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From YouTube: CQC board meeting – December 2016
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A
B
B
Jorah,
if
you're,
watching
a
completely
going
on
in
my
mind,
uh-huh
so
he's
an
apology,
he
was
with
us
last
night
being
contributing
to
the
board,
will
be
at
the
next
board
meeting
minutes
of
the
meeting
of
the
16th
of
November.
Are
they
true
and
accurate
record
of
everything
we
discussed?
Okay.
Thank
you
very
much
indeed,
I.
B
C
Thanks
good
morning,
everybody
so
I'll
do
this
at
some
pace,
but
I
think
Mike
and
Andrea
may
also
make
a
contribution
to
these
items
when
I
get
there.
So
as
as
usual,
there's
a
performance
report
which
is
for
the
month
of
October,
where
you
can
see
the
progress
which
is
being
made
in
relation
to
completion
of
the
inspection
program,
are
not
going
to
present
this
in
detail.
I
think
the
top
line
from
this
is
these
programs
are
on
track
for
completion.
You'll
also
see
improvements
in
the
performance
in
relation
to
the
timeliness
of
reports.
C
C
Can
colleagues
that
term
more
work
on
enforcement,
she's
being
done
in
fact,
I
think
at
this
point
in
the
year
we've
done
more
enforcement
work
than
we
did
in
the
whole
of
last
year
and
it's
some
important
to
point
that
out
so
I
think
this
works
through
in
a
relation
to
work
Lords.
So
if
I
pause
at
that
point,
Peter
and
just
ask
colleagues
if
there's
any
questions
the
reserve,
there
is
a
monthly
dashboard.
C
It's
not
the
quarterly
detailed
report,
but
there's
a
monthly
dashboard
supports
a
performance
reports
and
may
well
be
comment
to
questions
from
the
board
in
relation
to
performance
on
either
one
I've
said
what's
written
or
on
the
annex
to
the
report.
If
I
just
pulls
it
up.
D
Question
about
enforcement,
which
talks
about
a
for
1667,
published
enforcement.
In
addition,
1337
enforcement
action
in
progress
or
they're.
Not,
although
these
will
result
in
the
published
action,
I,
wasn't
quite
clear
what
that
meant
the
incentive,
if
there's
an
enforcement
notice
or
action,
is
there
a
reason
why
it's
not
published
and
if
there
is
an
action?
Why
isn't
that
publish
that?
Thank
you,
in
other
words,
a
bit
worth
enforcing,
why?
Why
is
it
not?
C
E
Just
to
be
supportive,
David,
and
so
this
is
part
of
the
issue
that
we
have
about
not
being
able
to
publish
the
enforcement
action
that
we've
got
in
progress,
which
I
think
is
an
issue
for
us,
because
we
will
be
taking
enforcement
action.
For
example,
a
proposal
to
cancel
the
registration
of
a
provider
that
will
be
going
through
its
process.
E
They
have
the
opportunity
to
make
representations
against
that
and-
and
those
representations
may
be
upheld
for
whatever
reason,
and
therefore
we
wouldn't
end
up
whether
a
published
action-
or
we
may
actually
by
force
of
the
notice
of
proposal
to
counsel
actually
get
the
improvement
that
we
expect
to
see
and
therefore
we
would
cease
taking
that
action
because
the
improvement
has
been
made
and
in
those
circumstances
we
wouldn't
be
publishing
the
option
because
it
would
not
have
been
completed
because
we
would
have
stopped
partway
through
the
process.
I
think.
D
E
E
D
E
So
we
are
not
supposed
to,
and
there
are
obviously
sort
of
conversations
that
we
have,
and
you
will
see
in
the
comments
that
were
making
about
the
molle
group
later
on
in
the
paper
that
we
are
being
cleared,
that
we
are
taking
enforcement
action,
although
we're
not
being
specific
about
what
that
action
is,
but
it
does
put
is
an
extremely
difficult
situations
and
I
think
you're.
One
of
the
one
of
the
issues
that
I
think
is
is
even
more
difficult
is
actually
if
we
are
undertaking
that
enforcement
action,
it
does
come
to
a
conclusion.
E
It
does
mean
the
service
is
going
to
close
the
people
who
it
most
directly
effects,
which
are
the
people
who
are
living
in
that
service
or
using
that
service.
If
it's
a
domicile
care
service
and
and
obviously
has
an
impact
on
Steven
Mike's
areas
as
well
and
the
last
people
to
know
about
it
are
the
people
who
are
going
to
be
directly
affected
and
so
I
think
new.
There's
there's
there's
there's
a
really
good
reason
for
us
to
try
and
make
sure
that
we
can.
C
I
would
be
anything
I'd
say
is.
This
is
why
it's
important
we're
pressing
for
the
change
in
regulations,
because
for
exactly
this
point,
Robert
people
could
be
selecting
homes
that
were
concerned
about
and
taking
action
on,
but
it's
not
public
and
the
longer.
It
takes
us
producer
reports
along
with
that
period
rooms
and
therefore
the
more
likelihood
is
somebody's
going
to
choose
a
care
home
about
which
were
concerned,
but
we
can't
publish
I
think
when
these
regulations
were
drafted.
C
They
were
drafted
in
favor
of
the
providing,
not
in
favor
of
people
that
will
be
using
services.
So
the
department
is
going
to
change
our
regulations.
They
want
us
to
read
things
which
we
currently
can't
wrap
my
drug
services
and
that's
the
opportunity
to
get
these
changes
introduced
as
well,
so
they
do
operate
in
favor
of
people
select
in
services,
but
at
the
minute
I
think
anything
we
say
will
be
deemed
to
be
published.
C
I
think
what
does
happen,
however,
is
some
local
authorities
will
put
a
moratorium
on
which
there
can
do
independently
of
those,
and
we
do
advise
local
authorities
if
we're
taking
action.
So
there
is
it's
not
uncomplete.
Lee
unfettered
in
the
win,
the
action
we
can
take,
but
we
can't
say
we
are
taking
up
chance
against
this
home
in
this
way
and
that's
what
we
want
to
change
and
that's
why
we've
been
pressing
and
Moltres
thema
during
that
Andrea
raises
it
I've
written
to
the
department
and
said
we
view
this
as
the
utmost
importance.
F
That
up
there's
a
similar
question.
So
I
don't
know
if
you
you're
also
answering
that
Andrea,
but
about
the
about
those
that
locations
have
been
in
breached
for
more
than
four
quarters.
Where
there's
an
equivalent
I
suppose
question
about.
Well,
it's
sixteen
hundred
and
one
and
that
at
the
end
of
October,
so
in
breach
for
more
than
four
quarters
64%
have
an
inspection
planned,
so
just
check
I
understand
what
that
that
means
in
relation
to
the
hundred
percent.
But
the
underlying
point
us
is
the
one
that
I
think
Roberts
raising
about
the
about.
F
F
If
you
actually
go
to
the
care
home
and
look
at
the
place
where
it's
been
displayed
and
that
may
not
apply
to
to
most
people
who
families
who
are
visiting
come
people
can
live
quite
a
long
way
away
when
they
arrive
their
primary
focus
might
not
be
the
notice
board,
and
so
you
know
these
are.
We
do
need
to
think
about
how
we
can
improve
the
general
information
that
comes
back
to
the
families
as
a
result
of
our
concerns,
even
when
they
don't
quite
reach
the
point
of
of
direct
action
or
publication.
F
E
You
very
much
Lewis
I
mean
it
is
a
separate
point
and
we
have
them
in
terms
of
the
answering
the
point
about
sixty
four
percent
to
one
hundred
percent,
and
there
are
issues
with
that.
We're
looking
at
in
terms
of
some
of
those
have
already
had
an
inspection
and
it's
about
a
data
cleansing
issue
in
terms
of
being
clear,
what
further
action
we're
taking
and
how
that
it's,
not
just
whether
we've
had
an
inspection,
it's
kind
of
the
monitoring
that
we're
doing
and
and
the
engagement
that
we're
having
with
the
survey.
E
So
so
there's
there's,
there's
more
flavor
to
that
than
just
the
sixty-four
percent
that
you
see
there.
The
second
bit
of
the
question,
which
is
the
information
provided
so
in
the
reports.
It
will
say
that
the
regulations
have
been
breached
and
it
will
say
what
action
we
have
asked
the
providers
to
take
as
a
consequence
of
that
set
out
in
the
back
of
the
report,
and
we
would
have
said
in
the
summary
that
they're
there
they're
happy,
which
is
the
regulations
so
that
ten
people
are
directed
to
that.
