►
From YouTube: CQC board meeting – November 2016
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
Did
you
see
we
have
apologies
from
absent
/
absence
from
Paul
Roo
who's
in
hong
kong,
from
robert
Francis
who's
in
New
York
and
for
Jorah
Gill?
Who
is
our
new
non-executive
director
who
sends
a
particular
apology,
because
the
long-standing
commitment
to
be
in
Australia
today
and
that
commitment
predated
his
appointment
to
our
board,
he's
really
sorry
not
to
be
at
his
first
board
meeting
and
is
likely
like
not
likely?
A
He
has
a
clash
also
for
the
December
board,
so
his
first
board
meeting
will
actually
be
with
us,
will
not
be
to
January,
but
the
dates
for
the
whole
of
next
year
safely
lodged
in
his
diary
and
I
would
just
say
David
that
you
and
I
have
meetings
already
read
or
so,
even
though
it's
not
of
the
board
he's
already
engaged
in
in
our
activities.
So
apologies
from
from
those
three
does
anybody
have
any
declaration
of
interest.
They
need
to
make
okay
minutes
of
the
meeting
of
19th
of.
A
October
I,
don't
think
that's
the
right
date
is
anyway,
then,
our
last
minute.
So
they
are
they
the
are
they
okay.
Does
everybody
prove
them
as
a
true
and
accurate
record,
it's
the
September
meeting.
Isn't
it
and
is
there
anything
arising
from
those
that
anybody
needs
to
raise
good?
So
we
then
have
a
have
an
action
log
with
a
small
number
of
items.
Anybody
want
to
raise
anything
like
anything
coming
out
of
that
are
either
on
course,
or
whether
all
on
course,
although
that
they've
got
an
actual
date.
B
Check
I
understand
one
thing
on
the
on
the
public
action
log,
which
is
the
second
item
in
which
there
is
a
report
to
be
presented
to
the
board,
considering
underlying
reasons:
failure
of
providers
to
improve
on
reinspection
kamagra,
quite
an
important
issue,
and
there
isn't
a
date
there
at
the
moment
it
said,
there's
data
analysis
set
out
in
the
state
of
care
report.
I
think
I
was
quite
limited
reasons.
It
reported
the
non
non
improvement
I'm,
not
sure
it
gave
much
analysis
of
the
oven
on
improvement.
I
just
wanted
to
be
clear.
A
C
Sorry,
I'm
I,
don't
know
the
answer
to
it
Peter.
What
I
would
know
is
that
I
think
this
is
paul
bear
its
initial,
which
means
that
this
is
slightly
more
historic
than
it
is
contemporary.
C
A
C
So
I'll
do
this
at
some
speed
if
I
met
Peter
there's
an
awful
lot
here,
which
is
referencing
the
performance
reports
and
my
suggestion
to
the
board
is
we
have
the
debate
about
performance
on
the
back
of
the
performance
report
rather
than
on
a
few
paragraphs
and
sentences?
I've
got
in
this
report,
but
some
in
relation
to
adult
social
care.
There's
a
brief
update
here
on
something
that
Andrea
and
her
team
have
been
dealing
with
in
relation
to
a
particular
residential
care
home.
C
28
reports
that
come
in
in
terms
of
hospitals,
just
a
paragraph
they're
updating
on
those
that
have
gone
into
special
measures
and
those
that
have
been
rated
outstanding.
The
Walton
trust
in
in
the
northwest
has
been
rated
outstanding,
which
is
another
one
added
to
that
select.
The
important
group
we've
just
touched
on
in
the
private
board
meeting
the
agreement
for
publication
of
the
consultation
document
on
registering
the
right
support,
and
this
public
report
just
gives
me
the
opportunity
to
reference.
C
It
will
be
publishing
a
consultation
document
in
December
which
reflects
the
approach
that
we're
seeking
people's
views
on
about
how
we
take
that
forward
and
then,
pending
the
receipt
of
those
views,
we
can
bring
that
back
to
the
board.
For
final
decision-
and
that
will
be-
the
policy
will
operate
from
from
march
in
the
state
of
care.
C
C
There
are
a
group
of
x
experts
by
experience
and
some
current
ones,
who
I
think,
for
the
past
three
months
a
week
before
a
public
board
meeting
of
written
to
members
of
the
board,
raising
their
concerns
and
issues,
and
what
I
wanted
to
do
in
this
paragraph
is
just
set
out
the
fact
that
we
are
actively
monitoring
the
x
by
x,
contract
and-
and
indeed
since
this
report
was
drafted,
there's
been
a
performance
meeting
with
r
employ
and
there's
also
been
an
internal
program
board
which
has
continued
to
review.
The
approach
that
we
are
taking.
C
The
number
of
complaints
were
receiving
around
training
continued
to
be
made.
However,
there
has
been
a
reduction
in
concerns
raised
by
inspectors
about
the
quality
of
x
by
x,
support
and
the
number
of
x
by
x
is
rated
good
or
outstanding
by
inspectors,
because
that's
what
they
do
after
they've
been
on
an
inspection
is,
and
the
last
performance
report
was
running
h.
2
percent
there's
been
a
reduction
in
complaints
about
r,
employ
and
communication
that
coming
into
CQC
and
there's
been
a
reduction
to
the
executive
team
in
complaints
from
inspectors.
C
The
feedback
before
forms
that
were
receiving
support
this
overall
progress
and
we
are
proposing
to
remove
the
requires
action
notice
from
a
conversation
that
we're
having
with
employee
in
light
of
the
achievements
of
taking
place.
This
isn't
say
this
is
running
perfectly,
but
it
is
to
say
that
improvements
are
occurring
and
are
taking
place.
C
Rem
ploy
you're
deeply
committed
to
this
contract
and
you're
working
hard
to
make
it
work
and
in
the
meetings
that
I've
had
with
the
managing
director
of
Rome
ploy,
that's
very
clear
and
I
think
we
can
see
your
trajectory
of
an
improvement.
There
are
actions
for
us.
Performance
of
the
contract
works
two
ways
and
we
need
to
continue
to
pay
attention
to
ensuring
that
we're
providing
r
employ
with
a
fill
rates
are
contracts
sets
out
as
well.
C
So
so
I'd
want
to
provide
some
reassurance
to
the
board
a
week
by
week,
month
by
month,
improvements
are
indeed
taken
place
in
relation
to
this
contract,
as
we
extract
improved
performance
from
it
and
REM
ploy.
Entro
support
remain
committed
to
it
and
we
remain
committed
to
it.
But
we
need
to
ensure
that
we're
continuing
to
deliver
the
fin
inverted
commas
to
fill
where
it's
to
make
a
contract
perform
at
the
level.
It's
a
two-way
issue.
D
As
the
three
points
actually
and
first
is
to
do
with
the
expert
by
experience
contract-
and
it's
some-
it's
good
that
it's
improving-
I
mean
I
think
at
some
point.
It
will
be
good
to
do
some
kind
of
review
or
evaluation
either
by
a
user
led
organization
or
in
partnership
with
a
user
led
organization,
not
sure
what
the
timing
would
be.
D
But
at
some
point
I
think
that
would
be
a
good
thing
to
do
to
make
sure
it's
working
as
we
would
want,
but
also
people
who
use
services
that
they
would
how
they
would
want
it
to
work.
To
other
points.
I
agree.
The
state
of
care
report
was
very
good
lots
of
good
coverage,
very
authoritative,
something
to
be
proud
of.
So
it
was
a
good
report.
Good
coverage-
and
the
third
point
is
a
small
point,
but
it's
an
important
one
on
the
registering
the
right
care.
Consultation,
I
think
we
should.
D
We
may
be
doing
this,
but
it
would
be
good
if
we
could
outreach
to
some
learning
disability
organizations,
particular
user
LED
ones,
to
find
out
what
they
think
about
it.
There's
a
new
organization
called
I
think
it's
learning.
Disability
England,
it
is
a
user
lead
organization,
so
I
think
you
know
it
has
to
be
accessible,
but
to
get
some
feedback
from
them.
I
think
would
be
a
good
thing
to
do
on.
A
D
Just
just
to
say
on
that
point:
okay,
a
couple
of
things:
one
I
have
recently
met
with
Len,
disability,
England,
and
so
we've
got
relationships
established,
which
are
very
helpful
and
also
with
Jill
Morel.
Excuse
me:
I,
had
a
public
engagement
met
with
one
of
the
learning
disabilities
and
Musa
led
organizations
change
people
up
in
Leeds
earlier
this
year
and
I
know
that
the
publican,
when
team,
have
a
variety
of
those
contacts
and
I'll
absolutely
make
sure
that
we're
doing
that
explicitly
in
this
consultation,
I'm
sure
and
the
public
engagement
two
more
helpers
with
that.
