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From YouTube: CQC board meeting - May 2021
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A
Good
good
morning
and
welcome
to
cqc
public
board
meeting
for
may.
We
have
no
apologies
for
absence,
but
I
I'm
particularly
pleased
to
be
able
to
welcome
belinda
black
to
our
board.
Blinder
join
the
board
on
the
first
of
may,
and
this
is
your
first
board
meeting
so
extremely
welcome,
belinda
lovely
to
see
you.
I
also
also
like
to
welcome
sarajet
olanji,
who
is
the.
A
Vice
chair
of
our
carers,
equality
network
and
is
with
us
today,
you're
extremely
extremely
welcome.
Thank
you.
Can
I
check
that
there
are
no
declarations
of
interest.
Anybody
needs
to
raise
excellent,
and
I
think
that
then
deals
with
the
perimeters
and
takes
us
on
to
the
minutes
of
our
meeting
the
21st
of
april.
They
are
through
an
accurate
record
of
everything
we
discussed
yeah
excellent,
so
they
are
approved,
that's
good,
and
there
is
nothing
on
the
action
log
that
is
outstanding.
Is
that
any
other
matter
arising?
A
B
Thank
you
peter.
Thank
you.
The
the
report
this
month
is
sort
of
uncharacteristically
short
and
that's
quite
deliberate.
B
I
wanted
to
do
a
couple
of
things
really
want
to
to
reflect
the
fact
that,
on
later
on,
the
agenda
is
our
end
of
year
performance
report
and
whilst
we
will
cover
off
our
our
performance
as
an
organization
during
that
report,
I
thought
it
would
be
useful,
as
part
of
the
exec
team
report,
to
invite
each
of
the
chief
inspectors
to
cover
off
their
headline
reflections
on
on
risk
in
in
their
in
their
sectors-
and
I
know
chris
chris
day
he's
also
going
to
talk
talk
briefly
about
some
of
some
of
his
thoughts
on
give
feedback
on
care
in
particular
and
and
the
important
role
they
give
feedback
on
care,
which,
of
course,
as
you
know,
is
our
is
both
our
telephone
and
our
digital
service
for
receiving
information
and
intelligence
from
the
public
just
cover
off
the
important
role
that
plays
in
driving
a
lot
of
our
of
our
activity
at
the
moment,
and
so
you
know
in
this
public
board
meeting
just
a
shameless
plug
for
for
to
the
to
the
public.
B
So
we
launched
our
new
strategy
on
the
27th
of
may,
which
I
hope
will
position
us
well
to
to
to
to
examine
these
sector
risks
and
to
act
on
on
the
sector,
risk
that
the
chief
inspectors
will
will
talk
about
as
well
as
I
think,
making
us
for
the
future
as
we
start
to
look
forwards
at
towards
system
working
or
particularly,
strengthening
system
working,
as
outlined
in
the
in
the
forthcoming
health
and
health
and
care
bill.
B
So,
and
I
think
we
also
need
to,
I
think
recognize
that
that
that
our
performance,
our
strategy
and
the
risks
that
the
chief
inspectors
will
talk
about
have
to
be
placed
in
this.
This.
This
whole
era
of
covered
recovery,
which
I
think
I
think
we're
in
at
the
moment
and
depending
on
you
know
who
you
talk
to
there's
estimates
of
somewhere
between
two
and
five
years
before
before
we
recover
from
from
from
the
aftershocks
of
of
of
covid.
So
that's
all.
B
C
Thanks
ian
thanks
peter,
so
I'm
going
to
talk
about
close
cultures
and
learning
disabilities
first
and
then
I'll
pause.
The
questions.
Now
I'm
going
to
talk
about
care,
home,
visiting
and
pause
and
then
do
the
risk
piece
if
that's
okay,
so,
first
of
all
on
closed
cultures,
so
we've
got
refresh
guidance
that
has
been
published
externally
earlier
and
this
month
next
week
is
autism
awareness
week.
C
C
It
looks
at
how
you
can
have
a
very
beautiful
care
plan,
but
how
do
you
understand
and
have
assurance
that
that
care
plan
is
what
is
being
delivered
for
those
people
who
are
receiving
care
and,
finally,
on
close
cultures
board,
will
remember
that
back
in
october,
we
published
our
report
called
out
of
sight.
C
Who
cares
and
in
it
we
called
for
various
other
organizations
to
take
action
to
stop
people
inappropriately
being
placed
in
inpatient
units
a
long
way
away
for
that
from
their
family
home
and
often
as
a
result
of
that
delivering
getting
quite
poor
outcomes
as
a
result
of
outside
we've
taken
action.
So
we
have
appointed
debbie
van
over
as
our
lead
deputy
chief
inspector
to
drive
our
work
around
services
for
people
with
learning
disabilities
and
autism.
C
What
we
really
need
now
is
the
other
organizations
who
are
have
recommendations
against
them
as
outlined
in
our
site,
and
who
cares
to
make
good
progress
on
that
and
to
update
us
so
we've
written
to
those
organizations
asking
for
an
update
and
we
will
be
reporting
on
that
later
in
the
year.
That's
a
bit
about
closed
cultures
and
then
briefly,
the
work
that
debbie
even
over
is
leading
on
learning
disabilities
and
autism.
So
it
has
kind
of
three
areas
of
focus.
The
first
one
is
making
sure
that
we
register
the
right
services.
C
So
that's
our
our
commitment
of
our
right
support
right
care,
right
culture
that
we
register
services
that
are
going
to
deliver
us
the
best
outcomes
for
people.
It's
about
making
sure
that
we
transform
the
way
we
regulate
services
for
people
with
learning
disabilities
and
autism,
and
that
we
take
robust
action
when
we
find
poor
care-
and
it's
also
looking
at
the
pathways
where
people
are
accessing
health
and
social
care
to
make
sure
it's
joined
up
and
through
may,
we've
undertaken
four
inspections
of
inpatient
services,
where
we
were
concerned
about
the
quality
of
care.
C
A
No
okay,
it's
really
really
important
topic,
but
obviously
obviously
no
questions
kate.
So
on
we
go.
C
Okay,
thank
you
so
so
care
home
visiting.
So
bored
we've
talked
about
this
on
a
number
of
occasions,
and
it
continues
to
be
a
really
important
issue
for
care
home
residents
for
family
members
and
for
those
providing
care
in
in
care
homes.
So
just
wanted
an
opportunity
to
remind
board
our
position
on
care
home
visiting.
So
throughout
the
pandemic,
we've
been
absolutely
clear
that
we
expect
providers
to
take
a
person-centered
approach
to
delivering
care
that
they
should
follow
government
guidelines.
C
They
should
listen
to
local
advice
from
the
directors
of
public
health,
but
they
should
absolutely
look
to
make
visiting
happen
where
possible.
Obviously,
there
have
been
changes,
along
with
the
lockdown
changes
for
people
to
have
access
to,
visiting
and
designated
carers,
etc.
We're
in
regular
communication
with
the
sector
about
our
expectations.
C
We
have
frequent
conversations
with
the
large
corporate
providers
about
how
they
are
ensuring
that
visiting
is
happening
and
how
they're
assuring
themselves
about
their
corporate
policies
and
how
that's
translating
to
their
various
care
homes.
We
are
then
looking
at
visiting
on
every
inspection,
so
every
inspection
has
a
mandatory
question
about
visiting
we're,
having
regular
conversations
with
local
authorities
to
kind
of
corroborate
the
information
we've
been
given
and
our
information
we
get
through
our
give
feedback
on
care
has
been
critical
in
helping
us
understand
how
visiting
is
going.
C
So
we
took
a
snapshot
of
the
last
eight
weeks.
We've
undertaken,
941
inspections
in
care
homes
and
as
part
of
each
of
those
inspections,
we've
looked
at
visiting
and
95
of
cases.
We
were
confident
and
saw
evidence
that
visiting
was
happening
as
per
government
guidelines
at
five
percent.
C
We
needed
to
take
some
action
and
that
was
often
a
conversation
with
the
provider
to
ensure
that
they
were
doing
what
they
needed
to
and
then
finally,
on
visiting,
we
are
absolutely
clear
that
we
do
not
expect
to
see
any
blanket
approaches
to
visiting
even
in
circumstances
where
there
is
outbreaks,
we
would
expect
a
provider
to
enable
visiting
to
happen
in
circumstances
such
as
end
of
life
care
for
people.
C
We
are
asking
the
public.
We
are
asking
representative
bodies
to
tell
us
if
they
know
of
any
homes
where
there's
a
blanket
approach
to
visiting
and
each
time
we've
been
informed
about
our
blanket
approach.
We
are,
we
are
going
out
and
we
are
taking
action
and
that
action
can
be
conversation
with
a
provider.
Physical
inspection
raising
a
safeguarding
there
and
working
with
local
authorities.
D
D
C
Thanks
robert,
so
I've
been
talking
to
my
inspectors
and
my
inspection
managers
and
my
heads
of
inspection
a
lot
about
this
over
the
last
few
months
and
there's
a
kind
of
strong
message
I
get
back
from
my
frontline
staff
is
that
visiting
is
happening,
but
it
feels
very,
very
different
for
residents
and
for
their
families.
So
visiting
is
happening,
but
it
might
involve
booking
a
slot
to
visit
your
loved
one.
It
might
involve
seeing
them
in
a
different
part
of
the
home.
C
There
might
be
a
limitation
on
the
time
spent
in
visiting
so
so
visiting
is
happening,
but
it
feels
incredibly
different
for
people
and
I
think
that's
where
there's
sometimes
a
mismatch
between
people's
perceptions,
about
whether
they're
able
to
visit
their
loved
one
and
and
the
kind
of
reality
again.
You
raise
an
important
point.
C
Every
care
home
has
a
different
geographical
setup,
so
in
some
care
homes
they
can
make
visiting
happen
in
a
way
that
feels
more
acceptable
to
families
in
other
care
because
of
limitations
around
that
environment,
it
might
still
be
in
a
in
a
pod
in
in
the
garden
or
in
a
communal
area,
etcetera.
So
when
we
look
at
it,
we
we
want
to
see
evidence
that
visiting
is
being
able
to
happen
that
it
is
as
flexible
as
possible.
C
But
we
absolutely
know
that
the
challenging
roles
that
particularly
care
home
registered
managers
have
had
over
the
last
year
of
that
balance,
I'll
talk
about
it
in
a
minute
when
I
talk
about
risk
of
physically
keeping
people
safe,
but
also
endeavoring,
to
meet
their
their
well-being
needs
to
enable
them
to
see
their
families
as
well.
A
But
I
think
casey
I
mean
that
that
number
of
inspections
is
is
really
phenomenal
and
I
think
the
board
would
want
to
thank
your
your
inspectors
and
your
your
teams
for
for
doing
that,
and,
of
course,
they're
not
just
inspecting
for
visiting
important,
though
that
that
is,
it's
obviously
very
much
a
safety
infection
prevention
and
control
inspection,
so
really
really
important,
and
that's
just
phenomenal.
So
thank
you
very
much
through
to
your
teams.
Please.
C
Thank
you
peter
so
and
if
I
just
move
on
and
just
do
a
kind
of
look
back
over
the
last
year
and
just
provide
some
comments
to
board
on
risk
in
adult
social
care,
so
I
think
we've
had
really
good
visibility
of
risk
within
the
sector
over
the
last
year.
So
70
of
social
care
providers
have
had
a
regulatory
activity
with
us,
and
that
might
be
one
of
our
structured
monitoring
tools
or
that
might
be
a
visit
and
generally
the
social
care
providers.
C
C
Chris
might
talk
about
this
a
bit
more,
but
we've
in
in
light
of
our
decision
early
on
in
the
pandemic,
about
causing
routine
inspections.
We
really
wanted
to
see
how
we
could
do
more
to
hear
from
people
about
their
experiences
of
receiving
care.
C
So
there's
been
a
big
push
over
the
last
year
on
asking
people
to
give
feedback
on
care
through
our
joint
campaign
with
healthwatch
england
called
because
we
all
care
and
as
a
result
of
that
kind
of
national
campaign
in
adult
social
care,
we've
never
received
as
much
intelligence
from
people
who
use
receive
care
and
their
families
and
people
who
work
in
the
sector,
as
we
have
done
over
the
last
12
months.
C
So,
on
average,
in
adult
social
care,
we
get
about
a
thousand
whistleblowing
concerns
a
month
and
about
2
000
safeguarding
concerns.
So
we
get
a
huge
amount
of
intelligence
that
comes
into
us
and
each
of
these
bits
of
information.
Each
of
these
bits
of
intelligence
helps.
Our
inspectors
have
a
really
good
view
of
quality
quality
and
risk.
C
Where
we
have
concerns
about
a
service,
we
do
a
variety
of
things.
We
usually
start
off
with
picking
up
the
phone
and
having
a
conversation
with
the
provider.
We
gain
additional
information
from
other
stakeholders,
like
local
authorities
and
we'd
undertake
monitoring,
monitoring,
review,
calls
or
we'd
go
out
and
inspect,
or
a
kind
of
combination
of
all
of
those.
C
During
last
year.
We
undertook
3553
risk-based
inspections,
so
these
were
where
we
were
going
out
because
we
were
concerned
about
what
was
happening
in
the
service.
So
of
those
three
and
a
half
thousand
inspections.
C
We
found
breaches
and
regulation
in
slightly
over
a
thousand
locations,
so
1059
locations
and
the
breaches
we
found
were
similar
to
the
the
reaches
we
used
to
find
prior
to
the
pandemic.
So
they
were
breaches
around
regulation
12,
which
is
about
providers
delivering
safe
care
and
treatment
to
people
and
regulation
17,
which
is
about
good
governance.
C
C
We
then
in
each
of
those
circumstances,
would
use
our
enforcement
policy,
so
we've
got
a
range
of
powers
that
we
would
have
used
from
requirement
notices,
putting
positive
or
restrictive
conditions
on
a
service
or
removing
the
registration
of
a
service.
So
that
is
a
rare
occurrence,
but
just
to
give
board
a
flavor
of
what
that's
looked.
Like
over
the
last
12
months
in
61
locations,
we
closed
the
service
down
as
a
result
of
our
enforcement
action.
