
cancer
field
work.
I
We've
done
all
of
the
work
behind
the
scenes
and
we
are
continuing
to
engage
with
a
lot
of
the
cancer
stakeholders,
but
the
actual
field
work
we've
postponed
and
we're
looking
to
reinstate
that
as
soon
as
we
possibly
can,
because
it
does
go
to
some
way
to
answer
liz
and
mark's
question
about
the
care
for
non-covered
patients
and
we're
also
behind
the
scenes
preparing
for
our
learning
disability
pcr.
So
that's
underway
as
well.
A
F
Thank
you.
Thank
you
rosie
for
for
that
report.
My
question
is
about
the
vaccination
programme
and,
as
you
said,
the
this
vaccination
program
is
a
different
scale
and
a
different
order
to
anything.
F
That's
happened
before
and
I
want
just
from
the
question
I
don't
want
to
is
is
how
you
assess
risk
and
what
sort
of
information
do
you
you
get
about
risk
in
relation
to
fact
that
you
know
these
brand
new
sort
of
vaccination
centers
bearing
in
mind
the
huge
variety
of
locations
in
which
these
are
being
set
up,
and
I
just
wonder
to
what
extent
we
look
at
the
consistency
of
practice
in
relation
to
infection
control,
you're,
gathering
crowds
of
sometimes
very
elderly
and
vulnerable
people,
and
I'm
not,
I
mean
I've
seen
one
of
these
in
operation
and
it's
hugely
impressive.
F
What
happens,
but
on
the
other
hand,
then
there
was
a
few
of
people
in
the
streets
outside
and
you
just
wonder
how
how
that's
working-
and
I
just
wonder
what
our
remit
is
actually
in
relation
to
what
is
you
know-
half
public
health,
half,
gps
and
half
volunteers?
Well,
not
not
half!
That's
bad
mathematics!
You
know
what
I
mean,
and
you
know
quite
what
our
role
can
be
apart
from
being
supported.
I
So
if,
if
I
could
just
explain,
what's
happening
in
the
primary
care
sites-
and
then
maybe
ted
and
kirsty
would
like
to
join
in
about
the
the
mass
vaccination
sites
and
the
work
we're
doing
in
registration
around
this,
so
in
primary
care,
a
lot
of
the
things
that
we
look
for
anyway,
with
vaccination
need
to
be
in
place
such
as
emergency
drugs
and
and
defibrillators,
and
the
the
correct
kind
of
oversight
of
the
staff
that
are
giving
drugs
and
vaccines.
I
So
that
that
is
things
we
already
look
for
as
part
of
our
inspection
program.
Anyway.
And
we're
already
looking
at
that.
As
part
of
our
our
monitoring
of
providers
to
check
that
those
things
are
in
place.
The
ccgs
have
a
critical
role
to
play
in
the
in
the
vaccination
programs
with
primary
care,
and
they
do
a
lot
of
the
insurance
visits
themselves
in
terms
of
making
sure
that
the
vaccination
sites
are
set
up
and
that
they've
got
the
correct
handover
facilities
with
the
vaccines
themselves
and
all
of
those
logistical
issues.
I
And
so
the
ccgs
have
have
got
a
an
assurance
role
and
we're
working
closely
with
them.
To
make
sure
that
we
don't
duplicate,
but
what
we
do
is
is
actually
complementary,
and
so
we
we
are
having
regular
conversations
with
the
ccgs
risks
are
being
fed
through
to
us,
and
if
there
are
concerns
about
how
vaccines
are
being
delivered,
then
we
are
following
them
up,
but
I
think
it's
there's
assurance
levels
in
other
parts
of
the
system.
So
we
are
working
in
partnership
with
those
places
to
to
avoid
duplication.
E
D
Thank
you
rosie.
You
said
it
was
a
massive
fractionation
sites
and
those
sites
run
by
nhs
trusts.
We
are
using
a
modified
version
of
our
transitional
monitoring,
app
called
the
vaccine
monitoring
app,
which
we
are
contacting
them
all
and
going
through
a
series
of
assurance
questions
with
them
to
make
sure
that
they
have
the
essential
safety
assurance
in
place
operating.
D
We
we
anticipate
that
to
be
relatively
straightforward
for
them.
We're
not
looking
to
to
put
any
and
do
demands
in
any
way.
They'll
hold
up
the
vaccination
process,
but
we
do
think
it's
essential.
We
make
sure
they
have
this.
The
the
the
basic
safety
measures
in
place.
I
mean
clearly
the
vaccine
itself.
A
vaccination
itself
is
relatively
low
risk,
but
when
your
vaccine
vaccinating
50
million
people
relatively
low
risk
could
be
quite
significant
yeah.
Thank
you.
J
Sorry,
thank
you.