As
we
have
discussed
before.
E
And
there
are
issues
with.
There
is
an
expectation
that
the
summary
of
the
report
will
be
shared
with
people
who
are
using
services,
be
there
residential
or
domiciliary
care
services
and
by
the
provider,
and
it's
not
just
the
display
physically,
but
also
the
display
on
the
website
and
that
people
are
expected
to
do
in
terms
of
the
ratings.
And
we
have
taken
action
against
some
services
who
have
not
done
that
with
in
once
the
20
days
and
grace
period
has
passed.
E
It's
across
all
three
of
the
sectors
that
Mike
Steve
and
I
am
responsible
for
and
I
think
that
thinking
through
things
like
how
do
we
make
the
website
a
lot
more
user
friendly
so
that
people
can
get
the
information
understand,
see
the
history
of
a
provider
in
a
much
easier
way,
except
to
accept
whether
there
are
a
host
of
issues
which
are
underneath.
That
would
suggest
the
detail
in
the
detail
of
the
public
engagement
strategy
that
we
all
need
to
pursue.
E
F
If
I
can
buy
that
for
one
second,
that's
very
helpful
reply.
I
think
the
I
just
still
have
a
concern
that
I
think
we
can
improve
information.
Our
website
can
be
informative
and
so
on,
but
the
illness
is
still
on
families
to
find
out,
and
that
seems
to
me
to
be
a
potential
flaw,
because
you
know
you
have
to
know
your
way
about
the
system
a
little
bit
to
know
where
to
look,
and
it
would
be
much
better.
E
And
you,
as
I
say,
we
have
indeed
taken
actually
going
against
people
in
terms
of
highlighting
to
them,
but
the
things
that
they
need
to
do
and
and
issuing
fine
they're,
fixed
penalty
notices.
So
I'm.
Sorry,
where,
where
they've
not
done
that.
So
here
that
it's
it's
kind
of
you,
it's
something
that
we
have
to
relentlessly
continue
to
do
but
term.
But
it's
something
that
we're
very,
very
mindful
of.
B
C
This
is
I've.
G
C
Lincoln's
seamlessly
to
sorry
Peter,
linking
seamlessly
to
the
update
on
the
more
the
group
and
panorama
from
Louis's
question:
there's
just
a
few
brief
paragraphs
here
just
to
give
the
opportunity
for
the
board
I
in
public
to
actually
have
any
questions
or
discussions
answered
by
Andrea
I
in
relation
to
panorama.
I
mean
these
few
paragraphs
so
stating
you
know
the
factual
points.
C
C
My
sense
is
that
focusing
on
what
is
it
that
we're
doing
in
relation
to
picking
this
up,
it
might
be
the
the
area
that
you
would
want
to
explore
and
certainly
andrea
is
very
happy
to
answer
any
questions
on
what
it
is
that
we're
doing
as
a
consequence
of
the
panorama
program.
I
think
it
picks
up
on
the
general
point
about
what
we
can
say
where
we
are
taking
enforcement
and
also
your
last
point
news,
which
is
where
there's
been
required
to
improvement
outstanding
for
more
than
two
consecutive
quarters.
What
does
that
mean
as
well?
C
G
H
Paul
I
was
one
again
really
concerned
a
bit
more
about
how
we're
looking
at
groups
like
naughty
group,
which
has
got
issues
where
you've
got
earlier
group
with
ya
up
to
10
or
so
homes,
where
we've
got
a
significant
number
which
causing
us
problems,
because
it
seems
that
that's
a
that's
a
potential,
significant
risk
area
and
I'll.
What
are
we
doing
differently
now
serve
as
a
result
of
this,
so.
E
What
we've
done
is
we've
got
an
analysis
of
the
numbers
of
groups
who
have
more
than
fifty
percent
of
their
homes
that
are
either
requires
improvement
or
inadequate.
Those
are
being
reviewed
by
the
heads
of
inspection
at
the
moment,
and
the
plan
is
to
get
to
each
of
those
groups
will
have
a
relationship
manager
and
what
we're
going
to
do
is
to
absolutely
make
sure
that
it's
the
right
relationship
manager
to
have
the
conversations
that
need
to
be
had
that
we
will
hold
management
review
meetings
around
each
of
those
groups.
E
In
terms
of
you,
are
there
consistent
themes
across
across
those
patches
that
we
need
to
be
looking
at?
Are
they
are
they
kind
of
at
the
requires?
Improvement
is
arranged,
so
there
are
some
that
are
kind
of
requires
improvement.
A
couple
of
requires
improvement,
but
they're
kind
of
getting
close
to
good
as
others
that
are.
E
You
know
one
inadequate
for
requires
improvement
and
some
breeches.
So
they
knew
that
would
be
really
worried
about
and
just
kind
of
getting
the
flavor
of
the
risk
risk.
That's
presented
to.
As
from
that
analysis,
so
that
we
can
determine
what
the
appropriate
regulatory
action
would
be
and
also
to
make
sure
that
each
of
the
inspectors
that
have
got
those
services
on
their
portfolios
because
they
may
usually
these
are
geographically
concentrated,
but
they
may
sort
of
go
across
and
local
authority
boundaries
and
therefore
and
be
on
different
inspectors.
Portfolios.
E
Also
making
sure
that
we're
joining
the
dots
up
so
that
the
relationship
manager
for
the
group's
is
sharing
that
information
with
the
individual
inspectors
to
identify
where
there
might
be
where
it
might
be
appropriate
to
be
going
back
to
those
services
more
quickly.
And
of
course,
we
will
be
going
back
to
those
services
that
are
already
inadequate
within
six
months
and
if
they're
requires
improvement
within
12.
E
H
Think
would
be
helpful.
Are
we
also
looking
at
whether
geography
plays
a
part
in
this
I
know
their
particular
parts
of
the
country
where
this
is
more
risk
than
others,
and
is
that
something
where
we're
thinking
about
our
risk
and
I
don't
know
whether,
in
this
case,
Cornwall
was
a
main
course
very
poor
area,
so.
E
There's
there's
a
there's,
a
kind
of
triangulation
that
we
need
to
do
around
that.
We
do
already
know
that
we
have
some
hot
spot
areas
where
we've
had
higher
proportions
of
an
adequate
requires
improvement
services
and
then
others.
This
is
now
looking
at.
Is
that
related
to
the
nature
of
the
group
and
and
what
and
those
services
are
doing,
and
so
we
can
bring
that
together.
So
no,
it's
not
there's
not
a
kind
of
direct
answer.
E
I
can
give
you
now,
but
certainly-
and
we've
observed
that
and
what's
been
interesting,
we've
had
some
areas
over
the
course
of
the
two
Plus
that
we've
been
doing.
The
new
methodology,
where
we
did
indeed
identify
hotspots
and
very
kind
of
concerted
action
by
the
local
inspection
team
with
the
local
authority,
has
moved
that.
Put
that
picture
on
in
certain
areas,
so
so
kind
of
making
sure
that
we're
picking
up
on
these
trends
and
themes
then
taking
the
action
with
other
partners
and
local
authorities.
The
clinical
commissioning
groups
are
also
with
providers.
F
The
many
services
which
are
rated
requires
improvement,
which
might
signal
that
there
is
something
more
here.
We
should
be
looking
more
and
it
may
be
that
a
group
having
a
series
of
Rabbis
improvement
ratings.
That's
in
the
same
group,
that's
one
of
the
indicators
but
I'm
asking
that
same
question
in
a
broader
sense,
whether
we
are
getting
to
the
point
where
our
prediction
could
be
better.
What
other
information
we
might
need
and
I
suppose
behind?
That
is
the
question
that
would
can
we
get
information?
F
Is
there
is
an
information
available
to
us
in
this
case
the
family,
for
example,
that
doesn't
in
the
end,
lead
us
to
rely
on
the
media,
because,
although
that
in
that
might
have
the
right
outcome
for
this
particular
care
home,
you
know
that's
a
very
unreliable
resource
and
in
the
end
we
can't
rely
on
it
in
the
future,
and
people
who
will
not
people
will
not
be
reassured
by
the
fact
that
we
then
took
action.
They'll
I
am
concerned
that
that's
what
it
took.
Okay,.
E
So
what
I'd
say
Louis
is
that
it
did
not
take
the
panorama
program
to
expose
the
depth
of
the
problem.
This
was
a
group
of
services
that
we
had
been
concerned
about
album.