C
So
our
focus
is
usually
supportive
enabling
the
provider
to
take
action
to
improve
outcomes
for
people,
but
where
people
are
getting
unsafe
care,
and
we
are
not
confident
in
that
services
ability
to
provide
safe
care.
We
can
take
action
and
close
services
down
and
then
finally,
on
this
thing
before
I
pause
and
invite
questions
and
hand
back
to
ian,
as
I've
already
mentioned,
there's
been
a
real
focus
over
the
last
particularly
six
months
on
the
care
for
people
with
learning
disabilities
and
autistic
people.
C
So
we
had
outside
in
october,
and
then
we
had
our
glinis
murphy
final
review
report
in
december
and
both
of
those
really
important
pieces
of
work
told
us
that
actually
people
with
learning
disabilities
and
autistic
people
are
at
higher
risk
when
they're
in
an
environment
a
long
way
away
from
their
community
and
their
family
home
receiving
care,
where
there's
maybe
less
visibility
from
external
visiting
professionals
and
families.
C
So
we
have
decided.
We
made
a
conscious
effort
to
prioritize
our
efforts
on
the
risk
we
perceive
for
people
who
are
in
inpatient
units
and,
as
I've
already
mentioned
through
through
this
last
month,
we
have
been
targeting
our
inspection
activity
at
those
poorer
quality,
inpatient
services
and
we
are
taking
action
where
we're
finding
poor
care
and
once
those
inspection
reports
are
published,
I'd
be
really
keen
to
give
board
a
bit
more
of
an
update
about
what
we
are
seeing
in
that
area.
G
Thanks
peter
and
thank
you,
kate,
I'd
echo
what
peter
said
before
about
such
an
impressive
long
list
of
inspections.
So,
thanks
to
you
and
your
team,
I
just
wanted
to
ask
where
you
found
the
thousand
breeches.
Are
they?
Can
you
give
us
a
sense
of
how
serious
they
are
so?
G
Are
they
minor
breaches
which
are
broadly
fixed
quite
quickly
when
you
point
things
out
or
do
you
think
they're
longer
term
embedded
problems,
because
a
thousand
is
still
quite
a
huge
number,
but
if
990
of
them
are
actually
relatively
minor
and
once
you
point
it
out
the
setting
improved
the
care
they
offered,
then
that's
very
different.
Isn't
it
yeah?
Thank.
C
You
sally
so
so
we
think
of
those
1059
locations
with
breaches
and
the
fact
that
we
closed
61
of
them.
That
gives
you
a
bit
of
a
proportional
scale
about
with
the
rest
of
those
either
they
improved
quickly
and
we
kept
an
eye
on
it
or
they're
still
on
an
improvement
journey,
and
we
are
keeping
a
you
know,
a
close
eye
on
their
progress,
but
of
that
of
that
1000.
C
The
fact
that
61
we
needed
to
take
action
to
stop
the
service
delivering
care,
hopefully
gives
you
a
bit
of
a
flavor
of
severity,
usually
when,
when
issues
are
pointed
out
to
providers,
they
are
eager
and
quick
to
want
to
address
them,
because
most
people
are
in
this
business
because
they
want
to
provide
high
quality,
excellent
care
and
sometimes
it's
having
a
fresh
pair
of
eyes
come
in
and
say
you
know,
you
really
need
to
refresh
your
policy
around
infection,
prevention
and
control.
C
This
is
maybe
what
a
good
good
practice
policy
looks
like.
That
is
enough
for
them
to
take
the
action
they
need
to
to
address
the
issue.
Thank
you.
That's
reassuring.
F
Okay,
thanks
peter,
so
so
I
I
just
like
talking
about
risk
in
the
hospital
sector.
I
just
like
to
break
it
up
into
into
three
areas,
particularly
the
first
area
is
very
much
related
to
the
pandemic.
We've
just
come
through
and,
and
I've
talked
to
the
board
before
about
the
amazing
response
to
the
pandemic
from
the
acute
sector,
and
I
think
you
know
coming
out
of
the
after
the
second
phase
of
the
pandemic.
F
We
can
be
enormously
pleased
by
what
was
achieved
in
terms
of
meeting
the
the
the
immediate
acute
demand
of
the
pandemic,
but,
of
course,
that
has
had
onward
onward
effects
and
first
of
all,
you'd
have
heard
earlier
on
this
morning
this
week
that
that
the
waiting
list
for
planned
procedures
is
now
running
at
record
levels.
F
Nearly
five
million
people
on
the
waiting
list
in
england
and
four
hundred
thousand
of
those
waiting
more
than
a
year,
so
there's
a
very
significant
impact
on
patients
waiting
for
planned
procedures,
and
we
need
to
focus
on
that
now.
But,
of
course,
this
is
in
the
context
of
services
that
still
have
reduced
capacity
because
of
precautions
they're
taking
against
infection,
but
also
staff
that
have
been
through
managing
enormous
pressures
at
the
height
of
the
pandemic,
particularly
the
second
wave
of
the
pandemic.
F
So
when
we're
looking
we're
working
with
providers
and
the
providers
are
telling
us
that
they
are
putting
in
plans
to
deal
with
this
backlog
of
planned
care,
but
equally,
we
are
asking
them
about
their
plans
to
manage
their
workforce
and
make
sure
their
workforce
get
the
support
and
respite
they
need
in
order
to
go
on
providing
high
standards
of
care.
I
think
it's
very
important
as
we
as
we
deal
with
the
with
the
aftermath
of
the
pandemic,
that
we
focus
on
the
effects
on
the
workforce
as
well
as
that
effect
on
patients.
F
F
This
includes
people
with
mental
health
problems,
and
it
also
includes
people
who
are
on
the
waiting
list
for
planned
treatment
who
are
coming
to
emergency
departments,
because
they're
worried
about
their
condition,
and
I
think
there
is
an
exceptional
pressure
now
on
emergency
departments.
It's
different
from
the
pressure
during
the
peak
of
the
wave,
the
the
second
wave
during
the
first
wave
emergency
departments
are
relatively
quiet
during
the
second
wave.
There
was
a
lot
of
serious
patients
presenting
at
emergency
departments
over
the
winter.
They
had
a
difficult
winter.
F
Now
they
are
having
a
difficult
summer,
and
this
is
driven
by
this.
This
unmet
demand
from
patients
with
relatively
minor
illnesses,
and
I
think
what
we
must
do
is
recognize
that
the
pandemic
is
having
these
after
effects
and
they're
affecting
people's
abilities.
Some
people
may
have
delayed
seeking
treatment.
Others
are
having
a
difficulty
accessing
the
care
they
need
and
are
because
emergency
departments
have
an
ever
open
door.
They
are
ending
up
in
emergency
departments
and
that
is
putting
exceptional
pressures
on
them.
F
What
we
are
doing,
colleagues
will
remember:
we
published
some
guidance
last
winter
patient
first,
which
was
about
keeping
the
emergency
department
safe
when
they're
under
enormous
pressure.
What
we're
doing
now
is
bringing
together
emergency
departments
clinicians
from
all
over
england
in
a
workshop
early
in
june,
and
what
we
want
them
to
do
is
learn
from
each
other
about
how
they
can
best
keep
services
safe
when
they
are
under
this
exceptional
pressure.
F
The
second.
The
second
thing
I
want
to
go
on
to
is
is
something
that
is
long-standing.
It
isn't
it's
just
pandemic
related
directly,
and
this
is
safety
culture,
and
during
the
pandemic
we've
seen
an
increase
in
whistleblowing.
Kate
was
talking
about
it
in
social
care.
We've
seen
this
in
hospitals
as
well.
That
has
been
really
useful
to
us
because
it
has
helped
us
identify
risk
in
services
and
during
the
pandemic,
of
course,
we've
been
driving
this
risk-based
inspection
methodology
and
the
staff
who've
been
raising.
F
Concerns
with
us
have
been
really
very
valuable
to
us
in
the
identifying
problems
and
we're
very
grateful
to
them
for
that.
But
I
think
one
of
the
things
we
want
to
do
is
promote
a
culture
of
openness
and
transparency,
where
staff
feel
free
to
raise
concerns
within
their
organizations,
and
those
concerns
are
listened
to
and
dealt
with
effectively,
and
that
is
so
important.
F
If
we're
going
to
see
the
safety
improvements
we
want
to
see
going
forward
and
in
in
a
sense,
we
can
build
on
the
success
of
of
staff's
stronger
voice
during
the
pandemic
going
forward,
and
I
think
that's
going
to
be
an
important
theme
as
we
go
forward
from
here.
F
A
couple
of
weeks
ago,
we
intend
we
attended
a
national
summit
of
national
bodies
on
maternity
services
and,
as
I've
described
before,
to
the
board
maternity
services
are
an
area
where
we're
particularly
concerned
about
safety,
culture
and
in
a
sense
that
is
where
we
want
to
start
in
getting
the
safety
culture
right
to
drive,
consistently
safe
care
and
we'll
be
working
with
national
bodies
and
with
local
services
to
drive
that
improvement
in
safety
culture.
At
the
moment.
We're
undertaking
inspections,
safety,
focused
inspections
of
maternity
services.
F
We
have
a
program
of
that
underway
at
the
moment
and
later
in
the
summer,
we'll
be
reporting
our
the
outcome
of
that,
but
essentially
early
on,
we
are
still
seeing
recurrent
problems
with
cultures
where
people
don't
feel
free
to
speak
up
about
concerns,
and
I
think
that's
really
important.
We
have
to
have
to
deal
with
that
going
forward
and
then
the
final
thing
I
want
to
come
back
to
what
kate
was
talking
about
in
terms
of
closed
cultures.
F
We
are
seeing
that
as
well
within
the
hospital
sector,
particularly
in
small
inpatient
units
for
mental
health
and
learning,
disability
and
autism
in
the
similar
way
to
cases
finding,
and
I
think
that
is
something
that
we've
seen
continually
throughout
the
pandemic.
I
don't
think
it's
pandemic
related
directly,
but
I
think
it
is
part
of
a
long-term
pattern
of
coming
to
grips
with
close
cultures
and
these
small
organizations,
where
staff
perhaps
don't
have
the
training
they
don't
have
the
sport.
F
They
don't
have
the
leadership
to
provide
that's
consistently
safe
care,
and
I
think
it's
really
important
going
forward
that
we
make
sure
the
lessons
that
we
drew
out
in
our
report
outside.
Who
cares
last
autumn
are
taken
forward
if
we
can
make
a
big
impact
on
services
in
these
small
areas,
and
we
will
of
course
continue
our
inspection
regime,
and
we
will
be
extending
our
inspection
over
this
year
to
make
sure
that
we
we
see
the
majority
of
mental
health
services
by
the
end
of
the
financial
year.
D
Well,
thank
you.
Thank
you,
ted
for
an
illuminating
report
and
clearly
a
great
deal
of
work
is
going
on
by
your
inspectors.
Behind
that
you
raised
what
in
effect
is
encouraging
news
about
whistleblowing
and
the
use
it
is
to
us,
but
measure
I
sense
with
a
bit
of
a
hint
that
why
are
they
having
to
whistleblowers,
opposed
to
talk
within
their
organization?
D
What
I'd
like
to
know
is
whether
we
keep
information
or
know
what,
if
any,
are
the
consequences
for
the
whistleblowers
who
talk
to
us
now?
Obviously,
some
of
them
will
have
done
so
anonymously,
but
not
all,
fortunately
do
that,
and
I
just
wonder
whether
we
keep
track
of
that
and
if
so,
what
we
know
about
it.
F
Well,
well,
we
do
keep
track
of
it
and,
of
course,
if,
if,
if,
if
staff
speak
to
us,
we
keep
that
confidential,
and
we
do
absolutely
everything
to
maintain
that
confidentiality
to
make
sure
the
whistleblowers
can
feel
protected.
In
that
way,
robert,
where
we
do
see
action,
detrimental
action
taken
event
against
whistleblowers.
F
We
regard
that
as
a
very
serious
issue
and
that
it
will
drive
our
well-led
inspections
to
to
to
look
at
the
safety
culture
of
the
organization
and
will
be
reflected
in
the
enforcement
action
and
reports
we
produce.
So
as
we
develop
our
well-led
approach,
we
are
going
to
focus
much
more
on
how
well
organizations
listen
to
whistleblowers
internally
and
whether
they
take
action.
On
that,
I
I
should
say
I
don't.
A
Good
thanks
ted
mark
saxton.
E
Thanks
chairman
and
ted
thanks
very
much
for
this
report,
just
listening
to
you
about
ed,
you
talked
about
pandemic
pressure.
It
talked
about
summer
pressures
talked
about
winter
pressures.
I
mean
really
we're
just
talking
about
all
around
annual
pressure
where
we
used
to
just
talk
about
winter
pressures.
So
you
know
your
point
about
transfer
of
best
practice
is,
I
think,
absolutely
critical.
You
know
to
you
know,
fend
off
this,
this
ongoing
challenge
for
for
ed.
E
I
thought
your
point
about
safety.
Culture
is
absolutely
right,
but
could
I
ask
you
to
what
extent
do
you
feel
that
organizational
challenges
are
safety
factors
as
well?
So
I'm
talking
about
tiredness
of
staff
about
roster
gaps
due
to
staffing
levels,
about
long-term
absence
coming
from
the
pandemic.
You
know
these.
You
know
this
is
a
real
challenge
for
for
those
for
the
for
the
sector.
A
real
well
led
element
for
us
to
look
at,
but
I
just
wanted
to
what
extent
is
culture
versus
organizational
structure?
I.
F
I
think
the
way
organizations
manage
their
workforce
mark
is
very
tied
up
with
the
safety
culture.
I
think
we
know
that
hierarchical
cultures,
cultures,
where
there's
bullying,
cultures,
where
staff
don't
feel
supported,
start
where
staff
aren't
trained,
as
you
say,
when
they
can't
get
adequate
risk.
All
their
rotors
are
unsatisfactory.
F
Those
tend
to
drive
unsafe
practices,
and
I
think
we've
seen
a
lot.
We've
learned
a
lot
during
the
pandemic.
