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From YouTube: CQC board meeting – November 2018
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A
Okay,
good
morning,
everybody
welcome
to
the
November
meeting
board
meeting
for
the
CQC.
We
have
apologies
this
morning
from
Jorah,
gill
and
multi-cat,
whose
motorist
courses
on
his
long
paternity
leave
particular
welcome
this
morning
to
david
Hastings
who's,
the
chair
of
the
CQC's
lgbtq+
network,
david,
extremely
welcome
to
you.
I'll
introduce
Henry
Esther
in
a
moment,
but
you're
obviously
welcome
I
think
everybody
else
is
normally
here,
but
anyway,
everybody's
welcome.
So
that's
good
as
there
any
declaration
of
interest
that
anybody
needs
to
raise
good,
all
right
minutes
of
the
17th
October
meeting.
A
Are
there
true
and
accurate
record
of
all?
We
discussed
excellent
I'll.
Take
silences
totally
since
that's
good
there's
a
couple
of
items
on
the
the
action
log,
money's,
sort
of
ongoing
updates
on
the
digital
intelligence
and
that
I
think
we
might
take
this
off
the
action
log,
because
I
think
by
definition,
is
it's
ongoing
but
doesn't
just
click.
You
know
if
you're,
oh
action,
log
doesn't
mean
it's
not
going
to
be
continued
and
then
the
the
other
item
is
on
the
agenda
for
today
later
anyway.
So
that's
okay.
Anything
else
arising.
A
B
Since
I
last
attended
this
board,
which
doesn't
feel
like
a
year
ago,
I
have
to
say
I
really
believe
that
substantial
changes
have
come
about
in
the
speaking
up
arrangements
in
England
and
I'm
pleased
to
present
my
2018
annual
report
to
you.
So
just
in
brief.
We
now
have
800
guardians,
champions
and
ambassadors
across
England.
To
date
they
have
handled
over
12,000
cases
and
the
numbers
are
going
up
quarter-on-quarter.
B
The
largest
group
of
cases
is
around
bullying
and
harassment,
and
the
second
largest
is
around
patient
safety,
and
we've
been
providing
training
for
guardians
and
development
for
boards
of
NHS
trusts
and
foundation
trusts,
and
we've
recently
published
our
2018
survey
again.
It
shows
that
many
Guardians
don't
have
protected
time
and
this
impacts
on
the
ability
for
them
to
do
justice
to
their
role.
B
We
found
that
if
they
don't
have
protected
time,
they're
less
likely
to
have
access
to
their
chief
executive
to
present
to
their
board
in
person
to
attend
training
or
regional
events,
and
probably,
most
importantly,
to
seek
feedback
on
their
own
performance.
So
we
call
to
all
leaders
of
organizations
to
put
sufficient
investment
into
this
role
and
I'm
pleased
that
many
trusts
are
actually
increasing
the
amount
of
protected
time,
but
I
think
I'd
like
to
see
that
go
further
and
faster.
B
We
want
organizations
to
use
speaking
up
as
a
way
of
improving,
as
they
say
at
West,
Suffolk,
NHS,
Ft,
freedom
to
speak
up,
freedom
to
improve
and
I
think
that's
a
good
motto
to
actually
show
that
this
is
not
just
about
raising
concerns.
This
is
also
about
great
ideas
and
they've
got
some
lovely
examples
of
very
junior
members
of
staff
being
able
to
make
significant
changes
to
patient
safety.
We've
completed
the
12-month
pilot
of
our
case
review
process
and
within
that
we're
identifying
and
systematically
tackling
some
of
the
barriers
to
speaking
up.
B
But
more
than
that,
we
need
to
work
out
who
needs
to
do
what
to
make
the
changes
happen
and
those
include
conflicts
of
interest.
So,
for
example,
in
one
trust,
only
one
member
of
out
of
9,000
had
completed
a
conflicts
of
interest
declaration.
We're
going
to
be
looking
in
detail
at
settlement
agreements
in
a
case
review
that
we'll
be
publishing
shortly,
but
also
bias
in
the
way
that
investigations
have
conducted
and
also
looking
at
bullying
and
harassment
in
more
detail.
And
as
a
result
of
that,
we've
got
some
special
projects
that
we're
doing.
B
B
We
working
in
a
roundtable
with
NHS
employers,
law
firms
and
it
just
improvement,
and
also
the
Department
of
Health
and
Social
Care
in
detail
at
Rowan
settlement
agreement,
guidance
and
working
with
NHS
England
on
implementing
the
conflicts
of
interest
policy
and
tonight
I'm
glad
to
that
I'm
going
to
be
presenting
the
first
award
for
developing
a
supportive
staff
culture
at
the
HS
J
Awards.
So
this
is
not
just
about
thinking
about.
B
My
ask
of
you
as
a
board
is
well
first
of
all
to
say
thank
you
for
including
this
as
part
of
well-led.
I.
Think
that's
really
focuses
the
mind
of
organisations
and
also
the
way
that
you
role
model
good
practice
with
your
hundred
freedom
to
speak
up
Guardian
champion
network,
but
also
how
we
can
help
you
to
achieve
your
goals.
So
I
really
wanted
to
not
talk
for
too
long.
So
there
was
plenty
of
time
for
questions
Henriette.
C
I
agree
test
traffic
progress
and
and
on
my
visits
to
hospitals,
I'm,
seeing
a
real
sense
of
energy
around
this
agenda,
which,
which
I
know
is
being
driven
by
Henrietta,
her
team
and
the
freedom
to
speak
up
Guardian.
So
that's
really
good.
As
you
say,
Henrietta,
it
is
a
reflection
of
how
good
an
organization
is
how
well
they
do
this,
which
is
why
it's
so
central
to
our
well
that
inspections
and
I
should
say
I'm,
very
grateful
for
the
work
that
you
and
your
team
have
done.
C
Looking
at
our
inspections
and
feeding
back,
so
we
can
continually
improve
our
inspections,
because
this
is
something
I
think
we
need
to
keep
central
to.
Well
there,
it's
all
about
culture.
It
is
all
about
creating
a
culture
in
which,
as
you
say,
people
can
speak
up,
because
that
drives
improvement
and
those
are
the
organizations
that
really
succeed.
So
we
will
keep
it
central
to
our
well
inspection
and
I
hope.
C
B
D
Know
I
thought
you
were
first
so
Robert
and
then
John.
Thank
you.
I
mean.
Firstly,
this
is
a
tremendous
advance
on
where
we
were
this
time
last
year
and
it
does
shape
to
me
the
value
of
of
developing
networks
and
I'd
like
to
pay
tribute
to
the
Guardians,
many
of
whom
I've
managed
to
meet
at
one
or
other
of
Henrietta's
event.
They
are
the
most
incredibly
dedicated
bunch
of
people,
some
of
whom
are
working
in
very
challenging
circumstances
indeed,
and
they
deserve
all
the
support
that
they
can
get,
and
it
was
really
about
that.
D
D
I
mean
some
of
them
will
actually
must
be
working
way
beyond
the
call
of
duty
in
terms
of
the
challenges
they
have
and
I
wonder
whether
there's
anything
our
the
CQC
continue
or
the
Henrietta
can
do,
which
actually
puts
this
more
on
the
agenda
of
trust
boards.
In
terms
of
understanding
that
this
is
not
an
optional
extra
in
terms
of
supporting
Guardians,
it
is
actually
a
vital
part
of
preserving
or
developing
the
culture
and
their
own
trusts,
but
in
these
financially
challenging
tasks.
This
is
one
of
those
areas
which
is
like
training.
B
I
think
that
that
boils
down
to
the
risk
that
we
have
is
that
we
are
creating
a
cadre
of
emotionally
intelligent,
highly
skilled
and
empathetic
individuals,
and
they
need
to
be
able
to
speak
up
into
an
equivalent
type
of
board.
The
risk
is
when
a
Guardian
is
doing
the
right
thing
and
they're
escalating
issues
and
not
getting
the
right
response.
So
that's
when
they
come
to
us
and
if
we
really
feel
that
they're
getting
stuck
and
we're
not
able
to
help
move
things
forward,
then
that's
when
we'll
be
coming
to
you.
E
E
I
think
the
link
back
to
the
board
sort
of
be
a
general
link
about
how
do
you
make
sure
we've
got
vacancies
you
deal
with
that
to
manage
winter
and
Beyond
winter,
but
bringing
this
into
the
equation
about
how
you
make
yourself
an
attractive
employer
by
how
you
deal
and
respond
to
the
concerns
of
colleagues
in
the
organization
to
drive
a
change
generation.
I
think
is
I.
Think
a
link
back
to
the
board
I
think.