C
Did
neglect
to
give
one
update
it's
in
Steve's
area
sitter
than
this
one
went
through
pms,
but
recently
there
was
one
of
the
decisions
that
we'd
made
in
relation
to
the
registration
of
the
general
practice.
We
should
have
such
an
31
notice
of
decision
following
an
inspection
where
they've
been
serious
failures
and
that
was
appealed
to
a
tribunal
and
dismissed.
There
was
then
a
further
appeal
to
the
upper
tribunal,
and
that
was
remitted
back
to
the
first-tier
tribunal
for
a
rehearing
anyway,
the
backwards
and
forwards.
C
In
relation
to
this,
as
has
now
concluded,
and
last
week,
a
tribunal
concluded
that
the
GP
didn't
have
an
understanding
of
in
the
importance
of
complying
with
the
regulations
and
the
CTSA,
and
this
is
the
important
point
were
justified
in
suspending
the
doctors.
Registration
in
relation
so
I
think
a
further
reflection
of
the
summer
kind
of
challenging
circumstances
and
the
appeals
which
my
instinct
is
is
that
pulse
walk
be
running
this
on
the
front
page.
C
But
these
are
exactly
the
decisions
that
were
making,
and
it
is
an
important
part
of
our
process
that
we're
we're
challenged
on
some
of
our
decisions.
They
do
get.
This
opportunity
to
go
to
a
tribunal-
and
this
is
another
successful
tribunal
hearing
from
our
point
of
view-
and
the
issue
here
is
really
about
patient
safety,
which
is
why
it's
important
we
we
do
these
things,
but
some
I
didn't
want
to
give
the
report
without
just
commenting,
on
the
don't
say
anything
save
in
mersin
system,
okay,
but.
B
This
am
well
first
of
about
the
state
of
care
report.
I
thought
they
I
think
came
out
very
well
actually,
given
the
discussions
we've
had
about
it
and
getting
the
tone
right
and
the
getting
the
balance
between
reporting.
What
was
good
and
caution
about
the
future,
and
that
I
was
very
pleased
to
see
how
much
CQC
emphasized
the
importance
of
the
social
care
component
of
it.
B
That
seemed
to
be
one
of
the
main
messages
that
was
coming
across,
although
it
was
noticeable
that
quite
often
that
was
reported
not
because
of
what
we
said,
but
it
was
reported
as
if
the
main
problem
of
Social
Care
was
in
how
it
was
clogging
up
A&E
departments
by
not
doing
its
job
more
efficiently.
So
there's
still
a
bit
of
a
way
to
go
yet
in
understanding
that
they
about
the
crisis
of
quality.
B
That
is
also
in
social
care
and
as
if
to
back
that
up,
your
report
is
referring
to
I
think
we
should
let
this
go
without
mentioning
it,
the
the
first
prosecution,
it's
actually
referring
to
the
coroner's
comments
actually,
but
that
it's
the
same
case
not
case
not
I'm
sure
where
there
was
the
first
prosecution
for
corporate
manslaughter
of
a
care
home
or
carol
owner,
and
it's
just
a
reminder
of
the
extent
of
the
problem
that
can
arise
in
social
guess.
So
so
that's
why
we
have
a
comment.
Well.
B
My
question
is
that
so
here
we
have
the
the
national
regulator
of
Health
and
Social
Care
saying
we
have
reached
a
tipping
point
or
we're
reaching
a
tipping
point
now
it
could
hardly
be
more
serious
except
to
be
on
the
other
side
of
the
tipping
point,
which
is
where
we
are
in
danger
of
getting
and
the
the
question.
That
is
what
what
what
happens
next.
So
our
message
is
a
very
serious
message
about
the
problems
facing
social
care
and
we're
not
the
first.
It's
not
the
first
time.
B
We've
said
it
we're
not
the
only
people
to
be
saying
it,
but
but
what?
What
is
the
next
step
for
something
for
something
like
that?
A
public
statement
of
the
impending
difficulties
and
where
they're
leading
us
well,
what
is
what
its
response
are
we
now
getting
from
the
department
of
health
from
NHS
England
from
the
care
home
sector
itself?
Very
importantly,
I
just
get
an
idea
of
I
know
we
published
the
report
and
that's
out
into
the
world
it's
launched
into
the
world,
but
what?
What
next.
A
So
I
think
comment
that
you
just
made
and
David
made
earlier
is
the
first
important
point:
it's
not
the
number
of
hits
to
our
report
or
the
media
coverage.
Is
it
actually
influencing
policy,
and
we
don't
know
at
the
moment,
there's
certainly
been
a
lot
of
debate
in
Parliament
referencing,
both
the
scene
as
a
crisis
and
Social
Care
and
referencing
our
our
report.
So
that's
good.
What
what
government
decides
to
do?
If
anything
is,
is
one
question
and
then
the
other
point
you
rightly
make
is:
what
does
the
sector
itself
choose
to
do?
D
You
so
just
a
couple
of
comments.
One
I
think
that
you're
absolutely
right
the
kind
of
reflection
that
we've
had
about
the
comments
that
we've
made
have
focused
on
the
implications
for
the
health
service,
but
the
report
was
very
clear
about
the
implications
of
people
who
are
using
services
and
the
impact
on
their
lives
and
and
the
importance
of
social
care
both
in
terms
of
its
ability
to
transform
people's
lives
positively,
but
also
the
detrimental
impact
it
has.
D
One
has
24
hour
seven
day
a
week,
52
weeks
of
the
year,
experience
is
utterly
miserable,
or
indeed
exposing
people
to
harm
and
neglect.
So
I
think
that
we
just
have
to
constantly
kind
of
be
putting
up
those
messages,
as
well
as
demonstrating
that
people
can
get
it
right,
and
some
people
do
indeed
get
it
right,
and
there
is
good
practice
that,
and
people
can
learn
from
in
terms
of
the
impact
on
the
different
sectors
that
you
identify.
The
Department
of
Health
new
has
indeed
taken
on
board.
D
D
We
are
doing
work
in
a
variety
of
different
way
is
with
NHS,
England
and
other
partners
on
the
health
side
to
strengthen
the
relationships
between
health
and
social
care
in
a
meaningful
way,
so
supporting,
for
example,
the
work
of
the
Vanguard's
around
the
enhanced
health
into
care
homes,
where
you,
frankly,
the
health
service
can
help
and
social
care
by
actually
having
a
much
more
positive
attitude
in
terms
of
the
way
that
it
supports
services,
but
the
the
final
bit,
which
is
that
about
the
sector.
So
we
had
clearly
identified
the
concerns
without
around
resources.
D
But
it's
not
just
about
resources.
It's
about
how
we
use
those
resources
and
what
both
care
home
and
dom
celery
care
providers
do
with
that,
and
we
are
undertaking
some
work
across
the
sector
with
providers
with
commissioners
with
other
national
organizations.
They
say
we
need
to
have
a
better
understanding
about
what
good
quality
care
looks
like,
and
what
a
quality
strategy
for
adult
social
care
should
look
like,
which
aligns
and
reflects
that
which
we've
got
or
developing
for
the
NHS
through
the
National
Quality
board,
which
mike
am
co-chairs
with
bruce
care
from
NHS
England.
D
So
I
think
that
there
are
a
variety
of
different
initiatives
that
are
responding
to
this.
But
we've
just
got
to
keep
on
doing
the
job
that
we're
here
to
do,
which
is
to
to
monitor,
what's
happening
and
report
on
that,
but
also
to
be
highlighting
some
of
the
things
that
we
think
people
can
do
in
response
and.
A
I
suppose,
just
just
final
thought,
loose
I
I
think
there
is
now
a
broad
consensus
within
the
NHS
that
if
there
is
any
additional
money,
if
that
actually
it
would
be
most
effectively
applied
into
the
the
social
care
sector.
So
if
we've,
if
that's
right,
that
is
a
broad
consensus,
OMB
everybody's
view,
then
actually
that
is
quite
a
significant
policy
shift.
If
you
like,
whether
it
actually
gets
us
anywhere,
depends
on
whether
there's
any
money
available
but
I
think
we
have
had
an
impact
and
changing
thinking.
B
Another
guy
is
very
important,
and
that
has
been
said
again
this
this
week.
I've
noticed
that
and
there
again,
though,
it
is
just
still
carry
that
slight
flavor
of
the
purpose
of
Social
Care
is
to
help
the
NHS
sort
out
some
of
its
problems
and
that-
and
we
just
need
to
remind
people
that
as
well
as
that
being
very
important.