It
was,
I
think,
one
of
the
really
impressive
things
during
the
pandemic
was
how
staff
rose
to
the
challenge,
but
also
how
the
organizations
enabled
and
supported
them
rising
to
the
challenge
and
a
lot
was
put.
A
lot
of
effort
was
put
into
support
staff
during
the
heights
of
the
pandemic.
That
needs
to
go
on
to
deal
with
the
aftermath
of
the
pandemic,
but
also
to
build
these
real
important.
These
really
important
safety
cultures
going
forward.
F
A
So
ted
you
just
said
just
now
said
you,
you
saw
staff
in
in
in
hospitals
rising
to
the
challenge.
I
think
your
staff
have
risen
to
the
challenge
over
the
pandemic
as
well.
So
I
think
the
board
would
want
to
recognize
that
and
and
pass
on
our
thanks
to
your
teams,
please,
I
think
just
really
interesting.
I
mean,
in
addition
to
all
the
individual
inspections
and
findings
and
our
normal
day
job
of
monitoring
and
inspecting
and
rating.
A
I
mean
you
raised
three
really
big
themes
there,
which
we've
discussed
before,
but
I
think
and
I'm
sure
you
will
want
to
come
back
to
the
board
from
time
to
time
and
report
on
progress
on
safety,
culture
in
particular,
closed
cultures,
hugely
important,
and
I
think
the
the
ed
workshop
be
really
interesting
to
find
out
what
learning
comes
from
that
and
and
and
and
how
that
that
sort
of
whole
national
approach
develops.
So
I
think,
really
really
important
report.
Thank
you
very
much
indeed,
and
then,
if
ted's
finished,
do
we.
F
One
is,
I
was
going
to
say
during
the
performance
report
that
that,
while
the
frontline
clinical
staff
have
been
rightly
praised-
and
I
add
my
prayer
to
that-
I
also
want
to
praise
our
frontline
staff,
who
had
had
an
enormous
impact
and
have
adapted
really
well.
So
perhaps
we
come
back
to
that
in
the
performance
report
that
peter.
F
On
these
various
issues,
ed
is
an
issue
now,
but
next
winter
I
think
potentially
could
be
very
difficult
because
of
resurgence
of
other
winter
viruses
that
have
been
suppressed
during
this
last
winter.
So
I
think,
there's
a
real
concern
around
next
winter
and
eds
need
to
be
well
prepared
and
we
want
to
do
best.
We
can
to
support
that
and,
as
I
say,
we'll
come
back
to
your
maternity
service.
F
F
That
I
may
be
raising
expectations
unrealistically,
but
later
in
the
year
we
will
produce
a
report
on
that.
A
Perfect,
thank
you
very
much
ted,
so
I'll
be
happy
to
move
on
to
rosie.
H
And
can
I
just
echo
my
thanks
to
my
team
as
well:
who've
been
working
extremely
hard
and
we'll
we'll
pick
it
up
in
the
performance
report,
but
the
the
pms
team
have
been
equally
kind
of
following
up
risk
supporting
other
directorates
as
well,
and
adult
social
care
and
registration
with
their
work
and
and
dealing
with
a
whole
range
of
issues
that
have
been
passing
through.
So
so
thank
you
very
much
to
the
pms
team
and
all
their
hard
work
during
the
last
few
months.
H
Access
is
a
key
theme
I
wanted
to
cover
over
the
the
next
few
minutes.
If
that's,
okay,
peter
we're
talking
about
oral
health
access
later
with
the
insight
report,
so
I
won't
talk
about
oral
health.
H
I
just
want
to
focus
a
little
bit
on
on
general
practice
during
the
next
few
minutes,
and
I
think
I
just
wanted
to
echo
something
ted
was
saying
is
that
we
are
dealing
with
a
very
exhausted
tired
workforce
who
have
been
working
flat
out
now
since
last
march
and
that
in
itself
poses
risks
to
quality
and
safety,
because
because
of
the
the
the
burnout
that
is
being
experienced
by
some
parts
of
the
workforce
general
practice,
we
are
hearing
reports
of
significant
increase
in
demand,
particularly
in
the
last
few
months,
and
that's
due
to
a
whole
variety
of
factors.
H
We've
got
the
backlog
of
things
that
weren't
done
during
the
the
significant
waves
of
the
pandemic,
so
long-term
conditions,
management,
screening,
immunizations
and
late
presentations
of
of
cancers,
late
presentations
of
various
other
illnesses,
we're
hearing
an
increase
in
the
number
of
people
presenting
with
mental
health
conditions.
Due
to
the
difficult
situation.
H
There
is
an
impact
of
people
waiting
on
long
waiting
lists
on
primary
care.
People
do
present
frequently
with
wanting
help
and
support
during
that
time
when
they
are
waiting,
and
that
has
a
significant
impact
and,
of
course,
the
the
vaccination
program
that
primary
care
has
been
very
involved
in
that
that
is
having
people
are
very
busy
delivering
the
vaccination
program
as
well,
and
that's
on
also
complicated
by
various
issues
around
certain
facilities
and
estates
and
the
complications
of
social
distancing
and
various
other
things
in
primary
care.
Just
to
just
to
back
that
up.
H
The
data
around
appointments
show
that
in
march
of
2021,
27
million
appointments
were
delivered
in
in
general
practice,
and
that
is
a
20,
almost
20
increase
from
march
2020,
when
22.8
million
appointments
were
delivered.
So
there
has
been
a
significant
increase
year
on
year
that
we've
seen
in
appointments
that
there
is
some
caveats
around
that
data
because
of
the
quality
of
data,
and
there
is
also
a
feeling
that
might
under
represent
some
of
the
digital
contacts
that
that
are
had
in
primary
care.
H
On
the
flip
side,
we
are
hearing
negative
experiences
from
some
patients
around
access
about
not
being
able
to
get
face-to-face
appointments
particularly,
and
we
are
identifying
risks
on
inspection.
We
have
seen
quite
a
shift
in
the
type
of
access
pre-pandemic
76
of
people
were
seen
face
to
face,
and
in
march
21
this
figure
was
41.
H
42
were
seen
face
to
face
with
their
gp,
so
there
has
been
a
shift
and
clearly,
in
some
cases,
that's
more
convenient
for
a
person,
but
in
some
cases
it's
not
appropriate
and
we
really
welcome
the
rcgp
position
in
this.
That
they've
done
a
recent
report,
which
was
called
the
future
role
of
remote
consultations
and
patient
triage
where
their
position
states,
the
mode
of
consultation,
should
be
determined
through
shared
decision
making
between
a
patient
and
practice
staff,
and
I
think
that's
absolutely
right.
H
It
needs
to
be
very
person-centred
to
identify
what
how
how
a
person's
needs
are
going
to
be
met,
we're
continuing
to
work
with
partners
on
access
across
the
primary
care
community,
and
I
just
wanted
to
flag
as
well
that
through
our
pr
provider,
collaboration
work,
we
are
identifying
really
good
practice
and
we're
flagging
that
and
some
of
that
you'll
see
in
the
cancer
report.
That
is
in
the
insight
report
later.
But
we
want
to
continue
to
identify
good
practice
and
share
that
learning
as
much
as
possible.
H
I
think
just
going
on
to
ted's
point
about
people
attending
a
e
and
with
minor
illness.
I
think
it's
really
important
more
so
than
ever
that
systems
local
systems
work
together
right
across
all
of
the
different
resources
in
a
local
system
and
that's
pharmacies:
optometrists,
dentists,
gps,
andes,
all
of
the
community
services,
as
well
as
the
acute
settings
and
the
mental
health
services
to
really
look
at
where
how
do
they
work
together
to
meet
patients
needs?
H
There's,
no
doubt
there's
huge
demands
on
all
of
the
parts
of
the
system
at
the
moment
and-
and
the
only
way
through
this,
I
think,
is
by
people
working
together
and
we
certainly
don't
want
to
get
into
any
situation
where
we've
got
different
parts
of
the
system.
Saying
well
we're
busy
and
you're
not-
and
I
think
everyone's
busy
at
the
moment
and
and
we
need
to
recognize
that
and
need
to
make
sure
that
access
is
high
on
systems
agenda
and
people
get
the
right
care
at
the
right
time.
I
Coming
up
neat
and
just
a
couple
things
just
one
thing
to
go
through
in
a
report
and
I'll
just
come
back
to
some
of
the
comments
that
people
have
made
earlier,
just
to
say:
we've
given
quite
a
bit
of
information
to
parliament.
Recently
ian
spoke
with
close
from
dhsc
an
mhcl
at
the
public
accounts
committee.
The
focus
of
that
was
on
market
oversight
and
the
wider
social
care
stability.
I
He
talked
very
a
about
our
the
fact
that
most
services
were
were
rated
as
good,
but
sixteen
percent
of
services
are
still
rated
in
inadequate
or
requires
improvement.
We
talked
about
also
about
the
the
limited
scope
of
our
financial
oversight
of
those
organizations
and
that's
been
taken
into
account
in
the
latest
national
audit.
Sorry,
public
accounts
committee
report.
That's
come
out.
We
we
at
the
moment
have
a
financial
oversight
of
about
30
percent
of
the
market
with
65
difficult
to
replace
providers.
I
We
also
gave
evidence
to
the
joint
committee
and
human
rights
and
just
to
reiterate
what
kate
said
earlier,
where
we
hear
the
voice
of
people
giving
us
concern
about
access
to
visiting.
We
follow
up
on
each
of
those
individual
cases
and
we
are
very
grateful
to
hear
from
people
to
continue
to
hear
from
people
in
their
views
in
this
space.
We're
writing
to
the
committee
again
to
confirm
our
position
on
this,
and
we
also
gave
some
evidence
at
the
the
with
ofsted,
alongside
officer
the
children's
commissioner.
I
Just
looking
at
our
joint
inspections
with
with
ofsted
and
again,
there
was
a
strong
support
for
the
continuation
of
that
work.
Just
going
back
to
something
that's
coming
up.
That
strategy
is
due
for
publication
on
the
27th
of
may.
She
wanted
to
say
three
things
about
that.
One
is
to
thank
everybody,
both
internally
and
externally,
for
their
their
engagement
over
the
last
year
on
the
development
of
this
strategy.
I
We
we
recently
took
it
to
an
external
studio
advisory
group
this
week.
There's
really
strong
support
for
the
themes
in
the
strategy
and
really
strong
support
for
to
help
the
organization
arrive
at
the
best
solution
for
each
part
of
that
strategy
for
each
part
of
each
one
of
those
themes.
I
just
wanted
to
say
thank
you
to
to
the
colleagues
both
instantly
and
externally
have
made
that
happen.
It's
also
for
us
bear
in
mind.
I
What's
happened
over
the
last
year,
it's
the
flexible
use
of
both
online
and
offline
engagement,
so
we've
used
new
approaches
to
engagement
with
with
groups
of
people
who
use
services,
groups
of
providers
and
groups
of
stakeholders
that
we
wouldn't
have
used
before
and
actually
we've
reached
many
more
thousands
of
people
because
of
that
engagement,
so
using
both
face-to-face
workshop
meetings,
which
are
both
online
and
offline,
webinars
and
recorded
events,
we've
reached
many
more
people
than
we
would
have
done
in
a
in
a
different
in
a
different
way.
So
thank
you.
I
Thank
you
for
their
support.
Thank
people
for
their
continued
support
as
we
work
on
the
implementation
of
those
and
then
finally,
just
come
back
to
a
point
that
ian
made
earlier
and
I
think
kate's
made
it
as
well.
The
last
year
has
been
more
important
than
ever
to
hear
about
the
voice
of
people
youth
services
since
the
beginning
of
the
pandemic.
We
know
that
the
voice
of
people
and,
in
fact
the
voice
of
frontline
staff,
has
been
critical
in
our
understanding
of
how
services
are
performing.
I
I'm
delighted
to
say
that,
with
a
partnership
with
healthwatch
and
with
other
organizations
that
we,
where
we
have
a
joint
approach
to
to
the
gathering
of
information,
we've
seen
a
60
rise
in
online
feedback
using
the
give
feedback
on
care
application
which
which
we
redeveloped
recently,
we've
also
seen
some
really
strong
improvements
in
both
health.
What
england's
feedback
and
other
organizations
the
partnership
organization's
feedback?
I
We've
had
a
number
of
spikes
of
that
work.
So
looking
at
people
with
long-term
conditions,
older
people,
carers,
people
with
learning
disabilities,
we've
looked
at
particular
groups
of
people
where
we
were
unrepresented
in
terms
of
that
feedback
from
black
asian
and
minority
ethnic
communities
from
other
settlement
communities.
We've
also
had
specific
issues:
spikes
around
nhs
111
and
around
kirby
vaccinations
and
we've
got
another
one
planned
as
well,
as
you
mentioned,
around
access
to
primary
care
as
well.
I
These
are
vital
in
in
in
our
ability
to
take
action
quickly
when
we
see
concerns
and
just
to
be
just
to
reiterate
something
that
that
ted
said
earlier.
We
do
protect
the
individuals
that
offer
that
information
and
we
use
it
to
guide
our
our
responsive
inspections
and
we've
taken
on
many
more
thousand
responsive
inspections
and
respond
direct
response
to
the
feedback
we've
received
from
people,
and
I
hope
that's
something
we
can
take
out
of
the
the
pandemic
and
learn
from.
I
I
think
the
idea
of
an
emotive
campaign
that
also
overcomes
a
barrier
of
I
shouldn't
criticize
being
positioned,
as
this
is
feedback
to
support
learning,
going
back
to
ted's
point
a
campaign
that
works
for
both
service
providers,
partners
and
others,
because
this
is
useful
to
organizations
and
that
we
do
in
partnership
with
with
wider
organizations,
represent
people's
views.
I
hope
very
much
we'll
take
that
on
board
as
we
develop
our
campaigns
into
into
this
year.
That
was
all
I
had
to
say
peter.
A
No,
I
mean
chris,
I
I
just
think
it's
really
encouraging
that
we're
seeing
this,
this
steady
increase
of
information
from
the
public
service
users
and
and
and
from
staff
and
yeah
the
more
as
you
say,
the
more
we
get
then
the
more
we
can
turn
that
into
useful
response
from
us.