So,
just
in
terms
of
the
registration
piece,
we
are
we're
part
of
a
cross-sector
working
group
with
nhs
e
department
of
health
and
social
care,
and
other
regulators
such
as
mhra,
to
look
at
this
a
more
proportionate
approach
to
regulation
in
terms
of
how
we
do
that
as
tesla.
These
are
have
been
registered
as
sub-locations
of
hospitals
so
that
we're
able
to
check
those
as
part
of
that
registration
we've
been
prioritizing
that
activity
to
ensure
that
we
that
regulation
doesn't
become
a
blocker
to
effective
operation
around
these.
A
So
I
think
each
of
the
chief
inspectors
pay
tribute
to
the
work
that's
going
on
on
on
the
front
line,
but
I
think
we
should
also
pay
tribute
to
the
work
that
our
own
colleagues
are
doing.
I
mean
you
just
heard
them
the
massive
amount
of
activity
and
difficult
circumstances
for
everybody,
so
just
publicly,
on
behalf
of
the
board
like
to
say,
thank
you
very
much
to
our
to
our
own
colleagues.
B
Thanks
peter,
so,
if
I
make
should
I
move
on
to
move
us
on
to
part
two
of
my
report,
this
please,
that
will
be
very
quick.
I
promise
just
just
two
very
quick
things
from
from
me
from
the
part
from
part
two
of
the
report.
B
Firstly,
just
just
just
let
the
board
know
I'm
continuing
to
work
with
my
opposite
numbers
across
the
uk
and
the
republic
of
ireland,
and
we
are
we're
doing
a
series
of
pieces
of
work
just
to
share
experiences
really
and
that's
been
a
useful,
useful
conduit
all
the
way
through
this
all
the
way
through
the
pandemic,
and
that
continues
and
we're
working
alongside
our
government
policy.
Colleagues
as
well
just
to
make
sure
that
those
those
channels
are
also
open.
B
Just
a
point
of
detail,
the
kovid
testing
as
an
activity
is
no
longer
a
regulated
activity,
so
there
was
a
change
in
december
allegedly
to
change,
and
that's
meant
that
we
don't
need
now
need
to
to
to
register
those.
Those
testing
sites
which
I
think
is
is
is
a
good
thing.
So
that's
all
I
wanted
to
say
if
I
now
hand
over
to
kate
for
her
section.
C
Thank
you,
and
I
I
will
be
brief,
as
well
as
I've
covered
the
infection,
prevention
control
and
designation
scheme
update
during
the
priorities
conversation.
So
if
I
just
briefly
mentioned
closed
cultures,
really
focus
discussion
on
this
agenda
at
the
last
board
following
professor
glennis
murphy's
findings
just
wanted
to.
Let
board
know
that
debbie,
even
over
deputy
chief
inspector
in
my
area,
going
forward
for
the
next
12
months
will
be
providing
across
organisational
leadership
around
around
the
issue
of
learning
disabilities
and
services
for
people
with
autistic
people.
C
So
she'll
not
only
be
looking
at
services
in
adult
social
care,
but
she'll
be
looking
at
things
such
as
access
to
animal
health
checks
within
gps
through
to
inpatient
units
and
the
the
starting
point
for
her
focus
will
be
around
inpatient
units
as
that's
where
we're
currently
concerned
around
risks
around
close
cultures
so
for
next
board,
debbie
hasn't
officially
started
just
just
yet,
but
for
next
week
we
will
have
an
update
on
what
that
program
of
activity
looks
like
that
she'll
be
taking
forward
over
the
next
12
months.
D
D
I
think
one
thing
that
has
become
very
clear
during
the
kobe
pandemic
is
that
a
lot
of
the
risks
we
saw
in
services
before
covid,
if
you
like,
were
it
were
brought
to
light
and
highlighted
by
kovid,
so
the
for
instance,
critical
care
services
are
the
one
of
the
services
that
have
always
scored
most
highly
in
our
in
our
inspections,
and
they
have
really
responded
magnificently
well
to
the
pressures
of
kobe
down.
It
is
dramatic
what
what
they
have
achieved
under
enormous
pressure.
D
I
was
talking
to
a
hospital
this
week
normally
runs
70
critical,
cleared
beds.
It
has
gone
up
to
200,
sometimes
over
200
critical
care
beds,
a
dramatic
increase
in
critical
care
facilities
from
a
service
that
is
under
enormous
pressure,
but
we
have
rated
a
a
very
highly
up
until
now
across
the
country
fairly
consistently.
Well,
another
service,
such
as
emergency
medicine,
which,
despite
the
hard
work
of
everyone
at
the
front
line,
and
we
recognize
that
every
winter
has
been
under
enormous
pressure
again.
It
is
finding
it
very
difficult
now.