There
is
an
issue
of
the
quality
and
and
and
sometimes
the
really
a
poor
care
in
some
parts
of
the
adult
social
care
world.
It
isn't
just
the
issue
of
discharges
and
so
on.
C
In
from
the
NHS
Lewis,
my
my
set
piece
was
to
make
exactly
that
point
at
the
beginning
that
the
impact
of
this,
what
we're
saying
about
Social
Care,
is
thirst,
people
who
should
have
access
to
carry
not
getting
it.
Secondly,
the
people
who
should
have
access
to
good
quality
social
care,
not
necessarily
getting
it
in
the
numbers
that
they
should
and
then.
Thirdly,
that
washes
into
the
NHS.
But
the
true
issue
here
is
and
that
need
and
poor
quality,
so
I
get
accused
of
being
blunt
at
times,
I
think
I
was
pretty
ambiguous.
C
This
is
about
adult
social
care,
not
about
the
impact
on
the
NHS.
That
said,
I
have
no
doubt
at
all
that
some
of
eid
lines
run
your
point
about
the
media
because
of
what
we
said
about
the
NHS,
so
I
don't
think.
We
should
be
particularly
naive
about
about
this
as
well,
just
just
on
this
Chris.
They
had
70
supported
courts
before
the
day
from
user
groups
and
trade
associations.
C
A
generally
sum
up
and
say:
oh,
it
was
but
a
very
senior
journalist
as
recently
as
yesterday,
told
me
that
term,
when
they
try
and
get
stories
landed,
they
will
get
well
saw
what
these
people
would
say
that
wouldn't
they
and
I
think
what
was
a
game-changer
in
her
words
is-
and
this
is
a
very
senior
tennis-
was
the
regular
to
set
this.
So
it
actually
changed
its
own
of
the
debate
and
if
you
look
at
health
orals
yesterday,
I
cannot
think
of
a
time.
C
In
the
past
four
years,
when
they've
been
that
many
questions
on
adult
social
care
at
health,
orals,
I,
canted,
five
I,
don't
know
whether
it's
just
the
way
our
team
put
it
together,
but
they
were
the
first
five
questions
that
were
asked,
not
not
the
last
five
when
we
were
running
out
of
time
and
there
was
no
space.
So
oh
and
the
key
point
is,
is
unamed
this
point
in
sort
of
the
interviews
the
report
wasn't
to
the
government.
C
The
report
is
to
Parliament
so
in
a
sense
by
providing
Parliament
with
the
ammunitions
have
their
political
debates
I
think
we
did
it
service
and
that
will
take
over
at
a
different
rate
than
you
know.
What
is
the
chance
we're
going
to
do
next
week
when
he
does
the
autumn
statement?
I,
don't
know
what
he's
going
to
do,
but
actually
I
wouldn't
judge
our
success
in
the
state
okay
report,
whether
he
does,
or
he
doesn't
say
anything
about
social
time.
It
is
about
whether
Parliament
will
debate
these
issues
in
a
way.
C
A
Okay,
are
we
happy
to
move
on
to
the
performance
report?
David
we've
got
a
very
comprehensive
summary
nearly
as
long
as
the
performance
report
itself.
I,
don't
know
that
you
need
to
do
anything
by
way
of
introduction,
but
if
you
wish
to,
of
course,
please
do
I,
don't
you've
stolen.
My
words.
I
was
just
I.
C
I
can
both
take
the
hint
that
that
was
also
what
was
going
to
do.
You
have
got
a
comprehensive
report.
I
think
the
better
thing
to
do
is
to
ask
questions.
I
think,
there's
some
very
strong
performance
showing
through
I
think
earlier.
Today
we
talked
about
performance
against
delivering
the
program
and
I
think
that
set
out
we've
got
content
here
about
the
number
of
people
we've
got,
who
were
working
hard
to
deliver
that,
but
also
some
quite
granular
data
and
Mia
and
colleagues,
be
very
happy
to
answer
any
questions
that
the
board
have
got.
C
There's
nothing
particularly.
I
want
to
draw
attention
to
Peter
in
the
lesson
to
finance.
Also
in
this
report
you
can
see
that
we're
projecting
an
out
turn
towards
the
end
of
the
year
and
again
capes
here
and
between
Kate
and
I
will
be
very
answer
happy
to
answer
any
questions
colleagues
have
got,
but
rather
than
Witter
on
I'll
I'll
leave
it
to
colleagues
to
ask
questions.
D
You
know
that
the
feedback
that
we
get
from
providers
I
just
wanted
to
if
there's
any
sort
of
correlation
or
association
between
the
ratings
we
give.
So
you
know,
for
example,
our
I'm
not
going
to
read
anything
into
it.
I
just
wondered
if
you
know
it
would
seem
quite
natural
if
people
got
a
not-so-great
rating
to
give
some
sort
of
more
negative
feedback.
D
I
just
wondered
if
we
kind
of
looked
at
looks
at
that,
and
maybe
given
the
consideration
to
how
we
can
get
feedback
that
tried
to
provide
sort
of
neutral,
more
neutral
comments,
it's
very
specific
on
specific
things,
because
otherwise
it
could
give
you
a
quite
a
distorted
view
as
to
what
you
know
what's
actually
happening.
So
so
it's
about
whether
you've
looked
at
the
links
and
the
correlation
and
whether
there's
anything
we
need
to
change
or
amend
from
that
in
terms
of
the
feedback
we
get
from
from
trusts.
D
The
second
point
was
about
corporate
complaints.
We
don't
get
a
report
or
perhaps
we
get
an
annual
report,
but
I
just
wondered
if
whether
the
board
ought
to
know
a
little
bit
more
about
the
types
of
complaints
we
get
and
whether
we're
kind
of
learning
from
them,
because
obviously
we
expect
that
of
providers
I,
certainly
don't
get
it
on
a
regular
basis.
But
I
think.
D
In
fact,
I
think
sometimes
people
say
that
they,
you
know
that
we're
not
responding
or
you
know
and
I
just
wondered
if
there's
a
similar
to
the
complaints.
But
if
there
were
ways
of
being
reporting
more
about
the
sorts
of
issues
that
were
being
responded
to
and
what
we
actually
do
with
them,
and
maybe
some
examples
of
you
know
of
when
things
have
been
raised
with
us
and
what
we've
done
like
you
want.
E
To
say
they
only
response
to
the
first
point:
yes,
in
terms
of
feedback,
of
course,
we
get
feedback
from
a
lot
of
angles
and
not
just
from
the
provider
survey
or
the
pride
survey
is
very
useful
because
we
can
get
comparisons,
quarter-by-quarter,
etc,
and
so
I
and
my
adapter
chief
inspectors
spend
a
lot
of
time
getting
a
direct
feedback
from
achieve
executives
and
medical
directors
and
others.
So
we
get
that
informal
feedback
in
response
to
your
specific
question
about
how
does
it
correlate
with
ratings?
I?
E
Think
it's
probably
a
closer
correlation
with
what
people
are
expecting
their
rating
to
be,
and
if
there
is
a
difference
between
what
their
expectation
is,
I
don't
think.
We've
ever
had
never
given
feedback
from
a
trust
that
we've
rated
outstanding
that
that
nor
have
we
had
any
challenge
on
those
ratings
and
they
say
I'm
at,
but
I
think
is
sometimes
if
a
good
for
us
thinks
it
should
be
outstanding.
There
may
be
comment
on
that,
and
one
that's
requires
improvement
rather
than
having
expected
it
to
the
self
to
be
good.
So
it's
it's
not
straightforward.
E
A
I'd
support,
then
this
isn't
totally
anecdotal,
but
I
spend
a
lot
of
time
with
trusts
and
the
last
two
trusts
I
visited
literally
this
month.
One
both
were
rated
as
as
our
I
one
was
complimenting
me
as
if
I'd
had
something
to
do
with
the
repair,
the
inspection
on
the
quality
of
the
work,
the
usefulness,
the
recommendations
around
this
was
from
the
board,
and
it
was
you.
A
I
came
away
from
that
feeling
really
good
and
then
the
other
one
I
went
to
I
just
got
an
absolute
earful,
the
they
regarded
the
whole
thing
as
a
travesty
of
justice,
because
exactly
to
my
explain
their
have
a
an
expectation
which
was
not
met
with
either
what
the
inspections
or
offer
what
it's
worth
I
saw
as
I
wandered
around
the
hospital.
So
it's
a
it's.