We
had
rated
them,
as
requires
improvement
on
a
regular
basis.
One
of
them
we
had
rated
as
inadequate
at
one
stage
and
the
with
the
support
of
the
local
authority
in
the
clinical
commissioning
group
they'd
made
changes
which
took
the
motive
inadequate
and
back
into
requires
improvement.
E
So
we
kind
of
had
had
that
background
and
understanding.
We
had
already
picked
up
in
two
of
the
nursing
homes,
but
not
the
two
that
the
panorama
program
went
into.
We
had
already
picked
up
that
there
were
increased
concerns
and
indeed
had
inspected
one
and
were
inspecting
another
at
the
point
that
the
panorama
program
provided
their
information
and
in
terms
of
the
reports
that
we've
got
of
the
other
two
homes.
It
is
quite
clear
if
you
read
them
that
the
depth
of
the
problems
were
exposed
by
those
inspections.
E
So
you
know
indeed
panorama
program
identifying
that
we
had
that
they
had
been
in
and
they'd
seen
that
didn't
share
the
footage
with
us,
but
they
did
share
a
fairly
detailed
letter
with
us
of
the
concerns
we
were
already
in
the
process,
because
actually
that
that
group
was
is
all
kind
of
looked
at
by
one
team
and
to
go
back
to
Paul's
point
and
we're
already
in
the
process
of
thinking
through
what
we
needed
to
do
with
the
group
as
a
whole.
But
we
brought
those
two
inspection
inspections
forward.
E
F
E
I
would
absolutely
take
your
point
about
you.
We
do
have
services
that
requires
improvement.
What
are
the
signals
that
we
need
to
be
picking
up
on
in
terms
of
focusing
our
risk-based
approach
around
when
we
go
back
to
services
and
how
quickly
we
go
back
to
services
and
actually,
with
the
morally
group,
we
have
been
doing
that
I
mean
we'd
actually
been
into
those
places.
E
A
lot
more
often
than
a
requires
improvement
rating
might
have
might
have
indicated
and
I
think
that
we
need
to
look
at
that
history,
but
we
also
need
to
look
at
the
one
of
the
feel
the
pieces
of
work
that
we're
doing
is
looking
at
services
where
we
have
had
a
requires
improvement
on
a
number
of
occasions,
so
that
we
can
go
into
that
and
to
look
out
again.
What
are
the
tell-tale
signs
and
symptoms,
at
least
in
one
of
these
services,
I
think
the
manager
had
moved.
E
For
me,
that
is
always
a
bit
of
an
alarm
bell
and
in
terms
of
you,
and
it
was
the
manager
that
had
started
to
make
the
changes
that
had
taken
the
amount
of
inadequate
and
previously
so
so.
I
think
that
there
are
there
are
there
are
things
like
that
which
we
need
to
make
sure
we're
picking
up
on
which
we
would
do
because
of
the
registration
of
the
managers
and
that
we're
feeding
that
into
inspectors
and
that
we
are
using
that
and
to
bring
forward
our
inspections
as
we
need
to.
I
A
I'll
in
The
Times
articles
on
adult
social
care.
This
week
there
was
a
kind
of
insert
about
a
care
home
in
Yorkshire
called
fulford,
forefoot
nursing
home
which,
which
we
have
rated
as
good.
Actually,
we
rated
safety,
as
requires
improvement,
and
if
you
read
our
report,
you
just
wonder
whether
that
really
was
requires
improvement,
or
you
know,
the
improvement
required
was
so
modest
should
that
have
affected
what
was
clearly
in
an
excellent
home.
So
sometimes
you
know,
we've
got
modest,
requires
improvement
as
I
think
in
the
case
of
fulford
and
safety.
A
E
E
There
will
be
and
clarity
in
the
report
after
that,
and
so
you
know
if
it
was
something
relatively
minor
but
actually
still
needed
to
be
sorted,
and
you
I
think
it's
important
that
we
make
sure
that
we
don't
duck
the
issue
even
in
a
good
home
of
the
things
that
they
can
do
to
improve
and
ensure
that
people
are
protected
and
from
harm
and
abuse
and
neglect
we
need
to.
We
need
to
be
doing
that,
but
the
claritin
it
should
be
in
it
there
in
the
report.
E
E
One
of
the
issues
that
we
do
have,
which
we're
exploring
with
the
publications
and
digital
team
is,
as
you
know,
if
somebody
has
had
an
inadequate
rating
in
one
area
and
has
an
adequate
rating
kind
of
it,
it
two
times
in
a
row,
then,
actually
they
go
into
special
measures
as
well,
and
we
don't
make
that
as
public
as
we
was
this,
not
something
that
designates
unless
you
go
into
the
detail
of
the
report
that
they
are
in
special
measures.
So
there
is
something
I
think
that
we
can
do
that.
A
Just
slightly
so
I
suppose
the
concern
is
that
a
relative
will
look
at
the
headline
or
the
headline
ratings
and
I
think
andruw's
point
about
breaches.
Maybe
that
should
be
part
of
our
front
page
or
emphasized
in
some
way.
So
too
is
it
as
I
say,
find
out
without
adding
another
rating
find
a
a
way
of
strengthening
the
severity
of
a
requires
improvement,
I'm.
E
Sure
that
that's
I
mean
versus
stage
with
both
publication.
In
terms
what
report
looks
like,
but
also
what
information
is
available
on
the
website
of
looking
at
that
with
them.
Various
members
of
Malta's
team-
and
you
know,
I-
think
all
of
those
understand
that
our
website
is
not
as
user
friendly
as
it
could
be
in
terms
of
giving
people
the
information
quickly
and
easily,
and
there
are
things
that
we
want
to
do
to
improve
that,
and
this
is
certainly
one
of
those
areas
that
we
can
take
into
consideration.
Mike,
lamb,
shah.
D
E
You
allude
am
Robert
it's
different
in
different
circumstances
because,
as
you
know,
and
we
range
from
services
where
there's
one
or
two
services,
all
the
way
through
to
significant
corporate
structures,
where
there's
lots
of
layers
and
and
lots
of
lots
of
governance
around
those
layers.
So
it
would
be.
There
would
be
a
variety
of
different
things
that
we
would
take
into
consideration
both
in
terms
of
what
we
might
do
individually
because
of
the
the
service.
E
What
we
might
do
in
the
relationship
management
that
we
have
and
with
the
corporate
structure
in
terms
of
highlighting
things,
but
the
the
limitations
of
the
fission
proper
persons
regulation
apply
in
adult
social
care
as
well
as
they
do
in
health.
And
it
is
a
challenge
for
us
to
do
that
because,
of
course,
it
is
the
expectation
that
it's
the
organization
itself
that
assesses
whether
people
are
fit
and
proper.
E
D
C
C
So
I,
don't
know
whether
that's
a
big
enough
number
a
small
enough
number,
but
it
is
a
sense
of
what
may
be
behind
your
question
rubber
that
we
are
indeed
taking
action
in
relation
to
this,
and
the
review
of
fit
and
proper
person
for
me
has
got
to
be
of
the
totality
of
our
responsibilities,
not
just
in
hospitals
and
the
include
trust,
there's
some
figures
there
for
steve's
area.
As
I
was
angry
Azarian,
we
need
to
look
at
it
in
the
round
as
well.
C
Bring
with
you
no
time
whatsoever,
so
I'm
going
to
do
this
at
some
speed
now,
if
I
may
so,
a
three
and
four
there's:
no
regulatory
updates
from
hospitals
and
primary
medical
services
in
a
sense
touching
on
the
issues
that
we've
just
been
exploring
about.
What
do
we
do
with
services
which
are
requires
improvement
and
I
think
has
been
two
aspects
to
this
of
previous
discussions.
One
is
how
do
they
improve
and
what
are
the
factors
of
improvement,
and
why
do
they
not
improve
and
what
are
the
factors
of
that?
C
And
there
was
an
outstanding
minute
which
had
Paul
bits,
name
against
it,
which
kept
coming
back
on
the
action
log.
So
what
I'm
trying
to
suggest
in
this
paragraph
is
this
is
how
we
will
deal
with
both
the
quality,
improvement
and
I.
Think
Andrea's
contribution
to
the
conversation
about
morally
and
requires
improvement
also
contributes
to
this.
Our
hope.
The
board
up
some
sense
of
this
issue
is
being
progressed
and
we'll
take
it
forward
and
I
think
it
picks
up
your
some
of
your
points,
Lewis
about
getting
an
understanding
of.