D
This
issue,
working
with
our
colleagues
over
the
summer,
the
importance
of
preparing
for
the
pressures
of
covid
and
the
pandemic,
and
I
think
what
the
covid
has
demonstrated
is
that
the
the
the
structural
problems
we
see
in
emergency
care
need
to
be
addressed
if
we're
going
to
be
ready
to
deal
with
a
normal
winter
as
much
as
as
a
kobe
winter,
and
I
think
think
that
to
some
extent
is
unfinished
business
and
we
will
be
continuing
that
work
with
emergency
care.
D
Two
other
areas
we're
looking
at
we
mentioned
earlier
on
about
recovery
from
copied
and
recovery
of
other
services
and
we're
doing
work
with
providers
to
explore
what
best
practice
would
look
like
and
hopefully,
we'll
be
able
to
provide
some
support
and
guidance,
as
that
goes
forward,
and
we've
also
set
up
a
a
a
risk
summit
around
maternity
services,
which
I
hope
will
be
either
towards
the
end
of
this
month
or
next
month,
to
set
to
set
some
momentum
into
the
improvement
in
maternity
services
that
I've
called
for
previously,
while
maternity
services
are
not
at
the
center
of
the
coveted
pandemic,
although
they
are
involved
to
some
extent.
D
A
Nobody
wants
to
come
in,
so
rosie
will
move
swiftly
on
to
you.
Yes,.
I
Very
quick
update
from
me
just
to
say
that
the
do
not
attempt
cardiopulmonary
resuscitation
review
is
very
much
on
track.
We
have
finished
the
field
work
now
in
the
seven
ccg
areas
and
we
are
now
analyzing
all
the
information
that
we've
got
and
we
are
on
track
for
delivery
of
a
report
to
be
delivered
to
ministers
at
the
end
of
february.
I
A
Gosh
everybody
seems
to
come
very
silent.
So
that's
that's!
That's
that
take
that
as
a
as
a
positive
kirsty.
J
Thank
you
peter,
so
just
a
short
bit
from
the
people
plan
update
this
month,
so
we
have
been
reviewing
our
policies
over
the
last
12
months,
as
these
are
sort
of
overall
hr
policies
to
make
sure
they
bring
being
brought
up
to
date
and
ensure
that
they're
fit
for
purpose.
In
december,
we
launched
three
new
key
policies:
managing
sick
absence,
critical
illness
and
conflict
resolution.
J
J
So
that's
all
I
wanted
to
say
in
that
area.
Thank
you.
Chris
is
going
to
pick
up
the
performance
piece
so
chris
over
to
you.
B
Thank
you.
So
this
is
the
performance
report
for
november.
So
this
is
there's
a
there's,
a
one
p
for
benefit
of
new
new
members
to
the
board.
There's
a
one-page
dashboard
in
the
annex
on
a
quarterly
basis,
there'll
be
a
more
in-depth
packs,
that'll
be
next
month
for
the
the
quarter.
Three
reports
we'll
also
look
to
how
we
can
cast
this
based
on
the
three
priority
categories
that
we
referenced
earlier.
So.
B
Just
a
few
areas
to
to
pull
out
from
me
keeping
it
brief
registration,
so
we
continue
to
track
the
simple
and
complex
applications
which
is
work
we've
been
doing
in
in
year
to
change
how
we
look
at
our
kpis.
B
Simple
applications
are
taken
on
average
24.2
days,
it's
processed
with
complex,
taking
114
days
on
average,
but,
as
we
mentioned
before,
the
team
will
continue
to
prioritize
applications
that
support
the
system's
response
to
covert
in
terms
of
safeguarding
and
whistleblowing.
We
aim
to
actually
95
percent
of
safeguarding
actions
in
one
day
currently
achieving
just
over
that
97
percent
and
also
into
action
95
percent
of
safeguarding
concerns
in
five
days,
we're
currently
just
under
that
94
in
terms
of
regulate
reaction.
B
Between
april
and
november,
we
inspected
3250
locations
and
if
you
exclude
thematic
inspections,
80
of
those
inspections
with
the
sizes
that
were
conducted
due
to
risk
with
the
remaining
being
prioritized
due
to
risk,
for
example,
breaches
of
regulation
it's
in
in
alongside
that
inspections
continue
to
be
mainly
triggered
by
information
of
concern
or
statutory
notifications.
Example
whistleblowing
or
safeguard
concerns
last
bit
from
me
just
on
our
money.
B
So
our
revenue
budget
is
forecast
to
be
10.7
million
under
spent
by
the
end
of
this
financial
year,
which
is
just
under
five
percent,
and
our
capital
budget
is
forecast
to
be
0.2
million
under
spent
for
the
year
so
happy
to
take
any
questions
on
on
the
report.
J
Can
I
can,
I
just
add
in
sorry
so
just
in
terms
of
I
know,
we've
been
having
conversations
with
mark
around
the
people,
people
metrics
and
just
wanted
to
assure
him
that
the
next
report,
which
will
be
the
quarterly
report
there,
will
be
a
much
more
detailed,
deep
dive
into
our
people.