C
Just
want
to
come
back
to
Robert's
point
and
I
think
there
is
still
there
will
still
be
organizations
that
don't
want
to
support
their
freedom
speak
up
Guardian
effectively
and
those
are
the
organizations
that
really
have
the
deficit
in
leadership
because
I
mean
this
is
if
they
see
this
as
an
obligation,
rather
than
as
an
essential
way
of
driving
the
culture
and
the
quality
in
their
trust,
they're.
Looking
at
it
the
wrong
way
and
I
think
that's
what
we've
got
to
learn
to
test
out.
I
mean
it's
not
a
matter.
C
G
F
Henrietta
I
want
to
join
others
saying
this
was
very
impressive
and
well-written
report.
So
thank
you,
but
also
can
I
commend
you
on
your
media
appearances,
because
I
thought
they
were
very
well
measured
and
came
over
really
clearly.
My
question
is
looking
ahead
to
your
developing
this
in
primary
care.
Can
you
just
give
us
some
thoughts
about
how
that
might
go?
Thank.
B
That
will
work
it's
about
having
that
engagement,
and
this
is
where
our
regional
approach
is
going
to
make
a
big
difference.
We're
adjusting
our
region's
so
that
they're
going
to
mirror
the
and
it
just
England
NHS
improvement
regions
with
a
regional
Engagement
Manager
in
each
in
each
region,
so
that
they
can
then
act
as
that
that
glue
to
bring
together
all
the
parts
of
the
system.
B
Clearly,
as
part
of
the
pumps
and
the
Chloe's
in
the
world
led
at
the
moment,
there's
a
requirement
for
organizations
to
have
speaking
up
arrangements
and
I
think
it's
again
that
journey
of
discovery.
You
know
we're
not
a
knowitall
organization,
we're
a
learning
tool
organization
and,
as
we
test
out
the
different
ways
of
this
working,
we'll
start
seeing
some
themes
about
leadership
and
how
the
leadership
of
organizations
enables
every
voice
to
be
heard.
Great
ideas
to
come
to
the
fore
and
concerns
to
be
raised.
B
J
Louis
and
then
Liz
thanks,
it's
very
much
an
appoint
here
about
this
is
a
model
of
cultural
change
in
in
the
NHS
and
there's
such
a
huge
organizers
in
the
NHS,
and
that
that's
a
lesson
that
the
wider
system
needs
to
learn.
I.
Think
because
there
may
be
other
places.
Other
parts
of
the
the
NHS
other
sort
of
problems
in
the
NHS
that
might
adopt
a
similar
style.
I
want
to
ask
you
about
measurement
and
how
we
or
how
you
will
know
over
time
and
that
things
are
getting
better.
J
So
I'm
struck
by
I
think
you're
right
to
highlight
the
relationship
between
ratings
and
the
success
of
the
Guardian.
Although
presumably
there
are
different
ways
of
interpreting
that
it
sounds
like
you
might
not
get
an
outstanding
rating
unless
you
are
doing
the
right
thing
by
your
freedom
to
speak
up
Guardi.
So
it's
not
entirely
independent.
J
An
independent
set
of
ratings
and
but
I
was
I'm
also
struck
by
so
sorry
to
introduce
a
slightly
negative
note,
I'm
so
stoked
by
the
fact
that
about
half
of
the
people
who
responded
to
the
survey
from
outstanding
trusts,
we're
saying
that
there
might
be
detriment
to
the
person
who
was
speaker.
So
that
worries
me
that
it
happens
at
all,
and
it
worries
me
that
half
the
people
in
trust
rated
outstanding
are
saying
that,
and
so
I
just
want
to
get
your
impression.
B
Yeah-
and
you
know
there
are
lots
of
ways
that
we
can
do
this
measurement.
One
of
them
is
in
the
staff
survey,
which
is
always
a
lag
indicator,
but
I
think
there's
something
about
how
organizations
look
at
their
total
reporting.
Clearly,
this
is
an
interim
step
and
the
Nirvana
is
that
anyone
can
speak
to
anyone
about
anything
and
they
shouldn't
have
to
go
to
a
Guardian.
What
we
can
say
is
that,
if
there's
no
data
or
zero
cases
of
speaking
up,
that's
probably
an
indicator
of
concern
and
I
was
at
Moorfields
this
morning.
B
In
fact,
they
brought
the
entire
trust
together
for
the
Barbican,
and
they
recognized
that
the
system
that
they'd
had
in
the
preemie
to
needs
of
their
staff,
because
they
had
no
cases
in
one
case
and
then
they've
changed
the
way
they're
doing
it.
And
now
people
are
actually
speaking
up
through
their
Guardian,
so
I
think
there's
something
about
how
trusts
view
their
data.
The
data
that
we're
publishing,
how
they're
using
that
to
compare
themselves,
but
also
in
the
case,
reviews
that
we
do.
B
We
make
recommendations
and
when
I
go
to
a
trust
and
a
non-exact
director
or
the
chief
exec
or
the
Guardian
says
to
me,
oh
well,
what
we
did
was
when
we
read
that
report
and
then
we
we
use
the
recommendations.
As
a
kind
of
you
know,
a
gap,
analysis
and
we've
immediately
changed
this,
and
we've
immediately
changed
that.
If
what
if
we
start
seeing
the
same
recommendation
coming
up
again
and
again,
that's
a
sign
of
failure,
so
I'm
describing
failure.
I
think
success
is
going
to
be.
B
As
we
see,
the
staff
survey
results
improve,
particularly
in
confidence
about
the
way
that
investigations
are
done
about
bullying
and
harassment.
We're
the
best
in
the
NHS
is
still
20%,
but
also
in
the
work
that's
happening,
for
example,
in
just
culture
and
some
of
the
Trust's
up
in
the
northwest.
If.
B
What
we're
finding
is
that
things
that
have
been
left
neglected
for
maybe
many
months
or
years,
the
root
cause
of
it
doesn't
get
sorted
until
the
Guardian
gets
involved
and
that's
a
mess.
That's
a
lesson
back
to
trusts.
To
say
why
does
it
take
the
involvement
of
the
Guardian
to
tackle
the
root
cause?
You
know
and
I
think
as
an
example,
it's
just
extraordinary
that
the
staff
are
so
habituated.
Oh,
you
know
the
pipes
leaked
again
clean
it
up.
You
know
and
nobody
thinks
what
we
need
to
do
this.
B
We
need
to
do
that
and
we've
seen
these
similar
examples
when
it
comes
to
recruitment
practice.
Looking
at
junior
doctor
rota
gaps,
looking
at
you
know,
training
on
dignity
and
consent
on
infection
control,
if
there's
something
about
the
the
escalation
from
the
Guardian
that
leads
to
the
root
cause
being
fixed
in
these
situations,
this.
H
K
I
was
gonna,
ask
a
very
similar
question
to
Luis
actually,
but
just
to
build
on
it,
and
there
are
some.
There
are
some
really
good
stories
of
Guardian
speaking
up,
leading
to
change
and
I
just
wondered
how
you
plant
track
and
communicate
those
kinds
of
quite
tangible
impacts
that
come
about
so
as
well
as
the
cultural
impact,
which
is
obviously
crucial.
K
The
actual
improvements
that
happen
I
wondered
if
you
were
going
to
have
any
kind
of
tracker
of
recommendations
and
what's
happened
to
them
or
or
anything
of
that
sort
so
that
over
time,
you've
got
a
quite
a
big
bank
that
can
be
communicated
to
trusts
boards,
but
also
to
staff.
You
know
there
is
a
point
in
this
because
look
the
sorts
of
changes
it
can
lead
to
I.
B
Look
at
that
in
three
different
ways:
the
first
one
is
the
recommendations
we
make
from
our
case
reviews
and
the
feedback
we've
had
from
guardians
is:
could
we
simplify
it
because
there's
73
at
the
moment?
Could
we
in
a
bit
duplicate
of?
Could
we
make
it
a
bit
more
straightforward
and
we're
looking
to
do
that
so
that
there's
a
library
of
recommendations
that
all
trusts
should
be
easily
able
to
demonstrate
how
they've
done
their
gap
analysis
then?
B
The
case
reviews,
sorry
case
studies
and
the
case
studies
I,
think
because
they
tell
the
stories
I
mean
some
people
like
data
and
some
people
like
stories,
and
you
know
so.
We
have
to
have
the
stories
and
we're
looking
to
build
a
library
of
case
studies
that
people
can
read,
and
you
know,
learn
about
in
different
themes,
but
I.
B
Think
more
importantly
than
both
of
those
is
actually
the
feedback
from
the
individuals
who've
been
supported,
and
when
we
read
the
feedback-
and
it
will
often
say
things
like
it's
the
first
time
I
felt
listened
to
you
know
this
has
made
the
big
change
in
my
working
life
or
now
I
feel
safe.