So
it's
very
good.
A
I
missed
it.
Sorry,
thank
you
great
good.
Let's
move
on
then
to
the
quarterly
people,
performance
and
finance
report.
Mr
usha.
B
Thank
you
peter,
so
it
is
more
than
just
the
quarterly
is
it
is
the
story
of
the
year,
so
we,
the
papers,
were
included,
provide
a
reflective
review
of
our
performance
in
2021,
but
obviously
in
the
year
that
was
our
business
plan.
B
Measures
only
tell
part
of
the
story,
so
our
performance
team
is
therefore
they've
included,
a
two-page
summary
which
tries
to
give
a
graphical
representation
that
rounds
up
a
bit
of
our
delivery
and
performance
in
the
year
in
support
that
we've
also
got
the
the
the
standard
business
plan
dashboard
for
the
year
and
supporting
analysis
as
well
as
the
people
metrics.
B
I
I'm
going
to
hand
over
now
because
we're
going
to
do
some
highlights
from
the
year
from
each
of
the
exec
and
I'll
I'll.
If
we
come
back
to
me
I'll
do
a
bit
on
before
sorry
in
finance
as
well,
but
kirsty.
I
think
you
were
going
to
start
us
off.
J
I
was
thank
you
and
then
chris,
if
you
can
come
back
to
me
I'll,
do
the
people
bit
at
the
end,
if
that's
okay,
so
from
a.
J
Just
a
couple
of
areas
I'd
like
to
draw
your
attention
to,
I
think
one
is
our
quality
improvement
program.
I
think
this
continues
to
go
from
strength
to
strengths.
Over
the
year
we
now
have
more
than
nearly
50
of
our
workforce
have
done
their
bronze
training
and
we've
got
a
number
of
projects
on
on
the
stocks.
We've
got
over
80
projects
that
have
been
that
are
in
in
train
this
year.
J
Most
of
those
have
been
generated
by
our
colleagues
on
the
front
line
who
have
identified
areas
where
we
can
both
improve
our
processes
and
our
ways
of
working
to
make
their
jobs
easier
and
to
deliver
better
services,
and
I
think
that's
just
an
indication
of
the
enthusiasm
for
for
quality
improvement
throughout
the
organization.
It's
good
to
see
that
that's
really
starting
to
take
root.
Now
I
think
we
we,
we
have
been
looking
at
our
estate
over
the
year.
J
Obviously,
the
pandemic
has
has
made
us,
take
some
very
radical
moves
around
moving
people
out
of
out
of
offices
and
into
a
home-based
environment,
but
we
were
already
pre-pandemic
starting
to
think
about
our
office
space,
and
over
this
year
we've
actually
managed
to
permanently
reduce
our
office
works
workspace
by
34
we've
now
got
nearly
80
of
our
workforce
are
now
being
permanently
home
based,
and
I
think
this
is
all
contributing
to
our
our
agenda
around
our
overall
carbon
reduction
target,
which
I
think
is
is
really
positive.
J
J
They
have
performed
amazingly
well
over
this
year.
Most
of
those
are
our
most
junior
members
of
staff.
They
normally
sit
in
a
call
center
environment
in
newcastle,
where
they
have
a
lot
of
support
around
them
in
terms
of
floor
workers
with
the
pandemic,
we
moved
every
single
one
of
those
to
a
home-based
environment
and
we
have
managed
to
maintain
a
service
of
answering
the
telephone
within
our
target.
J
Calls
and
they've
handled
what
and
they
handled
well
over
1100,
so
112
000
notifications,
just
during
april
and
may
alone,
which
was
significantly
higher
than
that
had
been
doing
last
period
and
we've
continued
to
do
that
and
then
just
finally,
for
me,
I
think,
within
the
registration
space
we've
processed
nearly
30
000
registrations
over
the
year.
J
We
have
also
managed
to
prioritize
our
activity
in
response
to
covid
so
that
we
were
able
to
prioritize
those
applications
that
were
adding
capacity
in
the
system
to
support
the
covered
response
and,
as
part
of
that,
we've
also
been
fairly
innovative
in
terms
of
how
we've
worked
with
providers
to
to
ensure
that
we
can
upski
bring
on
capacity
quickly,
and
a
really
good
example
is.
That
is
how
we
worked
with
nhs
england
to
support
the
establishment
and
registration
of
the
new
united
girl
hospitals.
J
So
shall
I
hand
to
kate
next.
A
Can
I
can,
I
just
emphasize
something
you
just
said
kirsty,
which
is
that
some
of
those
hundred
and
twelve
thousand
calls
can
be.
You
know
quite
distressing
for
the
person
receiving
them,
and
the
support
that
we
would
normally
have
existed
by
being
in
in
the
office
is
obviously
not
there,
and
I
just
think
we
need
to
to
recognize
that
and
doubly
thank
the
people
taking
those
calls
for
the
way
they've
handled
them
and
and
their
resilience
in
handling
them,
because
it's
it's
not
always
very
easy,
to
put
it
mildly.
A
Absolutely
right
we'll
be
happy
to
move
on
then
who's
who's
gonna
speak
next.
C
So
there's
so
much
I
could
talk
about
in
terms
of
adult
social
care
inspection
activity
over
the
last
year,
but
I'll,
try
and
just
hone
it
down
to
a
few.
A
few
key
points
I
think
the
first
point
I'd
make
is
the
kind
of
flexibility
of
our
staff
to
adapt
new
ways
of
working
so
to
focus
at
the
start
of
the
pandemic.
On
increasingly
emphasizing
the
supportive
relationship
we
had
with
registered
providers
and
the
ability
to
escalate
their
concerns
and
take
action
when
needed.
We've
developed
new
methodologies
throughout
the
year.
C
So
obviously,
we've
had
the
new
approach
to
having
structured
monitoring
calls
in
adult
social
care.
Over
the
summer,
we
developed
a
kind
of
bespoke
inspection
around
infection
prevention
control,
with
a
real
focus
on
ensuring
providers
were
delivering
safe
care
and
then,
in
the
autumn,
in
response
to
recommendations
from
the
social
task
force.
C
We
responded
to
the
government's
request
for
designated
settings
to
be
set
up
across
the
country
so
that
people
leaving
hospital
with
a
covered
positive
status,
whose
long-term
destination
was
a
care
home,
had
an
interim
ability
to
stop
so
that
they
could
receive
their
care
until
they
were
able
to
move
to
their
long-term
care
bed.
So,
on
the
designated
settings
we
approved
144
locations
which
equated
to
over
2
100
beds
and
then
just
a
bit
in
terms
of
the
big
numbers.
C
So
for
the
last
financial
year,
adult
social
care
did
6
369
inspections
throughout
the
year
and,
as
I
mentioned
earlier,
on
board
70
of
our
25
and
a
half
thousand
providers
had
a
regulatory
intervention
or
activity
from
our
staff
and-
and
I
suppose,
just
to
finish
on
whether
it
was
our
inspectors
that
were
out
crossing
the
threshold
or
whether
it
was
our
inspectors
who,
for
various
health
reasons,
were
inspecting
from
their
home.
C
Whether
it
was
our
you
know,
directorate
support,
colleagues
or
our
staff
in
management
or
market
oversight,
everyone
has
had
a
role
to
play
in
ensuring
that
people
have
got
care
that
they've
needed
over
the
last
year.
So
just
a
big
thank
you
to
every
bit
of
the
organization
in
terms
of
enabling
my
inspectors
to
get
out
and
make
sure
that
people
are
getting
high
quality
care.
Thanks
thanks,
kate,
rosie.
H
Thank
you
peter.
Just
to
echo
what
kate
said.
Our
teams
have
learned
multiple
new
methodologies
over
the
last
year
and
adopted
them
very
very
quickly.
We've
had
the
emergency
support
framework,
the
transitional
monitoring
approach,
the
the
pra
as
well,
and
also
in
in
pms.
We
have
in
general
practice,
we've
introduced
a
new
way
of
looking
at
clinical
searches
to
to
identify
risk
as
well,
which
is
something
we
can
do
off-site
and
has
been
very
effective
at
identifying
areas
of
concern.
H
H
Those
and
I'm
really
pleased
to
say,
we've
seen
significant
improvements
in
many
of
those
special
measures,
practices
we're
just
working
through
the
data
and
the
learning
and-
and
I
hope
to
include
something
in
in
forthcoming
board
reports,
because
we've
seen
some
great
improvement
in
practices.
Despite
all
of
the
challenges
that
they've
faced
during
the
pandemic,
we're
continuing
to
work
with
their
local
partners
in
those
practices
where
we
haven't
seen
improvement
to
make
sure
that
those
improvements
are
are
made.
H
Our
current
focus
is
looking
at
going
back
to
requires
improvement
practices
to
make
sure,
likewise
that
the
improvements
that
have
happened
are
continuing
and
we're
following
up
our
areas
of
regulatory
breach
as
well.
H
The
other
thing
to
mention
is
our
teams
have
undertaken
over
two
and
a
half
thousand
tmas
during
the
last
year,
which
has
provided
to
be
proved
to
be
a
very
good
engagement
tool
with
providers,
and
we've
had
lots
of
positive
feedback,
particularly
from
our
oral
health
colleagues,
about
how
they've
how
they've
welcomed
the
engagement
and
the
support
that's
been
given
through
those
through
those
calls.
F
Yes,
thanks
peter,
and
just
just
again
to
pay
tribute
to
my
colleagues
in
what
has
been
a
very
difficult
year.
They
have
achieved
amazing
things
and
I
think
it
is
difficult
to
underestimate
how
radically
different
our
approach
has
been
during
the
pandemic
and
how
we've
managed
to
implement
an
effective
approach
to
regulation.
F
Despite
this
approach,
we've
been
interacting
on
a
regulatory
basis
with
more
providers
this
year
than
we
ever
planned
to,
because
we've
been
using
all
the
other
tools
that
the
colleagues
have
talked
about,
such
as
the
tma,
such
that.
The
fact
that
the
vaccination
monitoring
approach
that
we
had
to
look
at
vaccination
centers
and
those
things
were
developed
very
quickly
and
have
been
applied
very
effectively
and
making
sure
that
we
have
a
real
breadth
of
a
regulatory
spread
across
services.
The
cma
we've
done
for
all
independent
health
providers
across
the
country.
F
So
so
we
have
a
real
sense
of
independent
health
risk
at
a
time
when
a
lot
of
the
focus
has
been
on
the
the
acute
sector
dealing
with
the
pandemic,
where
we've
been
supportive
but
focusing
on
areas
of
risk
that
I
talked
about
earlier
on.
I
also
want
to
pay
tribute
to
my
colleagues
in
the
mental
health
act,
review
team
and
the
soad
team.
F
The
the
second
opinion,
a
second
opinion
appointed
doctors
team
who
have
been
really
changing
the
methodology
in
the
approach
of
mental
health
reviews
over
the
year
and
managed
to
maintain
a
really
focused
service
to
make
sure
that
we've
fulfilled
our
duties
under
the
mental
health
act,
to
review
mental
patients
determined
by
the
mental
health
health
act
of
the
year
and
make
sure
they're
consistently
getting
the
right
support
and
you've
been
so
easy
to
neglect
such
an
important
sector
during
a
time
of
pandemic,
but
they've
developed
virtual
approaches
that
have
been
really
innovative
in
driving
forward
that
approach
and,
of
course,
we'll
learn
from
that
going
forward.
F
So,
while
we're
not
going
to
stay
virtual,
we
will
learn
from
that
virtual
experience
going
forward,
and
one
last
thing
I
want
to
mention
is-
and
curse
kirsty
mentioned
this
earlier
on,
and
this
is
quality
improvement,
and
I
think
one
thing
that
that
the
the
directorate
has
been
doing
this
year,
which
has
been
really
successful,
is
implementing
quality
improvement
initiatives
and
taking
on
board
and
move
towards
a
real
quality
improvement,
driven
agenda
and
culture
within
the
organization
and
they've
done
some
really
great
work.
They've
done
some
work
about
induction,
which
has
been
really
good.
F
Welcoming
people
into
the
direct
trips
over
this
last
year
that
we've
recruited
they've
done
work
around
how
we
manage
whistleblowing
and
safeguarding
and
they've
done,
work
about
how
we
produce
reports
inducing
more
quickly
more
more
succinctly,
more
consistently
going
forward,
and
that
has
all
been
work
going
on.
In
the
background,
while
we've
been
managing
the
pressures
of
the
pandemic,
so
I
think
I
think
in
many
ways
it
is
a
bit
we've
come
through
the
pandemic.
F
Incredibly
well
as
a
directorate,
it's
been
really
challenging
at
times,
and
pressures
have
been
felt
by
those
people
who
who've
been
worried
about
the
the
the
infection
and
going
out
to
inspect.
But
having
said
that,
I
just
want
to
pay
tribute
to
all
of
them
and
what
they've
contributed
over
this
last
year.
A
Thanks
ted
and
I
think
the
point
you
made
that
we
have
adapted
and
and
learnt
a
lot
and
that's
great
success,
and
what
we
now
need
to
do
is
to
work
out
how
much
of
those
different
ways
of
working
we
want
to
retain
how
much
we
want
to
further
develop
and
how
much
of
what
we
used
to
do.
A
We
want
to
bring
back,
and
I
think
that's
that's
going
to
be
really
important,
but
it's
been
a
fantastic
opportunity
in
a
strange
sort
of
way
to
to
be
able
to
experiment
and
learn
at
a
pace
in
a
way
which
we
probably
couldn't
have
done
in.
In
other
circumstances,
can
I
can
I
bring
mark
something
in
having
failed
mark
to
give
you
your
moment
of
glory
on
the
cyber
security
earlier.
K
I
I
think
I
just
echo
what
what
colic
said
earlier
on
about
the
the
the
new
way
of
working
over
the
last
year.
I
think
for
us
in
in
digital,
it's
been
a
huge
opportunity
for
us
to
to
accelerate
some
of
the
transformational
work
that
we'd
we'd
already
had
planned
and
underway.