Metrics
I'll.
Just
ask
that
question
before
I
get.
H
Asked
very
good,
I
feel
I
had
to
respond
chairman
just
to
say
kirsty
thanks
very
much
for
that
and
yes,
I
had
a
very,
very
good
meeting
with
jill
and
with
some
members
of
the
people
directorate
and
what
we're.
What
we're
trying
to
produce
is
some
more
people,
information
that
sort
of
highlights,
joiners,
levers,
promotions
and
temporary
transfers
shines
a
light
on
our
dni
data.
H
A
Great
chris,
I
know
the
answer
to
my
question,
but
I'm
going
to
kind
of
raise
it
anyway.
I
mean
november
seems
an
awfully
long
time
ago,
particularly
this
year.
I
understand
why
there
will
always
be
this
sort
of
lag
because
there's
a
lot
of
data
pulled
together,
but
if
something
was
going
seriously
wrong,
if
if
if
a
wheel
was
coming
off
somewhere,
I
just
would
like
your
assurance
on
the
et's
assurance
generally
that
that
collectively,
that
a
we
would
know
and
b
would
be
brought
to
the
board
attention.
B
Absolutely
yeah,
it
is
an
unfortunate
lag,
but
obviously
yes,
we
would.
We
would
flag
anything
urgent
and
the
the
executive
would
have
seen
kind
of
just
getting
into
the
the
month
ahead.
We're
just
finishing
off
the
december
report,
so
yeah
absolutely
would
flag
anything.
A
So
the
absence
of
anything
being
flagged
is
a
positive,
yes,
excellent,
good.
Thank
you,
ian's
nodding
as
well.
Thank
you
very
much
right,
so
I
think
we
move
on
mark
to
you.
K
Yes
and
I'm
delighted
to
report
again,
no,
no
any
cyber
security
issues
to
report
this
month.
Perfect.
I
love
your
reports
on
that.
L
All
right,
so
I've
got
a
couple
things
to
go
through
from
my
perspective.
Firstly,
just
to
talk
a
little
bit
about
the
the
strategy
feedback
to
your
sense
of
where
we
are,
as
you've
probably
heard
from
all
the
conversations
that
we've
had
so
far.
There's
never
been
a
more
important
time
for
to
ckc
to
ensure
that
it's
going
to
be
effective
in
the
future
around
how
it
delivers
its
regulatory
activity.
We've
been,
as
the
board
knows.
L
Over
a
number
of
months,
we've
been
having
conversations
with
people
your
services,
with
providers
that
we
regulate
with
our
own
colleagues
and
with
other
stakeholders
to
understand
how
cqc
needs
to
improve
and
change
what
it
does
to
be
responsive,
not
just
because
of
covert,
but
because
of
the
other
challenges
around
how
we
provide
timely
information
to
people.
L
The
latest
round
of
engagement,
just
prior
to
the
end
of
the
of
the
we've
we've
we've
met
with
a
mixture
of
groups,
so
in
terms
of
public
over
5000,
public
group
stakeholders
and
individuals
in
terms
of
providers,
we've
met
with
recently
with
about
seven
seven
and
a
half
thousand
providers
of
different
different
types,
as
well
as
colleagues
internally
across
all
aspects
of
the
business.
L
The
logic
of
doing
that
is
to
continue
to
test,
not
just
our
our
thinking,
but
some
of
our
approach
to
how
we
might
change-
and
I
have
to
say
some
of
the
conversations
have
been
very
positive
in
this
week-
came
to
a
an
overarching
group
which
is
made
up
of
ppu
services
providers
and
other
stakeholders
to
talk
through
all
of
the
student
themes.
L
I
just
wanted
to
just
to
give
a
couple
of
them
nuggets
of
information
on
each
of
the
four
themes
and
the
important
feedback
we've
had
from
from
different
groups
in
terms
of
people
and
communities.
I
think
the
challenge
about
how
we
weight
the
voice
of
people
alongside
the
voice
from
the
sources
and
how
we
make
sure
we
can
provide
an
open
and
honest
account
of
what
is
going
on.
There's
a
strong
support,
which
leads
into
a
smarter
regulation
for
real-time
information.
L
Real-Time
updates
on
what
people
have
said,
but
smart
regulation
itself
is
again
a
lot
of
support
for
an
increasing
emphasis
on
providing
information
in
a
more
real-time
way,
with
our
ambition
of
making
more
data
and
information
available
and
the
challenges
of
how
we
make
that
meaningful
to
all
groups,
so
providers
so
that
they
can
learn
and
drive
their
own
change.
And
so
the
public
can
be
informed
about
choice
in
terms
of
safety.
L
There's
a
really
strong
emphasis
on
learning,
and
I
think,
both
from
the
conversations
we've
had
with
providers
and
from
public
and
other
stakeholders,
the
ability
of
of
of
to
move
to
a
situation
where
people
feel
able
to
support
or
able
to
speak
up
about
issues
needs
to
be
driven
from
all
organizations.