You
know
happy
that
the
patience
to
say
it's
that
real
time
real
live
feedback,
which
I
think
is
you
know
so
in
the
way
that
boards
have
patient
stories.
Some
trusts
are
actually
having
staff
stories
as
well
and
I.
B
I
B
So
we've
now
trained
over
500
people
and
we
offer
information
sessions
to
a
whole
wide
range
of
people
who
might
be
interested
to
learn
more
about
it
and
in
terms
of
capacity.
We've
now
trained
up
guardians
to
be
trainers
so
that
they
can
deliver
training
regionally
as
well,
and
some
of
them
are
delivering
that
to
Guardians
and
champions,
but
also
to
others
in
their
trusts.
And
we've
been
thinking
about
how
we
can
set
the
standard
in
terms
of
training
so
that
other
organisations
can
deliver
it.
B
Because,
with
a
team
of
11
now
I
do
have
a
capacity
issue
that
we
can't
be
training
everybody.
But
we
really
want
training
that
gets
delivered
to
managers
to
align
with
our
with
our
narrative,
with
the
idea
that
speaking
up
is
an
entire
spectrum
and
to
ensure
that
managers
see
Guardians
as
an
adjunct
to
their
role,
but
also
a
role
a
route
for
themselves.
If
they
need
to
speak
up
about
something
as
well
so
where
we
are
planning
that
and
we'll
be.
A
Henriette
I
I
suspect
that
the
the
board
would
like
to
go
on
talking
to
you
all
morning.
I
think
there's
a
lot
of
interest
in
enthusiasm.
That
unfortunate
is
also
a
lot
of
other
things
on
the
agenda,
so
I'm
going
to
bring
this
to
an
end
but
are
on
behalf
of
everybody.
Thank
you
very
much
for
dying,
I.
Think,
we've
all
said
every
almost
every
speaker
has
said
fantastic
progress
in
a
year.
So
thank
you
very
much
and
congratulations
right.
L
Jim
I
wants
to
say
three
things
before
I
hand
over
to
the
chief
inspectors
to
talk
about
the
sections
that
they've
they've
written
first
thing
that
there's
been
a
lot
of
media
interest
in
the
case
of
Bethany
a
17
year
old,
inpatient
with
autism,
who
was
held
for
about
22
months
in
a
secluded
seclusion
room
in
st.
Andrews
Hospital.
L
But
but
but
it
is
a
significant
report
and
I'm
I'm
really
pleased
that
we've
been
asked
to
to
carry
out
that
that
work,
so
we're
in
the
process
of
just
agreeing
the
finals.
The
final
detailed
scope
of
that
report
to
make
sure
that
what
we
produce
is,
as
everyone
mullux
would
expect,
and
also
it
has
it-
has
genuine
long-term
long-term
impact.
Our
current
thinking
is
that
we
would
do
the
reporting
in
two
parts.
L
There
would
be
an
initial
report
of
some
sort
in
May
of
2019
as
an
interim
report,
with
the
final
report
being
being
published
before
the
end
of
the
financial
year
2019.
So
as
I
say
that
the
final
details
are
being
agreed
with
our
colleagues
at
the
Department
of
Health
and
Social
Care,
but
I
think
it's
an
important
report
and
and
I
think
it
will.
L
We
that
the
second,
the
second
thing
I
wanted
to
talk
about
was
Peter
myself
and
the
three
chief
inspectors
appeared
before
the
Health
and
Social
Care
Select
Committee.
Recently
I
think
that
was
an
important
session.
We
covered
a
range
of
topics
that,
as
you
would
expect,
around
the
NHS
independent
inspect
in
and
inspect
independent
Hospital
inspection
findings
range
from
ambulance
services,
mental
health
and
and
our
our
engagement
with
the
voluntary
sector.
L
Thirdly,
the
initial
findings
from
our
your
voice,
employee
survey,
I,
think
we've
had
we've
had
our
initial
findings
and
the
details
are
in
the
paperwork,
but
I
think
in
some
respects
our
our
overall
engagements
good
engagement
score
looks
like
it
has
dropped
slightly
by
one
percentage
point
and
but
but
our
3s
engagement
index,
which
is
a
slightly
different
cut
of
the
data,
looks
like
it
has.
It
is
just
it
has
held
up
and
he's
above
the
Civil
Service
average.
L
So
what
we'd
like
to
do
is
to
to
take
away
the
detailed
findings
which
are
which
we've
got
down
at
team
level,
pull
together
an
action
plan
and
bring
all
of
that
back
to
that
back
before
the
board
in
February,
because
I
think
what
we
have
seen
is
there's
been
some
improvements
in
some
areas.
I
think
there's
still
a
strong
sense
and
sense
of
mission
and
motivation
in
the
organisation
and
people
believe
in
what
we
do.
But
equally
there
are
still
some
concerns
are
around
around
technology.
There's
some
concerns
around
learning
developments.
L
So
it's
actually
there's
some
concerns
around
stress
around
the
knowledge
of
strategic
direction,
but
some
of
the
things
that
have
been
mentioned
in
in
earlier
years,
around
learning
and
development
and
around
well-being
work
later
have
improved
slightly
so
but
I
think
it
easy'
quite
a
mixed
picture
across
across
the
organisation.
So,
rather
than
trying
to
talk
at
length
now
in
generic
terms,
we
want
to
break
that
down
by
Directorate
and
by
team.
So
we
can
have
a
more
more
structured
conversation
about
that
in
February,
so
Joe
if
I
could
hand
over
to
to
Andrea.
Okay.
K
Yes,
just
on
the
review
that
we've
been
asked
to
do
on
the
segregation,
seclusion
and
restraint
and
the
scope
so
I
mean
my
sense
from
sort
of
people
out,
there
is
there's
a
little
bit
of
kind
of
well.
What's
another
review
going
to
do
because
there
have
been
other
kind
of
reviews
and
people
know
a
certain
amount
about
what
the
problems
are.
K
So
I
just
really
wanted
to
ask
whether,
as
part
of
our
review
part
of
the
scope,
we
will
be
looking
at
effective
approaches
to
reducing
seclusion
restraint
and
segregation
so
because
I
think
pointing
to
the
good
practice
and
how
it
can
be
spread.
It
just
might
get
us
further
forwards
than
a
review
that
focuses
that
overly
focuses
on
what
the
problems
are,
what
I
mean,
and
the
second
thing
is
who
the
who
the
review
might
be
directed
at
in
terms
of
who
needs
to
do.
K
What
and
I
wondered
whether
that
will
include
CQC
itself,
because
there
might
be
learning
for
us
for
our
own
inspection,
etc.
Finally,
I
know
that
the
important
Human
Rights
Commission
has
been
doing
some
work
on
restraint
and
other
people
have
been
as
well.
So
be
good,
I'm
sure
you've
got
this
in
train,
but
just
to
make
sure
that
we're
kind
of
linking
up
with
other
bodies
as
useful
Lois.
J
M
J
All
of
that
creating
a
perfect
storm
in
which
vulnerable
people
are
essentially
left
in
a
weird
combination
of
care
and
neglect,
and
so
we
could
write
that
we
could
write
the
one
about
restraint,
which
is
about
overuse
the
problem
of
measurement
problems,
problems
of
definition
and
what's
the
alternative.
And
so
could
we
use
that
as
our
starting
point
in
this
review,
because
we
have
had
quite
a
lot
that
that's
come
up
with
those
conclusions
and
here
would
be
a
chance
to
do
something.
J
A
little
bit
different
to
look
for
solutions
and
to
find
a
way
of
giving
the
solutions
force
and
and
therefore
making
them
happen
and
focusing
on
that.
The
prat,
the
not
not
trying
to
I
think
what
we
need
to
understand
is
given
that
everybody
understands
that
that
is
the
situation.
What
are
the
obstacles
that
have
got
in
the
way
of
doing
of
solving
this
in
the
past?
And
for
me
that
is
the
key
question.
Not
what
the
problem
is.
L
L
But
what
we
want
to
try
and
do
is
is
is
produce
a
report
which,
which
does
do
something
I,
think
if
this
is
a
report
that
just
sits
on
a
shelf
somewhere
and
describes
a
problem,
then
then
we
haven't
really
achieved
very
much
and,
as
you
said,
a
number
of
people
have
written
reports
in
this
area
in
the
past.
So
job
one
will
of
course
be
to
review
the
existing
existing
literature,
but
we
need
to
do
something
for
which
does.
L
Make
a
difference,
and
my
sense
is
the
Secretary
of
State
in
his
direction.
Is
it
scheme
to
for
us
to
do
something
that
makes
a
difference,
and,
and
that
is
why
the
report
well,
that's
why
the
process
will
take
a
reasonably
long
period
of
time.