K
So
the
support
of
the
the
organization
through
the
emergency
support
framework
and
the
transitional
monitoring
authority
application,
has
enabled
us
to
to
embed
some
of
the
technology
earlier
and
rolling
out
earlier
than
we
had
originally
planned,
for
which
I
think
has
been
a
great
testament
to
not
only
the
the
technology
teams
and
the
suppliers
that
we
work
with
in
order
to
enable
us
to
to
to
achieve
that
and
to
enable
us
to
continue
to
continue
our
regulatory
activity
through
the
pandemic,
but
also
to
you
know
to
the
organization
that
have
embraced
this
new
way
of
working
in
this
new
technology.
K
To
help
us
to
to
do
our
work.
And
I
think
just
looking
at
the
the
fact
that
over
the
over
the
last
year,
we
we've
been
able
to,
through
this
method,
had
some
kind
of
regulatory
contact
or
activity
with
over
half
of
our
providers
throughout
the
last
year.
K
I
think
that's
a
a
great
testament
to
the
teams
working
working
very
well
and
and
that
that
foundational
work
is
really
standing
us
in
now
in
good
stead,
as
we
move
forward
with
the
development
of
our
digital
platforms
to
support
our
strategic
aims
in
the
future.
K
So
I'm
looking
forward
to
to
smarter
regulation,
our
microsoft
dynamics,
solution
that
we've
implemented
through
the
emergency
support
framework
and
and
and
and
the
transitional
monitoring
application
will,
it
will
essentially
morph
to
become
a
new
regulatory
platform
and
enhancing
them
and
extending
them
to
provide
better
services
for
our
for
our
colleagues
internally
to
be
able
to
carry
out
their
regulatory
activity
to
give
them
more
meaningful
insights,
but
to
also
provide
a
better
digital
services
for
our
providers
that
we
that
we
regulate
and
to
be
able
to
deliver
not
not
only
much
much
much
more
efficient
and
richer
services
online
to
to
our
providers,
but
to
be
able
to
provide
much
better,
more
insightful
information
to
to
the
public
as
well.
A
A
I
mean
we
were
actually
in
a
much
better
position
to
be
able
to
move
to
new
ways
of
working
than
we
would
have
been
had
we
not
done
that
work
and
if
the
pandemic
had
hit
you
know
a
year
earlier
or
something
I
know
we're
not
the
only
organization
you
can
say
that,
but
I
think
we
are
particularly
well
placed
thanks
to
the
efforts
of
your
team
and
and
kirsty's.
K
Team,
thank
you
peter.
Yes,
I
think
the
the
the
the
technology
that
we've
embraced
around
collaboration
has
really
supported
us
well,
and
the
ability
for
us
to
to
essentially
move
our
contact
center
completely
online
and
to
be
able
to
work
remotely
from
people's
homes.
K
I
think
is
a
is
great
achievement
again,
both
both
the
technology
achievement
and
an
achievement
from
our
colleagues
to
rapidly
adapt
to
that
new
way
of
working
but
centers
in
an
almost
good
stead
for
the
future
as
well,
because
I
know
a
lot
of
the
successes
that
we've
had
will
continue
to
support
us
well
in
the
future
as
well.
Yeah
ian.
B
But
in
doing
that,
we
also
tried
to
make
sure
that
our
strategic
ambitions
and
you've
touched
upon
some
of
them.
There
continued
as
well
so
some
of
the
big
strategic
pieces,
investment
in
the
in
the
technology
platforms,
reducing
our
reducing
our
office
footprint
by
moving
out
to
stratford
all
of
those
sorts
of
things.
We
tried
to
continue
to
do
those
things.
B
At
the
same
time,
we
also
invested
in
in
some
of
the
cultural
pieces
that
ted
was
talking
around
around
around
process
improvement,
all
the
time
aiming
to
try
and
make
sure
that
we
were
a
credible
partner
to
government
where
that
was
appropriate.
We
were
doing
what
we
needed
to
do
as
a
as
a
regulator
in
terms
of
in
terms
of
delivering
for
the
public,
but
also
setting
ourselves
up
for
the
future,
so
that
we
could
we
could.
B
We
could
learn
the
lessons
from
from
covert
and
come
out
the
other
side
in
a
way
that
that
satisfied
all
of
our
stakeholders-
and
I
I
I
think
we
we
we've
largely
succeeded.
I
think
there's
always
going
to
be
things
that
we
will
want
to
do
more
of
and
better
and
so
on.
And
I
know
I
think,
we're
all
concerned
about
the
lack
of
of
being
able
to
come
together
during
this
year,
which
has
been
some
of
the
pieces
around.
B
Our
our
cultural
change
are
possibly
not
necessarily
incomplete
completely
there
yet,
but
I
think
we've
certainly
made
some
some
really
good
strides
during
the
pandemic,
so
that
notion
of
bringing
the
tactical
and
the
strategic
together
and
and
making
progress
on
both
agendas
has
been
a
a
factor
that
we,
as
an
exec
team,
have
have
tried
to
try
to
pursue,
and
I
think
I
think
these
these
figures
really
sort
of
summarize
the
year
really
really
well.
B
I
know
chris
wants
to
talk
about
the
money
in
a
minute
and
and
and
kirsten
wants
to
finish
off
with
some
other
people
measures.
But
but
that
was
sort
of
the
summary
of
where
I
wanted
to
wanted
us
to
get
to
thanks
peter.
A
I
Actually
to
fairies,
it
said
a
lot
of
what
I
was
going
to
say.
I
think
the
ability
for
us
to
operate
both
tactically
and
strategically
in
real
time
has
been
really
important.
An
example
of
that
is
is
a
covered
insight
report
and
a
weekly
ipc
report,
so
they
bring
data
and
information
together
in
real
time
to
drive
the
policy
debate
and
understanding
at
the
center
and
locally.
I
So
I
think,
there's
much
to
learn
from
what
we've
what
we've
experienced
over
the
last
12
months
as
we
look
ahead
to
how
we
implement
the
strategy
well
and
continue
that
policy
development
thanks
chris.
A
So
chris
usher
am,
I
gonna
have
to
leave
a
note
to
my
successor
to
say
there
is
no
more
money
or
are
we
okay.
B
I
think
we're
okay
yeah,
so
on
the
on
the
revenue
budget,
we
ended
the
10
million
underspent,
which
largely
reflects
the
impact
of
corvid
on
our
activity,
we'll
we'll
retain
that
underspend
and
that'll
support
future
regulatory
delivery
and
also
our
transformational
change
agenda,
both
of
which
would
benefit
providers
in
the
medium
to
long
term.
On
the
capital
side,
we
were
400k
under
spent
within
obviously
exponential,
largely
supporting
our
transformational
change.
I
think
that's
that's
the
most
capital
expenditure
we've
incurred,
possibly
ever,
I
think
so.
B
It's
a
good
delivery
on
our
capital
budget
and
aiming
helping
us
to
support
our
our
change
agenda
so
that
that
was.
That
was
the
main
bits
I
was
going
to
cover.
I
know
cursey
wanted
to
talk
on
the
people
side
as
well,
but
I
don't
know
cover
that
off
under
the
change
ups.
J
Yeah,
but
just
a
couple
of
ways,
I
have
got
some
more
sort
of
up-to-date
people
stuff
in
the
in
the
change
update.
But
just
just
just
in
terms
of
this
year's
performance
around
our
our
people,
I
mean,
I
think
it
has
been
quite
a
challenging
year
in
terms
of
the
on
terms
of
people
front
and
a
lot
of
our
colleagues
have
suffered
a
lot
of
distress
with
a
personal
personal
loss
as
well
as
as
working
in
a
difficult
scenario.
J
So
we
as
an
organization,
have
tried
very
hard
to
support
our
people
with
a
lot
of
well-being
initiatives
and
making
sure
that
people
have
access
to
support
services
to
enable
them
to
to
cope
as
best
as
possible,
and
I
think
you
know-
we've
had
a
lot
of
people.
J
Who've
been
isolating
and
having
to
work
in
a
very
in
in
difficult
circumstances,
and
I
think,
as
an
organization
we
have
pulled
together
to
support
to
support
our
people
as
best
we
can
as
well
as
that,
we've
done
quite
a
lot
of
work
in
terms
of
making
sure
we
can
continue
with
our
fairly
extensive
programme
of
training.
J
The
team
did
a
fairly
phenomenal
job
of
moving
all
our
in
face-to-face
training
online
and
have
continued
to
deliver
a
fairly
extensive
program
over
the
year
with
with
minimal
disruption,
and
we've
also
continued
to
work
on
our
our
program
of
cultural
change,
as
ian
alluded
to
by
developing
some
of
the
work
around
supporting
our
managers
and
developing
work,
developing
our
success
profiles
and
really
setting
out
some
of
the
behaviors
and
ways
of
working
that
we
want
to
see
going
forwards
and
we've
managed
to
continue
to
do
that
I'll,
be
in
a
remote
way
and
I
think
again,
a
testament
to
the
team
to
have
been
able
to
continue
with
that
work
in.
J
You
know
quite
difficult
circumstances
where
they've
been
they've
been
challenged
in
terms
of
just
keeping
the
show
on
the
road
in
terms
of
making
sure
people
are
still
supported
and
we've
managed
to
keep
the
agenda
going.
It's
been
a
huge
amount
of
work
on
our
dni
initiative
and
I
will
touch
on
some
of
that
later
in
the
change
program
work.
But
I
do.
I
do
think
that
has
been
a
key
element
of
some
of
the
work
we've
had
going
forwards.
J
I
think
we've
done
some
really
interesting
work,
particularly
around
the
listening
events
and
strengthening
the
work
that
we
are
doing
to
support
our
black
and
minority
ethnic
colleagues,
both
in
terms
of
making
sure
that
their
voice
is
heard,
but
also
in
terms
of
putting
structural
support
in
to
ensure
that
we're
able
to
support
them
to
be
to
to
to
to
fulfill
their
potential
and
career
ambitions
over
the
year
as
well.
Thank
you.
A
Thanks
kirsty,
so
we've
heard
from
everybody
and
we've
also
got
a
massive
amount
of
other
data
in
the
in
the
board
papers.
So
let
me
just
open
it
up
for
anybody
wants
to
come
in
and
I
know
that
mark
chambers
you
do
want
to
come
in
so
mark.
L
Thanks
very
much
yeah
I
wanted
to
come
in
on
on
one
of
the
on
one
of
the
people
points
in
the
in
in
the
pack.
You
know
peter
you
talked
earlier
about.
You
know
the
extraordinary
resilience
that
that
some
that
folk
in
our
contact
center
have
had
to
show.
Often
you
know
some
of
the
more
junior
people
in
our
organization
doing
an
already
difficult
job
under
extraordinarily
challenging
conditions
without
the
usual
support
infrastructure
of
colleagues
and
and
managers
sitting
in
the
same
physical
space.
L
We
we've
heard
quite
a
bit
about
the
the
well-being
support
that
has
been
provided.
I
think
that's
been
innovative.
I
think
it's
been
timely
and
I
think
it's
been
very
well
targeted.
I
think
that's
that's!
It's
been
really
encouraging
to
see
that
just
an
observation,
though,
on
the
on
the
sickness
absence
rates
and
that
we've
got
very
low,
sickness
sickness
absence
rates.
L
You
can't
be
sick
if
you
can,
if
you
can
manage
to
physically
work
and
the
you
know
the
pressures
to
work
while
unwell
are
you
know
the
same
pressures
that
they
would
be
in
an
office
based
environment,
but
good
managers
in
an
office
based
environment
would
have
the
trigger
of
somebody
emailing,
saying
or
phoning
saying,
I'm
ill,
I'm
going
to
work
from
home
and
then
the
opportunity
for
the
manager
to
say
no
you're
not
what
needs
to
be
delivered
today.
How
can
we
reprioritize
it?
How
can
I
manage
expectations?
L
How
can
I
take
that
off
you
but
concentrate
on
getting
well
how
we,
how
are
we
addressing
that
particular
risk
of
pressures
to
work
while
unwell,.
J
Yes,
so
we
are
very
conscious
of
I
suppose
under
reporting,
if
people
are
home
based
working
and
they're
sick
because
they
can
carry
on,
and
so
we
have
been
really
proactive
about
telling
people
they
are
ill,
not
to
report
not
to
come
in
and
not
to
work
and
making
sure
that
we
are
telling
people
to
record
if
they
are
if
they
are
ill,
so
that
we
we
are
having
those
conversations
with
managers.
J
I
think
I
think
we
don't
want
presenteeism
if
people
are
really
ill,
they
need
to
be
at
home
and
off,
but
I
think
historically,
we
have
had
generally
quite
low
levels
of
sickness
in
cqc.
We
are.
We
are
our
statistics
and
our
performance
around
sickness
is
generally
pretty
good.
So
I
don't
think
we've
we
haven't
seen
a
sort
of
massive
drop
off
as
more
and
more
people
have
been
working
at
home,
but
just
to
remind
it,
we
we've
had
60
of
our
workforce
home
based
anyway,
but
prior
to
the
pandemic.
J
A
So
you
would
actually
expect
to
some
extent,
sickness
to
have
gone
down
strangely
enough,
so
since
nobody's
jumped
in
and
said
that
was
rubbish.
Let's
move
on
mark
saxton
won't.
E
Comment
chairman,
no
thank
you.
I
wanted
to
talk
about
the
the
year
at
a
glance.
I
thought
super
to
hear
from
everyone
on
that,
but
it's
a
it's
a
great.
It
jumps
out
at
you
on
the
screen,
especially
comparisons
to
previous
year,
so
you
know
to
do
all
that
and
still
outperform
the
previous
year
super.
I
I
suppose
the
downside
is
that
I
think
I've
had
to
learn
five
new
acronyms,
but
you
know
that's
language
that
we've
we've
developed
in
this
12-month
period,
so
esf,
tma,
ipc,
ds
and
pra.
E
I
mean
it's,
it's
remarkable!
So
well
done!
Congratulations!
I
think
it.
It
feeds
right
through
to
the
performance
charts.