L
To
the
point
of
this
is
about
the
learning
that
organizations
and
the
learning
journey
that
all
organizations
how
you
create
a
positive
environment
for
learning,
even
in
these
difficult
times,
as
well
as
being
clear
about
what
it
means
to
be
safe
and
having
that
good
conversation
with
frontline
colleagues
about
what
it
means
to
be
safe
and,
lastly,
around
accelerated
improvement.
L
Recognizing
there's
different
coalitions
in
different
in
different
sectors,
but
how
we
use
what
we
now
have
the
really
powerful
information
that
we
know
both
from
our
inspection
activity
and
other
data
that
we
hold
to
drive
that
to
drive
and
accelerate
the
right
improvement
in
each
of
the
sectors
and
as
rose
mentioned
earlier
across
sectors.
So
this
is
not
just
about
individual
organizations.
L
M
Thank
you
peter
and
chris.
Thank
you
very
much
for
for
the
update
the
the
the
question
I
just
wanted
to
get
your
view
on
is
as
you're
developing
the
strategy.
M
How
do
you
see
it
potentially
needing
to
flex
and
adapt
as
we
learn
the
lessons
of
the
pandemic,
because
we've
got
some
a
really
major
system,
change
and
development
going
on
in
real
time
now
and
we're
trying
to
develop
a
strategy
for
the
organization
and
some
at
some
point,
these
need
to
keep
sort
of
integrated,
iterating
and
and
talking
to
each
other,
so
that
the
strategy
is
informed
by
the
learning
from
the
pandemic.
How
does
that
work?
I
mean.
L
In
a
sense,
that's
exactly
that.
That
is
exactly
the
most
important
point
and
it's
what's
been
what's
really
been
helpful
over
the
last
year,
as
we
begin
to
think
about
the
themes
of
the
strategy
through
the
testing
we've
done
as
part
of
the
pandemic,
we've
been
able
to
hone
our
thinking
around
what
it
might
mean
to,
for
example,
use
data
and
information
to
drive
our
view
of
inspection.
L
Ironically,
I
think
that
the
pandemic
has
helped
us
test
some
of
those
the
reality
of
that
in
in
live
and
give
people
and
providers,
people
use
services
a
sense
of
what
that
might
be,
but
it
does
rely
upon
really
strong
feedback.
So
we've
been
really
working
with
the
to
program
around
the
implantation,
really
feeding
back
from
people
who
are
experiencing
those
those
services
and
experiencing
the
the
changes
that
we've
made
about.
What's
worked.
L
So
what's
worked
around
transitional
regulatory
approach,
what
hasn't
what
people,
what
people
like,
what
they
don't
like,
so
we
can
feed
into
that
work,
and
I
know
from
the
the
colleagues
that
are
involved
in
the
next
stage
of
this.
That
really
important
feedback
is
guiding
our
view
about.
For
example,
how
we
developed-
and
you
know,
master
thoughts
about
it
earlier-
how
we
develop
that
new
platform
for
how
we
develop
and
share
information,
so
people
use
services
providers
and
importantly,
our
colleagues
have
helped
shape
how
that
should
work.
L
I
think
there's
more
work
to
do
with
that.
I
think
there'll
be
more
conversations
that
we
need
to
have,
and
I
think
the
more
we
can
keep
it
to
real-time
and
iterative
views.
I
I
know
the
strategy
has
a
sort
of
a
five-year
timeline.
This
will
literate
for
me
over
over
a
period
of
time.
I
think
you
shouldn't
be
afraid
of
allowing
it
to
iterate
the
great
thing
about
the
technology
platform
that
we've
got.
Is
it
allows
for
that
iteration?
L
It
allows
for
those
those
those
changes
that
we
make
as
we
as
we
go
through
this
year
into
the
next,
but
it's
a
really
important
feature
that
we
can
hold
ourselves
accountable
to
the
changes
that
we
make
over
time
and
explain
why,
and
I
think.
A
Just
to
add
to
that,
chris,
stephen
from
from
the
outset,
we've
recognized
that
there
will
be
an
awful
lot
of
other
changes.
Just
give
you
one
example.
We
don't
know
at
this
this
time
how
ics's
are
going
to
develop,
and
you
know
we
have
to
have
a
five-year
strategy
that
is
able
to
adapt
to
whatever
whatever
comes
along.
So
in
a
sense,
that's
been
integral,
even
in
our
thinking,
even
before
the
pandemic
arrived
yeah.
A
L
As
part
of
our
stakeholder
engagement,
we
we
regularly
engage
with
obviously
with
the
hsc
with
ministers
and
also
with
opposition
groups
as
well,
so
we've
been
met
as
part
of
that
ongoing
engagement.
We've
recently
met
with
colleagues
from
the
labor
party
again
to
talk
through
the
strategy.