What's
behind.
C
Some
of
this
stuff
survey
is
now
out
and
in
the
department
and
is
being
brought
together.
It
comes
to
the
executive
team
next
week
in
its
fullness
with
now
I
think
got
all
the
analysis
from
the
surveyor
company
and
I
have
to
say
it's
been
the
best
analysis
that
I've
seen
in
my
time
at
CQC,
in
the
work
that
they've
done
and
that
will
come
in
full
and
will
be
published
in
full
in
the
board
meeting
in
January.
C
C
Important
issues
are
about
our
performance
and
our
future
direction
were
explored
by
a
good
turnout
of
MPs
and
a
pretty
full
three
hours.
I
think
we
were.
The
experts
by
experience
continue
to
update
the
board
in
relation
to
this.
My
update
this
month
is
brief.
I've
shared
previous
correspondence
will
do
that
publicly
as
well,
but
we
continue
to
monitor
in
performance
of
the
contract
and
performance
is
improving
across
the
range
of
the
contract
with
r
employ
and
then
lastly,
colleagues
I'm
just
logging
the
publications
that
we've
made
since
the
last
board.
C
The
monitoring
the
Mental
Health
Act,
which
I
out
say
I,
thought
I'd,
some
profound
and
important
things
to
say
which
we
will
follow
up
in
subsequent
reports
over
the
next
12
months.
Some
quite
different
ways
of
working
combining
speaks
of
the
new
models
with
Carolyn
our
strategy
combining
the
way
we
look
at
urgent
and
emergency
care
by
not
just
looking
at
gps
or
ambulances,
it
one
more
ones,
but
by
looking
at
the
range
of
services
and
how
to
sit
together
and
then
a
third
item
here
is
the
review.
C
An
investigation
on
this
that
Moltres
team
have
largely
been
responsible
for
drawing
together
and
consulting
with
people
who
use
services,
running
surveys
and
questionnaires
of
staff,
and
my
cable
affronted
yesterday
in
terms
of
presenting
this
was
well
received.
I
think
by
the
media,
by
a
number
of
groups,
Secretary
of
State,
accepted
all
the
recommendations.
C
When
we
made
a
statement
to
parliament
and
work,
is
there
so
again,
I'm
air
posite
that
one-pager,
because
it's
the
first
opportunity
of
the
board
will
have
had
to
consider
that
the
other
reports
you've
had
the
last
item
here
is
a
consultation
documents
and
we
will
as
a
board,
return
to
that
and
or
will
be
revealed
as
a
results
of
those
deliberations.
But
if
I,
just
paused
for
molten
Mike
on
the
investigation,
the
deaths
after
Susan
excellent
report
by
the
way
as
well
so
Mike.
K
B
B
A
very
brief
overview,
I
suspect,
board
members
who
had
any
time
would
have
now
seen
the
report
every
I
think
knows
of
it
stemmed
from
the
tragic
death
of
Connor
Sparrowhawk
and
then
from
the
Mars
report
to
looked
at
southern
health,
and
then
we
were
asked
by
the
Secretary
of
State
to
look
across
acute
community
and
mental
health
trusts,
not
just
that
people
with
learning
disabilities
who
died,
but
but
obviously
there
was
a
major
focus
on
on
that.
We
surveyed
all
of
the
trust
in
the
country
we
went
on
visits.
B
We
engaged
a
lot
with
families
and
carers
and
I
like
set
particular
word
of
thanks
to
all
the
people
that
we've
engaged
with
amber,
but
particularly
the
families
who
spoke
eloquently
to
us
about
where
the
system
has
been
failing,
and
we
had
really
asked
five
key
questions
in
and
our
whole
review.
First
of
all,
how
well
our
parents
being
involved.
Secondly-
and
it
may
sound
strange-
but
how
well
are
we
identifying
deaths
and
that's
relatively
straightforward?
B
B
Fourth,
question
was:
what
is
the
quality
of
investigations
when
they're
done
fifth
question
was:
are
trusts
are
learning
from
this
and
taking
action
and
the
the
truth
of
it
is
that
we
found
our
failings
at
all
five
different
steps
and,
as
we
said
yesterday,
we
didn't
identify
a
single
trust
which
is
getting
all
of
those
steps
right
there
are.
Some
trusts
are
doing
a
great
deal
better
than
others
at
one
or
more
of
the
steps.
So
we've
made
a
number
of
recommendations.
B
There's
a
lot
of
work
to
be
done
to
develop
a
national
framework
which
the
National
Quality
board,
which
I
co-chair
will
be
overseeing
that
elite,
that
there
are
training
issues
which
health
education,
England
will
lead
on
and
then
there's
the
specific
issues
related
to
learning
disabilities
and
again,
the
secretary
of
state
made
comment
on
that
in
his
statement
about
the
rollout
of
the
program
to
learn
about
learning
disabilities
and
people
who
have
died
from
them.
I
think
there's
also
important
to
say
that
we
need
to
take
action.
B
Are
we
can
and
will,
as
a
result
of
this,
strengthen
our
own
assessment?
And
we
put
that
into
the
report,
we
will
have
a
particular
focus
on
looking
at
how
well
a
deaths
for
learning
disabilities
and
people
with
mental
health
problems
are
being
investigated
by
trust,
will
look
at
the
quality
of
the
investigations.
We
will
look
at
the
reports
that
are
going
to
be
going
to
trust
boards,
but
importantly,
we'll
be
looking
at
what
action
they're
taking
on
it
and
throughout
this
will
be
saying
our
families
being
involved
or
are
they
not?
B
F
L
F
F
A
lot
of
the
difficulties
that
arise
in
my
experience
is
once
the
is
that
right
from
the
start,
the
families
of
not
consulted,
and
therefore
everything
else
goes
wrong
after
that,
because
the
wrong
questions
then
get
asked,
the
right
learning
doesn't
happen
because
the
right
questions,
weren't
out
and
so
on,
but
get
it
knowing
what
families
want
to
know
is
a
really
important
starting
point
for
investigation
and
making
sure
that
they
have
the
opportunity
to
feed
in
and
so
on.
All
of
that
is
crucial
to
the
eventual
your
eventual
point
about
learning.
F
So
my
question
about
CQC:
what
will
we
do
to
make
sure
that
that
that
role
is
developed
as
well
as
the
as
the
as
the
sort
of
broader
intention
and
similarly
on
who
will
be
responsible
for
ensuring
that
learning
happens?
The
report
makes
reference
to
board
members
having
a
responsibility
there,
and
that
is
a
very
important
point,
but
who
will
oversee
learning
as
in
its
to
make
a
learning
organization,
so
I
just
want
to
get
your
view
of
whether
we
will
look
specifically
at
those
the
development
of
those
rules.
F
Go
for
that,
and
but
I
was
very,
I
must
say
I
want
to
ask
the
question
again
whether
if
there
are
inequities
in
the
system
where
people
have
learning,
disability
and
people
with
mental
illness,
don't
get
the
right
the
same
level
of
care.
So
there's
a
health
inequality
there.
Whether
we
can
really
address
that
unless
we
deliberately
set
out
to
tilt
the
inequality.
The
other
way,
if
we'd
said,
if
we
apply
the
same
model
to
everybody's,
can't
ask
the
same
questions
about
everybody's
care.
F
That
has
the
runs
the
risk
of
perpetuating
inequality
because
isn't
trying
to
change
it
and
I.
Just
wonder
whether
we
should
be
saying
more
forcefully
to
acute
trusts
that
they
that
we
will
take
a
particular
interest
in
how
they
and
they
provide
a
qk
general
health
care
for
people
with
with
LD
and
mental
illness,
and
that
will
feed
into
their
ratings.
It
isn't
just
going
to
be
a
question
it's
something
which
will
have
a
direct
impact
on
their
ratings.
F
B
Lost
count
of
the
number
of
questions
they're
actually
embedded
in
that,
but
I
absolutely
agree
with
you
about
the
business
of
getting
it
right
right
from
the
start,
and
that
was
a
point
that
was
actually
made
by
a
colleague
of
yours,
Simon
Wesley,
when
we
were
consulting
on
this
before
publication.
The
importance
of
that
first
conversation,
the
one
thing
I
left
out
of
my
very
brief
summary
of
what
the
Secretary
of
State
said
was.
He
has
accepted
the
recommendation
that
there
should
be
a
board-level
leader
in
each
in
each
provider
organization.