A
What
I
think
is
really
interesting,
and
it's
a
slightly
different
point
is
that
there
are
a
lot
of
truss
who
I'm
talking
specifically
about
trust
but
actually
I
think
it
would
apply
to
to
right
across
the
piece.
You
really
take
our
our
our
reports
as
useful
work.
Programs
form
you
know
where
they
need
to
be
as
spending
time
and
all
of
that,
and
that's
that's
really
positive,
however
they've
been
rated
and
there
are
others
that
are
just
in
denial
and
arguing
and
pushing
back,
and
that's
really
worrying.
A
C
F
I
mean
I
think
how
you
make
two
very
important
points
about
some
concerns
and
complaints
and
I.
Think
during
the
the
time
that
you
and
I've
worked
together,
we
have
had
a
root
and
branch
review
of
how
we
work
with
both
concerns
and
complaints,
as
a
subset
of
that,
and
they
sit
in
the
responding
to
concerns
program.
So
the
complaints
and
the
performance
within
complaints
and
some
of
the
trends
in
complaints
have
been
reported
to
the
auditing,
Corporate,
Governance,
Committee
and
I.
F
F
If
you
like,
and
individual
directorates,
do
pick
up
on
things,
so
I
would
suggest
that
bring
it
back
again
through
any
cgc
is
a
good
thing
to
do,
and
it
might
be
that
we
would
want
to
perhaps
annually,
as
you
suggest,
to
bring
something
to
the
main
board
in
terms
of
the
state
of
complaints
and
complaints
are
going
through
currently
living
through
a
major
revision
of
working
practices.
I
think
that's
all
to
the
good.
F
You
see
live
to
ensure
they're
dealt
with
with
empathy
with
sympathy
and
with
professionalism
and
and
I
think
we
are
in
a
much
better
place
around
that
and
directorates,
and
each
of
them
can
give
you
examples
of
where
something's
been
received
and
acted
upon.
We've
also
done
a
great
deal
of
work
on
is
setting
out
with
much
more
clarity.
F
What
CQC
is
able
to
do
what
it
is
not
able
to
do
directing
people
as
appropriate
to
two
other
bodies
who
are
better
placed
to
actually
assist
them
and
to
make
sure
that
when
people
get
responses,
they
are
consistent,
there's
clarity
associated
with
language,
and
they
are
designed
to
be
helpful.
And
although
we
are
mindful
that
were
not
always
giving
people
the
answer,
they
want
from
us
as
a
regulator
so,
and
the
learning
from
those
is
certainly
drawn
out
in
terms
of
volumes.
F
Understanding
better
safeguarding
issues
are
coming
through
to
us
relationships
with
others.
But,
as
I
said
for
complaints,
it
would
be
entirely
possible
to
take
that
back
particular
through
the
rgc,
which
is
where
it's
been
already,
and
to
give
that
an
update
on
progress
and
maybe
again
annually
give
some
sense.
The
border,
the
volumes
and
the
types
are
received.
A
F
We're
supplying
an
indeed
Peter.
What
we
have
done
is
to
under
the
responding
to
concerns
process.
There
are
three
elements:
what
one
is
concerns
where
people
don't
want
to
make
a
complaint,
then
there
are
complaints
and
then
there's
whistle
blowing
each
requires
a
slightly
different
response.
I've
dropped
into
the
shorthand
of
saying
that
we
sit
at
all
under
an
umbrella
called
responding
to
concerns
and
under
whistle
blowing
I
think
to
be
mindful.
F
We
have
statutory
responsibilities
around
it,
but
also
those
that
bring
concerns
to
us
do
not
necessarily
want
to
be
called
whistleblowers,
and
that's
part
of
the
learning
that
we've
taken
on
board
during
the
process
of
really
revisiting
and
rethinking
all
that
we
do
so.
We
certainly
do
get
some
whistle
blowing
we're
getting
a
great
deal
more
where
people
don't
want
to
turn
themselves
whistleblowers,
but
they
want
to
share
something
of
concern.
B
Gosh,
that's
one
a
question
about
the
number
of
locations
in
breach
for
four
quarters
or
more
cuz.
That's.
This
is
different
from
the
reinspection
question.
Although
it's
sort
of
related
we've
got
1,800
organizations
now
that
have
been
breached
for
over
four
quarters
and
although
what's
the
modern
social
characters,
price
carry
the
quite
a
substantial
number
of
primary
medical
services,
and
we
have
talked
in
the
past
about
doing
some
further
work
on
on
that
group
and
I.
B
G
What
I
welcome
your
chin?
Tfc
thanks,
I
mean
and
numbers
are,
are
small,
but
we
know
exactly
each
one
of
the
locations
what's
happening
to
it.
So
for
the
g,
for
example,
for
general
practice
out
at
ours,
urgent
care,
we
have
an
inspection
planned
in
the
diary
already
for
seventy-seven
percent,
and
then
the
group
that
aren't
so
that
comes
down
to
about
46,
so
small
numbers
compared
with
social
care.
G
One
of
our
heads
of
in
of
inspection
has
an
oversight
of
this
and
reports
to
me
every
month
in
our
own
performance
meeting,
but
of
those,
for
example,
16
have
already
been
completed,
but
CRM,
which
is
the
database
it
is
it
there's
a
delay
it.
Actually.
Those
numbers
coming
out
onto
these
figures
such
a
recurring
thing,
30
of
them,
are
actually
in
the
process
of
D
registering
at
the
moment
so
and
then
we
can
break
them
down
even
more
14
our
prisons
and
slimming
clinics.
G
Most
of
those
are
in
prisons,
but
we
have
to
follow
the
HMI
prison
in
their
inspection
routine.
So
in
fact
they
might
be
delayed,
but
there's
nothing.
We
can
really
do
about
about
it
unless
it's
a
specific,
urgent
piece
of
action
and
then
there
are
dentists
as
well,
but
we
have
a
register
with
all
of
them,
so
some
will
be
minor
things
and
we
have
to
prioritize
when
we
send
the
inspectors
in
at
a
particular
date,
or
we
can
place
our
program
on
time
and
going
to
reports
out
on
time.
D
As
some
Louis
quite
likely
says,
the
volume
sits
with
adult
social
care
and
in
a
sense
of
the
thousands
of
locations
that
we
are
regulating.
That's
perhaps
not
surprising
in
relation
to
how
what
we're
doing
about
those.
Clearly,
we
have
a
reinspection
process,
and
so,
if
they've
been
identified
as
a
rated
as
inadequate
we're
back
within
six
6
months,
it
could
be
a
lot
earlier
and
with,
if
we've
rated
them.
D
So
they
will
look
as
if
they
are
continuing
to
be
in
breach
of
regulations,
but
they
may
well
be
different
regulations
that
they're
in
breach
of
and-
and
that
is
that
is
something
that
I
think
we
are
very
mindful
of,
and
is
one
of
the
reasons
why,
if
the
rating
of
leadership
is
not
so
good
in
adult
social
care,
because,
obviously
what
we're
looking
for?
There
is
consistency
in
performance
in
terms
of
improvement
and
and
seeing
that
and
seeing
that
happen.
But
I
think
that
we,
we
are
we're
on
it.
D
The
local
teams
are
on
it.
But
if
there
is
an
issue
about
what
providers
are
doing
in
response
to
that,
and
we
identified
in
the
state
of
care
that
we
were
worried
that
a
quarter
of
those
services
that
we've
rated
as
inadequate
had
not
improved
and
that
only
about
half
of
these
services
that
we
rated
as
requires
improvement,
had
improved
and
eight
percent
of
them
had
deteriorated
and
to
inadequate.
D
So
I
think
we've
still
got
a
real
challenge
with
in
adult
social
care
to
see
the
improvement
that
we
need
to
see,
and
it's
not
just
the
regulator.
That's
going
to
make
that
happen.
It's
what
the
providers
themselves
are
doing,
what
their
staff
are
doing
and
and
what
the
local
commissioners
are
doing
as
well.
F
You-
and
it
obviously
were
coming
to
the
end
of
three
year
period,
where
we're
inspecting
everything
and
I
would
probably
take
a
moment
to
say
well
done,
because
I
think
the
figures
are
looking
and
looking
really
good.
For
me,
the
what
would
be
interesting
is
moving
into
the
next
phase.
What
next
looks
like
the
risk
based
assessment-
and
I
would
just
like
to
ask
whether
the
board
will
have
a
chance
to
just
pause
and
reflect
and
see
what
that's
going
to
look
like
in
the
future.
So
that's
one
point.