I
think
it's
important
that
all
sides
of
the
house
understand
what
we're
trying
to
do
and
why
roslyn,
who
we
met
recently
is
a
front
line,
a
e
doctor,
so
she
understands
the
front
line
of
the
pandemic.
L
Her
particular
area
responsibilities
is
mental
health,
but
there
was
broad
support
for
some
of
our
thinking
around
our
intentions
around
the
strategy,
and
I
think
it's
important
that
we
can
keep
all
parts
of
all
parts
of
the
house
informed
about
what
we
do
so
that
they
can
understand
the
relationships
about
how
we're
changing
over
time.
We
regularly
get
correspondence
with
north
of
100
mps,
so
there
is
an
ongoing
dialogue
with
a
number
of
groups.
L
I
just
want
to
make
the
board
aware
that
we'll
continue
that
dialogue
alongside
the
wider
stakeholder
dialogue
that
we
have
with
with
them,
with
with
groups
that
work
alongside
us
and
those
that
we
regulate
and
then
the
last
thing,
let's
just
just
sort
of
to
tidy
this
bit
off
and
sort
of
already
mentioned
this
about
the
voice
of
of
people
who
services
and
frontline
clinicians
to
give
feedback
on
our
own
care.
L
The
latest
spiking
that
is
is
is
due
to
underway
shortly,
spikes,
one
and
two
that
we
focus
on
different
groups
where
we
want
to
hear
from
from
individuals
a
particular
individual.
We
think
it
might
be
underrepresented.
L
We've
seen
a
21
increase
in
in
the
information
received
by
by
telephone
because
of
the
information
comes
in
that
way
and
a
61
increase
in
the
care
received
by
our
new
dedicated
feedback
on
care
web
platform.
The
key
thing
for
me
this
is
allowing
us
to
do
more,
responsive
inspections
that
are
responding
to
that
risk,
both
from
people
who
use
services,
but
also
from
frontline
staff,
and
I
think,
just
to
talk
to
robert's
point
of
early
about.
How
can
you
be
assured
with
closed
cultures?
L
Well,
actually,
I
think
the
fact
we're
hearing
more
from
from
frontline
staff
is
to
be
is
to
be
encouraging
their
and
carers
and
and
people
your
services
as
well,
and
I
think
it
does
give
a
lens.
Not
it's
not
a
it's,
not
a
it's
not
a
panacea,
but
I
think
it
does
give
a
lens.
The
key
thing
for
me
is
about
how
people
feel
that
we
are
responding
to
their
to
their
request.
L
So
I
think
the
fact
we're
doing
more,
responsive
inspections
is,
is
really
really
important
and
that
trust
that
develops
from
how
people
give
that
feedback
and
how
it's
responded
to
will
be
something
that
we
take
into.
I
think
on
the
next
strategy.
A
Great,
so
I
think
ian
that
that
that
completes
the
executive
team
report.
We
have
to
move
on.
A
So
chris
we
come
back
to
you
on
the
the
inside.
I
think
these
insight
reports
have
been
a
really
valuable
contribution
to
understanding
what's
going
on
through
the
pandemic.
So
what
I'm
about
to
say
does
not
in
any
way
take
away
from
the
importance,
but
given
that
these
are
ready
to
aid
in
understanding
and
both
members
of
the
public
and
our
various
stakeholders
and
ourselves
can
read
that
I'm
kind
of
hoping
we
can
be
fairly
quick
on
a
board
discussion
on
this
particular
inside
report.
L
I
get
I've
got
that
that
sort
of
subtle
note
I
just
what
I'll
say
is,
I
think,
just
to
say,
let's
just
say
to
say
a
couple
of
things.
Then
these
reports
are
designed
to
partly
to
share,
what's
gone
well,
partly
to
understand
and
help
learning
in
the
system
and
in
organizations.
L
So
the
issues
that
we've
talked
this
time
around
bed
occupancy
and
designated
settings
is
designed
to
give
us
a
view
about
how
different
areas
are
responding
to
the
issues
around
moving
people
from
secondary
care
out
of
secondary
care
into
either
in
either
home
or
into
adult
social
care,
to
give
both
regional
people
responsible,
regionally,
but
also
people
responsible,
nationally,
a
sense
of
what's
working.
L
And
what
isn't
and
alongside
that.
We
continue
to
provide
data
information
that
we
know
that
people
are
looking
for
as
a
as
a
as
think,
tanks
and
others
begin
their
work
and
hopefully
provide
a
useful
contribution
to
the
debate
about
how
services
need
to
change
and
improve
the
particular
exploration
of
a
destination.
Social
care
has
been
an
important
topic
for
us
and
I
want
to
make
sure
that
we're
able
to
openly
describe
what
we
think
is
happening
in
different
areas.
L
F
Causing
popularity
as
usual
peter,
thank
you
just
one
good
question.