B
That
is
somebody
who
we
would
undoubtedly
one
to
talk
to
as
part
of
our
well
led
assessment
for
trust,
and
we
would
want
to
say
okay
now
what
have
you
done
to
make
sure?
First
of
all
that
you
can
identify
people
with
learning
disabilities
who
may
have
died
in
your
trust
as,
secondly,
how
are
you
involving
families?
Can
you
give
us
examples
of
that?
Thirdly,
what
have
you
done
to
train
your
your
staff
to
do
the
investigations?
B
Well,
let's
look
at
the
reports
that
you're
taking
to
the
trust
board
and,
as
I
said
before,
most
importantly,
what
what
action
you're
taking
on
it
so
I
think
we
will
have
that
focus
and
we've
said
we
will
it's
on
page
9
of
the
report.
What
CQC
will
do
and-
and
we
will
do
that-
I-
think
going
back
to
your
your
point
about
the
are
we
looking
at
learning
disabilities?
B
Well
enough
in
our
general
inspections.
We
do
of
course,
already
look
at
this
within
the
responsive
element
of
our
inspections
and
doesn't
just
apply
to
learning
disabilities.
It
would
be
lie
to
people
with
dementia
and
I
think
you
could
also
argue.
Other
physical
disabilities
should
be
in
there
as
well
and
if
I
think
it
is
certainly
an
opportunity
to
say
in
all
our
inspections.
Are
we
looking
at
those
people
with
individual
needs
and
are
we
giving
them
sufficient
priority?
B
I
have
always
resisted
the
idea
of
any
one
thing
being
a
limiter
on
a
rating,
but
I
think
we
can
come
back
to
that,
but
I
do
think
we
are
already
looking
at
it
under
responsive
and
we
are
finding
that
some
trusts
are
better
than
others.
You
know
we
ask
the
questions,
for
example
with
learning
disabilities.
Could
you
tell
me
who,
in
this
trust,
has
got
learning
disability
who's?
An
inpatient
now?
Is
that
flagged
on
the
patient
administration
system?
Do
you
have
a
learning
disabilities
nurse
specialist?
B
Would
they
know
who
the
patients
are
in
your
trust
with
learning
disabilities
and
what
reasonable
adjustments
have
been
made
for
them?
For
example,
if
they're
having
surgery
are
they
being
put
first
on
an
operating
list?
Those
are
questions
that
we
developed
with
dominic
Slowey,
the
national
clinical
director
for
learning
disability
and
those
should
be
being
asked
in
all
our
inspections.
D
Very
briefly,
echo
Lewis's
comments
about
the
quality
of
this
report
and
I'm
grateful
personally
for
the
opportunities
I
was
given
to
comment
on
it
in
advance,
particularly
as
the
issues
that
it
highlighted.
Okay,
quite
a
few,
that
one
found
in
mid
Stafford
and
which
brings
me
to
the
point
about
what
happens
to
report
this
number
of
years
after
mid
Stafford
went
of
incidence
of
deaths
still
has
to
be
fixed,
and
this
report
is
part
of
the
picture
and
I
appreciate
that
steps
of
lot
of
steps
are
now
being
taken
towards
that.
D
But
I
personally
cannot
rest
until
as
Lewis
puts
it.
We've
not
only
know
what
the
problem
is,
but
we
have
actually
fixed
it
and
we
are
seeing
results
coming
out
in
terms
of
the
effectiveness
of
the
care
given
to
patients
and
service
users.
The
only
question
are
therefore:
have
you
is
camp?
Can
we,
as
an
organization
we
may
have
distributed
responsibility,
doing
stuff
to
lots
of
other
people?
D
B
M
Happy
to
just
this
is
a
an
early
insight
into
some
of
the
themes
that
we've
been
developing
with
partner
organizations
as
we
begin
to
do
some
early
consultation
on
the
development.
This
strategy,
so
I
wanted
to
make
the
board
aware
of
where
we
got
to
with
the
development
of
those
things,
probably
the
two
areas,
particularly
to
notice
in
the
report.
M
Secreteer
a
member
of
the
people
and
communities
board
a
subordinate
I've
year
forward
view
and
that
groups
role
working
together
is
to
understand,
what's
driving
improvement
and
how
we
can
get
the
voice
of
people
of
who
use
services
into
that
improvement
story
and
strengthen
our
collective
voice.
So
we
can
drive
the
right
behavior
and
the
right
change
in
organizations
and
that's
something
that
they
as
a
group
they're,
keen
that
we
explore
as
part
of
this
strategy
and
I.
Think
it's
a
Lynx
well
to
that.
M
The
first
suzique
ambition
in
terms
of
an
intelligence
driven
approach
would
be
speaking
to
colleagues
at
HealthWatch
and
we've
been
speaking
to
other
organizations
as
well
about
how
we
join
up
the
voice
of
people
who
use
services.
So
it
can
amplify
what
we
know
about
services.
We've
been
historically
love
collecting
hard
data
this,
but
the
ability
to
collect
the
voice
of
people
use
services
and
use
it
well
is
something
that
we
have
to
do
as
part
of
this
strategy,
and
we've
been
so.
M
We
will
have
having
good
conversations,
particularly
with
HealthWatch,
about
how
we
can
join
up
that
understanding,
so
that
we
can
present
back
to
our
own
organization
into
others,
a
comprehensive
view
of
what
people
think
of
the
services
that
they
are
using
and
that
in
itself,
we
think
will
help
drive
the
right
behavior
in
the
right
change
within
those
organizations
in
terms
of
promoting
a
single
shared
view
of
quality.
It's
very
important
that
we
are
I
think
a
lot
of
this
is
focused
on
how
we
share
information
across
a
system,
and
that
is
very
important.
M
It
is
also
important
that
we
make
that
information
meaningful
to
people
who
use
services,
so
at
the
moment,
and
a
lot
of
our
activities
based
around
inspection
reports,
it's
important
that
we
can
lock
together
what
information
we
see
on
inspection
reports
and
the
constant
stream
information
that
we
and
other
organizations
will
get.
So
we
have
an
always-on
view
of
quality
that
links
those
those
two
things
and
lastly,
and
obviously
we
need
to
improve
our
own
efficiency
and
effectiveness
and
I
think
that's
about
how
we
find
the
right
partnerships
to
do
the
right
thing.
M
It's
an
untapped
resource
at
the
moment
that
we
need
to
make
the
most
of-
and
there
are
in
there
are-
we
know
existing
sources
of
qualitative
information
that
come
from
a
variety
of
sources
and
I
think
we
need
to
bring
that
together
more
effectively
than
we
do.
We've
been
talking
as
a
transparency
borders
that,
with
the
acreage
again
we're
a
part
of
to
try
and
bring
together
the
information
that
other
organizations
have.
So
we
have
a
well-constructed,
easy
to
understand
the
nut
and
act
view
of
how
services
are
are
developing.
M
Clearly
out,
our
digital
engagement
is
important
here
as
well,
how
we
engage,
how
we
use
the
technology
that
we
have
available
now
that
wasn't
available
24
years
ago
to
to
drive
that
engagements,
not
just
about
the
websites.
Also
both
applications
based
technology
as
well.
Recognizing,
not
everybody,
can
engage
you're
jittery
and
therefore
it's
important
to
have
the
channels,
both
directly
and
indirectly,
with
people
who
aren't
able
to
access
digital
channels
in
terms
of
partnerships
and
campaigns.
M
The
last
last
three
points
we've
begun
to
do.
Some
work
on
co-production
I
think
we've
we've
them
in
some
areas.
We've
been
doing
this
for
some
time
and
doing
very
well
I
think
it's
about
how
we
have
this
ambition
within
all
of
our
all
of
our
work,
so
that
we
generally
involve
people
in
the
design
and
development
of
our
work
and
the
consultation
and
the
work
that
we
do
post.
The
consultation
will
will
be
a
part
of
that
approach
and
we've
got
we.
M
It's
called
in
bed
of
a
public
focus
culture
across
CQC,
and
this
goes
back
to
my
point
about
hard
data
and
soft
date.
I
think
historically
of
the
organization
has
been
better
understanding
and
using
hard
data.
I
think
the
the
way
we
use
soft
intelligence
and
to
be
fair,
that
the
technology
is
now
available
to
help
us
bring
together
soft
intelligence
in
a
meaningful
way.
M
Well,
it
will
help
us
make
that
change
and
content
have
already
talked
about
the
idea
of
having
an
always-on
view
of
quality
needs
to
work
from
the
the
person
who's
using
services
wants
to
choose
or
just
wants
to
understand
what
they
should
expect
from
their
services,
so
how
we
develop
that
how
we
share
it
with
other
organizations.