If
you
look
at
the
regulatory
activity
chart
on
page
33
are
risk-based
risk
based
inspections,
as
ted
was
referring
to
you
know,
clearly
increasing
and
our
consistency
improving.
E
I
would
like
to
talk
a
bit
about
the
new
charts
in
the
performance
pack
on
the
people,
charts
so
equipping
our
people
and
our
organization
to
deliver
our
purpose.
I
think
these
are
great
charts,
but
they
they
they
give
some
good
information
that
I'm
quickly
trying
to
scroll
through
to
get.
But
one
of
the
things
I
wanted
to
make
the
point
about
was
in
terms
of
our
dni
and
our
turnover.
E
So
if
you
look
at
starters
by
ethnicity,
that's
significantly
higher
than
our
workforce
by
ethnicity
and
our
levers
by
ethnicity
is
lower
than
our
workforce
by
by
ethnicity
and
in
terms
of
the
labor
market.
We
are
above
the
labor
mug
and
I
think
that's
an
important
message
and
it's
one
that
we
will
continue
to
to
to
watch.
E
I
mean,
interestingly,
following
on
mark's,
sickness
and
well-being.
E
I
know
that
and
kirsten
is
going
to
refer
to
it
in
a
later
report
that
we've
done
the
mind
workplace,
well-being
survey
and
I
just
think
you
know
it'd
be
great
to
hear
those
results
and
the
way
this
report
equipping
our
people
report
has
been
structured.
We've
got
the
opportunity
to
dig
down
into
what
are
we
doing
around
grade
c?
What
what
extra
support
are
we
putting
in
for
that
group
that
you
know
have
had
that
higher
rate?
Now?
E
I
would
just
ask
us
to
consider
that
that
might
be
a
good
thing
to
do
and
again,
looking
at
our
turnover
charts
the
movements
by
grade
the
starters,
the
promotions,
the
acting
ups.
The
levers
I
mean
that
looks
a
really
really
busy
chart
and
it
is
but
it
you
know
it
has
a
lot
going
on
in
it,
and
I
just
think
again
that
can
really
support
our
dni
initiatives.
E
So
we
could,
for
instance,
look
at
grade
b,
where
you
can
see
a
lot
of
churn
and
look
at
that
by
ethnicity
as
well,
and
that,
I
think,
would
be
a
evidence
of
our
look
and
our
actions
at
a
board
level
to
support
dni
and,
finally,
I
suppose
the
the
disability
percentages
still
are
low
for
us.
I
think
that
is
a
self-certification
issue.
E
I
think
it's
one
that
the
people
team
will
continue
to
look
at,
but
I
I'm
really
pleased
to
see
these
charts
in
the
pack
and
thank
you
for
providing
them.
Thanks.
Mark.
J
No,
I
think
we
we
are.
We
have
regular
conversation.
I
know
jill
and
mark
have
regular
conversations
outside
of
the
board
to
sort
of
make
sure
we're
we're
providing
the
data
in
in
a
way.
That's
that's
helpful
and
happy
to
take
feedback
from
from
other
board
members.
If
there's
anything
else
that
people
would
like
to
see
in
the
pack
in
terms
of
a
better
a
better
view
of
our
people
and
our
movements
within.
A
Thank
you
thanks
again
mark
robert.
D
Thank
you.
It's
just
a
slightly
off
the
pitch
question,
but
firstly,
this
is
really
useful
information
and
the
way
it's
been
presented,
I
think,
certainly
passes
my
test
for
actually
being
carefully
digested
and
understood.
So,
thank
you
very
much.
I
just
wonder
it's
a
bit
hot
off
the
press,
but
the
nao
published
a
report
this
morning
reviewing
the
government's
performance
during
covid
on
a
number
of
issues,
and
I
just
wondered,
although
obviously
it
is
addressed
at
the
government
at
what
what
it
did
or
didn't
do.
D
I
wonder
whether
we
are
going
to
or
should
consider
what
lessons
if
any
of
there
are
to
be
drawn
out
of
it
for
ourselves.
I
noticed
that
it
says
and
I'm
not
radically
in
full,
but
it
says
quite
a
lot
about
the
consist.
The
importance
of
the
consistency
of
communication
with
the
public.
D
Needless
to
say,
says
a
lot
about
planning
for
the
unforeseen,
and
it
says
a
lot
about
the
support
for
the
well-being
of
staff
and
I
suspected
all
those
areas
we
probably
don't
do
too
badly,
but
I
just
wonder
whether
it
will
be
just
a
useful
check.
It's
only
48
pages
or
so
short
for
a
report.
We
were
just
checking,
but
also
perhaps
looking
a
little
bit
at
what
our
contribution
was
either
to
the
positive
or
the
negative
parts
of
what
is
said.
Then.
A
B
Yeah,
absolutely
I
mean
we
are.
We
are
doing
some
working
just
in
terms
of
timelining
what
what
did
go
on
during
the
the
pandemic,
so
that
we
are
ready
for
any
subsequent,
more
formal
inquiries,
but
yeah
I'd
like
like
peter,
I
haven't
read
this
read
the
nao
report
in
any
dev,
but
it's
something
which,
which
I'm
sure
we
can
we
can
do.
But
yes,
absolutely.
I
Thanks,
chris
just
just
to
say,
we
were
helping
the
neo
with
their
compilation
this
report.
So
I
think
the
majority
of
the
issues
are
for
government,
but
certainly
there
are
issues
that
parallel.
We
can
learn
from
that.
We
should
and,
as
ian
said,
there
is
a
series
of
pieces
of
work
at
the
moment
to
look
at
the
decisions
that
we
made
and
what
we
can
learn
from
those
over
the
course
of
their
last
12
months,
so
that
that
piece
of
work
will
come
to
the
executive
and
to
the
board
in
due
course.
I
I
think
this
report
today
we've
helped
in
terms
of
the
information
that
we've
provided,
that
that
helped
contribute
to
the
the
report,
and
certainly
if
there
is
anything
for
us,
we've
had
a
couple
of
conversations
with
the
ne
already
we'll
pick
them
up.
We'll
pick.
Those
up
in
conversation
and
they'll
add
to
our
learning
that
we
bring
back
to
eating
board
great
thanks,
sally.
G
Thank
you
just
on
the
learning
lessons
from
the
pandemic
point
regulatory
governance
was
yesterday
and
we've
already
looked
at
two
of
our
directorates
in
terms
of
what's
gone
well
and,
what's
not
so
in
some
senses,
we're
ahead
of
the
game
with
the
third
to
come
next
month,
which
I
think
is
really
positive.
G
I
just
wanted
to
say
thank
you
for
the
pack.
I
think
it's
much
more
expansive
than
the
ones
we've
had
previously.
I
know
it's
a
year-end
special
effort,
but
there
are
some
really
useful
facts
and
statistics
in
there
and
they
reflect
just
how
much
has
been
achieved
over
the
last
year
so
I'd.
I
welcome
something
like
this
going
forward.
Thank
you.
G
So
I
noticed
we
only
about
only
about
half
of
people
have
an
exit
interview
and
some
of
the
other
factors
that
mark
saxton
pointed
out
before,
and
I
just
wanted
to
ask:
are
we
definitely
keeping
in
touch
with
both
people?
Who
are
still
here
and
working
for
us
despite
their
mental
health
struggles
and
potentially
being
alone,
and
do
we
take
the
information
from
people
who
are
leaving
to
try
and
think
about
improving
our
policies.
I
Was
just
going
to
I
can
talk
to
part
of
that
which
is
about
the
ongoing
engagement
with
colleagues.
So
each
week
we
do
as
part
of
the
sort
of
summation
of
all
the
conversations
we
have
with
colleagues,
we
do
a
sort
of
weekly
report,
which
is
actually
principally
foreign
and
myself.
That
goes
to
the
wider
et
as
well
just
to
look
at
some
of
the
key
themes
of
things
that
the
conversations
have
been
this
week
and
that's
a
really
good
guide.
I
I
We
also
use
it
as
a
conversation
piece
for
the
slt
30
and
the
wider
120
group,
so
that
leaders
feel
empowered
and
able
to
have
good
conversations
with
their
team,
because
part
of
this
is
particularly,
as
you
say,
with
a
whole
working
population.
It's
giving
managers
the
the
ability
to
to
engage
well
with
their
colleagues
who
are
working
remotely
so
that
they
have
access
to
the
information
at
the
right
time
so
that
that
report
comes
in
weekly
and
it
sort
of
picks
up
on
some
of
the
key
themes
from
ian's
calls.
I
What
are
we
saying
when
what
are
the
implications?
Where
do
we
want?
Where
do
we
want
involvement
what's
happening
next?
Those
are
the
messages
that
we
want
to
make
sure
both
leaders
and
and
colleagues
across
the
organization
understand
and
know.
I
know
that
only
answers
part
of
your
question,
but
hopefully
that
gives
you
a
sense
of
how
we're
maintaining
the
engagement
with
colleagues
in
in
the
organization.
A
J
Thank
you.
So,
yes,
in
terms
of
access
interviews,
we
do
try
and
have
as
many
of
those
as
as
feasible
as
possible.
The
team
did
collate
the
information
that
comes
from
that,
and
we
then
do
use
that
to
to
look
at
any
areas
that
that
that
we
might
want
to
adjust
in
terms
of
why
people
are
leaving
you
can
see
in
the
pack.
J
It
gives
you
a
sense
of
the
questions
in
terms
of
why
why
why
why
people
are
going
and
there's
some
things
that
where
we
have
people
leaving
well
and
that's
always
really
good,
where
people
are
going
on
promotion
and
things
like
that
and
it's
the
ones
where
we're
believing
not
so
quite
so.
Well
that
we
do,
we
do
want
to
really
dig
into
and
understand
and
use
our
our
data,
particularly
if
we've
got
areas
where
people
are
saying
they're
leaving
because
they
don't
like
their
line
manager
or
areas
like
that.
We
do.
J
A
Great.
Thank
you,
kate,.
C
Just
very
briefly,
on
the
interview
point,
so
we've
had
some
conversations
within
our
director
about
how
we
can
get
that
number
up
and
some
suggestions.
That's
come
up
that
we
need
to
think
about,
and
probably
talk
about,
the
people
board
was
a
suggestion
that
people
might
be
offered
an
extra
interview
with
someone
from
a
different
part
of
the
business.
So
maybe
you
don't
want
to
exit
an
interview
with
your
line
manager
or
your
line,
manager's
manager,
but
actually
maybe
having
someone
from
a
different
part
of
the
the
director.
C
A
Great,
thank
you
so
bored
are.
We
are
we
happy
to
note
the
year-end
performance
report
and
the
financial
position
excellent.
Thank
you
very
much
executive
colleagues
for
for
all
the
work
and
putting
that
all
together,
but
more
particularly
for
all
the
work
over
the
last
year,
which
has
been
phenomenal.
Thank
you.
So
kirsty
we're
back
with
you.
I
think,
with
the
change
report.
J
Thank
you,
so
thank
you
peter
so
in
just
in
terms
of
this
paper,
I'm
just
going
to
just
run
through
a
few
a
few
areas
and
just
put
out
a
few
highlights,
I
think,
over
the
last
quarter.
We
have
continued
to
make
some
really
good
progress
over
the
portfolio
of
change.
We
making
sure
that
we
are
aligning
our
activity
so
that
we
can
build
capability
and
capacity
to
realize
and
support
the
development
and
implementation
of
our
new
strategy.
J
As
part
of
that
work,
we've
been
reconfiguring
the
portfolio
and
we've
now
looked
to
build
that
into
three
change
into
three
three
areas:
the
first
one
of
those
is
around
developing
our
new
regulatory
activity
and
looking
at
how
we
want
to
regulate,
going
forwards
and
setting
a
program
of
work
around
that.
J
That
piece
of
work
is
now
is
coming
to
fruition
and
we
are
realigning
the
whole
of
the
portfolio
to
enable
us
to
deliver
against
those
three
key
areas
and
we'll
continue
to
report
that
on
that,
as
we
as
we
move
forwards
over
the
coming
year.
J
As
part
of
this
work,
we're
now
focused
on
also
mobilizing
that
portfolio
and
particularly
making
sure
that
we've
got
the
right
resources
in
place
to
deliver
on
our
ambitions
and
particularly
understanding
where
any
risks
may
sit
in
terms
of
our
ability
to
recruit
in
key
key
skills
in
terms
of
the
programs
that
we've
already
got
in
flight.
These
programs
are
ones
where
we're
continuing
to
build
our
capabilities
and
services,
such
as
registration
transformation,
developing
capability
around
our
data
and
insight
and
building
on
our
new
regulatory
platform.
J
Those
programs
are
continuing
to
make
good
progress
and
are
are
on
track
both
in
terms
of
delivery
and
in
terms
of
our
area.
Are
our
planned
expenditure
against
them
in
terms
of
the
people
front,
we've
had
another
busy
quarter.
We
have
launched
our
new
talent
management
framework
this
this
period
with
a
view
to
enabling
our
colleagues
to
for
all
of
our
colleagues
to
develop
their
careers
whilst
they're
here
at
cqc.
J
This
is
not
just
focusing
on
on
on
our
brightest
and
best,
but
actually
creating
a
a
platform
in
which
everybody
is
able
to
to
build
and
develop
their
skill
set.
We've
also
continued
to
hear
our
employee
voice
through
our
pulse
survey
work.
The
last
survey
was
in
march,
where
we
focused
on
people's
experiences
of
working
at
cqc
and
particularly
with
a
focus
on
our
diversity
and
inclusion
agenda,
and
then
our
next
survey
will
be
is
planned
for
late
june
early
july
and
again
that
one
will
focus
on
well-being.
J
We
continue
to
pull
this
data
to
give
us
a
really
up-to-date
and
continual
feedback
in
terms
of
taking
the
temperature
of
the
organization
and
giving
us
some
helpful,
steers
and
feedback
in
terms
of
what's
learning
well
and
what,
where,
where
we
might
need
to
focus
our
attention
as
a
as
an
executive
team
we've
also
in
this
last
quarter,
published
our
workforce,
disability
equality
standard
and
our
workforce
race
equality
standard.
J
This
is
the
first
time
we've
published
a
disability
quality
standard
and
we're
really
pleased
to
be
able
to
do
that
as
part
of
our
dni
strategy.