It's
not
something
that
we
are
going
to
to
do
particularly
quickly
and
I
know.
L
Some
people
would
like
to
see
action
sooner,
but
but
I
think
that
the
aim
is
to
bring
a
lot
of
the
voices
that
are
practitioners
in
this
in
this
space
into
the
room
and
make
sure
that
their
their
perspectives
and
thoughts
are
brought
to
bear
as
well,
so
either
whether
I
can
bring
Ted
in
just
just
to
build
on
them.
What.
C
The
scope
is
still
being
signed
off,
I'll
feedback.
These
comments
to
Paul
to
make
sure
that
this
is
included.
But
my
understanding
is
this:
we
very
much
want
to
focus
on
just
the
things
that-
and
this
has
raised
have
raised,
because
our
inspection
reports
describes
the
problem.
There's
no
point
in
just
kind
of
collating
aspect.
Well,
that's
the
starting
point
just
to
make
your
point
that
you
know
what
we
found
is
the
problem.
What
we
need
to
do
is
to
work
with
the
people
involved
from
people.
C
Who've
got
good
practice
in
this
regard,
and
the
people
commissioning
these
services
to
actually
find
a
solution
and
the
positive
way
forward.
I
think
that
is
a
real
test
for
this
report
and
I
mean
the
fact
that
others
have
looked
at
this
before
not
been
able
to
moving
forward
significantly.
It's
a
challenge
for
us,
but
we
need
to
rise
to
that
challenge,
which
is
is
why
we
giving
so
much
thought.
C
M
M
So,
as
the
report
sets
out
on
the
5th
of
November,
we
wrote
to
84
local
authorities
to
advise
them
that
we
believed
that
service
failure
was
likely
as
a
consequence
of
lengthy
business
failure
and
that
they
should
prepare
their
contingency
plans
and
that's
to
ensure
that
if
it
did
happen,
they
could
deliver
on
their
statutory
duty
to
continuity
of
care
for
the
people
using
those
services
and
just
to
reassure
the
board.
That's
everyone,
including
people
who
pay
for
their
own
care.
M
Since
that
time,
we
have
identified
from
the
information
supplied
a
further
two
local
authorities
who
are
affected,
and
that
brings
the
total
up
to
eighty
six
and
that
covers
around
nine
thousand
three
hundred
people
in
England
alone.
If
there
are
people
who
are
receiving
services
from
allied
in
Wales
and
Scotland,
and
we
are
in
close
dialogue
with
them
as
well.
M
Last
Friday
allied
healthcare
wrote
to
local
authorities,
their
staff
and
people
using
their
services
to
tell
them
that
they
would
either
be
handing
contracts
back
to
local
authorities
or
transferring
them
to
other
providers,
and
the
company
also
advised
that
their
lending
facilities
had
been
extended
from
the
30th
of
November.
For
up
to
three
weeks
to
facilitate
that
process.
M
Cqc
is
working
closely
with
all
these
partners.
Pay
tribute
to
the
market
oversight
team,
who
are
doing
a
tremendous
amount
of
work
on
all
of
this
at
the
moment,
to
monitor
the
ongoing
situation
with
allied
and
to
provide
advice
and
support
to
the
department,
local
authorities,
the
LGA
and
aid
us
and
I,
just
like
to
say
absolutely
recognize
that
this
is
a
worrying
time
for
people
who
rely
upon
allied
health
care
services,
their
families
and
carers.
M
As
well
as
the
staff
who
work
for
them
and
I'm
sorry
that
such
concern
has
been
caused,
but
I'm,
confident
and
I
think
that
the
subsequent
events
which
I've
just
described
to
you
have
proved
it
to
be
the
case
that
it
was
appropriate
for
CQC
to
me
this
notification,
as
it
has
given
local
authorities
more
time
to
put
in
place
contingency
plans
to
make
maintain
continuity
of
care
for
people,
which
is
the
prime
focus
and
the
responsibility
of
our
marker
of
light
scheme.
I
just
wanted
to
make
sure
that
I
brought
everybody
up
to
date.
M
On
that.
The
second
item
that
you've
got
from
adult
social
care
on
the
paper
is
the
successful
outcome
of
the
prosecution
of
Hill
green.
This
is
a
very
short
note
for
the
board,
because
this
happened
last
Thursday,
the
judgment
was
brought
down
guilty
on
two
counts
that
we
had
brought
to
prosecute
Hill
green
k,
limited.
They
were
fined
three
hundred
thousand
pounds.
We
were
awarded
full
costs
and
I
think
it's
fair
to
say
that
the
judge
was
quite
trenchant
in
her
criticism
of
the
company.
M
I
will
be
bringing
to
the
board
at
the
next
meeting
the
report
that
pulls
together
the
outcome
of
that
case
and
a
wrap-up
report
on
all
of
the
recommendations
that
were
made
in
the
independent
investigation
that
supposed
Jenkins
carried
out
earlier
this
year,
so
that
you
can
be
assured
that
all
of
the
lessons
which
we
committed
taking
forward
from
this
particular
case
and
have
been
implemented,
or
at
least
there
are
clear
plans
to
take
them
to
put
them
into
implementation
next
year.
So.
A
Thanks
I'm
driving
both
those
of
the
report,
not
for
discussion
but
can
I
just
say,
I
mean
having
been
involved
in
not
just
our
light,
but
the
work
of
the
market
oversight
team
generally
I,
just
most
of
their
work,
is
not
visible
for
good
reasons,
but
it's
terrific
work
and
I'd
like
just
to
echo
what
you
said
about
congratulating
them
on
the
work
they
do
and
and
similarly
and
I'll,
be
saying
more
about
this.
A
little
bit
later
in
the
meeting.
A
D
Having
said
it
was
not
for
discussion,
Robert
well
just
a
question
really
about
the
allied
healthcare
business
there,
a
quite
public
attack
was
made
on
the
CQC
by
over
on
behalf
of
allied
healthcare.
When
we
first
made
the
announcement
and
I
wondered
whether
Andrew
and
a
robust
response
was
was
made
to
that,
but
I
wonder
whether
there
is
any
way
in
which
the
nature
of
what
we
do
and
how
it
is
done.
It
inhibits
in
a
full
explanation
to
the
public
in
response
to
that
sort
of
criticism.
M
I'd
say
two
things
Robert.
The
first
is
that
I
wrote
to
the
chief
executive
of
allied
health
care
after
those
attacks
were
made
and
set
out
in
quite
clear
detail
why
it
was
that
we
had
made
the
decision
and
the
issues
that
had
contributed
to
that
and
the
this
is
not
a
decision
that
we
take
lightly.
This
has
a
tremendous
impact,
as
I've
said,
on
people
who
are
using
services
and
staff.
It
is
in
our
schema
delegation
a
decision
that
I
make
in
consultation
with
the
chief
executive
and
the
legal
team.
M
Based
on
the
advice
of
the
market
oversight
team.
We
had
several
management
review
meetings,
considering
the
information
that
we
had
available
to
us
and-
and
there
was
total
due
care
and
consideration,
put
into
making
that
decision
and
I
stand
by
it
and
I
set
out
four
and
the
chief
executive,
who
actually
I
don't
think
has
some
responded
to
me.
But
there
we
go.
M
M
A
C
N
C
Trusts
and
remind
them
of
that
guidance
that
we
produced
in
May
of
this
year
as
they
go
into
this
winter
and
we're
now
in
the
middle
of
November
middle
of
November
is
when
the
acuity
of
patients
starts
to
increase,
usually
because
of
the
the
cold
weather
and
the
winter
viruses,
and
that's
when
the
pressures
start
building
up
on
acute
services
and
hospitals.
So
it's
very
important.
C
Also,
the
ermine
report,
the
ionizing
radiation
regulations
report,
was
published
recently.
This
is
an
annual
report
that
details
all
the
first
instance
that
are
identified
in
the
use
of
ionizing
radiation
in
health
care,
and
we
highlight
the
instances
occurred,
but
also
the
learning
that
comes
from
them
and
that
reporters
be
well
received
by
the
the
sector.
You'll
remember
earlier.
O
Thought
a
nil
report
from
you.
Steve
was
too
good
to
be
true,
so
useful,
being
on
holiday.
Wasn't
it
for
you
anyway?
The
as
was
me
I,
just
want
to
briefly
mention
two
things
that
have
happened
in
the
last
week
or
so.
The
Health
Select
Committee
have
produced
an
excellent
report
on
prison,
health
care
or
health
care
off
prisoners,
of
which
we
gave
evidence
in
person
and
in
writing,
and
it's
just
to
say
to
the
board.
O
There
are
a
number
of
recommendations
in
their
report
for
us
and
we're
currently
putting
together
a
response
and
the
reason
I
raised.