So,
although
we
get
four
million
hits
a
month
to
our
site,
we're
not
the
only
organization
out
there
that
can
provide
this
information,
so
how
we
support
other
organizations
in
their
ability
to
share
that
information.
M
So
that's
the
work
that
we've
got
its
ongoing,
those
the
changes
that
we're
thinking
about
in
terms
of
development
of
strategy.
We
want
to
be
continued.
The
conversation
with
organizations
outside
CQC,
as
well
as
staff
and
experts,
by
experience
for
who
are
involved
with
CQC,
and
it's
brought
today
for
your
your
thoughts.
Thank.
J
Anybody
wants
to
raise
Paul
I'm,
it's
usually
what
this
is
about
is
seeking
a
much
richer
dialogue,
so
people
will
be
able
to
get
it
our
stuff
eat
more
easily
and
we'll
be
able
to
get
up
their
stuff
more
easily
under
stuff.
The
difference
of
the
stuff
there's
are,
as
you
say,
a
serious
quality
issues
and
as
a
series
of
quantitative
issues
and
between
17
and
21.
M
Important
point
and
two
things
are
saying
in
a
different
guys:
I
brought
had
conversations
about
the
IMT
strategy,
I
sent
David
a
note
this
week,
which
the
sometimes
difficult
process
of
getting
approval
to
to
spend
money
on
the
development
of
our
website
is
something
that
has
given
me
more
gray,
hairs
than
probably
anything
about
any
other
part
of
my
job.
We
obviously.
G
M
It's
coming
slowly,
but
more
quickly
than
I
would
like
and
the
it
may
not
say
what
the
approach
now
from
the
D
H
is
much
more
positive.
They
are
supporting
and
development
of
alpha
in
me.
We've
done
some
good
discovery
where
I
think
I
brought
as
part
of
the
amity
strategy,
because
I'm
really
good.
As
guru,
we
know
exactly
how
we
need
to
change
the
website.
It
is
not
fit
for
purpose
in
its
current
form,
but
we've
known
at
some
time.
Having
said
that,
the
satisfaction
of
the
website
is
actually
relatively
strong
people.
M
So
the
thing
that
you,
if
you
want
to
go
and
look
at
an
individual
organization
and
you
you're
you've
got
a
sense
of
where,
where
you're
going,
it
is
relatively
strong,
but
it
needs
to
be
far
better.
We
know
that
we
know
exactly
how
it
needs
to
change.
We've
now
got
support
for
the
dh2
begin
that
work
and
in
earnest.
We
need
to
be
progressing
that
before
or
at
the
cusp
of
the
new
financial
year,
and
we
recognize,
as
probably
two
of
the
shifts.
The
other
thing
is
active.
M
G
N
G
This
has
have
been
the
real
prize
of
ours
being
able
to
work
really
closely
together
and
I.
Think
of
the
phrase
people
used
to
say
to
me
when
I
first
arrived
in,
local
HealthWatch
was,
but
we
are
there
when
the
inspectors
go
home
and
that's
true
and
because
it's
even
more
true
now,
if
as
you
as
we're
moving
to
a
more
risk-based
inspection.
So
basically
you
had
your
elbow
and
we
stand
ready
to
great.
D
And
I
do
think
this
is
a
good
step
forward
and
obviously
his
challenges
in
actually
making
this
a
reality
which
will
lead
to
gray
hair
if
you
have
disguised
it
already.
But
one
point
I'd
like
to
emphasize,
which
is
undoubtedly
here,
which
is
about
finding
ways
listening
to
those
who
perhaps
our
bathes
could
all
have
no
resource
to
get
into
even
the
most
modern
digital
technology,
let
alone
the
old
old
one
who
are
perhaps
on
the
peripheries
of
the
hell's
provisional
social
care
system.
D
In
any
event,
at
a
time
when
we
learn,
through
all
sorts
of
things,
been
happening
recently
that
there
as
a
mass
of
people
out
there,
who
are
not
really
don't
feel
listened
to,
but
I'll
not
listen
to,
and
it
seems
to
me
that
we
have
a
really
important
role
in
relation
to
health,
to
reach
out
to
those
people
and
I
will
just
put
a
sense
of
caution
in
that
job.
I
think
it
depends
on
more
than
developing
experts
by
experience
in
order
to
do
that,
which
is
I.
D
Think
the
only
place
where
people
win,
bundle,
circumstances
are
particularly
mentioned
and
I
know.
That's
not
meant
to
be
an
exhaustive
description
of
what
we
do
but
outreach
through
HealthWatch
through
other
means,
through
organizations
and
partners
to
those
who
are
not
normally
listen
to.
It
is
a
really
important
part
of
what
we
need
to
do
just.
M
Just
to
respond
I
entirely
agree
with
you
and
one
of
them.
I
talked
earlier
on
about
the
development
of
partnerships,
both
national
and
local,
and
I
think
I
mentioned
trust
as
well.
I
think
in
development
of
those
partnerships,
so
we
met
with
a
group
of
organizations
for
the
evaporator
100
that
represents
small
and
large
communities
across
the
country,
medial
areas
as
well
as
the
national
and
they
are.
They
represent
people
exactly
as
you
described,
who
wouldn't
be
able
to
engage
in
through
normal
mainstream
channels
at
all
and
our
our.
G
M
Ironically,
some
of
the
way
with
an
automatic
reviews,
has
begun
to
build
that
trust,
and
I
mentioned
at
one
of
the
one
at
one
of
these
groups
about
the
idea
of
using
information
that
we
know
the
things
that
we
know
to
help
them,
and
then
they
could
help
us
build
on
that
knowledge.
More
and
I
think
there
is
a
really
important
reciprocal
process
that
we
go
through.
So
we
know
the
groups
and
organizations
that
can
they
can
provide
the
right
information
to
us
and
also
we
have
the
ability
to
share
that
information
back.
M
We
then
we
held
a
number
of
conversations
over
the
summer
with
some
of
those
organizations,
and
that
was
a
very
important
point.
That's
the
reciprocity
of
that
about
our
relationship,
but
it
is
built
upon
the
trust
and
they've
got
to
trust
us
and
we've
got
to
we
relax
on
the
information
but
I
internally.
B
G
You
very
much
indeed
so,
if
you'll
permit
me
chairman,
just
a
couple
of
end
of
first
year
reflections
and
perhaps
a
reminder
to
us
all
what
work.
What
this
is
about,
the
prize
that
we're
trying
to
get
here
is
a
is
a
Health
and
Social
Care,
Health
and
Social
Care
that
people
can
understand
and
can
use,
and
when
Susan
I
sat
down
at
the
beginning.
Here
we
I
think
we
either
intuitively
owning
and
gradually
over
the
air.
More
more
explicitly
had
sort
of
three
watch
words-
and
forgive
me
I
was
writing
this.
G
G
So
it's
just
was
interesting
to
really
really
try
and
get
to
what
people
actually
thought
simplicity.
We
had
a
machine.
We
had
a
system
which,
as
I
described
in
my
report,
should
be
just
as
simple
as
123,
but
in
some
way
we
were
making
it.
It
had
started,
look
over
intellectualize
and
we
had
to
sort
of
strip
it
back
to
essentials
and
focus
what
we
absolutely
want
you
to
make
sure
that
we
had
a
grip
on
our
on
our
structures
and
other
some
tripe
phrase
that
I
was
trying
to
on
Susan
yesterday
about
this
year.
G
We've
rebalance
we've
refocus
we've
restructured,
but
that
in
essence,
is
what
we've
done.
So
I'm
going
to
let
Susan
in
a
minute
talk
about
the
intelligence.
I
think
what
I
really
want
to
say
is
a
big
thank
you
to
Susanne.
Cuz
Susan
is
I,
can't
believe
I'm
saying
this
either
it's
retiring
in
quotes
in
early
January
and
Susan.
I've
had
a
really
good
here
and
I
hope
that
people
feel
that
we
have
done
something
useful
I
know.
G
G
I
think
I
said
that
already,
but
I
will
say
it
again
and
also
welcome
to
imelda
Imelda
Redmond
who's
going
to
be
our
new
national
director
coming
from
the
beginning
of
January
next
year
and
just
lastly,
if
I
can
serve
couple
of
seconds
looking
forward,
the
one
of
the
things
that
is
I
know
saw.