F
On
the
second
point,
looking
on
page
13,
we've
just
been
talking
about
social
care
being
at
a
tipping
point
because
of
when
you
look
here
at
our
ratings,
we've
got
a
really
quite
good
Rosie,
but
why
not
Rosie,
but
hopefully
a
good
picture
of
what's
happening
out
there.
So
what
is
driving
the
the
concern?
Is
it
just
at
the
business
model
you
have.
A
care
is
good,
but
the
business
model
underlying
social
care,
just
just
isn't
stacking
up.
D
So
you're
right
Jane
that
overall
we're
rating
services
at
the
majority
of
services
as
good,
but
I
think
it
comes
back
to
one
of
the
pipes
that
we're
making
earlier,
which
is
that
the
the
that
the
quality
of
social
care
impacts
on
people's
entire
lives.
So
a
quarter
of
services
being
requires
improvement
and
a
further
two
or
three
percentage
of
services
being
inadequate
is
frankly
absolutely
not
good
enough.
So
that's
one
point.
D
The
second
point
is
our
concern
about
the
fragility
and
the
resilience
that
there
is
within
adult
social
care
to
deliver
the
improvements
that
we
need
to
say
so
that
links
back
to
my
response
to
Louis's
question.
Just
now
around
you
only
half
of
the
services
that
we
r
rating,
as
requires
improvement,
actually
improving
by
the
time
that
we
go
back
and
and
that
I
think
is,
is
worrying
in
terms
of
actually
needing
to
make
sure
that
people
are
getting
the
care
and
the
support
at
the
quality
and
that
they
have
every
right
to
expect.
D
And
our
worry
is
that,
with
the
pressures
from
a
financial
point
of
view,
the
pressures
around
workforce,
because
we
have
high
levels
of
turnover
and
high
levels
of
vacancies,
both
in
care,
assistants,
nurses
and
leaders
within
adult
social
care
and
and
also
the
kind
of
increasing
demand
and
the
acuity
of
that
demand
noon,
the
sort
sir
and
was
managing
old
people,
services
and
the
health
service
20
years
ago.
None
of
those
people
that
I
cared
for
in
the
NHS
20
years
ago
would
touch
the
health
service
these
days
they
would
all
be
in
social
care.
D
A
A
G
G
One
location
remains
in
special
measures
because
it's
still
inadequate
and
at
risk
and
three
locations
of
deregistered
to
voluntarily
and
one
through
enforcement,
and
it's
just
that
the
amount
of
activity
we've
got
it's
still
quite
great
and
the
enforcement
activity
is
quite
great
and
despite
the
family
nearing
the
end
of
the
program
and
I
thought
from
the
board's
point
of
you
just
might
be
worth
bringing
that
out
of
the
report,
because
I
know
Mike
did
in
the
individual
court.
I
just
thought
it
might
be
helpful.
A
Thanks
to
you
all
right,
okay,
let's,
let's
move
on
to
the
medium
term
plan,
is
much
his
mark
because.
C
I
think
my
own
will
probably
appear
I
think
has
been
signaled
outside,
though,
if
I
just
said
something
by
way
of
introduction
molter
in
his
previous
incarnation
as
well
as
this
one
and
Kate
had
been
heavily
involved
in
this
and
with
people
as
he
talks
in
private
Boyd
sessions
about
the
work,
that's
been
done
on
the
medium
term
strategy
group.
This
is
the
first
time
we
brought
a
report
in
public.
C
So
the
purpose
of
the
medium
term
strategy
group
is
to
take
the
strategy
that
we
published
in
may
and
then
convert
that
into
a
sequence
of
delivery
plans.
So
what
we're
working
on
is
a
five
years
strategy,
a
three-year
financial
plan,
and
this
will
then
convert
into
the
business
plan
that
will
begin
to
bring
you
in
December
and
then
for
agreement
through
january
and
februari
peter
until
we
get
to
a
public
business
plan
at
the
februari
board.
C
Meeting
is
the
plan,
so
what
this
report
is
attempting
to
do,
colleagues
is
just
set
out
again
for
the
first
time
publicly.
What
the
strategy
implementation
plan
is
that
converts
the
strategy
into
delivery
and
effectively
what
we
want
to
land
here
is
the
approach
that
we're
taking
over
this
three
year
and
then
one
year
period,
where
we've
worked
on
the
money
that
we
know
we're
going
to
get
between
now
and
2020,
where
our
budget
will
go
from
249
last
year
down
to
217,
which
we've
called
the
glide
path.
C
So
the
anticipated
number
of
inspections
we
anticipate
doing
next
year,
I
think
this
is
why
Steve's
raising
this
issue
laterally
about
special
measures
and
GPS,
as
we
begin
to
finalize
those
numbers
for
next
year's
planning
and
then
converting
that
arithmetic,
that's
mapping.
Modeling.
Sorry,
not
mapping
modeling
into
well.
What
does
that
mean
for
the
number
of
people?
We
need
to
deliver
the
strategy
and
the
numbers
against
the
amount
of
money
that
we've
got.
C
So
what
this
report
is
doing
is
reporting
at
a
high
level
publicly
to
the
board,
where
we
are
in
relation
to
the
financial
glide
path
and
what
the
implications
are
at
a
high
level
in
terms
of
people.
The
number
of
people
we
employ
in
CQC
to
set
that
work
forward,
but
also
to
give
you
some
confidence
about
that.
This
is
modeled
on
the
number
of
inspections
we
anticipate
doing
next
year.
So
then,
next
to
this
report,
you've
got
a
plan
on
a
page
which
I
think
Paul.
C
Roux
is
asked
for
in
numerous
meetings
at
different
times
to
do
this,
and
this
is
the
work
to
the
reason
we've
oscillated
between
putting
lots
and
lots
of
detail
on
this,
in
which
it's
a
very
confusing
plan.
On
a
page
with
very
lots
of
small
writing
or
whether
there's
this
plan
on
a
page
which
has
less
detail
and
as
bigger
writing
the
point
I'd
want
to
make
is
not
a
cheap
one,
but
is
a
significant
one
that
some
see
underneath
each
of
these
lines.
C
So,
coming
back
from
the
plan
on
the
page,
what
we've
attempted
to
do
is
going
through
the
report
is
look
at
the
changes
to
what
we've
described
as
our
operating
model
in
terms
of
registration
set
out.
What
some
of
those
changes
are
simply
monitor
going
through
in
the
detail
of
the
reports
and
and
then
just
trying
to
capture
the
progress
of
that
work,
including
this
important
work
on
iron
and
T
we've
set
out.
C
C
Adele,
Select
Committee,
the
worst
position
we
could
have
been
in
is
the
first
time
we
were
saying
any
of
these
was
going
to
be
at
the
Health
Select
Committee
and
the
board
and
the
3,000
people
plus
that
work
in
the
organization
the
first
their
hear
of
it
is
with
Petyr
and
myself
at
Health
Select
Committee.
So
these
paragraphs
around
the
financial
position
and
the
people
position
a
hugely
important
I
hope.
The
board
have
taken
some
confidence
from
the
previous
performance
reports.
C
The
commitments
were
made
to
complete
the
program
during
this
financial
year
1617
will
be
carried
through
Lewis.
Your
question
is
still
about
the
quality
of
what
we
do
in
our
we
can
we
continue
to
work
on
that,
so
we
do
continue
to
work
not
just
on
the
overall
number,
but
the
quality
of
it,
but
some
picture.
What
this
report
is
designed
to
do
is
just
all
forgive
the
board.
Some
reassurance
as
well
as
I,
know
many
many
people
look
at
this
board
in
public.
C
C
I
do
expect
the
Health
Select
Committee
to
ask
us
some
challenging
questions
about
this,
but
it
does
allow
us
to
set
that
out
just
to
be
really
clear
about
why
this
is
here,
which
is
why
I'm
introducing
it
rather
than
mark,
as
said
but
mark
Mark's,
probably
got
a
better
grip
of
a
very
fine
detail
of
this
than
I
have,
but
some
I'm
sure
between
the
executive
team
and
Mark
around
the
table.
We
had
to
answer
any
questions
at
the
board
have,
but
if
I
leave
that
there
so
before.
A
We
get
the
challenging
questions
from
the
Select
Committee.
Let's
have
the
challenging
questions
from
the
board.
I
I
would
just
Paul
dizon
here,
but
I
would
just
say
that
I
think
the
plan
on
the
page
is
exactly
what
I
think
Paul
was
looking
for
and
I
think
it's
the
right
level
of
detail
as
well
as
the
right
size
from
that
you
had
to
use
to
produce
it.