It
is
that
because
Lewis
raised
an
issue
about
health
care
in
prisons,
very
vulnerable
people,
obviously-
and
one
of
the
recommendations
addresses
that
it
talks
about
ratings
about
the
extent
to
which
prisons
enable
prisoners
to
live
healthy
lives,
not
only
the
quality
of
provision,
but
the
extent
to
which
all
aspects
of
prison
life
enable
prisoners
to
enjoy
fundamental
right
health.
It
talks
about
our
legal
powers
of
entry
into
prisons.
O
It
commends
our
work
with
HMI
P,
but
also
asks
that
some
work
is
done
to
look
at
the
effectiveness
of
their
recommendations.
Through
their
letters,
but
it
also
suggests
that
the
secretary
of
state
should
ask
us,
through
a
section
48
order
to
look
at
health
within
prisons
too,
so
they're
important
recommendations,
I
think
we
should
bring
back
our
response
to
the
board
in
some
form,
because
it
has
been
an
issue
raised
here
and
also
at
the
RDC.
E
This
is
about
services,
improving
in
a
number
of
area,
so
the
resources
designed
to
help
organizations
understand
what
they
can
do
to
improve
their
own
performance.
It's
obviously
also
designed
to
give
people
a
sense
of
what
they
should
expect.
We
know
it's
already
had
a
positive
response
from
the
different
sets
that
have
been
involved
and
it's
instantly
a
cross
sector
collaboration
I,
think
that
will
be
important
as
we
take
this.
This
work
forward,
Paul's,
obviously
been
leading.
E
A
H
Thank
you
Peter.
So
this
is
the
q2
performance
report,
six
monthly
update
on
where
we
are
against
our
commitment
set
out
and
the
business
plan
just
some
headlines
from
myself.
Then
we
can
get
into
some
questions.
Perhaps
I
think
I
think
the
report
is
showing
an
improving
picture.
Overall
number
of
our
organizational
health
indicators
are
improving
or
in
a
good.
H
A
good
position
particularly
pleased
that
some
of
the
indicators
from
call
center,
the
nstac,
are
back
on
track
and
above
target,
so
delivering
their
measures
and
the
hospital's
areas
are
can
conduct
in
all
their
inspections,
in
line
with
the
re-inspection
rules
that
we've
we've
set
and
starting
to
see.
Some
improvements
now
within
the
report.
Analyst,
which
is
good,
could
be
good
to
see
and
and
you'll
notice
that
an
improving
position
overall,
one
report,
timeliness
sent
also
against
their
registration
applications.
H
So
I
think
overall,
is
context
of
a
good
and
improving
position,
and
this
still
remains
much
much
to
be
much
to
be
done.
I
think
one
of
the
things
for
us
from
the
report
we
showing
that
we
need
to
know,
as
we
start
to
hit
the
targets
and
committee
commitments
that
we
make
is
that
we
start
to
do
that
in
a
kind
of
sustainable
way.
So
we
actually
start
and
hit
those
regularly,
and
we
are
I
think
starting
to
see
that.
H
So
we
just
need
to
continue
to
track
that
quite
quite
closely
and
we've
put
in
into
the
report.
The
post
survey
results,
which
is
something
that
was
asked
for
at
the
board
last
period.
So
that's
in
there,
but
but
clearly,
we've
got
the
the
broader
CQC
staff
survey
results
coming
through
now,
which
we
just
analyzing
and
that
will
be
coming
back
to
the
board
in
its
broadest
sense.
But
I
wanted
to
just
draw
attention
to
that.
H
P
Just
add
on
the
finances
so
currently
I
only
spent
as
an
organization
by
400k
we're
still
forecast
to
overspend
at
the
end
of
the
year,
which
is
predominantly
crushes
in
hospitals
directions.
But
I
haven't
seen
latest
figures
I'm
fairly,
confident
that
we
we
won't
overspend
by
the
Emidio
would
be
on
budget.
A
Right,
thank
you.
Chris
Chris
could
I,
could
I
just
almost
make
one
statement
and
then
just
ask
you
to
clarify.
So
he
said
that
the
statement
is
just
to
make
very
clear
that
we
will
get
the
grant
in
aid.
It's
called
a
budget,
but
it
by
definition.
It
can't
really
be
a
budget
Kenya,
because
it's
it's
a
it's
an
activity
which
you
can't
forecast
the
the
volume
of.
So
it's
something
that
has
to
be
paid
under
grant.
A
There's
this
activity
that
we
can't
control
and
it
has
to
be
paid
underground
tonight,
and
it
will
be
so,
although
that
it
says
here
there's
a
name
for
spend
on
the
budget.
That's
that
somehow
conveys
the
wrong
impression.
I
just
wanted
to
sort
of
clarify
that
and
then
just
to
ask
you
to
clarify
in
six
six
B.
It
says
a
year-end
deficit
of
0.9
million
and
then
in
in
in
6c
the
next
paragraph.
It
says
an
overall
surplus
of
1.8
million
I
think
I
can
work
out
what
this
is
meant.
P
A
K
Thank
you,
I've
got
a
couple
of
this
is
on
the
whole
of
the
performance
and
Finance
report.
It.
Yes,
please
yeah,
okay,
couple
of
questions
first
question:
is
there
a
reason
why
our
expenditure
is
somewhat
back
bloated?
Is
that
something
we
need
to
think
about
for
the
future?
Or
is
it
just?
It's
worked
out
that
way,
and
it's
not
really
a
challenge
for
us,
sometimes
sometimes
those
that
load
of
expenditure
leads
it's
a
little
bit
of
risk
at
the
point
of
year-end
and
it
can
suggest
that
we've
let
something
slip,
I,
don't
know.
K
That's
one
question
second
question
and
perhaps
I
should
know
this
is
about
our
business
planning
for
the
next
financial
year,
because
it
strikes
me
that
some
of
the
patterns
of
performance
here
and
some
are
also
some
of
the
staff
surveying
results-
might
suggest
the
need
to
slightly
rebalance
priorities
or
and/or,
KPIs
and
I.
Just
wonder
if
we've
started
that
process
and
if
we're
doing
it
and
finally,
I've
got
one
specific
question.
K
Sorry
well
I've
got
the
floor,
which
is
on
the
slide
page
94
business
plan
priorities
starting
to
implement
registration
for
those
directing
and
controlling
care.
This
seems
to
have
been
pushed
in
to
medium
to
longer
term
and
I.
Do
and
I
know
that
we
agreed
some
time
ago
that
this
was
something
that
was
quite
important
and
was
going
to
happen
and
I
just
wondered
if
somebody
could
comment
on
what
the
implications
are
of
that
not
happening
until
medium
to
longer
term.
P
Mark
by
the
way
around
so
in
terms
of
the
phasing
and
the
backlog
dispenser,
so
quite
a
large
proportion
that
was
known
and
it
was
planned
and
anticipate.
Or
there
are
some
elements
where
our
recruitment
is.
It
is
increasing
and
in
terms
of
your
point
about
next
year.
That's
the
work
that
we're
doing
now
and
taken
to
18
next
next
week
in
terms
of
business
plan
for
next
year
and
what's
the
what
we
know
from
this
year
that
we
need
to
take
in
the
next
year
as
part
of
our
planning.
H
C
Can
I
just
come
back
on
that
point,
because
I
mean
it's
really
great,
that
the
hospitals
are
delivering
number
inspections
that
we
plan
forward
and
it's
great
credit
to
the
teams
out
there
doing
this
work,
but
and
also
bringing
down
the
report.
The
time
tech
juice
report.
Some
great
work
going
on
on
that
as
well.
N
C
F
Agree,
John
and
then
do
a
couple
of
things
first,
to
welcome
the
reduction
in
the
backlog
of
the
report.
Writing
and
that's
a
commendable
thing
and
looking
at
some
of
the
other
figures
I'm,
happily
not
against
considering
the
possibility
that
I'm
optimistic
there
is
some
genuine
shift
in
the
report.
Writing
timeliness.
I
think
the
effort
is
beginning
to
come
through.
F
My
other
question
is
5:37
on
action
against
long
term
in
breach
adult
social
care
and
primary
medical
services.
There's
a
section
that
there's
there's
no
active
or
planned
inspection
or
enforcement.
I
just
wondered
if
you
could
clarify
for
me
what
that
figure
represents
in
terms
of
services
being
received
by
people.
J
Completely
different
subject,
but
it's
it's
about
before
it's
it's,
the
Ted
I
should
have
given
you
advance
notice,
really
because
it's
about
the
mental
health
part
of
the
performance
reporting,
in
particular
the
Mental
Health
Act
element,
but
it
does
the
the
so.
The
two
slides
are
on
slide:
32
and
33
mental
health.
That's
very
topical
at
the
moment,
as
you
know,
there's
been
a
review.