Robert
will
probably
also
asked
me
this
question
in
a
minute,
but
one
of
the
things
that's
constantly
capturing
our
attention
about
the
network
itself,
but
local
HealthWatch,
which
is
a
concern,
is
the
funding.
Now
it's
not.
G
We
are
not
we're
not
getting
to
that
tipping
point
moment
that
love
it
from
andrew,
but
there
is
emerging
the
clear
evidence
that
in
more
deprived
areas,
the
local
HealthWatch
is
being
more
stripped
back
of
funding.
So
that's
going
to
be
one
of
our
concerns
going
forward.
I'm
also
very
keen
that
we
I
mean
our
business
is
engagement
and
I
would
like
to
see
us
somehow
make
more
of
it,
but
to
really
harness
the
expertise
that
has
been
gathered
by
that
the
system
that
was
set
up
was
very
much
let
a
thousand
flowers
bloom.
G
N
Priority
One
you'll,
see
from
the
report
stps
our
big
focus
for
us
at
the
moment
and
we've
been
doing
a
lot
of
work
with
a
network
to
make
sure
that
they
can
and
they
can
get
involved
in
a
number
of
ways,
because
they
can
either
help
with
the
engagement
or
they
can
advise
on
it
or
they
can
critique
it
and
be
a
critical
friend
to
the
organization's,
who
must
make
sure
that
they
are
involving
the
public
in
these
changes
and
I.
Think
the
M.
N
The
engagement
strategy
is
a
timely
reminder,
actually
that
we
must
not
be
completely
distracted
by
the
stp
agenda
and
forget
the
risk
agenda,
which
is
what
we
really
need
to
work
with
a
local
HealthWatch
on
to
support
your
new
investor,
inspection
strategy
and
I.
Think
the
other
thing
I
wanted
to
say
on
priority.
One
is
just
our
relationship
with
local
HealthWatch
I
feel
this
year
has
got
stronger,
I
feel
it
is
more
honest,
it's
more
trusting
and
we
have
had
very
many
more
mature
conversations
and
for
that
I
am
very
happy
and
but
I
think.
N
That
gene
is
expressed
Peter
and
David
to
you
and
your
your
board
and
your
teams
who
have
made
us
so
welcome
and
have
supported
us
tremendously
well,
and
it's
it's
wonderful
to
come
to
this
meeting
and
here
HealthWatch
being
spoken
off
so
freely
and
also
AM
within
the
equality
and
diversity
of
human
rights.
Work
I,
hope,
you've
seen
that
we
have
been
fully
engaged
in
that,
but.
N
B
Susan
I
I
was
going
to
say
that
there
is
an
absolute
mutuality
of
interest,
so
you,
the
reason
that
you
have
been
really
welcomed
is
not
just
because
you
only
nice
people
that,
of
course,
as
part
of
it,
but
actually
the
information
that
and
that
you
bring
both
local
healthwatches
and
then
through
youth
HealthWatch
England.
As
we
have
said
several
times
today,
as
David
and
I
said
several
times
to
the
Health
Select
Committee
is
really
really
valuable
and
the
more
that
we
try
and
focus
our
activity
to
where
the
problems
are
the
more.
B
We
need
the
information
to
know
where
those
problems
are
so
I
think
what
you
and
local
healthwatches
are
doing
is
really
important.
So
thank
you
from
us
as
much
as
the
other
way
around
I
think
I
I
was
also
going
to
wish
you
really
well
legally
correct
bot.
Jenica
James
said
you
were
retiring,
you're
retiring
from
CQC,
that's
not
to
say:
okay,
Rach
can
retire
all
together,
I'm
quite
sure
other
things
to
do
so
in
the
next
phase
of
life.
I
wish
you
really
well.
B
B
Igc,
michael
for
the
rgc,
would
it
would
it
be
sufficient
just
to
note
for
the
minutes
that
we
had
an
in-depth
discussion
on
matters
that
relate
to
the
consultations
that
we
will
be
releasing
in
due
course
that
a
sufficient
summary,
perfect
good,
but
I
sell
it
for
you,
so
you
can
move
quickly
to
any
other
business.
Well,
I'm!
Sorry
I
knew
left
up
in
here.
This
is
Robert.
You
look
as
if
you're
about
to
read
something
thank.
D
You
I
just
thought
I'd
probably
ought
to
report
in
one
minute
on
the
National
guardian,
because
we
have
now
had
the
first
meeting
of
what
we
I
think
are
calling
the
accountability
liaison
board,
which
is
basically
representatives
of
the
three
stakeholders
who
responsible
as
it
were,
overseeing
the
national
guardian,
and
that
was
a
productive
meeting.
We
received
a
report
from
Henrietta
the
National
guardian
about
the
work
she's
been
during
the
recruitment
for
office
and
so
on,
and
we
learned
that
about
the
setting
up
of
networks
of
local
Guardians.
D
But
the
point
I
want
apologize
is
that
to
date
we
think
that
188
trusts
have
appointed
a
guardian
or
a
group
of
guardians
or
whatever,
which
we
think
leaves
about
52
that
either
haven't
or
haven't
actually
said.
They
have,
which
probably
means
that
they
haven't.
The
date
is
now
long
past
when
actually
they
that
should
have
happened
and
I
just
flagged
that
up
as
a
potential
error,
if
it
concern
which
I
hope
we
will
be
reassured,
has
been
dealt
with
by
the
Natar
next
time.
I'm
able
to
report
you,
it
isn't.
B
K
I'm
David
Hogarth
I'm,
the
coordinator
of
offending
charity
in
North,
London
and
I'd,
like
to
go
back
to
the
morally
story
and
to
take
issue
with
Andrea
when
she
says
that
it
didn't
take
Karami
to
get
to
the
depths
of
the
problem.
I
think
those
of
you
who
watch
that
programme,
the
part
which
may
have
made
you
most
sick,
was
when
you
saw
those
two
members
of
staff
in
Clinton
house.
K
What
was
a
care
assistant,
a
dementing
woman
was
crying
out
for
help
and
she
just
said:
don't
be
naughty
I'm,
not
having
any
more
of
this
misbehaving,
and
then
we
went
on
and
saw
a
nurse
who
again
was
obvious.
The
case
of
a
man
being
miserable
and
all
she
could
recommend
was
giving
him
a
chemical
gosh
and
you
did
not
discover
those
things.
Parama
did
discover
those
things
because
when
you
look
back
at
the
report,
yes,
you
did
require
improvements
in
things.
K
I
was
trying
to
find
out
what
they
were,
but
you
taken
those
reports
off
the
website,
I
think,
but
what
you,
the
the
caring
domain
for
Clemson
house
in
the
most
recent
report,
was
good
and
I.
If
you're
saying
that
those
two
people
were
not
there
that
time,
then
that's
fine,
but
my
guess
is,
since
it
was
I
think
last
April
that
they
were
there
and
you
did
not
discover
them
now.
K
You
talk
a
lot
about
getting
thousands
and
thousands
of
people
ringing
up
your
customer
helpline
and
about
getting
information
from
HealthWatch
and
about
how
you're
doing
improving
you're
inspecting.
But
the
fact
is
that
you
are
not
actually
discovering
these
things.
It's
other
people
who
discover
them.
Unfortunately,
there
isn't
enough
money
for
panorama
and
the
Daily
Mail
to
do
all
the
care
homes.
That's
what
you're
supposed
to
doing,
and
you
are
not
finding
those
things
now
in
the
past.
K
I
have
mentioned
that
you
should
be
more
like
mi5,
causing
a
certain
amount
of
merriment
and
Eve
nice
or
certain
amount
of
jokingly.
But
the
fact
is
this
that
if,
if
mi5
had
been
looking
at
morley
care
homes,
last
April
I,
guess
that
they
would
have
discovered
those
two
nurses
and
done
something
about
it
and
as
a
result,
the
two
people
who
were
being
mistreated
would
not
would
have
had
a
happier
life.
And,
although
you
may
laugh
about
mi5
and
say,
oh
well,
we
wouldn't
do
things
like
that.
B
So
David
we've
had
this
conversation
numerous
times
in
the
board
and
privately.
The
difference
between
us
fundamentally,
is
that
you
are
suggesting
that
there
should
be
covert
surveillance
of
care
homes
and
I'm,
saying
that
there
needs
to
be
a
balance
between
that
and
care
and
sorry
under
and
the
dignity
and
respect
for
the
both
patients
and
staff.
So
we
have
a
fundamental
difference
said
at
the
last
board.