So
back
in
his
excellent
comments,
questions
list
I
think.
B
It
was
really
helpful
to
see
this
kind
of
thing
there.
What
I
read
these
documents?
Oh,
it's
clear
that
we're
trying
to
address
the
immediate
there's,
a
pressing
needs
of
the
next
year
or
two
which
are
partly
financial
and
they're,
partly
about
the
changing
NHS
and
I
suppose
they're,
partly
because
we've
come
to
the
end
of
a
cycle
in
our
own
work.
B
The
the
vision
thing,
the
point
in
a
few
years
time
that
we
want
to
be
at
and
whether
we've,
whether
all
of
that
the
point
we
want
to
reach,
is
properly
reflected
in
the
in
that
strategy
and
I
don't
mean
that
in
a
critical
way.
I
just
think
that
is
a
natural
way
of
looking
at
the
you.
Just
it's
very
easy
to
focus
on
the
things
that
are
going
to
hit
us
in
the
next
year
or
so,
and
and
so
for
me,
the
the
consequence
of
that
is
that
we
it's
less
clear
how
we
meet.
B
B
So
that
sense
of
public
accountability,
which
is
the
heart
of
what
we
do
doesn't
seem
so
obvious
in
this
kind
of
document
and
I.
Just
wonder
whether
it
might
be
because
it's
not
one
of
those
pressing
things.
That's
going
to
happen
hit
us
in
the
next
third
year
or
so,
but
in
the
end
it
is
at
the
core
of
what
we
expect
to
get
to
in
three
or
four
years
time.
B
C
I
think
it's
a
good
change,
and
I
think
my
mark
may
add
to
this,
but
the
strategy
document
itself.
There
were
sections
in
that
lewis
that
attempted
to
get
what
all
this
looked
like
in
20
21
and
I
can
be
a
nuisance
at
times,
but
one
of
the
things
I
had
kept
asking
the
median
term
strategy
group
is:
please:
will
you
relate
everything
back
to
the
strategy?
This
is
the
board's
position.
C
We
worked
hard
at
getting
that,
and
this
is
a
point
why
I've
emphasized
the
median
term
strategy
group
is
about
the
delivery
of
that
strategy.
That
is
our
agreed
position.
It's
not
for
anybody,
then,
to
do
artistic
interpretation
of
that
strategy
it
is
to
do,
is
to
set
out
the
delivering
the
strategy.
If
we
feel
we
need
to
change
the
strategy,
then
that
needs
bringing
back
to
the
board
and
that
needs
to
be
a
board
decision
to
change
it.
But
I've
been
a
stuck
record
at
times
where
I've
said.
C
What
does
the
structure
to
say
about
this,
and
how
does
this
deliver
the
strategy
and
I
think
what
the
plan
on
a
page
and
that
the
detail
that
sits
behind
this
is
literally
about?
How
do
we
carry
that
forward?
I
think
some
of
the
dilemmas
that
you've
said
set
out
continue
to
exist,
because
this
is
it's
a
rapidly
moving
environment.
How
many
accountable
care
organizations
will
we
up
next
year?
C
We
can
count
one
or
two,
but
will
it
be
three
or
four
or
four
or
five?
So
the
precision
of
the
planning
is
pretty
tricky
to
take
forward,
not
just
because
the
teams
are
still
looking
at.
What's
in
special
measures,
what
is
in
special
measures
and
therefore,
what
the
repeat
visits
are
in
terms
of
new
care
models?
Just
how
many
will
we
have
next
year?
C
A
H
Unless
we
get
more
into
the
detail
of
the
program
here,
because
this
is
a
program
of
change
that
we've
got
then
is
really
important-
that
we
come
back
to
why
we're
doin
in
the
first
place.
So
the
strategies
that
guide
in
principle
and
actually
the
probe
the
programs
are
work-
we've
set
out-
has
sort
of
set
of
the
starting
point.
H
What
the
audit
and
Corporate
Governance
Committee
asked
us
to
do
is
to
have
a
sort
of
an
independent
review
of
our
our
plans
as
they
come
through,
and
I
would
expect
part
of
that.
That
review
to
kind
of
look
to
make
sure
that
we
are
holding
true
to
the
stamp
wishes
and
the
in
strategy
as
well.
Andrea.
D
A
D
D
The
other
side
of
the
coin
is
that
we
stick
to
a
strategy
that
perhaps
is
no
longer
relevant
I'm,
not
suggesting.
We
need
a
whole
new
strategy,
but
there's
a
writ
because
we're
in
such
a
fast
changing
environment
in
health
and
social
care,
it
could
be
that
the
no
strategy
we
developed
last
year
may
actually
need
some
revision
for
next
year
and
the
year
after
so
I
agree
that
we
don't
lose
the
vision
that
we
should
very
much
have
a
strategy.
D
But
we
shouldn't
be
concerned
about
revising
that
strategy
if
we
feel
that
particularly
the
external
environment
is
very
different.
So
not
you
know
not
slavishly
keeping
to
the
strategy,
but
but
in
a
considered
way.
It's
not
a
bad
thing
to
you
know,
review
it
to
make
sure
that
it
you
know
it
still
fit
for
purpose.
If
you
like
so.
A
I
think
David
said
that
it
was
a
need
to
revise
the
strategy,
then
that
would
come
to
the
board
for
discussion
so
and
you're
absolutely
right.
You
need
to
keep
these
things
under
review.
Having
said
that,
the
strategy
I
think,
was
very
much
a
workers
of
rewriting
stretching
it.
We
were
very
much
aware
of
this
fast
changing
environment
and
I'd
actually
be
quite
surprised.
A
F
The
most
important
words
in
this
dr.
metra
back
was
it
flexible
and
evolving
and
then,
when
Louis
is
talking
to
us
on
just
now
about
things
that
will
hit
us
you're,
absolutely
right.
Kzo
things
will
happen
over
the
next
to
it.
I
don't
think
we'll
go
away
from
me
strategy,
but
we
just
knew
need
to
have
in
our
minds
I.
You
know
when
things
are
offered
to
us
like
new,
got
to
measure
the
use
of
resources
of
God
user,
and
so
you
know
what
we,
how
does
that
fit
with
our
strategic
priorities
and
objectives?
A
So
I
think
strategy
is
just
a
set
of
words
if
you
haven't
the
ability
to
implement
the
strategy
so
without
taking
anything
away
from
all
the
work
we
did
on,
the
stretch
is
really
important
mark.
This
is
this
is
absolutely
as
important
and
I
need
a
great
piece
of
work.
You
and
the
team
are
doing
so
just
want
to
feed
that
back
through
YouTube
to
everybody
else.
A
The
good
news,
bad
news,
is
I'm,
afraid
you'll
be
back
again
talking
about
it
from
her
as
we
go
forward.
Okay,
everybody
be
happy
to
to
move
on.
So
what
a
mark?
Thank
you
very
much
indeed,
would
take
a
ranch.
Thank
you.
So
I
is
Chris
out
there
he's
Chris
joining
us
for.
Are
you
going
to
do
it?
Malta
excellent.
I
So
in
front
of
you
is
the
revised
social
media
policy
for
CQC,
and
that
was
last
updated
in
2013
and
as
we're
moving
as
part
of
a
strategy
and
a
more
digital
future,
as
is
the
rest
of
the
world
as
an
organization.
We
want
to
encourage
our
staff
to
use
social
media
and
use
it
well
and
make
the
most
of
that
opportunity
for
us
as
an
organization.
I
At
the
same
time,
it
needs
to
be
clear
that
what
our
staff
do
through
the
ocean
media
does
not
replace
and
should
not
replace
what
we
do
through
our
formal
corporate
communication
channels.
So
this
policy
is
intended
to
clarify
the
expectations
on
our
staff
when
they
use
social
media
and
in
particular,
it's
modeled
on
the
general
code
of
conduct
for
all
of
staff
and
how
that
translates
through
to
the
use
of
social
media.
I
Parecer
provides
clarity
and
consistency
for
expectation
and
more
senior
staff,
where
the
differentiation
between
personal
views
and
views
as
a
member
of
CQC
becomes
more
gray
area
and
as
a
result,
needs
to
be
clearly
set
out.
And
finally,
it
sets
out
how
we
will
support
our
own
staff.
In
terms
of
guidance
and
training,
particularly
because
some
of
the
social
media
engagement
can
lead
to
more
difficult
conversations
and
how
those
can
be
handled
and
handled
well,
in
line
with
how
we
want
to
live
a
values
as
an
organisation.
B
B
Here's
what
you
do
if
you
get
into
a
difficult
situation.