It's
just
reached
its
final
stages
and
the
review
panel
has
has
now
completed
its
meetings.
J
I'm
on
the
review
panel,
I
should
say,
and
CQC
itself
is
for
me
on
the
review
panel,
something
quite
striking
about
the
availability
of
second
opinion.
Doctors
on
society,
I
just
wondered
whether
you
were
able
to
say
anything
about
about
that
this.
So
this
is
the
doctors
who
are
able
to
confirm
the
plan
of
care
for
patients
detained
by
the
men.
M
J
The
Mental
Health
Act
and
there's
been
a
dramatic
rise
in
the
availability
for
doctors,
assessing
community
treatment
orders.
It
just
so
happens,
that's
one
of
the
most
contentious
areas
of
the
Mental
Health
Act
review
and
then
there's
the
steady
rise
in
our
monitoring.
Visits
for
patients
who
are
detained,
I
I,
must
admit
I've
slightly
lost
track
of
what
those.
What
the
primary
purpose
of
those
monitoring
visits
is
it's
described
as
ensuring
that
the
spirit
of
the
Mental
Health
Act
is
being
applied
to
patient
safety.
J
M
I
think
I've
got
a
few
that
I
could
comment
on
there,
that
the
question
about
registration
and
the
plan
that
we
agreed
around
how
we
registered
services
at
a
higher
level
and
and
as
as
this
explained
in
the
report
because
of
the
work
that
we're
doing
on
registration
transformation
and
the
time
that
is
taking
we're,
not
in
the
not
in
a
position
yet
to
implement
the
policy
that
we've
agreed.
What
that
means
is
that
it
does
what
that
means.
M
M
However,
there
are
services
that
are
registered
at
that
level
and
we
are
taking
action
against
them
in
some
circumstances,
where
we
do
know
that
there
is
risk
we're
taking
action
at
a
provider
level
is
actually
the
right
and
proper
thing
to
do
so.
It's
it's
delayed
it.
It's
still
there
on
on
the
work
timetable
and
it
will
be
delivered
and
just
to
comment
on
the
point
about
rebalancing
priorities.
I
mean
just
to
echo
what
Ted
has
said
about
the
impact
of
workload
and
work-life
balance.
M
You
can
see
those
figures
in
for
adult
social
care
in
here.
I
am
acutely
conscious
of
that.
It
replicates
itself
again
in
the
full
survey.
Those
are
things
that
we
are
going
to
have
to
take
into
consideration
as
we
move
forward
and
think
about
the
impact
on
our
staff,
who
are
working
very
hard
and
in
adult
social
care
in
an
utterly
relentless
way
of
constantly
trying
to
respond
to
risk
and
trying
to
and
cope
with
problems.
M
So
we
do
need
to
think
about
that
and,
last
but
not
least,
the
gap
on
the
those
services
that
are
in
breach
for
more
than
four
quarters.
The
our
expectation
is
that
we
would
have
action
of
some
sort
being
taken
with
them,
either
as
you've
identified
here
that
we're
either
going
in
and
inspecting
we
have
just
inspected.
We've
got
enforcement
action
underway.
Any
of
that
there
were
164
for
us
in
adult
social
care
at
the
moment
that
don't
have
an
action
locked
against
them.
M
Each
of
those
will
be
being
reviewed
by
the
inspector
who's
holding
the
portfolio
and
their
management
chain
to
ensure
that
they
can
come
into
one
of
those
other
categories,
and
sometimes
it's
just
a
lag
in
in
CRM.
In
terms
of
you,
an
inspection
may
have
been
planned,
but
it
may
not
just
have
kind
of
and
hit
hit
here.
So
we've
always
given
ourselves
a
bit
of
a
gap,
because
we
wouldn't
necessarily
expect
a
hundred
percent
to
be
having
everything
signed,
sealed
and
delivered
in
CRM
to
feed
into
this
report.
M
F
O
You
look
back
on
the
grass
for
two
years
ago,
I
think
to
support
Andrea,
and
the
performance
has
improved
dramatically
and
part
of
that
is
the
work
very
closely
with
mark's
team
about
how
we
record
these
issues,
because
some
are
in
breach
over
one
issue.
You
go
back
and
they're
in
breach
over
something
else,
and
it
doesn't
need
to
be
a
bit
of
a
lag
and
and
within
the
GP
and
dental
end.
O
C
Sorry,
thank
you
Luis
the.
As
you
know,
the
second
opinion
appointed
doctors.
The
demand
is
going
steadily
up
and
the
the
Mental
Health
Act
team
have
been
recruiting
new
doctors
to
the
panel,
and
that
is
helping
us
sustain
accurate
performance.
It's
quite
a
complex
story
and
some
of
the
KPIs
may
be
structurally
wrong.
For
instance,
KP
about
electrical
faulty
therapy
he's
actually
virtually
impossible
for
us
to
achieve
because
of
the
of
the
way
that
the
the
the
ii
have
been
doctors
are
commissioning.
C
So
I
think
there
are
issues
we
need
to
look
at
in
this
and
I
think
it's
welcome
that
this.
This
needs
to
be
reviewed
as
part
of
the
response
to
the
mental
health
out
review,
going
on
at
the
moment
that
there
has
not
been
a
lot
of
work
being
done
to
tram,
actual
meeting
demand
and
and
as
I
say,
it's
important
to
stress
that,
but
there
are
ongoing
issues
in
terms
of
our
ability
to
meet
the
KP
Isis.
They
exist
at
the
moment.
C
I
think
the
community
treatment
orders
are
only
a
very
small
proportion
of
the
total,
the
majority
overall
majority
of
the
medicines.
Second
opinion:
point
of
doctors,
sir,
so
that's
the
CTOs
I
think
may
be
of
interest,
but
they
actually
are
not
a
very
big
part
of
the
whole
picture.
That's
probably
more
than
that.
There.
C
C
Among
the
monitoring
visits
are
to
look
at
the
compliance
with
the
code
of
practice
around
mental
fact
and
they
feed
into
into
our
report
that
comes
out
on
a
yearly
basis
and,
and
that
does
show
us
I'm
sure
your
were
very
mixed
picture
in
terms
of
compliance
with
a
code
of
practice
around
the
Mental,
Health,
Act
and
I.
Suppose
the
challenge
is:
how
is
the
system
responding
to
that
and
is
it
responding
effectively
and
again?
I
hope.
That's
part
of
the
review
that
that
you're
involved
in
good.
A
N
N
A
N
G
They'll
start
to
move
to
red
amber,
which
is,
which
is
definitely
an
improvement.
I.
Think,
okay,
there's
quite
a
little
detail
in
the
change
paper
that
we
put
forward
today.
So
I'm
just
going
to
put
out
a
few
highlights
and
then
take
questions
at
the
end.
If
that's
okay
in
terms
of
some
of
the
work
we've
been
doing
around
I've
changed
portfolio
and
looking
to
assure
that,
we've
now
concluded
the
work
on
the
assurance
of
a
change
portfolio
and
now
have
a
baseline
plan
in
which
we
can
monitor
delivery
against.
G
Some
outline
around
our
frameworks
with
the
reporting
frameworks.
We've
now
started
to
use
those
initially
very
small
amounts
of
data
going
in,
but
that's
now
going
to
start
to
pick
up
pace
and
we
have
a
delivery
plan
over
the
next
three
months
around
getting
that
data
really
embedded
into
our
into
our
reporting
so
that
we
can
track
both
expenditure,
resource
use
and
delivery
against
the
plan
on
our
honor
honor
on
a
much
more
detailed
basis
than
we
have
in
the
past.
G
G
Work
stream
within
within
the
within
the
registration
program
and
we've
developed
terms
of
reference
for
that
and
actually
a
couple
of
weeks
ago,
the
hell
was
a
sprint
forward
to
the
BET
Awards,
where
they
were
looking
at
a
number
of
a
number
of
areas
where
we
can
start
to
lean
out
our
processes
and
have
now
identified
two
or
three
areas
where
we
can
actually
start
to
implement.
Some
really
significant
changes.
G
Initial
initial:
our
findings
where
we
have
process
that
can
take
about
five
days
on
the
registration,
two
to
five
five
weeks,
I
should
say,
and
just
taking
those
out
we've
knocked
out
some
weeks
of
time
just
days
in
terms
of
look
at
how
we
can
prove
the
efficiency
of
that
so
again,
good
progress
in
there
and
then
I
think
within
the
registration
space
were
also
starting
to
think
about.
What
does
all
this
mean
in
terms
of
our
organizational
design?
G
And
what
does
that
mean
from
from
the
piece
of
work
that
we're
doing
around
around
this
destruct?