We
also
have
launched
our
reverse
mentoring
scheme
for
our
black
and
ethnic
minority
colleagues.
This
scheme
has
paired
senior
leaders
with
more
junior
colleagues
to
talk
about
their
lived
experiences,
not
just
at
cqc,
but
just
in
terms
of
their
lived
experiences
in
more
general
and
really
built
some
positive
positive
relationships.
There.
J
We
had
a
sort
of
a
review
of
that
earlier
earlier
in
the
month
where
colleagues
came
together
to
discuss
their
experience
as
a
scheme,
and
really
we
received
really
positive
feedback,
particularly
from
those
junior
colleagues.
Who've
been
paired
paired
with
senior
managers
to
to
to
to
hear
that,
so
we
can
hear
their
stories.
J
We've
also
continued
to
build
on
the
work
of
our
success
profiles
and
have
now
come
incorporated
these
into
our
performance
management
approach
with
colleagues
now
setting
their
their
their
their
objectives
for
the
year,
both
based
on
behavioral
objectives
set
out
in
the
in
the
before
in
the
success
profiles
and
also
the
task-based
task-based
objectives
that
we're
looking
to
see.
So
that's
a
quick
summary
for
me.
I
don't
know
mark
if
something
you
would
like
to
add
in
terms
of
the
tech
change
program.
K
Yeah
just
a
few
things
from
me,
so
it's
been
a
really
packed
quarter
for
digital
and
intelligence.
We've
made
really
strong
progress
in
our
you
know
in
our
key
programs
of
change,
which
essentially
are
the
regulatory
platform,
transforming
data
and
insight
programs
and
and
regular
continuous
technology
improvement
in
regulatory
platform.
We've
continued
our
transitional
regulatory
activities.
K
We
were
talking
about
earlier
on
throughout
the
pandemic
and
that's
included
not
only
the
transitional
monitoring
but
also
infection,
prevention,
control
assessments
and
designated
settings
in
adult
social
care
and
and
also
now,
the
monitoring
of
large-scale
covered
vaccination
centers.
But
our
core
regulatory
platform
foundation
work
is
going
really
well.
K
The
foundation's
been
established,
we've
introduced
new
data
architecture
and
data
synchronization
with
legacy
systems,
and
we've
we've
established
the
foundation
of
a
new
digital
portal
for
our
providers,
which
will
lead
to
really
significant
improvements
both
for
both
rob
cqc
and
providers
as
well,
and
we're
building
the
foundations.
K
But
in
the
meantime,
we've
delivered
a
really
successful
proof
of
concept
which
demonstrates
that
the
new
technology
supports
a
number
of
business
use.
Cases
such
as
real-time
views
of
health
and
care
systems,
which
gives
real-time
insights
graphically
and
the
ability
to
have
really
granular
insight
down
to
the
level
of
an
individual
providers.
Data
in
a
in
a
visual
form.
K
At
the
context
of
the
point
context
of
the
point
at
which
an
inspector
is
looking
at
quality
assessment
in
question
and
in
our
continuous
technology
improvement,
our
service
desk
service
and
security,
operational
center
is
unbelievably
shortly
going
to
be
celebrating
its
first
anniversary
and
the
customer
satisfaction
on
that
is
is
regularly
hitting
95
percent.
So
I'm
really
grateful
for
our
technology,
colleagues
and
suppliers
and
cqc
colleagues
for
making
this
recent
transformation
and
such
a
success.
K
We've
completed
a
rollout
of
our
new
windows,
10
laptop
image
to
improve
the
stability
and
reliability
of
colleagues,
which
has
involved
a
physical
physical
swap
for
for
everybody,
and
that's
no
mean
feat
when,
when
colleagues
have
been
working
at
home
for
for
for
now
for
well
over
a
year,
often
with
very
different
home
setups.
K
But
this
sets
us
up
really
well
for
the
future,
which
gives
us
the
ability
to
manage
our
estate
and
future
updates
remotely
and
we're
also
investing
in
our
people
across
the
organization
making
available
training
courses
in
the
new
technology
that
we're
adopting
with
a
number
of
colleagues
taking
courses
and
getting
accreditations
in
the
new
technology.
Microsoft,
azure
dynamics
and
analytics
expertise,
and
so
a
really
really
good
quarter
of
progress
in
transforming
our
digital
intelligence
capabilities
and
we'll
continue
to
progress
with
that
over
the
next
quarter.
A
Thanks
mark
a
95
satisfaction
in
anything
is
is
quite
quite
amazing,
so
well
done
brilliant
any
any
more
from
anybody
on
the
on.
M
A
Okay,
oh
sorry,
mark
saxton.
E
Thanks
chairman,
sorry,
I
know
you're
you're
in
a
hurry,
but
I
would
just
like
to
say
that
I
think
that
the
people
report
is
a
really
great
insight
into
our
planned
and
considered
management
of
our
people
and
stepping
ourselves
towards
being
as
we
want
to
be
a
first
class
employer.
But
I've
got
two
two
questions.
E
E
I
just
wonder
whether
in
the
next
quarter,
could
the
resourcing
report
just
give
us
some
insight
in
how
we're
going
forward
and
being
effective
in
in
this
area
and
steps
we're
taking
to
continue
our
positive
ethnicity,
recruitment
performance
just
if
we
could
have
that
in
in
the
next
quarter?
I
think
that
would
be
helpful
and
you
know
we've
seen
in
the
main
board
pack
today
a
really
helpful
people
report
and
demonstrating
the
quality
of
the
people
analytics.
E
J
Yes,
so
in
terms
of
the
data
pack,
every
manager
has
access
to
their
data
at
a
at
a
team
level,
so
they
get
that
they
get
that
level
of
detail
plus
more
actually,
so
they
they
really
have
they're
able
to
put
a
finger
on
the
pulse
in
terms
of
all
the
bits
they
need
to
access
so
that
that's
that's
definitely
available
to
them,
plus
the
the
data
that
comes
out
through
chris's
team
in
terms
of
the
performance
piece.
So
they
have
the
people,
data
and
the
performance.
J
Metrics
data
comes
together,
there's
an
awful
lot
of
information
for
them
to
access
in
terms
of
the
recruitment
pcs.
We
can
certainly
bring
some
a
bit
more
detail
in
that.
I
think,
as
I
said
earlier,
we
are
looking
we're
segmenting,
our
recruitment
by
type,
so
that
we
can
really
understand
the
risks
around
particular
skill
sets
and
look
at
how
quickly
we're
able
to
recruit
into
those
or
what
our
turnover
rates
are
for
those
particularly
sought
after
skills.
J
A
Great,
thank
you
good,
so
I
think
we
can.
We
can
say:
we've
we've
considered
the
report
and
we've
noted
it,
which
is
what
we
were
required
to
do
so,
shall
we
shall
we
now
move
on
chris
to
you.
I
Yes,
so
the
latest
insight
report
rosie's
talked
about
it
a
little
bit
at
the
start,
and
I
know
we
haven't
got
long.
So
let
me
just
quite
do
a
quick
summary.
First
of
all
insight
reports
are
about
sharing
good
practice
about
what's
going
on,
and
also
talking
about
some
topics
that
we
are
concerned
about
our
regulatory
activity.
I
This
report
focuses
on
two
issues:
what
we're
learning
from
the
good
nets
and
in
practice
in
cancer
services,
and
also
some
concerns
we
have
around
dental
access.
Dental
access
has
been
an
issue
long
before
pandemic.
At
the
start
of
the
pandemic,
routine
nhs
services
were
paused
as
practices
introduced,
infection
on
potential
control
measures
to
help
prevent
the
spread
of
covid
practices.
I
Holding
nhs
contract
were
advised
to
provide
advice
on
pain
relief
and
not
to
do
much
more
from
about
june
practices,
steadily
restored
their
services
while
introducing
stringent,
effective
preventive
control
measures
and
using
additional
ppe
and
allowing
sort
of
follow
time
between
inspection
activities.
I
We
know
that
there
is
a
there's,
a
financial
challenge
that
was
be
raised
by
some
practical
relationship
in
relation
both
to
the
purchase
of
ppe
and
to
the
cost
of
those
changes
and
and
what
they
can
manage
with
a
reduced,
a
a
number
of
clients
and
there's
a
there's
a
I.
This
has
raised
a
sort
of
potential
concern
around
access
to
services.
I
More
generally,
what
we're
seeing
in
terms
of
feedback
to
er
from
the
from
people
use
services
that
there's
a
there's
a
strong
sense
of
people,
one
hand
being
very
grateful
to
get
access
in
an
emergency
but
at
the
same
time,
a
lack
of
access.
A
general
lack
of
access,
we've
seen
a
a
a
rise
in
people
accessing
one
or
one
services
and
other
emergency
services
because
of
their
their
lack
of
ability
to
get
access
to
to
to
cert
to
dental
services.
I
We
know
that
the
feedback
that
healthwatch
england
have
received
has
expressed
the
same
sort
of
concerns,
and
we
and
if
you
look
at
the
numbers
about
58,
lower
activity
in
2020,
compared
to
2019
that
activity
has
to
go
somewhere.
It's
going
into
a
combination
of
nhs,
111
inquiries
and,
unfortunately,
emergency
services
treatment.
So
we
know
there's
some
the
concerns
there.
We
know
there's
some
issues
around
how
organizations
can
staff
well
and
schedule
well
because
of
the
the
the
what's
going
on
with
the
pandemic.
I
We
know
the
issues
around
access
to
technology
and,
to
what
extent
can
technology
support
that
we
know?
There's
been
some
really
good
work
in
terms
of
vulnerable
groups
and
how
some
dentists
have
responded,
be
more
proactive
in
their
in
our
access
of
vulnerable
groups
to
make
sure
they've
got
the
services
that
they
need,
and
we
know,
there's
been
some
patchy
work
on
system
working.
I
Some
really
good
examples
of
where
dentists
have
worked
well
with
community-based
pharmacies
and
other
organizations,
but
a
lot
of
a
lot
of
occasions
where
dentists
don't
see
the
relationship
between
themselves
and,
for
example,
a
gp
or
indeed
another
social
care
organization.
So
what
the
report
just
seeks
to
do
is
to
sort
of
raise
some
questions
that
we
think
we
need
to
explore
further.
So
this
is
about
the
confidence
that
the
across
that
there
is
in
terms
of
the
access
to
nhs.
I
Dental
services
are
they
available
for
everyone
in
terms
of
urging
dental
treatment,
what
measures
are
taken
to
prioritize
and
improve
the
access
to
one-on-one
and
use
that
service
to
prioritize
access
to
services
in
terms
of
commissioning
access?
Is
there
enough
capacity
being
commissioned
at
the
moment?
Are?
Are
nhs
colleagues
clear
about
where
the
demand
for
those
services
are
particularly
around
people
who
are
vulnerable
and
also
access
to
oral
and
dental
health
in
the
future
of
an
integrated
care
system?
How
do
we
join
up
those
services?
I
We
had
a
report
couple
years
ago,
a
year
or
so
ago,
which
talked
about
oral
health
in
care
homes,
which
is
a
you
know.
There
were
again
were
tremendous
examples
of
where
services
had
really
joined
up,
but
not
enough
of
that
across
the
country.
How
do
we
make
sure
that
integrated
care
systems
fully
focus
on
dental
health
as
part
of
those
services?
A
For
a
second,
let
me
bring
in
robert.
D
Well
personally,
thank
you
very
much
for
this
report
and
I
just
really
wanted
to
make
two
comments.
One
was
it's
a
good
example
of
the
collaboration
that
can
produce
a
result
and
information
between
healthwatch
england
who
issued
a
report
on
this
very
subject
at
the
end
of
december
last
year
and
the
cqc
and-
and
I
think
it
is
an
example
of
how
our
strategy
going
forward
of
feeding
off
people's
experiences
can
produce
powerful
information,
and
the
other
point
really
was
what
next
christmas
was
to.
D
Some
extent
talked
about
that
and,
of
course,
a
lot
of
what
needs
to
be
done
and
by
the
way
a
lot
of
this
stuff
is,
I
think
you
point
out
is
pre-pen,
as
the
pandemic
has
exacerbated
what
was
already
there,
but
is
what
what
next
and
I
appreciate
it's
not
for
us
necessarily
to
put
solutions
in
place.
D
But
I
would
hope
that
we
will
follow
this
through,
so
that
because
there's
been
a
habit,
certainly
a
health
watch,
and
we
want
to
change
this
too.
We
issue
a
report
and
then
you
know
someone's
going
to
do
something
about
it
and
we
go
on
to
the
next
prop
project.
But
dentistry
is
an
example
of
something
that's
been
going
on
for
years
like
this
and
somehow
it
seems
to
me
that
between
us
we
we
have
a
duty
to
keep
on
top
of
them.
A
Yes
thanks,
so
let
me
bring
in
stephen
and
then
rosie
will
give
you
the
last
word
on
on
dentists
since
they're
within
your
bailiwick
stephen.
M
Thanks
peter
and
really
it's
following
up
robert's
point,
because
I
think
this
this
model
of
producing
reports,
you
know
what
are
we
learning
from
kovid
is
really
really
helpful.
I
think
it's
a
fabulous
example
of
how
cqc
can
use
the
information
that
we
have
the
insight
that
we
can
create.
So
I
think
it's
a
really
really
good
model,
but
in
this
case
it
sort
of
led
to
putting
out
there
into
the
ether
some
quite
big
questions
about.
M
M
H
Shall
I
come
back
on
those
those
things
so
so?
Thank
you,
chris,
and
and
thank
you
for
the
questions
and
just
firstly
to
say
this
has
been
a
great
piece
of
work
done
by
the
dental
team.
So
thank
you
to
all
the
team
involved
in
that
at
quite
a
rapid
pace
and,
as
robert
said,
we
have
worked
really
collaboratively
with
healthwatch
and
there's
a
really
good
partnership
arrangement
working
with
healthwatch
and
sharing
information
and
looking
at
how
we
can
pull
on
the
intelligence
that
both
organizations
know
we
are
following
up.