You
and
I
will
not
agree
on
this,
and
we
can
laugh
about
whether
it's
a
mifi,
but
that
that
is
fundamentally
the
difference
between
us.
B
So
that
was
the
first
one.
I
want
to
just
make.
Second
point
is
absolutely
fundamentally,
and
we
made
it
very
clear:
we
do
rely
on
information
from
the
public,
and
that
is
from
the
media,
from
social
media,
from
service
users
from
their
families,
from
other
professionals
to
provide
information,
as
well
as
what
we
find
for
ourselves
on
inspection.
So
III,
don't
think
it's
a
problem
when
somebody
is
telling
us
something
that
we
need
to
look
at.
B
It's
actually
part
of
how
we
have
to
operate
for
kind
of
the
reason
you
said
there
isn't
resource
for
Andrea
to
have
an
inspector
in
every
home
24
hours
a
day,
seven
days
a
week,
so
I
think
it's
part
of
how
this
has
to
work
rather
than
it's.
It's
a
problem,
final
point
and
then
Andrew
may
or
may
not
want
to
add
anything.
B
Whilst
you
are
right
that,
of
course,
individual
incidents
that
we
weren't
present
at
may
have
been
filmed
by
by
panorama.
Andrea's
point
was
earlier
in
the
board
meeting
that
we
were
well
aware
of.
There
were
issues
that
was
work
on
the
way
and
we
would
have
got
to
the
same
point
with
or
without
panorama
and
I
think
that's
quite
an
important
distinction.
What
you
say
I,
don't
if
you
want
to
add
anything
under
the.
E
So
there
has
to
be
an
understanding
of
the
role
that
we
play.
The
expectations
that
we
can
set
the
way
that
we
do
our
monitoring.
The
way
that
we
do
our
inspections
than
the
way
that
we
provide
information
to
the
public
and
the
way
that
we
take
enforcement
action
and
when
that
is
necessary.
That
is
our
very
clear
commitment
it
set
out
and
everything
that
we
talked
about
everything
that
we've
written
in
the
various
strategy
documents
and
the
way
that
we
carry
out
our
job.
E
Think
the
one
of
the
things
that
we
need
to
do
as
an
organization
as
a
board
is
a
power
game
and
all
of
the
various
ways
that
we
need
to.
But
we
also
need
to
make
sure
that
people
who
are
responsible
for
delivering
that
care.
Do
it
in
the
right
and
proper
way
and
that
they
take
their
responsibilities
seriously
too.
A
A
But
I've
looked
at
sin,
Theresa's
Clinton
house
and
we
have
on
the
website,
got
all
the
well.
This
is
an
issuer
to
do
with
our
website
per
day.
I
just
wanted
to
you
know,
I
think
the
implication
that
we
might
be
suppressing.
Those
reports
is
just
not
the
case.
They
are
definitely
on
the
website.
They
might
not
be
easy
to
access,
but
I
can
promise
you
they're.
Definitely
there
thank.
B
I
30-11
Poquette
from
hope
to
HealthWatch
very
quick
questions
if
I
may
one
on
timeliness
and
one
on
GP
inspections
and
when
there
is
a
substantial
delay
in
publishing
the
inspection
from
hospital
trust,
as
is
the
case
with
a
London
hospital
inspected
in
April
and
for
whom
I
do
not
think
the
inspection
report
has
yet
been
published.
Is
there
a
possibility
of
publishing
an
interim
summary.
B
So,
just
just
just
more
generally,
this
is
an
issue
the
delay
in
getting
our
reports
out
well
aware
of
it.
If
you
do
spend
three
hours
as
David
saying
earlier
and
viewing
our
interrogation
at
the
Health
Select
Committee's
was
one
of
the
points
they
raised,
and
our
answer
was
that
there
are
a
number
of
actions
we
are
already
taking
to
speed
up
the
delivery
of
these
reports
quite
quite
dramatically,
and
in
the
fullness
of
time
and
I
was
very
clear
to
say
to
the
committee.
B
This
is
a
sort
of
a
couple
of
years
out,
rather
than
something
that's
immediate.
The
other
actions
are
immediate.
Then,
when
we
get
to
better
use
of
digital
technology,
we
will
be
able
to
make
a
quantum
leap
in
the
speed
of
getting
reports
out,
because
that's
actually
what
needs
to
happen,
I'm,
not
sure
Mike.
There
is
an
entry
intermediate
icon
to
the
way
intermediary
step.
We
could
take
just
completely
agree
that
the
delays
in
getting
our
report
out
is
not
in
any
way
satisfactory.
What
we
do
is
we.
B
We
write
a
letter
to
the
trust,
summarizing
the
immediate
feedback
that
we
gave
to
the
trust.
If,
of
course,
we
are
taking
any
enforcement
action
as
we
discussed
earlier,
what
we
will
then
do
is
as
soon
as
the
28-day
period
representation
is
over.
We
will
actually
make
it
public
that
we
have
taken
enforcement
action,
so
you
can.
L
L
Noted
we
that's
a
very
good
question
where
they
are
inspected.
We've
been
looking
at
how
we
regulate
independent
providers
of
healthcare
and
we've
made
a
decision
that
the
those
who
are
providing
private,
if
you
like,
independent
general
practice,
because
there
are
private
providers
providing
NHS
services
as
well,
we're
now
starting
to
look
at
those
in
the
next
phase
as
it
comes
forward.
So
they
are
very
important
but
we're
already
taking
action
when
we
have
information
or
data
on
independent
providers
as
a
matter
of
urgency
on
a
risk
base.
B
O
O
You
and
through
Larry
quick
points
really
the
first
one
in
terms
of
what
Chris
day
was
saying
about
trust
and
the
engagement
I
think
you
could
look
at
all
that
paper
and
boil
it
down
to
two
things
really,
which
is
exactly
just
that
trust
and
the
relationships.
I,
don't
think
we
should
use
partnerships
too
much
I,
think
that
touched
and
comes
across
to
me,
sometimes
as
convenience,
etc,
and
there's
a
clear
difference
between
partnerships
and
relationships
with
that
really
the
point
I'd
also
add
to
that
really
is.
O
Is
we
shouldn't
overlook
how
how
long
it
takes
to
build
that
trust
up
as
well?
We
don't
get
it
overnight.
We
have
to
earn
it
etc
and
when
Chris
is
talking
about
some
of
those
community
groups,
really
that
sometimes
I've
experienced
being
consulted
and
consulted
and
consulted,
and
they
don't
see
any
real
significance
and
particular
in
areas
of
greater
need
as
well.
Really
it's
really
difficult,
so
don't
overlook
how
how
how
much
on
opportunity
nas's
is
trust,
but
also
how
much
the
challenges
to
actually
time
period
him
make
sure
we're
realistic
with
that.
O
I
also
think
in
terms
of
hearing
about
the
website
and
whatever
really
and
the
developed
around
that
that
one
of
the
things
we
also
should
look
at
is
how
how
more
easy
we
can
promote
the
alerts
for
people
who
want
to
say
I'd
like
to
know
in
terms
of
with
the
inspection
of
the
acute
references
it's
there
and
whatever
really.
But
it's
just
not
easy
and
actually
I.
Think
that's
one
thing
that
we
can
do
I
looking
to
develop
the
website
and
whatever
really
particular
promotion
and
no
that's
not
applicable
across
all
three
sectors.
O
But
there
is
one
sector
in
particular
I
think
we
could
do
a
little
bit
better
on
really.
You
heard
me
say
this
before
really
but
I
think
the
CQC,
as
in
any
of
the
organization's
rises
and
falls
on
its
people
in
my
PA,
really
structured
systems,
etc,
are
supported
and
whenever
really
and
I
just
wanted
to
broad
but
bring
to
the
attention
the
board
of
inspiring
people
in
CQC
I
have
come
across,
and
you
had
one
presentation
from
chris
day
today
and
my
dealings
with
chris
over
some
time
now.
B
I
suspect
he's
monitoring
the
the
rivet,
the
the
meetings
in
system,
the
public
part,
but
I
will
pass
that
last
part
on.
Thank
you
very
much
d.
They
didn't
let
that
that
ends.
The
the
public
meeting.
Wish
you
all
a
very
happy
Christmas.
Thank
you
for
coming
today
board.
We
we
need
to
do
another.
Another
short
burst
of
work
before
we
get
a
break
for
lunch,
I'm
afraid
so.
I
just
ask
members
the
public
to
to
leave
us.