The
the
way
we're
going
to
be
working
in
future
and
looking
to
expand
that
program
to
include
an
organizational
design
element
in
that
to
ensure
that
we
are
best
organized
to
take
best
use
of
those
changes
as
we
make
them
in
terms
of
monitor
inspector
rate.
We
had
some
work
around
show
around
the
adult
adult
information
exchange
and
a
GP
a
provider
information
exchange.
G
That's
now
gone
back
into
discovery
because
we
weren't
able,
through
the
initial
bits
of
work,
that
we
did
to
really
get
a
very
solid
business
case
for
investment.
So
we've
taken
that
back
into
discovery,
we're
learning
from
the
work
we've
done
on
registration
and
put
taken
a
service
design
approach
to
this
and
really
started
to
scope
out
what
we're
doing.
We've
brought
in
a
program
director
to
sit
across
the
top
of
the
entire
program
to
really
ensure
we've
got
some
rigour
in
how
we're
delivering
and
managing
that
piece
of
work.
G
The
work
we're
doing
around
digital
is
ongoing
and
we
are
rolling
out
new
phones
or
were
trialing
new
phones
with
the
plan
start
to
roll
those
out
before
Christmas.
These
are
smart
phones
in
trying
to
improve
people's
usage
rather
than
being
on
the
blackberry.
We've
now
completed
the
rollout
of
the
laptops
and
starting
to
look
at
how
we
can
do
some,
how
we
can
put
a
programme
of
working
around
business
change
to
really
take
the
benefits
of
opera
of
what
office
365,
as
that
starts
to
come
forward.
G
G
Rather
than
do
so,
a
complete
sort
of
Big
Bang
approach
to
that,
so
that
we
ensure
that
what
we
build
is
the
right
thing
and
and
it's
supportive
and
delivers
what
we
need
for
the
organization.
Our
people
work
lots
of
work
going
on
in
this
space.
Obviously,
we've
got
our
staff,
several
results
that
have
just
come
out
with
doing
an
in-depth
piece
of
work,
as
he
answered
to
look
at
how
we,
how
what
was
that's
telling
us
both
at
the
organizational
level
but
also
individual
teams,
and
do
some
benchmarking
and
pulling
some
data
through.
G
So
we
can
really
start
to
get
into
into
the
detail
of
that
and
I
say
instead,
we'll
bring
that
back
in
February
for
more
of
a
discussion,
the
work
on
traction
and
retention,
we're
waiting
to
hear
back
from
the
Treasury
or
in
our
business
case
on
that,
but
we're
also
looking
at
the
other,
the
other
bits
around
our
attraction
retention
in
terms
of
our
and
non
pay
non
pay
offer
to
our
staff
as
well
workforce
strategy.
We've
done
some
work
to
develop
our
workforce
strategy
that
went
for
initial
discussion
with
et
this
week.
G
We're
now
starting
to
take
the
feedback
from
ET
and
pulling
together
sort
of
delivery
plan
associated
with
that.
So
we're
really
clear
that
what
we've
got
in
our
strategy
is
stuff
that
we'll
take
forward
to
deliver.
I.
Think
that's
going
to
come
back
to
this
board
at
some
point
in
the
not-too-distant
future,
and
the
work
around
our
diversity
and
inclusion
carries
on.
We
were
out
to
recruitment
for
a
diversity
and
inclusion
lead
and
we're
planning
to
come
back
to
the
board
in
December.
N
Yeah
I,
just
I,
would
just
add
to
that
I
think
you
know.
We've
made
a
huge
amount
of
progress
in
the
last
few
months
around
around
what
is
a
which
what
is
a
very,
very
big
program.
You
know
you
know
context
and
I
welcome
some
seeing
the
advances
which
are
being
made
and
the
progress
they're
just
being
made
around
it.
N
Bits
of
fine
but
I
think
we
helped
seal
that
fitting
together
to
give
us
the
narrative
that
goes
with
the
delivery
of
the
strategy
of
where
things
may
still
be
outstanding.
At
that
point,
doesn't
it
in
sense?
We
may
need
to
think
about
whether
that
strategy
still
holds
going
forward
or
whether
it
needs
to
be
tweaked
in
some
sort
of
way.
N
N
Obviously,
we
want
to
build
the
confidence
up
further,
that
you
won't
get
what
I'm
saying
confidence
everything,
but
we
need
to
move
across
that
that
line,
so
some
of
that
red
stuff
starts
to
move
down
a
bit
because
it's
red
in
areas
which
are
really
key
to
that
to
the
delivery
strategy
around
that.
So
I
think
that
that'd
be
my
suggestions
for
going
forward.
G
So
just
on
the
assurance
we
have
our
internal
auditors
starting
to
look
at
registration
program
and
also
that
what
we're
doing
around
changed.
It
actually
give
us
that
verification
and
yes
I,
agree
around
the
piece
around
and
strategy
and
I've
actually
commissioned
a
piece
of
work
which
takes
our
this
program
of
work
and
looks
our
strategy
and
maps
the
two
together.
So
and
then
we
should
be
able
to
report
on
that
on
a
regular
basis
in
terms
of
our
delivery
against
the
strategy.
F
F
How
has
the
et
given
thoughts,
or
can
you
perhaps
come
back
with
how
the
prioritization
that
they're
going
to
give
to
some
of
that
and
how
that's
going
to
be
managed,
because
I
think,
particularly
when
you
want
to
spread
that's
going
to
be
an
important
thing
and
thinking
about
it
now
before
you
get
to
that
point
and
getting
the
signals
to
the
people
in
the
system
of
expectation
will
be
an
important
thing
for
success.
Overall.
G
Yes,
so
part
of
our
business
planning
round
now
is
about
releasing
one
of
the
key
things
about
releasing
frontline
resource.
To
do
some
of
this
change.
Piece
and
I
see
this
as
a
real
opportunity
for
developing
our
talents
in
the
frontline,
giving
them
a
bit
more
scope
and
a
bit
more
breadth
of
things
to
do,
but
it
isn't
that
we
can't
expect
people
to
do
the
day
job
and
do
this.
G
So
it
is
literally
about
trying
to
free
up
money
and
resources
to
pull
people
out
of
the
business
day
to
day
twos
focus
on
delivering
the
change
and
working
with
bring
their
expertise
to
this,
to
ensure
that
we
can
really
make
sure
it's
fit
for
purpose
and
either
funding
backfill
where
possible
or
actually
changing.
You
know
trying
to
create
a
bit
of
space
in
the
business
to
ensure
that
we
can
do
that.
But
what
we
mustn't
do
is
try
and
get
people
to
do
both
things
at
the
same
time,
because
it
won't
work.
A
I
I
About
the
adaptability
of
the
organization,
the
changing
nature
of
work-
and
you
refer
to
the
leadership
conference
last
week,
which
was
a
great
event
from
from
my
point
of
view-
and
there
were
lots
of
seem
to
me
a
great
sense
of
of
an
appetite
for
the
key
themes
there.
So
multidisciplinary
team
working
cooperative,
working
breaking
down
barriers:
connectedness
were
these
key
themes
and
I.
G
Yes,
I
say
well
bring
it
back
to
the
board
in
in
I
think
maybe
next
month,
I'm,
not
sure
that
I
know
it's
in
the
ominous
and
the
plan
to
bring
it
back
at
some
point.
But
yes,
certainly,
the
whole
point
of
doing
this
is
to
enable
us
to
have
a
workforce,
that's
fit
for
the
future
to
enable
us
to
deliver
on
all
these
things.
So
all
those
things
we
talked
about
are
definitely
referenced
in
terms
of
and
what
we're
doing
now
is
trying
to
put
a
plan
or
we're
trying.
G
A
Excellent
Kirsty,
thank
you
very
much
and
thanks
obviously,
to
all
the
teams
that
are
that
are
involved
at
some
really
encouraging
progress.
I
think
so.
At
this
stage
of
the
proceedings,
we
quite
often
have
a
one
of
our
own
recognizing
outstanding
contribution
awards,
but
we
don't
have
one
this
this
month
we
have
something
different:
it's
an
externally
awarded
award
and
it's
actually
an
award
from
belivet,
not
the
prosecutors
convention
award,
2018
and
I
actually
going
to
read
out
the
citation
to
you,
because
it's
really
quite
I
think
quite
outstanding.
A
So
the
citation
that
goes
with
this
award
is
in
recognition
of
its
excellent
work
with
other
agencies
and
efficient
use
of
resources
in
respect
of
highly
important
work
undertaking
in
prosecuting
offences
committed
in
health
and
social
care
settings.
So
it's
really
quite
a
quite
a
kind
of
superb
a
statement
there
and
it's
signed
by
the
Attorney
General.
So
I
wanted
to
take
this
opportunity
Rebecca
because
they
sit
under
you
but
to
congratulate
the
litigation
prosecution,
an
inquest
team
for
achieving
that
award
and
I
think.