I
mean
firstly
this
as,
of
course,
these
reports
are
extremely
useful
and
this
one
ends
with
prompting
a
question
really,
which
is
the
analysis,
doesn't
explain
why
people
from
bme
groups
or
those
with
learning,
disability
and
autism
are
more
likely
to
have
died
from
covered,
which
obviously
promised
the
question
who
is
seeking
to
find
that
out
and-
and
you
know,
in
what
sense
can
we
contribute
to
that
for
what
clearly
needs
to
be
a
further
investigation.
L
Right,
so
there
is
there's
some
ongoing
work
with
the
with
the
ons
to
look
at
this
in
more
detail
and
with
other
organizations
as
well.
Part
of
the
reason
to
put
this
out
at
this
point,
robert
is
just
to
make
the
point
that
we
and
the
data
doesn't
lead.
You
at
the
moment
lead
you
one
way
or
the
other.
L
A
Thanks
chris
does
anybody
else
want
to
raise
anything
or
have
I
successfully
put
you
all
off
from
great,
that's
really
good,
so
we
get
back
on
to
track
time
wise,
but
ian
dodds.
Thank
you
very
much
for
work
that
you
do
on
this,
because
I
I
really
do
mean
what
I
say.
I
think
these
are.
These
are
really
really
important
documents
and
and
the
information
that
they're
providing,
I
think,
has
been
hugely
important
to
understanding
what's
going
on.
So
thank
you.
That's
very
good
to
hear
yeah
thanks
ian.
A
G
Thanks
very
much
peter.
So,
yes,
we
started
out
in
the
regulatory
governance
committee
by
just
taking
a
look
at
the
risk
register,
those
risks
that
relate
to
our
regulatory
functions
and,
for
example,
you
know
the
rapidly
changing
environment
and
how
well
has
cqc
been
able
to
adapt
and
what
risks
are
there
in
our
own
adaptation
to
that,
and
we
looked
in
detail
at
how
the
executive
team
had
rated
those
risks,
scored
them
and
the
mitigations,
and
we
were
satisfied
that
risks
were
being
identified
and
acted
upon.
So
that
was
the
first
point.
G
We
then
had
the
discussion
on
the
project
that
rosie's
already
mentioned
on.
Do
not
attempt
cpr,
and
so
the
stage
it's
at
is
that
from
the
the
field,
work
and
surveys,
emerging
findings
have
come
back
and
what
we
were
discussing
was
really
the
interpretation
of
those
findings
so
far,
the
framing
of
them
and
how
could
that
report
be
used
to
make
the
most
difference
to
improving
those
all-important,
advanced
care
planning
discussions
and
the
advanced
care
planning
process,
so
that
you
know
I
mean
the
findings
will
be
out.
G
As
rosie
said,
you
know
in
in
the
next
month
or
two,
but
but
just
to
sort
of
make
sure
that
we
are
really
thinking
about
who
can
make
a
difference
on
this
agenda.
So
it's
not
just
a
report.
G
We
then
looked
at
the
transition
regulatory
approach
and
the
vision
for
this
really
is
that
that
for
the
inspectors
they
would
have
in
one
place
all
the
information
they
need
to
know
about
their
patch
or
particular
provider.
So
that
might
be
not
just
information.
That's
come
from
earlier
inspections,
but
also
it's
issues
that
have
been
raised
by
people
using
services
or
their
carers
or
members
of
the
public
or
members
of
staff.
G
It
would
be
data
that
the
cqc
has
and
can
access
about
that
particular
provider
about
how
it's
doing
compared
with
other
providers
on
the
in
the
same
areas
that
sort
of
thing,
so
it
it
it's
about
creating
a
much
more
holistic
set
of
evidence
to
really
improve
decision-making
and
therefore
improve
regulation.
G
G
How
there
was
going
to
be
confidence
that
that
risk
would
be
identified,
including
sort
of
thematic
risks,
as
well
as
individual
risks.
We
looked
at
how
this
approach
fitted
as
against
what
other
regulators
are
doing
in
other
sectors
and
really
sort
of
gave
a
steer
to
the
executive
about
some
of
the
thinking
of
the
committee
on
how
to
develop
this
work,
which
obviously
will
come
to
the
to
the
full
board
in
the
fullness
of
time.
So
it
was
a
very
good
discussion.
G
A
G
A
A
Well,
I
do
I
want
to
acknowledge
liz
that
this
is
your
final
meeting
on
the
board
and
to
say
what
an
outstanding
colleague
you
have
been.
I
mean
you've
been
a
great
chair
of
the
rgc,
both
in
in
setting
the
agendas
which
I
mean.