Here's
who
you
can
turn
to
here's!
What,
where
you
can
find
advice,
I
think
people
do
need
that,
because
it's
surprising
and
in
fact,
quite
unpredictable,
sometimes
situations
you
can
find
yourself
in
and
social
media
and
there's
a
kind
of
mixed
message
in
seeing
here's
our
code
of
contact.
Please
stick
to
it
and
at
the
same
time
saying
this
is
social
media.
B
Your
abuser,
your
own
or
you
know,
go
out
there
and
exercise
your
responsibility
as
a
professional
and
we
and
I
think
there's
a
just
need
to
be
slightly
careful
that
we're
not
just
being
a
little
bit
too
prescriptive
about
what
people
can
do
in
what
is
it?
What
we're
one
of
the
great
virtues
of
social
media
is
the
freedom
that
it
provides
and
vapor
and
the
and
the
accessibility
that
it
provides
the
public
about
two
people
who
are
in
senior
roles
that
what
we
want.
B
B
So
when
people
start
documents
by
saying
we
seek,
you
see,
recognizes
social,
really,
very
important
part
of
public
discourse,
but
here
are
now
several
pages
of
how
you
should
go
about
it
and
that
slightly
jars
with
me,
I
have
to
say,
and
nothing
that
they're
all
sensible.
But
it's
like
vision
and
and
I
think
there
is
also
possibly
a
slightly
different
position
for
board
members
and
compared
to
employees,
and
that's
meant
to
be
protective
to
employees
as
well.
B
As
you
know,
setting
out
the
rules
because
board
that
we're
on
the
board
not
to
defend
CQC
and
although
we
often
do
defend
CQC,
but
that
isn't
our
main
purpose.
The
main
poster
as
ICS
miracle
is,
is
about
it's
about
that.
Public
accountability
is
about
representing
public
and
patient
interests
and
bringing
in
what
is
sometimes
independent
area
of
interest
and
expertise
to
bear
in
the
working
of
CQC.
So
it
isn't
just
about
working
from
within
the
organization
and
we
mustn't
it
suggests
story
in
the
way
we
set
this
out.
B
It
suggests
any
curtailment
of
that
I
think
people
expect
when
they
write
to
me
on
social
media,
expect
an
honest
answer
and
they
don't
expect
to
CQC
answer
and,
of
course,
that
may
be
knighted
my
duty
to
be
professional
and
respectful,
and
all
of
that
and
it
wouldn't
work
if
I
was
criticizing
decisions
in
a
you
know,
in
a
sort
of
lively
way,
and
but
on
the
other
hand,
I
think
people
need
an
honest
response
and
that,
in
the
end,
is
what
this
is.
It
should
be
about
particularly
for
board
members,
so
I
think.
A
This
is
quite
difficult
for
the
reasons
you've
said,
I
think
well.
The
way
I
looked
at
this
was
trying
to
make
sure
that
people
didn't
inadvertently
undermine
what
we're
doing
didn't,
breach
confidentiality,
the
little
kinds
of
proper
restrictions
without,
at
the
same
time,
absolutely
to
appoint
stopping
people
being
able
to
ever
to
the
discourse
that
you
you
would
want
them
to
get
to,
and
we
did.
A
Malta
I
mean
it
was
quite
a
lot
of
internal
discussion
and
consultation
around
this,
and
my
understanding
is
that
there
was
a
sort
of
general
sense
from
those
people's
employment
asking
David,
but
those
people
who
do
use
social
media
a
lot,
but
that
this
was
a
a
good
balance
is
that
is
that
fair
comment?
Yeah.
I
That's
right,
so
we've
tested
it
with
the
staff.
We
should
have
tested
it
with
some
board
members
and
as
well,
and
the
the
point
lose
that
you're
making
about.
If
you
want
to
sort
of
practical
advice,
when
things
turn
into
a
more
difficult
situation
of
things,
absolutely
right,
that's
what
the
guidance
of
the
training
is
meant
to
achieve
as
an
opportunity
for
support,
and
also
just
just
to
be
clear.
I
So
it's
much
more
about
those
boundaries
and
the
clarity
of
them
and
the
expectations
and,
of
course,
the
honesty
and
living
up
to
our
values
and
I've
done
that's.
Obviously,
one
of
our
values
are
enshrined.
Trying
to
them,
it
would
be,
would
be
part
of
that
or
ultimately,
it
is
not
something
that
is
black
and
white,
but
something
that
we
as
an
organization
go
in,
go
in
with
with
open
eyes
and
want
to
encourage.
In
that
context,.
A
So
are
we
happy
to
endorse
them?
The
the
the
policy,
because
a
strategy
is
not
its
policy?
Looking
that
I
work,
everybody
happy
to
endorse
the
policy
excellent,
so
we
then
got
the
audit
and
corporate
governance
committee
report
polls
not
here
to
present
it
but
I
think
it's
self-explanatory.
Does
anybody
want
to
raise
any
questions
or
comments.
A
Excellent,
so
then,
is
that
any
other
business
anybody
wants
to
raise
good
right
so
that
that
then
takes
us
to
the
section
where
and
the
members
the
public
can
ask
questions,
but
before
abdella
register
your
hand
shot
up
with
remarkable
speed,
but
before
we
get
to
that,
there
I
just
thought
that
there's
a
question
that
was
sent
to
us
by
Robin
Pike,
who
I
think
Jane
is
healthwatch,
and
our
teacher
is
that
right.
Okay,.
I
A
Yeah
anyway,
he
sent
a
question
couldn't
be
here
in
person
but
asked
if
we
would
ask
the
question
on
his
behalf.
So
I
will
ask
the
question
and
trued
work
balance
between
chair
and
chivas
8
I'll,
ask
the
question
and
gift
over
the
job
of
answering
it.
So
the
question
was:
are
there
any
judicial
reviews
ongoing
or
pending
in
relation
to
CQC
inspections?
A
C
Thanks,
I'm
not
quite
sure,
what's
behind
the
question,
so
we
will
give
Robin
a
written
answer
to
this,
but
we
will
ask
him
what's
behind
the
question,
so
in
answer
to
the
very
precise
question:
are
there
any
judicial
review
of
inspection
matters
either
current
or
pending?
The
answer
is
there?
Are
none
but
I
need
to
make
sure
I
understand
what's
behind
the
question
and
why
is
asking
it?
But
if
I
was
a
minister
now
in
Parliament
and
God
forbid,
that
would
ever
happen
and
so
I
answer
will
be
there.
I
not
right.
A
J
Well,
I'm
david
hager
ever
if
we
could
attend
drew
at
these
meetings
and
I
run.
A
small
chair
achieve
the
friendly
older
people
in
North,
London
I'd
like
to
start
with
what
is
good
and
I'd
like
to
thank
the
CQC
for
taking
a
pause,
making
a
positive
response
to
your
voice
matters
and
other
people's
campaign
to
stop
care
homes.
J
Taking
punitive
action
against
people
who
make
complaints
I,
don't
know
whether
you
can
stop
it,
but
at
least
you're
on
the
right
side
on
this
and
I'd
like
to
say,
I'm
sure
that
Jenny
more
if
she
was
here
would
want
to.
Thank
you
for
that.
You
all
know:
I
wrote
to
you
at
the
time
of
the
cancelled
October
meeting
about
the
difficulty
which
people
experience
in
bringing
complaints
or
bringing
concerns
to
the
CQC
and
Andrea
promise
to
respond
to
it
and
did
respond
to
it.
J
The
message
is
always
that
everything
is
satisfactory
as
it
is
at
the
moment
and
that
no
changes
are
required
and
I.
Having
read
the
state
of
care
report
and
that's
another
thing,
I
would
like
to
commend.
You
for
I
can
sort
of
see
why
why
you
have
to
respond
this
way?
Why?
Perhaps
you
have
been
reluctant
to
the
past
to
encourage
cameras?
Why
you've
been
reluctant
to
look
at
the
way
you
are
inspecting
for
quality
for
against
the
caring
domain
and
all
the
other
things?
J
It
is
the
least
would
care
homes
the
danger
that
care
homes
are
going
to
simply
if
they
are
called
they
r
RI,
requiring
improvement
or
inadequate
that
they
are
simply
going
to
pull
out
of
the
market,
and
the
trouble
is
of
course,
that
it
seems
to
me
there
is
a
sort
of
conflict
of
interest
for
you
because
of
the
one
hand
you
are
responsible
and
people
look
to
you
to
maintain
quality
in
the
places
in
the
in
the
bodies
that
you
recollect
you
regulate
and
on
the
other
hand,
you
are
responsible
for
oversight
of
the
market
and
if
you,
by
inspecting
more
vigorously
cause
a
number
of
care
homes
to
disappear,
you
will
increase
the
amount
of
bed
blocking
and
nobody
is
going
to.