A
At
the
same
time,
we
Andrea
are
updated
as
earlier
on
Hill,
Green
and
I.
Think
that
was
not
the
only
prosecution
by
any
means,
but
it's
it's
a
recent
and
very
high-profile
one.
So
I
wanted
to
congratulate
everybody
that
was
involved
both
in
the
teams
and
I
said
the
operational
colleagues
that
supported
the
prosecution's
generally
particularly
wanted
to
mention
bina
Browne,
who
leads
that
team
and
James
Lester,
who
led
the
specific
work
on
on
hill,
green.
So
I
just
thought
it's
really
fantastic.
So
congratulations
to
you
and
your
teams.
A
Is
there
any
other
business
that
the
board
wanted
to
raise,
so
I
then
wanted
to
do
something
which
is
also
slightly
different
from
what
we
usually
do
so
we're
normally
at
this
point
open
for
questions
from
the
public
and
we'll
do
that
just
a
second.
But
on
this
particular
occasion,
I
wanted
to
invite
a
member
the
public
to
come
and
tell
us
about
a
recent
event
and
it
so
happens.
Brenda.
You
also
won
an
award
so
well
we're
in
the
sort
of
spirit
of
congratulating
Award
winners.
You
won
you.
A
You
won
an
award
from
Southwest
ambulance
service
for
your
community
working
gloucestershire.
So
congratulations
on
that,
but
actually
come
and
talk
tell
us
about
the
event
that
you
organized
in
the
House
of
Lords
last
week,
which
I
wish
I
had
been
at
but
couldn't
be
at
so
Bren.
Just
tell
us
about
it.
Please.
Q
A
number
of
people
around
this
board
number
of
people
in
the
communities
and
then
the
number
of
people
are
their
arms
lengths
bodies
really
so
I've,
pretty
much
accepted
that
award
in
a
very
humbled
way,
but
a
very
clear
way
that
it
was
on
the
basis
of
that
sincerity
and
kindness
that
people
give
me
day
after
day
after
day,
moving
on
to
the
House
of
Lords
when
Peter
and
you
were
there
actually
Peter,
we
saw
the
video.
So
you
were
so
just
a
little
bit
of
a
background.
Q
A
lot
of
things,
what
you
love
to
go
out
read,
and
it
was
pretty
much
around
three
things-
really:
can
arms
lance
body's,
better,
harmonize
their
approaches
to
engage
in
our
very
community
and
neighborhood
level.
The
second
part
of
it
is
if
again,
you're
gonna
take
the
time
of
community
neighborhoods.
What
would
you
offer
and
the
third
part
of
it
really
was?
How
can
we
better
listen,
understand
the
offer
to
arm's
length,
bodies
from
community
and
neighborhood
groups?
Really,
so
he
did
say.
Well,
that's
not
my
portfolio
Brad
right
so
I
said.
Q
Q
It
came
back
to
how
much
they
weren't
getting
etc,
which
I
wasn't
really
sure
was
the
case
and
I
think
we're
the
smaller
neighborhood
community
groups.
Actually
I
didn't
hear
the
word
money
used
much
if
at
all,
really
it
was
just
that
you
know
very
proud
to
do
this.
This
is
what
I
did
on
the
gun.
This
is
what
I
do
on
the
voluntary
many
sheds
and
it
and
it
went
on
and
on
and
on
really-
and
it
was
absolutely
wonderful.
Q
We
then,
on
the
31st
of
January,
took
a
number
of
those
community
groups
up
to
the
House
of
Lords,
to
rightly
so,
celebrate
that,
and
that
was
with
the
community
groups
being
the
absolute
focus
of
that.
So
after
the
various
introductions,
my
decision
was
to
give
that
microphone
to
those
small
community
groups,
not.
Q
The
executives
from
either
Gloucestershire
or
sometimes
beyond
and
for
those
small
community
groups
again
just
to
say
you
know,
look.
This
is
what
I
do.
This
is
what
I'm
proud
of
this
is
what
I
do
at
the
madrasa:
don't
have
any
money
and
actually
really
we're
very
much
engaged
in
making
support
in
people
who
are
homeless
or
charities
as
fans
the
hospital.
So
again
it
wasn't
about
them.
Q
It
was
about
more
about
giving
really,
but
it
can
celebrate
in
that
moving
on
to
the
15th
of
November
Peter
and
your
fantastic
video,
if
I
might
say
that
who
we
played
there
and
we
took
it
again,
a
number
of
those
small
community
and
different
groups
as
well.
So
we
took
a
community
group
as
a
local
radio
station,
the
which
Dino
Hardin
had
visited
with
the
small
inner
city
farm,
so
in
Gloucestershire,
very
rural
and
in
the
inner
city.
Q
You
know
how
can
some
of
those
community
groups
either
a
afford
or
more
importantly,
feel
that
they're
all
aspect
is
is
welcoming
to
them.
So
we've
actually
looked
to
take
the
inner
city
farm
which
was
going
to
be
sold
by
the
City
Council
to
develop
her
add
to
it.
So
it
now
has
a
ride
in
paddock
to
it
to
it
as
well.
Q
So
that
and
and
again
we
had
the
house
for
the
carnival
how
we
have
the
House
of
Lords
committee
room
for
a
where
normally
it's
the
public
and
community
groups
or
whatever
at
the
back
of
the
room.
My
decision
on
this
case
was
to
change
that
and
have
the
community
groups
on
the
inner
circle
talking
about
what
they
did
really.
Q
Rightly
so
to
say,
you
know,
I
just
like
to
tell
you
what
what
I
do
day
after
day
after
day,
really
fantastic
hearing
of
Adam
a
gentleman.
That's
got
difficult
difficulty,
but
was
really
proud
to
share
about
what
he
was
going
to
do
with
his
shed
and
how
he
was
going
to
paint
it
out
and
how
that
was
going
to
be.
Q
Please
may
take
the
opportunity
to
say
thank
you
for
the
video
it
did
and
very
very
humbling
words
at
the
end
and
a
round
of
applause,
but
that
round
applause
should
have
been
for
you,
Chris
can
I.
Thank
you
for
the
hundred.
What
10,000
percent
support
that
you
give
to
this
and
the
belief
in
this
and
pork
and
I.
Thank
you
as
well
for
for
coming
and
also
given
your
arm
raised
in
when
you're
down
in
Gloucestershire
on
there,
the
song
you
lift
me
up
higher
than
the
maters
active
participation,
I.
Think
really.
Q
It
was
indeed
so
that
so,
of
course
it's
the
so
what
question?
Isn't
it
really
so?
On
the
30th
of
this
month,
we
will
take
the
principles
of
that
pilot
to
Plymouth
I've
been
talking
with
the
Director
of
Public
Health
and
they
are
put
in
those
community
groups
together
and
I've.
Seen
some
of
them
again.
The
the
overriding
principle
is
that
exactly
the
same
that
we
would
prefer
not
to
have
the
bigger
voluntary
organizations,
because
my
personal
feeling
is
that
they
are
often
ready
accessible.
They
they
have.
Q
You
know
different
approaches
and
whatever,
and
we
absolutely
need
that.
But
if
we're
talking
out
or
about
our
inequalities,
then
we've
got
to
demonstrate
that
and
we've
got
to
go
and
find
and
make
sure
we're
speaking
to
those
smaller
community
groups.
That
might
not
just
think
they've
got
a
voice
and
might
not
have
a
voice.
So
we
will
have
that
and
then
on
the
7th
of
March
Berenice,
Dido
Harding
will
be
joining
us
in
Coventry,
marmot
City
for
our
health
inequalities,
so
we'll
be
looking
at
those
principles
there.
Q
But
let
me
finish
by
saying
thank
you
because
again,
none
of
this
would
be
possible
without
the
support
of
Chris
and
his
team
and
people
around
the
board
really,
and
it
just
is
that
opportunity,
sometimes
to
real,
send
to
check
at
that
very
micro
level
at
the
community
groups
that
we're
not
always
reaching-
and,
let's
be
honest
about,
is
turf
really,
but
it's
right
to
do,
and
sometimes
we
need
to
take
on
board
the
tough
things
rather
than
the
easy
things
to
do.
Peter.
Thank
you
and
thank
you
for
this
opportunity.
So
Bren.
A
A
If,
if
you
have
the
time
thanks
brain
any,
were
there
any
questions
from
members
of
the
public,
so
the
the
litigation
prosecution
inquest
team
of
walked
in
beer
all
too
late,
because
Rebecca
Rebecca
took
all
the
the
work
that
you
guys
did
but
do
stay
and
join
us
for
lunch,
and
that
I
think
is
the
end
of
the
board
meeting.
So
thank
you
all
very.