A
I
I
think
it's
a
really
important
thing
in
a
group
like
the
rgc
to
make
sure
it's
focusing
on
things
that
really
matter
and
you've
done,
that
you
have
a
very
nice
style
of
chairing
and
you
have
a
brilliant
ability
to
summarize
something
which
I
am
totally
unable
to
do
so
I
I
admire
that
enormously,
but
you've
also
made
that
massive
contribution
in
other
ways
outside
the
board,
your
support
for
various
pieces
of
work
over
the
time
you've
been
on
the
board.
A
I
know
it's
been
much
appreciated
by
colleagues
and,
and
you
make
great
interventions
in
the
board-
we're
really
going
to
miss
you.
So
just
on
behalf
of
all
of
us,
a
very
big
thank
you
and
we
wish
you
well
in
whatever
you're
going
to
be
doing
next.
So
thank
you
liz.
G
Very
much
thank
you
very
much
peter.
It's
been
an
absolute
pleasure
and
privilege
and
I
look
forward
to
seeing
how
the
strategy
implementation
goes
I'll,
be
supporting
from
the
sidelines
thanks
very
much
so.
A
That's
great,
so
I
think
that
that
brings
the
meeting
itself
to
an
end.
We
have
two
questions
from
robin
pike:
the
by
the
way,
if
I'm
looking
and
I'm
sitting
in
the
dark
a
bit,
it's
because
the
light
bulb
above
me
went
off
just
as
we
started
the
meeting.
So
I
get
a
struggle
to
read
the
questions
now
but
anyway.
The
first
question,
I
think,
is
how
does
cqc
now
intend
to
make
all
areas
of
its
work
more
outcome
focused
and
less
process
driven.
B
B
They're
transforming
our
organization
work,
we'll
try
and
make
a
reality
of
that,
so
that
we
organize
ourselves
in
a
way
that
is
focused
around
particularly
geographical
outcomes
and
the
big
theme
around
smarter
regulation
is
an
important
way
of
making
ourselves
less
process
driven
and
in
our
people
theme.
The
first
theme
of
the
strategy
we
talk
about.
Our
regulations
should
be
driven
by
people's
experiences
and
what
they
expect
and
need
from
health
and
care
services,
rather
than
how
providers
want
to
deliver
them.
B
So
again,
that's
a
clear
indication
that,
as
we
do,
the
work
that
we're
doing
on
on
redesigning
our
methodologies
for
the
future.
That
will
very
much
be
at
the
heart
and
the
starting
position
of
our
thinking
and
the
communities
and
inequalities
focus
again.
That
runs
all
the
way
through
the
strategy
again
make
sure
that
we're
going
to
focus
on
outcomes
for
people
and
local
populations
and
how
providers
are
working
together
to
improve
them.
A
Thank
you
ian
and
then
the
second
question
from
robin
is
during
the
recent
holiday
period
nhs
111
came
under
pressure.
I
think
it's
been
under
pressure
actually
for
quite
a
long
time
in
one
way
or
another.
How
did
cqc
assess
the
performance
of
these
services
during
the
holiday
rosie?
Perhaps
you
could
comment
on
that.
I
Yes-
and
I'm
hoping
you
can
hear
me
and
see
me
because
my
internet's
causing
all
sorts
of
problems
today,
so
we
do
this
in
a
variety
of
ways.
We
look
at
the
siprep
data
from
nhs
england
and
if
there's
any
concerns
about
that
data,
we
take
appropriate
action
to
explore
further.
We
are
also
running
the
tma
process
with
with
providers
of
111
services,
and
we
will
continue
to
do
that,
particularly
in
those
providers
where
we're
concerned
about
any
risk.
I
We
work
very
closely
with
stakeholders
at
national
and
a
regional
level
to
make
sure
that
we've
got
a
good
visibility
of
what's
happening
and
and
also
we
do
that
at
a
local
level.
So
we
understand
how
the
system
is
working
and
what
the
pressures
on
the
system
are.
We've
also
finally
been
looking
at
one-on-one
in
the
recent
urgent
emergency
care
provider.
Collaboration
review
and
we've
found
some
really
innovative
approaches
to
how
one
one
is
being
supported.
So
we
will
be
fined
sharing
those
findings
soon.
A
Thank
you
rosie,
and
there
are
no
other
questions
from
the
public,
so
that
is
the
end
of
the
meeting.
Thank
you
all
very
much
indeed.
A
So,
just
before
we
all
go,
we
have
miraculously
now
got
ahead
of
ourselves
on
on
time,
so
we
have
a
choice
we
can
either.
We
can
either
have
the
omni
project
demonstration
at
1
15.
A
If
people
would
prefer
to
get
back
on
to
a
slightly
earlier
finish,
or
we
can
stick
to
what
we
said
and
we
do
it
after
the
the
end
of
the
meeting,
which
would
be
about
two
o'clock
so
an
hour
for
lunch
or
or
45
minutes
and
an
earliest
finish
any
strong
views,
god
dear
right,
so
was
let's,
let's,
in
the
absence
of
anybody,
say
anything
different.