J
Thank
you
for
that.
Now.
I
personally
feel
that
it
should
not
be
possible
for
a
care
home
which
has
been
criticised
simply
to
disappear.
I
think
that's
completely
wrong.
It
doesn't
happen
with
hospitals
and
he
shouldn't
happen
with
care
homes
either.
But
I
would
like
to
see
the
CQC
lobbying
government
to
make
that
less
make
that
impossible,
so
that
you
could
be
freed
up
to
do
the
sort
of
vigorous
inspecting
which
you
ought
to
be
doing.
J
Alternatively,
if
perhaps
the
conflict
of
interest
should
be
addressed
by
your
not
being
any
longer
responsible
for
market
oversight
as
I
do
believe
that,
having
heard
you
talk
today
and
known
you
for
a
long
time
that
you
really
do
care
about
quality,
that
seems
to
me
your
primary
function.
I
think
market
oversight
is
a
later
function
and
the
secondary
function
and
I
I
would
like
to
see
you
freed
up
to
do
that.
J
To
look
at
your
primary
function,
that
quality
comes
absolutely
first
and
if
you
can't
do
that,
if
you
keep
market
oversight,
then
to
think
perhaps
there
is
another
body,
perhaps
HealthWatch
or
something
of
that
kind
which
should
do
the
inspection
of
true
without
the
without
the
below
the
conflict
of
interest
of
which
I've
been
talking.
So
those
that's
where
my
thinking
has
got
to
at
the
moment,
David
before.
A
A
We
are
not
responsible
for
the
market
in
the
sense
that
you're
suggesting
what
I
do
think
there
is
is
a
is
a
Solomon's
judgment
at
times
as
to
whether
the
users
of
services
are
best
served
by
a
particular
service
being
maintained
or
or
not.
That
is
a
really
difficult
judgment
which
Andrea
and
her
team
have
to
make
quite
regularly.
But
it's
not.
F
A
D
Yes,
just
to
amplify
that,
and
because
you
are
absolutely
right,
there
is
not
a
conflict
of
interest
and
quality
is
the
absolutely
Lewis
said
this
earlier.
That
is
the
reason
why
we
exist.
That
is
the
reason
why
everybody
around
this
table
and
all
of
the
people
who
work
in
CQC
get
out
of
bed
in
the
morning
is
to
make
sure
that
people
are
receiving
em
care
and
support,
which
is
high
quality,
effective,
safe
and
compassionate
and
the
market
oversight.
D
Responsibility
a
is
in
relation
to
was
having
oversight
of
what
is
happening
in
those
providers
where,
if
there
was
a
surface
cessation
and
because
of
a
business
failure
that
would
damage
the
continuity
of
care
for
people
that
we
would
be
able
to
identify
that
and
provide
early
warning
notification
to
local
authorities
that
that
was
the
case.
So
actually
it
is
about
innocence
quality,
because
one
of
the
aspects
of
quality
is
ensuring
that
people
do
the
right
things
in
response
to
a
threat
and
the
continuity
of
care
being
delivered.
D
So
it's
there
is
absolutely
no
reason
for
that
oversight
and
responsibility
that
we
have
in
respect
of
the
larger
services.
That
would
be
difficult
to
replace
to
compromise
our
ability
to
assess
quality
on
an
individual
basis
in
every
single
inspection
and
equally
and
Peter's.
Right
again,
there
are
judgments
to
be
made,
and
we
have
an
enforcement
and
process
process
guided
by
our
colleagues
in
legal
services
team
to
assess
and
the
action
that
we
take
in
response
to
the
difficulties
that
we
find.
D
But
poor
capacity
in
adult
social
care
is
no
capacity
at
all,
and
if
we
genuinely
believe
that
people
are
at
threat
of
abuse,
harmonic
lect,
then
we
will
take
the
action
that
we
need
to
take
immune.
And
my
colleagues
in
in
from
medical
services
and
hospitals
do
this.
To
you
heard
Steve
talked
about
it
already
earlier
today.
J
J
Why
are
you
not
doing
more
to
be,
as
I
have
said
in
the
past,
like
mi5,
to
really
get
to
the
bottom
of
what
is
going
on
in
care
homes,
particularly
in
say,
the
caring
domain,
but
in
many
domains
is
not
just
about
abuse
and
so
on
as
the
mediocrity
of
the
care
which
people
are
getting,
and
you
know
if
I'm
delighted
to
hear
that
you
are
not
subject
to
these
sort
of
constraints.
But
if
you
aren't
subject
to
these
constraints,
that
I
think
there
are
a
lot
of
people
around.
D
We
may
not
get
to
the
bottom
of
absolutely
everything,
because
we
do
not
sit
on
the
shoulders
of
every
single
provider
365
days
of
the
year.
Nobody
is
going
to
expect
the
regulator
to
do
that,
but
we
do
identify
problems.
We
respond
to
the
concerns
that
are
being
raised
and
we
are
taking
action
in
a
variety
of
different
places,
both
to
enforce
improvements
where
that
improvement
is
possible,
but
also
to
take
action
that
restricts
people's
admissions
so
that
they
don't
exacerbate
the
problem
while
they're
fixing
it
or
indeed
to
cancel
their
registration.
D
If
we
believe
that
there
is
no
way
that
those
that
improvement
is
going
to
be
delivered
and
it
is
putting
people
at
serious
risk
of
harm,
so
I
think
new.
There
are,
and
we've
demonstrated,
that
in
the
state
of
care,
we
are
taking
more
enforcement
action
as
a
proportion
of
our
activity
and
taken
more
kind
of
serious
enforcement
action
and
using
our
powers
of
prosecution,
which
we've,
which
we've
done
and
successfully
concluded
two
cases
this
year.
So
there
were
a
variety
of
ways
that
we
are
improving.
D
A
I,
just
in
summary,
road
I,
absolute
guarantee
that
none
of
our
decisions
are
influenced
by
market
oversight,
because
as
I
say
that
actually
it's
a
completely
different
function
and
then
on
on
your
second
point,
we've
had
many
discussions.
You
and
I
both
here
at
this
board
and
and
separately
and
the
answer
is
we're
never
going
to
agree.
We
just
have
a
fundamental
difference.
I
do
not
personally
believe
and
I.
Don't
think
the
board
believes
that
we
should
be
acting
like
ml5
I
think
there
are
limits
on
covert
surveillance.
A
J
And
I
admit
you
in
force:
yes,
I've,
not
quarreling,
with
your
enforcing,
maybe
Jenni,
more
Mike,
but
I.
Don't
it's
about
finding
out
what
is
going
on.
I
gave
you
some
tables
back
in
February
and
June,
which
showed
that
in
a
great
many
cases
where
things
were
definitely
going
wrong
and
had
come
out
in
the
press,
oil
and
in
on
parama
and
so
forth,
but
you
had
not
discovered
this
then
I
thought.
Why
is
that
I
thought
it
is
possibly
because
people
are
not
willing
to
bring
things
to
zoo
to
the
CQC.
J
So
then
I
produce
these
five
ideas
about
how
you
could
make
it.
I
would
hope
that
you
will
just
look
at
those
ideas
and
see
whether
in
fact,
you
could
do
a
little
bit
more
to
make
it
to
you
to
get
to
encourage
people
to
actually
come
to
you.
I
know
it
might
be
a
Pandora's
box,
but
no,
unless
it's
probably
you
could
be
proud
or
doing.
If
you
open
that
Pandora's
box
and.
D
I
think
that
if
you
look
at
the
performance
report,
you
will
see
the
thousands
of
contacts
that
we
get
through
the
the
customer
center
of
people
raising
concerns
with
those.
Undoubtedly
more
can
be
done,
and
certainly
more
can
be
done
of
those
professionals,
health
professionals
and
social
care
professionals
who
are
going
into
services
and
seeing
some
of
these
things
that
are
happening
and
absolutely
have
a
professional
responsibility
to
share
that
with
us.
So
I
think
new.
We.
A
A
A
29,
it's
99
in
total,
a
huge
service
and
I
think
we
are
all
very
grateful
for
what
you've
done.
I
think
more
particularly
more
importantly,
I
think
service
users
generally
should
be
a
very
appreciative
of
your
efforts,
so
I
just
want
to
thank
you.
Thank
on
behalf
of
everybody
and
I
have
excellent
David.