H
This
is
probably
one
of
my
major
areas
of
concern
at
the
moment
in
terms
of
dental
access,
and
I
think,
as
chris
has
said,
it
has
really
exacerbated
inequalities
and
we've
we've
seen
those
that
in
a
quantity
gap
grow,
and
I
think
I
want
to
give
absolute
assurance
to
the
board.
That
is
this,
isn't
something
that
we're
going
to
write
a
report
and
then
forget
about
it's
absolutely
something
that
we're
continuing
to
work
on.
H
We
we
run
a
dental
reference
group
where
we
work
with
all
of
the
key
stakeholders
from
all
of
the
different
dental
stakeholders
and
we
meet
with
them
regularly,
and
these
these
issues
have
been
absolutely
recognized
with
those
stakeholders,
and
we
will
continue
to
work
with
them
to
look
at
how
we
can
influence
and
and
encourage
organizations
that
to
take
up
the
recommendations
that
we
we
can't
influence
ourselves,
because
some
of
these
are
outside
of
our
control
because
of
the
way
our
legislation
is
is
set
up
at
the
moment.
H
I,
I
think
we're
continuing
to
look
at
individual
providers
and
look
at
what
we
can
do
with
individual
providers
and
improving
access,
and
we
look
at
through
our
key
lines
of
inquiry
and
on
inspection
around
access,
and
we
will
continue
to
follow
up
concerns
that
are
raised
with
us.
So
just
looping
back
to
what
chris
said
earlier
in
the
meeting.
If
people
have
concerns
about
access,
can
they
please
get
in
touch
with
us
through
our
give
feedback
on
care
service,
because
we
want
to
hear
them
and
we
will
follow
them
up.
H
Some
of
the
issues
that
we
we
can't
look
at
relate
to
the
commissioning
arrangements
and
the
how
the
access
for
the
dental
services
is
looked
at
across
a
locality
and
and
that's
out
of
our
scope
at
the
moment.
But
we
would
be
very
keen
if
we
were
asked
to
look
at
that
in
more
detail.
A
Yeah
we
would
indeed
robert
where
you
wanted
to
come
back.
No
just
okay,
that's
fine,
but
stephen.
I
I
I
your
general
point
is
is
well
taken
and
we
do
normally
return
to
themes
that
we've
been
worried
about,
even
when
we
don't
have
the
ability
ourselves
to
to
remedy
whatever
the
situation
was
we
don't
we
don't
raise
an
issue
and
then
then
then
just
drop
it.
So
we
will
definitely
be
back
on
this
one.
I
think
so.
Chris.
That
was
part.
One.
I
Part
two
part
two
and
so
collaboration
amongst
cancer
services,
so
this
is
particularly
looking
at
good
practice
in
the
way
that
services
are
working
together
to
support
people
with
cancer
and
a
number
of
themes.
In
of
this
of
this
good
good
practice,
I
just
wanted
to
just
highlight
a
couple
of
those
in
the
context
of
time
which
don't
highlight
a
couple
of
those
themes.
I
Firstly,
we
found
that,
even
during
the
pandemic,
the
engagement
of
local
communities,
the
ability
of
services
to
work
together
to
engage
local
communities
and
local
sort
of
cancer
alliances
was
critically
important
to
how
services
operated
and
how
they
worked.
We
saw
some
systems
where
there's
close
liaison
between
community
leaders,
local
faith
groups
and
services,
providing
detection
and
treatment
services,
and
they
are
critical
in
early
detection
and
early
support
for
people
with
with
cancer.
I
We
found
another
another
service
where
they
were
using
patient
advisory
groups,
creating
videos
highlighting
the
importance
of
things
like
lung
checks
through
the
pandemic,
to
encourage
attendance
at
appointments
and
again
targeting
this
work
to
people.
Whether
there's
a
known
high
risk
of
people
not
taking
up
invitations
to
to
screening
and
treatment
is
important.
I
There's
also
been
a
lot
around
innovation
and
collaboration
using
systems,
so
things
like
chemotherapy
at
home,
which
wouldn't
probably
wouldn't
have
wouldn't
have
been
a
a
regular
occurrence,
has
been
much
more
prevalent
during
the
pandemic
virtual
ward
rounds,
where
different
organizations
and
professionals
in
different
areas
coming
together
virtually
to
talk
about
and
plan
how
they
keep
people
both
safe
and
well
cared
for,
and
then
the
support
for
recovery
as
well,
how
how
services
are
beginning
to
think
about
their
backlog,
their
diagnostic
procedures,
their
surgery
collectively,
not
as
individual
organizations-
and
I
say
these
reports
are
designed
to
show
what
is
possible
and
what
is
working
well.
I
We
have
heard
from
from
system
leaders
and
from
people
in
both
of
these,
and
we
want
to
encourage
systems
to
think
about
what
their
recovery
options
could
be
using
the
information.
That's
in
this,
this
part
of
the
report
and
again
we'll
come
back
later
to
talk
about
a
wider
view
of
provided
club
reviews
in
cancer
services
thanks
peter.
Thank
you.
Rosie.
H
Just
following
up
from
stephen's
question
in
the
last
regarding
dental
in
the
provider
collaboration
review
space,
what
we're
doing
is
every
time
we've
been
into
a
system.
We
are
feeding
back
all
of
our
findings
into
that
system
and
we're
asking
for
an
action
plan
from
that
system
based
on
the
findings.
H
So,
whilst
this
is
an
interim
reporters,
chris
says
to
share
the
the
best
practice,
because
we've
we've
made
that
deliberate
choice,
because
we
want
to
make
sure
that
that
good
practice
is
out
as
quickly
as
possible,
whilst
we're
waiting
for
the
final
report
to
to
be
generated,
and
we
don't
want
the
delay
in
people
having
that
access
to
ideas
and
ways
of
improving
the
situation
to
benefit
patient
care.
H
A
Thanks
ali.
N
Thank
you.
It
was
great
to
read
about
both
of
the
areas
in
which
we
looked
at,
and
cancer
is
a
particularly
interesting
area,
because
it's
so
vast
and
complex
spans,
so
many
different
discipline,
specialties
and
ownerships
and
also
is
an
area
where
sometimes
the
changes
that
you
make
at
the
earlier
stage
may
not
be
visible
for
some
years
to
come
to,
and
similarly
it's
great
to
hear
about
the
amount
of
organic
development,
that's
happened
to
make
sure
people
can
continue
to
access
services
at
every
level.
I
A
Great
thank
you
chris
and
the
team
behind
the
insight.
A
report
really
really
really
useful
couple
of
reports
there
we're
happy
to
move
on
and
that
takes
us
to
the
regulatory
governance
committee,
a
very
good
meeting
last
night.
I'm
sorry,
I
couldn't
quite
stay
to
the
end,
had
to
leave
to
deal
with
something
else,
but
it's
a
great
meeting.
Can
you
just
give
us
the
highlights
mark
please.
L
Yeah
very
happy
to
peter,
and
it
was
a
it
was
a
good
meeting,
but
which
was
informed
by
some
very
helpful
papers
from
the
executive.
So
thanks
for
the
effort
that
went
into
that
two
substantive
items
on
the
agenda.
First
of
all,
we
looked
at
the
the
qualitative
and
quantitative
insights
from
a
review
and
evaluation
of
the
of
the
tma,
the
transitional
monitoring
app.
L
Looking
at
the
you
know,
additional
capability
that
that
has
given
us
some
of
the
risks
and
issues
and
how
those
have
been
addressed
and
the
importance
of
of
robust
evaluation
and
and
assurance.
But
we
tied
it
into
what
would
have
been
a
separate
discussion
about
future
monitoring
activity
and,
and
the
main
purpose
of
the
discussion
was
to
look
forward
to
to
see
how
those
learnings
are
influencing
our
forward.
Our
forward
thinking
our
plans
for
use
of
data
and
intelligence
and
our
quality
standards.
L
You
know
we
talked
about
consistency,
but
it
was
emphasized
that
there's
no
one-size-fits-all
approach
to
monitoring
and
I
think
one
of
the
important
you
know
really
important
parts
of
the
discussion
which
stephen
referenced
earlier
was.
You
know
the
vital
role
of
inspectors.
Continuing
to
exercise
their
prof
that
their
professional
judgment-
and
you
know
that's
still
going
to
be
an
a
vitally
important,
fundamental
part
of
our
approach
going
forwards.
L
You
know
the
second
item
was
yeah.
Following
on
from
a
great
review
we
had
in
the
march
meeting
on
adult
social
care
we
heard
from
ted
and
his
team
in
relation
to
the
hospitals
directorate
on
learnings
from
the
pandemic.
L
The
you
know
we
we
heard
earlier
in
the
meeting
at
how
how
the
director
had
risen
to
the
to
the
challenge,
and
we
you
know
we
were
pleased
to
see
the
you
know
the
sort
of
trail
of
increasing
confidence
with
which
the
team
had
adapted,
monitoring
and
and
inspection
activity,
to
reflect
the
extraordinary
restrictions
that
that
everyone
was
operating
under
you
know
again,
the
focus
of
the
discussion
was
how
those
learnings
are
informing
our
future
approach
to
to
regulation.
L
L
We
were
all
pleased
to
to
hear
that
people
had
felt
safe
through
the
the
efforts
of
the
organization
on
provision
of
of
ppe
testing
and
risk
assessment
that
had
helped
colleagues
feel
safe
in
in
the
the
difficult
circumstances
in
which
they
were
they
were
operating
and
also
the
the
commitment
to
communication
which,
because
ian
has
has
led
from
the
top
with
his
with
his
twice
weekly
calls
to
to
to
to
all
colleagues.
L
We
we
heard
similar
themes
to
to
to
the
things
we'd
heard
from
you
know
from
during
the
adult
social
care
update.
You
know
pride
from
the
front
line
in
doing
a
really
difficult
job
in
enormously
challenging
circumstances.
The
importance
of
empathy,
compassion
and
care,
which
I
I
think
we
you
know.
We
know
that
many
of
our
colleagues
absolutely
embody
and
the
importance
of
teamwork
being
joined
up
internally
and
joined
up
with
external
stakeholders
through
this
time.
L
Next
time
we
will,
we
will
hear
from
rosie
and
primary
medical
services
the
same
the
same
story.
We
looked
at
the
ford
planner
and
we
looked
at
the
risk
register,
particularly
those
risks
that
are
relevant
to
to
to
our
committee,
and
we
were
encouraged
to
see
improvements
in
the
residual
risk
scores.
A
Great
thank
you,
so
anybody
want
to
come
in,
if
not
excellent.
Thank
you
mark
very
much
as
it
was.
It
was
a
great
meeting
for
at
least
for
the
pot
that
I
was
able
to
be
be
there
for.
Is
there
any
other
business
for
the
board
perfect?
So
that
is
the
end
of
the
board
meeting.
We
do,
though,
have
a
couple
of
questions
from
the
public
actually
both
from
robin
pike.
So
the
first
question
is:
how
does
cqc
regulate
telephone
consultations
in
gp
and
hospital
clinics,
so
I
guess
rosie.
H
Yes,
certainly
so
we
look
at.
We
look
at
access
through
our
work
that
we
do
on
inspection
and
part
of
that
looks
at
the
the
type
of
access
people
are
getting
and
whether
they
their
needs
are
met
through
that
access.
So
we
look
at
whether
people
are
being
seen
face
to
face
through
telephone
consultations.
H
We
also
make
sure
that
all
staff
are
trained
in
recognition
of
deteriorating
patients
so
that,
for
example,
if
someone
is
booked
in
for
a
telephone
consultation
but
sounds
like
they're
getting
worse,
that
they're
the
receptionist
or
the
the
person
triaging
that
not
triaging
taking,
that
call
is
able
to
identify
it.
We
also
look
at
how
people
assign
procedure
to
the
most
appropriate
level
of
access
and
that
how
that's
communicated
out
to
people
using
services
and
making
sure
that
people
do
get
that
appropriate
consultation.
H
So
I
hope
that
I
hope.
F
Nearly
made
it
to
the
end
ted
well,
rosie
did
a
great
demonstration
in
the
hazards
of
virtual
technology.
There,
which
I
thought
was
was
was
brilliantly
timed,
the
so
in
terms
of
hospital
clinics.
I
I
suppose
the
first
principle
is
exactly
the
same.
Standards
apply
to
telephone
or
virtual
hospital
clinics,
as
would
apply
to
a
face-to-face
clinic,
so
we
don't
have
a
different
standard
to
regulate
by
and
we
would
apply
exactly
the
same
principles.
F
In
truth,
if
you
speak
to
patients,
a
lot
of
the
feedback
we
get
about,
hospitals
is
about
the
unsatisfactory
nature
of
clinics.
Long
waits
delays,
cancellations,
car
parking
which
for
people
attending
the
hospital
site,
is
always
a
problem,
and
so
I
think
we're
very
keen
to
encourage
the
appropriate
use
of
virtual
virtual
technology
for
clinics,
and
hospitals,
of
course,
have
been
experimenting
with
that
during
the
pandemic.
However,
that
that
having
been
said,
the
standards
of
quality
and
safety
will
apply
as
ever.
A
Thanks
ted,
fortunately,
the
the
second
question
is
one
for
you
not
for
rosie
as
well.
So
the
second
question
from
robin
is
what
form
the
cqc
visits
to
secure
hospitals
take
when
whistleblower
information
has
been
received.
F
That's
well
robin.
Thank
you
very
much
for
raising
this
a
very
important
issue.
We
apply
exactly
the
same
principles
with
the
secure
hospitals,
as
we
do
with
any
other
hospital,
so
whistleblowing
information
is
is
processed
in
exactly
the
same
way.
We
will
assess
the
risk
and,
if
necessary,
we'll
undertake
inspections
at
short
notice
and
unannounced
as
required.
A
Thank
you,
ted
and
thank
you
robin
and
thank
you
board.
We
are
finishing
just
one
minute
after
the
scheduled
time,
which
is
quite
good,
unfortunately,
for
the
board.
We
have
more
work
to
do
this
afternoon,
so
we'll
have
some
lunch
and
we'll
see
you
all
at
13
40..
Thank
you
very
much
indeed.